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Johns Hopkins International Injury Research Unit

A World Health Organization Collaborating Center for Injuries, Violence and Accident Prevention

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Keyword: trauma care

Road traffic injuries (RTIs) are a leading cause of death and disability in Africa. With a rate of 28.3 fatalities per 100,000 population, it’s the highest in the world. What’s more, the economic cost of RTIs on the continent is estimated to be 1-2% of the gross national product. Despite these high numbers, there is little data available on prevention and treatment strategies.  This is true for the central African country of Cameroon, where the number of road traffic deaths has been steadily increasing since the 1970s.

Recently, in an effort to examine road traffic injuries JH-IIRU team members published “Road Traffic Injuries in Yaoundé, Cameroon: A hospital-based pilot surveillance study,” in the journal Injury. The paper looked at patients injured in RTIs who sought care at the main referral hospital in Yaoundé to determine not only the characteristics of those injured but also to identify the associations between these characteristics and outcomes which could be used to improve treatment in Cameroon as well as  other low- and middle-income countries (LMICs). The study provides valuable information about RTIs which the team hopes can be used to improve emergency care in Cameroon and other LMICs and highlights the importance of RTI prevention.

The team included JH-IIRU associate director, Kent Stevens and director Adnan Hyder, and colleagues from WHO Africa, the Ministry of Public Health in Yaoundé, as well as the Department of Surgery at the University of California, San Francisco.  Catherine Juillard, currently in the Department of Surgery at Johns Hopkins Hospital, was a post-doctoral fellow in JH-IIRU when this study was conducted.

This study is part of the unit’s ongoing global work on trauma care.

Read more here

Injury severity scores are important and necessary tools for both evaluating care of the injured patient and establishing institutional quality and research practices. In high-income countries (HICs), several injury severity scores have been used to evaluate and study trauma patients; however, despite the fact that more than 90% of the estimated 5.8 million deaths each year caused by injury worldwide occur in low- and middle-income countries (LMICs), few scores have been validated for use in these countries.  The Kampala Trauma Score (KTS) is an injury severity score that was developed specifically for use in low-resource settings.

In the recently published paper, “Is the Kampala Trauma Score an Effective Predictor of Mortality in Low-Resource Settings? A Comparison of Multiple Trauma Severity Scores,” a group of researchers, including Johns Hopkins International Injury Research Unit’s (JH-IIRU) associate director, Kent Stevens and director, Adnan Hyder, compared five trauma severity scores against the ability of KTS to predict mortality of trauma patients in the Central Hospital of Yaounde, Cameroon.

The results suggest that there is potential for the adoption of KTS for injury surveillance and triage in resource-limited settings and that KTS is as effective as other scoring systems in predicting patient mortality. Because the system is simple to administer and record, this makes KTS a potentially valuable tool for low-resource settings, where many hospitals are understaffed and basic record-keeping and data collection is unreliable or incomplete.

To read more about the study, click here.

Emergency care in Pakistan suffers from critical gaps in both essential equipment and provider knowledge necessary for effective emergency and trauma care.  Those are the findings of a recent study undertaken in the country’s Sindh province by the Johns Hopkins International Injury Research Unit (JH-IIRU) in collaboration with colleagues at Aga Khan University’s Department of Emergency Medicine.

The study, “Emergency and trauma care in Pakistan: A cross-sectional study of healthcare levels,” published in Emergency Medicine Journal, used the World Health Organization’s (WHO) assessment protocols—the Guidelines for essential trauma care and the Prehospital care systems—to evaluate emergency and trauma care at different levels of health facilities in Pakistan. The study focused on two specific aspects: 1) infrastructure and essential equipment and supplies and 2): availability and knowledge of physicians providing emergency care.

The findings suggested that both facility-level equipment and supplies and human resource gaps exist in the current emergency care system in the country—gaps that are likely to compromise the level of emergency care—and point to the need for comprehensive reform of the emergency care system in the province of Sindh.  The study also provided a set of recommendations, which include increasing the investment in health provider training for acute care, providing facilities with low-cost commonly-used supplies such as bag valve masks and integrating improved emergency care protocols.

The study was partly supported by the NIH-Fogarty funded Johns Hopkins-Pakistan International Collaborative Trauma and Injury Research Training Program (JHU-Pakistan ICTIRT).

To read more, click here.

On March 5, 2014, the Johns Hopkins International Injury Research Unit (JH-IIRU) will formally launch “Improving Trauma Care Systems to Reduce the Burden of Road Traffic Injuries in the Sultanate of Oman,” with a signing ceremony in Muscat.

The project will assess the trauma systems in order to improve hospital and pre-hospital care. The first stages of the project will engage members of the Omani government and The Research Council (TRC) as well as potential stakeholders and collaborators, such as the Ministry of Health and academic institutions such Sultan Qaboos University.

In February, JH-IIRU team members Amber Mehmood, Kent Stevens and Katharine Allen visited several hospitals, including the Royal Hospital, the Armed Forces Hospital, Khoula Hospital Sultan Qaboos University Hospital, Sohaar Hospital and Nizwa Hospital for potential collaborations.

JH-IIRU director, Adnan Hyder will participate in the signing ceremony, which will also include H.E. Dr. Hilal Al Hinai, Secretary General of The Research Council; Dr. Saif Al Hiddabi, member of the steering committee of the national road safety program; and Dr. Talal Al Belushi, board member Oman Road Safety Association (ORSA)

Next steps for the project will include both quantitative and qualitative assessment of various components of trauma care in Oman, training workshops for clinical and research capacity building in trauma/injury prevention and pilot testing hospital based trauma registries.

Stakeholders and decision makers across health and allied sectors must play a key role in developing and implementing innovative solutions to road traffic injuries and trauma care, especially in developing nations, according to recommendations published in a new report developed by researchers at the Johns Hopkins Bloomberg School of Public Health. The report was issued as part of an international health summit held in Doha, Qatar on December 10.

"Road Injuries and Trauma Care: Innovations for Policy," written by professor of International Health and director of the Johns Hopkins International Injury Research Unit (JH-IIRU), Adnan Hyder, together with JH-IIRU faculty Prasanthi Puvanachandra and doctoral student Kate Allen, identified the best available evidence, good practices and promising innovations emerging around the world on road traffic injury prevention and trauma care.  Developed with a team of global experts, including colleagues from the World Health Organization, The Global Road Safety Partnership, private sector and Bloomberg Philanthropies, the report was released as part of the inaugural World Innovation Summit on Health, 2013 (WISH-2013).

“Road traffic injuries kill more than 1.2 million people worldwide each year and injure an additional 20 to 50 million. They are the 8th leading cause of death globally, and the leading cause of death for young people aged 15-29 years,” said Hyder. “Our report assesses the current spectrum of available innovations to address road traffic injuries and trauma care, contextualizes the work that needs to be undertaken to move the field forward and synthesizes this knowledge into practical policy recommendations for decision-makers.”

Perhaps most importantly, the report takes a global and multi-sectoral perspective, with sensitivity to those regions of the world that face specific social, economic and financial challenges, to examine the current work being done and provoke both discussion and action, especially in those areas requiring immediate attention or urgent retooling of approaches.

“The symposium in Qatar—the first of its kind—stresses the pivotal role innovation plays in addressing global health challenges,” said Professor David Bishai, forum member and senior technical advisor to JH-IIRU. “I believe the resulting report represents an important milestone for global health.”

The report concludes by setting forth ten recommendations the authors hope will be taken up by decision-makers and serve as a foundation for future work, including urging stakeholders to promote and use evidence-based innovations for road safety and trauma care, and asking global health leaders and UN agencies to ensure road safety and trauma care are included as key concerns for sustainable global health.

The summit, a high-profile initiative aimed at promoting and facilitating innovations in the delivery of healthcare around the globe, was attended by high-level officials, key decision-makers, government officials, academics, researchers and business leaders focused on tackling some of the most pressing global health challenges like road traffic injury and trauma care, as well as mental health, obesity and end-of-life care, among others.

“The cost of dealing with the consequences of these crashes, including trauma care, is in the billions of dollars. Moreover, in low- and middle-income countries, the rate of road traffic injuries is twice as high as in developed nations. While road safety issues have recently begun garnering more attention, the reality is that road injuries are responsible for more than one third of the world’s injury burden. These shocking numbers are unacceptable and represent a call to action for the global health community,” added Hyder.

JH-IIRU director, Adnan Hyder, speaks at the inaugural World Innovation Summit for Health

"Road Injuries and Trauma Care: Innovations for Policy" is available for download at

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