Assessing the effectiveness and optimal structure of trauma systems: A consensus among experts

Objective: To determine whether a consensus exists among experts regarding the effect of organized trauma systems on patient outcomes based on peer-reviewed, published evidence. Second, to ascertain whether experts agree on the optimal structure of trauma systems. Methods: A multistage, longitudinal survey was administered to trauma system experts participating in a national symposium designed to assess the published evidence regarding trauma system effectiveness. Survey questions assessed published evidence by evaluating study designs, potential biases, and sample case mix. Trauma system structure was assessed by asking participants to rate the merit of previously identified key trauma system characteristics. Analyses were conducted using consensus theory. Results: Ninety symposium participants (99%) completed all five surveys. Respondents considered the evidence to be "moderately supportive" of trauma system effectiveness when considering severely injured patients in urban settings. Several key trauma system characteristics were identified as mandatory or highly desirable components of trauma system implementation and maintenance. Experts currently favor exclusive rather than inclusive trauma systems. Conclusion: A consensus does exist among trauma system experts regarding the effectiveness of trauma systems and the optimal structure of trauma systems. Additional research is needed to determine whether trauma system benefits extend to other patient subgroups in other geographic regions. Consensus theory provides an impressive model for assessing rater agreement by controlling for response bias and providing a probability measure to determine whether a true consensus exists.