Accepted for/Published in: JMIR Human Factors
Date Submitted: Sep 6, 2025
Date Accepted: Mar 6, 2026
Impact of Rural Trauma Team Development Education on Prehospital Time, Referral Decision to Dispatch Interval, and Outcomes of Neurological and Musculoskeletal Injuries: A Cluster Randomized Controlled Trial
ABSTRACT
Background:
Scarce human resources for health and high injury-related mortality coincide with inequities to accessing quality trauma education programs in low-and middle-income countries. Existing observational studies restrict assessments of trauma training program impacts on providers' knowledge, hindering their effectiveness in influencing clinical practice and policy changes for patient outcomes.
Objective:
To assess the impact of rural trauma team development course (RTTDC) on clinical processes and patient outcomes of motorcycle-accident-related neurological and/or musculoskeletal injuries in selected Ugandan hospitals.
Methods:
Trial design: Pragmatic two-arm, parallel, multi-period, cluster-randomized controlled trial. Participants: Trauma care frontliners, and patients aged 2-80 years at three intervention and three control Ugandan hospitals (1:1 allocation). Randomization: Hospitals were randomly allocated to intervention or control using permuted block sequences. Blinding: Patient-participants and outcome assessors were blind to allocation. Intervention arm: 500 trauma care frontliners received RTTDC; patients received standard care. Control arm: Patients received standard care without RTTDC for staff. Primary outcomes: Time from accident to admission and from referral to discharge. Secondary outcomes: 90-day mortality and morbidity related to neurological and/or musculoskeletal injuries. We followed the CONSORT guidelines for cluster randomized trials. Ethical considerations: Ethical approval was obtained from the Uganda National Council for Science and Technology (Ref: SS 5082) and Mbarara University of Science and Technology (Ref: MUREC 1/7; 05/05-19).
Results:
We analyzed 1003 participants (501 intervention, 502 control). The intervention arm had a shorter median prehospital time (1hr; IQR=0·50-2·00) and referral to discharge interval during interfacility transfers (median 2hrs; IQR=1·25-2·75) vs. [(2hrs; IQR=1·50-4·00) and (4hrs; IQR=2·50-4·10) in the control arm respectively, P<·001]. The 90-day mortality was more than halved in the intervention (5%, 24/457) vs. (13%, 58/430) in the control arm (P<·001). Fewer participants in the intervention group had unfavorable Glasgow Outcome Scale scores (9%, 42/457) vs. (20%, 87/430), P<·001. No difference was found in musculoskeletal injury morbidity outcomes (P=·57).
Conclusions:
Despite the potential bias due to retrospective registration, rural trauma team development training improved organizational time efficiency and clinical outcomes for neurological injuries without negatively impacting musculoskeletal injury morbidity outcomes. Clinical Trial: Retrospectively registered on 17/08/2023 with Pan African Clinical Trial Registry (PACTR202308851460352); https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25763 International Registered Report Identifier (IRRID): DERR1-10.2196/55297
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