More research needed to show whether ATLS training in hospitals can cut death rates and decrease disability in injured people

Jayaraman S, Sethi D

Published Online:

April 15, 2009

Training in 'advanced trauma life support' (ATLS) is increasingly used in both rich and poor countries. ATLS is intended to improve the way in which care is given to injured people, thereby reducing death and disability. Some research has been done that suggests ATLS programmes improve the knowledge of staff who have been trained, but there have been no trials to show the impact of ATLS-trained staff (or staff trained in similar programmes) on the rates of death and disability of injured patients themselves. The review calls for more research and puts forward suggestions about how future research might be conducted.

Abstract (click to read)

Background:

Injury is responsible for an increasing global burden of death and disability. As a result, new models of trauma care have been developed. Many of these, though initially developed in high-income countries (HICs), are now being adopted in low and middle-income countries (LMICs). One such trauma care model is advanced trauma life support (ATLS) training in hospitals, which is being promoted in LMICs as a strategy for improving outcomes for victims of trauma. The impact of this health service intervention, however, has not been rigorously tested by means of a systematic review in either HIC or LMIC settings.

Objectives:

To quantify the impact of ATLS training for hospital staff on injury mortality and morbidity in hospitals with and without such a training program.

Search strategy:

We searched the CENTRAL, MEDLINE, EMBASE, PUBMED, CINAHL and ZETOC databases and the Cochrane Injuries Group's Specialised Register. For this update, the search strategy was expanded to include more parameters on research methodology and was run for all years to September 2008.

Selection criteria:

Randomised controlled trials, controlled trials and controlled before-and-after studies comparing the impact of ATLS-trained hospital staff versus non-ATLS trained hospital staff on injury mortality and morbidity.

Data collection and analysis:

One author applied the eligibility criteria to trial reports for inclusion, and extracted data.

Main results:

There is a limited amount of literature about this topic. None of the studies identified by the search met the inclusion criteria for this review.

Authors' conclusions:

There is no clear evidence that ATLS or similar programs impact the outcome for victims of injury, although there is some evidence that educational initiatives improve knowledge of hospital staff of available emergency interventions. Furthermore, there is no evidence that trauma management systems that incorporate ATLS training impact positively on outcome. Future research should concentrate on the evaluation of trauma systems incorporating ATLS, both within hospitals and at the health system level, by using more rigorous research designs.

This record should be cited as:

Jayaraman S, Sethi D. Advanced trauma life support training for hospital staff. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD004173. DOI: 10.1002/14651858.CD004173.pub3

Assessed as up to date:

September 17, 2008

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Primary Review Group:

Injuries Group

Health topics:

Orthopaedics & trauma > Pre-hospital trauma care

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

More research needed to show whether ATLS training in hospitals can cut death rates and decrease disability in injured people

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