Implementation of a nationwide trauma network for the care of severely injured patients.
BACKGROUND
Regional differences in the care of severely injured patients remain problematic in industrial countries.


METHODS
In 2006, the German Society for Trauma Surgery initiated the foundation of regional networks between trauma centers in a TraumaNetwork (TNW). The TNW consisted of five major elements as follows: (a) a whitebook on the treatment of severely injured patients; (b) evidence-based guidelines (S3); (c) local audits; (d) contracts of interhospital cooperation among all participating hospitals; and (e) TraumaRegister documentation. TNW hospitals are classified according to local audit results as supraregional (STC), regional (RTC), or local (LTC) trauma centers by criteria concerning staff, equipment, admission capacity, and responsibility.


RESULTS
Five hundred four German trauma centers (TCs) were certified by the end of December 2012. By then, 37 regional TNWs, with a mean of 13.6 TCs, were established, covering approximately 80% of the country's territory. Of the hospitals, 92 were acknowledged as STCs, 210 as RTCs, and 202 as LTCs.In 2012, 19,124 patients were documented by the certified TCs. Fifty-seven percent of the patients were treated in STCs, 34% in RTCs, and 9% in LTCs. The mean (SD) Injury Severity Score (ISS) was highest in STCs (21 [13]), compared with 18 (12) in RTCs and 16 (10) in LTCs. There were differences in expected mortality (based on Revised Injury Severity Classification) according to the differences in the severity of trauma among the different categories, but in all types, the expected mortality was significantly higher than the observed mortality (differences in STCs, 1.8%; RTCs, 1.4%; LTCs, 2.0%).


CONCLUSIONS
According to our findings, it is possible to successfully structure and standardize the care of severely injured patients in a nationwide trauma system. Better outcomes than expected were observed in all categories of TNW hospitals.


METHODS
Epidemiologic study, level III. Therapeutic/care management study, level IV.
From the Department of Trauma, Hand and Reconstructive Surgery (S.R., U.L., F.D., C.M., C.A.K.), University Hospital Giessen and Marburg GmbH, Marburg; IFOM (R.L.), Witten Herdecke University, Cologne; and German Society for Trauma Surgery (H.S.), Berlin, Germany.
Steffen
S
Ruchholtz
Rolf
R
Lefering
Ulrike
U
Lewan
Florian
F
Debus
Carsten
C
Mand
Hartmut
H
Siebert
Christian A
CA
Kühne
D003131:Combined Modality Therapy / Q000592:standards; D004282:Documentation / Q000592:standards*; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D015601:Injury Severity Score; D033183:Interdisciplinary Communication; D008006:Licensure, Hospital / Q000592:standards; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000628:therapy*; D012042:Registries / Q000592:standards*; D012189:Retrospective Studies; D012955:Societies, Medical; D014193:Trauma Centers / Q000592:standards*