What Is the Need for and Access to Trauma Surgery in Low- and Middle-Income Countries? A Scoping Review

Abstract

Introduction: Trauma is a major source of morbidity and mortality globally, but low- and middle-income countries (LMICs) are disproportionately affected by higher volumes of trauma and worse health outcomes. Despite this, there are limited data describing how many individuals in these regions need trauma surgery, and how many are able to access it.

Methods: We performed a scoping review to examine the current available evidence on the need for, and access to, trauma surgery in LMICs in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. We included studies published after 2000, across all languages, that reported data on LMICs, as defined by the Organization for Economic Cooperation and Development.

Results: We identified 32 articles describing the need for trauma surgery and 24 articles describing the access to trauma surgery, representing 27 LMICs overall. The median rate of trauma need was 7361 individuals per 100,000 per year (IQR 6313-9461), whereas the median rate of trauma surgery was 64.8 procedures per 100,000 per year.

Conclusion: Our study suggests that the need for trauma surgery is far greater than the access provided in LMICs. Indeed, the median rate of trauma surgery currently performed in the represented LMICs was 20 times less than the Lancet Commission on Global Surgery's benchmark. This scoping review illustrates the pressing requirement to generate high-quality prospective data to describe trauma care in LMICs.

Keywords: global health; surgery; trauma.

FIGURE 1

A schematic of the potential pathways of a trauma patient and how they relate to access, need, and quality.

FIGURE 2

PRISMA flowchart.

FIGURE 3

Map showing the location of the included studies.