Department of Trauma and Orthopaedics, Countess of Chester Hospital NHS Foundation Trust, Chester, UK.
Department of Orthopaedics, Kamuzu Central Hospital, Lilongwe, Malawi.
BMJ Open. 2018 Sep 17;8(9):e023473. doi: 10.1136/bmjopen-2018-023473.
Low/middle-income countries (LMICs) have a growing need for trauma and orthopaedic (T&O) surgical interventions but lack surgical resources. Part of this is due to the high amount of road traffic accidents in LMICs. We aimed to develop recommendations for an essential list of equipment for three different levels of care providers.
The Delphi method was used to achieve consensus on essential and desirable T&O equipment for LMICs. Twenty experts with T&O experience from LMICs underwent two rounds of questionnaires. Feedback was given after each round of questionnaires. The first round of questionnaire consisted of 45 items graded on a Likert scale with the second round consisting of 50 items. We used an electronic questionnaire to collect our data for three different levels of care: non-operative-based provider, specialist provider with operative fracture care and tertiary provider with operative fracture care and orthopaedics.
After two rounds of questionnaires, recommendations for each level of care in LMICs included 4 essential equipment items for non-operative-based providers; 27 essential equipment items for specialist providers with operative fracture care and 46 essential equipment items for tertiary providers with operative fracture care and orthopaedic care.
These recommendations can facilitate in planning of appropriate equipment required in an institution which in turn has the potential to improve the capacity and quality of T&O care in LMICs. The essential equipment lists provided here can help direct where funding for equipment should be targeted. Our recommendations can help with planning and organising national T&O care in LMICs to achieve appropriate capacity at all relevant levels of care.
中低收入国家（LMICs）对创伤和骨科（T&O）手术干预的需求不断增长，但缺乏手术资源。部分原因是 LMICs 中道路交通伤害的数量较高。我们旨在为三个不同级别的医疗服务提供者制定一份基本设备清单的建议。
采用德尔菲法就 LMICs 中创伤和骨科基本和理想设备达成共识。来自 LMICs 的 20 名具有 T&O 经验的专家进行了两轮问卷调查。每轮问卷后都会提供反馈。第一轮问卷包含 45 项按李克特量表评分的项目，第二轮包含 50 项。我们使用电子问卷收集了三个不同级别的护理数据：非手术提供者、有手术骨折护理的专科提供者和有手术骨折护理和骨科的三级提供者。
两轮问卷后，LMICs 中每个级别的护理推荐包括非手术提供者的 4 项基本设备；有手术骨折护理的专科提供者的 27 项基本设备和有手术骨折护理和骨科的三级提供者的 46 项基本设备。
这些建议有助于规划机构所需的适当设备，从而有可能提高 LMICs 中 T&O 护理的能力和质量。这里提供的基本设备清单可以帮助指导设备资金的投向。我们的建议可以帮助规划和组织 LMICs 中的国家 T&O 护理，以在所有相关护理级别实现适当的能力。
