Trauma systems: a global comparison

OTA International The Open Access Journal of Orthopaedic Trauma, vol. 8, pp. e376

Abstract

Traumatic injuries are a leading cause of global morbidity and mortality, with 40 million people permanently injured and nearly 6 million deaths every year. Approximately 90% of trauma-related deaths occur in low- and middle-income countries, and 50% of trauma-related deaths are believed to be preventable. Although effective trauma systems encompassing prehospital, hospital, and rehabilitative care are critical for improving outcomes, global documentation remains limited. This study provides a comparative analysis of trauma care systems across 8 countries-the United States, Canada, Brazil, Belgium, the Netherlands, Australia, Japan, and South Africa-spanning 5 continents. Each country's analysis includes demographic context, system organization (including prehospital, hospital, and posthospital care), clinical and systemic outcomes, and future directions. Trauma systems across countries vary significantly in the structure and regulation of trauma care, injury patterns, national data collection, and accessibility, reflecting diverse demographics and healthcare infrastructures. National trauma registries are well established in countries like the Netherlands, Japan, and Canada but are in early development stages in Brazil, South Africa, and Belgium. In some countries, such as the Netherlands and Canada, trauma from traffic collisions and falls dominates, whereas others, such as Brazil and South Africa, have higher rates of violence-related injuries like homicides. Accessibility in remote areas remains a challenge in countries with large landmasses such as Canada and Australia, where rural populations often face limited or delayed trauma care. Other countries, such as the United States and South Africa, face different challenges linked to disparities in quality of and access to care between public and private systems. Although centralization of trauma care, standardization of national trauma care systems, and investment in workforce and infrastructure are universal goals for improving outcomes, solutions tailored to each country are required to optimize trauma systems globally.

Authors 15

1. Theodore Miclau corresponding

   San Francisco General Hospital · University of California, San Francisco

   Affiliation as printed

   Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California San Francisco, School of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA

2. Zsolt Janos Balogh

   John Hunter Hospital

   Affiliation as printed

   John Hunter Hospital and the University of Newcastle, Newcastle, Australia

3. Katherine R. Miclau

   University of California, San Francisco

   Affiliation as printed

   University of California, San Francisco, School of Medicine, San Francisco, CA

4. Brian P. Bernstein

   University of Cape Town

   Affiliation as printed

   Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa

5. Kodi Edson Kojima

   Universidade de São Paulo · Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

   Affiliation as printed

   Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil

6. Taketo Kurozumi

   Teikyo University Hospital · Teikyo University

   Affiliation as printed

   Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan

7. ROSS K. LEIGHTON

   Dalhousie University

   Affiliation as printed

   Dalhousie University, Halifax, NS, Canada

8. Douglas W. Lundy

   St. Luke's University Health Network

   Affiliation as printed

   St. Luke's University Health Network, Bethlehem, PA

9. Guy Putzeys

   AZ Groeninge

   Affiliation as printed

   Orthopedic and Trauma Department, AZ Groeninge Hospital, Kortrijk, Belgium

10. Inger Birgitta Schipper Aachen Department of Trauma Surgery at Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Trauma Surgery at Leiden University Medical Center, Leiden, the Netherlands

11. Wim Vandesande

    Universitair Ziekenhuis Leuven

    Affiliation as printed

    Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium

12. Marcos de Camargo Leonhardt

    Universidade de São Paulo · Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

    Affiliation as printed

    Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil

13. Maria Adelaide de Miranda Gonçalves

    Universidade de São Paulo · Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

    Affiliation as printed

    Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil

14. Guilherme Pelosini Gaiarsa

    Universidade de São Paulo · Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

    Affiliation as printed

    Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil

15. Hans‐Christoph Pape

    University Hospital Zurich

    Affiliation as printed

    Department of Trauma, University Hospital, Zurich, Switzerland