Reporting data following major trauma and analysing factors associated with outcome using the new Utstein style recommendations
Introduction
The importance of organised trauma care is documented [1], [2], [3], [4], [5], [6], [7], [8]. Even though there are formal trauma registries in some countries [9], [10], it is difficult to compare different trauma systems due to a lack of data standardisation. In the case of cardiac arrest, international recommendations for uniform reporting of clinical data (The Utstein Template) have been proven valuable and have become an internationally used standard [11]. In 1994 the International Trauma Anesthesia and Critical Care Society (ITACCS) initiated an international task force in order to draw up recommendations for uniform reporting of data following major trauma based on the Utstein concept.
These recommendations for reporting of data following major trauma in the Utstein style have recently been published in several journals, including Resuscitation [12]. To our knowledge studies have not been published which test the applicability of these recommendations from any trauma system.
The implementation of a trauma registry is resource demanding. Hence, we wanted to test how easy it was to collect and present retrospectively the recommended core data of the Utstein style from already existing pre-hospital and hospital records in our own trauma system, and then, use the collected data to analyse factors influencing with outcome in major trauma. We also found it appropriate to discuss the value of the definition of major trauma. Does it ensure inclusion of all life-threatening cases?
Section snippets
Materials and methods
Ulleval University Hospital is a 1200 bed local and regional hospital. It has an established trauma organisation [13], and serves as the primary trauma hospital for the population of Oslo (≈500 000), and as a trauma referral centre for an urban and rural population of about 2 million people. Trauma patients are admitted by either ground or air ambulances directly from the scene or transferred from local hospitals. Basic pre-hospital trauma care is performed by regular ambulance crews and
Results
During the study period a total of 20 500 patients were admitted to Ulleval Hospital, of which 3391 (17%) were trauma related admissions. Two hundred and twenty five fulfilled the Utstein style recommended criterion for major trauma (ISS>15) and were included in the study. In every one of these 225 patients, we were able to obtain at least 47% of the recommended core data.
One hundred and fifty nine (71%) of the 225 with major trauma were admitted directly from the scene, and 66 (29%) were
Discussion
Evaluating and comparing trauma systems is necessary to develop trauma care further. In most cases randomised, controlled trials are unacceptable, both for logistical and ethical reasons. Other different methods have been used to investigate the efficiency of trauma systems; evaluation of patient outcome by expert panels [18], [19], trauma registry based studies [9], [10], and population based studies [5], [13], [20], [21], [22]. In all type of studies, clear and standardised definitions are
Conclusions
In summary, our study emphasises the problems of retrospective extrication of data and a small sample size, which is representative for many trauma centres. Since the study was retrospective, its value in the evaluation of the Utstein style recommendations as such is limited. By using the Utstein style recommendations, we found that the definition of major trauma did not cover all injuries that led to death or prolonged ICU stay. In uni- and multivariate analyses, we found only three factors
Acknowledgements
The authors want to acknowledge Bo Conneryd, Norwegian Air Ambulance, for superior computer software support, senior consultant Nils-Oddvar Skaga and Dr. Torsten Eken, Ulleval University Hospital, for constructive discussions, and Rolf Geir Gjertsenı́s Memorial Foundation for the financial support.
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2015, Accident Analysis and PreventionCitation Excerpt :While there are many ways to dichotomize between severe and non-severe injury, the US National Expert Panel recommended ISS > 15 as partition threshold (Sasser et al., 2012). In addition, a substantial majority of data registries (Lossius et al., 2001; MacLeod et al., 2003) use that threshold for defining very severe injury. ISS > 15 was first described by Boyd et al. (1987) as being predictive of 10% mortality and it is widely accepted as corresponding to the highest priority level in an Emergency Department (ED) (Palmer, 2007).
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2013, Journal of Surgical ResearchCitation Excerpt :In the presence of equivalent injury severity, mortality in elderly patients is known to be two times higher than that in younger patients [1]. Despite this, older patients are more likely to be undertriaged compared with other adult trauma victims [2–4]. Undertriage (UT) exposes patients to critical delays in diagnostic, resuscitative, and therapeutic measures [5].