title: The International Assessment of Capacity for Trauma (INTACT): an index for trauma capacity in low-income countries.
abstract: BACKGROUND
  Injury remains a leading cause of death worldwide with a disproportionate impact in the developing world. Capabilities for trauma care remain limited in these settings. We propose the implementation of the International Assessment of Capacity for Trauma (INTACT) index to provide a standardized way of assessing a health care facility's capacity to provide adequate trauma care.
  
  
  METHODS
  A retrospective review of the trauma capacity of 10 government hospitals (district, secondary, regional, maternity, and tertiary facilities) in Sierra Leone was performed using data collected during on-site visits in August 2011. The index incorporates 40 key elements, including resuscitation, laparotomy, chest tube insertion, fracture repair, and burn management capabilities. The INTACT index was calculated on a scale of 0-10 and compared with a previously published index of surgical capacity, the personnel, infrastructure, equipment, and supplies (PIPES) index.
  
  
  RESULTS
  Connaught Hospital, the only tertiary referral center, had the highest index (9.0), consistent with it being the best equipped and staffed of the country. The three district hospitals assessed had the lowest scores from 3.5 to 4.3. INTACT and PIPES scores were correlated overall (r = 0.88). The proportionate difference compared with the PIPES survey was 30% for the maternity hospital and 1% for the tertiary center, suggesting that the INTACT index may be specific for trauma. Deficiencies are especially prominent in personnel, imaging, fracture repair, and burn management.
  
  
  CONCLUSIONS
  The INTACT index is a simple tool designed to specifically assess trauma capacity from initial resuscitation to definitive care. Shortcomings in trauma capacity remain prominent and the INTACT index could be used to assess trauma care deficiencies in developing countries.
authors.affiliation: Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Surgeons OverSeas, New York, New York. Electronic address: evan.wong@mail.mcgill.ca.
authors.forename: Evan G
authors.initials: EG
authors.lastname: Wong
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Surgeons OverSeas, New York, New York; Department of Surgery, University of California, San Francisco, East Bay.
authors.forename: Shailvi
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Dan L
authors.initials: DL
authors.lastname: Deckelbaum
authors.affiliation: Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Tarek
authors.initials: T
authors.lastname: Razek
authors.affiliation: Department of Surgery, Connaught Hospital, Freetown, Sierra Leone; College of Medicine and Allied Health Science, Freetown, Sierra Leone.
authors.forename: Thaim B
authors.initials: TB
authors.lastname: Kamara
authors.affiliation: Surgeons OverSeas, New York, New York; Nationwide Children's Hospital, Ohio State University, Columbus, Ohio.
authors.forename: Benedict C
authors.initials: BC
authors.lastname: Nwomeh
authors.affiliation: Center for Surgical Trials and Outcomes Research (CSTOR), Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Surgeons OverSeas, New York, New York; Department of Surgery, Columbia University, New York, New York.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
mesh_terms: D019049:Developed Countries / Q000191:economics; D006801:Humans; D012189:Retrospective Studies; D012807:Sierra Leone; D014193:Trauma Centers / Q000191:economics / Q000592:standards*; D014947:Wounds and Injuries / Q000191:economics / Q000628:therapy
keywords: Capacity; Developing; Index; International; Low-income; Trauma