Department of Neurological Surgery, University Hospitals Cleveland Medical Center , Cleveland, OH, USA.
Case Western Reserve University School of Medicine , Cleveland, OH, USA.
Neurol Res. 2021 Feb;43(2):87-96. doi: 10.1080/01616412.2020.1824391. Epub 2020 Sep 24.
The number of trauma systems has increased dramatically within the United States over the past 40 years. The implementation of these systems has contributed to a decrease in mortality and improved outcomes in patients with trauma. Several studies have evaluated the effect of implementation of these systems on outcomes, but few studies examine the effects of such systems specifically on traumatic brain injury (TBI).
A systematic review of the literature was conducted according the guidelines for the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to determine the effects of trauma system implementation and regionalization on mortality and other outcome measures in adult TBI. We sought to include both experimental and observational studies within the United States.
From 1983 to 2015, nine studies were identified that adhered to the predefined inclusion and exclusion criteria representing six different geographic areas within the United States. All studies utilized a retrospective pre-post implementation methodology. A variety of mortality outcome measures were identified in the literature. Six of the nine studies demonstrated some benefit on various mortality metrics.
The existing literature on the effects of trauma system implementation or regionalization on outcomes in TBI is sparse but overall seems to convey an improvement in mortality.
在过去的 40 年中，美国的创伤系统数量急剧增加。这些系统的实施有助于降低创伤患者的死亡率并改善其预后。有几项研究评估了实施这些系统对结果的影响，但很少有研究专门研究这些系统对创伤性脑损伤 (TBI) 的影响。
根据系统评价和荟萃分析的首选报告项目 (PRISMA) 的指南进行了系统的文献回顾，以确定创伤系统实施和区域化对成人 TBI 死亡率和其他结果测量的影响。我们试图在美国纳入实验和观察性研究。
从 1983 年到 2015 年，确定了九项符合预先设定的纳入和排除标准的研究，代表美国六个不同的地理区域。所有研究均采用回顾性实施前后的方法学。文献中确定了各种死亡率的预后指标。九项研究中有六项显示出在各种死亡率指标上有一定的益处。
关于创伤系统实施或区域化对 TBI 结果的影响的现有文献很少，但总体上似乎传达了死亡率的改善。
