Institutional members access full text with Ovid®

Share this article on:

Trauma systems around the world: A systematic overview

Dijkink, Suzan MD; Nederpelt, Charlie J. BSc; Krijnen, Pieta PhD; Velmahos, George C. MD, PhD; Schipper, Inger B. MD, PhD

Journal of Trauma and Acute Care Surgery: November 2017 - Volume 83 - Issue 5 - p 917–925
doi: 10.1097/TA.0000000000001633
Systematic Review

BACKGROUND Implementation of trauma care systems has resulted in improved patient outcomes, but international differences obviously remain. Improvement of care can only be established if we recognize and clarify these differences. The aim of the current review is to provide an overview of the recent literature on the state of trauma systems globally.

METHODS The literature review over the period 2000 to 2016 was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Prehospital care, acute hospital care and quality assurance were classified using the World Health Organization Trauma System Maturity Index in four levels from I (least mature) to IV (most mature).

RESULTS The search yielded 93 articles about trauma systems in 32 countries: 23 high-income (HI), 8 middle-income (MI) countries and 1 low-income (LI) country. Trauma-related mortality was highest in the MI and LI countries. Level IV prehospital care with Advanced Life Support was established in 19 HI countries, in contrast to the MI and LI countries where this was only reported in Brazil, China, and Turkey. In 18 HI countries, a Level III/IV hospital-based trauma system was implemented, whereas in nine LI- and MI countries Level I/II trauma systems were seen, mostly lacking dedicated trauma centers and teams. A national trauma registry was implemented in 10 HI countries.

CONCLUSION Despite the presence of seemingly sufficient resources and the evidence-based benefits of trauma systems, only nine of the 23 HI countries in our review have a well-defined and documented national trauma system. Although 90% of all lethal traumatic injuries occur in middle and LI countries, according to literature which our study is limited to, only few of these countries a hold formal trauma system or trauma registry. Much can be gained concerning trauma systems in these countries, but unfortunately, the economic situation of many countries may render trauma systems not at their top priority list.

LEVEL OF EVIDENCE Systematic review, level III.

Supplemental digital content is available in the text.

From the Leiden University Medical Center (S.D., C.N., P.K., I.B.S.), Leiden, the Netherlands; and Massachusetts General Hospital (G.C.V.), Boston, Massachusetts

Submitted: April 8, 2017, Revised: June 8, 2017, Accepted: June 19, 2017, Published online: July 17, 2017.

Presented at 18th European Congress of Trauma & Emergency Surgery, May 7–9 2017, Bucharest, Romania.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Suzan Dijkink, MD, Trauma Surgery, D6-0-28 Post zone K6-R P.O. Box 9600 2300 RC Leiden, the Netherlands; email:

© 2017 Lippincott Williams & Wilkins, Inc.