National assessment of trauma care system capacity in Ecuador: Evaluating institutional resources and practitioner KAPS domains
7 affiliations
- 1Faculty of Public Health and Administration, Universidad Peruana Cayetano Heredia, LimaPerú.
- 2Faculty of Medicine, Universidad del Azuay, Cuenca, Ecuador.
- 3Faculty of Medicine, Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador.
- 4Department of Surgery, Monte Sinaí General Hospital, Guayaquil, Ecuador.
- 5Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, United States of America.
- 6School of Human Medicine, Faculty of Health Sciences, Universidad Nacional de Tumbes, Tumbes, Perú.
- 7Center for Global Health, Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Perú.
Abstract
We evaluated Ecuador’s trauma care system capacity by analyzing the discrepancy between hospital infrastructure and the individual dimensions of the Knowledge, Attitudes, Practices, and Safety (KAPS) framework among medical specialists. A nationwide, multicomponent cross-sectional study was conducted (2025–2026), comprising a complete structural audit of 49 eligible public hospitals (Levels II and III) and a KAPS survey of 215 trauma-facing specialists representing 36 institutions (73.5% institutional participation rate). Spatial workflow efficiency was assessed via Emergency Department-to-Computed Tomography (ED-CT) transit distances. Independent multivariable Poisson regression models evaluated each KAPS dimension separately, reporting adjusted Incidence Rate Ratios (IRR)accounting for institutional clustering and professional seniority. The institutional audit revealed significant operational constraints: 51.0% of hospitals lacked 24/7 radiological coverage, and 16.3% experienced CT scanner downtime. Spatial ED-to-CT distances were significantly greater in Level III tertiary centers, reaching up to 300 meters (p = 0.006). Among specialists (N = 215 across 36 hospitals), ecological associations with provincial trauma volume yielded wide confidence intervals spanning the null value across domains (Knowledge: rho = 0.113, 95% CI: -0.39–0.61; Reported Practice: rho = -0.160, 95% CI: -0.66–0.34), reflecting low statistical precision from macro-level aggregation. Dimension-specific multivariable models revealed marked inter-specialty divergence: Emergency Physicians exhibited lower Knowledge (aIRR = 0.61; 95% CI: 0.50–0.74), but higher rate ratios in Reported Practices (aIRR = 1.48; 95% CI: 1.34–1.65), Attitudes (aIRR = 1.12; 95% CI: 1.09–1.16), and Safety (aIRR = 1.18; 95% CI: 1.12–1.25) relative to General Surgery. Ecuador’s trauma network exhibits a measurable discrepancy between nominal infrastructure and operational availability. System capacity is constrained by physical architectural barriers and a divergence between practitioners’ subjective perceptions and objective decision-making skills. Strategic priorities must include a unified National Trauma Registry, integrated teleradiology, and continuous scenario-based training.
Related
- Evaluating and leveraging large language models in clinical pharmacology and therapeutics assessment: From exam takers to exam shapers
- Quantifying the unique needs of women with lower limb loss: A national, cross-sectional, survey-based needs assessment
- Remote sensing assessment of nature-based solution priorities and green finance needs for ecosystem restoration in Shahdag National Park
- Bridging Local Ecological Knowledge and Remote Sensing for Wildlife Assessment and Conservation: Insights from Sebitoli, Kibale National Park, Uganda
- Agricultural expansion and mining drive forest loss in Ghana despite declining deforestation rates: Evidence from a national-scale assessment
BibTeX
@article{sarmientoaltamirano2026national,
title = {{National assessment of trauma care system capacity in Ecuador: Evaluating institutional resources and practitioner KAPS domains}},
author = {Doris Sarmiento-Altamirano and Edison Angamarca-Angamarca and Juan Carlos Salamea and Edgar B Rodas and Luz María Moyano-Vidal},
journal = {PLOS Global Public Health},
year = {2026},
month = oct,
doi = {10.1371/journal.pgph.0007065},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007065},
note = {CC BY},
}
RIS
TY - JOUR
TI - National assessment of trauma care system capacity in Ecuador: Evaluating institutional resources and practitioner KAPS domains
AU - Doris Sarmiento-Altamirano
AU - Edison Angamarca-Angamarca
AU - Juan Carlos Salamea
AU - Edgar B Rodas
AU - Luz María Moyano-Vidal
PY - 2026
DA - 2026/10/26
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007065
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007065
AB - We evaluated Ecuador’s trauma care system capacity by analyzing the discrepancy between hospital infrastructure and the individual dimensions of the Knowledge, Attitudes, Practices, and Safety (KAPS) framework among medical specialists. A nationwide, multicomponent cross-sectional study was conducted (2025–2026), comprising a complete structural audit of 49 eligible public hospitals (Levels II and III) and a KAPS survey of 215 trauma-facing specialists representing 36 institutions (73.5% institutional participation rate). Spatial workflow efficiency was assessed via Emergency Department-to-Computed Tomography (ED-CT) transit distances. Independent multivariable Poisson regression models evaluated each KAPS dimension separately, reporting adjusted Incidence Rate Ratios (IRR)accounting for institutional clustering and professional seniority. The institutional audit revealed significant operational constraints: 51.0% of hospitals lacked 24/7 radiological coverage, and 16.3% experienced CT scanner downtime. Spatial ED-to-CT distances were significantly greater in Level III tertiary centers, reaching up to 300 meters (p = 0.006). Among specialists (N = 215 across 36 hospitals), ecological associations with provincial trauma volume yielded wide confidence intervals spanning the null value across domains (Knowledge: rho = 0.113, 95% CI: -0.39–0.61; Reported Practice: rho = -0.160, 95% CI: -0.66–0.34), reflecting low statistical precision from macro-level aggregation. Dimension-specific multivariable models revealed marked inter-specialty divergence: Emergency Physicians exhibited lower Knowledge (aIRR = 0.61; 95% CI: 0.50–0.74), but higher rate ratios in Reported Practices (aIRR = 1.48; 95% CI: 1.34–1.65), Attitudes (aIRR = 1.12; 95% CI: 1.09–1.16), and Safety (aIRR = 1.18; 95% CI: 1.12–1.25) relative to General Surgery. Ecuador’s trauma network exhibits a measurable discrepancy between nominal infrastructure and operational availability. System capacity is constrained by physical architectural barriers and a divergence between practitioners’ subjective perceptions and objective decision-making skills. Strategic priorities must include a unified National Trauma Registry, integrated teleradiology, and continuous scenario-based training.
SN - 2767-3375
ER -