Miclau Theodore, Balogh Zsolt J, Miclau Katherine R, Bernstein Brian, Kojima Kodi Edson, Kurozumi Taketo, Leighton Ross K, Lundy Douglas W, Putzeys Guy, Schipper Inger B, Vandesande Wim, de Camargo Leonhardt Marcos, Miranda Goncalves Maria Adelaide, Pelosini Gaiarsa Guilherme, Pape Hans-Christoph
Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California San Francisco, School of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA.
John Hunter Hospital and the University of Newcastle, Newcastle, Australia.
OTA Int. 2025 May 2;8(3 Suppl):e376. doi: 10.1097/OI9.0000000000000376. eCollection 2025 May.
Traumatic injuries are a leading cause of global morbidity and mortality, with 40 million people permanently injured and nearly 6 million deaths every year. Approximately 90% of trauma-related deaths occur in low- and middle-income countries, and 50% of trauma-related deaths are believed to be preventable. Although effective trauma systems encompassing prehospital, hospital, and rehabilitative care are critical for improving outcomes, global documentation remains limited. This study provides a comparative analysis of trauma care systems across 8 countries-the United States, Canada, Brazil, Belgium, the Netherlands, Australia, Japan, and South Africa-spanning 5 continents. Each country's analysis includes demographic context, system organization (including prehospital, hospital, and posthospital care), clinical and systemic outcomes, and future directions. Trauma systems across countries vary significantly in the structure and regulation of trauma care, injury patterns, national data collection, and accessibility, reflecting diverse demographics and healthcare infrastructures. National trauma registries are well established in countries like the Netherlands, Japan, and Canada but are in early development stages in Brazil, South Africa, and Belgium. In some countries, such as the Netherlands and Canada, trauma from traffic collisions and falls dominates, whereas others, such as Brazil and South Africa, have higher rates of violence-related injuries like homicides. Accessibility in remote areas remains a challenge in countries with large landmasses such as Canada and Australia, where rural populations often face limited or delayed trauma care. Other countries, such as the United States and South Africa, face different challenges linked to disparities in quality of and access to care between public and private systems. Although centralization of trauma care, standardization of national trauma care systems, and investment in workforce and infrastructure are universal goals for improving outcomes, solutions tailored to each country are required to optimize trauma systems globally.
创伤性损伤是全球发病和死亡的主要原因，每年有4000万人永久性受伤，近600万人死亡。约90%与创伤相关的死亡发生在低收入和中等收入国家，且据信50%与创伤相关的死亡是可预防的。尽管涵盖院前、医院和康复护理的有效创伤系统对于改善治疗效果至关重要，但全球范围内的相关记录仍然有限。本研究对横跨5个大洲的8个国家——美国、加拿大、巴西、比利时、荷兰、澳大利亚、日本和南非的创伤护理系统进行了比较分析。每个国家的分析包括人口背景、系统组织（包括院前、医院和院后护理）、临床和系统结果以及未来方向。各国的创伤系统在创伤护理的结构和监管、损伤模式、国家数据收集和可及性方面存在显著差异，反映了不同的人口结构和医疗基础设施。国家创伤登记系统在荷兰、日本和加拿大等国已很完善，但在巴西、南非和比利时尚处于早期发展阶段。在一些国家，如荷兰和加拿大，交通碰撞和跌倒导致的创伤占主导，而在其他国家，如巴西和南非，与暴力相关的损伤（如凶杀）发生率较高。在加拿大和澳大利亚等幅员辽阔的国家，偏远地区的可及性仍然是一个挑战，农村人口往往面临有限或延迟的创伤护理。其他国家，如美国和南非，面临着与公共和私人系统之间护理质量和可及性差异相关的不同挑战。尽管集中创伤护理、规范国家创伤护理系统以及对劳动力和基础设施进行投资是改善治疗效果的普遍目标，但需要针对每个国家量身定制解决方案，以在全球范围内优化创伤系统。
