Polytrauma patients in the Netherlands and the USA: A bi-institutional comparison of processes and outcomes of care.

Autor: Dijkink S; Department of Surgery, Leiden University Medical Center, The Netherlands. Electronic address: S.Dijkink@lumc.nl., van der Wilden GM; Department of Surgery, Leiden University Medical Center, The Netherlands., Krijnen P; Department of Surgery, Leiden University Medical Center, The Netherlands., Dol L; Department of Surgery, Leiden University Medical Center, The Netherlands., Rhemrev S; Department of Surgery, Haaglanden Medical Center, The Netherlands., King DR; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, United States., DeMoya MA; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, United States., Velmahos GC; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, United States., Schipper IB; Department of Surgery, Leiden University Medical Center, The Netherlands.
Jazyk: angličtina
Zdroj: Injury [Injury] 2018 Jan; Vol. 49 (1), pp. 104-109. Date of Electronic Publication: 2017 Oct 10.
DOI: 10.1016/j.injury.2017.10.021
Abstrakt: Background: Modern trauma systems differ worldwide, possibly leading to disparities in outcomes. We aim to compare characteristics and outcomes of blunt polytrauma patients admitted to two Level 1 Trauma Centers in the US (USTC) and the Netherlands (NTC).
Methods: For this retrospective study the records of 1367 adult blunt trauma patients with an Injury Severity Score (ISS) ≥ 16 admitted between July 1, 2011 and December 31, 2013 (640 from NTC, 727 from USTC) were analysed.
Results: The USTC group had a higher Charlson Comorbidity Index (mean [standard deviation] 1.15 [2.2] vs. 1.73 [2.8], p<0.0001) and Injury Severity Score (median [interquartile range, IQR] 25 [17-29] vs. 21 [17-26], p<0.0001). The in-hospital mortality was similar in both centers (11% in USTC vs. 10% NTC), also after correction for baseline differences in patient population in a multivariable analysis (adjusted odds ratio 0.95, 95% confidence interval 0.61-1.48, p=0.83). USTC patients had a longer Intensive Care Unit stay (median [IQR] 4 [2-11] vs. 2 [2-7] days, p=0.006) but had a shorter hospital stay (median [IQR] 6 [3-13] vs. 8 [4-16] days, p<0.0001). USTC patients were discharged more often to a rehabilitation center (47% vs 10%) and less often to home (46% vs. 66%, p<0.0001), and had a higher readmission rate (8% vs. 4%, p=0.01).
Conclusion: Although several outcome parameters differ in two urban area trauma centers in the USA and the Netherlands, the quality of care for trauma patients, measured as survival, is equal. Other outcomes varied between both trauma centers, suggesting that differences in local policies and processes do influence the care system, but not so much the quality of care as reflected by survival.
(Copyright © 2017 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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