National trauma systems play a critical role in improving survival and reducing disability from musculoskeletal and other injuries. An update on trauma systems around the world and priorities for developing and standardizing care; in lower- and higher-income countries is presented in a supplement to OTA International, open-access journal of the Orthopedic Trauma Association. The journal is published in the Lippincott portfolio by Wolters Kluwer.
The special issue includes a current snapshot and forward look at national trauma systems in Asia, Australia, Europe, Latin America; and North America. “This work represents a collaboration of member societies of the International Orthopedic Trauma Association (IOTA); which is an international association of orthopedic societies dedicated to the promotion of musculoskeletal trauma care; through advancements in treatment, education, and research,” writes Guest Editor Theodore Miclau, MD, of University of California, San Francisco.
Trauma Systems Around the World
Worldwide, trauma is the leading cause of death among people under the age of 45. But road traffic injuries alone cause 1.2 million deaths and 20 to 50 million nonfatal injuries each year. So, recent reports suggest that 90% of trauma deaths occur in low- and middle-income countries.
Posted today, the OTA International supplement reflects the growing interest in improving trauma care; in order to reduce trauma-related mortality around the world. “Well-developed trauma systems in higher income countries have been shown to improve patient outcomes; however the overall adoption of such systems remains low,” Dr. Miclau writes.
Contributed by authors representing IOTA member organizations in 15 countries, the supplement papers summarize the current state and future development of national trauma systems in:
The United States and Canada both have well-developed trauma systems while each has room for improvement; “both provide effective access and quality care to the vast majority of injured patients,” write Douglas W. But Lundy, MD, MBA, FACS, of Resurgens Orthopaedics, Atlanta; and colleagues. They note that the Canadian trauma system is more unified the US system, where trauma centers are verified by individual states.
Tim J.S. Chesser, FRCS, of North Bristol (UK) NHS Trust and colleagues report on the development of trauma systems in England, Germany, the Netherlands, and Spain. But in these and other countries with well-establishing trauma system, as more patients survive severe injuries; so there is a growing focus on quality of life and other patient-reported outcomes.
Australia faces challenges related to providing trauma care across a geographically large and sparsely populated country, write Kirrily-Rae J. Warren, MBBS, of John Hunter Hospital, Newcastle, NSW, and colleagues. Hence, in a system where one-third of patients are transferred for definitive care, the focus is on improving and coordinating transfers to major trauma centers.
Luis G. Padilla-Rojas, MD, of General Hospital, Guadalajara, Jalisco, and colleagues summarize the state of trauma care in Mexico and Brazil, two countries with emergent economies. While both countries have well-organized trauma systems, the authors highlight the need for universal, standardized trauma care across Latin America.
5.India and China.
“Neither India nor China has a formalized trauma system in place,” write Sushrut Babhulkar, MS, MCh, of Sushrut Institute of Medical Sciences, Nagpur, Maharashtra, India, and colleagues. They note the pressing need for concerted effort toward the concept of “adequate trauma care for all” especially with the rapid economic growth and increasing numbers of motor vehicles in these and other Asian countries.
While acknowledging the gap in trauma system development between higher- and lower-income countries, the supplement papers draw attention to a common goal: documenting improvements in survival and subsequent outcomes, as a direct result of care provided by national trauma systems. Dr. Miclau concludes: “The information presented in this supplement will contribute to larger efforts toward understanding, improving, and standardizing existing trauma systems worldwide.”