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Teaching Trauma in Austere Settings: A scoping review of pediatric trauma courses in resource-limited settings

Abstract

Background

Injury remains an important cause of death and disability globally, with 95% of all childhood injury deaths occurring in low-and middle-income countries (LMICs). Pediatric trauma training, tailored to the resources and settings in LMICs, represents an opportunity to improve such outcomes. We explored the nature of course offerings in pediatric trauma in resource-limited settings.

Methods

A scoping systematic review of seven databases was interrogated, and abstracts were reviewed and selected by independent authors based on established criteria. Data from included studies was extracted, analyzed, and summarized. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS).

Results

After screening 3960 articles for eligibility, 17 were included for the final analysis. Course delivery methods include didactic modules, simulations, clinical mentorship, small group discussion, audits, assessment and feedback. Knowledge acquisition was assessed by pre/post-tests, clinical skills assessments, and self-assessment questionnaires. Twelve studies detailed course content, 9 being based on the WHO Emergency Triage, Assessment and Treatment (ETAT) model, which is not a specific trauma course. The other 3 studies introduced novel pediatric trauma-focused training courses, teaching airway management, head trauma and cervical spine management, thoracic and abdominal trauma, orthopedic trauma, burn and wound management, and shock. Assessment of course effectiveness relied on Likert scales and unstructured written feedback, with only one course including a post-course knowledge test.

Conclusion

This review identifies the course content and training modalities of existing paediatric trauma courses and may serve as scaffold for the future development of an internationally recognized paediatric trauma course in LMICs.

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