Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis
Background The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clini...
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| Veröffentlicht in: | World journal of surgery 2018-05, Vol.42 (5), p.1327-1339 |
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| creator | Moore, Lynne Champion, Howard Tardif, Pier-Alexandre Kuimi, Brice-Lionel O’Reilly, Gerard Leppaniemi, Ari Cameron, Peter Palmer, Cameron S. Abu-Zidan, Fikri M. Gabbe, Belinda Gaarder, Christine Yanchar, Natalie Stelfox, Henry Thomas Coimbra, Raul Kortbeek, John Noonan, Vanessa K. Gunning, Amy Gordon, Malcolm Khajanchi, Monty Porgo, Teegwendé V. Turgeon, Alexis F. Leenen, Luke |
| description | Background
The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes.
Methods
We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria.
Results
We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65–0.80]) and helicopter transport (OR = 0.70 [0.55–0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4–7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44–1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [−0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68–0.85]). Quality of evidence was low or very low for mortality and healthcare utilization.
Conclusions
This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions. |
| doi_str_mv | 10.1007/s00268-017-4292-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1956082681</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1956082681</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4656-8061bd94af66b2963ca1b06dbe1cb2dafa319b3246bbc4becdd51b141639f6043</originalsourceid><addsrcrecordid>eNqFkM9rFDEYhkNR7Nr6B_QiAS9eRr8vyWYnva3F6kql0K146CEkmUyZZX6sycQy_70ps1YQxNP3HZ735eUh5AzhHQKs3kcAJssCcFUIplgBR2SBgrOCccafkQVwKfKP_Ji8jHEHGZQgX5BjpmCFgokFudt0e-NGOtT0NpjUGbqd4ug7uh1DcmMKng493fS7FCZ6nUY3dD6e0_UBM2Pj6I3_2fgHavqKfvWjKda9aafYxFPyvDZt9K8O94R8u_x4e_G5uLr-tLlYXxVOyKUsSpBoKyVMLaVlSnJn0IKsrEdnWWVqw1FZzoS01gnrXVUt0aJAyVUtQfAT8nbu3YfhR_Jx1F0TnW9b0_shRY1qKaHMpjCjb_5Cd0MKeW_UDBgvVamUyhTOlAtDjMHXeh-azoRJI-hH83o2r7NQ_WheQ868PjQn2_nqKfFbdQbUDDw0rZ_-36i_f9l-uIRyxWTOsjkbc6y_9-HP7H8v-gUOEp4-</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2023898999</pqid></control><display><type>article</type><title>Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Moore, Lynne ; Champion, Howard ; Tardif, Pier-Alexandre ; Kuimi, Brice-Lionel ; O’Reilly, Gerard ; Leppaniemi, Ari ; Cameron, Peter ; Palmer, Cameron S. ; Abu-Zidan, Fikri M. ; Gabbe, Belinda ; Gaarder, Christine ; Yanchar, Natalie ; Stelfox, Henry Thomas ; Coimbra, Raul ; Kortbeek, John ; Noonan, Vanessa K. ; Gunning, Amy ; Gordon, Malcolm ; Khajanchi, Monty ; Porgo, Teegwendé V. ; Turgeon, Alexis F. ; Leenen, Luke</creator><creatorcontrib>Moore, Lynne ; Champion, Howard ; Tardif, Pier-Alexandre ; Kuimi, Brice-Lionel ; O’Reilly, Gerard ; Leppaniemi, Ari ; Cameron, Peter ; Palmer, Cameron S. ; Abu-Zidan, Fikri M. ; Gabbe, Belinda ; Gaarder, Christine ; Yanchar, Natalie ; Stelfox, Henry Thomas ; Coimbra, Raul ; Kortbeek, John ; Noonan, Vanessa K. ; Gunning, Amy ; Gordon, Malcolm ; Khajanchi, Monty ; Porgo, Teegwendé V. ; Turgeon, Alexis F. ; Leenen, Luke ; International Injury Care Improvement Initiative</creatorcontrib><description>Background
The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes.
Methods
We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria.
Results
We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65–0.80]) and helicopter transport (OR = 0.70 [0.55–0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4–7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44–1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [−0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68–0.85]). Quality of evidence was low or very low for mortality and healthcare utilization.
Conclusions
This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-017-4292-0</identifier><identifier>PMID: 29071424</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abdominal Surgery ; Cardiac Surgery ; Emergency Medical Services - organization & administration ; General Surgery ; Health care ; Hospital Mortality ; Humans ; Injury analysis ; Injury prevention ; Length of Stay - statistics & numerical data ; Medical personnel ; Medicine ; Medicine & Public Health ; Meta-analysis ; Morbidity ; Mortality ; Population density ; Qualitative analysis ; Reviews ; Scientific Review ; Surgeons - supply & distribution ; Surgery ; System effectiveness ; Systematic review ; Thoracic Surgery ; Transport ; Trauma ; Trauma centers ; Trauma Centers - organization & administration ; Universal design ; Vascular Surgery ; Websites ; Wounds and Injuries - mortality</subject><ispartof>World journal of surgery, 2018-05, Vol.42 (5), p.1327-1339</ispartof><rights>Société Internationale de Chirurgie 2017</rights><rights>2018 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>World Journal of Surgery is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4656-8061bd94af66b2963ca1b06dbe1cb2dafa319b3246bbc4becdd51b141639f6043</citedby><cites>FETCH-LOGICAL-c4656-8061bd94af66b2963ca1b06dbe1cb2dafa319b3246bbc4becdd51b141639f6043</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-017-4292-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-017-4292-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,41464,42533,45550,45551,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29071424$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Moore, Lynne</creatorcontrib><creatorcontrib>Champion, Howard</creatorcontrib><creatorcontrib>Tardif, Pier-Alexandre</creatorcontrib><creatorcontrib>Kuimi, Brice-Lionel</creatorcontrib><creatorcontrib>O’Reilly, Gerard</creatorcontrib><creatorcontrib>Leppaniemi, Ari</creatorcontrib><creatorcontrib>Cameron, Peter</creatorcontrib><creatorcontrib>Palmer, Cameron S.</creatorcontrib><creatorcontrib>Abu-Zidan, Fikri M.</creatorcontrib><creatorcontrib>Gabbe, Belinda</creatorcontrib><creatorcontrib>Gaarder, Christine</creatorcontrib><creatorcontrib>Yanchar, Natalie</creatorcontrib><creatorcontrib>Stelfox, Henry Thomas</creatorcontrib><creatorcontrib>Coimbra, Raul</creatorcontrib><creatorcontrib>Kortbeek, John</creatorcontrib><creatorcontrib>Noonan, Vanessa K.</creatorcontrib><creatorcontrib>Gunning, Amy</creatorcontrib><creatorcontrib>Gordon, Malcolm</creatorcontrib><creatorcontrib>Khajanchi, Monty</creatorcontrib><creatorcontrib>Porgo, Teegwendé V.</creatorcontrib><creatorcontrib>Turgeon, Alexis F.</creatorcontrib><creatorcontrib>Leenen, Luke</creatorcontrib><creatorcontrib>International Injury Care Improvement Initiative</creatorcontrib><title>Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes.
Methods
We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria.
Results
We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65–0.80]) and helicopter transport (OR = 0.70 [0.55–0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4–7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44–1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [−0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68–0.85]). Quality of evidence was low or very low for mortality and healthcare utilization.
Conclusions
This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.</description><subject>Abdominal Surgery</subject><subject>Cardiac Surgery</subject><subject>Emergency Medical Services - organization & administration</subject><subject>General Surgery</subject><subject>Health care</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Injury analysis</subject><subject>Injury prevention</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Population density</subject><subject>Qualitative analysis</subject><subject>Reviews</subject><subject>Scientific Review</subject><subject>Surgeons - supply & distribution</subject><subject>Surgery</subject><subject>System effectiveness</subject><subject>Systematic review</subject><subject>Thoracic Surgery</subject><subject>Transport</subject><subject>Trauma</subject><subject>Trauma centers</subject><subject>Trauma Centers - organization & administration</subject><subject>Universal design</subject><subject>Vascular Surgery</subject><subject>Websites</subject><subject>Wounds and Injuries - mortality</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkM9rFDEYhkNR7Nr6B_QiAS9eRr8vyWYnva3F6kql0K146CEkmUyZZX6sycQy_70ps1YQxNP3HZ735eUh5AzhHQKs3kcAJssCcFUIplgBR2SBgrOCccafkQVwKfKP_Ji8jHEHGZQgX5BjpmCFgokFudt0e-NGOtT0NpjUGbqd4ug7uh1DcmMKng493fS7FCZ6nUY3dD6e0_UBM2Pj6I3_2fgHavqKfvWjKda9aafYxFPyvDZt9K8O94R8u_x4e_G5uLr-tLlYXxVOyKUsSpBoKyVMLaVlSnJn0IKsrEdnWWVqw1FZzoS01gnrXVUt0aJAyVUtQfAT8nbu3YfhR_Jx1F0TnW9b0_shRY1qKaHMpjCjb_5Cd0MKeW_UDBgvVamUyhTOlAtDjMHXeh-azoRJI-hH83o2r7NQ_WheQ868PjQn2_nqKfFbdQbUDDw0rZ_-36i_f9l-uIRyxWTOsjkbc6y_9-HP7H8v-gUOEp4-</recordid><startdate>201805</startdate><enddate>201805</enddate><creator>Moore, Lynne</creator><creator>Champion, Howard</creator><creator>Tardif, Pier-Alexandre</creator><creator>Kuimi, Brice-Lionel</creator><creator>O’Reilly, Gerard</creator><creator>Leppaniemi, Ari</creator><creator>Cameron, Peter</creator><creator>Palmer, Cameron S.</creator><creator>Abu-Zidan, Fikri M.</creator><creator>Gabbe, Belinda</creator><creator>Gaarder, Christine</creator><creator>Yanchar, Natalie</creator><creator>Stelfox, Henry Thomas</creator><creator>Coimbra, Raul</creator><creator>Kortbeek, John</creator><creator>Noonan, Vanessa K.</creator><creator>Gunning, Amy</creator><creator>Gordon, Malcolm</creator><creator>Khajanchi, Monty</creator><creator>Porgo, Teegwendé V.</creator><creator>Turgeon, Alexis F.</creator><creator>Leenen, Luke</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201805</creationdate><title>Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis</title><author>Moore, Lynne ; Champion, Howard ; Tardif, Pier-Alexandre ; Kuimi, Brice-Lionel ; O’Reilly, Gerard ; Leppaniemi, Ari ; Cameron, Peter ; Palmer, Cameron S. ; Abu-Zidan, Fikri M. ; Gabbe, Belinda ; Gaarder, Christine ; Yanchar, Natalie ; Stelfox, Henry Thomas ; Coimbra, Raul ; Kortbeek, John ; Noonan, Vanessa K. ; Gunning, Amy ; Gordon, Malcolm ; Khajanchi, Monty ; Porgo, Teegwendé V. ; Turgeon, Alexis F. ; Leenen, Luke</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4656-8061bd94af66b2963ca1b06dbe1cb2dafa319b3246bbc4becdd51b141639f6043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Abdominal Surgery</topic><topic>Cardiac Surgery</topic><topic>Emergency Medical Services - organization & administration</topic><topic>General Surgery</topic><topic>Health care</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Injury analysis</topic><topic>Injury prevention</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Medical personnel</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Population density</topic><topic>Qualitative analysis</topic><topic>Reviews</topic><topic>Scientific Review</topic><topic>Surgeons - supply & distribution</topic><topic>Surgery</topic><topic>System effectiveness</topic><topic>Systematic review</topic><topic>Thoracic Surgery</topic><topic>Transport</topic><topic>Trauma</topic><topic>Trauma centers</topic><topic>Trauma Centers - organization & administration</topic><topic>Universal design</topic><topic>Vascular Surgery</topic><topic>Websites</topic><topic>Wounds and Injuries - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moore, Lynne</creatorcontrib><creatorcontrib>Champion, Howard</creatorcontrib><creatorcontrib>Tardif, Pier-Alexandre</creatorcontrib><creatorcontrib>Kuimi, Brice-Lionel</creatorcontrib><creatorcontrib>O’Reilly, Gerard</creatorcontrib><creatorcontrib>Leppaniemi, Ari</creatorcontrib><creatorcontrib>Cameron, Peter</creatorcontrib><creatorcontrib>Palmer, Cameron S.</creatorcontrib><creatorcontrib>Abu-Zidan, Fikri M.</creatorcontrib><creatorcontrib>Gabbe, Belinda</creatorcontrib><creatorcontrib>Gaarder, Christine</creatorcontrib><creatorcontrib>Yanchar, Natalie</creatorcontrib><creatorcontrib>Stelfox, Henry Thomas</creatorcontrib><creatorcontrib>Coimbra, Raul</creatorcontrib><creatorcontrib>Kortbeek, John</creatorcontrib><creatorcontrib>Noonan, Vanessa K.</creatorcontrib><creatorcontrib>Gunning, Amy</creatorcontrib><creatorcontrib>Gordon, Malcolm</creatorcontrib><creatorcontrib>Khajanchi, Monty</creatorcontrib><creatorcontrib>Porgo, Teegwendé V.</creatorcontrib><creatorcontrib>Turgeon, Alexis F.</creatorcontrib><creatorcontrib>Leenen, Luke</creatorcontrib><creatorcontrib>International Injury Care Improvement Initiative</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moore, Lynne</au><au>Champion, Howard</au><au>Tardif, Pier-Alexandre</au><au>Kuimi, Brice-Lionel</au><au>O’Reilly, Gerard</au><au>Leppaniemi, Ari</au><au>Cameron, Peter</au><au>Palmer, Cameron S.</au><au>Abu-Zidan, Fikri M.</au><au>Gabbe, Belinda</au><au>Gaarder, Christine</au><au>Yanchar, Natalie</au><au>Stelfox, Henry Thomas</au><au>Coimbra, Raul</au><au>Kortbeek, John</au><au>Noonan, Vanessa K.</au><au>Gunning, Amy</au><au>Gordon, Malcolm</au><au>Khajanchi, Monty</au><au>Porgo, Teegwendé V.</au><au>Turgeon, Alexis F.</au><au>Leenen, Luke</au><aucorp>International Injury Care Improvement Initiative</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2018-05</date><risdate>2018</risdate><volume>42</volume><issue>5</issue><spage>1327</spage><epage>1339</epage><pages>1327-1339</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Background
The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes.
Methods
We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria.
Results
We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65–0.80]) and helicopter transport (OR = 0.70 [0.55–0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4–7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44–1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [−0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68–0.85]). Quality of evidence was low or very low for mortality and healthcare utilization.
Conclusions
This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>29071424</pmid><doi>10.1007/s00268-017-4292-0</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0364-2313 |
| ispartof | World journal of surgery, 2018-05, Vol.42 (5), p.1327-1339 |
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| language | eng |
| recordid | cdi_proquest_miscellaneous_1956082681 |
| source | MEDLINE; Springer Nature - Complete Springer Journals; Wiley Online Library Journals Frontfile Complete |
| subjects | Abdominal Surgery Cardiac Surgery Emergency Medical Services - organization & administration General Surgery Health care Hospital Mortality Humans Injury analysis Injury prevention Length of Stay - statistics & numerical data Medical personnel Medicine Medicine & Public Health Meta-analysis Morbidity Mortality Population density Qualitative analysis Reviews Scientific Review Surgeons - supply & distribution Surgery System effectiveness Systematic review Thoracic Surgery Transport Trauma Trauma centers Trauma Centers - organization & administration Universal design Vascular Surgery Websites Wounds and Injuries - mortality |
| title | Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis |
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