Improving Initial Management of the Injured at Ghanaian District and Regional Hospitals with a Trauma Intake Form - ABSTRACT
Injuries cause millions of deaths each year, with the vast majority in low- and middle-income countries. Improving
care of the injured (trauma care) is a way to lower this burden. The initial period of trauma care is especially
important, but is often chaotic and prone to errors. The World Health Organization created a Trauma Care
Checklist (TCC), which improved key performance indicators of care and lowered mortality at tertiary hospitals
in multiple countries. As with any checklist, it requires a team of providers to go through the checklist as a group,
which decreases its uptake. A model Trauma Intake Form (TIF) has potential to achieve the benefits of the TCC,
but with automatic usage and with accompanying improvements in documentation. The TIF is a 2 page form,
filled out by health care providers as part of the medical record, with built-in memory prompts for key elements
of care. It is especially oriented for smaller hospitals. Our broad goal is to assess the effectiveness of the TIF to
improve trauma care at non-tertiary hospitals. We propose a pragmatic randomized clinical trial with introduction
of the TIF at 8 hospitals sequentially, with start times randomized by stepped-wedge design. We propose three
Specific Aims:
1. To determine the effectiveness of a model Trauma Intake Form (TIF) to function as a checklist for
increasing the appropriate use of key performance indicators (e.g. airway maintenance, pulse oximeter
placed, tests to exclude internal bleeding) during care of the injured in emergency units in district (first
level) and regional (second level) hospitals in Ghana, as assessed by independent observers.
Hypothesis: The TIF will increase use of key performance indicators by significant and clinically
meaningful levels. For example, the TIF will increase the percent of all injured patients who have their
consciousness level checked by at least 9% (50% to 59%).
2. To determine the percent of injured patients with adequate data on initial assessment before vs. after
introduction of the TIF in emergency units in district and regional hospitals in Ghana.
Hypothesis. The TIF will increase documentation of important clinical data on injured patients
(including all of the following: time of injury, mechanism of injury, respiratory rate, heart rate, blood
pressure, consciousness level, temperature, and time of disposition) by at least 5% (10% to 15%).
3. To increase the capacity of the Kwame Nkrumah University of Science and Technology and the
network of district and regional hospitals in southern Ghana to undertake high-quality trauma care
research, including clinical trials.
The proposal is innovative as it employs the novel idea of a checklist for trauma care (the TIF) that is built into
the clinical chart. The proposal is significant as it will advance scientific knowledge on checklists and will
evaluate an intervention that is feasible to use in non-tertiary hospitals in countries at all economic levels.
