In the early 1900s, an American surgeon named Ernest Amory Codman introduced the concept of “the end result idea” to encourage scrutiny of patient outcomes in hospitalized patients. Codman suggested that this approach be used to compare hospitals and surgeons and thus the era of benchmarking began. Controversy ensued as “the end result idea” threatened to shift focus from a system based on the privileges of seniority to a more objective one. Prompted by Codman's idea, the American College of Surgeons (ACS) developed a committee called the Standardization of Hospitals in the late 1920s that ultimately became the Joint Commission for the Accreditation of Hospitals. Let's jump ahead 60 years to the reports of Wennberg who reported remarkable differences in the rate of carotid endarterectomies, tonsillectomies, and hysterectomies in various geographic regions. These early reports ushered in the era of evidence-based medicine, defined as the integration of the current best evidence with clinical expertise and patient preferences used in making decisions regarding care. Trauma research focusing on outcome studies and evidence-based methodology is in its early stages and will be reviewed below.

Trauma systems

Optimal pediatric trauma care: pediatric vs. adult trauma centers

The debate regarding the optimal setting for pediatric trauma care delivery has existed for more than two decades and is unresolved at present. The Major Trauma Outcome Study and TRISS methodology have been used in several studies to highlight care of the pediatric trauma victim in adult trauma centers.