Admission delays’ magnitude of traumatized patients in the emergency department of a hospital in Egypt: a cross-sectional study

  • H. M. Saleh
  • A. E. Elsabagh
  • M. G. Elewa
  • A. A. Fawzy
  • O. M. Hassan
  • A. C. Comer
  • I. M. Abdelmonem
  • J. M. Hirshon
  • M. El-Shinawi
Original Article



Injury is an escalating public health problem, representing about 9% of global mortality, which disproportionately impacts lower- and middle-income countries. There are approximately 12,000 annual fatalities from road traffic injuries in Egypt, but a little information about delays in seeking emergent care is available.


To measure the time interval between sustaining an injury and presentation to the emergency department of Ain Shams University Surgery Hospital and to identify possible causes of these delays.


We conducted a cross-sectional, facilitated survey of a convenience sample of trauma patients presenting to the emergency department of Ain Shams University Surgery Hospital from 1 February to 31 May 2014. Data obtained included: demographic information, trauma incident details, and injury assessment.


The average reported transport time for patients from injury to hospital arrival was 3.8 h, while the mean ambulance response time was 45 min. Referral from other hospitals was revealed to be a significant cause of delay (P = 0.004), while ignorance of the local ambulance phone number could not be confirmed as a cause (P = 0.2).


This study demonstrated that trauma patients at our hospital experience more than 3 h of delay until they reach the ED. It also identified the possible causes accounting for that delay. However, additional nationwide research is needed to establish the clear causation or association of these causes with the delay intervals.


Emergency care Trauma Delays Ambulance Referral 



We are grateful to Dr.Hani Mowafi, Department of Emergency Medicine, Yale University School of Medicine and Dr.Waleed Hammad, Department of Emergency Medicine, University of Maryland School of Medicine for providing us their valuable feedback on the study protocol. The authors also would like to thank Dr. Ahmed Mohsen Hassan, Faculty of Medicine Ain Shams University for his cooperation in data collection.

Compliance with ethical standards

Conflict of interest

Haitham M. Saleh, Abdelrahman E.Elsabagh, Mohammad Gamal Elewa, Ahmed AlaaEldin Fawzy, Omar Mahmoud Hassan, Angela C.Comer, Ibrahim M. Abdelmonem, Jon Mark Hirshon, and Mohamed El-Shinawi declare that they have no conflict of interest.


Drs. Hirshon and El Shinawi would like to acknowledge funding support for their efforts from the National Institute of Health Fogarty International Center Grant 5D43TW007296. The authors also would like to thank Ainshams Medical Students Research Association (AMSRA) for supporting this study.

Statement of human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Statement of informed consent

Informed consent was obtained from all patients for being included in the study.


  1. 1.
    Sakran JV, Greer SE, Werlin E, McCunn M. Care of the injured worldwide: trauma still the neglected disease of modern society. Scand J Trauma Resusc Emerg Med. 2012;20:64. doi: 10.1186/1757-7241-20-64.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    WHO. Injuries and violence: the facts 2014. [accessed 26.3.2016].
  3. 3.
  4. 4.
    Puvanachandra P, Hoe C, El-Sayed HF, Saad R, Al-Gasseer N, Bakr M, et al. Road traffic injuries and data systems in Egypt: addressing the challenges. Traffic Inj Prev 2012;13 Suppl 1:44–56. doi: 10.1080/15389588.2011.639417.CrossRefPubMedGoogle Scholar
  5. 5.
    Oestern H, Trentz O, Uranues S. General Trauma Care and Related Aspects.1.3.2.pre-hospital care, pp 8–10. Trauma Surgery II. 2014. doi: 10.1007/978-3-540-88124-7.
  6. 6.
    Mock NC, Tiska M, Adu-Ampofo M, Boakye G. Improvements in prehospital trauma care in an African country with no formal emergency medical services. J Trauma. 2002;53:90–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Alaedini P, Marcotullio P. Urban implications of information technology: new electronics for developing countries. United Nations Univ Inst Adv Stud 1853;9:89–108.Google Scholar
  8. 8.
    International Telecommunication Union (2014): Final WSIS Targets Review: Achievements, Challenges and the Way Forward. accessed [26.3.2016].
  9. 9.
    Kobusingye OC, Hyder AA, Bishai D, Hicks ER, Mock C. Emergency medical systems in low- and middle-income countries†¯: recommendations for action. Bull World Health Organ 2005;020412.Google Scholar
  10. 10.
    McCoy CE, Menchine M, Sampson S, Anderson C, Kahn C. Emergency medical services out-of-hospital scene and transport times and their association with mortality in trauma patients presenting to an urban Level I trauma center. Ann Emerg Med. 2013;61:167–74. doi: 10.1016/j.annemergmed.2012.08.026.CrossRefPubMedGoogle Scholar
  11. 11.
    Khan A, Zafar H, Naeem SN, Raza SA. Transfer delay and in-hospital mortality of trauma patients in Pakistan. Int J Surg. 2010;8:155–8. doi: 10.1016/j.ijsu.2009.10.012.CrossRefPubMedGoogle Scholar
  12. 12.
    Harrington DT, Connolly M, Biffl WL, Majercik SD, Cioffi WG. Transfer times to definitive care facilities are too long. Ann Surg. 2005;241:961–8. doi: 10.1097/01.sla.0000164178.62726.f1.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Rouleau DM, Feldman DE, Parent S. Delay to orthopedic consultation for isolated limb injury: cross-sectional survey in a level 1 trauma centre. Can Fam Physician 2009;55:1006–7.e1–5.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Carr BG, Caplan JM, Pryor JP, Branas CC. A meta -analysis of prehospital care times for trauma. Perhosp Emerg Care 2005:198–206. doi: 10.1080/10903120500541324.
  15. 15.
    Dinh MM, Bein K, Roncal S, Byrne CM, Petchell J, Brennan J. Redefining the golden hour for severe head injury in an urban setting: the effect of prehospital arrival times on patient outcomes. Injury. 2013;44:606–10. doi: 10.1016/j.injury.2012.01.011.CrossRefPubMedGoogle Scholar
  16. 16.
    Norouzpour A, Khoshdel AR, Modaghegh M-H, Kazemzadeh G-H. Prehospital management of gunshot patients at major trauma care centers: exploring the gaps in patient care. Trauma Mon. 2013;18:62–6. doi: 10.5812/traumamon.10438.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Crandon IW, Harding HE, Williams EW, Cawich SO. Inter-hospital transfer of trauma patients in a developing country: a prospective descriptive study. Int J Surg. 2008;6:387–91. doi: 10.1016/j.ijsu.2008.07.004.CrossRefPubMedGoogle Scholar
  18. 18.
    Hodkinson PW, Wallis LA. Cross-sectional survey of patients presenting to a South African urban emergency centre. Emerg Med J. 2009;26:635–40. doi: 10.1136/emj.2008.063362.CrossRefPubMedGoogle Scholar
  19. 19.
    Haghparast-Bidgoli H, Saadat S, Bogg L, Yarmohammadian MH, Hasselberg M. Factors affecting hospital length of stay and hospital charges associated with road traffic-related injuries in Iran. BMC Health Serv Res. 2013;13:281. doi: 10.1186/1472-6963-13-281.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Blackwell TH, Kaufman JC. Response time effectiveness†¯: Comparison of response time and survival in an urban emergency medical services system. Acad Emerg Med. 2002;9(4):288–95.CrossRefPubMedGoogle Scholar
  21. 21.
    Cone DC, Middleton PM, Marashi Pour S. Analysis and impact of delays in ambulance to emergency department handovers. Emerg Med Australas. 2012;24:525–33. doi: 10.1111/j.1742-6723.2012.01589.x.CrossRefPubMedGoogle Scholar
  22. 22.
    Alamshah SM, Pipelzadeh M, Mousavi SR, Baharanfar H, Rezapour E. Determination of predictors and risk factors in patients with multiple emergency surgical traumas. Ulus Travma Acil Cerrahi Dreg. 2010;16(5):421–6.Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • H. M. Saleh
    • 1
  • A. E. Elsabagh
    • 1
  • M. G. Elewa
    • 1
  • A. A. Fawzy
    • 1
  • O. M. Hassan
    • 1
  • A. C. Comer
    • 2
  • I. M. Abdelmonem
    • 1
  • J. M. Hirshon
    • 2
    • 3
    • 4
  • M. El-Shinawi
    • 5
  1. 1.Faculty of MedicineAin Shams UniversityCairoEgypt
  2. 2.Charles McC. Mathias, Jr. National Study Center for Trauma and EMSUniversity of Maryland School of MedicineBaltimoreUSA
  3. 3.Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreUSA
  4. 4.Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreUSA
  5. 5.Department of General Surgery, Faculty of MedicineAin Shams UniversityCairoEgypt

Personalised recommendations