Citation

Van Ditshuizen JC, Rojer LA, Van Lieshout EMM, Bramer WM, Verhofstad MHJ, Sewalt CA, Den Hartog D. J. Trauma Acute Care Surg. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000003890

PMID

36726194

Abstract

BACKGROUND: Trauma networks have multiple designated levels of trauma care. This classification parallels concentration of major trauma care, creating innovations and improving outcome measures.

OBJECTIVES: To assess associations of level of trauma care with patient outcomes for populations with specific severe injuries.

METHODS: A systematic literature search was conducted using six electronic databases up to April 19, 2022 (PROSPERO CRD42022327576). Studies comparing fatal, non-fatal clinical, or functional outcomes across different levels of trauma care for trauma populations with specific severe injuries or injured body region (Abbreviated Injury Scale ≥3) were included. Two independent reviewers included studies, extracted data, and assessed quality. Unadjusted and adjusted pooled effect sizes were calculated with random-effects meta-analysis comparing level I and level II trauma centers.

RESULTS: Thirty-five studies (1,100,888 patients) were included, of which 25 studies (n = 443,095) used for meta-analysis, suggesting a survival benefit for the severely injured admitted to a level I trauma center compared to a level II trauma center (adjusted OR 1.15 (95% CI 1.06-1.25)). Adjusted subgroup analysis on in-hospital mortality was done for patients with traumatic brain injuries (OR 1.23, 95% CI 1.01-1.50) and hemodynamically unstable patients (OR 1.09, 95% CI 0.98-1.22). Hospital and intensive care length of stay resulted in an unadjusted MD of -1.63 (95% CI -2.89--0.36) and -0.21 (95% CI -1.04-0.61), respectively, discharged home resulted in an unadjusted OR of 0.92 (95% CI 0.78-1.09).

CONCLUSION: Severely injured patients admitted to a level I trauma center have a survival benefit. Non-fatal outcomes were indicative for a longer stay, more intensive care, and more frequently post-hospital recovery trajectories after being admitted to top levels of trauma care. Trauma networks with designated levels of trauma care are beneficial to the multidisciplinary character of trauma care. LEVEL OF EVIDENCE: Systematic review and meta-analysis, level III.

Language: en