Systematic review of trauma system regionalization and implementation on outcomes in traumatic brain injury patients

ABSTRACT

Background

The number of trauma systems has increased dramatically within the United States over the past 40 years. The implementation of these systems has contributed to a decrease in mortality and improved outcomes in patients with trauma. Several studies have evaluated the effect of implementation of these systems on outcomes, but few studies examine the effects of such systems specifically on traumatic brain injury (TBI).

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.

Conclusion

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.

KEYWORDS:

• Regionalization
• trauma systems
• traumatic brain injury
• spinal cord injury
• neurological outcomes

Acknowledgments

We thank Carrie Price as Clinical Informationist with the Johns Hopkins Medical Institutions for her invaluable help is organizing and performing the search.

Author contributions

B.H.S. and M.L.K. designed the study, B.H.S., L.W., and J.M.W. screened the articles, B.H.S. and L.W. wrote the manuscript, B.H.S. and L.W. assessed studies for bias, L.W., J.M.W., and M.L.K. critically reviewed and edited the manuscript

Disclosure statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Financial disclosure

The authors received no financial support for the research, authorship, and/or publication of this article.

Additional information

Notes on contributors

Berje H. Shammassian

Berje H. Shammassian, MD is a Chief Resident in Neurosurgery at University Hospitals Cleveland Medical Center in Cleveland, OH.

Luke Wooster

Luke Wooster, BA is a third year medical student at Case Western Reserve University School of Medicine.

James M. Wright

James M. Wright, MD is a neurosurgeon and current spine fellow at the Cleveland Clinic.

Michael L. Kelly

Michael L. Kelly, MD is an Assistant Professor of Neurological Surgery, Physical Medicine & Rehabilitation, and Bioethics at Case Western Reserve University School of Medicine and MetroHealth Medical Center in Cleveland, OH. His research focuses on trauma systems and clinical outcomes in patients with neurotrauma.