Prehospital triage and survival of major trauma patients in a Dutch regional trauma system: relevance of trauma registry.
OBJECTIVE
Since 1999, the Dutch trauma care has been regionalized into ten trauma systems. This study is the first to review such a trauma system. The aim was to examine the sensitivity of prehospital triage criteria [triage revised trauma score (T-RTS)] in identifying major trauma patients and to evaluate the current level of trauma care of a regionalized Dutch trauma system for major trauma patients.


METHODS
Major trauma patients (n=511) (June 2001-December 2003) were selected from a regional trauma registry database. The prehospital T-RTS was computed and standardized W scores (Ws) were generated to compare observed vs expected survival based on contemporary US- and UK-norm databases.


RESULTS
The T-RTS showed low sensitivity for the prehospital identification of major trauma patients [34.1% (T-RTS< or =10)]. Nevertheless, 78.0% of all major trauma patients were directly managed by the trauma center. These patients were more severely injured than their counterparts at non-trauma-center hospitals (p<0.001). No significant difference emerged between the mortality rates of both groups. The Ws {-0.46 calculated on the US model [95% confidence interval (CI) ranging from -1.99 to 1.07]} [0.60 calculated on the UK model (95% CI ranging from -1.25 to 2.44)] did not differ significantly from zero.


CONCLUSIONS
The trauma center managed most of the major trauma patients in the trauma system but the triage criteria need to be reconsidered. The level of care of the regional trauma system was shown to measure up to US and UK benchmarks.
Sturms
Leontien M
LM
Trauma Center West-Netherlands, Section of Traumatology, Department of Surgery, K6-R, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. G.N.Jukema@lumc.nl
Hoogeveen
Josephine M
JM
Le Cessie
Saskia
S
Schenck
Peter E
PE
Pahlplatz
Paul V M
PV
Hogervorst
Mike
M
Jukema
Gerrolt N
GN
D000328:Adult; D000368:Aged; D019985:Benchmarking / Q000592:standards; D003431:Cross-Cultural Comparison; D016208:Databases, Factual / Q000592:standards; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000145:classification / Q000401:mortality* / Q000601:surgery*; D009426:Netherlands; D012042:Registries / Q000592:standards*; D015996:Survival Rate; D014193:Trauma Centers / Q000592:standards; D015599:Trauma Severity Indices; D014218:Triage / Q000592:standards*; D006113:United Kingdom; D014481:United States