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PRIoritisation of orthopaedic resources and interventions in trauma (PRIORI-T): A modified delphi consensus study
Jeandre Deon Kotze1, Mikail Amod2, Cornel Breedt3
1Division of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
Injury
|June 24, 2026
Summary
This study established consensus on factors for prioritizing orthopedic surgery in South African public hospitals, focusing on patient and injury specifics. It provides a framework, not a scoring system, for resource-constrained settings.
Area of Science:
- Orthopaedic Surgery
- Health Systems Research
- Public Health
Background:
- Operative orthopaedic care in resource-constrained systems faces limitations in theatre time, staffing, and resources.
- Lack of explicit prioritization frameworks leads to variability in surgical decision-making.
- This study addresses the need for a structured approach to prioritize patients awaiting orthopedic surgery in South African public hospitals.
Purpose of the Study:
- To establish consensus among South African public-sector orthopaedic clinicians on factors for prioritizing operative orthopaedic care.
- To develop a framework for decision-making in resource-limited settings.
- To identify patient-specific and injury-specific factors influencing surgical prioritization.
Main Methods:
- A three-round modified Delphi study was conducted with South African public-sector orthopaedic clinicians.
- Patient-specific factors (e.g., age, comorbidities) and injury-specific factors (e.g., soft-tissue status, anatomical site) were rated on importance scales.
- Consensus was defined by median scores and agreement percentages, excluding polytrauma and spinal injuries.
Main Results:
- Six patient-specific factors (age, diabetes, severe comorbidities, functional status, physiological reserve, psychiatric instability) reached inclusion consensus.
- Six injury-specific factors, including soft-tissue status, anatomical site, and neurovascular status, also reached consensus.
- Acute compartment syndrome and threatened limb vascular status were identified as red-flag overrides; no tie-breakers reached consensus.
Conclusions:
- A consensus framework for prioritizing operative orthopaedic care in low- and middle-income countries (LMICs) was developed.
- The findings suggest a preliminary framework rather than a validated scoring system.
- Further research is needed for implementation, including prospective weighting and outcome validation.
