Studies selected for this review were identified from MEDLINE. We also used articles from the grey literature and journals from Mexico, Malaysia, and Ghana that are not MEDLINE referenced. These included unpublished documents, institutional and government reports, and conference proceedings. We considered any article addressing the subject of injury in any country. Studies were included or excluded on the basis of their contribution to the principal question of how the current scenario of
SeriesStrengthening the prevention and care of injuries worldwide
Introduction
Injury is one of the leading causes of death in children and working-aged adults in almost every country. There are more than five million injury-related deaths every year, as well as a tremendous burden of disability and economic loss;1, 2, 3, 4 yet, little attention is given to injury. In high- income countries, research expenditures for injury are small compared with those for cancer and cardiovascular disease.5 The situation is even more pronounced in less-developed countries. External assistance to the health sector of less-developed countries was US$2–3 per disability adjusted life year (DALY) lost to major infectious diseases such as HIV/AIDS and malaria, but only $0·06 per DALY lost to injury.6
Part of this neglect might stem from the fact that the solutions lie outside the usual frameworks of health care. Part may also stem from a sense of fatalism, that injuries are caused by bad luck and that little can be done to prevent them. However, the experience of most high- income countries over the past 40–50 years has been that, in fact, injury rates can be lowered and the consequent morbidity and mortality can be reduced.5, 7, 8 Part of the success has been achieved through advances in transport systems, housing construction, and industrial machinery. However, much has been accomplished by the application of scientific methods of injury prevention and control.7, 8, 9
The largest gains are to be made in less-developed countries, where rates of injury-related death are highest4, 10 (table and figure), where there have been limited applications of scientific methods of injury control, and where most of the world's people live. Improvements are needed across a range of injury control activities, encompassing surveillance, prevention, and treatment. For all of these, progress can be made by applying or adapting some of the interventions that have been effective in high-income countries. However, there is an important role for new research to identify and elucidate injury risk factors and to rigorously assess the effectiveness of injury control policies in less-developed countries.11, 12, 13, 14
In this review, we discuss what is known and what new information is needed. This includes both basic research to elucidate injury risk factors and operations research to decide how best to implement and assess policies to promote safety in different societies worldwide. The major focus of this review is to identify ways in which current injury prevention and treatment could be strengthened, especially in less-developed countries.
Section snippets
Surveillance
All too often, injury control activities in both high-income nations and less-developed countries have been done without adequate assessment of their effectivness.9, 15 Data on the extent and characteristics of injuries should be collected in every country. Such follow-up assessment would allow better targeting of interventions and assessment of their success or failure. Most high-income countries have formal surveillance systems, such as the Fatality Analysis Reporting System (PARS)16 for
Prehospital care
Most injury-related deaths occur before any chance of treatment, indicating the importance of prevention in all countries. The proportion of prehospital deaths seems to increase with decreasing economic status. For example, 81% of injury deaths occurred in the field in Kumasi, Ghana compared with 59% in Seattle, USA.94 Based on the site of death of most injury victims, development of prehospital emergency medical services (EMS) could be more effective in reducing death rates than would
Trauma system organisation
Efforts to strengthen injury treatment worldwide can build on trauma system organisation in place in several high-income contries. Part of such organisation entails trauma service verification, involving a review of hospitals' completeness for clinical services (human resources), physical resources, and administrative functions, such as quality improvement. Such verification is provided by professional organisations,120 while governments designate which hospitals should fill the roles of trauma
Essential trauma care
Improvements in injury treatment could probably be brought about through better organisation along the lines of trauma system planning. WHO and the International Society of Surgery have a project underway to elucidate what treatment capabilities should be available in hospitals of varying levels in countries at varying economic levels. The collaborative Essential Trauma Care Working Group has developed a list of injury treatment services that are deemed essential and/or desirable in different
Capacity for injury control
All the efforts for surveillance, prevention, and treatment of injuries that we have discussed require a certain level of resources and legal authority within institutions such as universities, road safety agencies, and ministries of health. Because road traffic is such a great cause of injury, the role of road safety agencies merits special attention. In most countries, there is a need for a sufficiently funded government department, with adequate and appropriately trained staff, and with
The way forward
Much can be done to lower the huge global burden of death and disability from injury by improved application of scientifically-based evidence on injury control, and strengthened surveillance, prevention, and treatment. Current efforts, especially those in less-developed countries, could be enhanced by addressing various research and policy issues (panel), but more human resources, finances, and legal authority are needed. Furthermore, injury-control workers need to be versed in advocacy and
Search strategy
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2021, African Journal of Emergency MedicineAssociation between volume resuscitation & mortality among injured patients at a tertiary care hospital in Kigali, Rwanda
2021, African Journal of Emergency MedicineUsing modified Delphi method to propose and validate the components of a child injury surveillance system for Iran
2020, Chinese Journal of Traumatology - English EditionAn audit of admissions and mortality of orthopedic indoor patients in a tertiary care hospital of India
2020, Journal of Clinical Orthopaedics and TraumaCitation Excerpt :Among the trauma patients the most common cause of trauma was Road traffic accident(RTA). Trauma particularly RTA are one of the major health problem in the world.10,11 Slip and fall was most common cause of trauma in female.