A Systematic Review of Global Implementation of the World Health Organization’s Trauma Care Guidelines
LaGrone, Lacey Nicole
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Objective: Between 2004 and 2010, the World Health Organization (WHO) released three publications intended to provide guidance to policymakers in low- and middle-income countries towards system-wide improvements in trauma care. We sought to understand the degree to which these guidelines have been implemented globally, including understanding location and type of implementation. We thus hoped to identify priorities for future implementation and dissemination strategies. Methods: We conducted a systematic review in which the titles of the WHO trauma care guidelines were used as the search terms: “Guidelines for Essential Trauma Care”, “Prehospital Trauma Care Systems”, “Guidelines for Trauma Quality Improvement Programmes”. Nineteen databases were queried, validation of results was performed through citation analysis and expert consultation. Two reviewers independently scored sources. Findings: The search returned 112 sources describing 140 implementation events in 51 countries. These were divided between those that described needs assessments (45%), endorsement by stakeholders (27%), educational interventions (14%), and incorporation into policy (14%). There was evidence of implementation in 40% of low-income countries, 32% of lower-middle, and 28% of upper-middle income countries. Conclusions: The WHO trauma care guidelines are widely implemented in meaningful ways. However, given the substantial disparities that remain in trauma care, efforts to bring the standards described in the publications to the remaining 143 WHO member states are needed. Particular emphasis should be on: serial needs assessments for ongoing monitoring of capacity for trauma care in health systems, incorporation of guidelines into formal education of healthcare providers, and incorporation of the guidelines into health policy.
- Global health