The future of injury control is precise

Abstract

In the past five decades, trauma systems have emerged across North America and around the world as a comprehensive public health approach to a pervasive societal problem. Data from trauma centers worldwide have shaped clinical practice, systems design, and injury prevention. By viewing injury along a continuum of care, including injury prevention, and by accounting for the social determinants of health, the most successful trauma systems have made a substantial impact on trauma mortality. Now, with advances in genomics and proteomics, and with parallel explosions in digital technology and computing power, trauma systems will begin to navigate the era of precision medicine, which is already defining the frontiers of oncology, critical care, cardiology, and other disciplines. However, the precision medicine movement, which has focused on developing specific, and often expensive, therapies customized for individual patients, may be at odds with the societal approaches that have been taken in the development of trauma systems. Will investments in precision medicine divert support from and stall the momentum of public health and population-based approaches to health, as exemplified by trauma systems? This chapter explores the worldwide burden of traumatic injury, and the converging movements of trauma systems and precision medicine, including the ethical dimensions of choosing between societal and individual patient welfare, with violence-related injury as an example. By balancing ethics considerations and harnessing principles and capabilities of precision medicine, trauma surgeons and investigators have an opportunity to define and lead a new movement, precision injury control, at the intersection of trauma systems and precision medicine.