Ten year maturation period in a level-I trauma center, a cohort comparison study

Abstract

Purpose: Many changes have been made to improve trauma care. Improved trauma team response and usage of a hybrid resuscitation room are examples of how this trauma center has developed. The aim was to assess how the outcome of the trauma population was influenced by the maturation. Methods: A cohort comparison, between June 2004–July 2005 and 2014, was performed. All adult trauma patients with an Injury Severity Score (ISS) >15 were included. Variables collected were: patient demographics, mechanism of trauma, total prehospital time, pre- and inhospital trauma scores, vital signs, blood values and interventions, and physician staffed helicopter emergency medical services (P-HEMS) involvement and outcome. Results: From June 2004 to July 2005 219, patients were admitted, and for the year 2014, this was 282 patients. The 2014 cohort was significantly older (mean age of 53.6 ± 23.8 vs 45.6 ± 22.7 years). The mean RTS did not differ. P-HEMS assists increased to 116 (13.5 %). The number of CT scans, blood transfusion, and acute trauma surgical interventions decreased. Mean LOS, ICU admission, and ICU LOS did not differ. The mortality rate, however, decreased by 7.0 %, observed and predicted survival was significantly different in favour of the 2014 cohort, with a Z-score of 4.25. Conclusion: An increase in age is seen, though trauma scores remain comparable. The number of blood products transfused and acute trauma surgical interventions performed declines. Mortality significantly decreased and a significant difference in observed and predicted survival is seen. Showing improved trauma care in our hospital, in favour of the second period.