This new study aimed to establish consensus on the most important barriers, within a Three Delays framework, to accessing injury care in Low and Middle Income Countries that should be considered when evaluating a health system.
Do trauma courses change practice? A qualitative review of 20 courses in East, Central and Southern Africaby Grace Le
Infectious Outcomes Assessment for Health System Strengthening in Low-Resource Settings: The Novel Use of a Trauma Registry in Rwandaby Global Musculoskeletal
Background: More than 90% of injury deaths occur in low-income countries where a shortage of personnel, infrastructure, and materials challenge health system strengthening efforts. Trauma registries developed regionally have been used previously for injury surveillance in resource-limited settings, but scant outcomes data exist.
Injury is a leading cause of death in many limited resource settings. This study aimed to measure the quality of trauma care at the largest referral hospitals in Rwanda, the University Teaching Hospitals in Kigali and Butare,compared to international trauma care standards.
Development of the International Assessment of Capacity for Trauma (INTACT) Index: An Initial Implementation in Sierra Leoneby Global Musculoskeletal
Injury remains a leading cause of death worldwide with a disproportionate impact in the developing world. Capabilities for trauma care remain limited in these settings. Previous attempts have been made to assess basic trauma resources but have been limited to essential care. We propose the implementation of the International Assessment of Capacity for Trauma (INTACT) index, which incorporates surgical capacity beyond initial resuscitation.
Objective: To characterize the relationship between tranexamic acid (TXA) use and patient outcomes in a severely injured civilian cohort, and to determine any differential effect between patients who presented with and without shock. Background: TXA has demonstrated survival benefits in trauma patients in an international randomized control trial and the military setting. The uptake of TXA into civilian major hemorrhage protocols (MHPs) has been variable. The evidence gap in mature civilian trauma systems is limiting the widespread use of TXA and its potential benefits on survival. Methods: Prospective cohort study of severely injured adult patients (Injury severity score > 15) admitted to a civilian trauma system during the adoption phase of TXA into the hospital's MHP. Outcomes measured were mortality, multiple organ failure (MOF), venous thromboembolism, infection, stroke, ventilator-free days (VFD), and length ofstay. Results: Patients receiving TXA (n = 160, 42%) were more severely injured, shocked, and coagulopathic on arrival. TXA was not independently associated with any change in outcome for either the overall or nonshocked cohorts. In multivariate analysis, TXA was independently associated with a reduction in MOF [odds ratio (OR) = 0.27, confidence interval (CI): 0.10–0.73, P = 0.01] and was protective for adjusted all-cause mortality (OR = 0.16 CI: 0.03–0.86, P = 0.03) in shocked patients. Conclusions: TXA as part of a major hemorrhage protocol within a mature civilian trauma system provides outcome benefits specifically for severely injured shocked patients.
Major trauma is a major public health problem. It is the leading cause of death in people from the age of 1–40, accounting for one in ten deaths overall, and leads to significant morbidity.1 Over the last 40 years many countries in the developed world have developed regionalised trauma systems to improve the survival rates of their patients who sustain traumatic injury.
Background Trauma has become a worldwide pandemic. Without dedicated public health interventions, fatal injuries will rise 40% and become the 4th leading cause of death by 2030, with the burden highest in low-income and middle-income countries (LMICs). The aim of this study was to estimate the prevalence of traumatic injuries and injury-related deaths in low-resource countries worldwide, using population-based data from the Surgeons OverSeas Assessment of Surgical Need (SOSAS), a validated survey tool.
Injury prevalence and causality in developing nations: Results from a countrywide population-based survey in Nepalby Global Musculoskeletal
Traumatic injury affects nearly 5.8 million people annually and causes 10% of the world's deaths. In this study we aimed to estimate injury prevalence, to describe risk-factors and mechanisms of injury, and to estimate the number of injury-related deaths in Nepal, a low-income South Asian country.
Traumatic injuries are an important cause of disability and mortality worldwide and more than 90% of injury-related deaths occur in low-income and middle-income countries. Despite its overall significance, little information exists about the burden of injuries in developing countries. We aim to estimate the prevalence of traumatic injuries, describe injury mechanisms, and assess the degree of associated disability in Sierra Leone.