Department of Accident and Emergency, Complejo Hospitalario de Navarra, Health Service of Navarra - Osasunbidea, Calle Monasterio de Urdax 47, 4°D, 31011, Pamplona, Navarra, Spain.
Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Straße 200 (Building 38), 51109, Cologne, Germany.
Scand J Trauma Resusc Emerg Med. 2017 Nov 2;25(1):107. doi: 10.1186/s13049-017-0453-2.
International benchmarking can help identify trauma system performance issues and determine the extent to which other countries also experience these. When problems are identified, countries can look to high performers for insight into possible responses. The objective of this study was to compare the treatment and outcome of severely injured patients in Germany and Navarra, Spain.
Data collected, from 2010 to 2013, in the Navarra Major Trauma Registry (NMTR) and the TraumaRegister DGU® (TR-DGU) were compared. Both registries followed the Utstein Trauma Template (European Core Dataset) for documentation of trauma patients. Adult patients (≥ 16 years) with New Injury Severity Score (NISS) being >15 points were included in this study. Patients who had been admitted to the hospital later than 24 h after the trauma, had been pronounced dead before hospital arrival, or had been injured by hanging, drowning or burns, were excluded. Demographic data, injury data, prehospital data, hospital treatment data, time intervals, and outcome were compared. The expected mortality was calculated using the Revised Injury Severity Classification score II (RISC II).
A total of 646 and 43,110 patients were included in the outcome analysis from NMTR and TR-DGU, respectively. The difference between observed and expected mortality was -0.4% (standardized mortality ratio [SMR] 0.97; 95% CI 0.93-1.04) in Germany and 1.6% (SMR 1.08; 95% CI: 1.02-1.14) in Navarra. Differences in the characteristics of trauma patients and trauma systems between the regions were noted.
The higher observed mortality in Navarra is consistent with the epidemiological characteristics of its population. However, to improve the quality of trauma care in the Navarra trauma system, certain improvements are necessary. There were less young adults with severe injuries in Navarra than in Germany. It is possible to compare data of severely injured patients from different countries if standardized registries are used.
国际基准测试可以帮助确定创伤系统的性能问题，并确定其他国家是否也存在这些问题。当发现问题时，各国可以向表现出色的国家寻求可能的应对措施的见解。本研究的目的是比较德国和西班牙纳瓦拉严重受伤患者的治疗和结果。
比较了 2010 年至 2013 年期间收集的纳瓦拉重大创伤登记处（NMTR）和创伤登记处 DGU®（TR-DGU）的数据。这两个登记处都按照创伤患者的 utstein 创伤模板（欧洲核心数据集）进行记录。本研究纳入了新损伤严重程度评分（NISS）>15 分的成年患者（≥16 岁）。排除了在创伤后 24 小时后住院、在到达医院前已宣布死亡或因上吊、溺水或烧伤受伤的患者。比较了人口统计学数据、损伤数据、院前数据、医院治疗数据、时间间隔和结果。使用修订创伤严重程度分类评分 II（RISC II）计算预期死亡率。
NMTR 和 TR-DGU 的结果分析分别纳入了 646 例和 43110 例患者。德国的观察死亡率与预期死亡率相差 0.4%（标准化死亡率比[SMR]0.97；95%CI0.93-1.04），纳瓦拉相差 1.6%（SMR1.08；95%CI：1.02-1.14）。两个地区创伤患者和创伤系统的特征存在差异。
纳瓦拉观察到的死亡率较高与该地区人口的流行病学特征一致。然而，为了提高纳瓦拉创伤系统的创伤护理质量，需要进行某些改进。纳瓦拉的严重受伤年轻成年人比德国少。如果使用标准化登记处，有可能比较来自不同国家的严重受伤患者的数据。
