SynthesisWorld journal of surgery2018
Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis.
Synthesis in World journal of surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
56 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Cost-effectiveness of specialized trauma care: A systematic review.Journal of health services research & policy · 2026Pooled it
- Helicopter EMS for scene response to head-injured patients: systematic review & meta-analysis.BMC emergency medicine · 2025Pooled it
- Effects of Injury Registry Data on Policymaking, Hospitalizations, and Mortality: Systematic Review.JMIR public health and surveillance · 2025Pooled it
- Guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC): Enhanced Recovery After Surgery (ERAS) and International Association for Trauma Surgery and Intensive Care (IATSIC) Society Recommendations: Part 3: Trauma Ethics and Systems Aspects.World journal of surgery · 2025Guideline
- Organised trauma systems and designated trauma centres for improving outcomes in injured patients.The Cochrane database of systematic reviews · 2025Pooled it
- Does the implementation of a trauma system affect injury-related morbidity and economic outcomes? A systematic review.Emergency medicine journal : EMJ · 2024Pooled it
- The effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis.World journal of emergency surgery : WJES · 2021Pooled it
- Effectiveness of Quality Improvement Processes, Interventions, and Structure in Trauma Systems in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.World journal of surgery · 2021Pooled it
- Designing and Implementing a Simulation-Based Pediatric Trauma Training Program in a Resource-Limited Setting: The PRACTICE Study.Pediatric reports · 2026Article
- Impact of a comprehensive trauma pathway on workflow and clinical processes in a level III trauma center.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Severe trauma care: advances and future directions in diagnostic and therapeutic techniques and information technology support.Medical review (2021) · 2026Article
- Association between total prehospital time and early mortality in patients with severe torso trauma: a retrospective study at an urban Emergency and Critical Care Center.International journal of emergency medicine · 2026Article
- Trauma Activation Fee Variations Across Hospital Ownership, Safety-net, American College of Surgeons Committee-on-Trauma Verification, and State Designation Status.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2026Article
- Defining the bellwether procedures and processes for global trauma care: an international Delphi study.BMJ global health · 2026Article
- Trauma-related mortality in a European region with an intermediately mature trauma system: a comprehensive population-based analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Observational
- Traumatic spine injuries in paediatric and adolescent patients: a registry-based study of ICU needs and clinical outcomes.BMC pediatrics · 2025Article
- What Is the Need for and Access to Trauma Surgery in Low- and Middle-Income Countries? A Scoping Review.World journal of surgery · 2025Article
- From bedside to data and back to bedside: why do we need better data to perform trauma phenotyping and improve trauma care?Intensive care medicine · 2025Article
- The Norwegian national trauma registry: development process and essential data insights.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Development and usability testing of a multifaceted intervention to reduce low-value injury care.BMC health services research · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
23 authors.
Funding
Abstract
backgroundThe 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.
methodsWe 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.
resultsWe 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.
conclusionsThis 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.
Indexed as
Identifiers
29071424What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.