Skip to main content
Top
Published in: World Journal of Emergency Surgery 1/2008

Open Access 01-12-2008 | Research article

Comparison of quality control for trauma management between Western and Eastern European trauma center

Authors: Stefano Massimiliano Calderale, Raluca Sandru, Gregorio Tugnoli, Salomone Di Saverio, Mircea Beuran, Sergio Ribaldi, Massimo Coletti, Giorgio Gambale, Sorin Paun, Livio Russo, Franco Baldoni

Published in: World Journal of Emergency Surgery | Issue 1/2008

Login to get access

Abstract

Background

Quality control of trauma care is essential to define the effectiveness of trauma center and trauma system. To identify the troublesome issues of the system is the first step for validation of the focused customized solutions. This is a comparative study of two level I trauma centers in Italy and Romania and it has been designed to give an overview of the entire trauma care program adopted in these two countries. This study was aimed to use the results as the basis for recommending and planning changes in the two trauma systems for a better trauma care.

Methods

We retrospectively reviewed a total of 182 major trauma patients treated in the two hospitals included in the study, between January and June 2002. Every case was analyzed according to the recommended minimal audit filters for trauma quality assurance by The American College of Surgeons Committee on Trauma (ACSCOT).

Results

Satisfactory yields have been reached in both centers for the management of head and abdominal trauma, airway management, Emergency Department length of stay and early diagnosis and treatment. The main significant differences between the two centers were in the patients' transfers, the leadership of trauma team and the patients' outcome. The main concerns have been in the surgical treatment of fractures, the outcome and the lacking of documentation.

Conclusion

The analyzed hospitals are classified as Level I trauma center and are within the group of the highest quality level centers in their own countries. Nevertheless, both of them experience major lacks and for few audit filters do not reach the mmum standard requirements of ACS Audit Filters. The differences between the western and the eastern European center were slight. The parameters not reaching the minimum requirements are probably occurring even more often in suburban settings.
Literature
1.
go back to reference Donabedian A: The role of outcomes in quality assesment and assurance. Qual Rev Bull. 1992, 18: 356-360. Donabedian A: The role of outcomes in quality assesment and assurance. Qual Rev Bull. 1992, 18: 356-360.
2.
go back to reference Eastes LS, Norton R, Brand D: Outcomes of Patients Using a Tiered Trauma Response Protocol. J Trauma. 2001, 50: 908-913. 10.1097/00005373-200105000-00022.CrossRefPubMed Eastes LS, Norton R, Brand D: Outcomes of Patients Using a Tiered Trauma Response Protocol. J Trauma. 2001, 50: 908-913. 10.1097/00005373-200105000-00022.CrossRefPubMed
3.
go back to reference Maryland Trauma Registry, Education and Prevention Committee, Maryland Trauma Registry Data Dictionary, January 3, 2000. the Maryland Institute for Emergency Medical Services Systems – Information Technology Maryland Trauma Registry, Education and Prevention Committee, Maryland Trauma Registry Data Dictionary, January 3, 2000. the Maryland Institute for Emergency Medical Services Systems – Information Technology
4.
go back to reference Daley BJ, Garcia-Perez F: Reintubation as an Outcome Predictor in Trauma Patients. Chest. 1996, 110: 1577-80. 10.1378/chest.110.6.1577.CrossRefPubMed Daley BJ, Garcia-Perez F: Reintubation as an Outcome Predictor in Trauma Patients. Chest. 1996, 110: 1577-80. 10.1378/chest.110.6.1577.CrossRefPubMed
5.
go back to reference McDermott FT, Cordner SM, Tremayne AB: Consultative Committee on Road Traffic Fatalities: Trauma Audit Methodology. Aust N Z J Surg. 2000, 70: 710-721. 10.1046/j.1440-1622.2000.01939.x.CrossRefPubMed McDermott FT, Cordner SM, Tremayne AB: Consultative Committee on Road Traffic Fatalities: Trauma Audit Methodology. Aust N Z J Surg. 2000, 70: 710-721. 10.1046/j.1440-1622.2000.01939.x.CrossRefPubMed
6.
go back to reference Ruchholtz S: Das Traumaregister der DGU als Grundlage des interklinischen Qualitätsmanagement in der Schwerverletztenversorgung. Unfallchirurg. 2000, 103: 30-37. 10.1007/s001130050005.CrossRefPubMed Ruchholtz S: Das Traumaregister der DGU als Grundlage des interklinischen Qualitätsmanagement in der Schwerverletztenversorgung. Unfallchirurg. 2000, 103: 30-37. 10.1007/s001130050005.CrossRefPubMed
7.
go back to reference Guenther S, Waydhas C, Ose C: Quality of Multiple Trauma Care in 33 German and Swiss Trauma Centers During a 5-Year Period: Regular versus On-Call Service. J Trauma. 2003, 54: 973-978. 10.1097/01.TA.0000038543.58142.28.CrossRefPubMed Guenther S, Waydhas C, Ose C: Quality of Multiple Trauma Care in 33 German and Swiss Trauma Centers During a 5-Year Period: Regular versus On-Call Service. J Trauma. 2003, 54: 973-978. 10.1097/01.TA.0000038543.58142.28.CrossRefPubMed
8.
go back to reference Munro PT, Smith RD, Parke TR: Effect of patients' age on management of acute intracranial haematoma: prospective national study. BMJ. 2002, 325: 2-10.1136/bmj.325.7354.2.CrossRef Munro PT, Smith RD, Parke TR: Effect of patients' age on management of acute intracranial haematoma: prospective national study. BMJ. 2002, 325: 2-10.1136/bmj.325.7354.2.CrossRef
9.
go back to reference Friedl W, Karches C: Das Schadel-Hirn-Trauma in der chirurgischen Akutversorgung. Primarversorgung in einem Krankenhaus der Grund- und Regelversorgung. Der Chirurg. 1996, 67: 1107-1113. 10.1007/s001040050111.CrossRef Friedl W, Karches C: Das Schadel-Hirn-Trauma in der chirurgischen Akutversorgung. Primarversorgung in einem Krankenhaus der Grund- und Regelversorgung. Der Chirurg. 1996, 67: 1107-1113. 10.1007/s001040050111.CrossRef
10.
go back to reference Henderson KIM, Coats TJ, Hassan TB: Audit of time to emergency trauma laparotomy. British Journal of Surgery. 2000, 87;4: 472-10.1046/j.1365-2168.2000.01392.x.CrossRef Henderson KIM, Coats TJ, Hassan TB: Audit of time to emergency trauma laparotomy. British Journal of Surgery. 2000, 87;4: 472-10.1046/j.1365-2168.2000.01392.x.CrossRef
11.
go back to reference Chung TK: Trauma surgeons, trauma centres. Ann Coll Surg. 2000, 4: 1-8. 10.1046/j.1442-2034.2000.00046.x.CrossRef Chung TK: Trauma surgeons, trauma centres. Ann Coll Surg. 2000, 4: 1-8. 10.1046/j.1442-2034.2000.00046.x.CrossRef
12.
go back to reference Bowley D, Boffard K: Pattern of injury in motor vehicle accidents, e Medicine World Medical Library, South Africa. Last Updated: October 2002 Bowley D, Boffard K: Pattern of injury in motor vehicle accidents, e Medicine World Medical Library, South Africa. Last Updated: October 2002
13.
go back to reference Pape HC, Stalp M, Dahlweid M: Welche primäre Operationsdauer ist hinsichtlich eines Borderlinezustandes polytraumatisierter Patienten vertretbar? Eine prospektive Evaluation anhand des Traumaregisters der DGU. Unfallchirurg. 1999, 102: 861-869. 10.1007/s001130050495.CrossRefPubMed Pape HC, Stalp M, Dahlweid M: Welche primäre Operationsdauer ist hinsichtlich eines Borderlinezustandes polytraumatisierter Patienten vertretbar? Eine prospektive Evaluation anhand des Traumaregisters der DGU. Unfallchirurg. 1999, 102: 861-869. 10.1007/s001130050495.CrossRefPubMed
14.
go back to reference David Galler, Adrian Skinner: Critical Care Considerations in Trauma, New Zealand, eMedicine World Medical Library. Last Updated: October 3, 2001 David Galler, Adrian Skinner: Critical Care Considerations in Trauma, New Zealand, eMedicine World Medical Library. Last Updated: October 3, 2001
15.
go back to reference Eckstein M, Chan L: Effect of Prehospital Advanced Life Support on Outcomes of Major Trauma Patients. J Trauma. 2000, 48: 643-648. 10.1097/00005373-200004000-00010.CrossRefPubMed Eckstein M, Chan L: Effect of Prehospital Advanced Life Support on Outcomes of Major Trauma Patients. J Trauma. 2000, 48: 643-648. 10.1097/00005373-200004000-00010.CrossRefPubMed
16.
go back to reference Golecki N: Endotracheale Intubation des Traumapatienten. Notfall & Rettungsmedizin. 2003, 6: 19-21. 10.1007/s10049-002-0526-1.CrossRef Golecki N: Endotracheale Intubation des Traumapatienten. Notfall & Rettungsmedizin. 2003, 6: 19-21. 10.1007/s10049-002-0526-1.CrossRef
17.
go back to reference Maghsudi M, Nerlich M: Polytrauma-Management Präklinisches Handling und Schockraumversorgung. Chirurg. 1998, 69: 313-322. 10.1007/s001040050419.CrossRefPubMed Maghsudi M, Nerlich M: Polytrauma-Management Präklinisches Handling und Schockraumversorgung. Chirurg. 1998, 69: 313-322. 10.1007/s001040050419.CrossRefPubMed
18.
go back to reference Tugnoli G, Casali M, Villani S, Biscardi A, Sinibaldi G, Baldoni F: The damage control surgery. Ann Ital Chir. 2007, 78 (2): 81-4.PubMed Tugnoli G, Casali M, Villani S, Biscardi A, Sinibaldi G, Baldoni F: The damage control surgery. Ann Ital Chir. 2007, 78 (2): 81-4.PubMed
19.
go back to reference Calderale SM: Study concearning audit filter in blunt trauma evaluation, 4th EATES Congress, Pisa, Aprilie 2000. Calderale SM: Study concearning audit filter in blunt trauma evaluation, 4th EATES Congress, Pisa, Aprilie 2000.
20.
go back to reference Zintl B, Ruchholtz S, Nast-Kolb D: Qualitätsmanagement der frühen klinischen Polytraumaversorgung: Dokumentation der Behandlung und Beurteilung der Versorgungsqualität. Unfallchirurg. 1997, 100: 811-819. 10.1007/s001130050198.CrossRefPubMed Zintl B, Ruchholtz S, Nast-Kolb D: Qualitätsmanagement der frühen klinischen Polytraumaversorgung: Dokumentation der Behandlung und Beurteilung der Versorgungsqualität. Unfallchirurg. 1997, 100: 811-819. 10.1007/s001130050198.CrossRefPubMed
21.
go back to reference Committee on Trauma of the American College of Surgeons, Resources for Optimal Care of Injured Patient. 1999 Committee on Trauma of the American College of Surgeons, Resources for Optimal Care of Injured Patient. 1999
22.
go back to reference Calderale SM, Guasticchi G, Cremonese F: Criteri clinico organizzativi per il trasferimento del paziente critico nella rete dell'emergenza. Linee guida per gli operatori. Monografie ASP Regione Lazio, Marzo. 2002 Calderale SM, Guasticchi G, Cremonese F: Criteri clinico organizzativi per il trasferimento del paziente critico nella rete dell'emergenza. Linee guida per gli operatori. Monografie ASP Regione Lazio, Marzo. 2002
23.
go back to reference Calderale SM, Guasticchi G, De Luca A: Protocollo sul il trasferimento interospedaliero del paziente critico in emergenza DGR 1729/02 GU Regione Lazio. Calderale SM, Guasticchi G, De Luca A: Protocollo sul il trasferimento interospedaliero del paziente critico in emergenza DGR 1729/02 GU Regione Lazio.
24.
go back to reference Flavin BM, Driscoll PA: Organizing and training the emergency department in the reception of major trauma. Emergency Medicine. 2000, 12: 112-115.CrossRef Flavin BM, Driscoll PA: Organizing and training the emergency department in the reception of major trauma. Emergency Medicine. 2000, 12: 112-115.CrossRef
25.
go back to reference Richardson JD: Is There an Ideal Model for Training the Trauma Surgeons of the Future?. The Journal of Trauma: Injury, Infection, and Critical Care. 2003, 54: 795-797. 10.1097/01.TA.0000056156.20400.E5.CrossRef Richardson JD: Is There an Ideal Model for Training the Trauma Surgeons of the Future?. The Journal of Trauma: Injury, Infection, and Critical Care. 2003, 54: 795-797. 10.1097/01.TA.0000056156.20400.E5.CrossRef
26.
go back to reference Rainer TH, de Villiers Smit P: Trauma systems and emergency medicine. Emergency Medicine. 2003, 15: 11-17.CrossRefPubMed Rainer TH, de Villiers Smit P: Trauma systems and emergency medicine. Emergency Medicine. 2003, 15: 11-17.CrossRefPubMed
27.
go back to reference Lien D, Chan A, Morris R: Impact of Trauma Case Management on Patient Outcomes. J Trauma. 2002, 53: 477-482.CrossRefPubMed Lien D, Chan A, Morris R: Impact of Trauma Case Management on Patient Outcomes. J Trauma. 2002, 53: 477-482.CrossRefPubMed
28.
go back to reference Holbrook TL, Hoyt DB, Anderson JP: The impact of major inhospital complications on functional outcome and quality of life after trauma. J Trauma. 2001, 50: 91-95. 10.1097/00005373-200101000-00016.CrossRefPubMed Holbrook TL, Hoyt DB, Anderson JP: The impact of major inhospital complications on functional outcome and quality of life after trauma. J Trauma. 2001, 50: 91-95. 10.1097/00005373-200101000-00016.CrossRefPubMed
29.
go back to reference Bardenheuer M, Obertacke U: Epidemiologie des Schwerverletzten. Eine prospektive Erfassung der praklinischen und klinischen Versorgung. Notfall & Rettungsmedizin. 2000, 3: 309-317. 10.1007/s100490070045.CrossRef Bardenheuer M, Obertacke U: Epidemiologie des Schwerverletzten. Eine prospektive Erfassung der praklinischen und klinischen Versorgung. Notfall & Rettungsmedizin. 2000, 3: 309-317. 10.1007/s100490070045.CrossRef
30.
go back to reference Danne P, Brazenor G: The Major Trauma Management Study: An Analysis of the Efficacy of Current Trauma Care. Aust N Z J Surg. 1998, 68: 50-57. 10.1111/j.1445-2197.1998.tb04637.x.CrossRefPubMed Danne P, Brazenor G: The Major Trauma Management Study: An Analysis of the Efficacy of Current Trauma Care. Aust N Z J Surg. 1998, 68: 50-57. 10.1111/j.1445-2197.1998.tb04637.x.CrossRefPubMed
31.
go back to reference George LR, McGwin G, Metzger J: The Association between Gender and mortality among Trauma Patients as Modified by Age. J Trauma. 2003, 54: 464-471. 10.1097/01.TA.0000051939.95039.E6.CrossRefPubMed George LR, McGwin G, Metzger J: The Association between Gender and mortality among Trauma Patients as Modified by Age. J Trauma. 2003, 54: 464-471. 10.1097/01.TA.0000051939.95039.E6.CrossRefPubMed
32.
go back to reference Kissoon N, Tepas JJ, Peterson RJ: The evaluation of paediatric trauma care using audit filters. Pediatr Emerg Care. 1996, 12: 272-6. 10.1097/00006565-199608000-00009.CrossRefPubMed Kissoon N, Tepas JJ, Peterson RJ: The evaluation of paediatric trauma care using audit filters. Pediatr Emerg Care. 1996, 12: 272-6. 10.1097/00006565-199608000-00009.CrossRefPubMed
33.
go back to reference Nicholl J, Turner J: Effectiveness of a regional trauma system in reducing mortality from major trauma: before and after study. BMJ. 1997, 315: 1349-1354.PubMedCentralCrossRefPubMed Nicholl J, Turner J: Effectiveness of a regional trauma system in reducing mortality from major trauma: before and after study. BMJ. 1997, 315: 1349-1354.PubMedCentralCrossRefPubMed
34.
go back to reference Champion HR, Copes WS, Sacco WJ: The Major Trauma Outcome Study: Establishing National Norms for Trauma Care. J Trauma. 1990, 30: 1356-1365.CrossRefPubMed Champion HR, Copes WS, Sacco WJ: The Major Trauma Outcome Study: Establishing National Norms for Trauma Care. J Trauma. 1990, 30: 1356-1365.CrossRefPubMed
35.
go back to reference Meredith E, Evans G, Kilgo PD: A Comparison of the Abilities of Nine Scoring Algorithms in Predicting Mortality. J Trauma. 2002, 53: 621-629. 10.1097/00005373-200210000-00001.CrossRefPubMed Meredith E, Evans G, Kilgo PD: A Comparison of the Abilities of Nine Scoring Algorithms in Predicting Mortality. J Trauma. 2002, 53: 621-629. 10.1097/00005373-200210000-00001.CrossRefPubMed
36.
go back to reference Osler T, Rutledge R: ICISS: An International Classification of Disease-9 Based Injury Severity Score. J Trauma. 1996, 41: 380-386. 10.1097/00005373-199609000-00002.CrossRefPubMed Osler T, Rutledge R: ICISS: An International Classification of Disease-9 Based Injury Severity Score. J Trauma. 1996, 41: 380-386. 10.1097/00005373-199609000-00002.CrossRefPubMed
37.
go back to reference Wan GJ, Neff-Smith M: The Impact of Demographics, Injury Severity, and Trauma Type on the Likehood of Survival in Child and Adolescent Trauma Patients. J Trauma. 1996, 40: 412-414. 10.1097/00005373-199603000-00015.CrossRefPubMed Wan GJ, Neff-Smith M: The Impact of Demographics, Injury Severity, and Trauma Type on the Likehood of Survival in Child and Adolescent Trauma Patients. J Trauma. 1996, 40: 412-414. 10.1097/00005373-199603000-00015.CrossRefPubMed
38.
go back to reference Rixen D, Raum M: Prognoseabschätzung des Schwerverletzten – Eine Analyse von 2069 Patienten des Traumaregisters der DGU. Unfallchirurg. 2001, 104: 230-239. 10.1007/s001130050719.CrossRefPubMed Rixen D, Raum M: Prognoseabschätzung des Schwerverletzten – Eine Analyse von 2069 Patienten des Traumaregisters der DGU. Unfallchirurg. 2001, 104: 230-239. 10.1007/s001130050719.CrossRefPubMed
39.
go back to reference Stewart RM, Myers JG, Dent DL: Seven Hundred Fifty-Three Consecutive Deaths in a Level I Trauma Center: The Argument for Injury Prevention. J trauma. 2003, 54: 66-71. 10.1097/00005373-200301000-00009.CrossRefPubMed Stewart RM, Myers JG, Dent DL: Seven Hundred Fifty-Three Consecutive Deaths in a Level I Trauma Center: The Argument for Injury Prevention. J trauma. 2003, 54: 66-71. 10.1097/00005373-200301000-00009.CrossRefPubMed
40.
go back to reference Young JS, Bassam D, Cephas GA, Brady WJ, Butler K, Pomphrey : Interhospital versus direct scene transfer of major trauma patients in a rural trauma system. Am Surg. 1998, 64: 88-91.PubMed Young JS, Bassam D, Cephas GA, Brady WJ, Butler K, Pomphrey : Interhospital versus direct scene transfer of major trauma patients in a rural trauma system. Am Surg. 1998, 64: 88-91.PubMed
41.
go back to reference Oestern HJ: Versorgung Polytraumatisierter im internazionalen Vergleich. Unfallchirurg. 1999, 102: 80-91. 10.1007/s001130050378.CrossRefPubMed Oestern HJ: Versorgung Polytraumatisierter im internazionalen Vergleich. Unfallchirurg. 1999, 102: 80-91. 10.1007/s001130050378.CrossRefPubMed
42.
go back to reference Kulla MO, Helm M, Lampl L: Schockraummanagement – Entwicklung, Einführung und Evaluation eines Pen-Computer basierenden Konzeptes zur Polytraumadokumentation – Der Notarzt. 1999, 15: A34-A35. Kulla MO, Helm M, Lampl L: Schockraummanagement – Entwicklung, Einführung und Evaluation eines Pen-Computer basierenden Konzeptes zur Polytraumadokumentation – Der Notarzt. 1999, 15: A34-A35.
43.
go back to reference Gopal S, Majumder S: Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia. J Bone Joint Surg [Br]. 2000, 82-B: 959-66. 10.1302/0301-620X.82B7.10482.CrossRef Gopal S, Majumder S: Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia. J Bone Joint Surg [Br]. 2000, 82-B: 959-66. 10.1302/0301-620X.82B7.10482.CrossRef
44.
go back to reference Pape HC, Giannoudis P: The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery. Am J Surg. 2002, 183: 622-9. 10.1016/S0002-9610(02)00865-6.CrossRefPubMed Pape HC, Giannoudis P: The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery. Am J Surg. 2002, 183: 622-9. 10.1016/S0002-9610(02)00865-6.CrossRefPubMed
45.
go back to reference Bone-Lawrence B, Johnson-Kenneth D, Weigelt-John , Scheinberg-Robert : Early versus Delayed Stabilization of Femoral Fractures. The Journal of Bone and Joint Surgery (American Volume). 1989, 71-A: 336-340. Bone-Lawrence B, Johnson-Kenneth D, Weigelt-John , Scheinberg-Robert : Early versus Delayed Stabilization of Femoral Fractures. The Journal of Bone and Joint Surgery (American Volume). 1989, 71-A: 336-340.
47.
go back to reference Dunham CM, Bosse MJ, Clancy TV, Cole FJ: Practice Management Guidelines for the Optimal Timing of Long-Bone Fracture Stabilization in Polytrauma Patients: The EAST Practice Management Guidelines Work Group. J Trauma. 2001, 50: 958-967. 10.1097/00005373-200105000-00037.CrossRefPubMed Dunham CM, Bosse MJ, Clancy TV, Cole FJ: Practice Management Guidelines for the Optimal Timing of Long-Bone Fracture Stabilization in Polytrauma Patients: The EAST Practice Management Guidelines Work Group. J Trauma. 2001, 50: 958-967. 10.1097/00005373-200105000-00037.CrossRefPubMed
48.
go back to reference Rommens PM, Broos PL: Preclinical and Clinical Care of Extremity Lesions in Polytraumatized Patients. Acta Chir Belg. 1990, 90: 32-8.PubMed Rommens PM, Broos PL: Preclinical and Clinical Care of Extremity Lesions in Polytraumatized Patients. Acta Chir Belg. 1990, 90: 32-8.PubMed
Metadata
Title
Comparison of quality control for trauma management between Western and Eastern European trauma center
Authors
Stefano Massimiliano Calderale
Raluca Sandru
Gregorio Tugnoli
Salomone Di Saverio
Mircea Beuran
Sergio Ribaldi
Massimo Coletti
Giorgio Gambale
Sorin Paun
Livio Russo
Franco Baldoni
Publication date
01-12-2008
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2008
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/1749-7922-3-32

Other articles of this Issue 1/2008

World Journal of Emergency Surgery 1/2008 Go to the issue