Systematic review of published evidence regarding trauma system effectiveness

Area of Science:

• Trauma care systems research
• Patient outcome analysis
• Health services research

Background:

• Trauma center and system implementation significantly impacts patient outcomes.
• Evaluating the effectiveness of trauma systems is crucial for improving emergency medical care.
• Existing literature on trauma system efficacy requires systematic review.

Purpose of the Study:

• To systematically review published literature on the impact of trauma center/system implementation on patient outcomes.
• To assess the strength of evidence supporting the effectiveness of trauma systems.
• To identify limitations in current research methodologies and suggest future directions.

Main Methods:

• Conducted a comprehensive bibliographic search of MEDLINE, HealthSTAR, and CINAHL databases (1966-1998).
• Included English-language studies on trauma systems in the United States and Canada.
• Classified studies into panel review, trauma registry comparison, and population-based designs, assessing evidence strength and potential biases.

Main Results:

• A total of 40 studies were included across three categories: 12 panel review, 11 registry comparison, and 17 population-based studies.
• The majority of included studies utilized weak evidence (Class III) to evaluate trauma system impact.
• Hospital deaths were identified as the predominant outcome measure in current effectiveness studies.

Conclusions:

• Current evidence on trauma system effectiveness is largely based on limited study designs and outcome measures.
• Future research should employ more rigorous study designs (Class II) to assess trauma system impact.
• Expanding outcome measures to include prehospital, rehabilitation, and long-term quality of life is essential for a holistic evaluation.