Surgical and Trauma Care in Low- and Middle-Income Countries: A Review of Capacity Assessments

Abstract Background Surgical and trauma capacity assessments help guide resource allocation and plan interventions to improve care for the injured in low- and middle-income countries (LMICs). To forge expert consensus on conducting these assessments, we undertook a systematic review of studies utilizing five tools: (1) World Health Organization’s (WHO) Guidelines for Essential Trauma Care (Guidelines), (2) WHO’s Tool for Situational Analysis to Assess Emergency and Essential Surgical Care (TSAAEESC), (3) Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) tool, (4) Harvard Humanitarian Initiative (HHI) tool, and (5) Emergency and Critical Care (EaCC) tool. Materials & Methods Publications describing utilization of surgical or trauma capacity survey instruments in LMICs were reviewed. Included articles underwent thematic analysis to develop recommendations. A modified Delphi method was used to establish expert consensus. Experts rated recommendations on a Likert-type scale via online survey. Consensus was defined by Cronbach’s α > 0.80. Recommendations achieving agreement by > 80% of experts were included. Results Two-hundred and ninety-eight publications were identified and 41 included, describing evaluation of 1,170 facilities across 36 LMICs. Nine recommendations were agreed upon by expert consensus: (1) inclusion of district hospitals, (2) inclusion of highest-level public hospital, (3) inclusion of private facilities, (4) hospital visits for on-site completion, (5) direct hospital inspections, (6) checking surgical logs, (7) adaptation of survey tools, (8) repeat assessments, and (9) need for increased collaboration. Conclusions Expert recommendations developed in this review describe methodology to be employed when conducting assessments of surgical and trauma capacity in LMICs. Consensus has yet to be achieved for tool selection.