A Systematic Review of the Impact of Focused Trauma Education in Low-resource Settings

Background: A variety of curricula have been developed to teach a systematic approach to the initial hospital management of injured patients, but limited data exists on the impact on patient outcomes, particularly in low-income countries.
Methods: We conducted a systematic review of the PubMed database to identify peerreviewed articles from 1980 to 2012 that address the impact of focused trauma education in low-resource settings. Studies were limited to those conducted in a low or lower-middle income country, as defined by the World Bank. We also searched the table of contents for all available issues from 1996-2012 of the East and Central African Journal of Surgery (ECAJS) on Bioline International. Randomized controlled trials and studies describing educational initiatives with before-and-after studies were selected for detailed review.
Results: We conducted 19 PubMed searches, yielding 80 unique published articles. 14 articles met the criteria for full-text review after abstract review. One article from ECAJS met the criteria for full-text review. Four studies documented improved trauma knowledge following the educational intervention. Two studies re-evaluated knowledge retention at one-year and two-years. One study showed improvement in documentation of burn size and analgesic use. No studies were identified that evaluated the impact of a focused trauma education program on quantitative outcomes or resource utilization.
Conclusions: Very few studies evaluate quantitative outcomes following the implementation of focused hospital-based trauma education initiatives in resource-limited settings. More rigorous research design is necessary to evaluate patient mortality and resource utilization in low-income and lower middle-income countries.

Keywords
global health; trauma education; low-resource settings; trauma outcomes; trauma team training