Suzan Dijkink1, Gwendolyn M van der Wilden2, Pieta Krijnen2, Lisa Dol2, Steven Rhemrev3, David R King4, Marc A DeMoya4, George C Velmahos4, Inger B Schipper2. 1. Department of Surgery, Leiden University Medical Center, The Netherlands. Electronic address: S.Dijkink@lumc.nl. 2. Department of Surgery, Leiden University Medical Center, The Netherlands. 3. Department of Surgery, Haaglanden Medical Center, The Netherlands. 4. Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, United States.
Abstract
BACKGROUND: Modern trauma systems differ worldwide, possibly leading to disparities in outcomes. We aim to compare characteristics and outcomes of blunt polytrauma patients admitted to two Level 1 Trauma Centers in the US (USTC) and the Netherlands (NTC). METHODS: For this retrospective study the records of 1367 adult blunt trauma patients with an Injury Severity Score (ISS) ≥ 16 admitted between July 1, 2011 and December 31, 2013 (640 from NTC, 727 from USTC) were analysed. RESULTS: The USTC group had a higher Charlson Comorbidity Index (mean [standard deviation] 1.15 [2.2] vs. 1.73 [2.8], p<0.0001) and Injury Severity Score (median [interquartile range, IQR] 25 [17-29] vs. 21 [17-26], p<0.0001). The in-hospital mortality was similar in both centers (11% in USTC vs. 10% NTC), also after correction for baseline differences in patient population in a multivariable analysis (adjusted odds ratio 0.95, 95% confidence interval 0.61-1.48, p=0.83). USTC patients had a longer Intensive Care Unit stay (median [IQR] 4 [2-11] vs. 2 [2-7] days, p=0.006) but had a shorter hospital stay (median [IQR] 6 [3-13] vs. 8 [4-16] days, p<0.0001). USTC patients were discharged more often to a rehabilitation center (47% vs 10%) and less often to home (46% vs. 66%, p<0.0001), and had a higher readmission rate (8% vs. 4%, p=0.01). CONCLUSION: Although several outcome parameters differ in two urban area trauma centers in the USA and the Netherlands, the quality of care for trauma patients, measured as survival, is equal. Other outcomes varied between both trauma centers, suggesting that differences in local policies and processes do influence the care system, but not so much the quality of care as reflected by survival.
BACKGROUND: Modern trauma systems differ worldwide, possibly leading to disparities in outcomes. We aim to compare characteristics and outcomes of blunt polytraumapatients admitted to two Level 1 Trauma Centers in the US (USTC) and the Netherlands (NTC). METHODS: For this retrospective study the records of 1367 adult blunt traumapatients with an Injury Severity Score (ISS) ≥ 16 admitted between July 1, 2011 and December 31, 2013 (640 from NTC, 727 from USTC) were analysed. RESULTS: The USTC group had a higher Charlson Comorbidity Index (mean [standard deviation] 1.15 [2.2] vs. 1.73 [2.8], p<0.0001) and Injury Severity Score (median [interquartile range, IQR] 25 [17-29] vs. 21 [17-26], p<0.0001). The in-hospital mortality was similar in both centers (11% in USTC vs. 10% NTC), also after correction for baseline differences in patient population in a multivariable analysis (adjusted odds ratio 0.95, 95% confidence interval 0.61-1.48, p=0.83). USTC patients had a longer Intensive Care Unit stay (median [IQR] 4 [2-11] vs. 2 [2-7] days, p=0.006) but had a shorter hospital stay (median [IQR] 6 [3-13] vs. 8 [4-16] days, p<0.0001). USTC patients were discharged more often to a rehabilitation center (47% vs 10%) and less often to home (46% vs. 66%, p<0.0001), and had a higher readmission rate (8% vs. 4%, p=0.01). CONCLUSION: Although several outcome parameters differ in two urban area trauma centers in the USA and the Netherlands, the quality of care for traumapatients, measured as survival, is equal. Other outcomes varied between both trauma centers, suggesting that differences in local policies and processes do influence the care system, but not so much the quality of care as reflected by survival.
Authors: Michael Grubmüller; Maximilian Kerschbaum; Eva Diepold; Katharina Angerpointner; Michael Nerlich; Antonio Ernstberger Journal: Scand J Trauma Resusc Emerg Med Date: 2018-01-08 Impact factor: 2.953
Authors: Suzan Dijkink; Pieta Krijnen; Aglaia Hage; Gwendolyn M Van der Wilden; George Kasotakis; Dennis Den Hartog; Ali Salim; J Carel Goslings; Frank W Bloemers; Steven J Rhemrev; David R King; George C Velmahos; Inger B Schipper Journal: World J Surg Date: 2018-11 Impact factor: 3.352