Uptake of the World Health Organization's trauma care guidelines: a systematic review.

Lacey Lagrone,Kevin Riggle,Manjul Joshipura,Teri Reynolds,Charles Mock,Kenneth Sherr,Robert Quansah

doi:10.2471/blt.15.162214

Abstract

ObjectiveTo understand the degree to which the trauma care guidelines released by the World Health Organization (WHO) between 2004 and 2009 have been used, and to identify priorities for the future implementation and dissemination of such guidelines.MethodsWe conducted a systematic review, across 19 databases, in which the titles of the three sets of guidelines – Guidelines for essential trauma care, Prehospital trauma care systems and Guidelines for trauma quality improvement programmes – were used as the search terms. Results were validated via citation analysis and expert consultation. Two authors independently reviewed each record of the guidelines’ implementation.FindingsWe identified 578 records that provided evidence of dissemination of WHO trauma care guidelines and 101 information sources that together described 140 implementation events. Implementation evidence could be found for 51 countries – 14 (40%) of the 35 low-income countries, 15 (32%) of the 47 lower-middle income, 15 (28%) of the 53 upper-middle-income and 7 (12%) of the 59 high-income. Of the 140 implementations, 63 (45%) could be categorized as needs assessments, 38 (27%) as endorsements by stakeholders, 20 (14%) as incorporations into policy and 19 (14%) as educational interventions.ConclusionAlthough WHO’s trauma care guidelines have been widely implemented, no evidence was identified of their implementation in 143 countries. More serial needs assessments for the ongoing monitoring of capacity for trauma care in health systems and more incorporation of the guidelines into both the formal education of health-care providers and health policy are needed.

Highlights

As a result of the unsafe conditions and the relatively poor outcomes once someone is injured in low- and middle-income countries, about 90% of the global burden of injury-related mortality and disability is found in low- and middle-income countries.[1]
We used the titles of the three sets of World Health Organization (WHO) guidelines of interest – “Guidelines for essential trauma care”, “Guidelines for trauma quality improvement programmes” and “Prehospital trauma care systems” – as our search terms
More implementation events for the Guidelines for essential trauma care were recorded as needs assessments,[18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,80,90] than as stakeholder recommendations[27,38,49,52,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,101] or incorporations into policy[18,27,31,37,75,76,77,78,79,81,82] or educational interventions.[37,40,53,63,83,84,85,86,87,88,89]

Summary

Introduction

As a result of the unsafe conditions and the relatively poor outcomes once someone is injured in low- and middle-income countries, about 90% of the global burden of injury-related mortality and disability is found in low- and middle-income countries.[1]. The World Health Organization (WHO) has made a concerted effort to address geographical inequalities in trauma care, especially via the development of the Essential Trauma Care Project and the publication of three sets of guidelines These guidelines – entitled Guidelines for essential trauma care, Prehospital trauma care systems, and Guidelines for trauma quality improvement programmes – were published in 2004, 2005 and 2009, respectively, following consultations with dozens of organizations and hundreds of experts.[8,9,10,11] Together, these guidelines represent the best of the otherwise very limited guidance available to policy-makers and clinicians, in countries at all economic levels, who are seeking ways to strengthen systems for trauma care. Implementation of these guidelines reflects, at least in part, the status of trauma care globally

Methods

Results

Conclusion