Five years experience of trauma care in a German urban level I university trauma center.

Abstract

A regionalized approach to trauma care with the implementation of designated level I trauma centers has been shown to improve survival after multiple injuries. Our study aimed to describe the current reality in an urban German level I university trauma center concerning the primary admission of patients into the emergency room. We performed a retrospective analysis of all multiple trauma patients that were prospectively documented in our documentation system TraumaWatch(®) from 2003 to 2007. Documentation included physiological findings as well as diagnostic and therapeutic procedures structured as: (A) preclinical phase; (B) emergency room treatment; (C) intensive care unit; and (D) final outcome according to the German Trauma Registry. In total, 1,848 patients were completely documented and, thus, analyzed. The mean ± standard deviation (SD) Injury Severity Score (ISS) was 16.5 ± 14.1 points and the mean ± SD age was 38.7 ± 21.9 years. An increasing number of patients received whole-body computed tomography (48.8% in 2003 vs. 83.3%in 2007, p < 0.001) and, on average, the ISS increased over the years (14.4 points in 2003 vs. 17.9 points in 2007). The overall hospital mortality was 7.1%, without significant change over time. The completionofimagingdiagnostics became significantly faster for all of the documented procedures (X-ray pelvis, X-ray chest, whole-body CT, abdominal ultrasound) (p < 0.001). Descriptive data on the current reality in urban level I trauma care can be derived from our study. Additionally, we achieved improved time intervals for emergency diagnostics and treatment, while hospital mortality remained constant, despite a higher injury severity. This is due to a standardized protocol which is applied during the 24-h in-house attending coverage. Regionalized trauma care with designated level I trauma centers is justified by the improvement of time intervals and outcome, but adequate resources are required.