Systematic review of published evidence regarding trauma system effectiveness

Objective: Provide a systematic review of the published literature assessing the affect of trauma center/system implementation on patient outcomes. Data Sources: A bibliographic search of MEDLINE (1966 - May of 1998), HealthSTAR (1995 - May of 1998), and CINAHL (1982 - May of 1998), Additional manuscripts were identified in the references of reviewed manuscripts. Literature was limited to English language reports on trauma systems in the United States and Canada. Study Selection: Initial inclusion criteria were based on methodologic criteria (i.e., a comparative [controlled] study). Authors independently assessed the strength of evidence demonstrated by each article. Data Extraction: Included articles were classified into three groups based on study design: panel review studies, trauma registry comparison studies, and population-based studies. Key demographic, sampling frame, study design, and outcome variables were tabulated for each included study, Potential sources of bias were also identified and tabled. Data Synthesis: A total of 12, 11, and 17 studies were incorporated into individual evidence tables for panel review, registry comparison, and population-based studies, respectively, Included studies rely on weak evidence (Class III) to assess the impact of trauma systems on patient care and outcome. Conclusions: To date, studies assessing trauma system efficacy rely on hospital deaths as the primary indicator of effectiveness. Future research should use more sophisticated study designs (Class II) and expand available outcome measures to assess the entire continuum of care, including prehospital, rehabilitation outcomes, and long-term quality of life.