Epidemiological comparison between the Navarra Major Trauma Registry and the German Trauma Registry (TR-DGU®).

BACKGROUND: International benchmarking can help identify trauma system performance issues and determine the extent to which other countries also experience these. When problems are identified, countries can look to high performers for insight into possible responses. The objective of this study was to compare the treatment and outcome of severely injured patients in Germany and Navarra, Spain. METHODS: Data collected, from 2010 to 2013, in the Navarra Major Trauma Registry (NMTR) and the TraumaRegister DGU® (TR-DGU) were compared. Both registries followed the Utstein Trauma Template (European Core Dataset) for documentation of trauma patients. Adult patients (≥ 16 years) with New Injury Severity Score (NISS) being >15 points were included in this study. Patients who had been admitted to the hospital later than 24 h after the trauma, had been pronounced dead before hospital arrival, or had been injured by hanging, drowning or burns, were excluded. Demographic data, injury data, prehospital data, hospital treatment data, time intervals, and outcome were compared. The expected mortality was calculated using the Revised Injury Severity Classification score II (RISC II). RESULTS: A total of 646 and 43,110 patients were included in the outcome analysis from NMTR and TR-DGU, respectively. The difference between observed and expected mortality was -0.4% (standardized mortality ratio [SMR] 0.97; 95% CI 0.93-1.04) in Germany and 1.6% (SMR 1.08; 95% CI: 1.02-1.14) in Navarra. Differences in the characteristics of trauma patients and trauma systems between the regions were noted. CONCLUSION: The higher observed mortality in Navarra is consistent with the epidemiological characteristics of its population. However, to improve the quality of trauma care in the Navarra trauma system, certain improvements are necessary. There were less young adults with severe injuries in Navarra than in Germany. It is possible to compare data of severely injured patients from different countries if standardized registries are used.

Escalas para predicción de resultados tras traumatismo grave / Scales for predicting outcome after severe trauma

En este artículo se ha hecho una revisión sobre el desarrollo de las escalas más utilizadas en los pacientes con traumatismo grave desde hace 40 años. Es sabido que, las escalas anatómicas son eficaces, tanto para medir la severidad de las lesiones, como para predecir resultados. Las escalas fisiológicas miden el componente dinámico tras el trauma, con gran influencia en el pronóstico de los traumatizados. Los índices metabólicos, tanto lactato como el déficit de base, son reflejo de un estado de hipoperfusión tisular, y por tanto de shock. Las escalas combinadas sirven para la predicción y comparación evaluativa de los resultados. La incorporación de factores que influyen en el pronóstico de los traumatizados ha conllevado al desarrollo de nuevas escalas. Sin embargo, carecen de estudios de validación externa para su uso generalizado. Hasta que estos estudios se lleven a cabo, estas escalas deben usarse con precaución (AU)

In this article we review the development of the most-used scales for severe trauma patients over the past 40 years. It is well known that anatomical scales are effective for measuring the severity of injuries and for predicting results. Physiological scales measure the dynamic component after trauma, with a great influence on the prognosis of injured patients. Metabolic scales, both lactate and base deficit, are reflections of tissue hypoperfusion states and therefore shock. The combined scales are used for prediction and comparative assessment of results. The inclusion of factors that influence the prognosis of trauma patients has led to the development of new scales. However, they lack external validation studies for their widespread use. Until these validation studies are conducted caution should be taken with the use of existing scales (AU)

[Scales for predicting outcome after severe trauma]. / Escalas para predicción de resultados tras traumatismo grave.

In this article we review the development of the most-used scales for severe trauma patients over the past 40 years. It is well known that anatomical scales are effective for measuring the severity of injuries and for predicting results. Physiological scales measure the dynamic component after trauma, with a great influence on the prognosis of injured patients. Metabolic scales, both lactate and base deficit, are reflections of tissue hypoperfusion states and therefore shock. The combined scales are used for prediction and comparative assessment of results. The inclusion of factors that influence the prognosis of trauma patients has led to the development of new scales. However, they lack external validation studies for their widespread use. Until these validation studies are conducted caution should be taken with the use of existing scales.

[Influence of prehospital response times in the survival of trauma patients in Navarre]. / Influencia de los tiempos de respuesta prehospitalarios en la supervivencia de los pacientes politraumatizados en Navarra.

The relation between response times and mortality of polytrauma patients in the so-called "golden hour" continues to be a subject of debate. The purpose of this study is to determine the variables related to mortality in these patients and the influence of response times of the Emergency Medical Services in this mortality. To this end, the data in the "Major Trauma of Navarre" Register (retrospective cohort of polytrauma patients attended to by the Navarre Health Service) were analyzed for the four year period between 2010 and 2013. Of the 217 trauma cases available for the analysis, 42 (19%) died. No significant association was found in the multi-variate analysis between the different response times and mortality: arrival at the scene (odds ratio (OR) 1.0; 95% confidence interval (CI) from 0.99 to 1.01), in the scenario (OR 1.00; 95% CI from 0.98 to 1.02) and total time (OR 1.00; 95% CI from 0.99 to 1.01). The variables that influenced mortality are patient age and severity of injuries measured by the prehospital Triage-Revised Trauma Score (T-RTS) and the New Injury Severity Score (NISS). The mortality of polytrauma patients attended to by the emergency system in our region is influenced by age and by the intensity of the aggression suffered, determined by the prehospital T-RTS and by the NISS. The response times of the hospital do not have a significant influence.

Influencia de los tiempos de respuesta prehospitalarios en la supervivencia de los pacientes politraumatizados en Navarra / Influence of prehospital response times in the survival of trauma patients in Navarre

La relación entre los tiempos de respuesta y la mortalidad de los pacientes politraumatizados en la denominada "hora de oro" sigue siendo tema de debate. El objetivo del presente estudio es determinar las variables relacionadas con la mortalidad en dichos pacientes y la influencia de los tiempos de respuesta de los Servicios Médicos de Emergencia en dicha mortalidad. Para ello se analizaron los datos del Registro "Major Trauma de Navarra" (cohorte retrospectiva de pacientes politraumatizados atendidos por el sistema sanitario de Navarra) durante los cuatro años comprendidos entre 2010 y 2013. De los 217 casos de trauma disponibles para el análisis, fallecieron 42 (19%). En el análisis multivariante no se encontró asociación significativa entre los diferentes tiempos de respuesta y la mortalidad: llegada a la escena (odds ratio (OR) 1,0; intervalo de confianza al 95% (IC) de 0,99 a 1,01), en el escenario (OR 1,00; IC 95% de 0,98 a 1,02) y tiempo total (OR 1,00; IC 95% de 0,99 a 1,01). Las variables que influyen en la mortalidad son la edad del paciente y la gravedad de las lesiones medidas por el Triage-Revised Trauma Score (T-RTS) prehospitalario y el New Injury Severity Score (NISS). La mortalidad de los pacientes politraumatizados atendidos por el sistema de emergencias en nuestra región está influida por la edad, y por la intensidad de la agresión sufrida determinada por el T-RTS prehospitalario y por el NISS. Los tiempos de respuesta prehospitalarios no influyen significativamente (AU)

The relation between response times and mortality of polytrauma patients in the so-called "golden hour" continues to be a subject of debate. The purpose of this study is to determine the variables related to mortality in these patients and the influence of response times of the Emergency Medical Services in this mortality. To this end, the data in the "Major Trauma of Navarre" Register (retrospective cohort of polytrauma patients attended to by the Navarre Health Service) were analyzed for the four year period between 2010 and 2013. Of the 217 trauma cases available for the analysis, 42 (19%) died. No significant association was found in the multivariate analysis between the different response times and mortality: arrival at the scene (odds ratio (OR) 1.0; 95% confidence interval (CI) from 0.99 to 1.01), in the scenario (OR 1.00; 95% CI from 0.98 to 1.02) and total time (OR 1.00; 95% CI from 0.99 to 1.01). The variables that influenced mortality are patient age and severity of injuries measured by the prehospital Triage-Revised Trauma Score (T-RTS) and the New Injury Severity Score (NISS). The mortality of polytrauma patients attended to by the emergency system in our region is influenced by age and by the intensity of the aggression suffered, determined by the prehospital T-RTS and by the NISS. The response times of the hospital do not have a significant influence (AU)

Implantado en Navarra el primer registro de politraumatizados de base poblacional en España / Implementation of the first Spanish population-based register for multiple-injury cases in Navarre

Se describen las características técnicas del primer registro de politraumatizados de base poblacional desarrollado en España (actualmente en fase de producción) así como la arquitectura informática, características técnicas, variables, estrategia de detección de casos, introducción y mantenimiento de los mismos y control de calidad de la base de datos. Entre el 1 de enero de 2010 y 31 de diciembre de 2011 se han recogido 243 casos. El sistema gestionado por un administrador ha soportado la entrada de 97 usuarios correspondientes a 7 servicios diferentes. El nivel de cumplimentación de las 63 variables fue del 90%. La mortalidad observada fue del 27%. Los tiempos de respuesta (llamada–entrada en el hospital, entrada en el hospital– realización de la primera tomografía computarizada, o primera intervención clave) son similares a los observados en otros registros europeos. En este momento tenemos operativo en Navarra el primer registro de politraumatizados español basado en el estilo Utstein. Su arquitectura informática nos permite introducir información de forma prospectiva y retrospectiva desde diferentes servicios con la participación de todos los escalones que atienden al paciente politraumatizado. Dicho registro nos ha permitido conocer las características de los politraumatizados, la calidad de la atención sanitaria, compararnos con otros sistemas y disponer de una base para que profesionales del Servicio Navarro de Salud dispongan de datos para sus investigaciones (AU)

To describe the technical features of the first population-based register for multiple-injury cases to be developed in Spain. Description of the system architecture and technical features of this population-based register, including the variables in the database, the case-finding strategy used, data inputting and maintenance, and quality control. Between January 1,2010 and December 31, 2011, we found 243 cases. The system was supervised by a database administrator and allowed97 users in 7 different departments to enter data. The level of reporting of 63 variables was 90%. Mortality was 27%.Response times (emergency call to hospital arrival and hospital arrival to first computed tomography scan or first key intervention) were similar to those recorded in other European registers. The first Utstein-style register for multipleinjuries in Spain is now being used in Navarre. The system architecture allows us to collect information prospectively and retrospectively from all who treat multiple-injury patients no matter their position on the staff of various hospital departments. This register has helped us determine the characteristics of multiple-injury patients and the quality of care they receive. We have been able to compare our setting with others’ and have provided a source of data for researchers in the Navarre health service (AU)