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German Congress of Orthopaedics and Traumatology (DKOU 2021)

26. - 29.10.2021, Berlin

Inter-Hospital Transfer of Polytraumatized and Severe Traumatic Brain Injury Patients: Retrospective Nationwide Cohort Study Using Data from the Swiss Trauma Registry

Meeting Abstract

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  • presenting/speaker Rebecca Maria Hasler - Universitätsspital Zürich, Klinik für Traumatologie, Zürich, Switzerland
  • Thomas Rauer - Universitätsspital Zürich, Klinik für Traumatologie, Zürich, Switzerland
  • Hans-Christoph Pape - Universitätsspital Zürich, Klinik für Traumatologie, Zürich, Switzerland
  • Marcel Zwahlen - Institut für Sozial- und Präventivmedizin, Universität Bern, Bern, Switzerland

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2021). Berlin, 26.-29.10.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocAB92-170

doi: 10.3205/21dkou657, urn:nbn:de:0183-21dkou6578

Published: October 26, 2021

© 2021 Hasler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objectives: Polytraumatised and traumatic brain injury (TBI) patients are among the most vulnerable patients in trauma care and exhibit increased morbidity and mortality. Timely care is essential for their outcome. Severe TBI with initially high scores on the Glasgow Coma (GCS) scores is difficult to recognise on scene and referral to a Major Trauma Center (MTC) might be delayed. Therefore, we examined current referral practice, injury patterns and mortality in these patients with the hypothesis that elderly patients are more often transferred to an MTC after initial admission to a regional hospital, and that a difference in mortality exists between patients with primary and secondary referral to an MTC.

Methods: Retrospective, nationwide cohort study with Swiss Trauma Registry (STR) data between 01/012015 and 31/12/2018. STR includes patients >=16 years with an Injury Severity Score (ISS) >15 and/or an Abbreviated Injury Scale (AIS) for head >2. We performed Cox proportional hazard models with injury type as the primary outcome and mortality as the dependent variable. Secondary outcomes were inter-hospital transfer and age.

Results: We present the first Swiss Trauma Registry study. 9,595 patients were included. Mortality was 12%, highest for patients with isolated TBI, followed by patients with concomitant TBI and lowest for patients without TBI (Figure 1 [Fig. 1]).

2,800 patients suffered from isolated TBI. 69% were men. Median age was 61 years and median ISS 21. Two thirds of TBI patients had a GCS of 13-15 on admission to the Emergency Department (ED). 26% of patients were secondarily transferred to an MTC. Patients with isolated TBI and those aged >=65 years were transferred more often. Crude analysis showed a significantly elevated hazard for death of 1.48 (95%CI 1.28-1.70) for polytrauma patients with severe TBI and a HR of 1.82 (95%CI 1.58-2.09) for isolated severe TBI, compared to polytrauma patients without TBI. Patients directly admitted to the MTC had a significantly elevated HR for death of 1.63 (95%CI 1.40-1.89), compared to those with secondary transfer. Results of the adjusted analysis, taking account of the detected interaction between injury type and admission type, are displayed in Table 1 [Tab. 1].

Between 60% and 73% of patients with a favourable initial GCS between 13-15 suffered from severe TBI (Table 2 [Tab. 2]).

Conclusions: A high initial GCS does not exclude the presence of severe TBI and triage to an MTC should be seriously considered for elderly TBI patients.