The effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis

World Journal of Emergency Surgery

Virginia Lewis¹  Sumina Shrestha²  Charne Miller³  Rayan Jafnan Alharbi⁴ 

[1] Australian Institute for Primary Care and Ageing, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, Australia;Australian Institute for Primary Care and Ageing, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, Australia;Community Development and Environment Conservation Forum, Chautara, Nepal;School of Nursing & Midwifery, La Trobe University, 1st floor, HSB 1, La Trobe University, 3086, Bundoora, VIC, Australia;School of Nursing & Midwifery, La Trobe University, 1st floor, HSB 1, La Trobe University, 3086, Bundoora, VIC, Australia;Department of Emergency Medical Service, Jazan University, Jazan, Saudi Arabia;

关键词: Trauma system;    Trauma centre;    Traumatic injury;    System effectiveness;    Mortality;    Systematic review;   

DOI  :  10.1186/s13017-021-00381-0

来源: Springer

【 摘 要 】

BackgroundTraumatic injury remains the leading cause of death, with more than five million deaths every year. Little is known about the comparative effectiveness in reducing mortality of trauma care systems at different stages of development. The objective of this study was to review the literature and examine differences in mortality associated with different stages of trauma system development.MethodA systematic review of peer-reviewed population-based studies retrieved from MEDLINE, EMBASE, and CINAHL. Additional studies were identified from references of articles, through database searching, and author lists. Articles written in English and published between 2000 and 2020 were included. Selection of studies, data extraction, and quality assessment of the included studies were performed by two independent reviewers. The results were reported as odds ratio (OR) with 95 % confidence intervals (CI).ResultsA total of 52 studies with a combined 1,106,431 traumatic injury patients were included for quantitative analysis. The overall mortality rate was 6.77% (n = 74,930). When patients were treated in a non-trauma centre compared to a trauma centre, the pooled statistical odds of mortality were reduced (OR 0.74 [95% CI 0.69–0.79]; p < 0.001). When patients were treated in a non-trauma system compared to a trauma system the odds of mortality rates increased (OR 1.17 [95% CI 1.10–1.24]; p < 0.001). When patients were treated in a post-implementation/initial system compared to a mature system, odds of mortality were significantly higher (OR 1.46 [95% CI 1.37–1.55]; p < 0.001).ConclusionThe present study highlights that the survival of traumatic injured patients varies according to the stage of trauma system development in which the patient was treated. The analysis indicates a significant reduction in mortality following the introduction of the trauma system which is further enhanced as the system matures. These results provide evidence to support efforts to, firstly, implement trauma systems in countries currently without and, secondly, to enhance existing systems by investing in system development.Systematic review registration numberPROSPERO CRD42019142842.

【 授权许可】

CC BY