Evidence map›Paper›PMID 38312029›Full record

Trial reportWorld journal of surgery2024

Differences in trauma care between district and regional hospitals and impact of a trauma intake form with decision support prompts in Ghana: A stepped-wedge cluster randomized trial.

Adam Gyedu, Forster Amponsah-Manu, Kwabena Awuku, Ernest Ameyaw, Kennedy K Korankye, Peter Donkor, Charles Mock

Registry-linked trialOpen access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in World journal of surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04547192 (Improving Initial Management of the Injured at Ghanaian District and Regional Hospitals With a Trauma Intake Form), which is not on this map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
4.1field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04547192 nacompletednot on this map

Improving Initial Management of the Injured at Ghanaian District and Regional Hospitals With a Trauma Intake Form

TypeinterventionalSponsorKwame Nkrumah University of Science and TechnologyRan2020 to 2022Enrolled4,105ConditionsBehavior ProblemArmsImproving initial care of the injured
3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.

  1. Guideline
  2. Towards sustaining a trauma quality improvement initiative in Ghana: results of a clinical trial.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025
    Trial
  3. Trial
  4. Global Emergency Medicine: A Scoping Review of the Literature From 2024.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026
    Article
  5. Review
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 6 institutions in 3 countries.

Adam GyeduDepartment of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.ORCID 0000-0002-4186-2403
Forster Amponsah-ManuDepartment of Surgery, Eastern Regional Hospital, Koforidua, Ghana.
Kwabena AwukuNsawam Government Hospital, Nsawam, Ghana.
Ernest AmeyawHoly Family Hospital, Techiman, Ghana.
Kennedy K KorankyeSunyani Regional Hospital, Sunyani, Ghana.
Peter DonkorDepartment of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Charles MockDepartment of Surgery, University of Washington, Seattle, Washington, USA.
Kwame Nkrumah University of Science and Technology · GHAll Nations University · GHHoly Family Hospital · GHMisawa City Hospital · JPSunyani Technical University · GHUniversity of Washington · US

Funding

Improving Initial Management of the Injured at Ghanaian District and Regional Hospitals with a Trauma Intake FormR21TW011685 · FIC · KWAME NKRUMAH UNIVERSITY/SCIENCE/TECH · PI GYEDU, ADAM · 2020 to 2021
$297k
FIC NIH HHS R21 TW011685
6 · The paper itself

Abstract

backgroundWe sought to determine the achievement of key performance indicators (KPIs) of initial trauma care at district (first-level) and regional (second-level) hospitals in Ghana and to assess the effectiveness of a standardized trauma intake form (TIF) to improve care.

methodsA stepped-wedge cluster randomized trial was performed with direct observations of trauma management before and after introducing the TIF at emergency units of eight hospitals for 17.5 months. Differences in KPIs were assessed using multivariable logistic regression and generalized linear mixed regression.

resultsManagement of 4077 patients was observed; 30% at regional and 70% at district hospitals. Eight of 20 KPIs were performed significantly more often at regional hospitals. TIF improved care at both levels. Fourteen KPIs improved significantly at district and eight KPIs improved significantly at regional hospitals. After TIF, regional hospitals still performed better with 18 KPIs being performed significantly more often than district hospitals. After TIF, all KPIs were performed in >90% of patients at regional hospitals. Examples of KPIs for which regional performed better than district hospitals after TIF included: assessment for oxygen saturation (83% vs. 98%) and evaluation for intra-abdominal bleeding (82% vs. 99%, all p < 0.001). Mortality decreased among seriously injured patients (injury severity score ≥9) at both district (15% before vs. 8% after, p = 0.04) and regional (23% vs. 7%, p = 0.004) hospitals.

conclusionsTIF improved care and lowered mortality at both hospital levels, but KPIs remained lower at district hospitals. Further measures are needed to improve initial trauma care at this level. CLINICAL TRIALS REGISTRATION: Clinicaltrials.gov (NCT04547192).

Indexed as

Emergency Service, HospitalHospitalsGhanaHospitals, DistrictHumansdistrict hospitalinjurylow- and middle-income countryquality improvementregional hospitaltrauma

Identifiers

PMID38312029
PMCPMC10960944
OpenAlexW4391611935

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.