Division of Trauma Surgery, Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany.
Eur J Trauma Emerg Surg. 2021 Aug;47(4):1273-1280. doi: 10.1007/s00068-020-01306-3. Epub 2020 Jan 29.
Swiss and German (pre-)hospital systems, distribution and organization of trauma centres differ from each other. It is unclear if outcome in trauma patients differs as well. Therefore, this study aims to determine differences in characteristics, therapy and outcome of trauma patients between both German-speaking countries.
The TraumaRegister DGU (TR-DGU) was used. Patients with Injury Severity Score ≥ 9 admitted to a level 1 trauma centre between 01/2009 and 12/2017 were included if they required ICU care or died. Trauma pattern, pre-hospital procedures and outcome were compared between Swiss (CH, n = 4768) and German (DE, n = 66,908) groups.
Swiss patients were older than German patients (53 vs. 50 years). ISS did not differ between groups (CH 23.8 vs. DE 23.0 points). There were more low falls < 3 m (34% vs. 21%) at the expense of less traffic accidents (37% vs. 52%) in the Swiss population. In Switzerland 30% of allocations were done without physician involvement, whereas this occurred in 4% of German cases. Despite a comparable number of patients with a GCS ≤ 8 (CH 29.6%; DE 26.4%), differences in pre-hospital intubation rates occurred (CH 31% vs. DE 40%). Severe traumatic brain injuries were diagnosed most frequently in Switzerland (CH 62% vs. DE 49%). Admission vital signs were similar, and standardized mortality ratios were close to one in both countries.
This study demonstrates that patients' age, trauma patterns and pre-hospital care differ between Germany and Switzerland. However, adjusted mortality was almost similar. Further benchmarking studies are indicated to optimize trauma care in both German-speaking countries.
瑞士和德国（前）医院系统，创伤中心的分布和组织彼此不同。目前尚不清楚创伤患者的结局是否也存在差异。因此，本研究旨在确定这两个德语国家的创伤患者在特征、治疗和结局方面的差异。
使用创伤登记处德国创伤救治协会（TR-DGU）。纳入在 2009 年 1 月至 2017 年 12 月期间入住 1 级创伤中心、损伤严重程度评分≥9 分且需要 ICU 治疗或死亡的患者。比较瑞士（CH，n=4768）和德国（DE，n=66908）两组患者的创伤模式、院前处理和结局。
瑞士患者比德国患者年龄更大（53 岁比 50 岁）。两组的 ISS 无差异（CH 23.8 分比 DE 23.0 分）。瑞士人群中，低高度坠落伤（＜3m）占比更高（34%比 21%），而交通事故占比更低（37%比 52%）。在瑞士，30%的病例是在没有医生参与的情况下进行分诊的，而在德国，这一比例为 4%。尽管 GCS≤8 的患者数量相当（CH 29.6%；DE 26.4%），但院前插管率存在差异（CH 31%比 DE 40%）。瑞士诊断出的严重创伤性脑损伤最常见（CH 62%比 DE 49%）。入院生命体征相似，两国的标准化死亡率比值接近 1。
本研究表明，德国和瑞士患者的年龄、创伤模式和院前护理存在差异。然而，调整后的死亡率几乎相同。需要进一步的基准研究来优化这两个德语国家的创伤救治。
