Evaluation of trauma care by comparing mortality risks and admission policy in a Dutch trauma region

Abstract

Objective: To evaluate the effectiveness of trauma care in the Netherlands compared to UK norms and in terms of mortality risks in three groups of patients. The hypothesis was that there is no difference in risk of hospital death between major trauma patients transferred from another hospital to the trauma centre and patients directly admitted to the trauma centre.

Methods: Trauma admissions (n=17,023) during the period 2000-2006 in 12 emergency departments were selected from a regional trauma registry database. In the analysis, the dependent variable was death within 30 days of admission. W-Statistics (W(s)) was used to compare outcomes of the total Dutch trauma population and the population admitted to the trauma centre, with norms for England and Wales. The effect of direct admission to a non-trauma centre and immediate admission to a trauma centre for major trauma patients versus indirect admission was tested in a logistic model and adjusted for confounding.

Results: 444 (2.6%) patients died within 30 days of admission. 6.1% of all patients were major trauma patients. W(s) resulted in 1.39 (95% CI 1.08-1.70) more observed survivors per 100 admitted trauma patients standardised for case mix using UK norms. W(s) of trauma patients in the trauma centre resulted in 0.85 (95% CI 0.44-1.27) more survivors than expected. Patients directly admitted to a trauma centre or a non-trauma centre without transfer were found to have a non-significant increasing risk of mortality (OR 1.5 (95% CI 0.7-3.4) and 1.9 (95% CI 0.9-4.1), respectively) compared to patients transferred from another hospital to a trauma centre.

Conclusion: Trauma care in this Dutch province is performing better than expected comparing to the norms for the England and Wales. The admission policy of transporting major trauma patients to the nearest hospital and, if necessary, then transferring them to the trauma centre, seems legitimate in Dutch trauma care.