title: Implementation of the World Health Organization Trauma Care Checklist Program in 11 Centers Across Multiple Economic Strata: Effect on Care Process Measures.
abstract: Trauma contributes more than ten percent of the global burden of disease. Initial assessment and resuscitation of trauma patients often requires rapid diagnosis and management of multiple concurrent complex conditions, and errors are common. We investigated whether implementing a trauma care checklist would improve care for injured patients in low-, middle-, and high-income countries.
  
  
  
  From 2010 to 2012, the impact of the World Health Organization (WHO) Trauma Care Checklist program was assessed in 11 hospitals using a stepped wedge pre- and post-intervention comparison with randomly assigned intervention start dates. Study sites represented nine countries with diverse economic and geographic contexts. Primary end points were adherence to process of care measures; secondary data on morbidity and mortality were also collected. Multilevel logistic regression models examined differences in measures pre- versus post-intervention, accounting for patient age, gender, injury severity, and center-specific variability.
  
  
  
  Data were collected on 1641 patients before and 1781 after program implementation. Patient age (mean 34 ± 18 vs. 34 ± 18), sex (21 vs. 22 % female), and the proportion of patients with injury severity scores (ISS) ≥ 25 (10 vs. 10 %) were similar before and after checklist implementation (p > 0.05). Improvement was found for 18 of 19 process measures, including greater odds of having abdominal examination (OR 3.26), chest auscultation (OR 2.68), and distal pulse examination (OR 2.33) (all p < 0.05). These changes were robust to several sensitivity analyses.
  
  
  
  Implementation of the WHO Trauma Care Checklist was associated with substantial improvements in patient care process measures among a cohort of patients in diverse settings.
authors: , 14 Chemin de Contamine, 01420, Chanay, France.
authors: Angela
authors: A
authors: Lashoher
authors: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 4-020, Boston, MA, 02120, USA. eschnei1@jhmi.edu.|Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD, USA. eschnei1@jhmi.edu.
authors: Eric B
authors: EB
authors: Schneider
authors: Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, 1001 Potrero Ave, 3A, San Francisco, CA, 94110, USA.
authors: Catherine
authors: C
authors: Juillard
authors: The Johns Hopkins School of Medicine, 1800 Orleans Street, Suite 6107E, Baltimore, MD, 21287, USA.
authors: Kent
authors: K
authors: Stevens
authors: Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
authors: Elizabeth
authors: E
authors: Colantuoni
authors: Department of Health Policy and Management, Harvard School of Public Health, 401 Park Drive, Boston, MA, 02215, USA.
authors: William R
authors: WR
authors: Berry
authors: Department of Emergency Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1228, Brooklyn, NY, 11203, USA.
authors: Christina
authors: C
authors: Bloem
authors: WHO Collaborating Center for Injury Prevention and Safety Promotion, Khon Kaen Hospital, Khon Kaen, 40000, Thailand.
authors: Witaya
authors: W
authors: Chadbunchachai
authors: Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India.
authors: Satish
authors: S
authors: Dharap
authors: Johns Hopkins Bloomberg School of Public Health, Rm 609, 624 N Broadway, Baltimore, MD, 21205, USA.
authors: Sydney M
authors: SM
authors: Dy
authors: World Self-Medication Industry, Rue de Cossonay 5, Case Postale 124, 1023, Crissier, Switzerland.
authors: Gerald
authors: G
authors: Dziekan
authors: Lee Kong Chian School of Medicine, Nanyang Technological University, Research Techno Plaza, #02-07, 50 Nanyang Drive, Singapore, 637553, Singapore.
authors: Russell L
authors: RL
authors: Gruen
authors: Department of Surgery, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
authors: Jaymie A
authors: JA
authors: Henry
authors: Clinic for Trauma Surgery and Orthopedics, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.
authors: Christina
authors: C
authors: Huwer
authors: Academy of Traumatology, 504, Sangita Complex, Parimal Garden, Ahmadabad, 380015, India.
authors: Manjul
authors: M
authors: Joshipura
authors: Service Delivery and Safety Department, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
authors: Edward
authors: E
authors: Kelley
authors: Department for the Management of NCDs, Disability, Violence and Injury Prevention, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
authors: Etienne
authors: E
authors: Krug
authors: Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, College Building, First Floor, Sion, Mumbai, 400022, India.
authors: Vineet
authors: V
authors: Kumar
authors: School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Nyarugenge Campus, P.O. Box. 3286, Kigali, Rwanda.
authors: Patrick
authors: P
authors: Kyamanywa
authors: Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, P.O. Box 25526, Yaounde, Cameroon.
authors: Alain Chichom
authors: AC
authors: Mefire
authors: Federal University of Rio de Janeiro, Rua Voluntarios da Patria, 445 SL 201, Botafogo, Rio de Janeiro, CEP: 22270-005, Brazil.
authors: Marcos
authors: M
authors: Musafir
authors: Department of Surgery, University of Toronto and Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D5 74, Toronto, Ontario, M4N 3M5, Canada.
authors: Avery B
authors: AB
authors: Nathens
authors: University Teaching Hospital of Kigali, P.O. Box 2534, Kigali, Rwanda.
authors: Edouard
authors: E
authors: Ngendahayo
authors: Duc Giang General Hospital, 54 Truong Lam, Long Bien, Hanoi, Vietnam.
authors: Thai Son
authors: TS
authors: Nguyen
authors: Department of Surgery, BARC hospital (Govt of India), HBNI University, Anushaktinagar, Mumbai, 400094, India.
authors: Nobhojit
authors: N
authors: Roy
authors: Johns Hopkins Medicine, 600 N Wolfe Street, CMSC 131, Baltimore, MD, 21287, USA.
authors: Peter J
authors: PJ
authors: Pronovost
authors: Department of Emergency Medicine, Aga Khan University, 1st floor, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
authors: Irum Qumar
authors: IQ
authors: Khan
authors: Johns Hopkins University School of Medicine, 5801 Smith Ave, Ste 220, Baltimore, MD, 21219, USA.|Aga Khan University, Karachi, Pakistan.
authors: Junaid Abdul
authors: JA
authors: Razzak
authors: MEDITECH Foundation, Neiva University Hospital, Calle 5#11-19, Huila, Neiva, Colombia.
authors: Andrés M
authors: AM
authors: Rubiano
authors: Department of Paedeatric Orthopedics, Sick Kids Hospital, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
authors: James A
authors: JA
authors: Turner
authors: Department of Orthopaedics, St Stephen's Hospital, Tis Hazari, Delhi, 110054, India.
authors: Mathew
authors: M
authors: Varghese
authors: St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
authors: Rimma
authors: R
authors: Zakirova
authors: Department of Surgery, Harborview Medical Center, HIPRC, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA.
authors: Charles
authors: C
authors: Mock
mesh_terms: D000328:Adult; D057189:Checklist; D005260:Female; D006801:Humans; D008297:Male; D017064:Process Assessment, Health Care / Q000592:standards*; D014944:World Health Organization; D014947:Wounds and Injuries / Q000628:therapy*