The Dutch Trauma Registry facts and figures 2015
Transcript of The Dutch Trauma Registry facts and figures 2015
The Dutch Trauma Registry facts and figures 2015
2nd November 2016
Symposium Trauma Systems
Leontien Sturms ([email protected])
Dutch Network for Acute Care
NO CONFLICT OF INTEREST
Regionalisation Dutch trauma Care
11 designated level 1 regional trauma centers (1999)
Responsibilities regional trauma centers:
care for the most severely injured (deployment Mobile Medical Team)
set up 11 trauma networks
monitor trauma care with trauma registry
knowledge/expert center (guidelines etc)
MMT
MMT
MMT
MMT
Dutch Trauma Registry (2007)
The Dutch Trauma Registry
Inclusion criteria:
All injured patients treated at ED (≤ 48h accident) and directly admitted to the hospital (including transfers/death at ED (excl. DOA))
Dataset
- 2007-2013: MTOS1 dataset (AIS98) + prehospital data
- 2014: addition items - Utstein Template2
- 2015: implementation Abbreviated Injury Scale 2008
1. Champion HR, Copes WS, Sacco WJ et al. The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma. 1990; 30: 1356-65.
2. KG Ringdal et al. The Utstein template for uniform reporting of data following trauma: a joint revision by SCANTEM, TARN, DGU-TR and RIGT. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2008; 16:3-19.
• Implementation AIS2008
• Patient characteristics and care process
• Outcome evaluation
Highlights registry data 2015
Implementation AIS2005, update 2008 in 2015
New codes/removed codes/severity changes of codes
ISS on average lower
Injury Severity Score (ISS)
- anatomical scoring system
- based on the Abbreviated Injury Scale (AIS)
- overall score for patients with multiple injuries
- severely injured => ISS≥16
AIS 1998 - AIS 2008
Severely injured AIS98-AIS08
2014
ISS>15 (AIS98) 2015
ISS>15 (AIS08)
n=5.882 (7%) n=4.202 (5%)
prehospital MMT 15% 21%
prehospital RTS≤10 23% 34%
directly to theatre 7% 12%
ICU admission 47% 56%
Hospital mortality 12% 17%
• Implementation AIS2008
• Patient characteristics and care process
• Outcome evaluation
Highlights registry data 2015
Number of patients
Dutch Trauma Registry Database: 630.000 admitted trauma patients (2007-2015)
43.317
56.924 62.990
68.600 71.609
76.351 79.520
83.287 83.870
64%
74% 77%
84% 89%
96% 98% 99% 100%
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2007 2008 2009 2010 2011 2012 2013 2014 2015
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Number cases Participation hospitals
The Dutch Trauma Registry: Patient characteristics and care process
230 trauma admissions per day
Trauma admissions per hospital (2015)
2.280
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2.500
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Non trauma center Trauma center
Age x gender admitted trauma patients (2015)
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66 95+
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Age (per year)
males females
The Dutch Trauma Registry: Patient characteristics and care process
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66 95+
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males females
Age x gender admitted trauma patients (incidence rate x 10.000) (2015)
The Dutch Trauma Registry: Patient characteristics and care process
Injury cause admitted trauma patients (2015)
The Dutch Trauma Registry: Patient characteristics and care process
All Severely injured (ISS>15)
Transport admitted trauma patients (2015)
The Dutch Trauma Registry: Patient characteristics and care process
31%
15%
1% 6%
10%
3%
25%
47%
5%
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Injury distribution admitted trauma patients (2015)
20% hip fracture
The Dutch Trauma Registry: Patient characteristics and care process
Hospital stay – admitted* trauma patients (2015)
The Dutch Trauma Registry: Patient characteristics and care process
3 5
8
11
14
12
6
ISS 1-3 ISS 4-8 ISS 9-15 ISS 16-24 ISS 25-49 ISS 50-75 Total
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* Excluding transfers out
ICU – admitted trauma patients (2015)
The Dutch Trauma Registry: Patient characteristics and care process
Hospital mortality* (2015) (2.5%)
* Excluding transfers out
1% 1% 3% 8%
39%
68%
0%
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ISS 1-3 ISS 4-8 ISS 9-15 ISS 16-24 ISS 25-49 ISS 50-75
Number patients % mortality
The Dutch Trauma Registry: Patient characteristics and care process
Glasgow Outcome Score at discharge - survivors (2015)
Preliminary results (31% missing)
The Dutch Trauma Registry: Patient characteristics and care process
• Implementation AIS2008
• Patient characteristics and care process
• Outcome evaluation
Highlights registry data 2015
Outcome evaluation
(a) right patient, right place, right time
(b) observed versus expected mortality
Right patient, right place, right time
In general:
• Less severe injuries (ISS 1-15) → nearby hospital
• Severely injured (ISS>15) → 11 level 1 regional trauma centers
Time required to first CT ISS≥16 (2015)
Outcome: getting the right patient to the right hospital?
ISS ≥ 16 67% trauma centers
“getting the patient to the right hospital?”
ISS 1-15 21% trauma centers
61%
58%
77%
70%
74%
73%
63%
87%
68%
62%
36%
Trauma networks overall percentage ISS>15 in trauma centers (36%-87%) Figure 45 annual report
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Non trauma center Trauma center Volume n=100
Volume per hospital ISS≥16 (2015)
Outcome: getting the right patient to the right hospital?
Figure 44 annual report
Performance
- Hospital mortality
- Expected versus observed
=> expected = TRISS (psurvival) (1987)
- US MTOS coefficients (1982-1987, update 1995)
- US NTDB coefficients (2002-2006)
MTOS coefficients = Champion HR et al. Injury Severity Scoring Again. Journal of Trauma 1995; 38: 94-95.
NTDB coefficients = Schluter et al. Trauma and Injury Severity Score (TRISS) Coefficients 2009 Revision. Journal of Trauma 2010.
Missing RTS = max value ; Ws = Hollis S. et al. Standardized comparison of performance indicators in trauma: a new approach to case-mix variation. J Trauma 1995; 38: 763-766
Outcome: expected versus observed mortality
Netherlands versus US
-0,19 -0,03
0,13 0,26
-0,36
-1,50
-1,00
-0,50
0,00
0,50
1,00
1,50
2011 2012 2013 2014 2015
Ws Netherlands [NTDB (2002-2006) TRISS coefficients]
Missing RTS = max value ; NTDB fractions; Ws = Hollis S. et al. Standardized comparison of performance indicators in trauma: a new approach to case-mix variation. J Trauma 1995; 38: 763-766
‘standardised excess survival rate’ : Ws = direct comparison (standardised US national case-mix)
Outcome: expected versus observed mortality
AIS 98 AIS 08
Dutch - TRISS coefficients 2015
NTDB coefficients = Schluter et al. Trauma and Injury Severity Score (TRISS) Coefficients 2009 Revision. Journal of Trauma 2010.
BLUNT INJURIES – DUTCH TRISS COEFFICIENTS 2015
ED measurement Dutch
PS NL 2015 NTDB
(Schluter 2010) Δ p value
b0 Intercept 1,509 1,649 -0,140 0,719
b1 RR 0,237 0,010 0,228 0,001
b2 SBP 0,646 0,426 0,220 0,004
b3 GCS 0,401 0,631 -0,230 0,001
b4 ISS -0,109 (AIS08) -0,080 (AIS98) -0,029 0,000
b5 AGE (>55) -2,209 -1,627 -0,588 0,000
Psurvival = 1 / (1+e-b) ;
b=b0 + b1(RR code) + b2(SBP code) + b3(GCS code) + b4(ISS) + b5(Age)
Outcome: expected versus observed mortality
Psurvival distribution (PSNL15) (2015)
77.027
4.816 1.147 491 178 149
21% 25%
59%
80% 84% 87%
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1.00-0.96 0.95-0.91 0.90-0.76 0.75-0.51 0.50-0.26 0.25-0.00
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PSurvival (PSNL15)
Total % trauma center
Outcome: expected versus observed mortality
SMR Funnelplot
Standardized Mortality Ratio (SMR): observed/expected : indirect comparison
Outcome: expected versus observed mortality
Figure 55 annual report
Improvements need to be made…
• More direct treatment ISS≥16 at 11 regional trauma centers
• Probability of survival -‘Ps’ risk adjustment model Dutch Trauma Registry
• Improve completeness of registry data
• …. Further analyses!
AGENDA
Special thanks to
- All participants
- Scientific committee
- Reports: Carin Zwartjes (IVZ)
- Analyses: Sonia Amodio & Erik van Zwet (biostatistics LUMC)
- Database: Brigit Kooijman & Ronald Brand (Advanced Datamanagement LUMC)