Variation in global trauma care: a survey of 187 hospitals across 51 countries

作者：Thomas Edmiston, Michael Bath, Eder Cáceres, Carlos M. Nuño‐Guzmán, Daniel Umugisha Baderhabusha, Monty Khajanchi, Joachim Amoako, Katharina Köhler, Abdullahi Said Hashi, Luca Carenzo, Zhongheng Zhang, Max Marsden, Raoof Saleh, C Hammer, Laura Hobbs, Brandon Smith, Peter J. Hutchinson, Thomas G. Weiser, Zane Perkins, Timothy Craig Hardcastle, Tom Bashford · 发表于：BMJ Global Health · 年份：2025 · DOI：10.1136/bmjgh-2025-021784 · 被引用次数：6 · 研究领域：Trauma and Emergency Care Studies、Global Health and Surgery、Trauma, Hemostasis, Coagulopathy, Resuscitation

BACKGROUND: Trauma is a heterogeneous disease entity, with high rates of mortality and morbidity observed globally. While the health systems in which trauma patients are cared for worldwide have been previously assessed to varying degrees, many of the system processes that shape trauma patient outcomes remain unknown. METHODS: We conducted a survey of 187 hospitals across 51 countries, through the GOAL-Trauma collaborative network. We explored prehospital, intrahospital and rehabilitation phases of trauma care. Data were compared across Human Development Index (HDI) tertiles, with thematic analyses performed to identify similarities and variation across settings. FINDINGS: Hospital-based care appeared to develop preferentially out of the three phases of trauma care, with challenges from the middle HDI tertile being more analogous to the upper HDI tertile than the lower HDI tertile. A lack of emergency medical services, limited patient finances and a lack of health literacy were common causes of prehospital delay in the lower and middle HDI tertiles. Surgeons and anaesthetists working in lower and middle HDI tertiles perform approximately 3-fold and 10-fold more operations, respectively, compared with upper HDI tertile counterparts. Across all HDI tertiles, infection was reported as the most common cause of postoperative morbidity. INTERPRETATION: A wide range of resources and processes exist globally in trauma care. Our findings suggest that with increasing resource availabil...