TY - JOUR
T1 - Effectiveness of Quality Improvement Processes, Interventions, and Structure in Trauma Systems in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis
AU - Jin, James
AU - Akau’ola, Salesi’
AU - Yip, Cheng-Har
AU - Nthumba, Peter
AU - Ameh, Emmanuel A.
AU - de Jonge, Stijn
AU - Mehes, Mira
AU - Waiqanabete, Iferemi
AU - The International Society of Surgery (ISS) and the G4 Alliance International Standards and Guidelines for Quality Safe Surgery and Anesthesia (ISG-QSSA) Group
AU - Henry, Jaymie
AU - Hill, Andrew
N1 - Publisher Copyright: © 2021, Société Internationale de Chirurgie.
PY - 2021/7
Y1 - 2021/7
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85104278916&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00268-021-06065-9
DO - https://doi.org/10.1007/s00268-021-06065-9
M3 - Article
C2 - 33835217
SN - 0364-2313
VL - 45
SP - 1982
EP - 1998
JO - World journal of surgery
JF - World journal of surgery
IS - 7
ER -