Effectiveness of Standardized Nurse-Led Triage Protocols in Improving Outcomes, Timeliness, and Accuracy in Road Traffic and Trauma Care in Low-Resource Settings: A Systematic Review

Purpose: Road-traffic and trauma emergencies are major causes of preventable mortality in low- and middle-income countries (LMICs). Nurses frequently act as first responders, yet standardized nurse-led triage systems remain inconsistently implemented. This systematic review evaluated the effectiveness of validated nurse-led triage protocols in improving diagnostic accuracy, timeliness, and patient outcomes in trauma and road-traffic injury (RTI) care across low-resource LMIC settings. Methods: Following PRISMA 2020 guidelines, five databases (PubMed, Embase, Scopus, CINAHL, and Web of Science) were searched from January 2010 to October 2025. Eligible studies implemented standardized triage tools such as the South African Triage Scale (SATS) or Rapid Emergency Triage and Treatment System (RETTS) in emergency department or prehospital contexts. Risk of bias was appraised using the QUADAS-2, ROBINS-I, and JBI checklists, and findings were narratively synthesized. Results: Eight studies from Africa, Asia, and the Caribbean (Haiti) met the inclusion criteria, encompassing trauma and road-traffic injury populations in emergency and prehospital settings. Standardized nurse-led triage improved diagnostic accuracy (70-97%), reduced under-triage (≤20%), and shortened waiting times (up to 45%) and on-scene-to-care intervals (~38%). Across settings, structured triage systems enhanced recognition of high-acuity trauma and alignment between triage category and injury severity. The greatest impact occurred when protocols were supported by trained nursing leadership, periodic retraining, and clear decision-support tools. Conclusion: Standardized nurse-led triage is feasible, safe, and effective for strengthening trauma-care systems in resource-limited environments. Embedding structured triage frameworks and empowering nursing leadership can substantially improve diagnostic accuracy, timeliness, and survival outcomes in LMIC emergency care systems.