Citation

Gross T, Braken P, Amsler F. Eur. J. Trauma Emerg. Surg. 2018.

Copyright

(Copyright © 2018, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00068-018-1027-3

PMID

unavailable

Abstract

PURPOSE: According to the American College of Surgeons (ACS) recommendations, the benchmark for trauma center need (TCN) is an Injury Severity Score (ISS) > 15. In contrast, Swiss highly specialized medicine (HSM) regulations set out TCN for all patients with an ISS > 19 or an Abbreviated Injury Severity (AIS) of the head ≥ 3. This investigation assessed to what extent the modification might be justified.

Methods: Consecutive analysis of all significantly injured (new ISS, NISS ≥ 8) adults treated in a trauma center from 2010 to 2016 based on their ISS and AIS head and in respect to utilized resources and outcome.

Results: Of 2171 patients (mean age 57.2 ± 21.6; ISS 15.0 ± 8.5) 40.1% fulfilled the ACS and 52.7% the HSM-definition of TCN. Comparative analysis of specified subgroups representing combinations of the ISS and the AIS head revealed that patients within the HSM but not within the ACS-definition of TCN achieved worse outcomes in mortality or on the Glasgow Outcome Score and had a higher inpatient rehabilitation rate than patients with an ISS < 15 and an AIS head < 3 compared to patients with an ISS > 15. Mortality for patients with an ISS 16-19 and AIS head < 3 (qualifying for the ACS but not the HSM-definition of TCN) was found to be twice as high for patients who were not in the ACS or the HSM group (ISS < 16 & AIS head < 3).

Conclusions: If confirmed by others, both the ACS and the Swiss-recommendations for TCN should be adapted accordingly, provided that the resultant increased workload is feasible for the trauma centers concerned.

Language: en

Keywords

Highly specialized medicine; Major trauma; Outcome; Trauma center need; Trauma team activation; Triage