Brabant Trauma Registry, Network Emergency Care Brabant, the Netherlands; Department of Surgery, ETZ Hospital, Tilburg, the Netherlands.
Brabant Trauma Registry, Network Emergency Care Brabant, the Netherlands.
Injury. 2019 Oct;50(10):1678-1683. doi: 10.1016/j.injury.2019.07.017. Epub 2019 Jul 13.
The 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.
We 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.
In 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.
Optimisation 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.
创伤系统的实施显著降低了死亡率和住院时间。在我们的一级创伤中心，实行了 24/7 的院内覆盖，并对创伤室进行了翻新，以改善创伤护理。本研究的目的是检查优化院内基础设施对死亡率、过程和临床结果的影响。
我们对前瞻性收集的数据进行了回顾性队列研究。所有直接入住我们创伤中心的成年创伤患者均包括在内。排除年龄在 18 岁以下的患者和在另一家医院进行初次创伤筛查的患者。使用逻辑和线性回归，并根据人口统计学和创伤特征进行调整。主要终点是死亡率。次要终点是早期死亡率和重伤患者亚组、过程和临床结果。
在第一阶段，纳入了 1290 名患者，在第二阶段，纳入了 2421 名患者。创伤室（比值比（OR）：0.18；CI：0.05-0.63）和总院内死亡率（OR：0.63 CI：0.42-0.95）的调整死亡率在第二阶段显著降低。创伤室（TR）时间减少了 30 分钟（p<0.001），CT 时间减少了 22 分钟（p<0.001）。第二阶段的延迟诊断和并发症数量显著减少，分别为 0.2（CI：0.1-0.2）和 0.4（CI：0.3-0.6）。住院时间和 ICU 住院时间分别显著减少了 1.5 天（p=0.010）和 1.8 天（p=0.022）。
与创伤护理相关的院内基础设施的优化导致重伤患者和整个创伤人群的生存率提高。此外，过程和临床结果得到改善，表现为住院时间缩短、TR 时间缩短、并发症减少和延迟诊断减少。
