title: Prioritizing injury care: a review of trauma capacity in low and middle-income countries.
abstract: BACKGROUND
  Trauma is a large contributor to the global burden of disease, particularly in low and middle-income countries (LMICs). This study aimed to summarize the literature assessing surgical capacity in LMICs to provide a current assessment of trauma capacity, which will help guide future efforts.
  
  
  METHODS
  The MEDLINE database was queried via PubMed to identify studies assessing baseline surgical capacity in individual LMICs. Data were collected from each study by extracting the relevant information from the full-published text or tables. Trauma capacity was evaluated using 12 surrogate criteria of trauma care, including laparotomy, cricothyroidotomy and chest tube insertion capabilities, and accessibility to a blood bank.
  
  
  RESULTS
  Seventeen studies were reviewed, documenting data from 531 hospitals in seventeen countries. None of the countries had access to all twelve trauma criteria in all their hospitals. Endotracheal intubation and cricothyrotomy or tracheostomy were available at 48% (107/222) and 41% (163/418) of facilities, respectively. Bag mask valves were available at 61% (234/383) of the institutions. Although 87% (193/221) of facilities responded that they were able to provide initial resuscitation, only 48% (169/349) of them had access to a blood bank and 70% (191/271) had access to intravenous fluids. A third or less of district hospitals had access to basic resuscitation (33%; 8/24), endotracheal tubes (32%; 31/97), blood banks (31%; 32/102), and cricothyrotomies and/or tracheostomies (32%; 30/95).
  
  
  CONCLUSIONS
  Deficiencies in trauma capacity in LMICs remain widespread. This study provides specific avenues for improved evaluations of trauma capacity and for strengthening trauma systems in LMICs.
authors.affiliation: Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Surgeons OverSeas (SOS), New York, New York. Electronic address: evan.wong@mail.mcgill.ca.
authors.forename: Evan G
authors.initials: EG
authors.lastname: Wong
authors.affiliation: Surgeons OverSeas (SOS), New York, New York; Department of Surgery, University of California, San Francisco - East Bay, Oakland, California.
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: Surgeons OverSeas (SOS), New York, New York; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Surgery, Columbia University, New York, New York.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
mesh_terms: D016208:Databases, Factual; D003906:Developing Countries / Q000706:statistics & numerical data; D013502:General Surgery / Q000706:statistics & numerical data*; D014943:Global Health / Q000706:statistics & numerical data*; D006292:Health Priorities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D012959:Socioeconomic Factors; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000601:surgery*
keywords: Capacity; Injury; Low income; Trauma