Impact of the primary trauma care course in the Kongo Central province of the Democratic Republic of Congo over two years

Tolppa, Timo; Vangu, A.M.; Balu, H.C.; Matondo, P; Tissingh, Elizabeth K

doi:10.1016/j.injury.2019.12.013

Cited by 10 publications

(21 citation statements)

References 19 publications

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“…The 34 studies meeting criteria provided trauma training in 24 different countries throughout the Middle East, Asia, Latin America and Africa ( Table 1 ) 10. , 11. , 12.…”

Section: Resultsmentioning

confidence: 99%

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Trauma training in low- and middle-income countries: A scoping review of ATLS alternatives

Brown

Tidwell

Prest

2022

African Journal of Emergency Medicine

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Introduction Trauma training for front-line providers is a critical component of injury mitigation and trauma systems strengthening. Although the Advanced Trauma Life Support (ATLS) course is standard in much of the world, cost and administrative barriers are prohibitive to deploying the course in many low and middle income countries (LMICs). The purpose of this study was to identify alternative trauma training courses used in LMICs by scoping review and compare their effectiveness. Methods Several peer-reviewed and grey literature databases were searched for relevant articles describing trauma training courses for front-line medical providers in LMICs. Studies were included if: performed in a LMIC; utilized a general trauma training course other than ATLS; trainees were hospital-based medical providers; study included some type of outcome measure. Results A total of 34 manuscripts met inclusion criteria. The majority of courses were novel, hospital-initiated courses and ranged in length from 1 day to 1 week. Physicians were the most common target audience, followed by medical students and nurses. Courses were taught in 24 different countries throughout the Middle East, Asia, Latin America and Africa. Comparison of pre- and post-test knowledge was the most common metric used and nearly all courses demonstrated a statistically significant knowledge gain. One study demonstrated a reduction in mortality for injured patients after course implementation. The majority of courses were a collaboration between universities in a high income country and local faculty/practitioners in the LMIC where the course was taught. Reported cost per participant ranged from $10 to $232 USD. Conclusions Several trauma courses are currently being utilized in LMICs effectively with increases in knowledge gained and at a lower reported cost than ATLS. More research is needed to link trauma training courses to patient outcomes.

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“…The 34 studies meeting criteria provided trauma training in 24 different countries throughout the Middle East, Asia, Latin America and Africa ( Table 1 ) 10. , 11. , 12.…”

Section: Resultsmentioning

confidence: 99%

“…The Primary Trauma Care (PTC) course was the most common replicated course with 9 manuscripts reporting on this 2 day course 10. , 11. , 12.…”

Section: Resultsmentioning

confidence: 99%

Trauma training in low- and middle-income countries: A scoping review of ATLS alternatives

Brown

Tidwell

Prest

2022

African Journal of Emergency Medicine

View full text Add to dashboard Cite

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“…As well, candidates’ confidence in trauma management improved by 20% MacLeod, 2009 and 2011 [ 41 , 42 ] Kenya, Zambia Acute Trauma Care and Fundamental Critical Care Support Course (ATC/FCCS) Medical officers (27) Physicians and Surgeons (21) Nurses (14) Clinical officers (13) Participants had increased overall trauma knowledge from an average of 51% to 63% (p = 0.002) post-course. Additionally, participants reported increased confidence over all 22 presented clinical trauma scenarios and 15 procedures O’Sullivan, 2012 [ 43 ] Malawi, Tanzania, Zambia Global Emergency Care Skills (GECS) Physicians (80) Nurses (5) Clinical officers (2) Trauma management knowledge test scores were significantly improved from pre-course (58.71%) to post-course (78.26%) (p = 0.0001) for participants from all countries Shaye, 2018 [ 44 ] Rwanda, Zimbabwe Craniomaxillofacial Trauma Course “Essentials in Facial Injuries” Course Residents (12) Surgeons (5) Unknown/Other (6) Mean pre-course and post-course test scores increased in both cohorts (cohort 1 = 30% increase, cohort 2 = 12% increase) Tolppa, 2020 [ 45 ] Democratic Republic of the Congo Primary Trauma Care (PTC) Physicians (36) and Nurses (23) Although increased post-course test scores were maintained over two years, confidence skills significantly decreased (p = 0.03). As well, 36 participants indicated a lack of equipment availability, while 52 felt different procedures were required for managing local patients Mock, 2005 and Quansah, 2008 [ 46 , 47 ] Ghana Kwame Nkrumah University of Science and Technology (KNUST) Trauma Course for Rural Hospitals Physicians (83) Participants had significant increases in post-course scores and the majority felt trauma care practice had improved at one-year follow-up.…”

Section: Resultsmentioning

confidence: 99%

“…In total, five studies followed participant outcomes for a period of at least six months, with only one study following up for greater than one year [ 45 ]. No studies described a recertification process.…”

Section: Resultsmentioning

confidence: 99%

“…No studies described a recertification process. The two studies comparing retention of knowledge several months after course administration reported retained competencies in trauma knowledge and skills at nine months [ 49 ] and two years [ 45 ]. None of the studies examined long-term patient mortality and morbidity for a period greater than one year, nor compared results to pre-course parameters.…”

Section: Resultsmentioning

confidence: 99%

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Trauma Training Courses and Programs in Low‐ and Lower Middle‐Income Countries: A Scoping Review

et al. 2021

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Background Injury is the leading cause of morbidity and mortality in low- and lower middle-income countries (LMICs). Trauma training is a cost-effective way to improve injury outcomes. Several trauma programs have been implemented in LMICs; however, their scope and effectiveness remain unclear. In this review, we sought to describe and assess the current state of trauma training in LMICs. Methods We searched MEDLINE, Embase, Global Health, Cochrane Library, and ProQuest Dissertations & Theses Global for trauma training courses in LMICs. An additional gray literature search was conducted on university, governmental, and non- governmental organizations’ websites to identify trauma-related postgraduate medical education (PGME) opportunities. Results Most studies occurred in sub-Saharan Africa and participants were primarily physicians/surgeons, medical students/residents, and nurses. General and surgical trauma management courses were most common, followed by orthopedic trauma or plastic surgery trauma/burn care courses. 32/45 studies reported on participant knowledge and skills, 27 of which had minimal follow-up. Of the four studies commenting on cost of courses, only one demonstrated cost-effectiveness. Three articles evaluated post-course effects on patient outcomes, two of which failed to demonstrate significant improvements. Overall, 43.0% of LMICs have PGME programs with defined trauma competency requirements. Conclusions Current studies on trauma training in LMICs do not clearly demonstrate sustainability, cost-effectiveness, nor improved outcomes. Trauma training programs should be in response to a need, championed locally, and work within a cohesive system to demonstrate concrete benefits. We recommend standardized and contextualized trauma training with recertifications in LMICs for lasting and improved trauma care.

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Clinical Practices Following Train‐The‐Trainer Trauma Course Completion in Uganda: A Parallel‐Convergent Mixed‐Methods Study

et al. 2023

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Background Despite the growth of trauma training courses worldwide, evidence for their impact on clinical practice in low- and middle-income countries (LMICs) is sparse. We investigated trauma practices by trained providers in Uganda using clinical observation, surveys, and interviews. Methods Ugandan providers participated in the Kampala Advanced Trauma Course (KATC) from 2018 to 2019. Between July and September of 2019, we directly evaluated guideline-concordant behaviors in KATC-exposed facilities using a structured real-time observation tool. We conducted 27 semi-structured interviews with course-trained providers to elucidate experiences of trauma care and factors that impact adoption of guideline-concordant behaviors. We assessed perceptions of trauma resource availability through a validated survey. Results Of 23 resuscitations, 83% were managed without course-trained providers. Frontline providers inconsistently performed universally applicable assessments: pulse checks (61%), pulse oximetry (39%), lung auscultation (52%), blood pressure (65%), pupil examination (52%). We did not observe skill transference between trained and untrained providers. In interviews, respondents found KATC personally transformative but not sufficient for facility-wide improvement due to issues with retention, lack of trained peers, and resource shortages. Resource perception surveys similarly demonstrated profound resource shortages and variation across facilities. Conclusions Trained providers view short-term trauma training interventions positively, but these courses may lack long-term impact due to barriers to adopting best practices. Trauma courses should include more frontline providers, target skill transference and retention, and increase the proportion of trained providers at each facility to promote communities of practice. Essential supplies and infrastructure in facilities must be consistent for providers to practice what they have learned.

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Impact of the primary trauma care course in the Kongo Central province of the Democratic Republic of Congo over two years

Cited by 10 publications

References 19 publications

Trauma training in low- and middle-income countries: A scoping review of ATLS alternatives

Trauma training in low- and middle-income countries: A scoping review of ATLS alternatives

Trauma Training Courses and Programs in Low‐ and Lower Middle‐Income Countries: A Scoping Review

Clinical Practices Following Train‐The‐Trainer Trauma Course Completion in Uganda: A Parallel‐Convergent Mixed‐Methods Study

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