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.

中文翻译：

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创伤系统区域化和实施对脑外伤患者预后的系统评价

摘要

背景

在过去的 40 年里，美国的创伤系统数量急剧增加。这些系统的实施有助于降低死亡率并改善创伤患者的预后。几项研究评估了这些系统的实施对结果的影响，但很少有研究专门检查此类系统对创伤性脑损伤 (TBI) 的影响。

方法

根据系统评价和元分析首选报告项目 (PRISMA) 的指南对文献进行了系统评价，以确定创伤系统实施和区域化对成人 TBI 死亡率和其他结局指标的影响。我们试图纳入美国境内的实验性和观察性研究。

结果

从 1983 年到 2015 年，确定了 9 项研究符合预定义的纳入和排除标准，代表美国境内的六个不同地理区域。所有研究都采用了回顾性的前后实施方法。文献中确定了多种死亡率结果指标。九项研究中有六项证明了对各种死亡率指标的一些益处。

结论

关于创伤系统实施或区域化对 TBI 结果影响的现有文献很少，但总体上似乎表明死亡率有所改善。