We commend Stewart et al1 on their article regarding their longitudinal capacity assessment of the progress in trauma service availability during the last decade in Ghana and their recognition of the need for expanding the evidence base for trauma care capacity in low- and middle-income countries. The successes in improving in-hospital capacity such as infrastructure (eg, blood bank), equipment (eg, chest tubes, ventilator), and services (eg, skin grafting, neurosurgery) are part of broader needed efforts for capacity development of a complex, multicomponent, interconnected, and evolving trauma care delivery system. Remaining gaps in process evaluation (eg, prevention, prehospital triage, mobile emergency services, definitive hospital care, workforce distribution, long-term rehabilitation, transfer protocols and criteria, communication, and workflow) as well as injury and outcome surveillance present ongoing opportunities for collaboration and building to overcome present barriers in the delivery of trauma care. These summative factors are necessary components for accurate and reliable appraisal of a country’s trauma care capacity. Moreover, the implementation of a formal injury surveillance mechanism would enable the collection of reliable injury data for problem assessment and determination of whether advances have been made regarding quality and process improvement. Establishing monitoring mechanisms that provide country-specific injury and outcome data will enable the accurate characterization of persistent deficits in trauma care capacity that may then more effectively inform policy making. Therefore, adoption of a systems-based approach and a broadening of the context-specific knowledge base are essential to trauma care capacity development. In short, we need timely, accurate, and available data on the occurrence of injuries and related deaths; once these data have been collected and outcomes have been reviewed, steps can be made toward applied data2—targeted, sustainable, and cost-effective strengthening of trauma care services in already resource-poor settings.
Hsiung G, Gause C, Abdullah F. Surveillance and Data Capture to Assess Trauma Care Capacity in Low- and Middle-Income Countries. JAMA Surg. 2016;151(2):171. doi:10.1001/jamasurg.2015.3634