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Open Access 01-11-2015 | Original Scientific Report

Demographic Patterns and Outcomes of Patients in Level I Trauma Centers in Three International Trauma Systems

Authors: Amy C. Gunning, Koen W. W. Lansink, Karlijn J. P. van Wessem, Zsolt J. Balogh, Frederick P. Rivara, Ronald V. Maier, Luke P. H. Leenen

Published in: World Journal of Surgery | Issue 11/2015

Abstract

Introduction

Trauma systems were developed to improve the care for the injured. The designation and elements comprising these systems vary across countries. In this study, we have compared the demographic patterns and patient outcomes of Level I trauma centers in three international trauma systems.

Methods

International multicenter prospective trauma registry-based study, performed in the University Medical Center Utrecht (UMCU), Utrecht, the Netherlands, John Hunter Hospital (JHH), Newcastle, Australia, and Harborview Medical Center (HMC), Seattle, the United States. Inclusion: patients ≥18 years, admitted in 2012, registered in the institutional trauma registry.

Results

In UMCU, JHH, and HMC, respectively, 955, 1146, and 4049 patients met the inclusion criteria of which 300, 412, and 1375 patients with Injury Severity Score (ISS) > 15. Mean ISS was higher in JHH (13.5; p < 0.001) and HMC (13.4; p < 0.001) compared to UMCU (11.7). Unadjusted mortality: UMCU = 6.5 %, JHH = 3.6 %, and HMC = 4.8 %. Adjusted odds of death: JHH = 0.498 [95 % confidence interval (CI) 0.303–0.818] and HMC = 0.473 (95 % CI 0.325–0.690) compared to UMCU. HMC compared to JHH was 1.002 (95 % CI 0.664–1.514). Odds of death patients ISS > 15: JHH = 0.507 (95 % CI 0.300–0.857) and HMC = 0.451 (95 % CI 0.297–0.683) compared to UMCU. HMC = 0.931 (95 % CI 0.608–1.425) compared to JHH. TRISS analysis: UMCU: Ws = 0.787, Z = 1.31, M = 0.87; JHH, Ws = 3.583, Z = 6.7, M = 0.89; HMC, Ws = 3.902, Z = 14.6, M = 0.84.

Conclusion

This study demonstrated substantial differences across centers in patient characteristics and mortality, mainly of neurological cause. Future research must investigate whether the outcome differences remain with nonfatal and long-term outcomes. Furthermore, we must focus on the development of a more valid method to compare systems.

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Title: Demographic Patterns and Outcomes of Patients in Level I Trauma Centers in Three International Trauma Systems
Authors: Amy C. Gunning
Koen W. W. Lansink
Karlijn J. P. van Wessem
Zsolt J. Balogh
Frederick P. Rivara
Ronald V. Maier
Luke P. H. Leenen
Publication date: 01-11-2015
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 11/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-3162-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Demographic Patterns and Outcomes of Patients in Level I Trauma Centers in Three International Trauma Systems

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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