Weill Cornell Medical Centre, New York, NY, USA; College of Medicine, Aga Khan University, Karachi Pakistan.
Manulife Canada, Toronto, ON, Canada.
Lancet. 2022 Jul 23;400(10348):329-336. doi: 10.1016/S0140-6736(22)00887-X. Epub 2022 Jun 30.
Over 90% of the annual 1·35 million worldwide deaths due to road traffic injuries (RTIs) occur in low-income and middle-income countries (LMICs). For this Series paper, our aim was two-fold. Firstly, to review evidence on effective interventions for victims of RTIs; and secondly, to estimate the potential number of lives saved by effective trauma care systems and clinical interventions in LMICs. We reviewed all the literature on trauma-related health systems and clinical interventions published during the past 20 years using MEDLINE, Embase, and Web of Science. We included studies in which mortality was the primary outcome and excluded studies in which trauma other than RTIs was the predominant injury. We used data from the Global Status Report on Road Safety 2018 and a Monte Carlo simulation technique to estimate the potential annual attributable number of lives saved in LMICs. Of the 1921 studies identified for our review of the literature, 62 (3·2%) met the inclusion criteria. Only 28 (1·5%) had data to calculate relative risk. We found that more than 200 000 lives per year can be saved globally with the implementation of a complete trauma system with 100% coverage in LMICs. Partial system improvements such as establishing trauma centres (>145 000 lives saved) and instituting and improving trauma teams (>115 000) were also effective. Emergency medical services had a wide range of effects on mortality, from increasing mortality to saving lives (>200 000 excess deaths to >200 000 lives saved per year). For clinical interventions, damage control resuscitation (>60 000 lives saved per year) and institution of interventional radiology (>50 000 lives saved per year) were the most effective interventions. On the basis of the scarce evidence available, a few key interventions have been identified to provide guidance to policy makers and clinicians on evidence-based interventions that can reduce deaths due to RTIs in LMICs. We also highlight important gaps in knowledge on the effects of other interventions.
全球每年因道路交通伤害（RTI）导致的 135 万死亡人数中，超过 90%发生在低收入和中等收入国家（LMICs）。本系列论文的目的有两个。首先，综述 RTI 受害者有效干预措施的证据；其次，估算有效创伤护理系统和临床干预措施在 LMICs 中可挽救的生命数量。我们检索了过去 20 年 MEDLINE、Embase 和 Web of Science 中关于与创伤相关的卫生系统和临床干预的所有文献。纳入研究中死亡率为主要结局，排除以 RTI 以外的创伤为主要损伤的研究。我们使用《2018 年全球道路安全状况报告》中的数据和蒙特卡罗模拟技术，估算 LMICs 中每年因可归因的创伤护理系统和临床干预措施而挽救的生命数量。在我们对文献的综述中，共检索到 1921 项研究，其中 62 项（3.2%）符合纳入标准。仅有 28 项（1.5%）有数据计算相对风险。我们发现，在 LMICs 中实施全面创伤系统并实现 100%覆盖，每年可挽救 20 多万人的生命。部分系统改进，如建立创伤中心（可挽救超过 145000 人的生命）和建立并改进创伤团队（可挽救超过 115000 人的生命）也同样有效。紧急医疗服务对死亡率的影响范围广泛，从增加死亡率到挽救生命（每年超过 20 万例超额死亡到超过 20 万例生命挽救）。对于临床干预措施，损伤控制性复苏（每年可挽救超过 60000 人的生命）和介入放射学的应用（每年可挽救超过 50000 人的生命）是最有效的干预措施。根据现有有限的证据，确定了一些关键干预措施，为决策者和临床医生提供基于证据的干预措施的指导，以减少 LMICs 中 RTI 导致的死亡。我们还强调了其他干预措施效果方面的重要知识空白。
