BACKGROUND: Over 90% of injury deaths occur in low-income countries. Evaluating the impact of focused trauma courses in these settings is challenging. We hypothesized that implementation of a focused trauma education initiative in a low-income country would result in measurable differences in injury-related outcomes and resource utilization. METHODS: Two 3-day trauma education courses were conducted in the Rwandan capital over a one-month period (October-November, 2011). An ATLS provider demonstration course was delivered to 24 faculty surgeons and 15 Rwandan trauma nurse auditors, and a Canadian Network for International Surgery Trauma Team Training (TTT) course was delivered to 25 faculty, residents, and nurses. Trauma registry data over the 6 months prior to the courses were compared to the 6 months afterward with emergency department (ED) mortality as the primary endpoint. Secondary endpoints included radiology utilization and early procedural interventions. Univariate analyses were conducted using χ(2) and Fisher's exact test. RESULTS: A total of 798 and 575 patients were prospectively studied during the pre-intervention and post-intervention periods, respectively. Overall mortality of injured patients decreased after education implementation from 8.8 to 6.3%, but was not statistically significant (p = 0.09). Patients with an initial Glasgow Coma Score (GCS) of 3-8 had the highest injury-related mortality, which significantly decreased from 58.5% (n = 55) to 37.1% (n = 23), (p = 0.009, OR 0.42, 95% CI 0.22-0.81). There was no statistical difference in the rates of early intubation, cervical collar use, imaging studies, or transfusion in the overall cohort or the head injury subset. When further stratified by GCS, patients with an initial GCS of 3-5 in the post-intervention period had higher utilization of head CT scans and chest X-rays. CONCLUSIONS: The mortality of severely injured patients decreased after initiation of focused trauma education courses, but no significant increase in resource utilization was observed. The explanation may be complex and multi-factorial. Long-term multidisciplinary efforts that pair training with changes in resources and mentorship may be needed to produce broad and lasting changes in the overall care system.
BACKGROUND: Over 90% of injury deaths occur in low-income countries. Evaluating the impact of focused trauma courses in these settings is challenging. We hypothesized that implementation of a focused trauma education initiative in a low-income country would result in measurable differences in injury-related outcomes and resource utilization. METHODS: Two 3-day trauma education courses were conducted in the Rwandan capital over a one-month period (October-November, 2011). An ATLS provider demonstration course was delivered to 24 faculty surgeons and 15 Rwandan trauma nurse auditors, and a Canadian Network for International Surgery Trauma Team Training (TTT) course was delivered to 25 faculty, residents, and nurses. Trauma registry data over the 6 months prior to the courses were compared to the 6 months afterward with emergency department (ED) mortality as the primary endpoint. Secondary endpoints included radiology utilization and early procedural interventions. Univariate analyses were conducted using χ(2) and Fisher's exact test. RESULTS: A total of 798 and 575 patients were prospectively studied during the pre-intervention and post-intervention periods, respectively. Overall mortality of injured patients decreased after education implementation from 8.8 to 6.3%, but was not statistically significant (p = 0.09). Patients with an initial Glasgow Coma Score (GCS) of 3-8 had the highest injury-related mortality, which significantly decreased from 58.5% (n = 55) to 37.1% (n = 23), (p = 0.009, OR 0.42, 95% CI 0.22-0.81). There was no statistical difference in the rates of early intubation, cervical collar use, imaging studies, or transfusion in the overall cohort or the head injury subset. When further stratified by GCS, patients with an initial GCS of 3-5 in the post-intervention period had higher utilization of head CT scans and chest X-rays. CONCLUSIONS: The mortality of severely injured patients decreased after initiation of focused trauma education courses, but no significant increase in resource utilization was observed. The explanation may be complex and multi-factorial. Long-term multidisciplinary efforts that pair training with changes in resources and mentorship may be needed to produce broad and lasting changes in the overall care system.
Authors: David S Radvinsky; Richard S Yoon; Paul J Schmitt; Charles J Prestigiacomo; Kenneth G Swan; Frank A Liporace Journal: Orthopedics Date: 2012-04 Impact factor: 1.390
Authors: Caleb R Schultz; Henri R Ford; Laura D Cassidy; Barbara L Shultz; Christian Blanc; Leslie W King-Schultz; Henry B Perry Journal: J Trauma Date: 2007-11
Authors: Simon Bergman; Dan Deckelbaum; Ronald Lett; Barbara Haas; Sebastian Demyttenaere; Victoria Munthali; Naboth Mbembati; Lawrence Museru; Tarek Razek Journal: J Trauma Date: 2008-10
Authors: Joseph B Mabula; Ramesh M Dass; Nkinda Mbelenge; Isdori H Ngayomela; Alphonce B Chandika; Japhet M Gilyoma; Phillipo L Chalya Journal: J Trauma Manag Outcomes Date: 2012-02-09
Authors: Jaymie Henry; Andrew Hill; James Jin; Salesi' Akau'ola; Cheng-Har Yip; Peter Nthumba; Emmanuel A Ameh; Stijn de Jonge; Mira Mehes; Iferemi Waiqanabete Journal: World J Surg Date: 2021-04-09 Impact factor: 3.352
Authors: Georges Ntakiyiruta; Evan G Wong; Mathieu C Rousseau; Landouald Ruhungande; Adam L Kushner; Alexander S Liberman; Kosar Khwaja; Marc Dakermandji; Marnie Wilson; Tarek Razek; Patrick Kyamanywa; Dan L Deckelbaum Journal: Can J Surg Date: 2016-02 Impact factor: 2.089
Authors: Adriana G Ramirez; Nebil Nuradin; Fidele Byiringiro; Robinson Ssebuufu; George J Stukenborg; Georges Ntakiyiruta; Thomas M Daniel Journal: Ann Thorac Surg Date: 2018-02-21 Impact factor: 4.330
Authors: Corrado Cancedda; Phil Cotton; Joseph Shema; Stephen Rulisa; Robert Riviello; Lisa V Adams; Paul E Farmer; Jeanne N Kagwiza; Patrick Kyamanywa; Donatilla Mukamana; Chrispinus Mumena; David K Tumusiime; Lydie Mukashyaka; Esperance Ndenga; Theogene Twagirumugabe; Kaitesi B Mukara; Vincent Dusabejambo; Timothy D Walker; Emmy Nkusi; Lisa Bazzett-Matabele; Alex Butera; Belson Rugwizangoga; Jean Claude Kabayiza; Simon Kanyandekwe; Louise Kalisa; Faustin Ntirenganya; Jeffrey Dixson; Tanya Rogo; Natalie McCall; Mark Corden; Rex Wong; Madeleine Mukeshimana; Agnes Gatarayiha; Egide Kayonga Ntagungira; Attila Yaman; Juliet Musabeyezu; Anne Sliney; Tej Nuthulaganti; Meredith Kernan; Peter Okwi; Joseph Rhatigan; Jane Barrow; Kim Wilson; Adam C Levine; Rebecca Reece; Michael Koster; Rachel T Moresky; Jennifer E O'Flaherty; Paul E Palumbo; Rashna Ginwalla; Cynthia A Binanay; Nathan Thielman; Michael Relf; Rodney Wright; Mary Hill; Deborah Chyun; Robin T Klar; Linda L McCreary; Tonda L Hughes; Marik Moen; Valli Meeks; Beth Barrows; Marcel E Durieux; Craig D McClain; Amy Bunts; Forrest J Calland; Bethany Hedt-Gauthier; Danny Milner; Giuseppe Raviola; Stacy E Smith; Meenu Tuteja; Urania Magriples; Asghar Rastegar; Linda Arnold; Ira Magaziner; Agnes Binagwaho Journal: Int J Health Policy Manag Date: 2018-11-01
Authors: Michael Noonan; Alexander Olaussen; Joseph Mathew; Biswadev Mitra; De Villiers Smit; Mark Fitzgerald Journal: Medicina (Kaunas) Date: 2019-08-30 Impact factor: 2.430
Authors: Maria Lisa Odland; John Whitaker; Dmitri Nepogodiev; Carolyn Achieng' Aling'; Irene Bagahirwa; Theophile Dushime; Darius Erlangga; Christophe Mpirimbanyi; Severien Muneza; Menelas Nkeshimana; Martin Nyundo; Christian Umuhoza; Eric Uwitonze; Jill Steans; Alison Rushton; Antonio Belli; Jean Claude Byiringiro; Abebe Bekele; Justine Davies Journal: World J Surg Date: 2020-09 Impact factor: 3.282