Status of trauma quality improvement programs in the Americas: a survey of trauma care providers

Zetlen, Hilary; LaGrone, Lacey N.; Foianini, Jorge Esteban; Egoávil, Eduardo Huamán; Sproviero, Jorge; Rivera, Felipe Vega; Mock, Charles

doi:10.1016/j.jss.2017.06.035

Cited by 8 publications

(7 citation statements)

References 13 publications

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“…This is consistent with other studies. 13,14 Trauma registries require a central organization, trained staff, and financial resources, which may make them cost prohibitive in resource-constrained countries. However, these are an achievable goal for HI countries if registries were made a priority.…”

Section: Discussionmentioning

confidence: 99%

Current Status of Musculoskeletal Trauma Care Systems Worldwide

Miclau

Hoogervorst

Shearer

et al. 2018

Journal of Orthopaedic Trauma

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BACKGROUND AND RATIONALE Although general trauma care systems and their effects on mortality reduction have been studied, little is known of the current state of musculoskeletal trauma delivery globally, particularly in low-income (LI) and low middle-income (LMI) countries. The goal of this study is to assess and describe the development and availability of musculoskeletal trauma care delivery worldwide. MATERIALS METHODS A questionnaire was developed to evaluate different characteristics of general and musculoskeletal trauma care systems, including general aspects of systems, education, access to care and pre-and posthospital care. Surgical leaders involved with musculoskeletal trauma care were contacted to participate in the survey. RESULTS Of the 170 surveys sent, 95 were returned for use for the study. Nearly 30 percent of surgeons reported a formalized and coordinated trauma system in their countries. Estimates for the number of surgeons providing musculoskeletal trauma per one million inhabitants varied from 2.6 in LI countries to 58.8 in high-income countries. Worldwide, 15% of those caring for musculoskeletal trauma are fellowship trained. The survey results indicate a lack of implemented musculoskeletal trauma care guidelines across countries, with even high-income countries reporting less than 50% availability in most categories. Seventy-nine percent of the populations from LI countries were estimated to have no form of health care insurance. Formalized emergency medical services were reportedly available in only 33% and 50% of LI and LMI countries, respectively. Surgeons from LI and LMI countries responded that improvements in the availability of equipment (100%), number and locations of trauma-designated hospitals (90%), and physician training programs (88%) were necessary in their countries. The survey also revealed a general lack of resources for postoperative and rehabilitation care, irrespective of the country's income level. CONCLUSION This study addresses the current state of musculoskeletal trauma care delivery worldwide. These results indicate a greater need for trauma system development and support, from prehospital through posthospital care. Optimization of these systems can lead to better outcomes for patients after trauma. This study represents a critical first step toward better understanding the state of musculoskeletal trauma care in countries with different levels of resources, developing strategies to address deficiencies, and forming regional and international collaborations to develop musculoskeletal trauma care guidelines.

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Section: Discussionmentioning

confidence: 99%

Current Status of Musculoskeletal Trauma Care Systems Worldwide

Miclau

Hoogervorst

Shearer

et al. 2018

Journal of Orthopaedic Trauma

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“…A lack of resources and equipment were highlighted in 58% (33/57) of papers [ 9 , 25 – 56 ]. This was a deficiency in both pre-hospital and hospital sectors.…”

Section: Resultsmentioning

confidence: 99%

“…Lack of training was referenced as a barrier to trauma care in 65% (37/57) of papers reviewed [ 9 , 27 – 29 , 31 – 36 , 38 , 40 – 46 , 49 , 53 , 55 , 57 – 72 ]. There was a lack of specialist trauma training for doctors across all grades and a lack of postgraduate training for Emergency Medicine clinicians.…”

Section: Resultsmentioning

confidence: 99%

“…The lack of standardised protocols and guidelines was highlighted in 51% (29/57) of papers [ 9 , 25 , 27 – 32 , 36 , 37 , 40 – 44 , 47 , 52 , 54 , 55 , 59 , 61 , 62 , 65 – 67 , 71 – 74 ]. Key themes relating to lack of protocol include those in relation to record-keeping (six papers) and pre-hospital communication, (six papers).…”

Section: Resultsmentioning

confidence: 99%

“…The region is economically diverse; according to the World Bank, it consists of three high-income countries (HIC), 12 upper middle-income countries (UMICs), four lower middle-income countries (LMICs) and no low-income countries (LIC) [ 7 ]. While only a small number of countries in the region fall into the LMIC category, disparities in availability and quality of trauma care account for approximately two million preventable deaths in LMIC and LICs, annually [ 8 , 9 ]. It should also be noted that almost one third of the region live in poverty (184 million) [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Barriers to Trauma Care in South and Central America: a systematic review

Kinder

Mehmood

Hodgson

et al. 2021

Eur J Orthop Surg Traumatol

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Introduction Trauma is widespread in Central and South America and is a significant cause of morbidity and mortality. Providing high quality emergency trauma care is of great importance. Understanding the barriers to care is challenging; this systematic review aims to establish current the current challenges and barriers in providing high-quality trauma care within the 21 countries in the region. Methods OVID Medline, Embase, EBM reviews and Global Health databases were systematically searched in October 2020. Records were screened by two independent researchers. Data were extracted according to a predetermined proforma. Studies of any type, published in the preceding decade were included, excluding grey literature and non-English records. Trauma was defined as blunt or penetrating injury from an external force. Studies were individually critically appraised and assessed for bias using the RTI item bank. Results 57 records met the inclusion criteria. 20 countries were covered at least once. Nine key barriers were identified: training (37/57), resources and equipment (33/57), protocols (29/57), staffing (17/57), transport and logistics (16/57), finance (15/57), socio-cultural (13/57), capacity (9/57), public education (4/57). Conclusion Nine key barriers negatively impact on the provision of high-quality trauma care and highlight potential areas for improving care in Central & South America. Many countries in the region, along with rural areas, are under-represented by the current literature and future research is urgently required to assess barriers to trauma management in these countries. No funding was received. Clinical Trial Registration: PROSPERO CRD42020220380.

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The Burden of High‐Energy Musculoskeletal Trauma in High‐Income Countries

2018

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ADDRESSING THE GAPS: While its impact is large, research on musculoskeletal conditions, including high-energy trauma, is underfunded compared to other fields of medicine. An increased awareness among policy makers and healthcare professionals of the importance of care for the high-energy musculoskeletal trauma patient is critical. Full implementation of trauma systems is imperative, and metrics such as the ICD-DALY have the potential to allow for real-time evaluation of prevention and treatment programs aimed to reduce injury-related morbidity and mortality. The dearth in knowledge in optimal and cost-effective post-acute care for high-energy musculoskeletal trauma is a reason for concern, especially since almost half of the costs are attributed to this phase of care. Multidisciplinary rehabilitation teams as part of a musculoskeletal trauma system may be of interest to decrease further the long-term negative effects and the economic burden of high-energy musculoskeletal trauma.

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Status of trauma quality improvement programs in the Americas: a survey of trauma care providers

Cited by 8 publications

References 13 publications

Current Status of Musculoskeletal Trauma Care Systems Worldwide

Current Status of Musculoskeletal Trauma Care Systems Worldwide

Barriers to Trauma Care in South and Central America: a systematic review

The Burden of High‐Energy Musculoskeletal Trauma in High‐Income Countries

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