Office of Global Surgery, Department of Surgery, University of Alberta, Walter Mackenzie Health Sciences Centre, 2D2.238440 - 112 Ave NW, Edmonton, AB, T6G 2B7, Canada.
John W. Scott Health Sciences Library, University of Alberta, Walter C. Mackenzie Health Sciences Centre, 2K3.288440 - 112 Ave NW, Edmonton, AB, T6G 2R7, Canada.
World J Surg. 2021 Dec;45(12):3543-3557. doi: 10.1007/s00268-021-06283-1. Epub 2021 Sep 5.
Injury is the leading cause of morbidity and mortality in low- and lower middle-income countries (LMICs). Trauma training is a cost-effective way to improve injury outcomes. Several trauma programs have been implemented in LMICs; however, their scope and effectiveness remain unclear. In this review, we sought to describe and assess the current state of trauma training in LMICs.
We searched MEDLINE, Embase, Global Health, Cochrane Library, and ProQuest Dissertations & Theses Global for trauma training courses in LMICs. An additional gray literature search was conducted on university, governmental, and non- governmental organizations' websites to identify trauma-related postgraduate medical education (PGME) opportunities.
Most studies occurred in sub-Saharan Africa and participants were primarily physicians/surgeons, medical students/residents, and nurses. General and surgical trauma management courses were most common, followed by orthopedic trauma or plastic surgery trauma/burn care courses. 32/45 studies reported on participant knowledge and skills, 27 of which had minimal follow-up. Of the four studies commenting on cost of courses, only one demonstrated cost-effectiveness. Three articles evaluated post-course effects on patient outcomes, two of which failed to demonstrate significant improvements. Overall, 43.0% of LMICs have PGME programs with defined trauma competency requirements.
Current studies on trauma training in LMICs do not clearly demonstrate sustainability, cost-effectiveness, nor improved outcomes. Trauma training programs should be in response to a need, championed locally, and work within a cohesive system to demonstrate concrete benefits. We recommend standardized and contextualized trauma training with recertifications in LMICs for lasting and improved trauma care.
在低收入和中低收入国家（LMICs），伤害是发病率和死亡率的主要原因。创伤培训是改善伤害结果的一种具有成本效益的方法。已经在 LMICs 中实施了多个创伤项目；然而，它们的范围和效果仍然不清楚。在本综述中，我们试图描述和评估 LMICs 中创伤培训的现状。
我们在 MEDLINE、Embase、全球健康、Cochrane 图书馆和 ProQuest Dissertations & Theses Global 中搜索了 LMICs 中的创伤培训课程。还在大学、政府和非政府组织的网站上进行了额外的灰色文献搜索，以确定与创伤相关的研究生医学教育（PGME）机会。
大多数研究发生在撒哈拉以南非洲，参与者主要是医生/外科医生、医学生/住院医师和护士。一般和外科创伤管理课程最为常见，其次是骨科创伤或整形烧伤护理课程。45 项研究中有 32 项报告了参与者的知识和技能，其中 27 项仅有很少的随访。在讨论课程成本的四项研究中，只有一项证明了成本效益。三篇文章评估了课程对患者结局的影响，其中两项未能证明显著改善。总体而言，43.0%的 LMICs 具有具有明确创伤能力要求的 PGME 计划。
目前关于 LMICs 中创伤培训的研究并未清楚地表明可持续性、成本效益或改善的结局。创伤培训计划应响应需求，在当地得到支持，并在一个协调的系统内运作，以展示具体的收益。我们建议在 LMICs 中进行标准化和情境化的创伤培训，并进行再认证，以实现持久和改善的创伤护理。
