Systematic review of trauma system effectiveness based on registry comparisons.

BACKGROUND Trauma registries offer distinct advantages and disadvantages when assessing the effectiveness of trauma systems. Detailed injury data and statistical comparisons that use TRISS methodology and the Major Trauma Outcome Study norms provide advantages over population-based or preventable death studies. However, miscodings and registry differences in injury severity coding limit the validity and generalizability of findings. The purpose of this study was to identify these strengths and weaknesses and to determine whether registry studies provide evidence of trauma system efficacy. METHODS A systematic review of published literature assessing trauma systems effectiveness by using registry-based data. RESULTS Eight of 11 articles reviewed provided comparable data and consistently demonstrated a 15 to 20% reduction in the risk of death comparing trauma system outcomes to Major Trauma Outcome Study norms. CONCLUSION These studies provide evidence of the effectiveness of trauma systems. However, future studies that use trauma registries would be strengthened by including both prehospital and postdischarge trauma deaths, standardizing trauma registry inclusion criteria and developing a contemporary national reference norm for trauma outcome.