Citation

Sawe HR. Emerg. Med. J. 2024; ePub(ePub): ePub.

Copyright

(Copyright © 2024, BMJ Publishing Group)

DOI

10.1136/emermed-2024-214005

PMID

38760020

Abstract

The impact of trauma care system implementation has largely and traditionally focused on demonstrating its potential to reduce injury-related mortality.1 In their EMJ paper, Bath et al report the results of a systematic review of comparator study types published since 2000 that investigated the impact of organised trauma systems on morbidity, quality of life and economic outcomes.2 The study screened 8181 articles and found only 7 addressing this important issue. The authors describe results from two studies that showed lack of benefit of trauma systems in morbidity from traumatic brain injuries. Three additional studies had conflicting results regarding the impact on quality of life after trauma system implementation, with two showing patients having significant increase in good recovery and lower limb salvage, while the third reported no change to minimal reduction in morbidity-mortality rates. Lastly, two studies evaluated health economic and cost-effectiveness outcomes. One demonstrated a positive cost-benefit analysis; however, the other found a substantial increase in years lived with disability, despite a reduction in years of life lost. All studies came from high-income countries. The authors conclude that there is a paucity of high-quality data assessing the impact of trauma system implementation on morbidity, quality of life and economic outcomes. They particularly caution the implementation of trauma system in low-income and middle-income countries (LMICs) because of the potential impact of creating more disabilities where the sociocultural and healthcare infrastructure may be unable to cope.

The findings of this systematic review stimulate important considerations for the development of safe and effective trauma systems in LMICs. Nearly 90% of the burden of death and disability from injuries occurs in LMICs.3 In most LMICs, there is no organised trauma care system, with most places facing challenges in creating such systems related to geographical challenges, infrastructural resources and expertise. As an example, in Tanzania, despite recent significant government investments in Emergency DepartmenD infrastructure, the country still has no formal prehospital care system.4 Trauma patients are brought to the nearest hospital by good Samaritans or police. From there, they will be transferred to a hospital with more resources and may eventually move up through the pyramidal structure of hospitals with increasing capabilities until reaching the one designated trauma centre in the country. ...

Language: en

Keywords

emergency care systems; Healthcare Disparities; major trauma management