Trauma care before and after optimisation in a level I trauma Centre: Life-saving changes
Section snippets
Background
Trauma is an important cause of death around the world [1]. In the last few decades, trauma care systems have evolved rapidly in western countries [[2], [3], [4]]. The benefit of the implementation of a trauma system has already proven itself with lower mortality rates and fewer hospitalisation days [[5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]]. A reduction in mortality up to 15% has especially been seen in severely injured patients [5,11,18]. However, the
Study setting
This study was conducted in a level I trauma centre in the Netherlands. The trauma centre serves a population of 2.2 million. In 2016, there were 340 severely injured patients (ISS ≥ 16) and more than 2600 hospitalised trauma patients [[24], [25], [26]]. The medical ethical editorial board (METC) judged our study protocol and approved the study.
A retrospective cohort study of prospectively collected data was conducted. The results of the period before and after the optimisations were compared.
Results
A total of 4633 trauma patients were admitted during the years 2010–2012 and 2014–2016: 1676 in the first period and 2957 in the second period. After the exclusion criteria were applied, 1290 from the first period and 2421 from the second period were included. Details regarding the number of and reasons for excluded patients are listed in Fig. 2.
The two patient groups were similar in regards to sex and type of injury. The type of injury was predominantly blunt, with 1247 (96.7%) in the first
Discussion
The aim of the present study was to examine the effect of the optimised in-hospital infrastructure in terms of mortality, processes and clinical outcomes in a level I trauma centre. In this study, the mortality decreased significantly, and the processes and clinical outcomes improved in all trauma patients.
The organisation of the trauma care was optimised in our hospital with 24/7 in-hospital coverage by the senior clinicians. With the 24/7 in-hospital coverage, the trauma patients in our
Conclusion
Optimisation of the in-hospital infrastructure results in improved survival rates in severely injured patients as well as in the whole trauma population. Moreover, the processes and clinical outcomes improved significantly with a shorter hospital length of stay, shorter ICU length of stay, fewer complications and fewer delayed diagnoses.
Declaration of Competing Interest
The authors declare no conflict of interest.
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Cited by (0)
Meetings: Orhopaedic Trauma Association (OTA) Annual Meeting 2018, Orlando; German Congress of Orthopaedics and Traumatology 2018 (DKOU), Berlin; Dutch Trauma Society 2018, Amsterdam