Jaymie Henry1, Andrew Hill2, James Jin3, Salesi' Akau'ola4, Cheng-Har Yip5,6, Peter Nthumba7, Emmanuel A Ameh8, Stijn de Jonge9, Mira Mehes10, Iferemi Waiqanabete4. 1. Department of Surgery, Florida Atlantic University, Boca Raton, USA. 2. Department of Surgery, The University of Auckland, Auckland, New Zealand. 3. Department of Surgery, The University of Auckland, Auckland, New Zealand. james.jin@auckland.ac.nz. 4. Department of Surgery, Fiji National University College of Medicine, Nursing and Health Sciences, Suva, Fiji. 5. Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia. 6. Department of Surgery, Subang Jaya Medical Centre, Subang Jaya, Malaysia. 7. Department of Surgery, AIC Kijabe Hospital, Kijabe, Kenya. 8. Division of Paediatric Surgery, National Hospital, Abuja, Nigeria. 9. Department of Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands. 10. G4 Alliance, Chicago, IL, USA.
Abstract
BACKGROUND: Trauma mortality in low- and middle-income countries (LMICs) remains high compared to high-income countries. Quality improvement processes, interventions, and structure are essential in the effort to decrease trauma mortality. METHODS: A systematic review and meta-analysis of interventional studies assessing quality improvement processes, interventions, and structure in developing country trauma systems was conducted from November 1989 to August 2020 according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were conducted in an LMIC population according to World Bank Income Classification, occurred in a trauma setting, and measured the effect of implementation and its impact. The primary outcome was trauma mortality. RESULTS: Of 37,575 search results, 30 studies were included from 15 LMICs covering five WHO regions in a qualitative synthesis. Twenty-seven articles were included in a meta-analysis. Implementing a pre-hospital trauma system reduced overall trauma mortality by 45% (risk ratio (RR) 0.55, 95% CI 0.4 to 0.75). Training first responders resulted in an overall decrease in mortality (RR 0.47, 95% CI 0.28 to 0.78). In-hospital trauma training with certified courses resulted in a reduction of mortality (RR 0.71, 95% CI 0.62 to 0.78). Trauma audits and trauma protocols resulted in varying improvements in trauma mortality. CONCLUSION: There is evidence that quality improvement processes, interventions, and structure can improve mortality in the trauma systems in LMICs.
BACKGROUND:Trauma mortality in low- and middle-income countries (LMICs) remains high compared to high-income countries. Quality improvement processes, interventions, and structure are essential in the effort to decrease trauma mortality. METHODS: A systematic review and meta-analysis of interventional studies assessing quality improvement processes, interventions, and structure in developing country trauma systems was conducted from November 1989 to August 2020 according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were conducted in an LMIC population according to World Bank Income Classification, occurred in a trauma setting, and measured the effect of implementation and its impact. The primary outcome was trauma mortality. RESULTS: Of 37,575 search results, 30 studies were included from 15 LMICs covering five WHO regions in a qualitative synthesis. Twenty-seven articles were included in a meta-analysis. Implementing a pre-hospital trauma system reduced overall trauma mortality by 45% (risk ratio (RR) 0.55, 95% CI 0.4 to 0.75). Training first responders resulted in an overall decrease in mortality (RR 0.47, 95% CI 0.28 to 0.78). In-hospital trauma training with certified courses resulted in a reduction of mortality (RR 0.71, 95% CI 0.62 to 0.78). Trauma audits and trauma protocols resulted in varying improvements in trauma mortality. CONCLUSION: There is evidence that quality improvement processes, interventions, and structure can improve mortality in the trauma systems in LMICs.
Authors: Robin T Petroze; Jean Claude Byiringiro; Georges Ntakiyiruta; Susan M Briggs; Dan L Deckelbaum; Tarek Razek; Robert Riviello; Patrick Kyamanywa; Jennifer Reid; Robert G Sawyer; J Forrest Calland Journal: World J Surg Date: 2015-04 Impact factor: 3.352
Authors: Lynne Moore; Howard Champion; Pier-Alexandre Tardif; Brice-Lionel Kuimi; Gerard O'Reilly; Ari Leppaniemi; Peter Cameron; Cameron S Palmer; Fikri M Abu-Zidan; Belinda Gabbe; Christine Gaarder; Natalie Yanchar; Henry Thomas Stelfox; Raul Coimbra; John Kortbeek; Vanessa K Noonan; Amy Gunning; Malcolm Gordon; Monty Khajanchi; Teegwendé V Porgo; Alexis F Turgeon; Luke Leenen Journal: World J Surg Date: 2018-05 Impact factor: 3.352
Authors: Anjuli D Wagner; Orvalho Augusto; Irene N Njuguna; Douglas Gaitho; Nancy Mburu; Geoffrey Oluoch; Naziat Carimo; Peter Mwaura; Peter Cherutich; Laura Oyiengo; Sarah Gimbel; Grace C John-Stewart; Ruth Nduati; Kenneth Sherr Journal: Implement Sci Commun Date: 2022-05-10