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J Trauma Acute Care Surg. 2017 Nov;83(5):917-925. doi: 10.1097/TA.0000000000001633.

Trauma systems around the world: A systematic overview.

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From the Leiden University Medical Center (S.D., C.N., P.K., I.B.S.), Leiden, the Netherlands; and Massachusetts General Hospital (G.C.V.), Boston, Massachusetts.



Implementation of trauma care systems has resulted in improved patient outcomes, but international differences obviously remain. Improvement of care can only be established if we recognize and clarify these differences. The aim of the current review is to provide an overview of the recent literature on the state of trauma systems globally.


The literature review over the period 2000 to 2016 was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Prehospital care, acute hospital care and quality assurance were classified using the World Health Organization Trauma System Maturity Index in four levels from I (least mature) to IV (most mature).


The search yielded 93 articles about trauma systems in 32 countries: 23 high-income (HI), 8 middle-income (MI) countries and 1 low-income (LI) country. Trauma-related mortality was highest in the MI and LI countries. Level IV prehospital care with Advanced Life Support was established in 19 HI countries, in contrast to the MI and LI countries where this was only reported in Brazil, China, and Turkey. In 18 HI countries, a Level III/IV hospital-based trauma system was implemented, whereas in nine LI- and MI countries Level I/II trauma systems were seen, mostly lacking dedicated trauma centers and teams. A national trauma registry was implemented in 10 HI countries.


Despite the presence of seemingly sufficient resources and the evidence-based benefits of trauma systems, only nine of the 23 HI countries in our review have a well-defined and documented national trauma system. Although 90% of all lethal traumatic injuries occur in middle and LI countries, according to literature which our study is limited to, only few of these countries a hold formal trauma system or trauma registry. Much can be gained concerning trauma systems in these countries, but unfortunately, the economic situation of many countries may render trauma systems not at their top priority list.


Systematic review, level III.

[Indexed for MEDLINE]

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