• Hendrik Wyen, Sebastian Wutzler, Miriam Rüsseler, Martin Mack, Felix Walcher, and Ingo Marzi.
• Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
• Eur J Trauma Emerg S. 2009 Oct 1;35(5):448.

BackgroundA regionalized approach to trauma care with the implementation of designated level I trauma centers has been shown to improve survival after multiple injuries. Our study aimed to describe the current reality in an urban German level I university trauma center concerning the primary admission of patients into the emergency room.Materials And MethodsWe performed a retrospective analysis of all multiple trauma patients that were prospectively documented in our documentation system TraumaWatch(®) from 2003 to 2007. Documentation included physiological findings as well as diagnostic and therapeutic procedures structured as: (A) preclinical phase; (B) emergency room treatment; (C) intensive care unit; and (D) final outcome according to the German Trauma Registry.ResultsIn total, 1,848 patients were completely documented and, thus, analyzed. The mean ± standard deviation (SD) Injury Severity Score (ISS) was 16.5 ± 14.1 points and the mean ± SD age was 38.7 ± 21.9 years. An increasing number of patients received whole-body computed tomography (48.8% in 2003 vs. 83.3%in 2007, p < 0.001) and, on average, the ISS increased over the years (14.4 points in 2003 vs. 17.9 points in 2007). The overall hospital mortality was 7.1%, without significant change over time. The completionofimagingdiagnostics became significantly faster for all of the documented procedures (X-ray pelvis, X-ray chest, whole-body CT, abdominal ultrasound) (p < 0.001).DiscussionDescriptive data on the current reality in urban level I trauma care can be derived from our study. Additionally, we achieved improved time intervals for emergency diagnostics and treatment, while hospital mortality remained constant, despite a higher injury severity. This is due to a standardized protocol which is applied during the 24-h in-house attending coverage.ConclusionRegionalized trauma care with designated level I trauma centers is justified by the improvement of time intervals and outcome, but adequate resources are required.

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