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study aimed determine effectiveness standardized trauma intake form tif improve achievement key performance indicators kpis initial trauma care among injured children compared adults nontertiary hospitals ghana steppedwedge cluster randomized trial performed research assistants directly observing management injured patients introducing tif emergency units 8 nontertiary hospitals 175 months differences outcomes children adults periods tif introduction determined multivariable logistic regression differences outcomes among children tif introduction determined using generalized linear mixed regression management 3889 injured patients observed 757 19 children 18 years trauma care kpis baseline lower children compared adults improvements primary survey kpis observed among children tif introduction examples include airway assessment 279 71 359 98 adjusted odds ratio aor 7442 p 0005 chest examination 225 58 349 95 aor 5380 p 0002 however despite improvements achievement kpis still lower compared adults examples pelvic fracture evaluation children 295 80 vs adults 1416 88 aor 056 p 0001 respiratory rate assessment children 310 84 vs adults 1458 91 aor 058 p 0030 tif effective improving kpis pediatric trauma care targeted education needed bridge gap quality pediatric adult trauma care nontertiary hospitals ghana low middleincome countries steppedwedged cluster randomized controlled trial