gms | German Medical Science

Objectives: The implementation of the trauma centres has led to a significant reduction in mortality and length of hospital stay. The trauma care should be optimised in order to reach even higher survival rates. The aim of the present cohort study was to evaluate the trauma care in a level I trauma centre after the implementation of a 24/7 in hospital coverage of the trauma surgeon, intensivist, anaesthesiologist and emergency physician. Besides, the in hospital infrastructure related to the trauma care has been optimised. The purpose is to reach improved survival rates for the trauma patients after the optimisations.

Methods: We performed a cohort study. All adult trauma patients admitted to our trauma centre directly during the years 2010 through 2012 (period I) and 2014 through 2016 (period II) were included and analysed. Data was obtained directly from the trauma registry database and the hospital records. Logistic and linear regression was used, adjusted for demographics and characteristics of trauma. The primary endpoint is mortality. Secondary endpoints are emergency room time (ER-time), time till CT, hospital length of stay (H-LOS), ICU length of stay (ICU-LOS), complications, emergency intervention, time till emergency intervention and delayed diagnosis.

Results and conclusion: A total of 3714 patients were included; 1290 in period I and 2424 in period II. Mean Injury Severity Score (ISS) decreased from 10,5 to 9,1. Mean Revised Trauma Score (RTS) increased from 11,3 to 11,6. In-hospital mortality adjusted for confounding factors showed a reduction in period II (odds ratio (OR): 0,65; p = 0,042). ER-time decreased with 30 minutes (p < 0,001) and time till CT decreased with 22 minutes (p < 0,001). The amount of delayed diagnosis and complications were significantly lower in the second period, with an OR of respectively 0,2 and 0,4 (p < 0,001). H-LOS and ICU-LOS decreased significantly, respectively -0,9 day (p = 0,032) and -1,8 days (p = 0,022).

The 24/7 in hospital coverage of the senior clinicians saves life's with the improved survival rates. Moreover, the clinical outcomes for the trauma patients improved and the length of hospital stay decreased. Therefore, the 24/7 in hospital coverage of senior clinicians and optimisation of the in-hospital infrastructure related to the trauma care, are recommended for other level I trauma centres to improve the survival rates.