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European Journal of Orthopaedic Surgery & Traumatology
Published in: European Journal of Orthopaedic Surgery & Traumatology 6/2022

Open Access 14-08-2021 | Care | Original Article

Barriers to Trauma Care in South and Central America: a systematic review

Authors: Florence Kinder, Sarah Mehmood, Harry Hodgson, Peter Giannoudis, Anthony Howard

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 6/2022

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Abstract

Introduction

Trauma is widespread in Central and South America and is a significant cause of morbidity and mortality. Providing high quality emergency trauma care is of great importance. Understanding the barriers to care is challenging; this systematic review aims to establish current the current challenges and barriers in providing high-quality trauma care within the 21 countries in the region.

Methods

OVID Medline, Embase, EBM reviews and Global Health databases were systematically searched in October 2020. Records were screened by two independent researchers. Data were extracted according to a predetermined proforma. Studies of any type, published in the preceding decade were included, excluding grey literature and non-English records. Trauma was defined as blunt or penetrating injury from an external force. Studies were individually critically appraised and assessed for bias using the RTI item bank.

Results

57 records met the inclusion criteria. 20 countries were covered at least once. Nine key barriers were identified: training (37/57), resources and equipment (33/57), protocols (29/57), staffing (17/57), transport and logistics (16/57), finance (15/57), socio-cultural (13/57), capacity (9/57), public education (4/57).

Conclusion

Nine key barriers negatively impact on the provision of high-quality trauma care and highlight potential areas for improving care in Central & South America. Many countries in the region, along with rural areas, are under-represented by the current literature and future research is urgently required to assess barriers to trauma management in these countries.
No funding was received. Clinical Trial Registration: PROSPERO CRD42020220380.
Appendix
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Literature
1.
2.
Padilla Rojas LG, López Cervantes RE, Pérez Atanasio JM, Sánchez MM, Gómez Acevedo JM, Kojima KE (2019) Latin America trauma systems—Mexico and Brazil. OTA Int 2(July 2018):e020 CrossRef
3.
Almanza-Cruz S, Rea-Field G. A model system for emergency medicine for Mexico City. Gac Med Mex. 1990
4.
Smith GS, Barss P (1991) Unintentional injuries in developing countries: the epidemiology of a neglected problem. Epidemiol Rev 13:228–266 PubMedCrossRef
5.
Nilsen P, Hudson D, Lindqvist K (2006) Economic analysis of injury prevention–applying results and methodologies from cost-of-injury studies. Int J Inj Contr Saf Promot 13:7–13 PubMedCrossRef
6.
Kotagal M, Agarwal-Harding KJ, Mock C, Quansah R, Arreola-Risa C, Meara JG (2014) Health and economic benefits of improved injury prevention and trauma care worldwide. PLoS ONE 9(3):1–7 CrossRef
7.
8.
9.
Zetlen HL, LaGrone LN, Foianini JE, Egoavil EH, Sproviero J, Rivera FV et al (2017) Status of trauma quality improvement programs in the Americas: a survey of trauma care providers. J Surg Res 220:213–222 PubMedCrossRef
10.
ECLAC. Poverty in Latin America Remained Steady in 2017, but Extreme Poverty Increased to the Highest Level since 2008, while Inequality has Fallen Notably since 2000. 2020.
11.
12.
13.
Kanavos P, Parkin GC, Kamphuis B, Gill J. Latin America Healthcare System Overview: a comparative analysis of fiscal space in healthcare. London Sch Econ Polit Sci. 2019;(August):16.
14.
Jones MD, Kalamchi LD, Schlinkert AB, Chapple KM, Jacobs JV, Bogert JN et al (2020) Are all trauma centers created equal? Level 1 to level 1 trauma center patient transfers in the setting of rapid trauma center proliferation. J Trauma Acute Care Surg 89:920–925 PubMedCrossRef
15.
16.
Carpenter B, Levine L, Niacaris T, Suzuki S (2017) Transitioning from a level II to level I trauma center increases resident patient exposure. J Foot Ankle Surg 56:1170–1172 PubMedCrossRef
17.
18.
Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC et al (2016) The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev 22(1):3–18 PubMedCrossRef
19.
20.
21.
22.
Haghparast-Bidgoli H, Hasselberg M, Khankeh H, Khorasani-Zavareh D, Johansson E. Barriers and facilitators to provide effective pre-hospital trauma care for road traffic injury victims in Iran: a grounded theory approach. BMC emergency medicine. 2010 Dec;10(1):1–1.
23.
Kironji AG, Hodkinson P, De Ramirez SS, Anest T, Wallis L, Razzak J, Jenson A, Hansoti B. Identifying barriers for out of hospital emergency care in low and low-middle income countries: a systematic review. BMC health services research. 2018 Dec;18(1):1-20.
24.
Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S et al (2018) High-quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Heal 6(11):e1196–e1252 CrossRef
25.
Liguori N, Tarque N, Bambaren C, Santa-Cruz S, Palomino J, Laterza M (2019) Basic seismic response capability of hospitals in Lima, Peru. Disaster Med Public Health Prep 13:138–143 PubMedCrossRef
26.
Dibene JC, Maldonado Y, Vera C, de Oliveira M, Trujillo L, Schütze O (2017) Optimizing the location of ambulances in Tijuana, Mexico. Comput Biol Med 80:107–115 PubMedCrossRef
27.
LaGrone LN, Isquith-Dicker LN, Egoavil EH, Castro MJ, Allagual A, Revoredo F, Mock CN (2017) Surgeons’ and trauma care physicians’ perception of the impact of the globalization of medical education on quality of care in Lima, Peru. JAMA Surg 152(3):251–256
28.
Dickason RM, Cioè-Peña E, Chisolm-Straker M (2017) Primary trauma care curriculum: a qualitative analysis of impediments to improvement. Trauma (United Kingdom) 19:127–132
29.
Cioè-Peña EC, Granados JC, Wrightsmith LL, Henriquez-Vigil AL, Moresky RT (2017) Development and implementation of a hospital-based trauma response system in an urban hospital in San Salvador, El Salvador. Trauma (United Kingdom)
30.
31.
O'Dwyer G, Konder MT, Reciputti LP, Lopes MG, Agostinho DF, Alves GF (2017) The process of implementation of emergency care units in Brazil. Revista de saude publica 51.
32.
LaGrone LN, Fuhs AK, Egoavil EH, Rodriguez Castro MJA, Valderrama R, Isquith-Dicker LN et al (2017) Mixed-methods assessment of trauma and acute care surgical quality improvement programs in Peru. World J Surg 41:963–969 PubMedCrossRef
33.
Johnson T, Gaus D, Herrera D (2016) Emergency department of a rural hospital in Ecuador. West J Emerg Med 66:72
34.
Bustos Y, Castro J, Wen LS, Sullivan AF, Chen DK, Camargo CA (2015) Emergency department characteristics and capabilities in Bogotá, Colombia. Int J Emerg Med 8(1):1–8
35.
Henwood PC, Beversluis D, Genthon AA, Wilson CN, Norwood B, Silva D, Foran M, Romero MG, Martinez YB, Vargas LE, Ocampo AC (2014) Characterizing the limited use of point-of-care ultrasound in Colombian emergency medicine residencies. Int J Emerg Med 7(1):1–7
36.
da Santana RS, Dias EMDS, de Oliveira GS, de Batista CA, Frota CA, da Silva RK et al (2020) Factors that interfer in the quality of service to the critical patient. Acta Sci Heal Sci 42:e48675 CrossRef
37.
Kesinger MR, Puyana JC, Rubiano AM (2014) Improving trauma care in low- and middle-income countries by implementing a standardized trauma protocol. World J Surg 8:1869–1874 CrossRef
38.
Pemberton J, Rambaran M, Cameron BH (2013) Evaluating the long-term impact of the Trauma Team Training course in Guyana: an explanatory mixed-methods approach. Am J Surg 205:119–124 PubMedCrossRef
39.
Velloso I, Ceci C, Alves M (2013) Configurations of power relations in the Brazilian emergency care system: analyzing a context of visible practices. Nurs Inq 20:256–264 PubMedCrossRef
40.
Parra MW, Castillo RC, Rodas EB, Suarez-Becerra JM, Puentes-Manosalva FE, Wendt LM (2013) International trauma teleconference: evaluating trauma care and facilitating quality improvement. Telemed e-Health 19:699–703 CrossRef
41.
Nielsen K, Mock C, Joshipura M, Rubiano AM, Zakariah A, Rivara F (2012) Assessment of the status of prehospital care in 13 low-and middle-income countries. Prehospital Emerg Care 16:381–389 CrossRef
42.
Adolfi Júnior MS, Pallini FM, Pessotti H, Wolf CM, Patelli HT, Capeli RD et al (2010) Emergency medical coordination using a web platform: a pilot study. Rev Saude Publica
43.
de Lima MLC, de Souza ER, Deslandes SF, Kelly A, de Santana Cabral AP (2010) An analysis of prehospital care for victims of accidents and violence in Recife. Rev Salud Publica, Brazil CrossRef
44.
O’Dwyer G, Konder MT, Machado CV, Alves CP, Alves RP (2013) The current scenario of emergency care policies in Brazil. BMC Health Serv Res
45.
Seymour L, Montejo R, Weston BW (2020) Efficacy of Distance-Based EMS Education in a Low-Resource Country. Environments 4:5
46.
Vansell HJ, Schlesinger JJ, Harvey A, Rohde JP, Persaud S, McQueen KA (2015) Anaesthesia, surgery, obstetrics, and emergency care in Guyana. J Epidemiol Glob Health 5:75 PubMedCrossRef
47.
48.
Coimbra SH, Camanho EDL, Heringer LC, Botelho RV, Vasconcellos C (2017) Analysis of the availability of the resources necessary for urgent and emergency healthcare in São Paulo between 2009–2013. Rev Assoc Med Bras 63:538–542 PubMedCrossRef
49.
Rubiano AM, Sánchez ÁI, Guyette F, Puyana JC (2010) Trauma care training for national police nurses in Colombia. Prehospital Emerg Care 14:124–130 CrossRef
50.
Landreau F, Valcarcel O, Noir J, Pernía G, Orzábal ML, Martínez S et al (2018) Helicopter emergency medical services in Buenos Aires: an operational overview. Air Med J 37:367–370 PubMedCrossRef
51.
Lentsck MH, Sato APS, de Mathias TAF (2019) Epidemiological overview - 18 years of ICU hospitalization due to trauma in Brazil. Rev Saude Publica 53:83 PubMedPubMedCentralCrossRef
52.
Bast HE, Jenkins JL (2018) Challenges to prehospital care in Honduras. Prehosp Disaster Med 33:637–639 PubMedCrossRef
53.
Bruni A, Kazmi K, Bailey K, Rambaran N, Rambaran M, Cameron B et al (2017) A qualitative assessment of trauma care at Georgetown Public Hospital Corporation in Guyana. West Indian Med J
54.
Dijkink S, Nederpelt CJ, Krijnen P, Velmahos GC, Schipper IB (2017) Trauma systems around the world: a systematic overview. J Trauma Acute Care Surg 83:917–925 PubMedCrossRef
55.
Blair KJ, Boeck MA, Barrientos JL, López JL, Helenowski IB, Nwomeh BC, Shapiro MB, Swaroop M (2017) Assessment of surgical and trauma capacity in Potosí, Bolivia. Ann Global Health 83(2):262–273
56.
Rocha TAH, da Silva NC, Amaral PV, Barbosa ACQ, Rocha JVM, Alvares V et al (2017) Access to emergency care services: a transversal ecological study about Brazilian emergency health care network. Public Health 153:9–15 PubMedCrossRef
57.
Patiño A, Alcalde V, Gutierrez C, Romero MG, Carrillo AM, Vargas LE et al (2017) Characteristics of emergency medicine residency programs in Colombia. West J Emerg Med 18:1120–1127 PubMedPubMedCentralCrossRef
58.
LaGrone LN, Isquith-Dicker LN, Huaman Egoavil E, Herrera-Matta JJ, Fuhs AK, Ortega Checa D et al (2017) Surgery and trauma care providers’ perception of the impact of dual-practice employment on quality of care provided in an Andean country. Br J Surg 104:704–709 PubMedPubMedCentralCrossRef
59.
Job PM, Von Bahten LC, de Oliveira-Junior N (2011) Evaluation of the effectiveness of systematized training of advanced trauma life support protocol in the interpretation of cervical spine and chest radiographs in three different emergency services. J Trauma 70:E122–E124 PubMed
60.
Kohrt BK, Murray MP, Cabel SL (2020) Establishing context to build capacity: a qualitative study to determine the feasibility, utility, and acceptability of a complex trauma training for psychologists working in urban migrant communities in Northern Peru. Community Ment Health J 56:1508–1520 PubMedPubMedCentralCrossRef
61.
Marsicano JA, Cavalleri NZ, Cordeiro DM, Mori GG, da Silveira JL, do Prado RL (2019) Epidemiology of maxillofacial trauma in a prehospital service in Brazil. J Trauma Nurs 26(6):323–327.
62.
Boeck MA, Callese TE, Nelson SK, Schuetz SJ, Bazan CF, Laguna JM, Shapiro MB, Issa NM, Swaroop M (2018) The development and implementation of a layperson trauma first responder course in La Paz, Bolivia: A pilot study. Injury 49(5):885–896
63.
Feitosa-Filho GS, Kirschbaum M, Neves YCS, Loureiro BMC, De Castro Lima VAC, Calazans RM et al (2017) Characteristics of training and motivation of physicians working in emergency medicine. Rev Assoc Med Bras 63:112–117 PubMedCrossRef
64.
Muñiz SA, Lang RW, Falcon L, Garces-King J, Willard S, Peck GL (2017) Preparing global trauma nurses for leadership roles in global trauma systems. J Trauma Nurs 24:306–311 PubMedCrossRef
65.
Kapoor R, Sandoval MA, Avendaño L, Cruz AT, Soto MA, Camp EA et al (2016) Regional scale-up of an Emergency Triage Assessment and Treatment (ETAT) training programme from a referral hospital to primary care health centres in Guatemala. Emerg Med J 33:611–617 PubMedCrossRef
66.
Crouse HL, Vaides H, Torres F, Ishigami EM, Walsh MT, Soto MA et al (2016) Quality and effectiveness of a pediatric triage training program in a Guatemalan Public Hospital. Pediatr Emerg Care 32:525–528 PubMedCrossRef
67.
Dos Santos MT, da Lima MADS, Zucatti PB (2016) Elder-friendly emergency services in Brazil: necessary conditions for care. Rev Esc Enferm USP 50:594–601 PubMedCrossRef
68.
Pringle K, Mackey JM, Modi P, Janeway H, Romero T, Meynard F et al (2015) A short trauma course for physicians in a resource-limited setting: Is low-cost simulation effective? Injury 46:1796–1800 PubMedCrossRef
69.
Simões RL, Bermudes FAM, Andrade HS, Barcelos FM, Rossoni BP, Miguel GPS et al (2014) Trauma leagues: an alternative way to teach trauma surgery to medical students. Rev Col Bras Cir 41:297–302 PubMedCrossRef
70.
de Salvador PTCO, Alves KYA, Martins CCF, Santos VEP, Tourinho FSV (2012) Perfil das dissertações e teses brasileiras acerca do trauma: uma pesquisa documental TT - Profile of brazilian dissertations and theses on trauma: a documentary research. Rev Col Bras Cir 39:328–334 PubMedCrossRef
71.
Dias ARN, Abib S de CV, Poli-de-Figueiredo LF, Perfeito JAJ (2011) Entrapped victims in motor vehicle collisions: characteristics and prehospital care in the city of São Paulo, Brazil. Clinics
72.
Furtado PL, Nakanishi M, Rezende GL, Granjeiro RC, de Oliveira TS (2011) Clinic-epidemiological analysis of an Otorhinolaryngology emergency unit care in a tertiary hospital. Braz J Otorhinolaryngol 77:426–431 PubMedCrossRef
73.
Parreira JG, Campos TD, Perlingeiro JA, Soldá SC, Assef JC, Gonçalves AC, ZUFFO B, Floriano CG, Oliveira EH, Oliveira RV, Oliveira AL (2015) Implementation of the trauma registry as a tool for quality improvement in trauma care in a Brazilian hospital: the first 12 months. Revista do Colégio Brasileiro de Cirurgiões 42:265–72.
74.
Trajano AD, Pereira BM, Fraga GP (2014) Epidemiology of in-hospital trauma deaths in a Brazilian university hospital. BMC Emerg Med 14(1):1–9
75.
76.
Callese TE, Richards CT, Shaw P, Schuetz SJ, Paladino L, Issa N et al (2015) Trauma system development in low- and middle-income countries: a review. J Surg Res 193:300–307 PubMedCrossRef
77.
Werner K, Risko N, Burkholder T, Munge K, Wallis L, Reynolds T (2020) Cost–effectiveness of emergency care interventions in low and middle-income countries: a systematic review. Bull World Health Organ 98:341–352 PubMedPubMedCentralCrossRef
78.
Minderhoud J, van Nispen RMA, Heijthuijsen AAAM, Beunders VAA, Bueno de Mesquita-Voigt AMT, Moll AC et al (2016) Epidemiology and aetiology of childhood ocular trauma in the Republic of Suriname. Acta Ophthalmol 94:479–484 PubMedCrossRef
79.
80.
81.
Sherbino J, Bandiera G, Doyle K, Frank JR, Holroyd BR, Jones G et al (2020) The competency-based medical education evolution of Canadian emergency medicine specialist training. CJEM 22(1):95–102 PubMedCrossRef
82.
83.
Rowland P, Lising D, Sinclair L, Baker GR (2018) Team dynamics within quality improvement teams: a scoping review. Int J Quality Health Care 30:416–422 CrossRef
Metadata
Title
Barriers to Trauma Care in South and Central America: a systematic review
Authors
Florence Kinder
Sarah Mehmood
Harry Hodgson
Peter Giannoudis
Anthony Howard
Publication date
14-08-2021
Publisher
Springer Paris
Keyword
Care
Published in
European Journal of Orthopaedic Surgery & Traumatology / Issue 6/2022
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-021-03080-3

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