Prioritizing injury care: a review of trauma capacity in low and middle-income countries

Wong, Evan G.; Gupta, Shailvi; Deckelbaum, Dan; Razek, Tarek; Kushner, Adam L.

doi:10.1016/j.jss.2014.08.055

Cited by 77 publications

(55 citation statements)

References 31 publications

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“…6 Because most conflicts and natural disasters occur in these settings, the sudden surge in injuryafflicted patients often overwhelms systems that are already strained at baseline. The large volume of operative trauma cases required from MSF in 17 countries sheds light on the important need for augmenting baseline trauma capacity in these settings.…”

Section: Discussionmentioning

confidence: 99%

Operative trauma in low-resource settings: The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster

Wong

Dominguez

Trelles

et al. 2015

Surgery

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CitationOperative trauma in low-resource settings: Background. Conflicts and disasters remain prevalent in low-and middle-income countries, and injury remains a leading cause of death worldwide. The objective of this study was to describe the operative procedures performed for injury-related pathologies at facilities supported by M edecins Sans Fronti eres (MSF) to guide the planning of future responses. Methods. A retrospective review of a prospectively collected database of all MSF procedures performed between July 2008 and June 2014 for injury-related indications was completed. Individual data points included country of project and date of procedure; age, patient sex, and the American Society of Anesthesiologists' score of each patient; indication for surgery, including mechanism of injury; operative procedure; operative urgency; operative order; type of anesthesia; and intraoperative mortality. Injury severity was stratified according to operative order and urgency. Results. A total of 79,715 procedures were performed in MSF projects that met the inclusion criteria. Of these, 35,756 (44.9%) were performed specifically for traumatic indications across 17 countries. Even after excluding trauma centers, 29.4% (18,329/62,288) of operative cases were for injuries. Operative trauma procedures were performed most commonly for road traffic injuries (29.9%; 10,686/35,756). The most common procedure for acute trauma was extensive wound debridement (31.6%; 3,165/ 10,022) whereas burn dressings were the most frequent planned reoperation (27.1%; 4,361/16,078). Conclusion. Trauma remains an important component of the operative care provided in humanitarian assistance. This review of procedures performed by MSF in a variety of settings provides valuable insight into demographics of trauma patients, mechanisms of injury, and surgical capabilities required in planning resource allocation for future humanitarian missions in low-and middle-income countries. (Surgery 2015;157:850-6.)

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Section: Discussionmentioning

confidence: 99%

Operative trauma in low-resource settings: The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster

Wong

Dominguez

Trelles

et al. 2015

Surgery

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“…Assessments in LMICs have consistently identified enormous gaps in the resources needed to provide adequate care for the injured (26,39,104), but little context-relevant guidance exists to help policy makers and planners set priorities in LMICs, where components of trauma care systems may be implemented in distinct ways.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Trauma Care Systems in Low- and Middle-Income Countries

Reynolds

Stewart

Drewett

et al. 2017

Annu. Rev. Public Health

140

120

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Injury is a leading cause of death globally, and organized trauma care systems have been shown to save lives. However, even though most injuries occur in low-and middle-income countries (LMICs), most trauma care research comes from high-income countries where systems have been implemented with few resource constraints. Little context-relevant guidance exists to help policy makers set priorities in LMICs, where resources are limited and where trauma care may be implemented in distinct ways. We have aimed to review the evidence on the impact of trauma care systems in LMICs through a systematic search of 11 databases. Reports were categorized by intervention and outcome type and summarized. Of 4,284 records retrieved, 71 reports from 32 countries met inclusion criteria. Training, prehospital systems, and overall system organization were the most commonly reported interventions. Quality-improvement, costing, rehabilitation, and legislation and governance were relatively neglected areas. Included reports may inform trauma care system planning in LMICs, and noted gaps may guide research and funding agendas.

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“…23 Deficiencies at the district level inevitably translate into delayed presentations at the referral hospitals. Strengthening district hospitals, in terms of the care for orthopedic and thoracoabdominal injuries for example, may improve outcomes while freeing resources at the referral level.…”

Section: Discussionmentioning

confidence: 99%

Trauma care and referral patterns in Rwanda: implications for trauma system development

Ntakiyiruta

Wong

Rousseau

et al. 2016

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Prioritizing injury care: a review of trauma capacity in low and middle-income countries

Cited by 77 publications

References 31 publications

Operative trauma in low-resource settings: The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster

Operative trauma in low-resource settings: The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster

The Impact of Trauma Care Systems in Low- and Middle-Income Countries

Trauma care and referral patterns in Rwanda: implications for trauma system development

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