Traumatic injury remains the leading cause of death, with more than five million deaths every year. Little is known about the comparative effectiveness in reducing mortality of trauma care systems at different stages of development. The objective of this study was to review the literature and examine differences in mortality associated with different stages of trauma system development. A systematic review of peer-reviewed population-based studies retrieved from MEDLINE, EMBASE, and CINAHL. Additional studies were identified from references of articles, through database searching, and author lists. Articles written in English and published between 2000 and 2020 were included. Selection of studies, data extraction, and quality assessment of the included studies were performed by two independent reviewers. The results were reported as odds ratio (OR) with 95 % confidence intervals (CI). A total of 52 studies with a combined 1,106,431 traumatic injury patients were included for quantitative analysis. The overall mortality rate was 6.77% (n = 74,930). When patients were treated in a non-trauma centre compared to a trauma centre, the pooled statistical odds of mortality were reduced (OR 0.74 [95% CI 0.69–0.79]; p < 0.001). When patients were treated in a non-trauma system compared to a trauma system the odds of mortality rates increased (OR 1.17 [95% CI 1.10–1.24]; p < 0.001). When patients were treated in a post-implementation/initial system compared to a mature system, odds of mortality were significantly higher (OR 1.46 [95% CI 1.37–1.55]; p < 0.001). The present study highlights that the survival of traumatic injured patients varies according to the stage of trauma system development in which the patient was treated. The analysis indicates a significant reduction in mortality following the introduction of the trauma system which is further enhanced as the system matures. These results provide evidence to support efforts to, firstly, implement trauma systems in countries currently without and, secondly, to enhance existing systems by investing in system development. PROSPERO CRD42019142842 .

中文翻译：

---

不同发展阶段的创伤护理系统在降低死亡率方面的有效性：系统评价和荟萃分析

外伤仍然是死亡的主要原因，每年有超过 500 万人死亡。关于在不同发展阶段降低创伤护理系统死亡率的比较有效性知之甚少。本研究的目的是回顾文献并检查与创伤系统发展的不同阶段相关的死亡率差异。从 MEDLINE、EMBASE 和 CINAHL 检索的同行评审的基于人群的研究的系统评价。从文章的参考文献、数据库搜索和作者列表中确定了其他研究。2000 年至 2020 年间发表的英文文章也包括在内。研究的选择、数据提取和纳入研究的质量评估由两名独立审查员进行。结果报告为具有 95% 置信区间 (CI) 的优势比 (OR)。共纳入 52 项研究，共计 1,106,431 名外伤患者，用于定量分析。总死亡率为 6.77% (n = 74,930)。与创伤中心相比，当患者在非创伤中心接受治疗时，死亡率的汇总统计几率降低（OR 0.74 [95% CI 0.69–0.79]；p < 0.001）。与创伤系统相比，当患者在非创伤系统中接受治疗时，死亡率的几率增加（OR 1.17 [95% CI 1.10–1.24]；p < 0.001）。与成熟系统相比，当患者在实施后/初始系统中接受治疗时，死亡率显着更高（OR 1.46 [95% CI 1.37–1.55]；p < 0.001）。本研究强调，创伤患者的存活率因患者接受治疗的创伤系统发展阶段而异。分析表明，引入创伤系统后死亡率显着降低，随着系统的成熟，死亡率进一步提高。这些结果提供了支持以下努力的证据：首先，在目前没有创伤系统的国家实施创伤系统，其次，通过投资于系统开发来增强现有系统。PROSPERO CRD42019142842 。在目前没有创伤系统的国家实施创伤系统，其次，通过投资于系统开发来增强现有系统。PROSPERO CRD42019142842 。在目前没有创伤系统的国家实施创伤系统，其次，通过投资于系统开发来增强现有系统。PROSPERO CRD42019142842 。