Pre-hospital trauma care: A comparison of two healthcare systems

Indian Journal of Critical Care Medicine, 03/30/2012

Tan XX et al. – Despite variation in pre–hospital transfer times and interventions, no significant difference was demonstrated in revised trauma score (RTS) upon arrival, or for the unadjusted mortality rates.

Methods

  • The Scottish trauma and audit group (STAG) and the German trauma registry (GTR) databases were used to compare the management and outcome of trauma patients in Scotland and Germany.
  • Severely injured patients (injury severity score (ISS)>16) were analyzed for a 3year period (2000 to 2002).
  • Patient demographics, pre-hospital interventions, ISS, revised trauma score (RTS), time from scene of injury to arrival to the emergency department (ED), 120 day mortality and standardized mortality ratios using TRISS methodology were compared.

Results

  • There were 227 patients identified from the STAG registry and 6878 patients from the GTR registry.
  • There was a significant difference in ISS (24.9 vs. 29.8, P=0.001, respectively).
  • No significant difference was observed for the RTS (P=0.2).
  • There was a significantly higher rate of pre-hospital interventions in the German group (P<0.001).
  • The mean time from an injury to arrival to the ED (73 vs. 247minutes, P=0.001) was longer for the Scottish patients.
  • There was no difference for an unadjusted mortality rate between the groups, but the standardized mortality ratio was significantly greater for the Scottish population (3.8 vs. 2.2, P=0.036).

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