Merging of two level-1 trauma centers in Amsterdam: premerger demand in integrated acute trauma care

Abstract

Purpose: Availability of adequate and appropriate trauma care is essential. A merger of two Dutch academic level-1 trauma centers is upcoming. However, in the literature, volume effects after a merger are inconclusive. This study aimed to examine the premerger demand for level-1 trauma care on integrated acute trauma care and evaluate the expected demand on the system.

Methods: A retrospective observational study was conducted between 1-1-2018 and 1-1-2019 in two level-1 trauma centers in the Amsterdam region using data derived from the local trauma registries and electronic patient records. All trauma patients presented at both centers' Emergency Departments (ED) were included. Patient- and injury characteristics and data concerning all prehospital and in-hospital-delivered trauma care were collected and compared. Pragmatically, the demand for trauma care in the post-merger setting was considered a sum of care demand for both centers.

Results: In total, 8277 trauma patients were presented at both EDs, 4996 (60.4%) at location A and 3281 (39.6%) at location B. Overall, 462 patients were considered severely injured patients (Injury Severity Score ≥ 16). In total, 702 emergency surgeries (< 24 h) were performed, and 442 patients were admitted to the ICU. The sum care demand of both centers resulted in a 167.4% increase in trauma patients and a 151.1% increase in severely injured patients. Moreover, on 96 occasions annually, two or more patients within the same hour would require advanced trauma resuscitation by a specialized team or emergency surgery.

Conclusion: A merger of two Dutch level-1 trauma centers would, in this scenario, result in a more than 150% increase in the post-merger setting's demand for integrated acute trauma care.

Keywords: Concentration; Hospital; Merger; Polytrauma; Trauma care; Trauma center centralization.

Fig. 1

Timing of trauma patients’ arrival at ED (n = 8277). ED Emergency Department

Fig. 2

Timing of patients’ arrival resuscitated by a specialized trauma team at the trauma resuscitation room in ED. ED Emergency Department, ISS Injury Severity Score

Fig. 3

Trauma care necessity per shift in both trauma centers. ED Emergency Department, ICU Intensive Care Unit, ISS Injury Severity Score

Fig. 4

Severely injured patients’ (Injury Severity Score ≥ 16) overlap in both trauma centers. ED Emergency Department, OR Operating Room, ISS Injury Severity Score