de Jongh Mariska A C, Meeuwis Jan D, van Baar Margriet E, van Stel Henk F, Schrijvers Augustinus J P
Trauma Centre Brabant, St. Elisabeth Hospital Tilburg, The Netherlands.
Injury. 2008 Sep;39(9):1007-12. doi: 10.1016/j.injury.2008.03.026. Epub 2008 Jul 24.
To evaluate the effectiveness of trauma care in the Netherlands compared to UK norms and in terms of mortality risks in three groups of patients. The hypothesis was that there is no difference in risk of hospital death between major trauma patients transferred from another hospital to the trauma centre and patients directly admitted to the trauma centre.
Trauma admissions (n=17,023) during the period 2000-2006 in 12 emergency departments were selected from a regional trauma registry database. In the analysis, the dependent variable was death within 30 days of admission. W-Statistics (W(s)) was used to compare outcomes of the total Dutch trauma population and the population admitted to the trauma centre, with norms for England and Wales. The effect of direct admission to a non-trauma centre and immediate admission to a trauma centre for major trauma patients versus indirect admission was tested in a logistic model and adjusted for confounding.
444 (2.6%) patients died within 30 days of admission. 6.1% of all patients were major trauma patients. W(s) resulted in 1.39 (95% CI 1.08-1.70) more observed survivors per 100 admitted trauma patients standardised for case mix using UK norms. W(s) of trauma patients in the trauma centre resulted in 0.85 (95% CI 0.44-1.27) more survivors than expected. Patients directly admitted to a trauma centre or a non-trauma centre without transfer were found to have a non-significant increasing risk of mortality (OR 1.5 (95% CI 0.7-3.4) and 1.9 (95% CI 0.9-4.1), respectively) compared to patients transferred from another hospital to a trauma centre.
Trauma care in this Dutch province is performing better than expected comparing to the norms for the England and Wales. The admission policy of transporting major trauma patients to the nearest hospital and, if necessary, then transferring them to the trauma centre, seems legitimate in Dutch trauma care.
与英国标准相比，评估荷兰创伤护理的有效性，并就三组患者的死亡风险进行评估。假设是从另一家医院转至创伤中心的严重创伤患者与直接入住创伤中心的患者在医院死亡风险上没有差异。
从区域创伤登记数据库中选取2000年至2006年期间12个急诊科的创伤入院患者（n = 17,023）。分析中，因变量为入院后30天内死亡。使用W统计量（W(s)）将荷兰创伤患者总数和入住创伤中心患者的结局与英格兰和威尔士的标准进行比较。在逻辑模型中测试了严重创伤患者直接入住非创伤中心和立即入住创伤中心与间接入住相比的效果，并对混杂因素进行了调整。
444名（2.6%）患者在入院后30天内死亡。所有患者中有6.1%为严重创伤患者。使用英国标准对病例组合进行标准化后，每100名入院创伤患者中，W(s)显示观察到的幸存者多1.39名（95%置信区间1.08 - 1.70）。创伤中心创伤患者的W(s)显示幸存者比预期多0.85名（95%置信区间0.44 - 1.27）。与从另一家医院转至创伤中心的患者相比，直接入住创伤中心或未转诊直接入住非创伤中心的患者死亡风险有非显著增加（分别为OR 1.5（95%置信区间0.7 - 3.4）和1.9（95%置信区间0.9 - 4.1））。
与英格兰和威尔士的标准相比，该荷兰省份的创伤护理表现优于预期。在荷兰创伤护理中，将严重创伤患者转运至最近医院并在必要时转至创伤中心的入院政策似乎是合理的。
