TY - JOUR
T1 - Impact of Trauma System Structure on Injury Outcomes
T2 - A Systematic Review and Meta-Analysis
AU - Moore, Lynne
AU - Champion, Howard
AU - Tardif, Pier-Alexandre
AU - Kuimi, Brice-Lionel
AU - O'Reilly, Gerard
AU - Leppaniemi, Ari
AU - Cameron, Peter
AU - Palmer, Cameron S
AU - Abu-Zidan, Fikri M
AU - Gabbe, Belinda
AU - Gaarder, Christine
AU - Yanchar, Natalie
AU - Stelfox, Henry Thomas
AU - Coimbra, Raul
AU - Kortbeek, John
AU - Noonan, Vanessa K
AU - Gunning, Amy
AU - Gordon, Malcolm
AU - Khajanchi, Monty
AU - Porgo, Teegwendé V
AU - Turgeon, Alexis F
AU - Leenen, Luke
PY - 2018/5/1
Y1 - 2018/5/1
N2 - BACKGROUND: The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes.METHODS: We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria.RESULTS: We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65-0.80]) and helicopter transport (OR = 0.70 [0.55-0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4-7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44-1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [-0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68-0.85]). Quality of evidence was low or very low for mortality and healthcare utilization.CONCLUSIONS: This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.
AB - BACKGROUND: The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes.METHODS: We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria.RESULTS: We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65-0.80]) and helicopter transport (OR = 0.70 [0.55-0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4-7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44-1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [-0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68-0.85]). Quality of evidence was low or very low for mortality and healthcare utilization.CONCLUSIONS: This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.
KW - Journal Article
KW - Review
KW - Hospital Mortality
KW - Humans
KW - Length of Stay/statistics & numerical data
KW - Trauma Centers/organization & administration
KW - Surgeons/supply & distribution
KW - Emergency Medical Services/organization & administration
KW - Wounds and Injuries/mortality
UR - http://www.scopus.com/inward/record.url?scp=85032205731&partnerID=8YFLogxK
U2 - 10.1007/s00268-017-4292-0
DO - 10.1007/s00268-017-4292-0
M3 - Review article
C2 - 29071424
SN - 0364-2313
VL - 42
SP - 1327
EP - 1339
JO - World Journal of Surgery
JF - World Journal of Surgery
IS - 5
ER -