Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun 20;41(7):409-414.
doi: 10.1136/emermed-2023-213782.

Does the implementation of a trauma system affect injury-related morbidity and economic outcomes? A systematic review

Michael F Bath  1   2 , Laura Hobbs  3   2   4 , Katharina Kohler  3   2   5 , Isla Kuhn  6 , William Nabulyato  3 , Arthur Kwizera  7 , Laura E Walker  8 , Tom Wilkins  9 , Daniel Stubbs  5 , R M Burnstein  5 , Angelos Kolias  2 , Peter John Hutchinson  2 , P John Clarkson  3   10 , Sara Halimah  11 , Tom Bashford  3   2   5   10
Affiliations

Does the implementation of a trauma system affect injury-related morbidity and economic outcomes? A systematic review

Michael F Bath et al. Emerg Med J. .

Abstract

Background: Trauma accounts for a huge burden of disease worldwide. Trauma systems have been implemented in multiple countries across the globe, aiming to link and optimise multiple aspects of the trauma care pathway, and while they have been shown to reduce overall mortality, much less is known about their cost-effectiveness and impact on morbidity.

Methods: We performed a systematic review to explore the impact the implementation of a trauma system has on morbidity, quality of life and economic outcomes, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All comparator study types published since 2000 were included, both retrospective and prospective in nature, and no limits were placed on language. Data were reported as a narrative review.

Results: Seven articles were identified that met the inclusion criteria, all of which reported a pre-trauma and post-trauma system implementation comparison in high-income settings. The overall study quality was poor, with all studies demonstrating a severe risk of bias. Five studies reported across multiple types of trauma patients, the majority describing a positive impact across a variety of morbidity and health economic outcomes following trauma system implementation. Two studies focused specifically on traumatic brain injury and did not demonstrate any impact on morbidity outcomes.

Discussion: There is currently limited and poor quality evidence that assesses the impact that trauma systems have on morbidity, quality of life and economic outcomes. While trauma systems have a fundamental role to play in high-quality trauma care, morbidity and disability data can have large economic and cultural consequences, even if mortality rates have improved. The sociocultural and political context of the surrounding healthcare infrastructure must be better understood before implementing any trauma system, particularly in resource-poor and fragile settings.

Prospero registration number: CRD42022348529 LEVEL OF EVIDENCE: Level III.

Keywords: operations research; research; systems.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
See this image and copyright information in PMC

References

    1. Murray CJL, Vos T, Lozano R, et al. Disability-adjusted life years (Dalys) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. The Lancet 2012. 10.1016/S0140-6736(12)61690-0 - DOI - PubMed
    1. Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. The Lancet 2020;396:1204–22. 10.1016/S0140-6736(20)30925-9 - DOI - PMC - PubMed
    1. WHO . Injuries and violence: the facts. Geneva; 2014.
    1. WHO . WHO global Alliance for care of the injured (GACI). 2022. Available: https://www.who.int/initiatives/global-alliance-for-care-of-the-injured
    1. Mock C, Joshipura M, Arreola-Risa C, et al. An estimate of the number of lives that could be saved through improvements in trauma care globally. World J Surg 2012;36:959–63. 10.1007/s00268-012-1459-6 - DOI - PubMed

Publication types