Maturation of trauma systems in Europe

PURPOSE: To provide an overview of trauma system maturation in Europe. METHODS: Maturation was assessed using a self-evaluation survey on prehospital care, facility-based trauma care, education/training, and quality assurance (scoring range 3–9 for each topic), and key infrastructure elements (scoring range 7–14) that was sent to 117 surgeons involved in trauma, orthopedics, and emergency surgery, from 24 European countries. Average scores per topic were summed to create a total score on a scale from 19 to 50 per country. Scores were compared between countries and between geographical regions, and correlations between scores on different sections were assessed. RESULTS: The response rate was 95%. On the scale ranging from 19 to 50, the mean (SD, range) European trauma system maturity score was 38.5 (5.6, 28.2–48.0). Prehospital care had the highest mean score of 8.2 (0.5, 6.9–9.0); quality assurance scored the lowest 5.9 (1.7, 3.2–8.5). Facility-based trauma care was valued 6.9 (1.4, 4.1–9.0), education and training 7.0 (1.2, 5.2–9.0), and key infrastructure elements 10.3 (1.6, 7.6–13.5). All aspects of trauma care maturation were strongly correlated (r > 0.6) except prehospital care. End scores of Northern countries scored significantly better than Southern countries (p = 0.03). CONCLUSION: The level of development of trauma care systems in Europe varies greatly. Substantial improvements in trauma systems in several European countries are still to be made, especially regarding quality assurance and key infrastructure elements, such as implementation of a lead agency to oversee the trauma system, and funding for growth, innovation and research.