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Invited Critique
June 2000

Trauma and Trauma Care Systems: In the Throes of an Identity Crisis—Invited Critique

Arch Surg. 2000;135(6):719. doi:10.1001/archsurg.135.6.719

Hurrah for Dr Esposito for providing a much-needed articulation of the fact that for the greater part of the 1990s the trauma community has exhibited symptoms of progressive loosening of tenuous bonds to reality. Massive achievements were realized in the 1970s and 1980s as bona fide attempts were made to provide timely matching of patient need with available expertise and resources. The difficulties that have occurred since then in delineating and documenting these as statistically significant outcome improvements may be a testament to the fact that but a small fraction of those patients corralled into trauma centers truly benefit in terms of lifesaving. Another fraction may benefit from reduced morbidity and reduced cost, but at what expense for all those who do not need to be there? Many of those who die, will die anyway. Most of those who do not, will not anyway. The correct denominator on which to prove a trauma center's worth continues to be a challenging scientific exercise. Perhaps the greatest achievement of the trauma community has been the Advanced Trauma Life Support course,1 which may have saved more lives than anything else.

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