Epidemiological Comparison Between the Navarra Major Trauma Registry and the German Trauma Registry (TR-DGU®)

Overview

Journal Scand J Trauma Resusc Emerg Med

Publisher Biomed Central

Specialty Emergency Medicine

Date 2017 Nov 4

PMID 29096679

Citations 2

Authors

B Ali Ali

R Lefering

M Fortun Moral

T Belzunegui Otano

Affiliations

Soon will be listed here.

Abstract

Background: International benchmarking can help identify trauma system performance issues and determine the extent to which other countries also experience these. When problems are identified, countries can look to high performers for insight into possible responses. The objective of this study was to compare the treatment and outcome of severely injured patients in Germany and Navarra, Spain.

Methods: Data collected, from 2010 to 2013, in the Navarra Major Trauma Registry (NMTR) and the TraumaRegister DGU® (TR-DGU) were compared. Both registries followed the Utstein Trauma Template (European Core Dataset) for documentation of trauma patients. Adult patients (≥ 16 years) with New Injury Severity Score (NISS) being >15 points were included in this study. Patients who had been admitted to the hospital later than 24 h after the trauma, had been pronounced dead before hospital arrival, or had been injured by hanging, drowning or burns, were excluded. Demographic data, injury data, prehospital data, hospital treatment data, time intervals, and outcome were compared. The expected mortality was calculated using the Revised Injury Severity Classification score II (RISC II).

Results: A total of 646 and 43,110 patients were included in the outcome analysis from NMTR and TR-DGU, respectively. The difference between observed and expected mortality was -0.4% (standardized mortality ratio [SMR] 0.97; 95% CI 0.93-1.04) in Germany and 1.6% (SMR 1.08; 95% CI: 1.02-1.14) in Navarra. Differences in the characteristics of trauma patients and trauma systems between the regions were noted.

Conclusion: The higher observed mortality in Navarra is consistent with the epidemiological characteristics of its population. However, to improve the quality of trauma care in the Navarra trauma system, certain improvements are necessary. There were less young adults with severe injuries in Navarra than in Germany. It is possible to compare data of severely injured patients from different countries if standardized registries are used.

Citing Articles

[Analysis of serious trauma injury patterns in Navarre (Spain) (2010-2019)].

Arbizu Fernandez E, Galbete Jimenez A, Belzunegui Otano T, Fortun Moral M, Echarri Sucunza A An Sist Sanit Navar. 2024; 47(2).

PMID: 39223961 PMC: 11409568. DOI: 10.23938/ASSN.1085.

Ten-year trends of adult trauma patients in Central Denmark Region from 2010 to 2019: A retrospective cohort study.

Trier F, Fjolner J, Sorensen A, Sondergaard R, Kirkegaard H, Raaber N Acta Anaesthesiol Scand. 2022; 66(9):1130-1137.

PMID: 36106860 PMC: 9541060. DOI: 10.1111/aas.14123.

References

Brinck T, Handolin L, Paffrath T, Lefering R . Trauma registry comparison: six-year results in trauma care in Southern Finland and Germany. Eur J Trauma Emerg Surg. 2015; 41(5):509-16. DOI: 10.1007/s00068-014-0470-z. View

Worz M, Busse R . Analysing the impact of health-care system change in the EU member states--Germany. Health Econ. 2005; 14(Suppl 1):S133-49. DOI: 10.1002/hec.1032. View

Lefering R, Huber-Wagner S, Nienaber U, Maegele M, Bouillon B . Update of the trauma risk adjustment model of the TraumaRegister DGU™: the Revised Injury Severity Classification, version II. Crit Care. 2014; 18(5):476. PMC: 4177428. DOI: 10.1186/s13054-014-0476-2. View

Chatrath V, Khetarpal R, Ahuja J . Fluid management in patients with trauma: Restrictive versus liberal approach. J Anaesthesiol Clin Pharmacol. 2015; 31(3):308-16. PMC: 4541175. DOI: 10.4103/0970-9185.161664. View

Nijboer J, Wullschleger M, Nielsen S, McNamee A, Lefering R, Ten Duis H . A comparison of severely injured trauma patients admitted to level 1 trauma centres in Queensland and Germany. ANZ J Surg. 2010; 80(3):145-50. DOI: 10.1111/j.1445-2197.2010.05210.x. View

Linder F, Mani K, Juhlin C, Eklof H . Routine whole body CT of high energy trauma patients leads to excessive radiation exposure. Scand J Trauma Resusc Emerg Med. 2016; 24:7. PMC: 4729033. DOI: 10.1186/s13049-016-0199-2. View

Wang H, Cook L, Chang C, Yealy D, Lave J . Outcomes after out-of-hospital endotracheal intubation errors. Resuscitation. 2008; 80(1):50-5. DOI: 10.1016/j.resuscitation.2008.08.016. View

Fortun Moral M, Ali Ali B, Montes Fernandez L, Rey Pecharroman J, Teijeira Alvarez R, Belzunegui Otano T . [Inclusion of prehospital mortality statistics in severe trauma registries: a study of the influence of inclusion on trauma lethality rates and survival prediction]. Emergencias. 2017; 28(3):173-178. View

Martin J, Neurohr C, Bauer M, Weiss M, Schleppers A . [Cost of intensive care in a German hospital: cost-unit accounting based on the InEK matrix]. Anaesthesist. 2008; 57(5):505-12. DOI: 10.1007/s00101-008-1353-7. View

10.

Civil I, Schwab C . The Abbreviated Injury Scale, 1985 revision: a condensed chart for clinical use. J Trauma. 1988; 28(1):87-90. DOI: 10.1097/00005373-198801000-00012. View

11.

Soreide K . Epidemiology of major trauma. Br J Surg. 2009; 96(7):697-8. DOI: 10.1002/bjs.6643. View

12.

Caputo L, Salottolo K, Slone D, Mains C, Bar-Or D . The relationship between patient volume and mortality in American trauma centres: a systematic review of the evidence. Injury. 2013; 45(3):478-86. DOI: 10.1016/j.injury.2013.09.038. View

13.

Gomez de Segura Nieva J, Boncompte M, Echarri Sucunza A, Louis C, Segui-Gomez M, Belzunegui Otano T . Comparison of mortality due to severe multiple trauma in two comprehensive models of emergency care: Atlantic Pyrenees (France) and Navarra (Spain). J Emerg Med. 2008; 37(2):189-200. DOI: 10.1016/j.jemermed.2007.10.089. View

14.

Ringdal K, Coats T, Lefering R, Di Bartolomeo S, Steen P, Roise O . The Utstein template for uniform reporting of data following major trauma: a joint revision by SCANTEM, TARN, DGU-TR and RITG. Scand J Trauma Resusc Emerg Med. 2008; 16:7. PMC: 2568949. DOI: 10.1186/1757-7241-16-7. View

15.

Hildebrand F, Giannoudis P, van Griensven M, Zelle B, Ulmer B, Krettek C . Management of polytraumatized patients with associated blunt chest trauma: a comparison of two European countries. Injury. 2005; 36(2):293-302. DOI: 10.1016/j.injury.2004.08.012. View

16.

Giannoudis P, Harwood P, Court-Brown C, Pape H . Severe and multiple trauma in older patients; incidence and mortality. Injury. 2009; 40(4):362-7. DOI: 10.1016/j.injury.2008.10.016. View

17.

Brenner D, Hall E . Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007; 357(22):2277-84. DOI: 10.1056/NEJMra072149. View

18.

Reyero Diez D, Belzunegui Otano T, Bermejo Fraile B, Jean Louis C, Ramirez J, Echarri Sucunza A . Use of a structural deformity index as a predictor of severity among trauma victims in motor vehicle crashes. J Emerg Med. 2010; 43(1):19-28. DOI: 10.1016/j.jemermed.2010.01.017. View

19.

Huber-Wagner S, Biberthaler P, Haberle S, Wierer M, Dobritz M, Rummeny E . Whole-body CT in haemodynamically unstable severely injured patients--a retrospective, multicentre study. PLoS One. 2013; 8(7):e68880. PMC: 3722202. DOI: 10.1371/journal.pone.0068880. View

20.

Zacher M, Kanz K, Hanschen M, Haberle S, van Griensven M, Lefering R . Association between volume of severely injured patients and mortality in German trauma hospitals. Br J Surg. 2015; 102(10):1213-9. PMC: 4758415. DOI: 10.1002/bjs.9866. View