• J C Van Ditshuizen, L De Munter, VerhofstadM H JMHJTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands., LansinkK W WKWWDepartment Trauma TopCare, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands; Network Emergency Care Brabant, Brabant Trauma Registry, The Netherlands; Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands., D Den Hartog, Van LieshoutE M MEMMTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands., M A C De Jongh, BIOS-group, and Dutch Trauma Registry Southwest.
• Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Trauma Centre Southwest-Netherlands, Erasmus MC, University Medical Center Rotterdam, The Netherlands. Electronic address: j.vanditshuizen@erasmusmc.nl.
• Injury. 2023 Mar 1; 54 (3): 871879871-879.

IntroductionMortality due to trauma has reduced the past decades. Trauma network implementations have been an important contributor to this achievement. Besides mortality, patient reported outcome parameters should be included in evaluation of trauma care. While concentrating major trauma care, hospitals are designated with a certain level of trauma care following specific criteria.ObjectiveComparing health status of major trauma patients after two years across different levels of trauma care in trauma networks.MethodsMulticentre observational study comprising a secondary longitudinal multilevel analysis on prospective cohorts from two neighbouring trauma regions in the Netherlands.Inclusion Criteriapatient aged ≥ 18 with an ISS > 15 surviving their injuries at least one year after trauma. Health status was measured one and two years after trauma by EQ-5D-5 L, added with a sixth health dimension on cognition. Level I trauma centres were considered as reference in uni- and multivariate analysis.ResultsRespondents admitted to a level I trauma centre scored less favourable EQ-US and EQ-VAS in both years (0.81-0.81, 71-75) than respondents admitted to a level II (0.88-0.87, 78-85) or level III (0.89-0.88, 75-80) facility. Level II facilities scored significantly higher EQ-US and EQ-VAS in time for univariate analysis (β 0.095, 95% CI 0.038-0.153, p = 0.001, and β 7.887, 95% CI 3.035-12.740, p = 0.002), not in multivariate analysis (β 0.052, 95% CI -0.010-0.115, p = 0.102, and β 3.714, 95% CI -1.893-9.321, p = 0.193). Fewer limitations in mobility (OR 0.344, 95% CI 0.156-0.760), self-care (OR 0.219, 95% CI 0.077-0.618), and pain and discomfort (OR 0.421, 95% CI 0.214-0.831) remained significant for level II facilities in multivariate analysis, whereas significant differences with level III facilities disappeared.ConclusionMajor trauma patients admitted to level I trauma centres reported a less favourable general health status and more limitations compared to level II and III facilities scoring populations norms one to two years after trauma. Differences on general health status and limitations in specific health domains disappeared in adjusted analysis. Well-coordinated trauma networks offer homogeneous results for all major trauma patients when they are distributed in different centres according to their need of care.Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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