Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
3Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
World J Emerg Surg. 2018 Apr 13;13:18. doi: 10.1186/s13017-018-0178-1. eCollection 2018.
Implementation of an inclusive trauma system leads to reduced mortality rates, specifically in polytrauma patients. Field triage is essential in this mortality reduction. Triage systems are developed to identify patients with life-threatening injuries, and trauma mechanisms are important for triaging. Although complex extremity fractures are mostly non-lethal, these injuries are frequently the result of a high-energy trauma mechanism. The aim of this study is to compare injury and patient characteristics, as well as resource demands, of lower extremity fractures between a level (L)1 and level (L)2 trauma centre in a mature inclusive trauma system.
This is a retrospective cohort study. Patients with below-the-knee joint fractures diagnosed in a L1 or L2 trauma centre between July 2013 and June 2015 were included. Main outcome parameters were patient demographics, trauma mechanism, fracture pattern, and resource demands.
One thousand two hundred sixty-seven patients with 1517 lower extremity fractures were included. Most patients were treated in the L2 centre (L1 = 417; L2 = 859). Complex fractures were more frequently triaged to the L1 centre. Patients in the L1 centre had more concomitant injuries to other body regions and ipsi- or contralateral lower extremity. Patients in the L1 centre were more resource demanding: more surgeries (> 1 surgery; 24.9% L1 vs 1.4% L2), higher immediate admission rates (70.1% L1 vs 37.6% L2), and longer length of stay (mean 13.4 days L1 vs 3.1 days L2).
The majority of patients were treated in the L2 trauma centre, whereas complex lower extremity injuries were mostly treated in the L1 centre, which placed higher demand on resources and labour per patient. This change in allocation is the next step in centralization of low-volume high complex care and high-volume low complex care.
实施包容性创伤体系可降低死亡率，特别是多发伤患者的死亡率。现场分类对于降低死亡率至关重要。分类系统的开发是为了识别有生命危险的伤员，而创伤机制对于分类非常重要。尽管复杂的四肢骨折大多不会致命，但这些损伤通常是高能创伤机制的结果。本研究旨在比较成熟包容性创伤体系中 1 级（L1）和 2 级（L2）创伤中心的下肢骨折患者的损伤和患者特征以及资源需求。
这是一项回顾性队列研究。纳入 2013 年 7 月至 2015 年 6 月期间在 L1 或 L2 创伤中心诊断为膝关节以下关节骨折的患者。主要结局参数为患者人口统计学特征、创伤机制、骨折类型和资源需求。
共纳入 1267 例 1517 例下肢骨折患者。大多数患者在 L2 中心接受治疗（L1=417；L2=859）。复杂骨折更常分诊至 L1 中心。L1 中心的患者伴有其他身体区域和同侧或对侧下肢的合并伤更多。L1 中心的患者资源需求更高：更多手术（>1 次手术；L1 为 24.9%，L2 为 1.4%），更高的即刻入院率（L1 为 70.1%，L2 为 37.6%）和更长的住院时间（L1 为 13.4 天，L2 为 3.1 天）。
大多数患者在 L2 创伤中心接受治疗，而复杂的下肢损伤主要在 L1 中心接受治疗，这增加了每个患者的资源和劳动力需求。这种分配的变化是低容量高复杂护理和高容量低复杂护理集中化的下一步。
