Top

European Journal of Trauma and Emergency Surgery

Published in:

01-12-2019 | Original Article

Pre-hospital rescue times and interventions in severe trauma in Germany and the Netherlands: a matched-pairs analysis

Authors: Alexander Timm, Marc Maegele, Klaus Wendt, Rolf Lefering, Hendrik Wyen, the TraumaRegister DGU

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2019

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.

Federal Institute for Occupational Safety and Health. Unfallstatistik 2014—Unfalltote und Unfallverletzte 2014 in Deutschland. 2016. https://www.baua.de/DE/Angebote/Publikationen/Fakten/Unfallstatistik-2014.pdf?__blob=publicationFile&v=8. Accessed 19 June 2017.

Debus F, Lefering R, Frink M, Kuhne CA, Mand C, Bucking B, et al. Numbers of Severely Injured Patients in Germany. A retrospective analysis from the DGU (German Society for Trauma Surgery) Trauma Registry. Dtsch Arzteblatt Int. 2015;112(49):823–9. https://doi.org/10.3238/arztebl.2015.0823.CrossRef

Robert Koch-Institut. Gesundheit in Deutschland. Gesundheitsberichterstattung des Bundes. Robert Koch-Institut, Berlin. 2006. http://www.gbe-bund.de/pdf/GESBER2006.pdf. Accessed 19 June 2017.

Timm A, Maegele M, Lefering R, Wendt K, Wyen H, TraumaRegister DGU. Pre-hospital rescue times and actions in severe trauma. A comparison between two trauma systems: Germany and the Netherlands. Injury. 2014; 45(Suppl 3):43–52. https://doi.org/10.1016/j.injury.2014.08.017.CrossRef

Lefering R, Huber-Wagner S, Nienaber U, Maegele M, Bouillon B. Update of the trauma risk adjustment model of the TraumaRegister DGU: the Revised Injury Severity Classification, version II. Crit Care. 2014;18(5):476. https://doi.org/10.1186/s13054-014-0476-2. (London England).CrossRefPubMedPubMedCentral

Wyen H, Lefering R, Maegele M, Brockamp T, Wafaisade A, Wutzler S, et al. The golden hour of shock - how time is running out: prehospital time intervals in Germany–a multivariate analysis of 15, 103 patients from the TraumaRegister DGU(R). Emerg Med J EMJ. 2013;30(12):1048–55. https://doi.org/10.1136/emermed-2012-201962.CrossRefPubMed

ten Duis HJ, van der Werken C. Trauma care systems in The Netherlands. Injury. 2003;34(9):722–7. https://doi.org/10.1016/S0020-1383(03)00162-1.CrossRefPubMed

de Jongh MA, van Stel HF, Schrijvers AJ, Leenen LP, Verhofstad MH. The effect of Helicopter emergency medical services on trauma patient mortality in the Netherlands. Injury. 2012; 43 (9):1362–7. https://doi.org/10.1016/j.injury.2012.01.009.CrossRefPubMed

Mommsen P, Bradt N, Zeckey C, Andruszkow H, Petri M, Frink M, et al. Comparison of helicopter and ground emergency medical service: a retrospective analysis of a German rescue helicopter base. Technol Health Care. 2012;20(1):49–56. https://doi.org/10.3233/THC-2011-0655.CrossRefPubMed

10.

Butler DP, Anwar I, Willett K. Is it the H or the EMS in HEMS that has an impact on trauma patient mortality? A systematic review of the evidence. Emerg Med J EMJ. 2010; 27(9):692–701. https://doi.org/10.1136/emj.2009.087486.CrossRefPubMed

11.

Westhoff J, Kroner C, Meller R, Schreiber T, Zech S, Hubrich V, et al. Entrapped motorists and air rescue services: analysis of tactical rescue approach, rescue techniques, and emergency medical services illustrated by a helicopter emergency medical service. Der Unfallchirurg. 2008;111(3):155–61. https://doi.org/10.1007/s00113-007-1380-x.CrossRefPubMed

12.

Hussmann B, Lendemans S. Pre-hospital and early in-hospital management of severe injuries: changes and trends. Injury. 2014; 45 (Suppl 3):39–42. https://doi.org/10.1016/j.injury.2014.08.016.CrossRef

13.

Hussmann B, Lefering R, Waydhas C, Ruchholtz S, Wafaisade A, Kauther MD, et al. Prehospital intubation of the moderately injured patient: a cause of morbidity? A matched-pairs analysis of 1200 patients from the DGU Trauma Registry. Crit care. 2011;15(5):R207. https://doi.org/10.1186/cc10442. (London, England).CrossRefPubMedPubMedCentral

14.

German Society for Trauma Surgery. S3 - Leitlinie Polytrauma/ Schwerverletzten Behandlung. German Society for Trauma Surgery. 2016. http://www.awmf.org/leitlinien/detail/ll/012-019.html. Accessed 01 Feb 2017.

15.

Bernard SA, Nguyen V, Cameron P, Masci K, Fitzgerald M, Cooper DJ, et al. Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial. Ann Surg. 2010; 252(6):959–65. https://doi.org/10.1097/SLA.0b013e3181efc15f.CrossRefPubMed

16.

Muakkassa FF, Marley RA, Workman MC, Salvator AE. Hospital outcomes and disposition of trauma patients who are intubated because of combativeness. J Trauma. 2010;68(6):1305–9. https://doi.org/10.1097/TA.0b013e3181dcd137.CrossRefPubMed

17.

Franschman G, Peerdeman SM, Greuters S, Vieveen J, Brinkman AC, Christiaans HM, et al. Prehospital endotracheal intubation in patients with severe traumatic brain injury: guidelines versus reality. Resuscitation. 2009;80(10):1147–51. https://doi.org/10.1016/j.resuscitation.2009.06.029.CrossRefPubMed

18.

Badjatia N, Carney N, Crocco TJ, Fallat ME, Hennes HM, Jagoda AS, et al. Guidelines for prehospital management of traumatic brain injury 2nd edition. Prehospital Emerg Care. 2008;12 (Suppl 1):S1-52. https://doi.org/10.1080/10903120701732052.CrossRef

19.

Foundation for national ambulance and emergency room protocols. Landelijk Protocol Ambulancezorg 8.1. Zwolle. 2016. http://www.ambulancezorg.nl. Accessed 19 June 2017 2017.

20.

Franschman G, Andriessen TM, Boer C, Van der Naalt J, Horn J, Haitsma I, et al. Physician-based emergency medical service deployment characteristics in severe traumatic brain injury: a Dutch multicenter study. Injury. 2013;44(9):1232–6. https://doi.org/10.1016/j.injury.2013.06.002.CrossRefPubMed

21.

Kulla M, Helm M, Lefering R, Walcher F. Prehospital endotracheal intubation and chest tubing does not prolong the overall resuscitation time of severely injured patients: a retrospective, multicentre study of the Trauma Registry of the German Society of Trauma Surgery. Emerg Medcine J EMJ. 2012;29(6):497–501. https://doi.org/10.1136/emj.2010.107391.CrossRef

22.

Ringburg AN, Spanjersberg WR, Frankema SP, Steyerberg EW, Patka P, Schipper IB. Helicopter emergency medical services (HEMS): impact on on-scene times. J Trauma. 2007; 63 (2):258–62. https://doi.org/10.1097/01.ta.0000240449.23201.57.CrossRefPubMed

23.

Spanjersberg WR, Ringburg AN, Bergs EA, Krijen P, Schipper IB. Prehospital chest tube thoracostomy: effective treatment or additional trauma? J Trauma. 2005;59(1):96–101. https://doi.org/10.1097/01.TA.0000171448.71301.13.CrossRefPubMed

24.

Knotts D, Arthur AO, Holder P, Herrington T, Thomas SH. Pneumothorax volume expansion in helicopter emergency medical services transport. Air Med J. 2013;32(3):138–43. https://doi.org/10.1016/j.amj.2012.10.014.CrossRefPubMed

25.

Schmid MC, Mang H, Ey K, Braun J, Schuttler J. [Airway management in the German air rescue service]. Der Anaesthesist. 2009;58(9):884–90. https://doi.org/10.1007/s00101-009-1584-2.CrossRefPubMed

26.

Berben SA, Kemps HH, van Grunsven PM, Mintjes-de Groot JA, van Dongen RT, Schoonhoven L. Guideline ‘Pain management for trauma patients in the chain of emergency care’. Nederlands tijdschrift voor geneeskunde. 2011;155(18):A3100.PubMed

Title: Pre-hospital rescue times and interventions in severe trauma in Germany and the Netherlands: a matched-pairs analysis
Authors: Alexander Timm
Marc Maegele
Klaus Wendt
Rolf Lefering
Hendrik Wyen
the TraumaRegister DGU
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 6/2019
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-018-0978-8

At a glance: The STEP trials

Springer Medicine

Pre-hospital rescue times and interventions in severe trauma in Germany and the Netherlands: a matched-pairs analysis

Abstract

Purpose

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2019

Non-invasive cardiac output monitoring device “ICON” in trauma patients: a feasibility study

Is there a need for standardized postoperative radiographs after operative treatment of wrist or ankle fractures?

Health-related quality of life in trauma patients at 12 months after injury: a prospective cohort study

Deceleration thoracic aortic ruptures in trauma center level I areas: a 6-year retrospective study

Outcome of pubic rami fractures with or without concomitant involvement of the posterior ring in elderly patients

The role of psychiatric status on pediatric extremity fractures: a prospective analysis