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Kennedy C, Ignatowicz A, Odland ML, Abdul-Latif AM, Belli A, Howard A, Whitaker J, Chu KM, Ferreira K, Owolabi EO, Nyamathe S, Tabiri S, Ofori B, Pognaa Kunfah SM, Yakubu M, Bekele A, Alyande B, Nzasabimana P, Byiringiro JC, Davies J. Commonalities and differences in injured patient experiences of accessing and receiving quality injury care: a qualitative study in three sub-Saharan African countries. BMJ Open 2024; 14:e082098. [PMID: 38955369 PMCID: PMC11218010 DOI: 10.1136/bmjopen-2023-082098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 06/02/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVES To understand commonalities and differences in injured patient experiences of accessing and receiving quality injury care across three lower-income and middle-income countries. DESIGN A qualitative interview study. The interviews were audiorecorded, transcribed and thematically analysed. SETTING Urban and rural settings in Ghana, South Africa and Rwanda. PARTICIPANTS 59 patients with musculoskeletal injuries. RESULTS We found five common barriers and six common facilitators to injured patient experiences of accessing and receiving high-quality injury care. The barriers encompassed issues such as service and treatment availability, transportation challenges, apathetic care, individual financial scarcity and inadequate health insurance coverage, alongside low health literacy and information provision. Facilitators included effective information giving and informed consent practices, access to health insurance, improved health literacy, empathetic and responsive care, comprehensive multidisciplinary management and discharge planning, as well as both informal and formal transportation options including ambulance services. These barriers and facilitators were prevalent and shared across at least two countries but demonstrated intercountry and intracountry (between urbanity and rurality) variation in thematic frequency. CONCLUSION There are universal factors influencing patient experiences of accessing and receiving care, independent of the context or healthcare system. It is important to recognise and understand these barriers and facilitators to inform policy decisions and develop transferable interventions aimed at enhancing the quality of injury care in sub-Saharan African nations.
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Affiliation(s)
- Ciaran Kennedy
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, St. Olavs University Hospital, Trondheim, Norway
- Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Abdul-Malik Abdul-Latif
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Volta Regional Health Directorate, Ghana Health Service, Accra, Greater Accra, Ghana
| | - Antonio Belli
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - Anthony Howard
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute of Health Research (NIHR) Biomedical Centre, University of Oxford, Headington, UK
| | - John Whitaker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Kathryn M Chu
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
- Department of Surgery, University of Botswana, Gaborone, Botswana
| | - Karen Ferreira
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Eyitayo O Owolabi
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Samukelisiwe Nyamathe
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Stephen Tabiri
- Ghana HUB of NIHR Global Surgery, Tamale, Ghana
- Department of Public Health, Tamale Teaching Hospital, Tamale, Ghana
- Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana
| | | | | | - Mustapha Yakubu
- Department of Public Health, Tamale Teaching Hospital, Tamale, Ghana
- School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
| | - Abebe Bekele
- University of Global Health Equity, Kigali, Rwanda
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Barnabas Alyande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jean-Claude Byiringiro
- University of Rwanda, Kigali, Rwanda
- Department of Surgery, University Teaching Hospital, Kigali, Rwanda
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Kassa S, Laytin AD. Long-term disability after trauma in Ethiopia: shedding light on a hidden epidemic. Trauma Surg Acute Care Open 2024; 9:e001473. [PMID: 38666011 PMCID: PMC11043769 DOI: 10.1136/tsaco-2024-001473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Affiliation(s)
- Seyoum Kassa
- Surgery, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Adam D Laytin
- Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Mock C. Strengthening Lay Advocacy for Trauma, Emergency, and Surgical Care. World J Surg 2023; 47:2338-2339. [PMID: 37227486 DOI: 10.1007/s00268-023-07076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 05/26/2023]
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Sule AZ, Alayande BT, Ojo EO, Taiwo FO, Riviello RR, Chirdan LB, Ezeome ER, Mshelbwala PM, Ugwu BT, Yawe KDT. The History and Evolution of the West African College of Surgeons/Jos University Teaching Hospital Trauma Management Course. World J Surg 2023; 47:1919-1929. [PMID: 37069318 PMCID: PMC10109223 DOI: 10.1007/s00268-023-07004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Inadequate trauma care training opportunities exist in Low- and Middle-Income Countries. Jos University Teaching Hospital and the West African College of Surgeons (WACS) have synergized, over the past 15 years, to introduce a yearly, certified, multidisciplinary Trauma Management Course. We explore the history and evolution of this course. METHODS A desk review of course secretariat documents, registration records, schedules, pre- and post-course test records, post-course surveys, and account books complemented by organizer interviews was carried out to elaborate the evolution of the Trauma Management Course. RESULTS The course was started as a local Continuing Medical Education program in 2005 in response to recurring cycles of violence and numerous mass casualty situations. Collaborations with WACS followed, with inclusion of the course in the College's yearly calendar from 2010. Multidisciplinary faculty teach participants the concepts of trauma care through didactic lectures, group sessions, and hands-on simulation within a one-week period. From inception, there has been a 100% growth in lecture content (from 15 to 30 lectures) and in multidisciplinary attendance (from 23 to 133 attendees). Trainees showed statistically significant knowledge gain yearly, with a mean difference ranging from 10.1 to 16.1% over the past 5 years. Future collaborations seek to expand the course and position it as a catalyst for regional emergency medical services and trauma registries. CONCLUSIONS Multidisciplinary trauma management training is important for expanding holistic trauma capacity within the West African sub-region. The course serves as an example for Low- and Middle-Income contexts. Similar contextualized programs should be considered to strengthen trauma workforce development.
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Affiliation(s)
- Augustine Z Sule
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Barnabas T Alayande
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria.
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda.
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
| | - Emmanuel O Ojo
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Femi O Taiwo
- Department of Orthopaedics and Trauma, Jos University Teaching Hospital, Jos, Nigeria
| | - Robert R Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Centre for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Lohfa B Chirdan
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Emmanuel R Ezeome
- Department of Surgery, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Philip M Mshelbwala
- Department of Surgery, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Benjamin T Ugwu
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - King-David T Yawe
- Department of Surgery, College of Health Sciences, University of Abuja, Abuja, Nigeria
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Tupper H, Oke R, Juillard C, Dissak-DeLon F, Chichom-Mefire A, Mbianyor MA, Etoundi-Mballa GA, Kinge T, Njock LR, Nkusu DN, Tsiagadigui JG, Carvalho M, Yost M, Christie SA. The CBS test: Development, evaluation & cross-validation of a community-based injury severity scoring system in Cameroon. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002110. [PMID: 37494346 PMCID: PMC10370767 DOI: 10.1371/journal.pgph.0002110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/06/2023] [Indexed: 07/28/2023]
Abstract
Injury-related deaths overwhelmingly occur in low and middle-income countries (LMICs). Community-based injury surveillance is essential to accurately capture trauma epidemiology in LMICs, where one-third of injured individuals never present to formal care. However, community-based studies are constrained by the lack of a validated surrogate injury severity metric. The primary objective of this bipartite study was to cross-validate a novel community-based injury severity (CBS) scoring system with previously-validated injury severity metrics using multi-center trauma registry data. A set of targeted questions to ascertain injury severity in non-medical settings-the CBS test-was iteratively developed with Cameroonian physicians and laypeople. The CBS test was first evaluated in the community-setting in a large household-based injury surveillance survey in southwest Cameroon. The CBS test was subsequently incorporated into the Cameroon Trauma Registry, a prospective multi-site national hospital-based trauma registry, and cross-validated in the hospital setting using objective injury metrics in patients presenting to four trauma hospitals. Among 8065 surveyed household members with 503 injury events, individuals with CBS indicators (CBS+) were more likely to report ongoing disability after injury compared to CBS- individuals (OR 1.9, p = 0.004), suggesting the CBS test is a promising injury severity proxy. In 9575 injured patients presenting for formal evaluation, the CBS test strongly predicted death in patients after controlling for age, sex, socioeconomic status, and injury type (OR 30.26, p<0.0001). Compared to established injury severity scoring systems, the CBS test comparably predicts mortality (AUC: 0.8029), but is more feasible to calculate in both the community and clinical contexts. The CBS test is a simple, valid surrogate metric of injury severity that can be deployed widely in community-based surveys to improve estimates of injury severity in under-resourced settings.
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Affiliation(s)
- Haley Tupper
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | - Rasheedat Oke
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | - Catherine Juillard
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | | | | | - Mbiarikai Agbor Mbianyor
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | | | - Thompson Kinge
- Hospital Administration, The Limbe Regional Hospital, Lime, Cameroon
| | - Louis Richard Njock
- Hospital Administration, The Laquintinie Hospital of Douala, Douala, Cameroon
| | - Daniel N Nkusu
- Hospital Administration, The Catholic Hospital of Pouma, Pouma, Cameroon
| | | | - Melissa Carvalho
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | - Mark Yost
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | - S Ariane Christie
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
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Brown HA, Stratton AJ, Gill J, Robinson SF, Tumisiime V, Brady C. Piloting a Layperson Prehospital Care System in Rural Uganda. Prehosp Disaster Med 2023; 38:179-184. [PMID: 36856030 DOI: 10.1017/s1049023x23000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
INTRODUCTION In many low-income countries, basic prehospital Emergency Medical Services (EMS) remain under-developed, resulting in significant delays or the complete inability to access care. STUDY OBJECTIVE The purpose of this study was to analyze the effectiveness of a layperson EMS training targeting motorcycle taxi (boda) drivers in a rural region of Uganda. METHODS Fifty (50) adult boda drivers from Masindi, Uganda were selected for a one-day training course including lectures and simulation. Course content covered basic prehospital skills and transport. Participants were given a first responder kit at completion of the course. Understanding of material was assessed prior to training, immediately after course completion, and four months from the initial course using the same ten question test. Test means were analyzed using a standard linear regression model. At the four-month follow up, all 50 boda drivers participated in semi-structured small group qualitative interviews regarding their perception of the course and experiences implementing course skills in the community. Boda drivers were asked to complete a brief form on each patient transported during the study period. For patients transported to Masindi Kitara Medical Center (MKMC), hospital trauma registry data were analyzed. RESULTS Trainees showed both knowledge acquisition and retention with pre-test scores of 21.8% improving to 48.0% at course completion and 57.7% at the four-month follow up. Overall, participant's scores increased by an average of 35% from the pre-test to the second post-test (P <.001). A total of 69 patient forms were completed on transported patients over the initial four-month period. Ninety-five percent (95%) of these were injured patients, and motorcycle crash was the predominant mechanism of injury (48% of injuries). Eight patients were transported to MKMC, but none of these patients were recorded in the hospital trauma registry. Major barriers identified through semi-structured interviews included harassment by police, poor road conditions, and lack of basic resources for transport. Ninety-four percent (94%) of trainees strongly agreed that the training was useful. Total costs were estimated at $3,489 USD, or $69 per trainee. CONCLUSION Motorcycle taxi drivers can be trained to provide basic prehospital care in a short time and at a low cost. While there is much enthusiasm for additional training and skill acquisition from this cohort, the sustainability and scalability of such programs is still in question.
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Affiliation(s)
- Heather A Brown
- Department of Emergency Medicine, Prisma Health Midlands/University of South Carolina, Columbia, South CarolinaUSA
| | - Amanda J Stratton
- Department of Emergency Medicine, Prisma Health Midlands/University of South Carolina, Columbia, South CarolinaUSA
| | - Joseph Gill
- Department of Emergency Medicine, UTHealth Houston/McGovern Medical School, Houston, TexasUSA
| | - Spencer F Robinson
- Department of Emergency Medicine, Prisma Health Midlands/University of South Carolina, Columbia, South CarolinaUSA
| | | | - Caroline Brady
- Department of Internal Medicine, Emergency Medicine Unit, Kamuzu University of Health Sciences, Blantyre, Malawi
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Amato S, Culbreath K, Dunne E, Sarathy A, Siroonian O, Sartorelli K, Roy N, Malhotra A. Pediatric trauma mortality in India and the United States: A comparison and risk-adjusted analysis. J Pediatr Surg 2023; 58:99-105. [PMID: 36328820 DOI: 10.1016/j.jpedsurg.2022.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is a paucity of research comparing pediatric risk-adjusted trauma mortality between high-income and low- and middle-income countries. This limits identification of populations and injury patterns for targeted interventions. We aim to compare independent predictors of pediatric trauma mortality between India and the United States (US). METHODS A retrospective cohort study was conducted for pediatric patients (age <18 years) in India's Towards Improved Trauma Care Outcomes (TITCO) project database and the US National Trauma Data Bank (NTDB) from 2013 to 2015. Demographic, injury, physiologic, anatomic and outcome data were analyzed. Multivariable regressions were used to determine independent predictors of mortality. RESULTS 126,678 pediatric trauma patients were included (India 3,373; US 123,305). Pediatric patients in India were on average significantly younger, with a higher median injury severity score (ISS), had lower systolic blood pressure, and suffered a higher case fatality rate (13.0% vs. 1.0%). When controlling for demographic, mechanism, physiologic, and anatomic injury characteristics, sustaining an injury in India was the strongest predictor of mortality (OR 22.70, 95% CI 18.70-27.56). On subgroup analysis, the highest relative odds of mortality in India was seen in children with lower injury and physiologic severity. CONCLUSIONS Risk-adjusted pediatric trauma-related mortality is significantly higher in India compared to the US. The comparative odds of mortality are highest among children with lower injury and physiologic severity. This suggests that low-cost targeted interventions focused on standard timely trauma care, protocols, training and early imaging could improve pediatric injury mortality in India. TYPE OF STUDY Retrospective Prognosis Study LEVEL OF EVIDENCE: II.
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Affiliation(s)
- Stas Amato
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA.
| | - Katherine Culbreath
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA; Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Emma Dunne
- University of Vermont, Larner College of Medicine, 89 Beaumont Ave, Burlington, VT 05401, USA
| | - Ashwini Sarathy
- University of Vermont, Larner College of Medicine, 89 Beaumont Ave, Burlington, VT 05401, USA
| | - Olivia Siroonian
- Department of Pharmacology, University of Vermont, Larner College of Medicine, 89 Beaumont Ave, Burlington, VT 05401, USA
| | - Kennith Sartorelli
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA
| | - Nobhojit Roy
- The George Institute for Global Health, 308, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi 110025, India; WHO Collaborating Centre for Research in Surgical Care Delivery, Anushakti Nagar, Mumbai, MH 400094, India
| | - Ajai Malhotra
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA
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Global Survey of Demand-Side Factors and Incentives that Influence Advanced Trauma Life Support (ATLS) Promulgation. World J Surg 2022; 46:1059-1066. [DOI: 10.1007/s00268-022-06461-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
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Amato S, Bonnell L, Mohan M, Roy N, Malhotra A. Comparing trauma mortality of injured patients in India and the USA: a risk-adjusted analysis. Trauma Surg Acute Care Open 2021; 6:e000719. [PMID: 34869908 PMCID: PMC8603298 DOI: 10.1136/tsaco-2021-000719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives Comparisons of risk-adjusted trauma mortality between high-income countries and low and middle-income countries (LMICs) can be used to identify specific patient populations and injury patterns for targeted interventions. Due to a paucity of granular patient and injury data from LMICs, there is a lack of such comparisons. This study aims to identify independent predictors of trauma mortality and significant differences between India and the USA. Methods A retrospective cohort study of two trauma databases was conducted. Demographic, injury, physiologic, anatomic and outcome data were analyzed from India’s Towards Improved Trauma Care Outcomes project database and the US National Trauma Data Bank from 2013 to 2015. Multivariate logistic regression analyses were performed to determine significant independent predictors of mortality. Results 687 407 adult trauma patients were included (India 11 796; USA 675 611). Patients from India were significantly younger with greater male preponderance, a higher proportion presented with physiologic abnormalities and suffered higher mortality rates (23.2% vs. 2.8%). When controlling for age, sex, physiologic abnormalities, and injury severity, sustaining an injury in India was the strongest predictor of mortality (OR 13.85, 95% CI 13.05 to 14.69). On subgroup analyses, the greatest mortality difference was seen in patients with lower Injury Severity Scores. Conclusion After adjusting for demographic, physiologic abnormalities, and injury severity, trauma-related mortality was found to be significantly higher in India. When compared with trauma patients in the USA, the odds of mortality are most notably different among patients with lower Injury Severity Scores. While troubling, this suggests that relatively simple, low-cost interventions focused on standard timely trauma care, early imaging, and protocolized treatment pathways could result in substantial improvements for injury mortality in India, and potentially other LMICs. Level of evidence Level 3, retrospective cohort study.
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Affiliation(s)
- Stas Amato
- Department of General Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Levi Bonnell
- Department of General Internal Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Monali Mohan
- Department of Health Systems Strengthening, Care India, Bihar, Patna, India
| | - Nobhojit Roy
- The George Institute for Global Health, New Delhi, India.,WHO Collaborating Centre for Research in Surgical Care Delivery, Mumbai, India
| | - Ajai Malhotra
- Department of General Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
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Turner J, Duffy S. Orthopaedic and trauma care in low-resource settings: the burden and its challenges. INTERNATIONAL ORTHOPAEDICS 2021; 46:143-152. [PMID: 34655318 DOI: 10.1007/s00264-021-05236-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND BURDEN Trauma with its early and late consequences disproportionately effects those from poor countries. The availability of effective orthopaedic and trauma care varies significantly across the globe. CHALLENGES The balancing out of quality care is required to reach the health-related UN development goal set out in 2015. A multifactorial approach addressing local, national and international aspects is key to improving the discrepancy seen between high- and low-income countries.
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Affiliation(s)
- James Turner
- Bristol Royal Hospital for Children, Bristol, UK.
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