title: How the changes in the system affect trauma care provision: The assessment of and implications for Lithuanian trauma service performance in 2007-2012.
abstract: OBJECTIVE
  The aim of this study was to identify and assess the effects of changes in the Lithuanian trauma service from 2007 to 2012. We postulate that the implications derived from this study will be of importance to trauma policy planners and makers in Lithuania and throughout other countries of Eastern and Central Europe.
  
  
  METHODS
  Out of 10,390 trauma admissions to four trauma centers in 2007, 294 patients (2.8%) were randomly selected for the first arm of a representative study sample. Similarly, of 9918 trauma admissions in 2012, 250 (2.5%) were randomly chosen for comparison in the study arm. Only cases with a diagnosis falling into the ICD-10 "S" and "T" codes were included. A survey of whom regarding changes in quality of trauma care from 2007 to 2012 was carried out by emergency medical service (EMS) providers.
  
  
  RESULTS
  The Revised Trauma Score (RTS) mean value was 7.45±1.04 for the 2007 year arm; it was 7.53±0.93 for the 2012 year arm (P=0.33). Mean time from the moment of a call from the site of the traumatic event to the patient's arrival at the trauma center did not differ between the arms of the sample: 49.95min in 2007 vs. 51.6min in 2012 (P=0.81). An application of the operational procedures such as a cervical spine protection using a hard collar, oxygen therapy, infusion of intravenous fluids, and pain relief on the trauma scene was more frequent in 2012 than in 2007. Management of trauma patients in the emergency department improved regarding the availability of 24/7 computed tomography scanner facilities and an on-site radiographer. Time to CT-scanning was reduced by 38.8%, and time to decision-making was reduced by 16.5% in 2012.
  
  
  CONCLUSIONS
  Changes in operational procedures in the Lithuanian pre-hospital care provision and management of trauma patients in emergency departments of trauma centers improved the efficiency of trauma care delivery over the 2007-2012 period.
authors.affiliation: Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. Electronic address: zilvinas.dambrauskas@gmail.com.
authors.forename: Žilvinas
authors.initials: Ž
authors.lastname: Dambrauskas
authors.affiliation: Department of Emergency Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Vytautas
authors.initials: V
authors.lastname: Aukštakalnis
authors.affiliation: Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Aurika
authors.initials: A
authors.lastname: Karbonskienė
authors.affiliation: Alytus County S. Kudirkos Hospital, Alytus, Lithuania.
authors.forename: Dmitrijus
authors.initials: D
authors.lastname: Kačiurinas
authors.affiliation: Republican Panevėžys Hospital, Panevėžys, Lithuania.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Vokietienė
authors.affiliation: Republican Panevėžys Hospital, Panevėžys, Lithuania.
authors.forename: Robertas
authors.initials: R
authors.lastname: Lapka
authors.affiliation: Centre of Orthopaedics and Traumatology, Republican Vilnius University Hospital and Medical Faculty of Vilnius University, Vilnius, Lithuania.
authors.forename: Algimantas
authors.initials: A
authors.lastname: Pamerneckas
authors.affiliation: Centre of Orthopaedics and Traumatology, Republican Vilnius University Hospital and Medical Faculty of Vilnius University, Vilnius, Lithuania.
authors.forename: Narūnas
authors.initials: N
authors.lastname: Porvaneckas
authors.affiliation: Department of Emergency Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Kęstutis
authors.initials: K
authors.lastname: Stašaitis
authors.affiliation: Department of Emergency Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Nedas
authors.initials: N
authors.lastname: Jasinskas
authors.affiliation: Department of Disaster Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Paulius
authors.initials: P
authors.lastname: Dobožinskas
authors.affiliation: Department of Disaster Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Dinas
authors.initials: D
authors.lastname: Vaitkaitis
authors.affiliation: Emergency General Surgery Unit, General Surgery Department, Merseyside and Cheshire Major Trauma Collaborative, University of Liverpool, Aintree University Hospital NHS Foundation Trust, Lower Lane, Liverpool, United Kingdom.
authors.forename: Raimundas
authors.initials: R
authors.lastname: Lunevičius
mesh_terms: D000552:Ambulances; D006801:Humans; D008097:Lithuania; D013192:Staff Development; D011795:Surveys and Questionnaires; D013997:Time Factors; D014193:Trauma Centers / Q000639:trends*; D014947:Wounds and Injuries / Q000517:prevention & control / Q000534:rehabilitation / Q000628:therapy*
keywords: Emergency department; Emergency medical service; Trauma center; Trauma service; Trauma system