Levi Amelia, Gupta Shailvi, Balasubramaniam Sunder, Civil Ian, Cole Elaine, Bala Miklosh, Cioffi Stefano, Caminsky Natasha, Chiara Osvaldo, Rivkind Avraham I, Fitzgerald Mark, James Arthur, Scalea Thomas, Wong Evan, Kushner Adam L, Ratnayake Amila
MedStar Georgetown/Washington Hospital Center, 110 Irving St, NW, Washington DC, USA.
R Adams Cowley Shock Trauma, 22 S Greene St. Baltimore MD, USA.
Injury. 2025 Apr;56(4):112260. doi: 10.1016/j.injury.2025.112260. Epub 2025 Mar 10.
As the ravages of war, road traffic crashes, and interpersonal violence have led society to view injury as a preventable illness, the delivery of trauma care has shifted from the standalone hospital to system-based care. A trauma system is an organized, coordinated, integrated effort that delivers care from the prehospital setting to the facility, and then to rehabilitation, to reduce morbidity and mortality of the injured patient. However, many countries still lack this systematic care. Recognizing this discrepancy, we conducted what appears to be the first multinational, collaborative study of mature trauma systems in order to identify their successes and challenges, so that we may close this gap in care.
From January 2022-January 2023, trauma system leaders in Australia, Canada, France, Israel, Italy, New Zealand, the United Kingdom, and the United States of America answered a semi-structured questionnaire. Each expert detailed their system's context for creation, delineated their successes and challenges, and described their plans for future development. From this data we extracted key themes shared by all eight systems.
Our results revealed that these eight mature trauma systems are encompassed by two main processes, which we titled 'development' and 'maturation'. We found that the developmental process relies on a sentinel paper inciting political leadership to build the system. The system then contains six essential elements: governance, trauma network, pre-hospital care, facility-based care, trauma registry/quality improvement, and rehabilitation. The maturation process is the course of operationalizing the system once it is established to produce the intended result. This consists of connectivity and coordination, supporting key stakeholders, and continually subjecting the system to review for improvement.
This innovative study describes eight distinct mature trauma systems and identifies commonalities between them. The lessons learned from these eight systems should be used both by countries with an existing trauma system to aid in maturation, and by developing nations looking to construct a trauma system, so that the disparities in trauma care delivery may start to dissipate.
