Trauma care in Germany: major differences in case fatality rates between centers.
BACKGROUND
Recent years have seen a further decline in the nationwide case fatality rate after major trauma in Germany, but it has not been clear until now whether all centers providing trauma care achieve comparable results. We have attempted to answer this question using data from the trauma registry of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU).


METHODS
The standardized mortality rate of each participating center was calculated on the basis of the RISC prognostic score (Revised Injury Severity Classification) and the observed case fatality rate of the center. Results were compared across centers for the years 2004 to 2007; only the centers that provided the primary treatment of at least 100 patients during this period were included in the analysis. Data from the ten highest-scoring centers, the ten lowest-scoring centers, and the ten centers in the middle of the group were compared, and differences between them were analyzed.


RESULTS
The case fatality rate in the top ten centers was 8.7%. The corresponding rate in the bottom ten centers was approXimately twice as high, even though the injuries treated there were of comparable severity.


CONCLUSIONS
It is evident that the fate of a trauma patient in Germany depends partly on the center in which he or she is treated. These data were drawn from a retrospective evaluation of a case registry and should be assessed in awareness of this fact.
Hilbert
Peter
P
Klinik für Anästhesiologie, Intensiv- u. Notfallmedizin, BG-Kliniken Bergmannstrost, Merseburgerstrasse 165, Halle/Saale, Germany. Peter.Hilbert@bergmannstrost.com
Lefering
Rolf
R
Stuttmann
Ralph
R
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D015996:Survival Rate; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult