Alexander Timm1,2, Marc Maegele3, Klaus Wendt4, Rolf Lefering5, Hendrik Wyen6. 1. Cologne-Merheim Medical Center (CMMC), Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany. atimm.unikoeln@yahoo.de. 2. Department of Anesthesiology, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. atimm.unikoeln@yahoo.de. 3. Cologne-Merheim Medical Center (CMMC), Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany. 4. Department of Trauma Surgery, University Medical Center Groningen (UMCG), Hanzeplein 1, 9700 RB, Groningen, Netherlands. 5. Cologne-Merheim Medical Centre (CMMC), Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostermerheimer Str, 200, Building 38, 51109, Cologne, Germany. 6. Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
Abstract
PURPOSE: The aim of this study was to compare the pre-hospital treatment of major trauma patients with similar injury patterns in Germany and the Netherlands. PATIENTS AND METHODS: This matched-pairs analysis is based on the TraumaRegister DGU®. The authors compared major trauma patients (ISS ≥ 16) from 2009 to 2015 treated in Dutch and German Level 1 trauma centers (TC). Endpoints were the pre-hospital times and interventions performed until hospital admission. Additional endpoints included hospital mortality, 24-h mortality and standardized mortality ratio (SMR) which was calculated using the Revised Injury Severity Classification, version II (RISC II). Patients were matched by age, gender, injury pattern, vital status on-scene and involvement into a traffic accident. Three subgroups were formed according to the mode of transportation and level of care provided during transport: Ambulance/Physician, Helicopter/Physician and Ambulance/Emergency Medical Technician. RESULTS: Patients were matched into 1094 pairs. German patients arrived at the TC after a mean pre-hospital time of 65.6 (± 29.6) min while Dutch patients arrived after 61.4 (± 28.7) min. Pre-hospital intubation rate was slightly higher in the Netherlands (44.1% GER vs 50.5% NL). Chest tubes were placed in 3.0% of German patients and 8.3% of Dutch patients. 63.5% of the German patients received analgesia/sedation which was below the rate of Dutch patients (71.1%). The hospital mortality was for 17.6% for German patients and 19.8% for Dutch patients. The SMR was about 1.0 for both groups. CONCLUSION: Multiple differences and some similarities in the treatment of major trauma patients with similar injury patterns were found but no clinically relevant differences in the chosen outcome parameters could be observed.
PURPOSE: The aim of this study was to compare the pre-hospital treatment of major traumapatients with similar injury patterns in Germany and the Netherlands. PATIENTS AND METHODS: This matched-pairs analysis is based on the TraumaRegister DGU®. The authors compared major traumapatients (ISS ≥ 16) from 2009 to 2015 treated in Dutch and German Level 1 trauma centers (TC). Endpoints were the pre-hospital times and interventions performed until hospital admission. Additional endpoints included hospital mortality, 24-h mortality and standardized mortality ratio (SMR) which was calculated using the Revised Injury Severity Classification, version II (RISC II). Patients were matched by age, gender, injury pattern, vital status on-scene and involvement into a traffic accident. Three subgroups were formed according to the mode of transportation and level of care provided during transport: Ambulance/Physician, Helicopter/Physician and Ambulance/Emergency Medical Technician. RESULTS:Patients were matched into 1094 pairs. German patients arrived at the TC after a mean pre-hospital time of 65.6 (± 29.6) min while Dutch patients arrived after 61.4 (± 28.7) min. Pre-hospital intubation rate was slightly higher in the Netherlands (44.1% GER vs 50.5% NL). Chest tubes were placed in 3.0% of German patients and 8.3% of Dutch patients. 63.5% of the German patients received analgesia/sedation which was below the rate of Dutch patients (71.1%). The hospital mortality was for 17.6% for German patients and 19.8% for Dutch patients. The SMR was about 1.0 for both groups. CONCLUSION: Multiple differences and some similarities in the treatment of major traumapatients with similar injury patterns were found but no clinically relevant differences in the chosen outcome parameters could be observed.
Entities:
Keywords:
Emergency medical services; Germany; International comparison; Major trauma; Rescue times; The Netherlands
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