Ordoñez-Arenas Laura, Orozco Nicolas, Bolaños John, Sánchez Álvaro Ignacio, Gutiérrez María Isabel, Puyana Juan Carlos, García-Marín Alberto
Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.
Facultad de Ingeniería, Universidad Icesi, Cali, Colombia.
World J Surg. 2025 Jun;49(6):1654-1664. doi: 10.1002/wjs.12607. Epub 2025 May 2.
Trauma mortality is strongly influenced by the distance between the trauma site and the hospital, as longer prehospital times delay definitive care and increase the risk of death. In cities like Cali, Colombia, with high rates of penetrating trauma due to systemic violence, geographic and socioeconomic disparities further hinder access to timely care. This study examines the association of not being treated at the nearest hospital on trauma in-hospital mortality, accounting for geographic and socioeconomic factors.
A prospective cohort study included 554 adults with moderate-to-severe trauma treated at three trauma centers in Cali, Colombia, between December 2012 and June 2013. Trauma sites were geocoded to calculate distances to the nearest hospital, with "nonproximal care" (NC) defined as treatment at a facility other than the closest one. Multivariable logistic regression evaluated mortality risk and predictors of NC care, whereas geospatial analyses examined socioeconomic associations using the multidimensional poverty index (MPI).
NC care was identified in 47.8% of patients, who were more likely male, uninsured, or subsidized and sustained gunshot injuries. NC care was associated with higher in-hospital mortality (25.5% vs. 18.0%, p = 0.02). Adjusted analyses identified NC care (OR: 1.815, 95% CI: 1.052-3.173), higher injury severity score, and physiologic impairment as predictors of mortality. Socioeconomic and geographic disparities were evident, with high MPI linked to NC care.
NC care is significantly associated with increased trauma mortality, compounded by socioeconomic and geographic inequities. Enhancing regionalized trauma systems, transportation networks, and equitable healthcare access is essential to reduce disparities and improve outcomes.
创伤死亡率受创伤地点与医院之间距离的强烈影响，因为较长的院前时间会延迟确定性治疗并增加死亡风险。在哥伦比亚的卡利等城市，由于系统性暴力导致穿透性创伤发生率较高，地理和社会经济差异进一步阻碍了及时获得治疗的机会。本研究探讨了不在最近的医院接受治疗与创伤住院死亡率之间的关联，并考虑了地理和社会经济因素。
一项前瞻性队列研究纳入了2012年12月至2013年6月期间在哥伦比亚卡利的三个创伤中心接受治疗的554名中重度创伤成人。对创伤地点进行地理编码以计算到最近医院的距离，“非近端治疗”（NC）定义为在距离最近医院以外的机构接受治疗。多变量逻辑回归评估死亡率风险和NC治疗的预测因素，而地理空间分析使用多维贫困指数（MPI）检查社会经济关联。
47.8%的患者接受了NC治疗，这些患者更可能是男性、未参保或享受补贴的人群，并且遭受枪伤。NC治疗与较高的住院死亡率相关（25.5%对18.0%，p = 0.02）。调整分析确定NC治疗（比值比：1.815，95%置信区间：1.052 - 3.173）、较高的损伤严重程度评分和生理损伤是死亡率的预测因素。社会经济和地理差异明显，高MPI与NC治疗相关。
NC治疗与创伤死亡率增加显著相关，社会经济和地理不平等使其更加复杂。加强区域化创伤系统、交通网络和公平的医疗服务可及性对于减少差异和改善治疗结果至关重要。
