Ambulance use among road injury victims: results from Pakistan National Emergency Departments Surveillance

摘要

Ambulance use in low-and middle-income countries is very low. This study assesses characteristics of road traffic injury (RTI) victims coming to emergency departments (EDs) by ambulance and compares with RTI victims coming via alternative modes of transportation. The Pakistan National Emergency Departments Surveillance (Pak-NEDS) was a surveillance conducted in seven major tertiary-care EDs in six main cities of Pakistan from November 2010-March 2011. Univariate and multivariate logistic regression was carried out to investigate the factors associated with ambulance use in RTI patients. The variables used for regression gender, age groups, cities, hospital type, road user type and disposition. There were four age categories; ≤18 years, 19 -45 years, 45 – R years and ≥65 years. RTI patients were divided into two road-user groups; VRUs (pedestrian, motorcycle driver and passenger, bicyclists) and non-vulnerable road-users (non-VRUs) including four-wheel vehicles' driver and passengers. Level of significance was set at 0.05. Ethical approval was obtained at all participating sites. Pak-NEDS enrolled 9769 RTI patients. The mode of arrival was known for 92.2% (n=9009) RTI patients, of which 9.1%(n=821) were brought to the ED by ambulance. The mean age was higher in the ambulance group (33.3±16.9 versus 28.8±14.1 years, p-value 0.001). The most common road-user in the ambulance group was motorcycle drivers (n=201,24.5%) and pedestrians (n=3131,38.2%) in the non-ambulance group. Head and neck injuries (n=240,32.9%) in ambulance and upper limb injuries (n=2470, 34.3%) in non-ambulance group were common. There were 3.7% (n=23) deaths in the ambulance group and only 0.6% (n=38) in the non-ambulance group. Patients of all age groups were more likely to use ambulance compared to those 65 years of age (p-value0.001) adjusted for gender, cities, hospital type, road use type and disposition. The adjusted odds ratio of utilizing ambulances for VRUs was 1.3 times higher than non-VRUs (p-value0.008). Although the overall use of ambulance for RTI patients is very low in Pakistan, however, we found that RTI patients who used ambulance were more likely to be younger and VRUs. Majority of these patients had suffered from head and neck injuries and were more likely to die in the ED.