title: Five years experience of trauma care in a German urban level I university trauma center.
abstract: BACKGROUND
  A regionalized approach to trauma care with the implementation of designated level I trauma centers has been shown to improve survival after multiple injuries. Our study aimed to describe the current reality in an urban German level I university trauma center concerning the primary admission of patients into the emergency room.
  
  
  METHODS
  We performed a retrospective analysis of all multiple trauma patients that were prospectively documented in our documentation system TraumaWatch(®) from 2003 to 2007. Documentation included physiological findings as well as diagnostic and therapeutic procedures structured as: (A) preclinical phase; (B) emergency room treatment; (C) intensive care unit; and (D) final outcome according to the German Trauma Registry.
  
  
  RESULTS
  In total, 1,848 patients were completely documented and, thus, analyzed. The mean ± standard deviation (SD) Injury Severity Score (ISS) was 16.5 ± 14.1 points and the mean ± SD age was 38.7 ± 21.9 years. An increasing number of patients received whole-body computed tomography (48.8% in 2003 vs. 83.3%in 2007, p < 0.001) and, on average, the ISS increased over the years (14.4 points in 2003 vs. 17.9 points in 2007). The overall hospital mortality was 7.1%, without significant change over time. The completionofimagingdiagnostics became significantly faster for all of the documented procedures (X-ray pelvis, X-ray chest, whole-body CT, abdominal ultrasound) (p < 0.001).
  
  
  CONCLUSIONS
  Descriptive data on the current reality in urban level I trauma care can be derived from our study. Additionally, we achieved improved time intervals for emergency diagnostics and treatment, while hospital mortality remained constant, despite a higher injury severity. This is due to a standardized protocol which is applied during the 24-h in-house attending coverage.
  
  
  CONCLUSIONS
  Regionalized trauma care with designated level I trauma centers is justified by the improvement of time intervals and outcome, but adequate resources are required.
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Wyen
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wutzler
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Rüsseler
authors.affiliation: Department of Radiology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Mack
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Walcher
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany. marzi@trauma.uni-frankfurt.de.|Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany. marzi@trauma.uni-frankfurt.de.
authors.forename: Ingo
authors.initials: I
authors.lastname: Marzi
keywords: Emergency surgery; Polytrauma management including prehospital and shockroom; Trauma management and education; Trauma systems
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