TY - JOUR
T1 - Defining the bellwether procedures and processes for global trauma care
T2 - an international Delphi study
AU - on behalf of the Global Trauma Care Delphi
AU - Bath, Michael F.
AU - Amoako, Joachim
AU - Edmiston, Thomas
AU - Ratnayake, Amila Sanjiva
AU - Kabatoro, Daphne
AU - Bagaria, Dinesh
AU - Menon, Raj
AU - Wohlgemut, Jared M.
AU - Hobbs, Laura
AU - Smith, Brandon G.
AU - Nuño-Guzmán, Carlos M.
AU - Vélez, Sebastian E.
AU - Brennan, Rick
AU - Conway Morris, Andrew
AU - Hardcastle, Timothy Craig
AU - Weiser, Thomas
AU - Bashford, Tom
AU - Feldheiser, Aarne
AU - Noureldin, Abeer
AU - Gupta, Abhinav
AU - Meidert, Agnes S.
AU - Landaluce-Olavarria, Aitor
AU - Cucino, Alberto
AU - Strumia, Alessandro
AU - Guner, Ali
AU - Lopes, Ana S.
AU - Naidoo, Anbin
AU - Zakaria, Andee Dzulkarnaen
AU - Carsetti, Andrea
AU - Gutiérrez, Andrea
AU - Sanna, Andrea
AU - Hartjes, Andreas
AU - Rubiano, Andres M.
AU - Robertson, Andrew G.
AU - Hasnaoui, Anis
AU - Gupta, Ankur
AU - Sharma, Ankur
AU - Piccolo, Annalisa
AU - Cherian, Anusha
AU - Sharma, Apurb
AU - Mahajan, Arnav
AU - James, Arthur
AU - Sousa, Ary S.de
AU - Bartakke, Ashish A.
AU - Roshdy, Ashraf
AU - Panda, Asish Kumar
AU - Zuki, Asyraf Mohd
AU - Gargavanis, Athanasios
AU - Adamu, Auwal
AU - Jawa, Randeep S.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group.. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
PY - 2026/2/20
Y1 - 2026/2/20
N2 - Background: The complexity of delivering trauma care makes the assessment of its provision challenging. The identification of bellwether procedures has previously been successful in the evaluation of global surgical care; however, any equivalent in assessing trauma care is currently lacking. Through a Delphi process, we aimed to produce the bellwether procedures and processes for global trauma care. Methods: A global Delphi process was undertaken with healthcare professionals and academics involved in trauma care from across the world. A list of potential procedures and processes was identified through literature review and expert opinion, along with subsequent additional options suggested by respondents. Three successive rounds were completed, with respondents rating the importance of each procedure or process to be undertaken at any hospital that cares for trauma patients using a five-point Likert scale. Results: A total of 411 respondents from 78 countries completed the initial round of the Delphi process, with minimal attrition observed across rounds. Following three successive rounds of the Delphi and functional aggregation, nine bellwethers of global trauma care were determined, subdivided into three functional categories: ‘Resuscitation & Stabilisation’—(1) Advanced Airway Management, (2) Short-term C-spine Immobilisation, (3) Long Bone Immobilisation; ‘Diagnosis & Monitoring’—(4) Blood Gas Analysis, (5) Focused Assessment with Sonography in Trauma (FAST) Scanning, (6) Continuous Access to CT Imaging; ‘Optimisation & Intervention’—(7) Blood Transfusion, (8) Tube Thoracostomy, (9) Laparotomy and Splenectomy. Conclusion: The Global Trauma Care Delphi study has produced nine metrics that provide pragmatic indicators for the overall assessment of trauma care capabilities at any healthcare setting worldwide. These bellwethers of global trauma care can enable hospitals, local managers and health ministries to identify institutions or regions that may require more in-depth assessment, allowing standards in the management of traumatic injuries to improve.
AB - Background: The complexity of delivering trauma care makes the assessment of its provision challenging. The identification of bellwether procedures has previously been successful in the evaluation of global surgical care; however, any equivalent in assessing trauma care is currently lacking. Through a Delphi process, we aimed to produce the bellwether procedures and processes for global trauma care. Methods: A global Delphi process was undertaken with healthcare professionals and academics involved in trauma care from across the world. A list of potential procedures and processes was identified through literature review and expert opinion, along with subsequent additional options suggested by respondents. Three successive rounds were completed, with respondents rating the importance of each procedure or process to be undertaken at any hospital that cares for trauma patients using a five-point Likert scale. Results: A total of 411 respondents from 78 countries completed the initial round of the Delphi process, with minimal attrition observed across rounds. Following three successive rounds of the Delphi and functional aggregation, nine bellwethers of global trauma care were determined, subdivided into three functional categories: ‘Resuscitation & Stabilisation’—(1) Advanced Airway Management, (2) Short-term C-spine Immobilisation, (3) Long Bone Immobilisation; ‘Diagnosis & Monitoring’—(4) Blood Gas Analysis, (5) Focused Assessment with Sonography in Trauma (FAST) Scanning, (6) Continuous Access to CT Imaging; ‘Optimisation & Intervention’—(7) Blood Transfusion, (8) Tube Thoracostomy, (9) Laparotomy and Splenectomy. Conclusion: The Global Trauma Care Delphi study has produced nine metrics that provide pragmatic indicators for the overall assessment of trauma care capabilities at any healthcare setting worldwide. These bellwethers of global trauma care can enable hospitals, local managers and health ministries to identify institutions or regions that may require more in-depth assessment, allowing standards in the management of traumatic injuries to improve.
KW - Delivery of Health Care
KW - Health policy
KW - Health systems evaluation
KW - Traumatology
UR - https://www.scopus.com/pages/publications/105035678389
U2 - 10.1136/bmjgh-2025-020909
DO - 10.1136/bmjgh-2025-020909
M3 - Article
AN - SCOPUS:105035678389
SN - 2059-7908
VL - 11
JO - BMJ Global Health
JF - BMJ Global Health
IS - 2
ER -