This retrospective review quantified access block (defined as resuscitation room length-of-stay >8 hours) among 2091 adult trauma patients admitted directly from the resuscitation room at Chris Hani Baragwanath Academic Hospital's Trauma Emergency Unit (TEU), Johannesburg, South Africa, over the full calendar year 2022.
Access block affected 61.3% of admitted patients (n=1282/2091). Strongest predictors were CT imaging (OR 4.17), ICU admission (OR 3.69), blunt mechanism (OR 2.19), mechanical ventilation (OR 2.10), night presentation (OR 1.85), and shock index ≥1 (OR 1.32). Mechanically ventilated patients had a mean LOS of 834 min vs 631 min for non-ventilated patients (P<0.01). Time-to-CT was more than twice as long in patients with access block (366 vs 165 min; P<0.01).
- Univariable analysis only; injury severity scores were unavailable, precluding multivariable modelling and causal inference. - The >8-hour access block threshold is derived from high-income general ED populations and may not reflect the appropriate standard for a low-resource trauma resuscitation environment. - 7.9% of admitted patients lacked arrival or departure timestamps, and GCS was sometimes derived from qualitative descriptors, introducing potential misclassification bias.
CT availability and ICU/high-dependency bed capacity are the highest-yield targets for reducing access block at this centre; aligning CT scanner staffing to overnight peak demand and implementing active bed management are pragmatic first steps that do not require infrastructure expansion.
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