PONE-D-20-26293

Maturation Process and International Accreditation of Trauma System in a Rapidly Developing Country

PLOS ONE

Dear Dr. El-Menyar,

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Zsolt J. Balogh, MD, PhD, FRACS

Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

Dear Authors,

Our reviewers have major concerns about your methodology and found your paper rather marginal.

Please attempt to address their questions and concerns in an itemised fashion to potentially reconsider it for review.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: No

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thankyou for the opportunity to review the article “Maturation Process and International Accreditation of Trauma System in a Rapidly Developing Country”.

I commend the authors on being leaders in improving trauma care in Qatar.

To determine if the positive results are because of the improved trauma system, there needs to be;

1. Specific detail about the trauma system and the changes introduced

2. A time series analysis of outcomes. It is not possible to do a pre/post analysis based on accreditation, because many of the changes were made leading up to accreditation – so the conclusions are not valid.

You have the data to do this, and it is possible. I suggest this is conducted and the manuscript revised and resubmitted.

I also have some minor comments around the abstract

The background in the abstract is a hypothesis, there needs to be a little bit of introduction / need for the paper provided – for example, some detail about the changes that were introduced as part of the trauma system

Methods: what type of analyses were performed?

In the conclusion you have introduced new results.

Reviewer #2: Thank you for your submission which sought to determine the effects of trauma system maturation to Level 1 trauma care on the outcomes of trauma patients in a rapidly developing country (Qatar).

Abstract: Appropriate representation of the manuscript.

Introduction: Provides thorough information as to the reason for the study.

Patients and methods:

Please add appropriate reference to AIS coding section.

It is difficult to see the split of injury severity within the data. The provision of ISS grouping i.e. <12, 12-15, >15 or similar would provide better understanding of the nuances of care for injured groups and also assist in the understanding of access to time critical intervention. An example of data that requires greater understanding is the ED LOS times. 405 mins is significant for those with ISS >15, but not so with those <15.

Results: Appropriately described.

Discussion: See comments

Comments:

The paragraph on education either needs to be related to the study data of removed as it does not currently add value to the discussion.

This is an important body of work and I would like to commend you on your commitment to improving the care provided to injured people and their families. Development and maturation of systems of care are never easy, particularly in developing countries.

Whilst I am enthusiastic about the results here, I do feel that further breakdown and analysis of data is required (as suggested above). I look forward to future developments.

Thank you for your paper.

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Reviewer #1: No

Reviewer #2: No

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Maturation Process and International Accreditation of Trauma System in a Rapidly Developing Country

PONE-D-20-26293R1

Dear Dr. El-Menyar,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Zsolt J. Balogh, MD, PhD, FRACS

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thankyou for addressing my comments. I have no further comments

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No