RT Journal Article
SR Electronic
T1 Does the implementation of a trauma system affect injury-related morbidity and economic outcomes? A systematic review
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP 409
OP 414
DO 10.1136/emermed-2023-213782
VO 41
IS 7
A1 Bath, Michael F
A1 Hobbs, Laura
A1 Kohler, Katharina
A1 Kuhn, Isla
A1 Nabulyato, William
A1 Kwizera, Arthur
A1 Walker, Laura E
A1 Wilkins, Tom
A1 Stubbs, Daniel
A1 Burnstein, RM
A1 Kolias, Angelos
A1 Hutchinson, Peter John
A1 Clarkson, P John
A1 Halimah, Sara
A1 Bashford, Tom
YR 2024
UL http://emj.bmj.com/content/41/7/409.abstract
AB 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 CRD42022348529Level of evidence Level III.All data relevant to the study are included in the article or uploaded as supplementary information.