Abstract
Background and Objectives: Major trauma centres manage severely injured patients using multi-disciplinary teams but the evidence-base that targeted Trauma Team Training (TTT) improves patients’ outcomes is unclear. This systematic review aimed to identify the association between the implementation of TTT programs and patient outcomes. Materials and Methods: We searched OVID Medline, PubMed and The Cochrane Library (CENTRAL) from the date of the database commencement until 10 of April 2019 for a combination of Medical Subject Headings (MeSH) terms and keywords relating to TTT and clinical outcomes. Reference lists of appraised studies were also screened for relevant articles. We extracted data on the study setting, type and details about the learners, as well as clinical outcomes of mortality and/or time to critical interventions. A meta-analysis of the association between TTT and mortality was conducted using a random effects model. Results: The search yielded 1136 unique records and abstracts, of which 18 full texts were reviewed. Nine studies met final inclusion, of which seven were included in a meta-analysis of the primary outcome. There were no randomised controlled trials. TTT was not associated with mortality (Pooled overall odds ratio (OR) 0.83; 95% Confidence Interval; 0.64–1.09). TTT was associated with improvements in time to operating theatre and time to first computerized tomography (CT) scanning. Conclusions: Despite few publications related to TTT, its introduction was associated with improvements in time to critical interventions. Whether such improvements can translate to improvements in patient outcomes remains unknown. Further research focusing on the translation of standardised trauma team reception “actions” into TTT is required to assess the association between TTT and patient outcome.
Highlights
Injury and trauma related deaths affect all age groups and have no geographical boundary
In terms of patient outcomes, we primarily focused on mortality
18 unique full text studies were identified for review, of which nine were included, and seven in the meta-analysis on mortality (Figure 1)
Summary
Injury and trauma related deaths affect all age groups and have no geographical boundary. It is difficult to separate the impact of trauma team-delivered care from that of trauma systems as a whole, there is evidence that the introduction of trauma teams has significantly improved patient outcomes [4,5]. Effective trauma teams must be self-reflective and open to learn from shared experiences; collectively, these are known as ‘non-technical skills’. It follows that ineffective trauma team performance cannot be attributed solely to inadequate knowledge or skills of the individual team members, but from deficits in the ‘non-technical skills’ of the team [7,8]. Major trauma centres manage severely injured patients using multi-disciplinary teams but the evidence-base that targeted Trauma Team Training (TTT) improves patients’ outcomes is unclear. Nine studies met final inclusion, of which seven were included in a meta-analysis of the primary outcome
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