Ten year maturation period in a level-I trauma center, a cohort comparison study

• Published in: European journal of trauma and emergency surgery (Munich : 2007) 2017-10, Vol.43 (5), p.685-690
• Main Authors: Harmsen, A. M. K., Giannakopoulos, G. F., Terra, M., de Lange de Klerk, E. S. M., Bloemers, F. W.
• Format: Article
• Language: English
• Subjects: Age Factors; Cohort Studies; Critical Care Medicine; Emergency Medical Services - utilization; Emergency Medicine; Female; Humans; Injury Severity Score; Intensive; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Netherlands - epidemiology; Original; Original Article; Sports Medicine; Surgery; Surgical Orthopedics; Survival Analysis; Trauma; Trauma care; Trauma centers; Trauma Centers - utilization; Traumatic Surgery; Wounds and Injuries - epidemiology; Wounds and Injuries - mortality
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-016-0722-1

Purpose Many changes have been made to improve trauma care. Improved trauma team response and usage of a hybrid resuscitation room are examples of how this trauma center has developed. The aim was to assess how the outcome of the trauma population was influenced by the maturation. Methods A cohort comparison, between June 2004–July 2005 and 2014, was performed. All adult trauma patients with an Injury Severity Score (ISS) >15 were included. Variables collected were: patient demographics, mechanism of trauma, total prehospital time, pre- and inhospital trauma scores, vital signs, blood values and interventions, and physician staffed helicopter emergency medical services (P-HEMS) involvement and outcome. Results From June 2004 to July 2005 219, patients were admitted, and for the year 2014, this was 282 patients. The 2014 cohort was significantly older (mean age of 53.6 ± 23.8 vs 45.6 ± 22.7 years). The mean RTS did not differ. P-HEMS assists increased to 116 (13.5 %). The number of CT scans, blood transfusion, and acute trauma surgical interventions decreased. Mean LOS, ICU admission, and ICU LOS did not differ. The mortality rate, however, decreased by 7.0 %, observed and predicted survival was significantly different in favour of the 2014 cohort, with a Z-score of 4.25. Conclusion An increase in age is seen, though trauma scores remain comparable. The number of blood products transfused and acute trauma surgical interventions performed declines. Mortality significantly decreased and a significant difference in observed and predicted survival is seen. Showing improved trauma care in our hospital, in favour of the second period.