History, development and future of trauma care for multiple injured patients in the Netherlands
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REVIEW ARTICLE
History, development and future of trauma care for multiple injured patients in the Netherlands K. W. W. Lansink • L. P. H. Leenen
Received: 3 April 2012 / Accepted: 19 August 2012 / Published online: 13 September 2012 Ó Springer-Verlag 2012
Abstract Introduction 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. Comparison with other trauma systems 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. Future, discussion and conclusion 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 prehospital helicopter system, on top of the current good functioning inclusive trauma system. These developments
K. W. W. Lansink L. P. H. Leenen (&) Department of Surgery, University Medical Center Utrecht, Suite G04.228, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands e-mail: [email protected]
could be a template for further developments of trauma systems in Europe. Keywords Trauma systems Polytrauma Quality assessment
Introduction The care for the injured patient in the Netherlands has changed considerably over the years. Since the early 1970s, trauma prevention and trauma care have been a matter of public health. A majority of the improvements and reduction in casualties is due to primary and secondary prevention and, proposedly, only at the most, 25 % of the reduction in casualties can be attributed to improvement in care: tertiary prevention [1]. This paper has a focus on tertiary prevention. After the introduction of a formalised regionalised trauma system in 1999 [2], several changes have taken place. In this review, we report an update of the current situation, on the basis of developments in our own institution over the last 10 years. Furthermore, we compare these results with other results in the world and try to extrapolate these findings into a future policy. As developments in the organisation of trauma systems in ot
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