Eight core components for trauma care: A 12-year retrospective cohort study before and after trauma center establishment

PURPOSE: Trauma remains the leading cause of death among individuals aged 1 - 46 years worldwide, with 5.8 million annual deaths. While trauma centers reduce mortality by approximately 25%, the core components constituting an effective trauma system and their specific impacts on preventable deaths require further elucidation, particularly in newly developing systems. METHODS: This retrospective study analyzed trauma admissions from January 1, 2013, to December 31, 2024, at a tertiary hospital in Shenzhen, Guangdong province, China. All the major trauma patients (injury severity score ≥16) who died were included for death review. A multidisciplinary panel reviewed all trauma deaths using standardized audit forms based on World Health Organization definitions and the Advanced Trauma Life Support guidelines. Outcomes were compared between the pre-trauma center period (2013 - 2018) and post-trauma center period (2019 - 2024). Data were analyzed using SPSS version 25.0. RESULTS: Among 17,192 trauma admissions, 1503 were major trauma patients (injury severity score ≥16), with 82 trauma deaths identified. Preventable or potentially preventable deaths accounted for 17 cases (23.2% of trauma deaths). Following trauma center establishment, trauma deaths among major trauma patients significantly decreased from 41 to 16 (p < 0.001) when excluding deaths on arrival. A total of 151 management errors were identified; delayed adequate treatment was the most common error in preventable deaths (10/16, 62.5%). CONCLUSION: The establishment of a trauma center with 8 core components: pre-notification systems, multidisciplinary trauma teams, Advanced Trauma Life Support-based resuscitation protocols, optimized trauma bays, massive transfusion protocols, damage control surgery principles, trauma audit meetings, and a dedicated trauma services framework, was associated with significantly reduced trauma mortality. These findings provide a practical and replicable framework for trauma center development in comparable healthcare settings.