Abstract
BackgroundTrauma represents a major global health problem projected to increase in importance over the next decade. The majority of deaths occur in low- and middle-income countries (LMICs) where survival rates are lower than their high-income country (HIC) counterparts. Health system level changes in care for injured patients have been attributed to significant improvements in care quality and outcomes in HIC settings. There is a need for further research to assess trauma care health systems in LMICs to inform health system strengthening for the care of the injured. This study aims to conduct a narrative synthesis of a systematic search of the literature on the assessment of trauma care health systems in LMICs in order to inform the further development of trauma care health system assessment.MethodsThe review will include primary quantitative, qualitative or mixed method studies and secondary literature reviews. No restriction will be placed on language or date. Reports and publications identified from the grey literature including from relevant national and international health organisations will be included. Articles will be screened by two independent reviewers with a third reviewer resolving any persisting disagreement. The search will reveal heterogenous studies not suitable for meta-analysis. A narrative synthesis of the identified papers will be conducted to identify key methodological ideas and paradigms used to assess trauma care health systems. The analysis will consider how the differing methodological approaches could be adopted to understand barriers and delays to seeking, reaching and receiving care within a “Three Delays” framework. An iterative approach will be adopted to categorise identified articles, with the results presented as both within and across study analysis.DiscussionThe results of the review will be disseminated through publication in a peer-reviewed academic journal. The study forms part of a PhD project. The results will inform the development of a trauma care health system assessment applicable to LMICs. As this is a review of secondary data, no formal ethical approval is required.Systematic review registrationPROSPERO CRD42018112990
Highlights
Trauma represents a major global health problem projected to increase in importance over the decade
Rationale Trauma represents a major global health problem with injuries accounting for more deaths than TB, malaria and HIV combined and with 90% of these deaths occurring in low- and middle-income countries (LMICs) [1]
The objective is to conduct a narrative synthesis of a systematic search of the literature on the assessment of trauma care health systems through a Three Delays model framework of understanding, in order to inform the development of trauma care health system assessment
Summary
The 2015 guidelines for Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) have been followed in the design of this protocol (Additional file 1). Eligibility criteria We will include primary quantitative, qualitative or mixed method studies and secondary literature reviews. We will include reports and publications identified from the grey literature including from relevant national and international health organisations (listed in Appendix 1). We will include any additional articles recommended by experts in health system research or trauma care that might inform our review. Qualitative or mixed method study Literature review Report or guideline from national or international health organisation. Each grey literature database search, Google search, focused website search and expert request will be conducted by one reviewer with a second reviewer confirming eligibility of identified articles. Risk of bias This review is primarily focused on the methodological approach identified in the article and aims to understand a wide breadth of diverse research approaches used to assess trauma care health systems. An iterative approach will be adopted to categorise identified articles, with the results presented as both within and across study analysis
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