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

Abstract

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.

Nível De Conhecimento Médico Acerca Do Atls E Seus Efeitos: Uma Revisão De Literatura

“…Ao se analisar os conteúdos selecionados, observa-se que a maioria dos estudos demonstraram resultados favoráveis em relação à importância do conhecimento do método ATLS, tanto na formação profissional, quanto no atendimento ao paciente traumatizado. Em 45 estudos, foi possível constatar considerável desenvoltura nas habilidades dos participantes sobre o manejo no trauma, o que foi substancial à redução da mortalidade de pacientes gravemente feridos em Ruanda (LIVERGANT et al, 2021). Após a realização do curso de ATLS, os próprios profissionais constataram um aprimoramento dos atendimentos, assim como aponta estudo de Rattan et al (2021), no qual 90% dos participantes consideram-se preparados para o atendimento ao paciente traumatizado.…”

The History and Evolution of the West African College of Surgeons/Jos University Teaching Hospital Trauma Management Course

“…Similar collaborations in East, Central, and Southern Africa between the College of Surgeons of East, Central, and Southern Africa and national surgical societies has led to many successful essential surgical skills trainings. Evidence from a scoping review of trauma training courses and programmes in LMICs by Livergant et al shows that trauma courses should be in response to local need, led by local champions, and nested in a cohesive system [ 37 ]. The WACS/JUTH trauma management course represents this dynamic.…”

Trauma Resuscitation Training: An Evaluation of Nurses' Knowledge

“…However, the high cost of these internationally recognized trauma courses makes them unfeasible to individuals and organizations as a training option (Armstrong et al, 2013; Gautreaux et al, 2019). Studies support the importance of high-capacity trauma training at low cost to achieve nursing resuscitation competence, specifically in the contexts of underdeveloped trauma systems or in low- to middle-income countries (El-Shinawi et al, 2016; Livergant et al, 2021; Oussi et al, 2018; Petroze et al, 2014). Moreover, not all countries have accredited centers for conducting these courses.…”