A comparison of severely injured trauma patients admitted to level 1 trauma centres in Queensland and Germany

Abstract

Background: The allocation of a trauma network in Queensland is still in the developmental phase. In a search for indicators to improve trauma care both locally as state-wide, a study was carried out comparing trauma patients in Queensland to trauma patients in Germany, a country with 82.4 million inhabitants and a well-established trauma system. Methods: Trauma patients Ն15 years of age, with an Injury Severity Score (ISS) Ն 16 admitted to the Princess Alexandra Hospital (PAH) and to the 59 German hospitals participating in the Trauma Registry of the German Society for Trauma Surgery (DGU-G) during the year 2005 were retrospectively identified and analysed. Results: Both cohorts are comparable when it comes to demographics and injury mechanism, but differ significantly in other important aspects. Striking is the low number of primary admitted patients in the PAH cohort: 58% versus 83% in the DGU-G cohort. PAH patients were less physiologically deranged and less severely injured: ISS 25.2 Ϯ 9.9 versus 29.9 Ϯ 13.1 (P < 0.001). Subsequently, they less often needed surgery (61% versus 79%), ICU admission (49% versus 92%) and had a lower mortality: 9.8% versus 17.9% of the DGU-G cohort. Conclusions: Relevant differences were the low number of primary admissions, the lesser severity of injuries, and the low mortality of the patients treated at the PAH. These differences are likely to be interrelated and Queensland's size and suboptimal organization of trauma care may have played an important role.

Epidemiological comparison between the Navarra Major Trauma Registry and the German Trauma Registry (TR-DGU®)

“…In Navarra, emergency physicians perform resuscitations, whilst in Germany, it is done by a surgeon-directed trauma team. These are general surgeons with extensive experience in trauma care including fracture management [ 7 ]. Therefore, the number of involved specialties, and subsequently doctors, is often lower than in Navarra.…”

“…Nijboer et al compared the demographics, injury mechanisms, treatment, and mortality of severely injured trauma patients (ISS >15) treated in 2005 in a level-one trauma center in Queensland (Australia) and in 59 German level-one trauma centers. The results exhibited that, despite the differences in trauma systems especially, in pre-hospital care, between both countries, the observed mortality was lower than expected in both Australia and Germany [ 7 ].…”

Trauma systems: models of prehospital and inhospital care

“…Similar to Canada, Australian trauma care must meet the challenge of managing patients injured thousands of kilometers from the closest trauma center [6][7][8][9]. 20-30 % of severe trauma cases present initially to a health care facility that is not a trauma center [10,11].…”

Traumatology in Australia: provision of clinical care and trauma system development

“…The current issue of ANZ Journal of Surgery contains three papers exploring some of the crucial aspects of Traumatology, namely clinical care provision, 1 and trauma system development 2,3 …”

“…Nijboer et al. evaluated the characteristics of trauma care in one of Queensland's major trauma centres before the implementation of the trauma plan and compared it with an established trauma system (German Trauma Registry) 3 . The comparison is not the most fortunate one as German trauma care is fundamentally different (from pre‐hospital care to the rehabilitation) in all aspects from Queensland trauma care.…”