Trauma Care in Nigeria: Time for an Integrated Trauma System

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

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01615-1 ◽

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.

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Effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis protocol

BMJ Open ◽

10.1136/bmjopen-2020-047439 ◽

2021 ◽

Vol 11 (6) ◽

pp. e047439

Author(s):

Rayan Jafnan Alharbi ◽

Virginia Lewis ◽

Sumina Shrestha ◽

Charne Miller

Keyword(s):

Systematic Review ◽

Trauma Care ◽

Data Extraction ◽

Meta Analysis ◽

Trauma System ◽

Secondary Data ◽

Trauma Centre ◽

Trauma Patients ◽

Trauma Systems ◽

Stages Of Development

IntroductionThe introduction of trauma systems that began in the 1970s resulted in improved trauma care and a decreased rate of morbidity and mortality of trauma patients. Worldwide, little is known about the effectiveness of trauma care system at different stages of development, from establishing a trauma centre, to implementing a trauma system and as trauma systems mature. The objective of this study is to extract and analyse data from research that evaluates mortality rates according to different stages of trauma system development globally.Methods and analysisThe proposed review will comply with the checklist of the ‘Preferred reporting items for systematic review and meta-analysis’. In this review, only peer-reviewed articles written in English, human-related studies and published between January 2000 and December 2020 will be included. Articles will be retrieved from MEDLINE, EMBASE and CINAHL. Additional articles will be identified from other sources such as references of included articles and author lists. Two independent authors will assess the eligibility of studies as well as critically appraise and assess the methodological quality of all included studies using the Cochrane Risk of Bias for Non-randomised Studies of Interventions tool. Two independent authors will extract the data to minimise errors and bias during the process of data extraction using an extraction tool developed by the authors. For analysis calculation, effect sizes will be expressed as risk ratios or ORs for dichotomous data or weighted (or standardised) mean differences and 95% CIs for continuous data in this systematic review.Ethics and disseminationThis systematic review will use secondary data only, therefore, research ethics approval is not required. The results from this study will be submitted to a peer-review journal for publication and we will present our findings at national and international conferences.PROSPERO registration numberCRD42019142842.

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Trauma Care at Rural Level III Trauma Centers in a State Trauma System

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000197671.00818.76 ◽

2007 ◽

Vol 62 (2) ◽

pp. 498-503 ◽

Cited By ~ 11

Author(s):

Thomas S. Helling

Keyword(s):

Trauma Care ◽

Trauma System ◽

Trauma Centers

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An inventory of Canadian trauma systems: opportunities for improving access to trauma care

CJEM ◽

10.2310/8000.2013.131089 ◽

2014 ◽

Vol 16 (03) ◽

pp. 207-213 ◽

Cited By ~ 3

Author(s):

Christopher C.D. Evans ◽

J.M. Tallon ◽

Jennifer Bridge ◽

Avery B. Nathens

Keyword(s):

Trauma Care ◽

System Development ◽

Trauma System ◽

Mail Survey ◽

Trauma Systems ◽

Trauma Centres ◽

Improved Outcomes ◽

System Components ◽

Trauma Surgeons ◽

Future Work

ABSTRACT Objective: Despite evidence that patients suffering major traumatic injuries have improved outcomes when cared for within an organized system, the extent of trauma system development in Canada is limited. We sought to compile a detailed inventory of trauma systems in Canada as a first step toward identifying opportunities for improving access to trauma care. Methods: We distributed a nationwide online and mail survey to stakeholders intended to evaluate the extent of implementation of specific trauma system components. Targeted stakeholders included emergency physicians, trauma surgeons, trauma program medical directors and program managers, prehospital providers, and decision makers at the regional and provincial levels. A “snowball” approach was used to expand the sample base of the survey. Descriptive statistics were generated to quantify the nature and extent of trauma system development by region. Results: The overall response rate was 38.7%, and all levels of stakeholders and all provinces/territories were represented. All provinces were found to have designated trauma centres; however, only 60% were found to have been accredited within the past 10 years. Components present in 50% or fewer provinces included an inclusive trauma system model, interfacility transfer agreements, and a mechanism to track bed availability within the system. Conclusion: There is significant variability in the extent of trauma system development in Canada. Although all provinces have designated trauma centres, opportunities exist in many systems to implement additional components to improve the inclusiveness of care. In future work, we intend to quantify the strength of the relationship between different trauma system components and access to definitive trauma care.

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Commentary: Regionalization of Spine Trauma Care in an Urban Trauma System in the United States: Decreased Time to Surgery and Hospital Length of Stay

Neurosurgery ◽

10.1093/neuros/nyy494 ◽

2018 ◽

Vol 85 (6) ◽

pp. E1002-E1003

Author(s):

Eeric Truumees

Keyword(s):

United States ◽

Length Of Stay ◽

Trauma Care ◽

Trauma System ◽

The United States ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Spine Trauma ◽

Time To Surgery

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Effect of Under Triage on Early Mortality After Major Pediatric Trauma: A Registry-based Propensity Score Matching Analysis

10.21203/rs.3.rs-87401/v1 ◽

2020 ◽

Author(s):

François-Xavier Ageron ◽

Jordan Porteaud ◽

Jean-Noël Evain ◽

Anne Millet ◽

Jules Greze ◽

...

Keyword(s):

Propensity Score ◽

Trauma Care ◽

Pediatric Population ◽

Pediatric Trauma ◽

Trauma System ◽

Early Death ◽

Risk Difference ◽

Early Mortality ◽

Trauma Patients ◽

Risk Of Death

Abstract Backgroundlittle is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24 hour-mortality after major pediatric trauma in a regional trauma systemMethodsThis cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24 hour-mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. ResultsA total of 1 143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 hours. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference: 6.0 [95% CI 1.3-10.7]) and Ps matching analyses (risk difference: 3.1 [95% CI 0.8-5.4]).ConclusionsIn a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.

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Trauma System Development and Future Directions

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00040152 ◽

1993 ◽

Vol 8 (2) ◽

pp. 111-114 ◽

Cited By ~ 3

Author(s):

Judith B. Braslow ◽

Joan A. Snyder

Keyword(s):

Public Health ◽

Emergency Medical Services ◽

Trauma Care ◽

System Development ◽

Trauma System ◽

The United States ◽

Advisory Council ◽

Medical Services ◽

Emergency Medical ◽

Care Systems

AbstractTraumatic injury, both unintentional and intentional, is a serious public health problem. Trauma care systems play a significant role in reducing mortality, morbidity, and disability due to injuries. However, barriers to the provision of prompt and appropriate emergency medical services still exist in many areas of the United States. Title XII of the Public Health Service Act provides for programs in support of trauma care planning and system development by states and localities. This legislation includes provisions for: 1) grants to state agencies to modify the trauma care component of the state Emergency Medical Services (EMS) plan; 2) grants to improve the quality and availability of trauma care in rural areas; 3) development of a Model Trauma Care System Plan for states to use as a guide in trauma system development; and 4) the establishment of a National Advisory Council on Trauma Care Systems.

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