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Annu Rev Public Health. 2017 Mar 20;38:507-532. doi: 10.1146/annurev-publhealth-032315-021412. Epub 2017 Jan 11.

The Impact of Trauma Care Systems in Low- and Middle-Income Countries.

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Department for the Management of NCDs, Disability, Violence and Injury Prevention, World Health Organization, Geneva CH-1211, Switzerland; email: , ,
Department of Surgery, University of Washington, Seattle, Washington 98105; email:
School of Medicine, Monash University, Melbourne 3800, Australia; email:
Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania; email:
Department Global Health, University of Washington, Seattle, Washington 98105; email:


Injury is a leading cause of death globally, and organized trauma care systems have been shown to save lives. However, even though most injuries occur in low- and middle-income countries (LMICs), most trauma care research comes from high-income countries where systems have been implemented with few resource constraints. Little context-relevant guidance exists to help policy makers set priorities in LMICs, where resources are limited and where trauma care may be implemented in distinct ways. We have aimed to review the evidence on the impact of trauma care systems in LMICs through a systematic search of 11 databases. Reports were categorized by intervention and outcome type and summarized. Of 4,284 records retrieved, 71 reports from 32 countries met inclusion criteria. Training, prehospital systems, and overall system organization were the most commonly reported interventions. Quality-improvement, costing, rehabilitation, and legislation and governance were relatively neglected areas. Included reports may inform trauma care system planning in LMICs, and noted gaps may guide research and funding agendas.


emergency care systems; injury; low- and middle-income countries; prehospital care; trauma care; trauma system

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