Unconscious trauma patients: outcome differences between southern Finland and Germany—lesson learned from trauma-registry comparisons

Abstract

Trauma registry comparison has several pitfalls needing acknowledgement: the explanation for outcome differences between trauma systems can be a coincidence, a weakness in the scoring system, true variation in the standard of care, or hospitals' reluctance to include patients with hopeless prognosis in registry. We believe, however, that such comparisons are a feasible method for quality control.

Resource use and clinical outcomes in blunt thoracic injury: a 10-year trauma registry comparison between southern Finland and Germany

“…A similar comparison has been done before and has also been found to be feasible [5]. The limitations of such a comparison are known from a previous study [6] and have been acknowledged. The study period consisted of 10 years and both registries are accurate and have good data coverage [7,18].…”

“…An international trauma registry comparison provides more options than comparing the results only within a national system. Accordingly, quality control and registry comparisons should be an integral part of trauma patient treatment in modern trauma hospital organisations [6]. Although HTR data came from one large trauma center and TR-DGU data for this comparison came from 102 Level 1 hospitals (that are mostly smaller), the patients were comparable as shown in a previous study [5].…”

“…Trauma registries are an important data source in evaluating severe injuries and those seriously injured. These data can also be used to compare different treatment options within one hospital over time, between one hospital and another or even between different countries and trauma systems [5,6,[12][13][14]. International comparison is possible if the collected data are similar or can be adjusted [15,16].…”

“…A previous trauma registry comparison of severely injured patients (including all injuries in different body regions) between southern Finland and Germany [5] showed distinct differences in outcome in patients with severe traumatic brain injury. Because of this finding, another comparison was performed to determine the possible reasons for that particular difference [6]. After this analysis, it was feasible to also look closely at other injuries to determine whether differences exist in, e.g., patients with severe thoracic injuries if isolated from all other severely injured patients.…”

Pre-hospital trauma care in Switzerland and Germany: do they speak the same language?

“…Thereby, the findings of the current study underline the benefits of emergency physician presence (reflected by higher intubation rates in the German cohort) in the treatment of craniocerebral injuries. Increased intubation rates may partly explain enhanced outcome observed in neurotrauma patients treated by emergency physicians compared with treatment systems with lower pre-hospital emergency physician attendance [22,23].…”