Eight core components for trauma care: A 12-year retrospective cohort study before and after trauma center establishment.

PURPOSE: Trauma remains the leading cause of death among individuals aged 1 - 46 years worldwide, with 5.8 million annual deaths. While trauma centers reduce mortality by approximately 25%, the core components constituting an effective trauma system and their specific impacts on preventable deaths require further elucidation, particularly in newly developing systems.

METHODS

This retrospective study analyzed trauma admissions from January 1, 2013, to December 31, 2024, at a tertiary hospital in Shenzhen, Guangdong province, China. All the major trauma patients (injury severity score ≥16) who died were included for death review. A multidisciplinary panel reviewed all trauma deaths using standardized audit forms based on World Health Organization definitions and the Advanced Trauma Life Support guidelines. Outcomes were compared between the pre-trauma center period (2013 - 2018) and post-trauma center period (2019 - 2024). Data were analyzed using SPSS version 25.0.

RESULTS

Among 17,192 trauma admissions, 1503 were major trauma patients (injury severity score ≥16), with 82 trauma deaths identified. Preventable or potentially preventable deaths accounted for 17 cases (23.2% of trauma deaths). Following trauma center establishment, trauma deaths among major trauma patients significantly decreased from 41 to 16 (p < 0.001) when excluding deaths on arrival. A total of 151 management errors were identified; delayed adequate treatment was the most common error in preventable deaths (10/16, 62.5%).

CONCLUSION

The establishment of a trauma center with 8 core components: pre-notification systems, multidisciplinary trauma teams, Advanced Trauma Life Support-based resuscitation protocols, optimized trauma bays, massive transfusion protocols, damage control surgery principles, trauma audit meetings, and a dedicated trauma services framework, was associated with significantly reduced trauma mortality. These findings provide a practical and replicable framework for trauma center development in comparable healthcare settings.