Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
Strengthening trauma care in low- and middle-income countries through guideline adaptation and scalable system reforms
Kim-Long Le, Tri-Nhan Pham, Minh-Quang Tran, My-Tran Trinh, Phu-Cuong Pham, Quynh-Nhu Duong-Ngoc, Khanh-Phat Thai, Nguyen-Khoi Le, Tuong-Anh Mai-Phan, Hoang-Long Luong-Toan
Kim-Long Le, Tri-Nhan Pham, Phu-Cuong Pham, Khanh-Phat Thai, Nguyen-Khoi Le, Tuong-Anh Mai-Phan, Department of Hepato-Pancreato-Biliary Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam
Kim-Long Le, Tri-Nhan Pham, Minh-Quang Tran, My-Tran Trinh, Phu-Cuong Pham, Nguyen-Khoi Le, Department of Surgery, Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 07000, Viet Nam
Minh-Quang Tran, My-Tran Trinh, Department of Gastroenterology Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam
Quynh-Nhu Duong-Ngoc, Department of Surgery, Khanh Hoi Hospital, Ho Chi Minh 07000, Viet Nam
Hoang-Long Luong-Toan, Department of Anesthesiology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 07000, Viet Nam
Author contributions: Le KL and Thai KP conceived the study concept and were responsible for the overall study design; Le KL, Luong-Toan HL, Pham PC, Trinh MT, and Thai KP performed the literature search, data acquisition, and data extraction; Pham TN, Duong-Ngoc QN, and Tran MQ contributed data analysis, interpretation, and drafting of the manuscript; Le KL, Le NK, and Mai-Phan TA prepared the figures, tables, and assisted in manuscript organization; Le NK and Mai-Phan TA provided critical revisions, language editing, and formatting of the manuscript; Le KL coordinated the writing process, supervised the project, and approved the final version of the manuscript.
Conflict-of-interest statement: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
Corresponding author: Nguyen-Khoi Le, PhD, Department of Surgery, Faculty of Medicine, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung Street, Ward 12, District 10, Ho Chi Minh City 07000, Viet Nam.
tg_lenguyenkhoi@pnt.edu.vn
Received: August 25, 2025
Revised: September 21, 2025
Accepted: December 18, 2025
Published online: September 20, 2026
Processing time: 321 Days and 7.4 Hours
Trauma is a leading global cause of death and disability, with nearly 90% of fatalities occurring in low- and middle-income countries (LMICs), where prehospital care, infrastructure, and trained personnel are limited. This narrative review synthesizes literature (2019-2025) on the initial management of adult polytrauma, and explores strategies to adapt global guidelines in resource-constrained settings. Contemporary frameworks such as advanced trauma life support (ATLS) and World Health Organization essential trauma care emphasize context-sensitive sequencing, permissive hypotension, balanced transfusion, damage-control surgery, and integration of point-of-care ultrasound. Adjuncts including tranexamic acid, viscoelastic-guided transfusion, prehospital whole blood, and selective aortic balloon occlusion offer incremental survival benefits. However, widespread barriers-training deficits, blood bank shortages, lack of imaging, and absent trauma registries-impede implementation. Emerging models demonstrate that scalable solutions such as primary trauma care courses, phased ATLS rollouts, hybrid emergency rooms, and tablet-based registries can reduce mortality and referral delays without requiring wholesale adoption of high-income systems. Meaningful progress requires adapting evidence-based guidelines to local realities, supported by investments in education, diagnostics, transfusion logistics, and national surveillance. Future work should quantify cost-effectiveness and refine context-specific frameworks to close the outcome gap in LMICs.
Core Tip: This narrative review synthesizes updated global guidelines on early polytrauma management and explores practical, scalable strategies for adapting these recommendations to low- and middle-income countries (LMICs). By integrating context-sensitive clinical priorities-such as circulation-airway-breathing sequencing in exsanguination, permissive hypotension, balanced transfusion, damage-control surgery, and point-of-care diagnostics-with phased system reforms in training, referral networks, and trauma registries, LMICs can significantly improve survival without requiring wholesale replication of high-income trauma models.
