The Evolution of Trauma Systems

IntroductionThe introduction of trauma systems that began in the 1970s resulted in improved trauma care and a decreased rate of morbidity and mortality of trauma patients. Worldwide, little is known about the effectiveness of trauma care system at different stages of development, from establishing a trauma centre, to implementing a trauma system and as trauma systems mature. The objective of this study is to extract and analyse data from research that evaluates mortality rates according to different stages of trauma system development globally.Methods and analysisThe proposed review will comply with the checklist of the ‘Preferred reporting items for systematic review and meta-analysis’. In this review, only peer-reviewed articles written in English, human-related studies and published between January 2000 and December 2020 will be included. Articles will be retrieved from MEDLINE, EMBASE and CINAHL. Additional articles will be identified from other sources such as references of included articles and author lists. Two independent authors will assess the eligibility of studies as well as critically appraise and assess the methodological quality of all included studies using the Cochrane Risk of Bias for Non-randomised Studies of Interventions tool. Two independent authors will extract the data to minimise errors and bias during the process of data extraction using an extraction tool developed by the authors. For analysis calculation, effect sizes will be expressed as risk ratios or ORs for dichotomous data or weighted (or standardised) mean differences and 95% CIs for continuous data in this systematic review.Ethics and disseminationThis systematic review will use secondary data only, therefore, research ethics approval is not required. The results from this study will be submitted to a peer-review journal for publication and we will present our findings at national and international conferences.PROSPERO registration numberCRD42019142842.

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Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments

BMJ Global Health ◽

10.1136/bmjgh-2020-004324 ◽

2021 ◽

Vol 6 (5) ◽

pp. e004324

Author(s):

John Whitaker ◽

Nollaig O'Donohoe ◽

Max Denning ◽

Dan Poenaru ◽

Elena Guadagno ◽

...

Keyword(s):

Systematic Review ◽

Health System ◽

Evidence Synthesis ◽

Rapid Assessment ◽

Sub Saharan Africa ◽

Trauma Systems ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Three Delays

BackgroundThe large burden of injuries falls disproportionately on low/middle-income countries (LMICs). Health system interventions improve outcomes in high-income countries. Assessing LMIC trauma systems supports their improvement. Evaluating systems using a Three Delays framework, considering barriers to seeking (Delay 1), reaching (Delay 2) and receiving care (Delay 3), has aided maternal health gains. Rapid assessments allow timely appraisal within resource and logistically constrained settings. We systematically reviewed existing literature on the assessment of LMIC trauma systems, applying the Three Delays framework and rapid assessment principles.MethodsWe conducted a systematic review and narrative synthesis of articles assessing LMIC trauma systems. We searched seven databases and grey literature for studies and reports published until October 2018. Inclusion criteria were an injury care focus and assessment of at least one defined system aspect. We mapped each study to the Three Delays framework and judged its suitability for rapid assessment.ResultsOf 14 677 articles identified, 111 studies and 8 documents were included. Sub-Saharan Africa was the most commonly included region (44.1%). Delay 3, either alone or in combination, was most commonly assessed (79.3%) followed by Delay 2 (46.8%) and Delay 1 (10.8%). Facility assessment was the most common method of assessment (36.0%). Only 2.7% of studies assessed all Three Delays. We judged 62.6% of study methodologies potentially suitable for rapid assessment.ConclusionsWhole health system injury research is needed as facility capacity assessments dominate. Future studies should consider novel or combined methods to study Delays 1 and 2, alongside care processes and outcomes.

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Do designated trauma systems improve outcome?

Current Opinion in Critical Care ◽

10.1097/mcc.0b013e3282f1e7a4 ◽

2007 ◽

Vol 13 (6) ◽

pp. 686-690 ◽

Cited By ~ 68

Author(s):

Koen WW Lansink ◽

Luke PH Leenen

Keyword(s):

Trauma Systems ◽

Improve Outcome

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Trauma systems and early management of severe injuries in Scandinavia: Review of the current state

Injury ◽

10.1016/j.injury.2009.05.027 ◽

2010 ◽

Vol 41 (5) ◽

pp. 444-452 ◽

Cited By ~ 49

Author(s):

Thomas Kristiansen ◽

Kjetil Søreide ◽

Kjetil G. Ringdal ◽

Marius Rehn ◽

Andreas J. Krüger ◽

...

Keyword(s):

Trauma Systems ◽

Severe Injuries ◽

Early Management ◽

Current State

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Book Review: Collaborative Treatment of Traumatized Children and Teens: The Trauma Systems Therapy Approach (2007). Glenn N. Saxe, B. Heidi Ellis, & Julie B. Kaplow, New York: Guilford, 338 page., US$40.00, ISBN 1-593385-315-7. Reviewed by Marja Humphrey

The Family Journal ◽

10.1177/1066480708317744 ◽

2008 ◽

Vol 16 (3) ◽

pp. 275-277

Author(s):

Marja Humphrey

Keyword(s):

New York ◽

Trauma Systems ◽

Therapy Approach ◽

Traumatized Children ◽

Trauma Systems Therapy

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An inventory of Canadian trauma systems: opportunities for improving access to trauma care

CJEM ◽

10.2310/8000.2013.131089 ◽

2014 ◽

Vol 16 (03) ◽

pp. 207-213 ◽

Cited By ~ 3

Author(s):

Christopher C.D. Evans ◽

J.M. Tallon ◽

Jennifer Bridge ◽

Avery B. Nathens

Keyword(s):

Trauma Care ◽

System Development ◽

Trauma System ◽

Mail Survey ◽

Trauma Systems ◽

Trauma Centres ◽

Improved Outcomes ◽

System Components ◽

Trauma Surgeons ◽

Future Work

ABSTRACT Objective: Despite evidence that patients suffering major traumatic injuries have improved outcomes when cared for within an organized system, the extent of trauma system development in Canada is limited. We sought to compile a detailed inventory of trauma systems in Canada as a first step toward identifying opportunities for improving access to trauma care. Methods: We distributed a nationwide online and mail survey to stakeholders intended to evaluate the extent of implementation of specific trauma system components. Targeted stakeholders included emergency physicians, trauma surgeons, trauma program medical directors and program managers, prehospital providers, and decision makers at the regional and provincial levels. A “snowball” approach was used to expand the sample base of the survey. Descriptive statistics were generated to quantify the nature and extent of trauma system development by region. Results: The overall response rate was 38.7%, and all levels of stakeholders and all provinces/territories were represented. All provinces were found to have designated trauma centres; however, only 60% were found to have been accredited within the past 10 years. Components present in 50% or fewer provinces included an inclusive trauma system model, interfacility transfer agreements, and a mechanism to track bed availability within the system. Conclusion: There is significant variability in the extent of trauma system development in Canada. Although all provinces have designated trauma centres, opportunities exist in many systems to implement additional components to improve the inclusiveness of care. In future work, we intend to quantify the strength of the relationship between different trauma system components and access to definitive trauma care.

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