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Meta-Analysis
. 2021 Jul 13;16(1):38.
doi: 10.1186/s13017-021-00381-0.

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

Rayan Jafnan Alharbi  1   2 , Sumina Shrestha  3   4 , Virginia Lewis  3 , Charne Miller  5
Affiliations
Meta-Analysis

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

Rayan Jafnan Alharbi et al. World J Emerg Surg. .

Abstract

Background: Traumatic 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.

Method: A 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).

Results: A 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).

Conclusion: The 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 number: PROSPERO CRD42019142842 .

Keywords: Mortality; System effectiveness; Systematic review; Trauma centre; Trauma system; Traumatic injury.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram showing the searching and screening processes
Fig. 2
Fig. 2
ROBINS-I overview risk of bias assessment
Fig. 3
Fig. 3
Meta-analyses of the association between the effectiveness of trauma systems at different stages of development and mortality. A Non-trauma centre (NTC) vs trauma centre (TC) and mortality by year of publication (10 studies). B Non-trauma system (NTS) vs trauma system (TS) and mortality by year of publication (10 studies). C Post trauma implementation (initial system) vs mature system and mortality by year of publication (14 studies)
Fig. 4
Fig. 4
Mortality rates for different subgroup analysis at different stages of trauma system development. 1 Trauma centre and mortality rate for older paediatric’ patients (≤ 18 years). 2 Trauma system implementation/maturation and road trauma mortality. 3 Trauma system implementation/maturation and mortality for severely injured patients (ISS > 15)
Fig. 5
Fig. 5
Funnel plot of meta-analysis assessing different stages of trauma system development and mortality rates. A Funnel plot for meta-analysis comparing mortality rate in the non-trauma centre vs trauma centre group. B Funnel plot for meta-analysis comparing mortality rate in the non-trauma system vs trauma system group. C Funnel plot for meta-analysis comparing mortality rate in initial system vs mature system
See this image and copyright information in PMC

References

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