Surveillance and Data Capture to Assess Trauma Care Capacity in Low- and Middle-Income Countries.

Abstract

WecommendStewartetal1on their article regarding their longitudinal capacity assessment of the progress in trauma service availability during the last decade inGhana and their recognition of the need for expanding the evidence base for trauma care capacity in lowand middle-income countries. The successes in improving in-hospital capacity such as infrastructure (eg, blood bank), equipment (eg, chest tubes,ventilator), andservices (eg, skin grafting, neurosurgery) are part of broader needed efforts for capacity development of a complex, multicomponent, interconnected, and evolving trauma care delivery system. Remaining gaps in process evaluation (eg, prevention, prehospital triage,mobile emergency services, definitivehospital care, workforce distribution, long-term rehabilitation, transfer protocols and criteria, communication, and workflow) as well as injury and outcome surveillance present ongoing opportunities for collaboration and building to overcome present barriers in the delivery of trauma care. These summative factors arenecessary components for accurate and reliable appraisal of a country’s trauma care capacity. Moreover, the implementation of a formal injury surveillance mechanismwould enable the collectionof reliable injurydata for problem assessment and determination of whether advances have been made regarding quality and process improvement. Establishing monitoring mechanisms that provide country-specific injury andoutcomedatawill enable the accurate characterization of persistent deficits in trauma care capacity that may then more effectively inform policy making. Therefore, adoption of a systems-based approach and a broadening of the context-specific knowledgebase are essential to trauma care capacity development. In short, we need timely, accurate, and available data on the occurrence of injuries and related deaths; once these data have been collected and outcomes have been reviewed, steps can bemade toward applied data2—targeted, sustainable, and costeffective strengthening of trauma care services in already resource-poor settings. A recent study demonstrating a largely unchanged preponderance of prehospital deaths (76%) in Ghana compared with adecadeearlier (80%)3 seems tounderscore the conceivable impact that prioritizationof strategic interventions at the level of prehospital triage and transport could have. As other sectors such as maternal and child health recognize the need for such monitoring and evaluation, even as part of the MillenniumDevelopment Goal Acceleration Framework,4 hopefully lessons learned can be transferred and applied to Ghana’s trauma care system.