Trauma care before and after optimisation in a level I trauma Centre: Life-saving changes |
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| Affiliation: | 1. Brabant Trauma Registry, Network Emergency Care Brabant, the Netherlands;2. Department of Surgery, ETZ Hospital, Tilburg, the Netherlands;3. Department of Emergency Medicine, ETZ hospital, Tilburg, the Netherlands;4. Department of Anaesthesiology & Resuscitation, ETZ hospital, Tilburg, the Netherlands;1. Trauma Service, Westmead Hospital, Westmead, NSW 2145, Australia;2. Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada;3. Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada;4. CAREX Canada, Faculty of Health Sciences, Simon Fraser University, Vancouver BC, Canada;5. Department of Geography and Planning, University of Toronto, Toronto, ON, Canada;6. Sydney Medical School, University of Sydney, Sydney, NSW, Australia;7. Discipline of Emergency Medicine, The University of Sydney, Sydney, NSW, Australia;8. Discipline of Surgery, Western Clinical School, Sydney Medical School, The University of Sydney, NSW, Australia;1. Yozgat City Hospital, Orthopedics and Traumatology Department, Viyana Avenue, 66100, Yozgat, Turkey;2. İbn’i Sina Training and Research Hospital, University of Ankara, Orthopedics and Traumatology Department, İbn’i Sina Hospital, Ankara University Medicine Faculty, 06100, Samanpazarı, Ankara, Turkey;1. Assistant Professor of Orthopaedic Surgery, Benha University, Faculty of Medicine, Egypt;2. Lecturer of Orthopaedic Surgery, Benha University, Faculty of Medicine, Egypt;1. University Hospital Basel, Department of Oral and Cranio-Maxillofacial Surgery, Basel, Switzerland;2. Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland;3. Department of Cranio-Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland;4. Department of Ophthalmology, University Hospital of Basel and University of Basel, Basel, Switzerland |
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| Abstract: | BackgroundThe 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.MethodsWe 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.ResultsIn 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.ConclusionsOptimisation 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. |
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| Keywords: | Trauma care Trauma centre Injury In-hospital coverage Trauma room Critical care Mortality Clinical outcome |
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