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Assessment of Trauma Care Capacity in Karachi, Pakistan: Toward an Integrated Trauma Care System

  • Surgery in Low and Middle Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Pakistan is a lower-middle-income country with a high burden of injuries. Karachi, its most populated city, lacks a trauma care system due to which trauma patients do not receive the required care. We conducted an assessment of the existing facilities for trauma care in Karachi.

Methods

Twenty-two tertiary and secondary hospitals from public and private sectors across Karachi were assessed. The Guidelines for Essential Trauma Care (GETC) tool was used to collect information about the availability of skills, knowledge, and equipment at these facilities.

Results

Among tertiary hospitals (n = 7), private sector hospitals had a better median (IQR) score, 90.4 (81.8–93.1), as compared to the public sector hospitals, 44.1 (29.3–75.8). Among secondary hospitals (n = 15), private sector hospitals had a better median (IQR) score, 70.3 (67.8–77.7), as compared to the public sector hospitals, 39.7 (21.9–53.3).

Discussion

This study identifies considerable deficiencies in trauma care in Karachi and provides objective data that can guide urgently needed reforms tailored to this city’s needs. On a systems level, it delineates the need for a regulatory framework to define trauma care levels and designate selected hospitals across the city accordingly. Using these data, improvement in trauma care systems can be achieved through collaboration and partnership between public and private stakeholders.

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References

  1. Dicker D, Nguyen G, Abate D et al (2018) Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet 392(10159):1684–1735. https://doi.org/10.1016/S0140-6736(18)31891-9

    Article  Google Scholar 

  2. Mock CN, Jurkovich GJ, nii-Amon-Kotei D, Arreola-Risa C, Maier RV (1998) Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma. 44(5):804–812; discussion 812–814. https://doi.org/10.1097/00005373-199805000-00011

  3. Mock C, Joshipura M, Arreola-Risa C, Quansah R (2012) An estimate of the number of lives that could be saved through improvements in trauma care globally. World J Surg 36(5):959–963. https://doi.org/10.1007/s00268-012-1459-6

    Article  PubMed  Google Scholar 

  4. Population Census | Pakistan Bureau of Statistics. Accessed November 4, 2020. http://www.pbs.gov.pk/content/population-census

  5. R J, Ma S. Descriptive epidemiology of Karachi road traffic crash mortality from 2007 to 2014. JPMA. The Journal of the Pakistan Medical Association. Published November 2016. Accessed November 2, 2020. https://pubmed.ncbi.nlm.nih.gov/27812072/

  6. Razzak JA, Baqir SM, Khan UR, Heller D, Bhatti J, Hyder AA (2015) Emergency and trauma care in Pakistan: a cross-sectional study of healthcare levels. Emerg Med J 32(3):207–213. https://doi.org/10.1136/emermed-2013-202590

    Article  PubMed  Google Scholar 

  7. Guidelines for essential trauma care / World Health Organization, International Society of Surgery/Société Internationale de Chirurgie and the International Association for the Surgery of Trauma and Surgical Intensive Care (IATSIC) . Accessed October 29, 2020. https://apps.who.int/iris/handle/10665/42565

  8. Babu BV, Vishwanathan K, Ramesh A et al (2020) Trauma care in India: capacity assessment survey from five centers. J Surg Res 252:156–168. https://doi.org/10.1016/j.jss.2020.03.002

    Article  PubMed  Google Scholar 

  9. Arreola-Risa C, Mock C, Vega Rivera F et al (2006) Evaluating trauma care capabilities in Mexico with the World Health Organization’s Guidelines for Essential Trauma Care publication. Rev Panam Salud Pública Pan Am J Public Health 19:94–103. https://doi.org/10.1590/S1020-49892006000200004

    Article  Google Scholar 

  10. Son NT, Mock C (2006) Improvements in trauma care capabilities in Vietnam through use of the WHO-IATSIC Guidelines for Essential Trauma Care. Int J Inj Control Saf Promot 13(2):125–127. https://doi.org/10.1080/17457300500310152

    Article  Google Scholar 

  11. Quansah R, Mock C, Abantanga F (2006) Status of trauma care in Ghana. Ghana Med J. https://doi.org/10.4314/gmj.v38i4.36013

    Article  Google Scholar 

  12. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research Electronic Data Capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381. https://doi.org/10.1016/j.jbi.2008.08.010

    Article  PubMed  Google Scholar 

  13. StataCorp (2013) Stata Statistical Software: Release 13. College Station, TX: StataCorp LP

  14. Smith J Jr, Martin LF, Young WW, Macioce DP (1990) (1990) Do trauma centers improve outcome over non-trauma centers: the evaluation of regional trauma care using discharge abstract data and patient management categories. J Trauma 30(12):1533–1538

    Article  PubMed  Google Scholar 

  15. Gabbe BJ, Biostat GD, Simpson PM et al (2012) Improved functional outcomes for major trauma patients in a regionalized inclusive trauma system. Ann Surg 255(6):1009–1015. https://doi.org/10.1097/SLA.0b013e31824c4b91

    Article  PubMed  Google Scholar 

  16. Callese TE, Richards CT, Shaw P et al (2015) Trauma system development in low- and middle-income countries: a review. J Surg Res 193(1):300–307. https://doi.org/10.1016/j.jss.2014.09.040

    Article  PubMed  Google Scholar 

  17. Waseem H, Naseer R, Razzak JA (2011) Establishing a successful pre-hospital emergency service in a developing country: experience from Rescue 1122 service in Pakistan. Emerg Med J EMJ 28(6):513–515. https://doi.org/10.1136/emj.2010.096271

    Article  PubMed  Google Scholar 

  18. Rehman A, Shaikh BT, Ronis KA (2014) Health care seeking patterns and out of pocket payments for children under five years of age living in Katchi Abadis (slums), in Islamabad, Pakistan. Int J Equity Health 13:30. https://doi.org/10.1186/1475-9276-13-30

    Article  PubMed  PubMed Central  Google Scholar 

  19. Cn M, Quansah R, Addae-Mensah L (1999) Kwame Nkrumah University of Science and Technology continuing medical education course in trauma management. Trauma Q 14:345–348. https://doi.org/10.1163/156857199750223857

    Article  Google Scholar 

  20. Jawaid M, Ahmed Memon A, Masood Z, Nadeem AS (2013) Effectiveness of the primary trauma care course: is the outcome satisfactory? Pak J Med Sci 29(5):1265–1268. https://doi.org/10.12669/pjms.295.4002

    Article  PubMed  PubMed Central  Google Scholar 

  21. Pringle K, Mackey JM, Modi P et al (2015) A short trauma course for physicians in a resource-limited setting: Is low-cost simulation effective? Injury 46(9):1796–1800. https://doi.org/10.1016/j.injury.2015.05.021

    Article  CAS  PubMed  Google Scholar 

  22. Hanche-Olsen TP, Alemu L, Viste A, Wisborg T, Hansen KS (2015) Evaluation of training program for surgical trauma teams in Botswana. World J Surg 39(3):658–668. https://doi.org/10.1007/s00268-014-2873-8

    Article  PubMed  Google Scholar 

  23. McIntosh N, Grabowski A, Jack B, Nkabane-Nkholongo EL, Vian T (2015) A public-private partnership improves clinical performance in a hospital network in lesotho. Health Aff (Millwood) 34(6):954–962. https://doi.org/10.1377/hlthaff.2014.0945

  24. Ali M, Miyoshi C, Ushijima H (2006) Emergency medical services in Islamabad, Pakistan: a public-private partnership. Public Health 120(1):50–57. https://doi.org/10.1016/j.puhe.2005.03.009

    Article  CAS  PubMed  Google Scholar 

  25. Nkurunziza T, Toma G, Odhiambo J et al (2016) Referral patterns and predictors of referral delays for patients with traumatic injuries in rural Rwanda. Surgery 160(6):1636–1644. https://doi.org/10.1016/j.surg.2016.08.006

    Article  PubMed  Google Scholar 

  26. Khan S, Zafar H, Zafar SN, Haroon N (2014) Inter-facility transfer of surgical emergencies in a developing country: effects on management and surgical outcomes. World J Surg 38(2):281–286. https://doi.org/10.1007/s00268-013-2308-y

    Article  PubMed  Google Scholar 

  27. Dinh MM, Bein K, Roncal S, Byrne CM, Petchell J, Brennan J (2013) Redefining the golden hour for severe head injury in an urban setting: The effect of prehospital arrival times on patient outcomes. Injury 44(5):606–610. https://doi.org/10.1016/j.injury.2012.01.011

    Article  PubMed  Google Scholar 

  28. Razzak JA, Hyder AA, Akhtar T, Khan M, Khan UR (2008) Assessing emergency medical care in low income countries: a pilot study from Pakistan. BMC Emerg Med 8:8. https://doi.org/10.1186/1471-227X-8-8

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We acknowledge all the public and private hospitals of Karachi who allowed us to conduct the survey. Our thanks to Anoosha Iqbal, Farea Noman Dar, Rida Fatima, and Rimsha Arshad for ensuring meticulous data collection.

Funding

This study did not receive any funding.

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Correspondence to Mohammad Salman Khalil.

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Khalil, M.S., Latif, A., Ashraf, M.N. et al. Assessment of Trauma Care Capacity in Karachi, Pakistan: Toward an Integrated Trauma Care System. World J Surg 45, 3007–3015 (2021). https://doi.org/10.1007/s00268-021-06234-w

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  • DOI: https://doi.org/10.1007/s00268-021-06234-w

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