World Journal of Surgery

, Volume 42, Issue 9, pp 2810–2812 | Cite as

Commentary on ‘A Consensus-Based Criterion Standard for the Requirement of a Trauma Team:’ Low-Resource Setting Considerations

  • Barclay T. Stewart
Invited Commentary

Appropriate and timely activation of an organized, rehearsed trauma team during the care of severely injured patients saves lives [1, 2, 3, 4, 5]. However, many hospitals in low-resource settings that routinely care for the injured do not have trauma teams. Resultantly, the care provided to seriously injured patients within the first hour of reaching the hospital is often delayed and under-coordinated and results in preventable death and disability [3].

Using a consensus-building process, Dr. Waydhas and colleagues distilled 95 proposed trauma team activation criteria into a more manageable list [6]. The final list offered by the authors has 20 criteria and represents an initial step for identifying the most useful criteria in their health system for quality improvement purposes. Although the authors employed a fairly rigorous consensus-building process, the 20 criteria have not yet been validated by over-triage or under-triage rates, or associated with improved healthcare utilization...


Compliance with ethical standards

Conflict of interest

The author declares that there is no conflict of interest.


  1. 1.
    Cherry RA, King TS, Carney DE, Bryant P, Cooney RN (2007) Trauma team activation and the impact on mortality. J Trauma 63(2):326–330CrossRefPubMedGoogle Scholar
  2. 2.
    Falcone RA Jr., Haas L, King E et al (2012) A multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons. J Trauma Acute Care Surg 73(2):377–384 discussion 384 CrossRefPubMedGoogle Scholar
  3. 3.
    Ryb GE, Cooper C, Waak SM (2012) Delayed trauma team activation: patient characteristics and outcomes. J Trauma Acute Care Surg 73(3):695–698CrossRefPubMedGoogle Scholar
  4. 4.
    St John AE, Rowhani-Rahbar A, Arbabi S, Bulger EM (2016) Role of trauma team activation in poor outcomes of elderly patients. J Surg Res 203(1):95–102CrossRefPubMedGoogle Scholar
  5. 5.
    Tignanelli CJ, Vander Kolk WE, Mikhail JN, Delano MJ, Hemmila MR (2018) Noncompliance with American College of Surgeons Committee on Trauma recommended criteria for full trauma team activation is associated with undertriage deaths. J Trauma Acute Care Surg 84(2):287–294CrossRefPubMedGoogle Scholar
  6. 6.
    Waydhas C, Baake M, Becker L et al (2018) A consensus-based criterion standard for the requirement of a trauma team. World J Surg. CrossRefPubMedGoogle Scholar
  7. 7.
    Davis JW, Dirks RC, Sue LP, Kaups KL (2017) Attempting to validate the overtriage/undertriage matrix at a Level I trauma center. J Trauma Acute Care Surg 83(6):1173–1178CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Tansley G, Stewart BT, Zachariah A, Boateng E, Achena C, Mock C (2015) Population-level spatial access to prehospital care by the National Ambulance Service in Ghana. Prehosp Emerg Care 20:768–775CrossRefGoogle Scholar
  9. 9.
    Zachariah A, Stewart BT, Boateng E, Achena C, Tansley G, Mock C (2015) The birth and growth of the National Ambulance Service in Ghana. Prehosp Emerg Care 32:83–93Google Scholar
  10. 10.
    Arreola-Risa C, Mock CN, Lojero-Wheatly L et al (2000) Low-cost improvements in prehospital trauma care in a Latin American city. J Trauma 48(1):119–124CrossRefPubMedGoogle Scholar
  11. 11.
    Mock CN, Tiska M, Adu-Ampofo M, Boakye G (2002) Improvements in prehospital trauma care in an African country with no formal emergency medical services. J Trauma 53(1):90–97CrossRefPubMedGoogle Scholar
  12. 12.
    Nielsen K, Mock C, Joshipura M, Rubiano AM, Zakariah A, Rivara F (2012) Assessment of the status of prehospital care in 13 low- and middle-income countries. Prehosp Emerg Care 16(3):381–389CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Reynolds TA, Stewart B, Drewett I et al (2017) The impact of trauma care systems in low- and middle-income countries. Annu Rev Public Health 38:507–532CrossRefPubMedGoogle Scholar
  14. 14.
    Stewart BT, Quansah R, Gyedu A et al (2015) Serial assessment of trauma care capacity in Ghana in 2004 and 2014. JAMA Surg 151:164–171CrossRefGoogle Scholar
  15. 15.
    Hadler RA, Chawla S, Stewart BT, McCunn MC, Kushner AL (2016) Anesthesia care capacity at health facilities in 22 low- and middle-income countries. World J Surg. PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Rominski S, Bell SA, Oduro G, Ampong P, Oteng R, Donkor P (2014) The implementation of the South African Triage Score (SATS) in an urban teaching hospital, Ghana. Afr J Emerg Med 4(2):71–75CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Gardner A, Forson PK, Oduro G et al (2017) Diagnostic accuracy of the Kampala Trauma Score using estimated Abbreviated Injury Scale scores and physician opinion. Injury 48(1):177–183CrossRefPubMedGoogle Scholar
  18. 18.
    Stewart BT, Quansah R, Gyedu A, Ankomah J, Donkor P, Mock C (2015) Strategic assessment of trauma care capacity in Ghana. World J Surg 39(10):2428–2440. CrossRefPubMedGoogle Scholar
  19. 19.
    Wong EG, Gupta S, Deckelbaum DL, Razek T, Kushner AL (2014) Prioritizing injury care: a review of trauma capacity in low and middle-income countries. J Surg Res 193:217–222CrossRefPubMedGoogle Scholar
  20. 20.
    Ashengo T, Skeels A, Hurwitz EJH, Thuo E, Sanghvi H (2017) Bridging the human resource gap in surgical and anesthesia care in low-resource countries: a review of the task sharing literature. Hum Resour Health 15(1):77CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bolkan HA, van Duinen A, Waalewijn B et al (2017) Safety, productivity and predicted contribution of a surgical task-sharing programme in Sierra Leone. Br J Durg 104(10):1315–1326CrossRefGoogle Scholar
  22. 22.
    Shrime MG, Verguet S, Johansson KA, Desalegn D, Jamison DT, Kruk ME (2016) Task-sharing or public finance for the expansion of surgical access in rural Ethiopia: an extended cost-effectiveness analysis. Health Policy Plan 31(6):706–716CrossRefPubMedGoogle Scholar
  23. 23.
    Lanktree E, Corluka A, Cohen M, Larocque R (2014) Addressing the human resources for health crisis through task-shifting and retention: results from the Africa Health Systems Initiative Support to African Research Partnerships program. Hum Resour Health 12(Suppl 1):I2CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Van Heng Y, Davoung C, Husum H (2008) Non-doctors as trauma surgeons? A controlled study of trauma training for non-graduate surgeons in rural Cambodia. Prehosp Disaster Med 23(6):483–489 discussion 490–481 CrossRefPubMedGoogle Scholar
  25. 25.
    Sebat F, Musthafa AA, Johnson D et al (2007) Effect of a rapid response system for patients in shock on time to treatment and mortality during 5 years. Crit Care Med 35(11):2568–2575CrossRefPubMedGoogle Scholar
  26. 26.
    Speech to United Kingdom Parliament (2015) [press release]. London, United KingdomGoogle Scholar
  27. 27.
    Tominaga GT, Dandan IS, Schaffer KB, Nasrallah F, Gawlik M, Kraus JF (2017) Trauma resource designation: an innovative approach to improving trauma system overtriage. Trauma Surg Acute Care Open 2:1–5CrossRefGoogle Scholar
  28. 28.
    Mock C, Juillard C, Joshipura M, Goosen J (2010) Strengthening care for the injured: success stories and lessons learned from around the world. World Health Organization, GenevaGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of WashingtonSeattleUSA
  2. 2.Department of Interdisciplinary Health SciencesStellenbosch UniversityCape TownSouth Africa

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