Background: We aimed to systematically review the literature on the educational impact of Advanced Trauma Life Support (ATLS) courses and their effects on death rates of multiple trauma patients. Methods: All Medline, Pubmed, and the Cochrane Library English articles on the educational impact of ATLS courses and their effects on trauma mortality for the period 1966-2012 were studied. All original articles written in English were included. Surveys, reviews, editorials/letters, and other trauma courses or models different from the ATLS course were excluded. Articles were critically evaluated regarding study research design, statistical analysis, outcome, and quality and level of evidence. Results: A total of 384 articles were found in the search. Of these, 104 relevant articles were read; 23 met the selection criteria and were critically analyzed. Ten original articles reported studies on the impact of ATLS on cognitive and clinical skills, six articles addressed the attrition of skills gained through ATLS training, and seven articles addressed the effects of ATLS on trauma mortality. There is level I evidence that ATLS significantly improves the knowledge of participants managing multiple trauma patients, their clinical skills, and their organization and priority approaches. There is level II-1 evidence that knowledge and skills gained through ATLS participation decline after 6 months, with a maximum decline after 2 years. Organization and priority skills, however, are kept for up to 8 years following ATLS. Strong evidence showing that ATLS training reduces morbidity and mortality in trauma patients is still lacking. Conclusions: It is highly recommended that ATLS courses should be taught for all doctors who are involved in the management of multiple trauma patients. Future studies are required to properly evaluate the impact of ATLS training on trauma death rates and disability.
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