Background and Rationale: Although general trauma care systems and their effects on mortality reduction have been studied, little is known of the current state of musculoskeletal trauma delivery globally, particularly in low-income (LI) and low middle-income (LMI) countries. The goal of this study is to assess and describe the development and availability of musculoskeletal trauma care delivery worldwide. Materials & Methods: A questionnaire was developed to evaluate different characteristics of general and musculoskeletal trauma care systems, including general aspects of systems, education, access to care and pre- and posthospital care. Surgical leaders involved with musculoskeletal trauma care were contacted to participate in the survey. Results: Of the 170 surveys sent, 95 were returned for use for the study. Nearly 30 percent of surgeons reported a formalized and coordinated trauma system in their countries. Estimates for the number of surgeons providing musculoskeletal trauma per one million inhabitants varied from 2.6 in LI countries to 58.8 in highincome countries. Worldwide, 15% of those caring for musculoskeletal trauma are fellowship trained. The survey results indicate a lack of implemented musculoskeletal trauma care guidelines across countries, with even high-income countries reporting less than 50% availability in most categories. Seventy-nine percent of the populations from LI countries were estimated to have no form of health care insurance. Formalized emergency medical services were reportedly available in only 33% and 50% of LI and LMI countries, respectively. Surgeons from LI and LMI countries responded that improvements in the availability of equipment (100%), number and locations of trauma-designated hospitals (90%), and physician training programs (88%) were necessary in their countries. The survey also revealed a general lack of resources for postoperative and rehabilitation care, irrespective of the country's income level. Conclusion: This study addresses the current state of musculoskeletal trauma care delivery worldwide. These results indicate a greater need for trauma system development and support, from prehospital through posthospital care. Optimization of these systems can lead to better outcomes for patients after trauma. This study represents a critical first step toward better understanding the state of musculoskeletal trauma care in countries with different levels of resources, developing strategies to address deficiencies, and forming regional and international collaborations to develop musculoskeletal trauma care guidelines.
Bibliographical noteFunding Information:
There was little variation in the duration of medical school or postgraduate training to treat musculoskeletal trauma with a mean duration of 6.3 years (SD, 1.3) and 5.4 years (SD, 1.9), respectively. No significant differences were identified between WHO income designations or World Bank Regions. However, in 84.9% of UMI and HI countries, training is funded by the government, whereas the trainee pays for the surgical education in about 67.5% of LI and LMI countries. The number of musculoskeletal residents trained per one million inhabitants was reported at 1.0, 1.8, 2.7, and 9.9 for LI, LMI, UMI, and HI countries, respectively. By World Bank designation, this number is the lowest in sub-Saharan Africa (0.8, SD, 1.6) and the highest in the European and Central Asian regions (11, SD, 19). Official accrediting bodies are available in 67.5% of LI and LMI countries and 84.6% of UMI and HI countries. Musculoskeletal trauma fellowship training is available in 22.5% of LI and LMI countries and 59.6% of UMI and HI countries. Worldwide, 15% of providers taking care of musculoskeletal trauma are fellowship trained (14% in LI and LMI countries and 17% in UMI and HI countries).
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- Trauma systems