Population-Based Research Assessing the Effectiveness of Trauma Systems

OBJECTIVE: To review published evidence regarding the effectiveness of trauma systems by using population-based data. DESIGN: A systematic review of peer-reviewed literature assessing the influence of trauma system implementation on the outcome of all injured patients. MATERIALS AND METHODS: Literature available in MEDLINE, HealthSTAR, and CINHAL was reviewed for studies that use population-based data to assess the benefit of trauma system development. Studies were included that assessed trauma systems in North America and used a comparison or control group in the analysis. MAIN RESULTS: Published evidence, reported for eight of the nine trauma systems evaluated, demonstrates improved outcomes, principally measured as hospital survival. Improvement occurred after the trauma system or some component of a trauma system (e.g., sophisticated prehospital care) was established. CONCLUSION: Population-based evidence supports a 15 to 20% improved survival rate among seriously injured patients with trauma system implementation. Future study is required to determine whether trauma systems improve the outcome of all injured patients, not just high-risk subsets of the population.