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Publications

Journal Article Epublish

PubMed: 41213661 DOI: 10.1136/bmjgh-2025-021784

Variation in global trauma care: a survey of 187 hospitals across 51 countries.

BMJ Glob Health 10(11)

Authors: Thomas Edmiston, Michael F Bath, Eder Caceres, Carlos M Nuño-Guzmán, Daniel Umugisha Baderhabusha, Monty Khajanchi, Joachim Amoako, Katharina Kohler, Abdullahi Said Hashi, Luca Carenzo, Zhongheng Zhang, Max Marsden, Raoof Saleh, Charlotte C Hammer, Laura Hobbs, Brandon G Smith, Peter Hutchinson, Thomas Weiser, Zane B Perkins, Timothy Craig Hardcastle, Tom Bashford

Affiliations

  • International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK.
  • International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK.
  • Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia.
  • Hospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde, Guadalajara, Mexico.
  • Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.
  • Hôpital de Kyeshero, Goma, Congo (the Democratic Republic of the).
  • Department of Surgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India.
  • University of Ghana Medical School, Accra, Ghana.
  • Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana.
  • Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
  • Department of Anesthesiology and Reanimation, Mogadishu Somali-Türkiye Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia.
  • IRCCS Istituto Clinico Humanitas, Milan, Italy.
  • Department of Emergency Medicine, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China.
  • School of Medicine, Shaoxing University, Shaoxing, Zhejiang, China.
  • Major Trauma Service, The Royal London Hospital, London, UK.
  • Médicins Sans Frontières Medical Unit, Berlin, Germany.
  • Centre for the Study of Existential Risk, Institute for Technology and Humanity, University of Cambridge, Cambridge, UK.
  • NIHR Global Health Research Group on Acquired Brain and Spine Injury, Cambridge, UK.
  • Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
  • Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.
  • Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK.
  • Trauma and Burns Unit, Inkosi Albert Luthuli Central Hospital, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
  • Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine (NRMSM), University of KwaZulu-Natal, Durban, South Africa.

Abstract

BACKGROUND

Trauma is a heterogeneous disease entity, with high rates of mortality and morbidity observed globally. While the health systems in which trauma patients are cared for worldwide have been previously assessed to varying degrees, many of the system processes that shape trauma patient outcomes remain unknown.

METHODS

We conducted a survey of 187 hospitals across 51 countries, through the GOAL-Trauma collaborative network. We explored prehospital, intrahospital and rehabilitation phases of trauma care. Data were compared across Human Development Index (HDI) tertiles, with thematic analyses performed to identify similarities and variation across settings.

FINDINGS

Hospital-based care appeared to develop preferentially out of the three phases of trauma care, with challenges from the middle HDI tertile being more analogous to the upper HDI tertile than the lower HDI tertile. A lack of emergency medical services, limited patient finances and a lack of health literacy were common causes of prehospital delay in the lower and middle HDI tertiles. Surgeons and anaesthetists working in lower and middle HDI tertiles perform approximately 3-fold and 10-fold more operations, respectively, compared with upper HDI tertile counterparts. Across all HDI tertiles, infection was reported as the most common cause of postoperative morbidity.

INTERPRETATION

A wide range of resources and processes exist globally in trauma care. Our findings suggest that with increasing resource availability, in-hospital care of trauma patients develops preferentially over prehospital or rehabilitation services. There is a clear need to coordinate available resources across all phases of care in order to improve outcomes among trauma patients.

MeSH

Global Health, Rehabilitation, Morbidity, Wounds And Injuries