TraumaNetzwerk DGU®: Optimizing patient flow and management

Ruchholtz, Steffen; Lewan, Ulrike; Debus, Florian; Mand, Carsten; Siebert, H.; Kühne, Christian

doi:10.1016/j.injury.2014.08.024

Cited by 20 publications

(14 citation statements)

References 19 publications

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“…Although the number of severely injured patients per year is small, the present data indicate that these hospitals provide appropriate medical care as there was just a small difference between the expected and observed mortality of about 1 per cent. Thus, it appears that the German system of trauma networks with designated level I, level II and level III hospitals seems to work well 28,29 .…”

Section: Discussionmentioning

confidence: 99%

Association between volume of severely injured patients and mortality in German trauma hospitals

Zacher

Kanz

Hanschen

et al. 2015

British Journal of Surgery

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BackgroundThe issue of patient volume related to trauma outcomes is still under debate. This study aimed to investigate the relationship between number of severely injured patients treated and mortality in German trauma hospitals.MethodsThis was a retrospective analysis of the TraumaRegister DGU® (2009–2013). The inclusion criteria were patients in Germany with a severe trauma injury (defined as Injury Severity Score (ISS) of at least 16), and with data available for calculation of Revised Injury Severity Classification (RISC) II score. Patients transferred early were excluded. Outcome analysis (observed versus expected mortality obtained by RISC‐II score) was performed by logistic regression.ResultsA total of 39 289 patients were included. Mean(s.d.) age was 49·9(21·8) years, 27 824 (71·3 per cent) were male, mean(s.d.) ISS was 27·2(11·6) and 10 826 (29·2 per cent) had a Glasgow Coma Scale score below 8. Of 587 hospitals, 98 were level I, 235 level II and 254 level III trauma centres. There was no significant difference between observed and expected mortality in volume subgroups with 40–59, 60–79 or 80–99 patients treated per year. In the subgroups with 1–19 and 20–39 patients per year, the observed mortality was significantly greater than the predicted mortality (P < 0·050). High‐volume hospitals had an absolute difference between observed and predicted mortality, suggesting a survival benefit of about 1 per cent compared with low‐volume hospitals. Adjusted logistic regression analysis (including hospital level) identified patient volume as an independent positive predictor of survival (odds ratio 1·001 per patient per year; P = 0·038).ConclusionThe hospital volume of severely injured patients was identified as an independent predictor of survival. A clear cut‐off value for volume could not be established, but at least 40 patients per year per hospital appeared beneficial for survival.

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Section: Discussionmentioning

confidence: 99%

Association between volume of severely injured patients and mortality in German trauma hospitals

Zacher

Kanz

Hanschen

et al. 2015

British Journal of Surgery

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“…In contrast to other countries, the German trauma care system represents a decentralized system. In addition to different structural requirements, a level-I trauma center must fulfil at least 40 admissions with an ISS ≥16 [ 13 , 15 – 17 ].…”

Section: Methodsmentioning

confidence: 99%

Severe thoracic trauma – still an independent predictor for death in multiple injured patients?

Grubmüller

Kerschbaum

Diepold

et al. 2018

Scand J Trauma Resusc Emerg Med

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BackgroundOver the past, the severe thoracic trauma has had decisive influence on the outcome of multiple injured patients. Today, new therapies (e.g. extracorporeal membrane oxygenation (ECMO), protective ventilation methods and new forms of patient positioning) are available and applied regularly. What impact on the patient’s outcome does the thoracic trauma have today?MethodsProspective data collection of multiple injured patients in a level-I trauma center was performed between 2008 and 2014. Patients with an ISS ≥16 were included and divided into 2 groups: Severe thoracic trauma (STT: AISThorax ≥ 3) and mild thoracic trauma (MTT: AISThorax < 3). In addition to preclinical and trauma room care, detailed information about clinical course and outcome were assessed.ResultsIn total, 529 patients (STT: n = 317; MTT: n = 212) met the in- and exclusion criteria. The mean Injury Severity Score (ISS) was significantly higher in patients of the STT group (STT: 33.5 vs. MTT: 24.7; p < 0.001), while the RISC II Score showed no significant differences (STT: 20.0 vs. MTT: 17.1; p = 0.241). Preclinical data revealed a higher intubation rate, more chest tube insertions and a higher use of catecholamines in the STT group (p < 0.05). Clinically, we found significant differences in the duration of invasive ventilation (STT: 7.3d vs. MTT: 5.4d; p = 0.001) and ICU stay (STT: 12.3d vs. MTT: 9.4d; p < 0.001). While the complication rate was higher for the STT group (sepsis (STT: 11.4% vs. MTT: 5.7%; p = 0.017); lung failure (STT: 23.7% vs. MTT: 12.3%; p = 0,001)), neither the non-adjusted lethality rate (STT: 13.2% vs. MTT: 13.7%; p = 0.493) nor the Standardized Mortality Ratio (SMR) showed significant differences (STT: 0.66 vs. MTT: 0.80; p = 0.397). The multivariate regressive analysis confirmed that severe thoracic trauma is not an independent risk factor for lethality in our patient cohort.ConclusionDespite a higher injury severity, the extended need of emergency measures and a higher rate of complications in injured patients with severe blunt thoracic trauma, no influence on lethality can be proved. The reduction of the complication rate should be a goal for the next decades.

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“…9 To the best of our knowledge, there has been little research on the system-based assessment of patient flow through a pediatric trauma center. Most research has focused on improving adult patient flow through regional trauma networks 8,10,11 and within and around the ED of a trauma center. [12][13][14] However, such local optimization does not necessarily improve overall system performance due to hospital-wide interdependencies.…”

Section: Background and Significancementioning

confidence: 99%