INTRODUCTION

Currently traffic accidents (TA) are the first priority in health research in Peru, due to the high mortality that this represents as well as the large number of affected who are left with irreversible injuries, this causes a high socioeconomic cost both for rehabilitation and the care of the injuries themselves. It is estimated that every year in the world 1.2 million people fail due to accidents on public roads and 50 million are injured and that if prevention and impact reduction systems are not improved and strengthened, it would increase by 65% in 20 years¹.

The economic costs of vehicle impact and AT injuries are 1% and 1.5% of Gross National Product (GNP) in low and middle income countries respectively and the annual global cost is close to US$ 518 000 million¹, in Peru, according to the National Road Safety Council (NRSC), every year there are approximately 70,000 traffic accidents with more than 3,000 deaths and more than 45,000 injuries, of which hundreds develop some kind of permanent disability².

In addition, the costs of traffic accidents in Peru could amount to one billion dollars per year, approximately 1.5 to 2% of GDP, according to the general office of statistics and informatics and the national rehabilitation institute, members of the National Sanitary Strategy for Traffic Accidents (ESNAT) of the Ministry of Health³.

The response to traffic accidents is through emergency medical services, in Peru the main responsible for this are the SAMU and firefighters, among other emergency response bodies, from their prompt and timely response depends on the survival of the affected population. The prehospital care time is divided into four parts, the first in relation to the call from the place of the accident and the departure of the assistance service, the second between the departure of the assistance service and the arrival at the accident, the third the time of assistance in the same place of the accident and the fourth from the point of the accident to the arrival at the hospital for the appropriate management of the patient⁴.

It is suggested that rapid pre-hospital care is associated with a decrease in mortality due to timely and effective hospital care. The objective of the study is to know the association between prehospital care time and hospital mortality in traffic accident victims.

METHODS

The question was asked: what is the association between prehospital care time and hospital mortality in vehicle accident victims? And the PEO question is: P: victims of traffic accidents; E: long time of prehospital care; O: mortality. For this, a systematic review was performed by searching related articles in indexing sources such as PubMed and BIREME.

The terms used for the PubMed search were: Accidents, Traffic; Traffic Accidents; Accident, Traffic; Traffic Accident; Time; Long-term Effect; Emergency Medical Services; Prehospital Emergency Care; Emergency Care,

Prehospital; Mortality; Case Fatality Rates; Excess Mortality; Mortality Decline; Mortality Determinants; Differential Mortality; Death Rate; Mortality Rate. The following syntax was used:(((((("Accidents, Traffic”(mh)) OR Traffic Accidents*(tiab)) OR Accident, Traffic*(tiab)) OR Traffic Accident*(tiab))) AND ((((("Time”(mh)) OR Longterm Effect*(tiab)) AND "Emergency Medical Services”(mh)) OR Prehospital Emergency Care*(tiab)) OR Emergency Care, Prehospital*(tiab))) AND (((((((("Mortality”(mh)) OR Case Fatality Rates*(tiab)) OR Excess Mortality*(tiab)) OR Mortality Decline*(tiab)) OR Mortality Determinants*(tiab)) OR Differential Mortality*(tiab)) OR Death Rate*(tiab)) OR Mortality Rate*(tiab)), other terms were also used, such as “Prehospital time association”. For the search on BIREME the following terms were used: Emergency Care, Prehospital; Traffic Accident and mortality, being the syntax: (tw:(Emergency Care, Prehospital)) AND (tw:(Traffic Accident)) AND (tw:(mortality)).

RESULTS

Two search engines were used, both with different number of studies found in relation to the systematic search, in PubMed, with the syntax mentioned above and exclusion criteria 35 studies were found, of which only 4 were useful for our review, as well as other terms such as "prehospital time association" where we found 6 studies containing relevant data for our review. In the search engine BIREME, with the syntax and exclusion criteria presented above, 134 articles were found, 3 of which contained the information required for this study. The exclusion of other studies in this systematic search was due to the presence of other pathologies, not associated with car accidents or motor vehicle collisions, whose mortalities were associated with prehospital care time. Of these 13 studies, 2 are prospective and 11 are retrospective.

Illustration 1 Article selection flow diagram 

DISCUSSION

This review looked the association between the time of prehospital care and mortality in AT victims, which has been the first priority in health due to the high mortality that AT represent. It was found that while prolonged prehospital care time until arrival at an emergency center is an important factor in mortality and if a significant association is shown as shown in the studies of Chandrasekharan et al.⁶, Gauss et al.⁵, Tansley et al.¹⁵, Boniface et al.¹⁷, Champion et al.¹⁶or Gonzalez et al.¹⁰, Several studies found a significant association, the presence of other factors such as type of transport, age, sex, type of injury, severity of injury, state of consciousness, as well as the use of safety devices such as helmets or seatbelts, alcohol consumption, vulnerable road users, characteristics of the environment, whether rural or urban, as well as the distance between the accident site and the emergency center and the use or not of an emergency system for prehospital transport, this shows in various studies a significant association with mortality¹¹as well as a minor association in other studies^(9,10),This variation may be due to the severity of the trauma presented by the patient, this being the most important factor and constantly significantly associated with higher mortality.

It is expected that the result of transportation by a more qualified emergency medical service will be more effective due to handling by personnel prepared to intervene in this kind of emergency with safe and appropriate handling, with the application of protective equipment to prevent further injury or sudden worsening of the current condition, as well as specialized life support for prehospital care such as hemorrhage control, respiratory tract and the speed of arrival from the SME call to the victim's arrival at a center of attention, although there are studies such as that of Vera-Lopez et al.¹⁴that associate the provision of prehospital services in traffic accident victims with higher mortality and yet find no association between a long prehospital response time and this, it is mostly because, as demonstrated in the study of Lovely et al.¹¹,There are other factors, such as those mentioned above, that are associated with higher mortality, such as the severity of the injury.

However, it is not the only reason associated with hospital mortality, with the level of the care center and its ability to respond to this kind of emergency and serious injuries being an important factor, as found in the study by Mills et al.⁷that there is an association with lower mortality in non-tertiary hospitals than in tertiary hospitals, being the capacity of the health center where it is carried, an important factor in the mortality of AT victims.

Although there are studies that do not find an association between prehospital care time and mortality in AT victims, it should be noted that prehospital care also depends on other factors, in a systematic review Harmsen et al.⁴found that rapid transportation seems beneficial for patients suffering from severe trauma with blood pressure involvement, more in patients with milder injuries and hemodynamically stable, there is no greater increase in mortality compared to prehospital care time.

One aspect to consider is the limited availability of studies that contribute to the association of these variables at the national level, being necessary to strengthen research in this area.

CONCLUSIONS

The time of prehospital care in AT is significantly associated with hospital mortality of patients due to the need for early stabilization of the patient's condition. However, this depends on several factors inherent to the accident, and the severity of the patient at the scene, the appropriate removal of the AT victim from the scene that may require more time than expected due to the limitations of the service that provides care or the difficulty of the procedure, for this reason some studies showed lower mortality in longer pre-hospital times. Given the results it is proposed to study factors associated with long prehospital care.