Relationship of trauma centre characteristics and patient outcomes: a systematic review

AIMS AND OBJECTIVES: To systematically review the relationship of trauma centre characteristics and trauma patient outcomes. BACKGROUND: Numerous studies have documented the impact of trauma centre level, trauma centre verification, volume per centre and per surgeon or resource availability on outcomes among trauma patients. However, there continues to be debated about whether trauma care is comparable by these trauma centre characteristics. DESIGN: Systematic review. METHODS: Eligible studies were identified via electronic database searches, footnote chasing and contact with clinical experts. Quality of selected studies was assessed in terms of internal and external validity using 14 questions. Two reviewers independently examined titles, abstracts and whether each met the predefined criteria. RESULTS: A total of 50 studies which met criteria were selected. Ten of 17 articles showed that level I trauma centres had better patient outcomes than level II centres. The achievement of trauma centre verification by American College of Surgeons or State was beneficial to decreasing mortality and length of stay in 9 of 11 studies. High trauma admission volume was beneficial in 8 of 16 studies. The volume per trauma surgeon did not contribute to better patient outcomes in 4 of 5 studies. The availability of in-house trauma surgeon was beneficial to lower mortality and shorter length of stay in only 2 of 9 studies. CONCLUSION: This review supports that achieving the trauma centre verification by American College of Surgeons or State is definitely beneficial to patient outcomes. However, the benefit of level I centres compared with level II centres, and volume of annual trauma patients to outcomes is still debating. Further prospective study examining this relationship is required. RELEVANCE TO CLINICAL PRACTICE: Understanding which characteristics of trauma centre provides the best prospect for improved outcomes depending on patient need and resource availability would allow further appreciation of the processes that foster such enhancement.