Development and use of clinical vignettes to assess injury care quality in Northern Malawi

Background It is known that outcomes after injury care in low-and-middle income countries (LMICs) are poorer than those high countries. However, little about healthcare provider competency to deliver quality these settings. We developed and used clinical vignettes evaluate an LMIC setting. Method Four serious scenarios, from agreed best practice, testing diagnostic management skills, were piloted with low-income setting clinicians. Scenarios primary referral facility clinicians Malawi. Participants described their course of action (assessment, diagnostic, treatment approaches) for each scenario, registering one point per practice response. Mean percentage total scores calculated univariable multivariable comparison made across groups, types, frequency training level. Results Fourteen Doctors, 51 Clinical Officers, 20 Medical Assistants 11 facilities participated. vignette varied significantly clinician group (Doctors 63.1% vs Officers 49.6%, p<0.001, 39.4% p=0.001). Important aspects most frequently included or omitted were: following chest injury, 88.2% reported drain insertion, 7.1% checked tracheal deviation; penetrating abdominal shock, 98.8% secured IV access, 0% mentioned tranexamic acid; severe head proposed CT neurosurgical transfer, ensured normotension; isolated open lower leg fracture, 90.1% arranged orthopaedic consultation, 2.4% assessed distal neurological status. Conclusion These proved easy use collected rich data. This supports assessing monitoring other similar