Prionas Apostolos, Tsoulfas George, Tooulias Andreas, Papakoulas Apostolos, Piachas Athanasios, Papadopoulos Vasileios
General Surgery, Queen's Hospital, Barking Havering and Redbridge Univesity Hospitals NHS Trust, Romford, London, UK.
Surgery and Cancer, Imperial College London, London, UK.
Trauma Surg Acute Care Open. 2020 Mar 17;5(1):e000401. doi: 10.1136/tsaco-2019-000401. eCollection 2020.
At present there is no organized trauma system in Greece and no national trauma database. The objective of this study was to record and evaluate trauma management at our university hospital and to measure the associated healthcare costs, while laying the foundations for a national database and the organization of regional trauma networks.
Retrospective study of trauma patients (n=2320) between 2014 and 2015, through our single-center registry. Demographic information, injury patterns, hospital transfer, investigations, interventions, duration of hospitalization, Injury Severity Score (ISS), outcomes, complications and cost were recorded.
Road traffic collisions (RTC) accounted for 23.2% of traumas. The proportion of patients who were transferred to the hospital by the National Emergency Medical Services decreased throughout the study (n=76/1192 (6.38%), n=109/1128 (9.7%)) (p<0.05). 1209 (52.1%) of our trauma patients did not meet the US trauma field triage algorithm criteria. Overtriage of trauma patients to our facility ranged from 90.7% to 96.7%, depending on the criteria used (clinical vs. ISS criteria). Ninety-one (3.9%) of our patients received operative management. Intensive care unit admissions were 21 (0.1%). Seventy-six (3.3%) of our patients had ISS>15 and their mortality was 31.6%. The overall non-salary cost for trauma management was €623 140. 53% of these costs were attributed to RTCs. The cost resulting from the observed overtriage ranged from €121 000 to €315 000. Patients who did not meet the US trauma triage algorithm criteria accounted for 10.5% of total expenses.
Our results suggest that RTCs pose a significant financial burden. The prehospital triage of trauma patients is ineffective. A reduction of costs could have been achieved if prehospital triage was more effective.
Level IV.
目前希腊没有系统化的创伤救治体系，也没有国家创伤数据库。本研究的目的是记录和评估我校医院的创伤管理情况，并测算相关医疗费用，同时为国家数据库及区域创伤网络的组建奠定基础。
通过单中心登记系统对2014年至2015年间的创伤患者（n = 2320）进行回顾性研究。记录人口统计学信息、损伤类型、医院转运情况、检查、干预措施、住院时间、损伤严重程度评分（ISS）、结局、并发症及费用。
道路交通碰撞（RTC）所致创伤占23.2%。在整个研究期间，由国家紧急医疗服务机构转运至医院的患者比例有所下降（n = 76/1192（6.38%），n = 109/1128（9.7%））（p < 0.05）。1209例（52.1%）创伤患者不符合美国创伤现场分诊算法标准。根据所用标准（临床标准与ISS标准），转诊至我院的创伤患者过度分诊率在90.7%至96.7%之间。91例（3.9%）患者接受了手术治疗。重症监护病房收治率为21例（0.1%）。76例（3.3%）患者ISS>15，其死亡率为31.6%。创伤管理的总体非薪资成本为623,140欧元。其中53%的成本归因于RTC。观察到的过度分诊导致的成本在121,000欧元至315,000欧元之间。不符合美国创伤分诊算法标准的患者占总费用的10.5%。
我们的结果表明，RTC造成了巨大的经济负担。创伤患者的院前分诊效果不佳。如果院前分诊更有效，成本本可降低。
四级。
