title: Ten year maturation period in a level-I trauma center, a cohort comparison study.
abstract: OBJECTIVE
  Many changes have been made to improve trauma care. Improved trauma team response and usage of a hybrid resuscitation room are examples of how this trauma center has developed. The aim was to assess how the outcome of the trauma population was influenced by the maturation.
  
  
  METHODS
  A cohort comparison, between June 2004-July 2005 and 2014, was performed. All adult trauma patients with an Injury Severity Score (ISS) >15 were included. Variables collected were: patient demographics, mechanism of trauma, total prehospital time, pre- and inhospital trauma scores, vital signs, blood values and interventions, and physician staffed helicopter emergency medical services (P-HEMS) involvement and outcome.
  
  
  RESULTS
  From June 2004 to July 2005 219, patients were admitted, and for the year 2014, this was 282 patients. The 2014 cohort was significantly older (mean age of 53.6 ± 23.8 vs 45.6 ± 22.7 years). The mean RTS did not differ. P-HEMS assists increased to 116 (13.5 %). The number of CT scans, blood transfusion, and acute trauma surgical interventions decreased. Mean LOS, ICU admission, and ICU LOS did not differ. The mortality rate, however, decreased by 7.0 %, observed and predicted survival was significantly different in favour of the 2014 cohort, with a Z-score of 4.25.
  
  
  CONCLUSIONS
  An increase in age is seen, though trauma scores remain comparable. The number of blood products transfused and acute trauma surgical interventions performed declines. Mortality significantly decreased and a significant difference in observed and predicted survival is seen. Showing improved trauma care in our hospital, in favour of the second period.
authors.affiliation: Department of Surgery, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1081, HV Amsterdam, The Netherlands. a.harmsen@vumc.nl.
authors.forename: A M K
authors.initials: AMK
authors.lastname: Harmsen
authors.affiliation: Department of Surgery, MC Slotervaart, Louwesweg 6, 1066, EC Amsterdam, The Netherlands.
authors.forename: G F
authors.initials: GF
authors.lastname: Giannakopoulos
authors.affiliation: Department of Surgery, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1081, HV Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Terra
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1117, 1081, HV Amsterdam, The Netherlands.
authors.forename: E S M
authors.initials: ESM
authors.lastname: de Lange de Klerk
authors.affiliation: Department of Surgery, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1081, HV Amsterdam, The Netherlands.
authors.forename: F W
authors.initials: FW
authors.lastname: Bloemers
mesh_terms: D000367:Age Factors; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016019:Survival Analysis; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000401:mortality
keywords: Center; Emergency medical services; Maturation; Outcome; Trauma