Academic Journal
Trauma governance and system maturity: A cross-national analysis of authority, funding, enforcement, and surveillance in 37 countries.
| Τίτλος: | Trauma governance and system maturity: A cross-national analysis of authority, funding, enforcement, and surveillance in 37 countries. |
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| Συγγραφείς: | Kewalramani D; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: dk1362@rwjms.rutgers.edu., Benton J; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: jb2066@rwjms.rutgers.edu., Choron RL; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: rc1147@rwjms.rutgers.edu., Teichman A; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: ateich13@rwjms.rutgers.edu., Englert Z; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: zpe1@rwjms.rutgers.edu., Gelster C; Department of Surgery, University of Texas Southwestern, Dallas, TX, USA., Goncalves J; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: jc125@rwjms.rutgers.edu., Skobelev E; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: es964@rwjms.rutgers.edu., Whitley D; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: dw765@rwjms.rutgers.edu., Goswami J; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: goswamju@rwjms.rutgers.edu., Hanna J; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: jh1091@rwjms.rutgers.edu., Singh G; SaveLIFE Foundation, Delhi, India. Electronic address: gsingh@savelifefoundation.org., Tewari P; SaveLIFE Foundation, Delhi, India. Electronic address: piyushtewari@savelifefoundation.org., Barie P; Division of Trauma, Burns, Acute and Critical Care, Weill Cornell Medicine, New York, NY, USA. Electronic address: pbarie@med.cornell.edu., Misra MC; Sitaram Bhartia Institute of Science and Research, New Delhi, India. Electronic address: mahesh.misra@aiimsdelhi.edu.in., Narayan M; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: mayur.narayan@rutgers.edu. |
| Πηγή: | Injury [Injury] 2026 Oct 01, pp. 113742. Date of Electronic Publication: 2026 Oct 01. |
| Publication Model: | Ahead of Print |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 0226040 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0267 (Electronic) Linking ISSN: 00201383 NLM ISO Abbreviation: Injury Subsets: MEDLINE |
| Imprint Name(s): | Publication: <2002->: Amsterdam : Elsevier Original Publication: Bristol, Wright. |
| Περίληψη: | Background: Organized trauma systems reduce mortality, yet most countries lack such systems and among those that exist, maturity varies widely. While the World Health Organization (WHO) emphasizes governance components including authority, funding, enforcement, and surveillance, empirical evidence linking these elements to measurable system outcomes is absent. We hypothesized that trauma governance entities (TGE) would demonstrate a dose-dependent association with WHO's Trauma System Maturity Index (TSMI) scores after adjusting for macro-economic resources. Methods: WHO reports, peer-reviewed literature, and national trauma registry publications spanning 2017-2024 were used to perform a cross-sectional analysis of 37 countries representing all World Bank regions and three income tiers (lower-middle, upper-middle, high). TSMI scores were assigned to four TSMI domains: prehospital care, facility-based care, education/training, quality assurance. For each nation, a composite mean TSMI score was calculated. A novel TGE score (0-4) was created to assess four domains: authority, funding, enforcement, surveillance (AFES). Spearman correlation and multivariable ordinary least-squares regression adjusting for income level, injury mortality rate (IMR), and system type were employed to assess associations between AFES and system maturity. The primary effect estimate was the contrast between countries with any governance component present (AFES≥1) and countries with none (AFES=0). Results: Of 37 nations, 15 (41%) nations had a TGE. Nations with a TGE demonstrated lower median IMR per 1000 persons (6.9 [IQR 5.2-8.1] vs 22.2 [IQR 8.7-34.9], p = 0.002) and higher composite TSMI scores (3.50 [IQR 3.25-4.00] vs 3.00 [IQR 1.81-3.44], p = 0.003). TSMI did not increase monotonically across AFES categories (median 2.25, 3.25, 3.88, 2.50 and 3.50 for AFES=0 through AFES=4). In an adjusted OLS model, countries with any governance components present (AFES≥1) had TSMI scores 0.66 points higher than countries with no governance components (β=0.66, 95% CI [0.13, 1.18], p = 0.016). Conclusions: Trauma governance, operationalized through establishment of AFES domains, is strongly associated with trauma system maturity with the difference concentrated between countries that have no formal governance and those that have any. Establishing any formal governance structure may be a particularly high-yield, scalable target to improve trauma system outcomes, especially in high-burdened, lower-middle income nations. Level of Evidence: Prognostic and Epidemiological; Level III. (Copyright © 2026 British Trauma Society. Published by Elsevier Ltd. All rights reserved.) |
| Competing Interests: | Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Authority, Funding; Governance; Maturity; Trauma Systems |
| Entry Date(s): | Date Created: 20261006 Latest Revision: 20261006 |
| Update Code: | 20261007 |
| DOI: | 10.1016/j.injury.2026.113742 |
| PMID: | 42838817 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1879-0267 |
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| DOI: | 10.1016/j.injury.2026.113742 |