title: History, development and future of trauma care for multiple injured patients in the Netherlands.
abstract: BACKGROUND
  The development of trauma systems all over the world resulted in improved outcome for a broad range of trauma victims. In this review, we demonstrate the developments of an inclusive regionalised trauma system in the Netherlands and the subsequent developments in our level one trauma centre and trauma region in comparison.
  With the seasoning of the trauma system, further improvements in outcome could be demonstrated, in the region an OR of 0.84 and in the trauma centre an OR of 0.61, in a later comparison over the years another OR 0.74 was noted. In addition, a further diversification of the trauma populations was seen in the various hospitals with different levels, based on a pre-hospital triage system. Torso and multiple injured patients were more seen in the trauma centre and increased to more than 350 patients with an ISS of >15, whereas monotrauma was almost exclusively seen in the level two and three hospitals. The further development of the trauma system is discussed, in which the minimum requirements of the individual trauma surgeon and institution are taken as a guideline.
  Based on these considerations, a further concentration of the most severely injured patients is proposed in a small country as the Netherlands culminating in one trauma centre for the most severely injured patients, combined with an integrated pre-hospital helicopter system, on top of the current good functioning inclusive trauma system. These developments could be a template for further developments of trauma systems in Europe.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Suite G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: K W W
authors.initials: KW
authors.lastname: Lansink
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Suite G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. l.p.h.leenen@umcutrecht.nl.
authors.forename: L P H
authors.initials: LP
authors.lastname: Leenen
keywords: Polytrauma; Quality assessment; Trauma systems
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