Implementation of the World Health Organization Trauma Care Checklist Program in 11 centers across multiple economic strata: effect on care process measures


Angela Lashohe, Chemin de Contamine, Chanay
Eric B. Schneider, Harvard Medical School
Catherine Juillard, University of California
Kent Stevens, Johns Hopkins School of Medicine
Elizabeth Colantuoni, Johns Hopkins University
William R. Berry, Harvard School of Public Health
Christina Bloem, SUNY Downstate Medical Center
Witaya Chadbunchachai, Khon Kaen Hospital
Satish Dharap, Lokmanya Tilak Municipal Medical College and General Hospital
Sydney Dy, Johns Hopkins Bloomberg School of Public Health
Gerald Dziekan, World Self-Medication Industry
Russell L. Gruen, Nanyang Technological University,
Jaymie A. Henry, University of Chicago,
Christina Huwer, Clinic for Trauma Surgery and Orthopedics
Manju Joshipura, Academy of Traumatology
Edward Kelley, World Health Organization
Etienne Krug, World Health Organization
Vineet Kumar, Lokmanya Tilak Municipal Medical College and General Hospital
Patrick Kyamanywa, University of Rwanda
Alain Chichom Mefire, University of Buea and Regional Hospital Limbe
Marcos Musafir, Federal University of Rio de Janeiro
Avery Nathens, University of Toronto and Sunnybrook Health Sciences Centre
Edouard Ngendahayo, University Teaching Hospital of Kigali
Thai Son Nguyen, Duc Giang General Hospital
Nobhojit Roy, HBNI University
Peter Pronovost, Johns Hopkins Medicine
Irum Qumar Khan, Aga Khan University
Junaid Abdul Razzak, Aga Khan UniversityFollow
James Turner, Sick Kids Hospital
Mathew Varghese, St Stephen's Hospital
Rimma Zakirova, University of Toronto
Charles Mock, University of Washington

Document Type



Emergency Medicine; Centre for Innovation in Medical Education



Trauma contributes more than ten percent of the global burden of disease. Initial assessment and resuscitation of trauma patients often requires rapid diagnosis and management of multiple concurrent complex conditions, and errors are common. We investigated whether implementing a trauma care checklist would improve care for injured patients in low-, middle-, and high-income countries.


From 2010 to 2012, the impact of the World Health Organization (WHO) Trauma Care Checklist program was assessed in 11 hospitals using a stepped wedge pre- and post-intervention comparison with randomly assigned intervention start dates. Study sites represented nine countries with diverse economic and geographic contexts. Primary end points were adherence to process of care measures; secondary data on morbidity and mortality were also collected. Multilevel logistic regression models examined differences in measures pre- versus post-intervention, accounting for patient age, gender, injury severity, and center-specific variability.


Data were collected on 1641 patients before and 1781 after program implementation. Patient age (mean 34 ± 18 vs. 34 ± 18), sex (21 vs. 22 % female), and the proportion of patients with injury severity scores (ISS) ≥ 25 (10 vs. 10 %) were similar before and after checklist implementation (p > 0.05). Improvement was found for 18 of 19 process measures, including greater odds of having abdominal examination (OR 3.26), chest auscultation (OR 2.68), and distal pulse examination (OR 2.33) (all p < 0.05). These changes were robust to several sensitivity analyses.


Implementation of the WHO Trauma Care Checklist was associated with substantial improvements in patient care process measures among a cohort of patients in diverse settings.

Publication (Name of Journal)

World Journal of Surgery

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.