Trauma facilities in Denmark - a nationwide cross-sectional benchmark study of facilities and trauma care organisation.

BACKGROUND: Trauma is a leading cause of death among adults aged < 44 years, and optimal care is a challenge. Evidence supports the centralization of trauma facilities and the use multidisciplinary trauma teams. Because knowledge is sparse on the existing distribution of trauma facilities and the organisation of trauma care in Denmark, the aim of this study was to identify all Danish facilities that care for traumatized patients and to investigate the diversity in organization of trauma management. METHODS: We conducted a systematic observational cross-sectional study. First, all hospitals in Denmark were identified via online services and clarifying phone calls to each facility. Second, all trauma care manuals on all facilities that receive traumatized patients were gathered. Third, anesthesiologists and orthopedic surgeons on call at all trauma facilities were contacted via telephone for structured interviews. RESULTS: A total of 22 facilities in Denmark were found to receive traumatized patients. All facilities used a trauma care manual and all had a multidisciplinary trauma team. The study found three different trauma team activation criteria and nine different compositions of teams who participate in trauma care. Training was heterogeneous and, beyond the major trauma centers, databases were only maintained in a few facilities. CONCLUSION: The study established an inventory of the existing Danish facilities that receive traumatized patients. The trauma team activation criteria and the trauma teams were heterogeneous in both size and composition. A national database for traumatized patients, research on nationwide trauma team activation criteria, and team composition guidelines are all called for.

Readmission and mortality in patients discharged with a diagnosis of medical observation and evaluation (Z03*-codes) from an acute admission unit in Denmark: a prospective cohort study.

BACKGROUND: We assessed the 30-day risk of readmission and mortality among patients receiving an International Classification of Diseases 10th edition diagnosis of medical observation and evaluation (Z03*) following admission to an acute medical admission unit (AMAU), stratified on any further specification of diagnosis during hospital stay. METHODS: We used Central Denmark's (Midt)-Electronic Patient Journal to identify patients with a Z03*-diagnosis among patients admitted to the AMAU, Aarhus University Hospital Nørrebrogade from April 2012 to March 2013, and noted any specification of diagnosis. Patients were followed from hospital discharge until death, emigration, or completion of 30 days follow-up. RESULTS: Of 409 patients with an initial Z03* diagnosis at the AMAU, 55% (n = 226) received a more specific discharge diagnosis after transferral to other departments. Among patients discharged to home with a Z03*-diagnosis, 30% were readmitted within 30 days, while the corresponding figure was 23% for patients receiving a specific diagnosis (p = 0.06). In contrast, corresponding figures for 30-day mortality were 3% for Z03*-diagnosed patients and 10% for those who obtained a specific diagnosis (p = 0.003). CONCLUSIONS: Patients diagnosed with Z03* at hospital discharge have a substantially lower 30-day mortality, but a higher readmission-rate, compared to patients who obtain a specific diagnosis during the entire hospital stay.

[Acute treatment of trauma patients with blood components]. / Akut blodkomponentterapi til traumepatienter.

INTRODUCTION: Massive bleeding is a common cause of death in trauma patients. The aim of this study was to describe the number and survival within the group of trauma patients who received treatment with blood components, as well as to describe the amount and kind of blood components in acute treatment. MATERIALS AND METHODS: Descriptive cohort investigation based on consecutively collected data on trauma patients in 2004. Information about the use of blood components was obtained from the database at the Clinical Immunological Department. Massive transfusion was defined as transfusion with 10 or more RBC (units of packed red blood cells) within 24 hours after admission to the Trauma Centre. Non-balanced treatment was defined as transfusion with more than 10 RBC without transfusion with FFP (fresh frozen plasma) or transfusion of more than altogether 30 RBC and/or FFP without transfusion of thrombocytes. RESULTS: In 2004, 565 trauma patients were taken primarily to Aarhus Trauma Centre. 7% (42) patients received treatment with blood components within 24 hrs. 2% (11) were massively transfused and within this group 45% (5) died; one patient did not receive balanced treatment. CONCLUSION: Acute transfusion with blood components was given to 7% of primarily admitted trauma patients in 2004. Only 2% were massively transfused and in this group mortality was high. All massive transfused patients except one received balanced treatment.