Evaluating trauma management performance in Europe: a multiple-layer data envelopment analysis model

Trauma management (TM) concerned with the medical treatment of injuries resulting from road crashes is considered key in avoiding preventable death and disability and in reducing the severity and suffering caused by the injury. To understand the concept of TM better and to evaluate the level of overall performance in different countries, a hierarchical set of TM indicators is developed and subsequently combined into an overall index. Data envelopment analysis (DEA) is explored, and a multiple-layer DEA model is developed to reflect the hierarchical structure of the indicators. With 17 TM performance indicators related to emergency medical services and permanent medical facilities, the most optimal TM index score is computed for 21 European countries. The weights assigned to the indicators of each layer of the hierarchy are deduced, to provide insight into the critical aspects of the prevalent TM system. In addition, country groups in accordance with the index score are evaluated, and a particular set of benchmark countries is identified for those countries with relatively poor performance.