Key messages

• Due to a lack of robust evidence, we could not determine the benefits and unwanted effects of hospital networks (organised trauma systems) or individual hospitals (designated trauma centres) that are specialised in the care of people with traumatic injuries.

• This research calls for improvement in designing studies and reporting important measures such as death and survival, unwanted effects, use or access to trauma care services, quality of the care provided, providing care to everyone who needs it, and informing everyone about the care available.

What are organised trauma systems, designated trauma centres, and usual care?

An organised trauma system is an entire service designed to provide care to injured people (for example, from road traffic collisions, weapons, and burns). It covers emergency and initial care at the location of the injury, transportation to the hospital, determining which hospital each patient is taken to, and care beyond their hospital stay. Trauma systems also include recovery of costs, overseas training, research, and injury prevention. Designated trauma centres are hospitals dedicated to treating people with traumatic injuries, and they form part of a trauma system network in a specific geographical location.

Trauma systems and trauma centres have been reported to offer a cost-effective approach to managing people with traumatic injuries in countries with a high standard of living. Evaluating its effectiveness by well-designed research is particularly important because this would support their use in resource-limited (poor) settings where the burden of injury is highest.

Usual care refers to general hospitals and healthcare systems that are not specifically dedicated to treating people with traumatic injuries. In regions or geographical locations where trauma systems have not been established, usual care is typically the standard approach.

What did we want to find out?

We wanted to find out if organised trauma systems and designated trauma centres are:

• better than usual care for avoiding deaths and improving a person's recovery;

• associated with unwanted effects.

We specifically wanted to find their impact on:

• healthcare-related unwanted effects

• use and access to health care

• quality of the care provided

• whether care was provided to everyone who needed it, and

• whether people knew what care was available.

What did we do?

We searched for studies that investigated the effect of organised trauma systems and designated trauma centres compared to usual care. We were interested in deaths, unwanted effects, use or access to trauma care services, the quality of the care provided, providing care to everyone who needs it, and informing everyone about the care available.

We compared and summarised the results of the studies, and rated our confidence in the evidence based on factors such as study methods, and how precise and reliable the results were.

What did we find?

We found four studies involving 157,111 people that evaluated the effectiveness of organised trauma systems or designated trauma centres. However, none of these studies were conducted in resource-limited countries.

We are not confident in the evidence because:

• there are insufficient studies to draw robust conclusions;

• the evidence did not comprehensively address all that we were interested in;

• some studies did not report data on what we were interested in;

• the studies varied in terms of the populations studied and the methods of delivering the care.

What are the limitations of the evidence?

Our confidence in the evidence is very low, and the results of further research could differ from the results of this review. The studies were not well designed, results were very inconsistent across the different studies, and they did not report all that we were interested in.

How up to date is this evidence?

The evidence is up to date to 16 December 2023.