Effects of major trauma care organisation on mortality in a European level 1 trauma centre: A retrospective analysis of 2016-2023

Philip Verdonck; Matthew Peters; Tom Stroobants; Johan Gillebeert; Eva Janssens; Sebastian Schnaubelt; Suresh Krishan Yogeswaran; Sabine Lemoyne; Anouk Wittock; Lore Sypré; Dominique Robert; Philippe G Jorens; Dennis Brouwers; Stijn Slootmans; Koenraad Monsieurs

doi:10.1016/j.injury.2024.112022

Effects of major trauma care organisation on mortality in a European level 1 trauma centre: A retrospective analysis of 2016-2023

Injury. 2024 Nov 13;55(12):112022. doi: 10.1016/j.injury.2024.112022. Online ahead of print.

Authors

Affiliations

¹ Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Emergency Department, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; Major Trauma Service, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium. Electronic address: [email protected].
² Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Department of Anaesthesiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium. Electronic address: [email protected].
³ Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Department of Anaesthesiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium. Electronic address: [email protected].
⁴ Emergency Department, Ziekenhuis aan de Stroom Cadix, Kempenstraat 100, 2030 Antwerp, Belgium. Electronic address: [email protected].
⁵ Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Emergency Department, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium. Electronic address: [email protected].
⁶ Emergency Department, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Emergency Medical Service Vienna, Radetzkystraße 1, 1030 Vienna, Austria. Electronic address: [email protected].
⁷ Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Major Trauma Service, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; Department of Thoracovascular surgery, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium. Electronic address: [email protected].
⁸ Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Emergency Department, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium. Electronic address: [email protected].
⁹ Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Department of Anaesthesiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium. Electronic address: [email protected].
¹⁰ Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Emergency Department, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium.
¹¹ Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Department of Intensive care, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium. Electronic address: [email protected].
¹² Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Department of Intensive care, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium. Electronic address: [email protected].
¹³ Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Major Trauma Service, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; Department of Orthopaedics and traumatology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium. Electronic address: [email protected].
¹⁴ Major Trauma Service, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; Centre for Research and Innovation of Care, Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium. Electronic address: [email protected].
¹⁵ Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Emergency Department, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium. Electronic address: [email protected].

PMID: 39549420
DOI: 10.1016/j.injury.2024.112022

Abstract

Introduction: The centralisation of care for trauma patients in trauma centres, alongside the creation of inclusive trauma networks, has proven to reduce mortality. In Europe, such structured trauma programs and trauma networks are in development.

Objective: To describe the aetiology and evolution of in-hospital mortality in a developing European level 1 trauma centre, to determine the early effect of trauma care reorganisation on mortality and to identify the areas for future investments in trauma care.

Materials and methods: This retrospective analysis included the calculation of the standardised mortality ratio (SMR), the time to in-hospital death and the cause of in-hospital death of all primary major trauma admissions to the Antwerp University Hospital from 2016 to 2023.

Results: A total of 1470 patients was included with a crude mortality of 16.4 %, a median Revised Injury Severity Classification II (RISC II) adjusted mortality of 1.47 %, and a SMR of 1.12. A limitation of care directive was registered for 18.1 % of the patients. The causes of in-hospital death were traumatic brain injury (TBI) in 60 %, haemorrhagic shock in 15 %, organ failure in 10 %, miscellaneous in 14 % and unknown in 1 %. Sixty percent died in the first 48 h of hospital admission (mainly due to TBI and haemorrhagic shock) and 27 % died after more than seven days (mainly due to organ failure and TBI). In 24 % of the deceased patients with severe TBI, a non-TBI related cause of death was found. Overall, the SMR showed a nonsignificant decreasing trend, with a significant decrease of the SMR in the highest risk group (RISCII > 75 %) and a nonsignificant increase in the lowest risk group (RISC II <15 %).

Conclusion: The standardised mortality ratio declined over a period of 8 years, even though the SMR increased nonsignificantly in the lowest risk-adjusted mortality group. Future analysis of this subgroup could clarify whether this trend is due to an increase of limitation of care directives and if these deaths could have been prevented with improved trauma care. There might be opportunities to increase the survival of patients with severe TBI who have a non-TBI cause of death.

Keywords: Cause of death; Major trauma; Mortality; Severe injury; Trauma centre; Trauma network; Trauma system.