Department of Trauma Surgery, Leiden University Medical Center, Post zone K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands.
Eur J Trauma Emerg Surg. 2022 Apr;48(2):1035-1043. doi: 10.1007/s00068-021-01615-1. Epub 2021 Mar 12.
Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time.
All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008-2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS.
The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63-74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC.
Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.
二十年前，荷兰实施了包容性创伤系统。本研究的目的是评估结构化创伤护理对随时间推移严重受伤患者集中程度的影响。
在 2008 年至 2018 年的荷兰创伤登记处（DTR）中，我们纳入了所有严重受伤患者（损伤严重程度评分[ISS]≥16）进行分析。我们比较了直接送往创伤中心（TC）和非创伤中心（NTC）的严重受伤患者，有无严重神经外伤。我们确定了直接送往创伤中心的患者比例，以及总简明损伤评分（AIS）和 ISS。
记录的严重受伤患者人数从 2008 年的 2350 人增加到 2018 年的 4694 人。在此期间，这些患者中平均有 70%（63-74%）直接送往 TC。与有严重神经外伤的患者相比，无严重神经外伤的患者送往 TC 的机会较低。直接送往 TC 的患者受伤更严重，总 AIS 和 ISS 更高，而直接送往 NTC 的患者则较低。
自荷兰建立组织良好的创伤系统以来，创伤护理已逐渐集中化，更多严重受伤患者直接送往 TC。然而，仍有 30%的患者最初被送往 NTC。未来的研究应重点关注改善院前分诊，以便更迅速地将合适的患者转往合适的医院。
