Edmiston Thomas, Bath Michael F, Ratnayake Amila, Reyes Luis Felipe, Reffin Eleanor, Zhang Zhongheng, Saleh Raoof, Caceres Eder, Amoako Joachim, Kuhn Isla, Smith Brandon G, Rambabu Lekaashree, Mantle Orla, Penmetcha Vedha, Hobbs Laura, Kohler Katharina, Hardcastle Timothy C, Weiser Thomas G, Bashford Tom
International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK.
Department of Surgery, Army Hospital, Colombo, Sri Lanka.
World J Surg. 2025 Jul;49(7):1928-1940. doi: 10.1002/wjs.12626. Epub 2025 May 19.
Trauma is a major source of morbidity and mortality globally, but low- and middle-income countries (LMICs) are disproportionately affected by higher volumes of trauma and worse health outcomes. Despite this, there are limited data describing how many individuals in these regions need trauma surgery, and how many are able to access it.
We performed a scoping review to examine the current available evidence on the need for, and access to, trauma surgery in LMICs in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. We included studies published after 2000, across all languages, that reported data on LMICs, as defined by the Organization for Economic Cooperation and Development.
We identified 32 articles describing the need for trauma surgery and 24 articles describing the access to trauma surgery, representing 27 LMICs overall. The median rate of trauma need was 7361 individuals per 100,000 per year (IQR 6313-9461), whereas the median rate of trauma surgery was 64.8 procedures per 100,000 per year.
Our study suggests that the need for trauma surgery is far greater than the access provided in LMICs. Indeed, the median rate of trauma surgery currently performed in the represented LMICs was 20 times less than the Lancet Commission on Global Surgery's benchmark. This scoping review illustrates the pressing requirement to generate high-quality prospective data to describe trauma care in LMICs.
创伤是全球发病和死亡的主要原因，但低收入和中等收入国家（LMICs）受创伤数量较多和健康结果较差的影响尤为严重。尽管如此，描述这些地区有多少人需要创伤手术以及有多少人能够获得创伤手术的相关数据却很有限。
我们按照系统评价和Meta分析扩展版的范围综述指南（Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews）进行了一项范围综述，以研究目前关于LMICs中创伤手术需求和可及性的现有证据。我们纳入了2000年以后发表的、所有语言的、报告了经济合作与发展组织定义的LMICs数据的研究。
我们确定了3篇描述创伤手术需求的文章和24篇描述创伤手术可及性的文章，共涉及27个LMICs。创伤需求的中位数率为每年每10万人中有个人（四分位间距为6313-9461），而创伤手术的中位数率为每年每10万人中有64.8例手术。
我们的研究表明，LMICs中对创伤手术的需求远远大于所能提供的服务。实际上，在所代表的LMICs中目前进行的创伤手术中位数率比《柳叶刀》全球外科委员会的基准低20倍。这项范围综述表明迫切需要生成高质量的前瞻性数据来描述LMICs中的创伤护理情况。
