Organized trauma care: does volume matter and do trauma centers save lives?

PURPOSE OF REVIEW: Trauma is the leading cause of death during the first four decades of life. Since the 1970s, organized systems for trauma care, including a prehospital emergency medical system and a network of hospitals designated as trauma centers, have been developed. The model of the trauma system and its efficacy have been reviewed. RECENT
FINDINGS: Fundamental to the trauma system is its recognition in the field and the transportation to a trauma center of patients with more serious injuries. Each trauma center has to treat at least 240 severe trauma patients per year to increase experience. It is cost-effective that less severely injured patients be treated in nontrauma center's acute care facilities, according to the inclusive system model. The effectiveness of trauma systems has been investigated by comparing postsystem with presystem trauma care with three methods: panel evaluation of preventable death rates, comparison of observed survival with expected probability of survival derived from large trauma registries, and evaluation of population-based general databases. These studies have demonstrated a decrease in preventable death rate and an increase in survival after system implementation. All these studies have been classified as providing weak class III evidence. However, with a large sample size and when properly designed, they generate important information regarding appropriateness of care delivered.
SUMMARY: Concentration of severely injured patients in trauma centers is associated with better outcomes. Population-based investigations provide the strongest evidence regarding effects of the trauma system on patient outcomes, other than survival outcome measures because long-term functional status may be more appropriate.