Trauma Imaging in Global Health Radiology

  • Tiffany M. Sills
  • John M. Campbell
  • Rodney D. Welling
  • Matthew P. Lungren


The worldwide incidence of morbidity and mortality related to trauma is increasing as low-income countries continue to undergo economic development and urbanization. It is important to understand the socioeconomic and the demographic data as related to trauma in low- and middle-income countries (LMICs), including traumatic brain injury, spinal cord injury, abdominal injury, and extremity injury. An understanding of trauma in the LMICs, and the challenges that exist for both the prevention and the treatment of traumatic injuries, may inform future plans for the implementation of medical imaging and organized trauma responders, thereby minimizing the impact of post-traumatic morbidity and mortality in low-income countries.


Radiology Global Health Global Health Trauma Imaging Trauma Global Health Traumatic Brain Injury in Global Health Traumatic Spinal Cord Injury in Global Health Blunt Abdominal Injury in Global Health FAST in Global Health EFAST in Global Health Essential Trauma Care Project Ultrasound in Trauma and Global Health X-ray in Trauma and Global Health Radiography in Trauma and Global Health CT in Trauma and Global Health 


  1. 1.
    Mock CLJ, Goosen J, Joshipura M, Peden M. Guidelines for essential trauma care. Geneva: World Health Organization; 2004.Google Scholar
  2. 2.
    Murray CJL, Lopez AD. The global burden of disease. Geneva: The Harvard School of Public Health; 1996.Google Scholar
  3. 3.
    Harris OA, Bruce CA, Reid M, Cheeks R, Easley K, Surles MC, et al. Examination of the management of traumatic brain injury in the developing and developed world: focus on resource utilization, protocols, and practices that alter outcome. J Neurosurg. 2008;109(3):433–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Museru LM, McHaro CN. The dilemma of fracture treatment in developing countries. Int Orthop. 2002;26(6):324–7.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Nantulya VM, Reich MR. The neglected epidemic: road traffic injuries in developing countries. BMJ. 2002;324(7346):1139–41.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Murray S. Global injury and violence. CMAJ. 2006;174(5):620–1.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Stuckler D, King L, Robinson H, McKee M. WHO’s budgetary allocations and burden of disease: a comparative analysis. Lancet. 2008;372(9649):1563–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Michau C. External assistance to the health sector in developing countries: a detailed analysis, 1972–1990. Geneva: World Health Organization; 1994.Google Scholar
  9. 9.
    Mock CN, Adzotor KE, Conklin E, Denno DM, Jurkovich GJ. Trauma outcomes in the rural developing world: comparison with an urban level I trauma center. J Trauma. 1993;35(4):518–23.PubMedCrossRefGoogle Scholar
  10. 10.
    Mock CN, Jurkovich GJ, nii-Amon-Kotei D, Arreola-Risa C, Maier RV. Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma. 1998;44(5):804–12; discussion 812–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Maru DS, Schwarz R, Jason A, Basu S, Sharma A, Moore C. Turning a blind eye: the mobilization of radiology services in resource-poor regions. Global Health. 2010;6:18.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Chen L, Kim Y, Moore CL. Diagnosis and guided reduction of forearm fractures in children using bedside ultrasound. Pediatr Emerg Care. 2007;23(8):528–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Palmer PE. Radiology in the developing world. Br J Radiol. 1984;57(682):853–6.PubMedGoogle Scholar
  14. 14.
    Ghajar J. Traumatic brain injury. Lancet. 2000;356(9233):923–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Joosse P, Smit G, Arendshorst RJ, Soedarmo S, Ponsen KJ, Goslings JC. Outcome and prognostic factors of traumatic brain injury: a prospective evaluation in a Jakarta University hospital. J Clin Neurosci. 2009;16(7):925–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Joosse P, Soedarmo S, Luitse JS, Ponsen KJ. Trauma outcome analysis of a Jakarta University Hospital using the TRISS method: validation and limitation in comparison with the major trauma outcome study. Trauma and Injury Severity Score. J Trauma. 2001;51(1):134–40.PubMedCrossRefGoogle Scholar
  17. 17.
    Procaccio F, Stocchetti N, Citerio G, Berardino M, Beretta L, Della Corte F, et al. Guidelines for the treatment of adults with severe head trauma (part II). Criteria for medical treatment. J Neurosurg Sci. 2000;44(1):11–8.PubMedGoogle Scholar
  18. 18.
    Procaccio F, Stocchetti N, Citerio G, Berardino M, Beretta L, Della Corte F, et al. Guidelines for the treatment of adults with severe head trauma (part I). Initial assessment; evaluation and pre-hospital treatment; current criteria for hospital admission; systemic and cerebral monitoring. J Neurosurg Sci. 2000;44(1):1–10.PubMedGoogle Scholar
  19. 19.
    Palmer S, Bader MK, Qureshi A, Palmer J, Shaver T, Borzatta M, et al. The impact on outcomes in a community hospital setting of using the AANS traumatic brain injury guidelines. Americans Associations for Neurologic Surgeons. J Trauma. 2001;50(4):657–64.PubMedCrossRefGoogle Scholar
  20. 20.
    Arreola-Risa C. Trauma in Mexico. Trauma Q. 1999;14(3):211–20.CrossRefGoogle Scholar
  21. 21.
    Pasquale M, Fabian TC. Practice management guidelines for trauma from the Eastern Association for the Surgery of Trauma. J Trauma. 1998;44(6):941–56; discussion 956–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Babl FE, Borland ML, Phillips N, Kochar A, Dalton S, McCaskill M, et al. Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study. Lancet. 2017;389(10087):2393–402.PubMedCrossRefGoogle Scholar
  23. 23.
    Nakhjavan-Shahraki B, Yousefifard M, Hajighanbari MJ, Oraii A, Safari S, Hosseini M. Pediatric Emergency Care Applied Research Network (PECARN) prediction rules in identifying high risk children with mild traumatic brain injury. Eur J Trauma Emerg Surg. 2017;43(6):755–62.PubMedCrossRefGoogle Scholar
  24. 24.
    Rahimi-Movaghar V, Sayyah MK, Akbari H, Khorramirouz R, Rasouli MR, Moradi-Lakeh M, et al. Epidemiology of traumatic spinal cord injury in developing countries: a systematic review. Neuroepidemiology. 2013;41(2):65–85.PubMedCrossRefGoogle Scholar
  25. 25.
    Rathore MF, Hanif S, Farooq F, Ahmad N, Mansoor SN. Traumatic spinal cord injuries at a tertiary care rehabilitation institute in Pakistan. J Pak Med Assoc. 2008;58(2):53–7.PubMedGoogle Scholar
  26. 26.
    Hoque MF, Grangeon C, Reed K. Spinal cord lesions in Bangladesh: an epidemiological study 1994–1995. Spinal Cord. 1999;37(12):858–61.PubMedCrossRefGoogle Scholar
  27. 27.
    Levy LF, Makarawo S, Madzivire D, Bhebhe E, Verbeek N, Parry O. Problems, struggles and some success with spinal cord injury in Zimbabwe. Spinal Cord. 1998;36(3):213–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Gosselin RA, Coppotelli C. A follow-up study of patients with spinal cord injury in Sierra Leone. Int Orthop. 2005;29(5):330–2.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Brasil AV, Coelho DG. The neurological outcome of acute spinal cord injury in a neurosurgical hospital of a developing country. Spinal Cord. 1998;36(5):353–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Brown MA, Casola G, Sirlin CB, Patel NY, Hoyt DB. Blunt abdominal trauma: screening us in 2,693 patients. Radiology. 2001;218(2):352–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Brown MA, Sirlin CB, Hoyt DB, Casola G. Screening ultrasound in blunt abdominal trauma. J Intensive Care Med. 2003;18(5):253–60.PubMedCrossRefGoogle Scholar
  32. 32.
    McGahan JP, Richards J, Gillen M. The focused abdominal sonography for trauma scan: pearls and pitfalls. J Ultrasound Med. 2002;21(7):789–800.PubMedCrossRefGoogle Scholar
  33. 33.
    Wisner DH, Chun Y, Blaisdell FW. Blunt intestinal injury. Keys to diagnosis and management. Arch Surg. 1990;125(10):1319–22; discussion 1322–3PubMedCrossRefGoogle Scholar
  34. 34.
    Stengel D, Bauwens K, Sehouli J, Rademacher G, Mutze S, Ekkernkamp A, et al. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma. Cochrane Database Syst Rev. 2005;(2):CD004446.Google Scholar
  35. 35.
    McKenney MG, Martin L, Lentz K, Lopez C, Sleeman D, Aristide G, et al. 1,000 consecutive ultrasounds for blunt abdominal trauma. J Trauma. 1996;40(4):607–10; discussion 611–2.PubMedCrossRefGoogle Scholar
  36. 36.
    Rozycki GS, Ballard RB, Feliciano DV, Schmidt JA, Pennington SD. Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg. 1998;228(4):557–67.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Smith ZA, Postma N, Wood D. FAST scanning in the developing world emergency department. S Afr Med J. 2010;100(2):105–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Brenchley J, Walker A, Sloan JP, Hassan TB, Venables H. Evaluation of focussed assessment with sonography in trauma (FAST) by UK emergency physicians. Emerg Med J. 2006;23(6):446–8.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Mohammadi A, Ghasemi-Rad M. Evaluation of gastrointestinal injury in blunt abdominal trauma “FAST is not reliable”: the role of repeated ultrasonography. World J Emerg Surg. 2012;7(1):2.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Chambers JA, Pilbrow WJ. Ultrasound in abdominal trauma: an alternative to peritoneal lavage. Arch Emerg Med. 1988;5(1):26–33.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Bakker J, Genders R, Mali W, Leenen L. Sonography as the primary screening method in evaluating blunt abdominal trauma. J Clin Ultrasound. 2005;33(4):155–63.PubMedCrossRefGoogle Scholar
  42. 42.
    Geeraedts LM Jr, Kaasjager HA, van Vugt AB, Frolke JP. Exsanguination in trauma: A review of diagnostics and treatment options. Injury. 2009;40(1):11–20.PubMedCrossRefGoogle Scholar
  43. 43.
    Shanmuganathan K, Mirvis SE, Sherbourne CD, Chiu WC, Rodriguez A. Hemoperitoneum as the sole indicator of abdominal visceral injuries: a potential limitation of screening abdominal US for trauma. Radiology. 1999;212(2):423–30.PubMedCrossRefGoogle Scholar
  44. 44.
    Montoya J, Stawicki SP, Evans DC, Bahner DP, Sparks S, Sharpe RP, et al. From FAST to E-FAST: an overview of the evolution of ultrasound-based traumatic injury assessment. Eur J Trauma Emerg Surg. 2016;42(2):119–26.PubMedCrossRefGoogle Scholar
  45. 45.
    Abdulrahman Y, Musthafa S, Hakim SY, Nabir S, Qanbar A, Mahmood I, et al. Utility of extended FAST in blunt chest trauma: is it the time to be used in the ATLS algorithm? World J Surg. 2015;39(1):172–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST). J Trauma. 2004;57(2):288–95.PubMedCrossRefGoogle Scholar
  47. 47.
    Di Bartolomeo S, Sanson G, Nardi G, Scian F, Michelutto V, Lattuada L. A population-based study on pneumothorax in severely traumatized patients. J Trauma. 2001;51(4):677–82.PubMedCrossRefGoogle Scholar
  48. 48.
    Ianniello S, Di Giacomo V, Sessa B, Miele V. First-line sonographic diagnosis of pneumothorax in major trauma: accuracy of e-FAST and comparison with multidetector computed tomography. Radiol Med. 2014;119(9):674–80.PubMedCrossRefGoogle Scholar
  49. 49.
    Odero WO, Kibosia JC. Incidence and characteristics of injuries in Eldoret. Kenya. East Afr Med J. 1995;72(11):706–10.PubMedGoogle Scholar
  50. 50.
    Nordberg E. Injuries in Africa: a review. East Afr Med J. 1994;71(6):339–45.PubMedGoogle Scholar
  51. 51.
    Keenan WN, Woodward AF, Price D, Eckloff K, Richards J, Powell J, et al. Manipulation under anaesthetic of children’s fractures: use of the image intensifier reduces radiation exposure to patients and theatre personnel. J Pediatr Orthop. 1996;16(2):183–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Sri-Pathmanathan R. The mobile X-ray image intensifier unit in maxillofacial surgery. Br J Oral Maxillofac Surg. 1990;28(3):203–6.PubMedCrossRefGoogle Scholar
  53. 53.
    Driscoll PA, Vincent CA. Organizing an efficient trauma team. Injury. 1992;23(2):107–10.PubMedCrossRefGoogle Scholar
  54. 54.
    Hoff WS, Reilly PM, Rotondo MF, DiGiacomo JC, Schwab CW. The importance of the command-physician in trauma resuscitation. J Trauma. 1997;43(5):772–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Vernon DD, Furnival RA, Hansen KW, Diller EM, Bolte RG, Johnson DG, et al. Effect of a pediatric trauma response team on emergency department treatment time and mortality of pediatric trauma victims. Pediatrics. 1999;103(1):20–4.PubMedCrossRefGoogle Scholar
  56. 56.
    Sakellariou A, McDonald PJ, Lane RH. The trauma team concept and its implementation in a district general hospital. Ann R Coll Surg Engl. 1995;77(1):45–52.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Nwadiaro HC, Yiltok SJ, Kidmas AT. Immediate mass casualty management in Jos University Teaching Hospital: a successful trial of Jos protocol. West Afr J Med. 2000;19(3):230–4.PubMedGoogle Scholar
  58. 58.
    Ndiaye A, Camara S, Ndoye A, Dansokho A, Sow CM, Ndiaye PD, et al. Mortality caused by traffic accidents at the Traumatology and Orthopedics Center of Grand-Yoff. A 2-year study. Apropos of 156 cases. Med Trop (Mars). 1993;53(4):487–91.Google Scholar
  59. 59.
    Ozguc H, Kaya E, Yunuk O, Armagan E, Tokyay R. Outcome of major trauma in a Turkish university hospital: did integrated approach make a difference? Eur J Emerg Med. 2000;7(3):183–8.PubMedCrossRefGoogle Scholar
  60. 60.
    Holder Y. Injury surveillance guidelines. Geneva: World Health Organization; 2001.Google Scholar
  61. 61.
    World Health Organization. Guidelines for essential trauma care. 2004. Available from
  62. 62.
    World Health Organization. WHO Trauma Care Checklist. 2016. Available from

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Tiffany M. Sills
    • 1
  • John M. Campbell
    • 2
  • Rodney D. Welling
    • 3
  • Matthew P. Lungren
    • 4
    • 5
    • 6
  1. 1.Department of Diagnostic RadiologyUniversity of North Carolina HospitalsChapel HillUSA
  2. 2.Department of RadiologyUniversity of North Carolina HospitalsChapel HillUSA
  3. 3.Pinehurst Radiology AssociatesPinehurstUSA
  4. 4.Department of RadiologyStanford University School of MedicineStanfordUSA
  5. 5.Lucile Packard Children’s HospitalStanford University Medical CenterPalo AltoUSA
  6. 6.Department of RadiologyStanford UniversityPalo AltoUSA

Personalised recommendations