Patients Referred to a Norwegian Trauma Centre: effect of transfer distance on injury patterns, use of resources and outcomes

Journal of Trauma Management & Outcomes

Pål A Næss⁴  Christine Gaarder⁴  Petter A Steen¹  Kjetil Søreide²  Hans M Lossius³  Thomas Kristiansen⁴ 

[1] Prehospital Division, Oslo University Hospital - Ullevål, Oslo, Norway;Department of Surgery, Stavanger University Hospital, Stavanger, Norway;Department of Surgical Sciences, University of Bergen, Bergen, Norway;Department of Traumatology, Oslo University Hospital - Ullevål, Oslo, Norway

关键词: Norway;    Interhospital Transfer;    Trauma System;    Injury;   

Others  :  801304
DOI  :  10.1186/1752-2897-5-9

 received in 2011-04-13, accepted in 2011-06-16,  发布年份 2011

【 摘 要 】

Background

Triage and interhospital transfer are central to trauma systems. Few studies have addressed transferred trauma patients. This study investigated transfers of variable distances to OUH (Oslo University Hospital, Ullevål), one of the largest trauma centres in Europe.

Methods

Patients included in the OUH trauma registry from 2001 to 2008 were included in the study. Demographic, injury, management and outcome data were abstracted. Patients were grouped according to transfer distance: ≤20 km, 21-100 km and > 100 km.

Results

Of the 7.353 included patients, 5.803 were admitted directly, and 1.550 were transferred. The number of transfers per year increased, and there was no reduction in injury severity during the study period. Seventy-six per cent of the transferred patients were severely injured. With greater transfer distances, injury severity increased, and there were larger proportions of traffic injuries, polytrauma and hypotensive patients. With shorter distances, patients were older, and head injuries and injuries after falls were more common. The shorter transfers less often activated the trauma team: ≤20 km -34%; 21-100 km -51%; > 100 km -61%, compared to 92% of all directly admitted patients. The mortality for all transferred patients was 11%, but was unequally distributed according to transfer distance.

Conclusion

This study shows heterogeneous characteristics and high injury severity among interhospital transfers. The rate of trauma team assessment was low and should be further examined. The mortality differences should be interpreted with caution as patients were in different phases of management. The descriptive characteristics outlined may be employed in the development of triage protocols and transfer guidelines.

【 授权许可】

   
2011 Kristiansen et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Celso B, Tepas J, Langland-Orban B, Pracht E, Papa L, Lottenberg L, Flint L: A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. J Trauma 2006, 60:371-378. discussion 378
• [2]Kuhne CA, Mand C, Sturm J, Lackner CK, Kunzel A, Siebert H, Ruchholtz S: [The Trauma Network of the German Society for Trauma 2009]. Unfallchirurg 2009.
• [3]Cameron PA, Gabbe BJ, Cooper DJ, Walker T, Judson R, McNeil J: A statewide system of trauma care in Victoria: effect on patient survival. Med J Aust 2008, 189:546-550.
• [4]Sturms LM, Hoogeveen JM, Le Cessie S, Schenck PE, Pahlplatz PV, Hogervorst M, Jukema GN: Prehospital triage and survival of major trauma patients in a Dutch regional trauma system: relevance of trauma registry. Langenbecks Arch Surg 2006, 391:343-349.
• [5]Davenport RA, Tai N, West A, Bouamra O, Aylwin C, Woodford M, McGinley A, Lecky F, Walsh MS, Brohi K: A major trauma centre is a specialty hospital not a hospital of specialties. Br J Surg 97:109-117.
• [6]American College of Surgeons: Resources for optimal care of the injured patient 2006. Chicago, IL; 2006.
• [7]Harrington DT, Connolly M, Biffl WL, Majercik SD, Cioffi WG: Transfer times to definitive care facilities are too long: a consequence of an immature trauma system. Ann Surg 2005, 241:961-966. discussion 966-968
• [8]Mullins RJ, Veum-Stone J, Hedges JR, Zimmer-Gembeck MJ, Mann NC, Southard PA, Helfand M, Gaines JA, Trunkey DD: Influence of a statewide trauma system on location of hospitalization and outcome of injured patients. J Trauma 1996, 40:536-545. discussion 545-536
• [9]Kruger AJ, Hesselberg N, Abrahamsen GT, Bartnes K: [When should the trauma team be activated?]. Tidsskr Nor Laegeforen 2006, 126:1335-1337.
• [10]Uleberg O, Vinjevoll OP, Eriksson U, Aadahl P, Skogvoll E: Overtriage in trauma - what are the causes? Acta Anaesthesiol Scand 2007, 51:1178-1183.
• [11]Dehli T, Bagenholm A, Johnsen LH, Osbakk SA, Fredriksen K, Bartnes K: [Seriously injured patients transferred from local hospitals to a university hospital.]. Tidsskr Nor Laegeforen 2010, 130:1455-1457.
• [12]Meisler R, Thomsen AB, Abildstrom H, Guldstad N, Borge P, Rasmussen SW, Rasmussen LS: Triage and mortality in 2875 consecutive trauma patients. Acta Anaesthesiol Scand 2010, 54:218-223.
• [13]Katsaragakis S, Drimousis PG, Kleidi ES, Toutouzas K, Lapidakis E, Papadakis G, Daskalakis K, Larentzakis A, Theodoraki ME, Theodorou D: Interfacility transfers in a non-trauma system setting: an assessment of the Greek reality. Scand J Trauma Resusc Emerg Med 18:14.
• [14]Kristiansen T, Soreide K, Ringdal KG, Rehn M, Kruger AJ, Reite A, Meling T, Naess PA, Lossius HM: Trauma systems and early management of severe injuries in Scandinavia: review of the current state. Injury 2010, 41:444-452.
• [15]Langhelle A, Lossius HM, Silfvast T, Bjornsson HM, Lippert FK, Ersson A, Soreide E: International EMS Systems: the Nordic countries. Resuscitation 2004, 61:9-21.
• [16]Sollid S, Munch-Ellingsen J, Gilbert M, Ingebrigtsen T: Pre- and inter-hospital transport of severely head-injured patients in rural Northern Norway. J Neurotrauma 2003, 20:309-314.
• [17]Brattebo G, Wisborg T, Hoylo T: [Organization of trauma admissions at Norwegian hospitals]. Tidsskr Nor Laegeforen 2001, 121:2364-2367.
• [18]Isaksen MI, Wisborg T, Brattebo G: [Organisation of trauma services--major improvements over four years]. Tidsskr Nor Laegeforen 2006, 126:145-147.
• [19]Larsen KT, Uleberg O, Skogvoll E: Differences in trauma team activation criteria among Norwegian hospitals. Scand J Trauma Resusc Emerg Med 2010, 18:21. BioMed Central Full Text
• [20]Rehn M, Eken T, Kruger AJ, Steen PA, Skaga NO, Lossius HM: Precision of field triage in patients brought to a trauma centre after introducing trauma team activation guidelines. Scand J Trauma Resusc Emerg Med 2009, 17:1. BioMed Central Full Text
• [21]Hestnes M: The Trauma Registry Ullevål University Hospital. Scand J Trauma Resusc Emerg Med 2004, 12:118-124.
• [22]American Association for the Advancement of Automotive Medicine: The Abbreviated Injury Scale 1990 revision-Update 98. De Plains, IL: AAAM; 1998.
• [23]Baker SP, O'Neill B, Haddon W Jr, Long WB: The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974, 14:187-196.
• [24]Lavoie A, Moore L, LeSage N, Liberman M, Sampalis JS: The New Injury Severity Score: a more accurate predictor of in-hospital mortality than the Injury Severity Score. J Trauma 2004, 56:1312-1320.
• [25]Ringdal KG, Coats TJ, Lefering R, Di Bartolomeo S, Steen PA, Røise O, Handolin L, Lossius HM: The Utstein template for uniform reporting of data following major trauma: a joint revision by SCANTEM, TARN, DGU-TR and RITG. Scand J Trauma Resusc Emerg Med 2008, 16:7. (28 August 2008) BioMed Central Full Text
• [26]Butcher N, Balogh ZJ: The definition of polytrauma: the need for international consensus. Injury 2009, 40(Suppl 4):S12-22.
• [27]Skaga NO, Eken T, Steen PA: Assessing quality of care in a trauma referral center: benchmarking performance by TRISS-based statistics or by analysis of stratified ISS data? J Trauma 2006, 60:538-547.
• [28]Injury Advisory Committee: Better Practice Guidelines Interhospital Trauma Transfers. Liverpool City: South Western Sydney Area Health Service; 2001.
• [29]Lossius HM, Kristiansen T, Ringdal KG, Rehn M: Inter-hospital transfer: the crux of the trauma system, a curse for trauma registries. Scand J Trauma Resusc Emerg Med 2010, 18:15. BioMed Central Full Text
• [30]Lossius HM, Langhelle A, Pillgram-Larsen J, Lossius TA, Soreide E, Laake P, Steen PA: Efficiency of activation of the trauma team in a Norwegian trauma referral centre. Eur J Surg 2000, 166:760-764.
• [31]Zalstein S, Danne P, Taylor D, Cameron P, McLellan S, Fitzgerald M, Kossmann T, Patrick I, Walker T, Crameri J, et al.: The Victorian major trauma transfer study. Injury 41:102-109.
• [32]Mullins RJ, Hedges JR, Rowland DJ, Arthur M, Mann NC, Price DD, Olson CJ, Jurkovich GJ: Survival of seriously injured patients first treated in rural hospitals. J Trauma 2002, 52:1019-1029.
• [33]Sasser SM, Hunt RC, Sullivent EE, Wald MM, Mitchko J, Jurkovich GJ, Henry MC, Salomone JP, Wang SC, Galli RL, et al.: Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. MMWR Recomm Rep 2009, 58:1-35.
• [34]American College of Surgeons: Interfacility Transfer of Injured Patients: Guidelines for Rural Communities. Chicago, IL; 2002.
• [35]Victorian State Trauma System [http://www.health.vic.gov.au/trauma/index.htm] webcite
• [36]Mann NC, Pinkney KA, Price DD, Rowland D, Arthur M, Hedges JR, Mullins RJ: Injury mortality following the loss of air medical support for rural interhospital transport. Acad Emerg Med 2002, 9:694-698.
• [37]Gomes E, Araujo R, Carneiro A, Dias C, Costa-Pereira A, Lecky FE: The importance of pre-trauma centre treatment of life-threatening events on the mortality of patients transferred with severe trauma. Resuscitation 81:440-445.
• [38]Meisler R, Berlac PA: [Prehospital trauma triage before and after deployment of a physician-manned mobile emergency care unit in Nordsjaelland]. Ugeskr Laeger 2009, 171:2548-2552.
• [39]American College of Surgeons: Regional Trauma Systems: Optimal Elements, Integration, and Assessment Systems Consultation Guide. Chicago, IL; 2006.