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Background:
Traumatic injury is a major global health challenge that contributes disproportionately to mortality and long-term disability, particularly in low- and middle-income countries (LMICs). In Cameroon, limited healthcare infrastructure and resource constraints contribute to high rates of preventable trauma-related deaths. Prior research by the Program for Surgical Equity (PASE) in Cameroon suggests that a significant amount of trauma deaths may be preventable and are often due to delayed recognition, inadequate initial management and limited access to critical interventions. These findings highlight the need for targeted, yet scalable, interventions to improve early identification and management of traumatic injury. Smartphone-based ultrasound (SBU) represents a low-cost, portable innovation with the potential to enhance diagnostic capacity and facilitate timely identification of life-threatening injuries in settings with limited resources.

Objectives:
We aim to evaluate the impact of an SBU program on trauma-related preventable deaths in Cameroon in order to reduce the burden of injury and improve overall trauma care in resource-limited setting. Specific objectives include: (1) quantify changes in care utilization patterns following SBU implementation, (2) assess changes in outcomes, and (3) evaluate the association between SBU implementation and preventable death rates.

Design:
Implementation of the SBU intervention requires standardizing and training providers on an SBU protocol across 4 Cameroonian hospitals. When a patient presents with a new traumatic injury at each of these sites, providers will implement the use of SBU during eFAST exams and subsequently record findings in a corresponding assessment tool (to be used for data and quality improvement measures). Data is collected across pre-implementation and implementation periods. Quantitative data (management, clinical findings, mortality, etc.) is collected through chart review and the Cameroon Trauma Registry (CTR). Qualitative data (identifying and categorizing preventability, barriers to implementation, etc.) is collected through semi-structured interviews and regular meetings with providers. Outcomes will ultimately be analyzed in a mixed-methods study.

Impact:
This study primarily evaluates changes in care utilization and diagnostic capacity following SBU implementation, with exploratory analyses of mortality and preventable death trends. Improvements in timeliness and appropriateness of interventions are expected to correlate with improved trauma outcomes. Findings will provide foundational evidence regarding the effectiveness and scalability of SBU programs in reducing trauma burden in LMIC healthcare systems.

Lessons Learned:
Implementation of an SBU program across sites and providers highlights the importance of standardizing imaging protocols and corresponding assessment. Variability in image capture underscores the need for structured training and validated rating systems to assess image quality. Additionally, developing a systematic approach to identifying and categorizing preventable deaths proves essential yet complex. Establishing clear definitions, standardized review criteria and an overall consensus process is critical to improving reliability and consistency in preventable death classification across institutions. These efforts are essential for ensuring data validity, enabling cross-site comparability and supporting scalable implementation of initiatives in the future.

Summary:
This intervention addresses a critical gap in trauma care by evaluating a scalable, resource-efficient diagnostic intervention in a low-resource setting. Findings will inform strategies to reduce preventable trauma-related deaths and support future program expansion, capacity building and future studies. The SBU model has potential for broader application across LMICs to strengthen emergency and trauma care systems and improve patient outcomes.