Uptake of the World Health Organization’s trauma care guidelines: a systematic review

Abstract

ObjectiveTo understand the degree to which the trauma care guidelines released by the World Health Organization (WHO) between 2004 and 2009 have been used, and to identify priorities for the future implementation and dissemination of such guidelines.MethodsWe conducted a systematic review, across 19 databases, in which the titles of the three sets of guidelines – Guidelines for essential trauma care, Prehospital trauma care systems and Guidelines for trauma quality improvement programmes – were used as the search terms. Results were validated via citation analysis and expert consultation. Two authors independently reviewed each record of the guidelines’ implementation.FindingsWe identified 578 records that provided evidence of dissemination of WHO trauma care guidelines and 101 information sources that together described 140 implementation events. Implementation evidence could be found for 51 countries – 14 (40%) of the 35 low-income countries, 15 (32%) of the 47 lower-middle income, 15 (28%) of the 53 upper-middle-income and 7 (12%) of the 59 high-income. Of the 140 implementations, 63 (45%) could be categorized as needs assessments, 38 (27%) as endorsements by stakeholders, 20 (14%) as incorporations into policy and 19 (14%) as educational interventions.ConclusionAlthough WHO’s trauma care guidelines have been widely implemented, no evidence was identified of their implementation in 143 countries. More serial needs assessments for the ongoing monitoring of capacity for trauma care in health systems and more incorporation of the guidelines into both the formal education of health-care providers and health policy are needed.

Expected years of life lost through road traffic injuries in Mexico

“…Nuevo León) and highly motorized (i.e. Mexico City) states, perhaps due to the quality of emergency care provided and the exposure of populations particularly vulnerable to traffic [23]. Within-country disparities in RTI burden have been described in other populations [21,24,25].…”

Guidelines in lower‐middle income countries

“…Improvement in the rate of implementation is affected by several factors, including awareness of the guidelines by policy makers, incorporation of the guidelines into educational curricula and continued systemic needs assessment based on the guidelines (LaGrone et al, 2016).…”

“…Research evidence published in other languages, such as French, Portuguese and Arabic (which are widely spoken in many LMICs), may not be considered even when such research findings more closely mirror the healthcare practices in these countries (Al-Rawah & Lee, 2015). Similarly, English is the language of choice for reporting guideline implementation events making them unavailable to countries where English is not the predominant language (LaGrone et al, 2016). For these to be used in LMICs, translation to the official languages spoken in specific countries will be required.…”

Risk of road traffic accidents in children

“…At a speed of 100 km/h the collision effects are the same as when dropped from a height of 40 m (12-13 floors). A person weighing 90 kg while driving without a seat belt in a collision at 50 km/h is comparable to hitting the windshield with the force of a concrete slab weighing 3.5 t [9][10][11].…”

“…Holidays are also a time for trips with parents to relax. Unfortunately, children are involved on such occasions in accidents as car passengers [5,8,9,13,15].…”