Elsevier

Injury

Volume 50, Issue 10, October 2019, Pages 1678-1683
Injury

Trauma care before and after optimisation in a level I trauma Centre: Life-saving changes

https://doi.org/10.1016/j.injury.2019.07.017Get rights and content

Highlights

  • Optimisations of the in-hospital infrastructure related to the trauma care resulted in improved survival rates.

  • Level I trauma centres should implement 24/7 in-hospital coverage of senior clinicians

  • Level I trauma centres should have a CT-scanner in the trauma room to optimise in-hospital processes.

Abstract

Background

The implementation of trauma systems has led to a significant reduction in mortality and length of hospital stay. In our level I trauma centre, 24/7 in-hospital coverage was implemented, and a renovation of the trauma room took place to improve the trauma care. 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.

Methods

We performed a retrospective cohort study of prospectively collected data. All adult trauma patients admitted to our trauma centre directly during two time periods (2010–2012 and 2014–2016) were included. Any patients below the age of 18 years and patients who underwent primary trauma screening in another hospital were excluded. Logistic and linear regression were used and adjusted for demographics and characteristics of trauma. The primary endpoint was mortality. The secondary endpoints were subgroups of earlier mortality rates and severely injured patients, processes and clinical outcomes.

Results

In period I, 1290 patients were included, and in period II, 2421. The adjusted mortality in the trauma room (odds ratio (OR): 0.18; CI: 0.05–0.63) and the total in-hospital mortality (OR: 0.63 CI: 0.42–0.95) showed a significant reduction in period II. The trauma room (TR) time decreased by 30 min (p < 0.001), and the time until CT decreased by 22 min (p < 0.001). The number of delayed diagnoses and complications were significantly lower in the second period, with an OR of 0.2 (CI: 0.1–0.2) and 0.4 (CI: 0.3–0.6), respectively. The hospital length of stay and ICU length of stay decreased significantly, −1.5 day (p = 0.010) and −1.8 days (p = 0.022) respectively.

Conclusions

Optimisation of the in-hospital infrastructure related to trauma care resulted in improved survival rates in both severely injured patients as well as in the whole trauma population. Moreover, the processes and clinical outcomes improved, showing a shorter hospital length of stay, shorter TR time, fewer complications and fewer delayed diagnoses.

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

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