METHODS: A systematic review of the literature was conducted according the guidelines for the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to determine the effects of trauma system implementation and regionalization on mortality and other outcome measures in adult TBI. We sought to include both experimental and observational studies within the United States.
RESULTS: From 1983 to 2015, nine studies were identified that adhered to the predefined inclusion and exclusion criteria representing six different geographic areas within the United States. All studies utilized a retrospective pre-post implementation methodology. A variety of mortality outcome measures were identified in the literature. Six of the nine studies demonstrated some benefit on various mortality metrics.
CONCLUSIONS: The existing literature on the effects of trauma system implementation or regionalization on outcomes in TBI is sparse but overall seems to convey an improvement in mortality.