Blair Kevin J, Paladino Lorenzo, Shaw Pamela L, Shapiro Michael B, Nwomeh Benedict C, Swaroop Mamta
Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, New York.
J Surg Res. 2017 Apr;210:139-151. doi: 10.1016/j.jss.2016.11.005. Epub 2016 Nov 10.
Surgical and trauma capacity assessments help guide resource allocation and plan interventions to improve care for the injured in low- and middle-income countries (LMICs). To forge expert consensus on conducting these assessments, we undertook a systematic review of studies using five tools: (1) World Health Organization's (WHO) Guidelines for Essential Trauma Care, (2) WHO's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, (3) Personnel, Infrastructure, Procedures, Equipment, and Supplies tool, (4) Harvard Humanitarian Initiative tool, and (5) Emergency and Critical Care tool.
Publications describing utilization of survey instruments to assess surgical or trauma capacity in LMICs were reviewed. Included articles underwent thematic analysis to develop recommendations. A modified Delphi method was used to establish expert consensus. Experts rated recommendations on a Likert-type scale via online survey. Consensus was defined by Cronbach's α ≥ 0.80. Recommendations achieving agreement by ≥80% of experts were included.
Two hundred and ninety-eight publications were identified and 41 included, describing evaluation of 1170 facilities across 36 LMICs. Nine recommendations were agreed upon by expert consensus: (1) inclusion of district hospitals, (2) inclusion of highest level public hospital, (3) inclusion of private facilities, (4) facility visits for on-site completion, (5) direct inspections, (6) checking surgical logs, (7) adaptation of survey instrument, (8) repeat assessments, and (9) need for increased collaboration.
Expert recommendations developed in this review describe methodology to be employed when conducting assessments of surgical and trauma capacity in LMICs. Consensus has yet to be achieved for tool selection.
手术和创伤能力评估有助于指导资源分配，并规划干预措施，以改善低收入和中等收入国家（LMICs）对伤者的护理。为了就开展这些评估达成专家共识，我们对使用五种工具的研究进行了系统评价：（1）世界卫生组织（WHO）的《基本创伤护理指南》；（2）WHO的《评估急诊和基本外科护理的情景分析工具》；（3）人员、基础设施、程序、设备和物资工具；（4）哈佛人道主义倡议工具；（5）急诊和重症护理工具。
对描述在LMICs中使用调查工具评估手术或创伤能力的出版物进行了综述。纳入的文章进行了主题分析以制定建议。采用改良的德尔菲法建立专家共识。专家通过在线调查对建议进行李克特量表评分。共识定义为Cronbach's α≥0.80。获得≥80%专家认可的建议被纳入。
共识别出298篇出版物，其中41篇被纳入，描述了对36个LMICs中1170家机构的评估。专家共识达成了九条建议：（1）纳入地区医院；（2）纳入最高级别的公立医院；（3）纳入私立机构；（4）进行实地考察以现场完成评估；（5）直接检查；（6）检查手术记录；（7）调整调查工具；（8）重复评估；（9）需要加强合作。
本综述中制定的专家建议描述了在LMICs中进行手术和创伤能力评估时应采用的方法。在工具选择方面尚未达成共识。
