Background The Lancet Commission on Global Surgery established the Three Delays framework, categorising delays in accessing timely surgical care into delays in seeking care (First Delay), reaching care (Second Delay), and receiving care (Third Delay). Globally, knowledge gaps regarding delays for fracture care, and the lack of large prospective studies informed the rationale for our international observational study. We investigated delays in hospital admission as a surrogate for accessing timely fracture care and explored factors associated with delayed hospital admission. MethodsIn this prospective observational substudy of the ongoing International Orthopaedic Multicenter Study in Fracture Care (INORMUS), we enrolled patients with fracture across 49 hospitals in 18 low-income and middle-income countries, categorised into the regions of China, Africa, India, south and east Asia, and Latin America. Eligible patients were aged 18 years or older and had been admitted to a hospital within 3 months of sustaining an orthopaedic trauma. We collected demographic injury data and time to hospital admission. Our primary outcome was the number of patients with open and closed fractures who were delayed in their admission to a treating hospital. Delays for patients with open fractures were defined as being more than 2 h from the time of injury (in accordance with the Lancet Commission on Global Surgery) and for those with closed fractures as being a delay of more than 24 h. Secondary outcomes were reasons for delay for all patients with either open or closed fractures who were delayed for more than 24 h. We did logistic regression analyses to identify risk factors of delays of more than 2 h in patients with open fractures and delays of more than 24 h in patients with closed fractures. Logistic regressions were adjusted for region, age, employment, urban living, health insurance, interfacility referral, method of transportation, number of fractures, mechanism of injury, and fracture location. We further calculated adjusted relative risk (RR) from adjusted odds ratios, adjusted for the same variables. This study was registered with ClinicalTrials.gov, NCT02150980, and is ongoing. Findings Between April 3, 2014, and May 10, 2019, we enrolled 31 255 patients with fractures, with a median age of 45 years (IQR 31-62), of whom 19 937 (63•8%) were men, and 14 524 (46•5%) had lower limb fractures, making them the most common fractures. Of 5256 patients with open fractures, 3778 (71•9%) were not admitted to hospital within 2 h. Of 25 999 patients with closed fractures, 7141 (27•5%) were delayed by more than 24 h. Of all regions, Latin America had the greatest proportions of patients with delays (173 [88•7%] of 195 patients with open fractures; 426 [44•7%] of 952 with closed fractures). Among patients delayed by more than 24 h, the most common reason for delays were interfacility referrals (3755 [47•7%] of 7875) and Third Delays (cumulatively interfacility referral and delay in emergency department: 3974 [50•5%]), while Second Delays ...

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Background: More than half of deaths in low-and middle-income countries (LMICs) result from conditions that could be treated with emergency care-an integral component of universal health coverage (UHC)-through timely access to lifesaving interventions. Methods: The World Health Organization (WHO) aims to extend UHC to a further 1 billion people by 2023, yet evidence supporting improved emergency care coverage is lacking. In this article, we explore four phases of a research prioritisation setting (RPS) exercise conducted by researchers and stakeholders from

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Background: In Iran, Road Traffic Injuries (RTIs) is the second-leading cause of deaths, and the first leading cause of disabilityadjusted life year, and has one of the highest rates of death (32.1 per 100 000 population) all over the world. This study’s aim was to investigate the epidemiological pattern and underlying components of hospitalized RTIs in 31 provinces of Iran in 2011. Methods: This study conducted on all hospitalized RTIs during one-year period (March 21, 2011 to March 21, 2012). Data extracted from a hospital-based traffic injury registration system. According to a national law passed in 2005, all hospital expenses of traffic injuries should be covered by ministry of health based on governmental tariffs. The medical costs of eligible patients will be paid to the hospitals only if the patient data are sent to the above mentioned database. Statistical analysis was performed using SPSS v.16 (SPSS Inc., Chicago, USA), and spatial maps are provided using GIS 10.2. Descriptive statistics and t-test were used to compare means. World (WHO 2000-2025) standard population used to calculate age-adjusted incidence rate. All statistical tests were performed at the 5% level of statistical significance. Results: There were 322,064 injured cases recorded in the registration system during the study period. The national age-adjusted incidence rate of RTIs was 405 per 100,000 population. The highest incidence rates were in the age group of 15-29 years (643 per 100,000 population), followed by 30-44 year age groups (401 per 100,000 population). The incidence rate in men was 3.36 times more than women. Motorcyclist were the most frequent type of road users (39.2%) who involved in RTIs, followed by passengers (28.9%) and pedestrians (20.0%). Head injuries were among the most affected part of the body which occurred in 27.2% of the patients. The proportion of urban crashes was 60.7%. Conclusion: The results of this study indicated that the majority of RTI occurred on motorcyclists and head injuries was the most commonly affected body part. Therefore, in order to reduce motorcycle accidents and avoiding head injury among them, stricter law enforcement is urgently needed for helmet use and promotion of safety behaviors among motorcycle riders.