LaGrone Lacey, Riggle Kevin, Joshipura Manjul, Quansah Robert, Reynolds Teri, Sherr Kenneth, Mock Charles
Harborview Injury Prevention and Research Center, Campus Box #356410, University of Washington, Seattle, WA 98104, United States of America (USA).
Department of Surgery, University of Washington, Seattle, USA .
Bull World Health Organ. 2016 Aug 1;94(8):585-598C. doi: 10.2471/BLT.15.162214. Epub 2016 May 13.
To 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.
We 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.
We 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.
Although 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.
了解世界卫生组织（WHO）在2004年至2009年期间发布的创伤护理指南的使用程度，并确定未来实施和传播此类指南的优先事项。
我们在19个数据库中进行了系统综述，使用了三套指南——《基本创伤护理指南》《院前创伤护理系统》和《创伤质量改进计划指南》的标题作为检索词。通过引文分析和专家咨询对结果进行验证。两位作者独立审查了指南实施的每条记录。
我们识别出578条提供了WHO创伤护理指南传播证据的记录，以及101个信息来源，它们共同描述了140个实施事件。在51个国家发现了实施证据——35个低收入国家中的14个（40%），47个中低收入国家中的15个（32%），53个中高收入国家中的15个（28%），59个高收入国家中的7个（12%）。在140个实施案例中，63个（45%）可归类为需求评估，38个（27%）为利益相关者认可，20个（14%）为纳入政策，19个（14%）为教育干预。
尽管WHO的创伤护理指南已得到广泛实施，但在143个国家未发现其实施的证据。需要对卫生系统中创伤护理能力的持续监测进行更多系列需求评估，并将这些指南更多地纳入医疗保健提供者的正规教育和卫生政策中。
