title: Effectiveness of regionalization of trauma care services: a systematic review.
abstract: OBJECTIVE
  Improving trauma systems in various forms has always been an important aspect of health policy. While several papers have reported the implementation of a structured trauma system of care, research evidence on the effectiveness of such regionalization for improvement in trauma outcome is limited.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Medline, EMbase, EconLit and Health Management Information Consortium were searched, using sensitive search terms, for interventional studies that reported a trauma regionalization system as their intervention, and compared important outcomes such as mortality and preventable deaths. At least two authors assessed eligibility for inclusion and risk of bias, and extracted data from the included studies. As meta-analysis was not possible for all studies, two controlled before-after studies were included in the meta-analysis, and a narrative analysis was conducted for the other studies.
  
  
  RESULTS
  After title and abstract sifting, 66 papers were retrieved. After reading the full texts, a total of 24 studies from the USA, UK, Canada, Australia, and the Netherlands were included in this review. In spite of variation in study specifications, most were before-after studies with a high risk of bias. Although a reduction in mortality was shown in most studies, only two studies were eligible for meta-analysis, and the results showed a significant reduction in mortality after implementation of an organized trauma system (odds ratio 0.840, 95% confidence interval 0.756-0.924; P = 0.00).
  
  
  CONCLUSIONS
  Correlation was found between a regionalized network of trauma care and a reduction in trauma-related mortality, based on studies that did not exclude the effects of other concurrent changes on observed reductions. It is recommended that more studies with robust research designs should be conducted in a more diverse range of countries to assess the effectiveness of regionalization. Despite this limitation, the present findings support the regionalization of trauma care services.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Y
authors.initials: Y
authors.lastname: Vali
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: arashidian@tums.ac.ir.
authors.forename: A
authors.initials: A
authors.lastname: Rashidian
authors.affiliation: Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Jalili
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
authors.forename: A H
authors.initials: AH
authors.lastname: Omidvari
authors.affiliation: Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Jeddian
mesh_terms: D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012040:Regional Health Planning; D014193:Trauma Centers / Q000458:organization & administration*; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*
keywords: Mortality; Regionalization; Trauma care; Trauma system