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Understanding trauma systems

A global need

Miclau, Theodore, MD*

doi: 10.1097/OI9.0000000000000010
International Orthopaedic Trauma Association Supplement: International Trauma Systems

Trauma is a leading cause of death worldwide. Many more survive their injuries and face lifelong disabilities, including limiting musculoskeletal conditions that significantly impact individuals and societies. According to the World Health Organization, the burden of injury resulting from trauma will continue to increase. Despite this expected increase, trauma systems remain poorly described and understood. This supplement, which represents a collaboration of member societies of the International Orthopaedic Trauma Association, will describe trauma systems in countries from 5 different continents. The expectation is that this work will assist in identifying existing trauma systems and developing strategies for improvements in post-injury care worldwide.

Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA

Corresponding author. Address: Orthopaedic Trauma Institute, 2550 23rd St., Bldg. 9, 2nd Floor, San Francisco, CA 94110. E-mail address: (Theodore Miclau)

The authors have no conflicts of interest to disclose.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Received July 18, 2018

Accepted August 17, 2018

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Injury is the leading cause of death under the age of 45,[1] with road traffic injuries accounting for 1.2 million deaths and 20 to 50 million nonfatal injuries worldwide every year.[2,3] Around 90% of these deaths occur in lower and middle-income countries (LMICs).[4] Further, reports estimate that surgical diseases account for approximately 11% of global disability-adjusted life years,[5] disproportionately affecting LMICs.[6]

Recently, there has been increased interest in evidence-based interventions and emphasis on the evaluation and implementation of trauma systems worldwide. In 2004, the World Health Organization published recommendations on how to improve essential trauma care in order to reduce trauma-related mortality.[7] Well-developed trauma systems in higher income countries have been shown to improve patient outcomes; however the overall adoption of these systems remains low.[1,8] A recent literature review showed that despite sufficient resources, only 9 of 32 high-income countries evaluated had documented trauma systems in place.[9]

Musculoskeletal injury represents a critical subset of trauma-related conditions and a major cause of long-term disability, yet it receives less attention than many other health conditions.[10] Effective treatment of these injuries relates directly to the overall trauma care systems in place, particularly as they relate to entire post-injury healthcare delivery processes, from prehospital to hospital to rehabilitative care. The state of existing trauma care systems worldwide is not well documented, and limited guidance exists to help improve these systems, particularly in lower resource settings.

This supplement seeks to describe trauma systems in countries throughout the world. This work represents a collaboration of member societies of the International Orthopaedic Trauma Association, which is an international association of orthopaedic societies dedicated to the promotion of musculoskeletal trauma care through advancements in treatment, education, and research. The information presented in this supplement will contribute to larger efforts toward understanding, improving, and standardizing existing trauma systems worldwide.

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1. Mock C, Joshipura M, Arreola-Risa C, et al An estimate of the number of lives that could be saved through improvements in trauma care globally. World J Surg. 2012;36:959–963.
2. World Health Organization. Global status report on road safety: time for action. [Internet]. Geneva: World Health Organization; 2009. Available at: Accessed March 7, 2018.
3. Organisation mondiale de la santé. Global status report on road safety 2015. Geneva (Switzerland): World Health Organization; 2015.
4. Mock C, Juillard C, Brundage S, et al Guidelines for trauma quality improvement programmes. J Trauma Injury Infect Crit Care. 2010;68:1518–11518.
5. Jamison DT, Breman JG, Measham AR, et al Disease Control Priorities in Developing Countries (Internet). 2006;World Bank Publications, [cited 2015 Jun 22].
6. Chandran A, Hyder AA, Peek-Asa C. The global burden of unintentional injuries and an agenda for progress. Epidemiol Rev. 2010;32:110–120.
7. Mock C, Lormand JD, Goosen J, et al Guidelines for Essential Trauma Care. Geneva: World Health Organization; 2004.
8. Mock C, Cherian MN. The global burden of musculoskeletal injuries: challenges and solutions. Clin Orthop Relat Res. 2008;466:2306–2316.
9. Dijkink S, Nederpelt CJ, Krijnen P, et al Trauma systems around the world: a systematic overview. J Trauma Acute Care Surg. 2017;83:917–925.
10. Bach O. Musculoskeletal trauma in an East African public hospital. Injury. 2004;35:401–406.

global; international; musculoskeletal; systems; trauma

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