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Referral delays, not distance, drive trauma deaths

Systemic Inefficiency versus Geographic Proximity: Decoupling Distance from Prehospital Delay in Urban Interhospital Trauma Transfers, Guayaquil-Ecuador
Journal of Surgical Research · Added 27 July 2026

Prehospital delay and injury severity exhibit a lethal synergistic interaction.

Study type

Cohort

Design

Retrospective single-centre cohort with regression modelling

Participants

339 trauma patients in Guayaquil, Ecuador (274 in main analysis)

Main finding

Prehospital delay predicted complications (RR 1.55, 95% CI 1.01-2.38); significant time × severity interaction (P=0.003); mortality escalated for critical patients after the first hour; transport distance did not differ between early and delayed groups (P=0.226)

Caveat

Retrospective single-city study, predominantly penetrating trauma, fragmented LMIC system limits generalisability

Bottom line

Context only

Learning goal

Recognise how system coordination failures, rather than distance, drive prehospital delay for time-critical trauma transfers.

More

• Topic: Trauma
• Daily scan: 27 July 2026

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