SynthesisWorld journal of emergency surgery : WJES2021
The effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis.
Synthesis in World journal of emergency surgery : WJES, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 6 of them syntheses that pooled it.
What it found
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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
55 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Evaluating CASS and BATSS scores for predicting laparotomy in blunt abdominal trauma: meta-analysis from low- and middle-income countries.Langenbeck's archives of surgery · 2026Pooled it
- Guidelines for Essential Trauma Care: Second Edition (2026).World journal of surgery · 2026Guideline
- Cost-effectiveness of specialized trauma care: A systematic review.Journal of health services research & policy · 2026Pooled it
- Does the implementation of a trauma system affect injury-related morbidity and economic outcomes? A systematic review.Emergency medicine journal : EMJ · 2024Pooled it
- Pediatric vs Adult or Mixed Trauma Centers in Children Admitted to Hospitals Following Trauma: A Systematic Review and Meta-Analysis.JAMA network open · 2023Pooled it
- Methodological considerations in injury burden of disease studies across Europe: a systematic literature review.BMC public health · 2022Pooled it
- The global burden of traumatic brain injury in adolescents and young adults, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021.Annals of medicine · 2026Article
- Incidence and mortality of severe trauma in South Korea: A nationwide registry-based cohort study, 2016 to 2024.Medicine · 2026Article
- The Rising Burden of Motorcycle Crashes and Rider Injuries in Türkiye (2018-2025): An Ecological Analysis of Routinely Collected National Statistics with Implications for Injury Prevention and Trauma Care.Healthcare (Basel, Switzerland) · 2026Article
- Predictive Performance of Trauma Scoring Systems for Mortality in Patients with High-Energy Trauma in the Emergency Department.Journal of clinical medicine · 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
- Impact of establishing a new emergency and critical care center on regional out-of-hospital cardiac arrest transport patterns and outcomes.Resuscitation plus · 2026Article
- Delays in seeking and reaching care for injured patients in four low-income and middle-income countries: a cohort study.BMJ global health · 2026Article
- Article
- Rehabilitation After Moderate-To-Severe Traumatic Injury: A Protocol for a Scoping Review.Acta anaesthesiologica Scandinavica · 2026Article
- Designated and non-designated trauma centers and trauma patients: a retrospective analysis of non-fatal trauma discharges in Georgia, 2021.Injury epidemiology · 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
- Clinical Transition Experiences of Internationally Educated Nurses Into Major Trauma Care: A Descriptive Phenomenological Study.Journal of nursing management · 2026Article
- A Twelve-Year Retrospective Analysis of a Journey Towards Rural Level I Trauma Center Verification.Open access emergency medicine : OAEM · 2026Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTraumatic injury remains the leading cause of death, with more than five million deaths every year. Little is known about the comparative effectiveness in reducing mortality of trauma care systems at different stages of development. The objective of this study was to review the literature and examine differences in mortality associated with different stages of trauma system development.
methodA systematic review of peer-reviewed population-based studies retrieved from MEDLINE, EMBASE, and CINAHL. Additional studies were identified from references of articles, through database searching, and author lists. Articles written in English and published between 2000 and 2020 were included. Selection of studies, data extraction, and quality assessment of the included studies were performed by two independent reviewers. The results were reported as odds ratio (OR) with 95 % confidence intervals (CI).
resultsA total of 52 studies with a combined 1,106,431 traumatic injury patients were included for quantitative analysis. The overall mortality rate was 6.77% (n = 74,930). When patients were treated in a non-trauma centre compared to a trauma centre, the pooled statistical odds of mortality were reduced (OR 0.74 [95% CI 0.69-0.79]; p < 0.001). When patients were treated in a non-trauma system compared to a trauma system the odds of mortality rates increased (OR 1.17 [95% CI 1.10-1.24]; p < 0.001). When patients were treated in a post-implementation/initial system compared to a mature system, odds of mortality were significantly higher (OR 1.46 [95% CI 1.37-1.55]; p < 0.001).
conclusionThe present study highlights that the survival of traumatic injured patients varies according to the stage of trauma system development in which the patient was treated. The analysis indicates a significant reduction in mortality following the introduction of the trauma system which is further enhanced as the system matures. These results provide evidence to support efforts to, firstly, implement trauma systems in countries currently without and, secondly, to enhance existing systems by investing in system development. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019142842 .
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