The impact of prehospital time intervals on mortality in moderately and severely injured patients

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Job F. Waalwijk ◽  
Rogier van der Sluijs ◽  
Robin D. Lokerman ◽  
Audrey A.A. Fiddelers ◽  
Falco Hietbrink ◽  
...  
Keyword(s):  
Severely Injured ◽  
Time Intervals ◽  
Severely Injured Patients ◽  
Injured Patients ◽  
Prehospital Time ◽  
The Impact

scholarly journals The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

2021 ◽  
Author(s):  
Suzan Dijkink ◽  
Erik W. van Zwet ◽  
Pieta Krijnen ◽  
Luke P. H. Leenen ◽  
Frank W. Bloemers ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Future Research ◽  
Severely Injured ◽  
Trauma Centers ◽  
Severely Injured Patients ◽  
The Right ◽  
Injured Patients ◽  
The Impact

Abstract Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008–2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63–74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.

scholarly journals The impact of prehospital tranexamic acid on mortality and transfusion requirements: match-pair analysis from the nationwide German TraumaRegister DGU®

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Sebastian Imach ◽  
Arasch Wafaisade ◽  
Rolf Lefering ◽  
Andreas Böhmer ◽  
Mark Schieren ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Massive Transfusion ◽  
Control Group ◽  
Transfusion Rate ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Match Pair ◽  
Transfusion Requirements ◽  
Injured Patients ◽  
The Impact

Abstract Background Outcome data about the use of tranexamic acid (TXA) in civilian patients in mature trauma systems are scarce. The aim of this study was to determine how severely injured patients are affected by the widespread prehospital use of TXA in Germany. Methods The international TraumaRegister DGU® was retrospectively analyzed for severely injured patients with risk of bleeding (2015 until 2019) treated with at least one dose of TXA in the prehospital phase (TXA group). These were matched with patients who had not received prehospital TXA (control group), applying propensity score-based matching. Adult patients (≥ 16) admitted to a trauma center in Germany with an Injury Severity Score (ISS) ≥ 9 points were included. Results The matching yielded two comparable cohorts (n = 2275 in each group), and the mean ISS was 32.4 ± 14.7 in TXA group vs. 32.0 ± 14.5 in control group (p = 0.378). Around a third in both groups received one dose of TXA after hospital admission. TXA patients were significantly more transfused (p = 0.022), but needed significantly less packed red blood cells (p ≤ 0.001) and fresh frozen plasma (p = 0.023), when transfused. Massive transfusion rate was significantly lower in the TXA group (5.5% versus 7.2%, p = 0.015). Mortality was similar except for early mortality after 6 h (p = 0.004) and 12 h (p = 0.045). Among non-survivors hemorrhage as leading cause of death was less in the TXA group (3.0% vs. 4.3%, p = 0.021). Thromboembolic events were not significantly different between both groups (TXA 6.1%, control 4.9%, p = 0.080). Conclusion This is the largest civilian study in which the effect of prehospital TXA use in a mature trauma system has been examined. TXA use in severely injured patients was associated with a significantly lower risk of massive transfusion and lower mortality in the early in-hospital treatment period. Due to repetitive administration, a dose-dependent effect of TXA must be discussed.

IMPACT OF ON-SITE CARE, PREHOSPITAL TIME, AND LEVEL OF IN-HOSPITAL CARE ON SURVIVAL IN SEVERELY INJURED PATIENTS

1993 ◽  
Vol 34 (2) ◽  
pp. 252-261 ◽  
Author(s):  
John S. Sampalis ◽  
Andre Lavoie ◽  
J. I. Williams ◽  
David S. Mulder ◽  
Mathias Kalina
Keyword(s):  
Hospital Care ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Injured Patients ◽  
Prehospital Time

Is NBATS-2 up to the Task? Actual vs. Predicted Patient Volume Shifts With the Addition of Another Trauma Center

2020 ◽  
pp. 000313482095238
Author(s):  
Jennings H. Dooley ◽  
Bradley M. Dennis ◽  
Louis J. Magnotti ◽  
John P. Sharpe ◽  
Oscar D. Guillamondegui ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Severely Injured ◽  
Patient Volume ◽  
Severely Injured Patients ◽  
Actual Patient ◽  
Minor Injuries ◽  
Injured Patients ◽  
The Impact ◽  
Post Period

Introduction Version 2 of the Needs-Based Assessment of Trauma Systems (NBATS) tool quantifies the impact of an additional trauma center on a region. This study applies NBATS-2 to a system where an additional trauma center was added to compare the tool’s predictions to actual patient volumes. Methods Injury data were collected from the trauma registry of the initial (legacy) center and analyzed geographically using ArcGIS. From 2012 to 2014 (“pre-”period), one Level 1 trauma center existed. From 2016 to 2018 (“post-”period), an additional Level 2 center existed. Emergency medical service (EMS) destination guidelines did not change and favored the legacy center for severely injured patients (Injury Severity Score (ISS) >15). NBATS-2 predicted volume was compared to the actual volume received at the legacy center in the post-period. Results 4068 patients were identified across 14 counties. In the pre-period, 72% of the population and 90% of injuries were within a 45-minute drive of the legacy trauma center. In the post-period, 75% of the total population and 90% of injuries were within 45 minutes of either trauma center. The post-predicted volume of severely injured patients at the legacy center was 434, but the actual number was 809. For minor injuries (ISS £15), NBATS-2 predicted 581 vs. 1677 actual. Conclusion NBATS-2 failed to predict the post-period volume changes. Without a change in EMS destination guidelines, this finding was not surprising for severely injured patients. However, the 288% increase in volume of minor injuries was unexpected. NBATS-2 must be refined to assess the impact of local factors on patient volume.

scholarly journals Influence of anaemia in severely injured patients on mortality, transfusion and length of stay: An analysis of the TraumaRegister DGU®

2021 ◽  
Author(s):  
Linda Tanner ◽  
Vanessa Neef ◽  
Florian Raimann ◽  
Philipp Störmann ◽  
Ingo Marzi ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Independent Predictor ◽  
Severe Anaemia ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Risk Of Death ◽  
Mild Anaemia ◽  
Injured Patients ◽  
The Impact ◽  
Moderate Anaemia

Abstract Purpose Anaemia is one of the leading causes of death among severely injured patients. Anaemia is known to increase the risk of death and prolong the length of hospital stay in various surgical groups. The main objective of this study is to analyse the anaemia rate on admission to the emergency department and the impact of anaemia on in-hospital mortality. Methods Data from the TraumaRegister DGU® (TR-DGU) between 2015 and 2019 was analysed. Inclusion criteria were age >= 16 years and worst Abbreviated Injury Scale (AIS) score ≥ 3. Patients were divided into three anaemia subgroups: no or mild anaemia (NA), moderate anaemia (MA) and severe anaemia (SA). Pre-hospital data, patient characteristics, treatment in the ER, outcomes, and differences between trauma centres were analysed. Results Of 67,595 patients analysed, 94.9% (n=64,153) exhibited no or mild anaemia (Hb ≥ 9 g/dl), 3.7% (n=2,478) displayed moderate anaemia (Hb 7–8 g/dl) and 1.4% (n=964) presented with severe anaemia (Hb < 7 g/dl). Haemoglobin (Hb) values ranged from 3 g/dl to 18 g/dl with a mean Hb value of 12.7 g/dl. In surviving patients, anaemia was associated with prolonged length of stay (LOS). Multivariate logistic regression analyses revealed moderate (p<0.001 OR 1.88 (1.66-2.13)) and severe anaemia (p<0.001 OR 4.21 (3.46-5.12)) to be an independent predictor for mortality. Further significant predictors are ISS score per point (OR 1.0), age 70-79 (OR 4.8), age >80 (OR 12.0), severe pre-existing conditions (ASA 3/4) (OR 2.26), severe head injury (AIS 5/6) (OR 4.8), penetrating trauma (OR 1.8), unconsciousness (OR 4.8), shock (OR 2.2) and prehospital intubation (OR 1.6). Conclusion The majority of severely injured patients are admitted without anaemia to the ER. Injury-associated moderate and severe anaemia is an independent predictor of mortality in severely injured patients.

scholarly journals The Impact of Regionalized Trauma Care on the Distribution of Severely Injured Patients in the Netherlands

2021 ◽  
Vol 233 (5) ◽  
pp. e224
Author(s):  
Suzan Dijkink ◽  
Erik W. Van Zwet ◽  
Pieta Krijnen ◽  
Inger B. Schipper ◽  
Landelijke Beraadsgroep Traumacentra
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Injured Patients ◽  
The Impact

scholarly journals The evolution of trauma care in the Netherlands over 20 years

2019 ◽  
Vol 46 (2) ◽  
pp. 329-335 ◽  
Author(s):  
Falco Hietbrink ◽  
Roderick M. Houwert ◽  
Karlijn J. P. van Wessem ◽  
Rogier K. J. Simmermacher ◽  
Geertje A. M. Govaert ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Trauma Surgeon ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
The Past ◽  
Level 1 ◽  
Trauma Surgeons ◽  
Injured Patients

Abstract Introduction In 1999 an inclusive trauma system was initiated in the Netherlands and a nationwide trauma registry, including all admitted trauma patients to every hospital, was started. The Dutch trauma system is run by trauma surgeons who treat both the truncal (visceral) and extremity injuries (fractures). Materials and Methods In this comprehensive review based on previous published studies, data over the past 20 years from the central region of the Netherlands (Utrecht) was evaluated. Results It is demonstrated that the initiation of the trauma systems and the governance by the trauma surgeons led to a region-wide mortality reduction of 50% and a mortality reduction for the most severely injured of 75% in the level 1 trauma centre. Furthermore, major improvements were found in terms of efficiency, demonstrating the quality of the current system and its constructs such as the type of surgeon. Due to the major reduction in mortality over the past few years, the emphasis of trauma care evaluation shifts towards functional outcome of severely injured patients. For the upcoming years, centralisation of severely injured patients should also aim at the balance between skills in primary resuscitation and surgical stabilization versus longitudinal surgical involvement. Conclusion Further centralisation to a limited number of level 1 trauma centres in the Netherlands is necessary to consolidate experience and knowledge for the trauma surgeon. The future trauma surgeon, as specialist for injured patients, should be able to provide the vast majority of trauma care in this system. For the remaining part, intramural, regional and national collaboration is essential

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