Reduction in mortality of severely injured patients in Germany

Abstract

Introduction: The trauma registry of the German Society of Trauma Surgery is a multicentric prospective record of the treatment of severely injured patients.

Methods: The present study examines the effect of a quality management system on key processes and outcomes, in hospitals included in the trauma registry. The study is based on data of 11 013 severely injured patients (injury severity score = 16) who were treated in 105 hospitals between 1993 and 2005. A variety of parameters relating to early diagnosis and treatment were considered. Outcome quality was measured by a comparison between observed and calculated mortality (revised injury severity classification).

Results: During the 13 year long study period mortality could be significantly reduced from 22.8% to 18.7%. The time to initial radiological and ultrasound diagnosis was reduced, the use of computed tomography increased, the time until emergency operations in hemorrhagic shock was reduced, and damage limiting orthopedic interventions were performed more frequently.

Discussion: The German Trauma Registry records processes and treatment results in severely injured patients. This information is fed back to participating hospitals. The continuous data feedback is associated with a continuous improvement of process and outcome quality in the treatment of severely injured patients.

Keywords: mortality; prognosis; quality management; research of accidents; trauma.

Figure 1

Number of hospitals participating in the trauma registry from 1993 to 2005

Figure 2

Numbers of total patients captured

Figure 3

Observed mortality and prognosis, on the basis of the "revised injury severity classification" (RISC), using as an example a participating hospital from the 2004 annual report of the trauma registry

Figure 4

Standardized mortality rates (SMR) on the basis of RISC ("revised injury severity classification") for patients with ISS ≥16 (n = 11 013). Values below 1 indicate that fewer patients died than was expected in the prognosis

Figure 5

Duration of ultrasound-radiological basic diagnostics in minutes (^*p <0.05 for 2005 compared with 1999)

Figure 6

Incidence of whole body CT scanning (data collected only since 2002) and damage control operation in fractured femur (external fixation) in severe trauma (ISS = 16)

Figure 7

Time to emergency surgery in hemorrhagic shock and time to admission to intensive care if no surgery was performed, in minutes. The variables have been collected generally only since 2002 (^*p<0.05 for 2005 compared with 2002).

E-Figure

Geographical distribution of participating hospitals in 2006