Trauma Systems: Standardization and Regionalization of Care Improve Quality of Care
Purpose of Review
This review focuses on how the development and regionalization of trauma systems improve outcomes and quality of care.
A comprehensive trauma system integrates and coordinates many different key components, resulting in cost-effective services for injury prevention and high-quality patient care without breaking the continuum of care. Developments of trauma systems along with the regionalization of care have led to the concentration of care in relatively few dedicated centers, which results in increase institutional resources, experience, and volume, leading to improved outcomes and a high-quality, cost-efficient health care for large populations. Data has started to emerge on the improvement in functional and long-term outcomes along with mortality.
Regionalization of care has resulted in changes in the delivery of care both in the pre-hospital and in-hospital setting leading to improved utilization of resources and improved outcomes.
KeywordsTrauma center designation Regionalization of care Volume of trauma Trauma systems Quality of care
Compliance with Ethical Standards
Conflict of Interest
The authors declare no conflicts of interest relevant to this manuscript.
The authors have no financial or proprietary interest in the subject matter or materials discussed in the manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–128. https://doi.org/10.1016/S0140-6736(12)61728-0.CrossRefPubMedGoogle Scholar
- 2.Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Injury prevention. 2016;22(1):3–18. https://doi.org/10.1136/injuryprev-2015-041616.CrossRefPubMedGoogle Scholar
- 3.Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) nonfatal injury data., 2016.Google Scholar
- 6.Trauma, A.C.o.S.C.o., Resources for optimal care of the injured patient. 1990: Amer College of Surgeons.Google Scholar
- 9.Trauma, N.R.C.C.o. and N.R.C.C.o. Shock, Accidental death and disability: the neglected disease of modern society. 1971: National Academies.Google Scholar
- 10.Surgeons, C.o.T.o.t.A.C.o. Optimal hospital resources for care of the seriously injured. ACS Bulletin. 1976;61:15–22.Google Scholar
- 11.West JG, Trunkey DD, Lim RC. Systems of trauma care: a study of two counties. Clin Orthop Relat Res. 1995;318:4–10.Google Scholar
- 12.West JG, Cales RH, Gazzaniga AB. Impact of regionalization: the Orange County experience. Arch Surg. 1983;118(6):740–4. https://doi.org/10.1001/archsurg.1983.01390060058013.CrossRefPubMedGoogle Scholar
- 16.• MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366–78. A breakthrough paper demonstrating the benefit of regionalization of trauma care and the need for continued efforts at regionalization. https://doi.org/10.1056/NEJMsa052049.CrossRefPubMedGoogle Scholar
- 17.Papa L, Langland-Orban B, Kallenborn C, Tepas JJ III, Lottenberg L, Celso B, et al. Assessing effectiveness of a mature trauma system: association of trauma center presence with lower injury mortality rate. J Trauma Acute Care Surg. 2006;61(2):261–7. https://doi.org/10.1097/01.ta.0000221789.53864.ba.CrossRefGoogle Scholar
- 19.Shackford SR, Mackersie RC, Holbrook TL, Davis JW, Hollingsworth-Fridlund P, Hoyt DB, et al. The epidemiology of traumatic death: a population-based analysis. Arch Surg. 1993;128(5):571–5. https://doi.org/10.1001/archsurg.1993.01420170107016.CrossRefPubMedGoogle Scholar
- 23.Bulger EM, Snyder D, Schoelles K, Gotschall C, Dawson D, Lang E, et al. An evidence-based prehospital guideline for external hemorrhage control: American College of Surgeons Committee on Trauma. Prehospital Emergency Care. 2014;18(2):163–73. https://doi.org/10.3109/10903127.2014.896962.CrossRefPubMedGoogle Scholar
- 27.• Hassan A, Jokar TO, Rhee P, Ibraheem K, Kulvatunyou N, Anderson KT, et al. More helmets fewer deaths: motorcycle helmet legislation impacts traumatic brain injury-related mortality in young adults. Am Surg. 2017;83(6):541–6. An important study showing the effect of legislations in decreasing the rates of injury and mortality related with trauma PubMedGoogle Scholar
- 28.• Joseph B, Haider A, Hassan A, Kulvatunyou N, Bains S, Tang A, et al. Injury prevention programs against distracted driving among students. J Trauma Acute Care Surg. 2016;81(1):144–8. A very important study looking at the injury prevention program initiated by trauma centers and its effect on outcomes. https://doi.org/10.1097/TA.0000000000001022.CrossRefPubMedGoogle Scholar
- 29.Violence, W.H.O., I. Prevention, and W.H. Organization, Global status report on road safety 2013: supporting a decade of action. 2013: World Health Organization.Google Scholar
- 34.• Cole E, Lecky F, West A, Smith N, Brohi K, Davenport R, et al. The impact of a pan-regional inclusive trauma system on quality of care. Ann Surg. 2016;264(1):188–94. A breakthrough study evaluating the impact of a pan-regional inclusive trauma system on quality of care. https://doi.org/10.1097/SLA.0000000000001393.CrossRefPubMedGoogle Scholar
- 35.• Rotondo M, et al. Resources for the optimal care of the injured patient. Chicago: American College of Surgeons; 2014. p. 6. Important document explaining the resources required to be a trauma center.Google Scholar
- 37.Demetriades D, Martin M, Salim A, Rhee P, Brown C, Doucet J, et al. Relationship between American College of Surgeons trauma center designation and mortality in patients with severe trauma (injury severity score> 15). J Am Coll Surg. 2006;202(2):212–5. https://doi.org/10.1016/j.jamcollsurg.2005.09.027.CrossRefPubMedGoogle Scholar
- 41.Rutledge R, Messick J, Baker CC, Rhyne S, Butts J, Meyer A, et al. Multivariate population-based analysis of the association of county trauma centers with per capita county trauma death rates. J Trauma Acute Care Surg. 1992;33(1):29–37. https://doi.org/10.1097/00005373-199207000-00007.CrossRefGoogle Scholar
- 42.Champion HR, Sacco WJ, Copes WS. Improvement in outcome from trauma center care. Arch Surg. 1992;127(3):333–8. https://doi.org/10.1001/archsurg.1992.01420030107020.CrossRefPubMedGoogle Scholar
- 44.Helling TS, Morse G, McNabney WK, Beggs CW, Behrends SH, Hutton-Rotert K, et al. Treatment of liver injuries at level I and level II centers in a multi-institutional metropolitan trauma system. J Trauma Acute Care Surg. 1997;42(6):1091–6. https://doi.org/10.1097/00005373-199706000-00018.CrossRefGoogle Scholar
- 47.Joynt KE, Orav EJ, Jha AK. The association between hospital volume and processes, outcomes, and costs of care for congestive heart failure. Ann Intern Med. 2011;154(2):94–102. https://doi.org/10.7326/0003-4819-154-2-201101180-00008.CrossRefPubMedPubMedCentralGoogle Scholar
- 56.• Khan M, Jehan F, O'Keeffe T, Pandit V, Kulvatunyou N, Tang A, et al. Primary repair for pediatric colonic injury; are there differences among adult and pediatric trauma centers? J Surg Res. 2017;220:176–81. Important study exploring the differences in outcomes in patients managed at adult vs. pediatric trauma centers. https://doi.org/10.1016/j.jss.2017.06.092.CrossRefPubMedGoogle Scholar
- 57.Ahmed, F.S., et al., Blunt and penetrating colonic injuries: similar approach yields different outcomes in level I and level II trauma centers. Journal of the American College of Surgeons. 225(4): p. e175.Google Scholar
- 59.Osler TM, Vane DW, Tepas JJ, Rogers FB, Shackford SR, Badger GJ. Do pediatric trauma centers have better survival rates than adult trauma centers? An examination of the National Pediatric Trauma Registry. J Trauma Acute Care Surg. 2001;50(1):96–101. https://doi.org/10.1097/00005373-200101000-00017.CrossRefGoogle Scholar
- 65.Brown JB, Stassen NA, Cheng JD, Sangosanya AT, Bankey PE, Gestring ML. Trauma center designation correlates with functional independence after severe but not moderate traumatic brain injury. J Trauma Acute Care Surg. 2010;69(2):263–9. https://doi.org/10.1097/TA.0b013e3181e5d72e.CrossRefGoogle Scholar