title: A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems.
abstract: BACKGROUND
  The establishment of trauma systems was anticipated to improve overall survival for the severely injured patient. We systematically reviewed the published literature to assess if outcome from severe traumatic injury is improved for patients following the establishment of a trauma system.
  
  
  METHODS
  A systematic literature review of all population-based studies that evaluated trauma system performance was conducted. A qualitative analysis of each study's design and methodology and a meta-analysis was performed to evaluate the evidence to date of trauma system effectiveness.
  
  
  RESULTS
  A search of the literature yielded 14 published articles. Trauma systems demonstrated improved odds of survival in 8 of the 14 reports. The overall quality-weighted odds ratio was 0.85 lower mortality following trauma system implementation.
  
  
  CONCLUSIONS
  The results of the meta-analysis showed a 15% reduction in mortality in favor of the presence of a trauma system. Evaluation of trauma system effectiveness must remain an uncompromising commitment to optimal outcome for the injured patient.
authors.affiliation: Department of Surgery, University of Florida, Jacksonville, Florida, USA. Brian.Celso@health-first.org
authors.forename: Brian
authors.initials: B
authors.lastname: Celso
authors.forename: Joseph
authors.initials: J
authors.lastname: Tepas
authors.forename: Barbara
authors.initials: B
authors.lastname: Langland-Orban
authors.forename: Etienne
authors.initials: E
authors.lastname: Pracht
authors.forename: Linda
authors.initials: L
authors.lastname: Papa
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lottenberg
authors.forename: Lewis
authors.initials: L
authors.lastname: Flint
mesh_terms: D019985:Benchmarking / Q000458:organization & administration; D002423:Cause of Death; D018672:Community Health Planning; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D009656:North America / Q000453:epidemiology; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D036301:Qualitative Research; D019984:Quality Indicators, Health Care; D012042:Registries; D012107:Research Design / Q000592:standards; D018401:Sample Size; D016019:Survival Analysis; D014193:Trauma Centers / Q000458:organization & administration*; D015599:Trauma Severity Indices; D014194:Traumatology / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy