Disparities in Trauma Care Worldwide: A Brief Overview

Updated: Oct 22

Written by,

Yousif Baho

4th Year Medical Student, Hull York Medical School

Injury is the leading cause of death globally [1] and as such it is undeniable that provision of effective care for trauma patients is imperative. Unfortunately, there are disparities in the quality of trauma care provided worldwide. Indeed, patients with life threatening injuries are 6 times more likely to die after trauma in low‐income country (LIC) when compared to a high‐income countries [2] (HIC). Research has calculated that if the case fatality rates in seriously injured people in LIC and middle income countries were similar to those in HIC, almost 2 million lives may be saved every year [1]!


This 6‐fold discrepancy is partially attributed to the relatively poor quality of trauma care in LICs. Additionality, this issue is worsened by poor levels of organization, development, and scarcity of programmes for the improvement of trauma care [3]. Additionally, the potential lack of equipment and resources in LICs may also contribute to this discrepancy.


It is important to note that there are differences in the types of trauma that is seen in LICs when compared to HICs. Injuries from road traffic accidents and war are among the leading causes of death in LICs and medium income counties [4]. The number of deaths experienced in HICs from wars for example, may possibly be less. Therefore, one can argue that different systems of trauma care could be provided and implemented in such LICs to accommodate for any differences.



The World Health Organisation (WHO) created several guidelines and the Essential Trauma Care Project in an attempt to address geographical inequalities in trauma care. These guidelines guide policy makers and clinicians in countries at all economic levels who are aiming to strengthen systems for trauma care [3]. However, as of 2016 there was no evidence which identified implementation of the WHO trauma care guidelines in 143 countries [3]. The guidelines were aimed at a more large-scale level but smaller, microscale interventions have been conducted to improve trauma care. Perhaps, in especially deprived countries which may lack basic abilities and struggle to care for trauma patients, a more proactive approach may, at least initially, be required to care for trauma patients as these services in such deprived countries may be severely lacking.


Education is perhaps a potential partial solution to alleviate such large discrepancies as this microscale intervention illustrates. For example, Husum et al. [5] trained 44 health workers from rural communities in Northern Iraq and Cambodia, to deliver low‐cost life support to trauma victims who then in turn trained 2800 laypeople village first responders. Overall, mortality rate for trauma victims decreased to 13.7% in 1999, from 22.6% in 1996 [5]. As can be seen, the transfer of knowledge to others can be an effective and simple method to reduce mortality in trauma patients.


Overall, given the significant impact that trauma has on individuals, especially in more deprived countries, improvements and developments in the trauma care provided in LICs may reduce mortality and morbidity and may help reduce this inequality gap. Initially, new strategies which aims to improve trauma mortality in LICs should ideally use the current resources that the country has as acquiring new resources/equipment may be challenging due to financial constraints.


References

  1. Reynolds TA, Stewart B, Drewett I, Salerno S, Sawe HR, Toroyan T, et al. The Impact of Trauma Care Systems in Low- and Middle-Income Countries. Annual Review of Public Health. 2017;38(1):507–32.

  2. Dagal A, Greer SE, McCunn M. International disparities in trauma care. Current Opinion in Anaesthesiology. 2014;27(2):233–9.

  3. LaGrone L, Riggle K, Joshipura M, Quansah R, Reynolds T, Sherr K, et al. Uptake of the World Health Organization’s trauma care guidelines: a systematic review. Bull World Health Organ. 2016;94(8):585-598C.

  4. Wisborg T, Montshiwa TR, Mock C. Trauma research in low- and middle-income countries is urgently needed to strengthen the chain of survival. Scand J Trauma Resusc Emerg Med. 2011;19:62.

  5. Husum H, Gilbert M, Wisborg T. Training pre-hospital trauma care in low-income countries: the ‘Village University’ experience. Medical Teacher. 2003;25(2):142–8.

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