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Review
. 2020 Apr;46(2):329-335.
doi: 10.1007/s00068-019-01273-4. Epub 2019 Nov 23.

The evolution of trauma care in the Netherlands over 20 years

Falco Hietbrink  1 , Roderick M Houwert  2 , Karlijn J P van Wessem  2 , Rogier K J Simmermacher  2 , Geertje A M Govaert  2 , Mirjam B de Jong  2 , Ivar G J de Bruin  2 , Johan de Graaf  2 , Loek P H Leenen  2
Affiliations
Review

The evolution of trauma care in the Netherlands over 20 years

Falco Hietbrink et al. Eur J Trauma Emerg Surg. 2020 Apr.

Abstract

Introduction: In 1999 an inclusive trauma system was initiated in the Netherlands and a nationwide trauma registry, including all admitted trauma patients to every hospital, was started. The Dutch trauma system is run by trauma surgeons who treat both the truncal (visceral) and extremity injuries (fractures).

Materials and methods: In this comprehensive review based on previous published studies, data over the past 20 years from the central region of the Netherlands (Utrecht) was evaluated.

Results: It is demonstrated that the initiation of the trauma systems and the governance by the trauma surgeons led to a region-wide mortality reduction of 50% and a mortality reduction for the most severely injured of 75% in the level 1 trauma centre. Furthermore, major improvements were found in terms of efficiency, demonstrating the quality of the current system and its constructs such as the type of surgeon. Due to the major reduction in mortality over the past few years, the emphasis of trauma care evaluation shifts towards functional outcome of severely injured patients. For the upcoming years, centralisation of severely injured patients should also aim at the balance between skills in primary resuscitation and surgical stabilization versus longitudinal surgical involvement.

Conclusion: Further centralisation to a limited number of level 1 trauma centres in the Netherlands is necessary to consolidate experience and knowledge for the trauma surgeon. The future trauma surgeon, as specialist for injured patients, should be able to provide the vast majority of trauma care in this system. For the remaining part, intramural, regional and national collaboration is essential.

Keywords: Centralisation; Mortality; Outcome analysis; Trauma systems.

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Conflict of interest statement

Falco Hietbrink declares that he has no conflict of interest. R. Marijn Houwert declares that he has no conflict of interest. Karlijn J. P. van Wessem declares that she has no conflict of interest. Rogier K. J. Simmermacher declares that he has no conflict of interest. Geertje A. M. Govaert declares that she has no conflict of interest. Mirjam B. de Jong declares that she has no conflict of interest. Ivar G. J. de Bruin declares that he has no conflict of interest. Johan de Graaf declares that he has no conflict of interest. Loek P. H. Leenen declares that he has no conflict of interest.

Figures

Fig. 1
Fig. 1
The effect of patient numbers. In case of too low numbers of severely injured patients, insufficient expertise per centre will be available to reduce mortality rates and optimize the logistic process. However, when the number of patients is too high patient ownership and coordination is hampered. It is likely that an optimum for the number of patients per centre exists
See this image and copyright information in PMC

References

    1. Ciesla DJ, Moore EE, Cothren CC, Johnson JL, Burch JM. Has the trauma surgeon become house staff for the surgical subspecialist? Am J Surg. 2006;192:732–737. doi: 10.1016/j.amjsurg.2006.08.035. - DOI - PMC - PubMed
    1. Goslings JC, Ponsen KJ, Luitse JS, Jurkovich GJ. Trauma surgery in the era of nonoperative management: the Dutch model. J Trauma. 2006;61:111–114. doi: 10.1097/01.ta.0000222704.86560.ac. - DOI - PubMed
    1. Hietbrink F, Smeeing D, Karhof S, Jonkers HF, Houwert M, van Wessem K, et al. Outcome of trauma-related emergency laparotomies, in an era of far-reaching specialization. World J Emerg Surg. 2019;14:40. doi: 10.1186/s13017-019-0257-y. - DOI - PMC - PubMed
    1. Timmers TK, Verhofstad MH, Leenen LP. Intensive care organisation: Should there be a separate intensive care unit for critically injured patients? World J Crit Care Med. 2015;4:240–243. doi: 10.5492/wjccm.v4.i3.240. - DOI - PMC - PubMed
    1. Hesselink L, Spijkerman R, van Wessem KJP, Koenderman L, Leenen LPH, Huber-Lang M, et al. Neutrophil heterogeneity and its role in infectious complications after severe trauma. World J Emerg Surg. 2019;14:24. doi: 10.1186/s13017-019-0244-3. - DOI - PMC - PubMed