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. 2022 Apr;48(2):1035-1043.
doi: 10.1007/s00068-021-01615-1. Epub 2021 Mar 12.

The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

Suzan Dijkink  1 , Erik W van Zwet  2 , Pieta Krijnen  3 , Luke P H Leenen  4 , Frank W Bloemers  5 , Michael J R Edwards  6 , Dennis Den Hartog  7 , Peter A Leenhouts  8 , Martijn Poeze  9 , W Richard Spanjersberg  10 , Klaus W Wendt  11 , Ralph J De Wit  12 , Stefan W A M Van Zuthpen  13 , Inger B Schipper  3
Affiliations

The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

Suzan Dijkink et al. Eur J Trauma Emerg Surg. 2022 Apr.

Abstract

Background: Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time.

Methods: All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008-2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS.

Results: The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63-74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC.

Conclusion: Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.

Keywords: Regionalization of care; The Netherlands; Trauma care; Trauma system.

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Conflict of interest statement

There are no conflicts of interest to report.

Figures

Fig. 1
Fig. 1
Changes in organization of trauma care in the Netherlands
Fig. 2
Fig. 2
Distribution of severely injured patients (ISS ≥ 16) registered in the Dutch Trauma Registry, directly brought to a level I trauma center or to a non-trauma center over time for a all patients, and separately for patients b with and c without severe neurotrauma, by calendar year
Fig. 3
Fig. 3
Proportion of severely injured patients (ISS ≥ 16) directly brought to a trauma center, after correction for difference in case mix and for non-participation in the Dutch Trauma Registry, for all patients (a), and separately for patients with (b) and without (c) severe neurotrauma, per calendar year
Fig. 4
Fig. 4
Median Injury Severity Score (ISS) for severely injured patients (ISS ≥ 16) directly brought to a trauma center or a non-trauma center, for a all patients, and separately for patients b with and (C) without severe neurotrauma, by calendar year
Fig. 5
Fig. 5
Median total Abbreviated Injury Score (AIS) for severely injured patients (ISS ≥ 16) directly brought to a trauma center or a non-trauma center, for a all patients, and separately for patients b with and c without severe neurotrauma, by calendar year
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