Mortality Decreases by Implementing a Level I Trauma Center in a Dutch Hospital

Spijkers, A T E; Meylaerts, S.A.G.; Leenen, Luke P. H.

doi:10.1097/ta.0b013e3181e12526

Cited by 29 publications

(25 citation statements)

References 19 publications

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“…In-hospital mortality was 10% in both trauma centers , which is similar to or lower than the percentage found in other studies. (2,7,8,(17)(18)(19)(20) Nearly every other outcome examined differed between both centers. For example, hospital stay was longer at the NTC but ICU stay longer at the USTC.…”

Section: Discussionmentioning

confidence: 99%

“…(17,21) The average total hospital length of stay of NTC patients was statistically and clinically significantly longer compared to USTC patients, but comparable or even shorter than that reported in other studies from the Netherlands. (7,17) The shorter length of stay for USTC patients might be explained by the fact that more patients were discharged to rehabilitation centers, suggesting a difference in discharge disposition policy. There are indeed differences between both countries in the organization of care after discharge from the hospital.…”

Section: Discussionmentioning

confidence: 99%

“…(6) In The Netherlands, the implementation of trauma centers has reduced the overall mortality risk by 16%, and by 21% in polytrauma patients. (7,8) Despite the similarities between the U.S. and the Dutch trauma systems, differences do exist, for instance regarding trauma training, patient volumes, type of injuries, prehospital care, distances travelled, and access to rehabilitation, possibly leading to differences in outcomes of care. The purpose of this study was to compare two urban Level-1 Trauma Centers, one in the U.S. and the other in the Netherlands, regarding demographics, injury characteristics, and outcomes of severely injured patients after blunt trauma.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Polytrauma patients in the Netherlands and the USA: A bi-institutional comparison of processes and outcomes of care

Dijkink

Wilden

Krijnen

et al. 2018

Injury

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Polytrauma patients in the Netherlands and the USA: A bi-institutional comparison of processes and outcomes of care

Dijkink

Wilden

Krijnen

et al. 2018

Injury

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“…In 1999 the Netherlands implemented an inclusive trauma system, which organized the country in 11 trauma regions [9]. The goal of this inclusive system is to present all patients on a timely basis at the right hospital, with the centralisation of the most severely injured patients in level 1 centres [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. The less severely injured patients are ideally treated at level 2 and level 3 centres.…”

Section: The Evolution Of Mortality In Traumamentioning

confidence: 99%

The evolution of trauma care in the Netherlands over 20 years

Hietbrink

Houwert

Wessem

et al. 2019

Eur J Trauma Emerg Surg

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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 regionwide 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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“…In the Netherlands, level I trauma centres are designated to provide the appropriate level of care for severely injured patients [16]. Central Netherlands has one level I trauma centre (University Medical Centre Utrecht) and seven level II or III trauma centres.…”

Section: Methodsmentioning

confidence: 99%

The role of emergency medical service providers in the decision-making process of prehospital trauma triage

Rein

Sadiqi

Lansink

et al. 2018

Eur J Trauma Emerg Surg

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Purpose Severely injured patients should be treated at higher-level trauma centres, to improve chances of survival and avert life-long disabilities. Emergency medical service (EMS) providers must try to determine injury severity on-scene, using a prehospital trauma triage protocol, and decide the most appropriate type of trauma centre. The objective of this study is to investigate the role of EMS provider judgment in the prehospital triage process of trauma patients, by analysing the compliance rate to the protocol and administering a questionnaire among EMS providers. Methods All trauma patients transported to a trauma centre in two different regions of the Netherlands were analysed. Compliance rate was based on the number of patients meeting the triage criteria and transported to the corresponding level trauma centre. The questionnaire was administered among EMS providers. Descriptive statistics were used to analyse the data. Results For adult patients, the compliance rate to the level I criteria of the triage protocol was 72% in Central Netherlands and 42% in Brabant. For paediatric patients, this was 63% and 38% in Central Netherlands and Brabant, respectively. The judgment on injury severity was mostly based on the injury-type criteria. Additionally, the distance to a level I trauma centre influenced the decision for destination facility in the Brabant region. Conclusion The compliance rate varied between regions. Improvement of prehospital trauma triage depends on the accuracy of the protocol and compliance rate. A new protocol, including EMS provider judgment, might be the key to improvement in the prehospital trauma triage quality.

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Mortality Decreases by Implementing a Level I Trauma Center in a Dutch Hospital

Abstract: This study implies that the implementation of a trauma center reduces mortality, shortens hospital stay, and decreases the number of intensive care unit admittances in Utrecht, the Netherlands.

Cited by 29 publications

References 19 publications

Polytrauma patients in the Netherlands and the USA: A bi-institutional comparison of processes and outcomes of care

Polytrauma patients in the Netherlands and the USA: A bi-institutional comparison of processes and outcomes of care

The evolution of trauma care in the Netherlands over 20 years

The role of emergency medical service providers in the decision-making process of prehospital trauma triage

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