PDF(Pubmed)
Abstract：
BACKGROUND: Trauma accounts for a huge burden of disease worldwide. Trauma systems have been implemented in multiple countries across the globe, aiming to link and optimise multiple aspects of the trauma care pathway, and while they have been shown to reduce overall mortality, much less is known about their cost-effectiveness and impact on morbidity.
METHODS: We performed a systematic review to explore the impact the implementation of a trauma system has on morbidity, quality of life and economic outcomes, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All comparator study types published since 2000 were included, both retrospective and prospective in nature, and no limits were placed on language. Data were reported as a narrative review.
RESULTS: Seven articles were identified that met the inclusion criteria, all of which reported a pre-trauma and post-trauma system implementation comparison in high-income settings. The overall study quality was poor, with all studies demonstrating a severe risk of bias. Five studies reported across multiple types of trauma patients, the majority describing a positive impact across a variety of morbidity and health economic outcomes following trauma system implementation. Two studies focused specifically on traumatic brain injury and did not demonstrate any impact on morbidity outcomes.
CONCLUSIONS: There is currently limited and poor quality evidence that assesses the impact that trauma systems have on morbidity, quality of life and economic outcomes. While trauma systems have a fundamental role to play in high-quality trauma care, morbidity and disability data can have large economic and cultural consequences, even if mortality rates have improved. The sociocultural and political context of the surrounding healthcare infrastructure must be better understood before implementing any trauma system, particularly in resource-poor and fragile settings.
UNASSIGNED: CRD42022348529 LEVEL OF EVIDENCE: Level III.
METHODS: We performed a systematic review to explore the impact the implementation of a trauma system has on morbidity, quality of life and economic outcomes, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All comparator study types published since 2000 were included, both retrospective and prospective in nature, and no limits were placed on language. Data were reported as a narrative review.
RESULTS: Seven articles were identified that met the inclusion criteria, all of which reported a pre-trauma and post-trauma system implementation comparison in high-income settings. The overall study quality was poor, with all studies demonstrating a severe risk of bias. Five studies reported across multiple types of trauma patients, the majority describing a positive impact across a variety of morbidity and health economic outcomes following trauma system implementation. Two studies focused specifically on traumatic brain injury and did not demonstrate any impact on morbidity outcomes.
CONCLUSIONS: There is currently limited and poor quality evidence that assesses the impact that trauma systems have on morbidity, quality of life and economic outcomes. While trauma systems have a fundamental role to play in high-quality trauma care, morbidity and disability data can have large economic and cultural consequences, even if mortality rates have improved. The sociocultural and political context of the surrounding healthcare infrastructure must be better understood before implementing any trauma system, particularly in resource-poor and fragile settings.
UNASSIGNED: CRD42022348529 LEVEL OF EVIDENCE: Level III.
摘要：
背景：创伤在全球范围内造成了巨大的疾病负担。创伤系统已经在全球多个国家实施，旨在连接和优化创伤护理途径的多个方面，虽然它们已经被证明可以降低总体死亡率，人们对它们的成本效益和对发病率的影响知之甚少。
方法：我们进行了系统综述，以探讨实施创伤系统对发病率的影响，生活质量和经济成果，根据系统评价和荟萃分析指南的首选报告项目。包括自2000年以来发表的所有比较研究类型，无论是回顾性的还是前瞻性的，语言没有限制。数据作为叙述性审查报告。
结果：确定了7篇符合纳入标准的文章，所有这些研究报告了高收入地区创伤前和创伤后系统实施情况的比较.整体研究质量较差,所有研究都表明存在严重的偏倚风险。五项研究报道了多种类型的创伤患者，大多数人描述了创伤系统实施后对各种发病率和健康经济结果的积极影响。两项研究专门针对创伤性脑损伤，未证明对发病结果有任何影响。
结论：目前评估创伤系统对发病率的影响的证据有限且质量差，生活质量和经济成果。虽然创伤系统在高质量的创伤护理中发挥着重要作用，发病率和残疾数据可能会产生巨大的经济和文化后果，即使死亡率有所改善。在实施任何创伤系统之前，必须更好地了解周围医疗基础设施的社会文化和政治背景。特别是在资源匮乏和脆弱的环境中。
■CRD42022348529证据级别：三级。
方法：我们进行了系统综述，以探讨实施创伤系统对发病率的影响，生活质量和经济成果，根据系统评价和荟萃分析指南的首选报告项目。包括自2000年以来发表的所有比较研究类型，无论是回顾性的还是前瞻性的，语言没有限制。数据作为叙述性审查报告。
结果：确定了7篇符合纳入标准的文章，所有这些研究报告了高收入地区创伤前和创伤后系统实施情况的比较.整体研究质量较差,所有研究都表明存在严重的偏倚风险。五项研究报道了多种类型的创伤患者，大多数人描述了创伤系统实施后对各种发病率和健康经济结果的积极影响。两项研究专门针对创伤性脑损伤，未证明对发病结果有任何影响。
结论：目前评估创伤系统对发病率的影响的证据有限且质量差，生活质量和经济成果。虽然创伤系统在高质量的创伤护理中发挥着重要作用，发病率和残疾数据可能会产生巨大的经济和文化后果，即使死亡率有所改善。在实施任何创伤系统之前，必须更好地了解周围医疗基础设施的社会文化和政治背景。特别是在资源匮乏和脆弱的环境中。
■CRD42022348529证据级别：三级。
