Linking the chain of survival: trauma as a traditional role model for multisystem trauma and brain injury.
OBJECTIVE
Trauma systems are central in the care of trauma patients and the concept of 'Critical Care Cascade' matches the concept of the 'Trauma Systems'. Both concepts aim to offer a model of continuum care from prehospital assistance to ICU discharge that can have a significant impact on outcome. In spite of the trauma system concept maturity, many controversies still remain unresolved. This text will review some of the relevant literature related to prehospital and early hospital care of trauma patients.


RESULTS
Effectiveness of trauma systems and outcome studies on prehospital and early hospital care have been published recently. Limitations, controversies and important points of those studies will be highlighted in this text.


CONCLUSIONS
Although there is a lack of definitive evidence to support many of the current recommendations for the acute care of trauma patients, the historical development of trauma systems, their long experience and even the existing controversies, can help to establish other critical pathways and can guide performance evaluations so necessary to improve outcomes.
Capone-Neto
Antonio
A
Sunnybrook Health Sciences Centre, University of Toronto, Ontario M4N3M5, Canada.
Rizoli
Sandro B
SB
D001930:Brain Injuries; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D017063:Outcome Assessment, Health Care; D016019:Survival Analysis; D014193:Trauma Centers / Q000458:organization & administration / Q000592:standards*