EVALUATION OF DELAYS IN EMERGENCY CARE OF TRAUMA PATIENTS USING THE THREE-DELAY FRAMEWORK: A PROSPECTIVE OBSERVATIONAL STUDY AT A TERTIARY CARE HOSPITAL
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Keywords
Trauma care delays; Three-delay model; Golden hour; Emergency medical services; Prehospital care
Abstract
Trauma remains a leading cause of mortality and morbidity globally, with outcomes significantly influenced by timeliness of care. The golden hour concept emphasizes that definitive treatment within 60 minutes of injury optimizes survival. However, multiple barriers delay trauma care in resource-limited settings. This study aimed to evaluate delays in emergency trauma care using the three-delay framework and identify factors associated with each phase of delay.
Methods: A prospective observational study was conducted at Gouri Devi Institute of Medical Sciences and Hospital, West Bengal, from March to August 2025. Two hundred adult trauma patients requiring emergency care were enrolled using consecutive sampling. Data on demographics, injury characteristics, and delays across three phases (decision to seek care, reaching healthcare facility, and receiving treatment) were collected using a structured proforma. Statistical analysis included chi-square tests, t-tests, and multivariate logistic regression.
Results: Only 12% of patients received definitive care within the golden hour, with median total delay of 156 minutes. Phase 2 delays (median 68 minutes) contributed most substantially. Mortality was significantly higher among patients with delays exceeding 120 minutes (9.9% vs. 3.4%, p=0.048). Independent predictors of prolonged delay included rural residence (OR: 2.86), referral from other facilities (OR: 4.24), distance exceeding 20 km (OR: 3.12), unawareness of emergency helpline (OR: 2.14), and off-hours arrival (OR: 1.86).
Conclusion: Substantial delays exist across all phases of trauma care, with transportation and referral-related factors contributing most significantly. Systematic interventions addressing geographic accessibility, emergency service awareness, and healthcare system capacity are urgently needed to improve trauma outcomes.
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Dr. Anup Kumar Dokania
Associate Professor, Department of Orthopedics, Gouri Devi Institute of Medical Sciences and Hospital, Durgapur, West Bengal
Dr. Ajay Kumar Kundan
Associate Professor, Department of Orthopedics, Shyamlal Chandrashekhar Medical College & S.P.N.M. Speciality Hospital, Khagaria, Bihar
Dr. Amar Satyam
Assistant Professor, Department of Orthopedics, Shyamlal Chandrashekhar Medical College & S.P.N.M. Speciality Hospital, Khagaria, Bihar
