Essential Resources for Musculoskeletal Trauma Care Worldwide: A Delphi Study

Purpose: Trauma is a leading cause of morbidity and mortality worldwide, with musculoskeletal injury representing a large proportion of this burden overall. Strategies to address this burden include coordinated trauma systems and established guidelines. Despite evidence that trauma systems and guidelines enhance functional outcomes and decrease mortality rates, there remains a lack of formalized trauma systems globally. The aim of this study was to develop international consensus on the most essential resources for musculoskeletal trauma care across diverse resource settings worldwide, which can aid in the development of trauma system guidelines.

Methods: The Delphi method was administered via a 3-round electronic survey to a panel of surgeons (1 expert per country) that treat traumatic injuries, selected from AO Trauma, AO Alliance, the OTA, or the European Society for Trauma and Emergency Surgery. Participants rated resources on a Likert scale from 1 (most important) to 9 (least important) and results were summarized with an aggregate rating. The “most essential” resources were rated ≤2 by ≥75% of the group.

Results: 103 of 111 invited participants responded to the first survey and were included throughout the subsequent rounds, yielding a 93% response rate. Most participants were fellowship-trained (78%) orthopaedic surgeons (90%) practicing in an academic setting (62%), with over 20 years of experience (46%). Participants represented low-income and lower-middle-income countries (LMICs; 35%), upper-middle income countries (UMICs; 30%), and high-income countries (HICs; 35%). The scoping survey yielded a total of 308 unique resources for pre-hospital, in-hospital, and post-hospital phases of care. 55 resources achieved consensus as the most essential trauma care resources and fell under the following categories: pre-hospital care (ancillary services, personnel, and supplies/equipment); in-hospital care (training, personnel, policies, protocols, supplies/equipment, Emergency Department, operating room, and infrastructure) and post-hospital care (personnel and supplies/equipment). There was a significant difference (α =.0167) in ratings between income groups for 16 resources, all of which were related to general trauma care rather than specific to musculoskeletal injury management.

Conclusion: Identifying this comprehensive list of resources for global musculoskeletal care provides support for improved allocation of resources. Further, these findings can aid in the development of effective guidelines and policies, creation of treatment standards, and advocacy for national musculoskeletal trauma systems worldwide.