Systematic review of trauma system effectiveness based on registry comparisons

Background: Trauma registries offer distinct advantages and disadvantages w hen assessing the effectiveness of trauma systems. Detailed injury data and statistical comparisons that use TRISS methodology and the Major Trauma Ou tcome Study norms provide advantages over population-based or preventable d eath studies. However, miscodings and registry differences in injury severi ty coding limit the validity and generalizability of findings. The purpose of this study was to identify these strengths and weaknesses and to determi ne whether registry studies provide evidence of trauma system efficacy. Methods: A systematic review of published literature assessing trauma syste ms effectiveness by using registry-based data. Results: Eight of 11 articles reviewed provided comparable data and consist ently demonstrated a 15 to 20% reduction in the risk of death comparing tra uma system outcomes to Major Trauma Outcome Study norms. Conclusion: These studies pro, ide evidence of the effectiveness of trauma systems. However, future studies that use trauma registries mould be streng thened by including both prehospital and postdischarge trauma deaths, stand ardizing trauma registry inclusion criteria and developing a contemporary n ational reference norm for trauma outcome.