• Suzan Dijkink, Erik W van Zwet, Pieta Krijnen, LeenenLuke P HLPHDepartment of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands., Frank W Bloemers, EdwardsMichael J RMJRDepartment of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., HartogDennis DenDDTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands., Peter A Leenhouts, Martijn Poeze, W Richard Spanjersberg, Klaus W Wendt, Ralph J De Wit, Stefan W A M Van Zuthpen, and Inger B Schipper.
• Department of Trauma Surgery, Leiden University Medical Center, Post zone K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. s.dijkink@lumc.nl.
• Eur J Trauma Emerg Surg. 2022 Apr 1; 48 (2): 1035-1043.

BackgroundTwenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time.MethodsAll severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008-2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS.ResultsThe documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63-74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC.ConclusionSince the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.© 2021. The Author(s).

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