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Prehospital triage and survival of major trauma patients in a Dutch regional trauma system: relevance of trauma registry

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Abstract

Background and aims

Since 1999, the Dutch trauma care has been regionalized into ten trauma systems. This study is the first to review such a trauma system. The aim was to examine the sensitivity of prehospital triage criteria [triage revised trauma score (T-RTS)] in identifying major trauma patients and to evaluate the current level of trauma care of a regionalized Dutch trauma system for major trauma patients.

Patients and methods

Major trauma patients (n=511) (June 2001–December 2003) were selected from a regional trauma registry database. The prehospital T-RTS was computed and standardized W scores (Ws) were generated to compare observed vs expected survival based on contemporary US- and UK-norm databases.

Results

The T-RTS showed low sensitivity for the prehospital identification of major trauma patients [34.1% (T-RTS≤10)]. Nevertheless, 78.0% of all major trauma patients were directly managed by the trauma center. These patients were more severely injured than their counterparts at non-trauma-center hospitals (p<0.001). No significant difference emerged between the mortality rates of both groups. The Ws {−0.46 calculated on the US model [95% confidence interval (CI) ranging from −1.99 to 1.07]} [0.60 calculated on the UK model (95% CI ranging from −1.25 to 2.44)] did not differ significantly from zero.

Conclusion

The trauma center managed most of the major trauma patients in the trauma system but the triage criteria need to be reconsidered. The level of care of the regional trauma system was shown to measure up to US and UK benchmarks.

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Acknowledgements

We would like to thank Mr. D.E. Clark and Mr. O. Bouamra for providing us, respectively, with the NTDB and TARN population distributions of the Ps for the calculation of the Ws statistics for our study. The following hospitals have contributed data to the regional trauma registry of the TCWN (the trauma surgeons acting as coordinators for the trauma registry at the respective hospitals are in parentheses): Leiden University Medical Center, Leiden (G.N. Jukema, M.D., Ph.D.); The Hague Medical Center, The Hague (M. Hogervorst, M.D.); Hospital Leyenburg, The Hague (P.V.M. Pahlplatz, M.D.); Bronovo Hospital, The Hague (A.H.P. Niggebrugge, M.D., Ph.D.); Juliana Children’s Hospital, The Hague (J.H. Allema, M.D., Ph.D.); Red Cross Hospital, The Hague (J.H. Allema, M.D., Ph.D.); Rijnland Hospital, Leiderdorp (A.J. den Outer, M.D.); Diaconessen Hospital, Leiden (B.J. Hornstra, M.D.); ’t Lange Land Hospital, Zoetermeer (L.J.J.P. Speetjens, M.D.); Reinier de Graaf Hospital, Delft (M. van der Elst, M.D., Ph.D.)

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Authors and Affiliations

  1. Trauma Center West-Netherlands, Section of Traumatology, Department of Surgery, K6-R, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands

    Leontien M. Sturms, Josephine M. Hoogeveen, Peter E. Schenck & Gerrolt N. Jukema

  2. Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands

    Saskia Le Cessie

  3. Trauma Center West-Netherlands, Section of Traumatology, Department of Surgery, Leyenburg Hospital, The Hague, The Netherlands

    Paul V. M. Pahlplatz

  4. Trauma Center West-Netherlands, Section of Traumatology, Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands

    Mike Hogervorst

Authors
  1. Leontien M. Sturms
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  2. Josephine M. Hoogeveen
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  3. Saskia Le Cessie
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  4. Peter E. Schenck
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  5. Paul V. M. Pahlplatz
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  6. Mike Hogervorst
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  7. Gerrolt N. Jukema
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Corresponding author

Correspondence to Gerrolt N. Jukema.

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Sturms, L.M., Hoogeveen, J.M., Le Cessie, S. et al. Prehospital triage and survival of major trauma patients in a Dutch regional trauma system: relevance of trauma registry. Langenbecks Arch Surg 391, 343–349 (2006). https://doi.org/10.1007/s00423-006-0057-1

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  • DOI: https://doi.org/10.1007/s00423-006-0057-1

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