Trauma registry

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The trauma registry of the German Society of Trauma Surgery ( own notation : Trauma Registry DGU ) is an association accident surgical focus clinics for scientific and standardized collection and analysis of accident injuries and treating accident injured patients and a registered trademark. The data is collected anonymously and prospectively from the scene of the accident to discharge from the hospital. The aim is to improve the care of accident victims, to integrate as many trauma surgery clinics as possible across the board and to develop treatment guidelines. The Trauma Network DGU was founded for increasing networking .

The DGU trauma register is managed as a working group under the leadership of Rolf Lefering and Thomas Paffrath from Cologne within the Emergency, Intensive Care Medicine and Seriously Injured Care Section of the German Society for Trauma Surgery .

history

A meeting on scoring systems at the DGU's annual meeting in November 1989 under the direction of Schmit-Neuerburg from Essen resulted in the establishment of a scoring working group in the DGU, which was set up in Essen in January 1992 and in which six clinics initially took part. In January 1993 the first documentation sheet was presented, which was tested at the five founding clinics. After a symposium in October 1993, the trauma registry was established.

The first standardized annual report was published in 1997, and since then results have been published annually for each participating clinic, which positions them in comparison to the whole. After funding from the German Research Foundation expired in 2002 and the manual central data entry of the questionnaires previously filled out on paper could no longer be financed, an Internet-supported input platform was set up. Since then, data has been collected online .

With a "White Paper serious injuries supply", which was released in 2006, called for the trauma registry and the DGU a nationwide introduction of a three-coordinated network trauma surgical clinics to care for polytrauma -Patients, the requirements for the availability of clinics and made to quality management.

Based on this, a nationwide trauma network was initiated together with the DGU in 2008 , which is intended to enable a complete record of all clinics that take care of the care of accident victims. By 2014, 600 trauma centers of the first to third order were organized in 45 regional trauma networks. The affiliated trauma centers are audited and certified every three years . Participating clinics have since been obliged to submit data.

Since 2009 the Academy for Trauma Surgery, which belongs to the DGU, has taken over the financing and operation of the infrastructure.

Elevation

The data is recorded online using five questionnaires to be recorded at different times:

  • S: master data
  • A: Findings when the emergency doctor arrives at the scene of the accident
  • B: Findings at hospital / emergency room
  • C: Findings on admission to the intensive care unit
  • D: Findings on discharge / graduation, divided into three sections

Inclusion and exclusion criteria

First of all, all patients were recorded who were admitted to the emergency room and who were potentially in need of intensive care . As of 2013, the inclusion criterion was made more precise so that patients are also recorded who reach the hospital alive but die before admission to the intensive care unit.

Patients who are no longer alive when admitted to the emergency room, patients with severe burns , who have hanged themselves, who have been drowning or have been poisoned are excluded . Accidents of all ages, including children, are recorded.

Data evaluation

The most important results for the DGU trauma register are the mortality ( lethality ), the length of the hospital stay and the state of health or degree of disability at discharge. These parameters depend primarily on the injury pattern and the injury severity, which is why an adjustment must be made in order to compare the clinics with one another . At the same time, one of the goals of the DGU trauma registry is to be able to make a survival prognosis based on the injury pattern and severity at the time of admission to the hospital.

Two scores are mainly used for this. Initially, the TRISS score was used as an orientation , which was developed in America in the 1980s as an age-adapted calculation from two other common accident scores, the Revised Trauma Score (RTS) and the Injury Severity Score (ISS). Since 2004 this has been replaced by the Revised Injury Severity Classification Score (RISC score), which in turn was developed directly from the data of the DGU trauma register. Ten weighted indicators are included in the calculation, and a probability of survival can be calculated directly. In a study by the score developers, the RISC score has shown that it is more accurate than other scores.

One criticism of the quality of the results of the registry data is the incomplete data collection - due to the high number of data to be entered and often insufficient time in everyday clinical practice - as well as problems with the validity of the data.

Quality management

Every year the results of the DGU trauma register are published in the form of an annual report, and each participating clinic can receive its own report that compares the clinic's own results with the previous results and the overall collective. As part of the quality management of the clinic involved, the report is used to monitor the quality of care in the care of the severely injured, and the development of the quality indicators can be seen directly.

Special quality indicators for process quality are also analyzed, with the aim of improving the quality of care with indicators that change over the years. Eight indicators are currently being recorded, three of which are pre-clinical , i. H. before or until hospital admission. These are the period from the time of the accident to admission to the emergency room, the intubation rate in the case of severe thoracic trauma or if a severe traumatic brain injury is suspected. In the shock room, the times that elapse before individual important diagnostic procedures are carried out are recorded, currently the x-rays of the pelvis, lungs, the ultrasound examination of the abdominal and chest cavity ( FAST ) and computed tomography of the skull or the whole body.

Data collected

According to the 2009 annual report, data on 42,248 patients had been collected by the end of 2008. 166 clinics took part, eleven of them Austrian, four Slovenian, and one Belgian, one Dutch and one Swiss clinic each.

In the first twenty years until the end of 2012, 49,801 seriously injured people were recorded. 72% of them are men. The mean age was 46.3 years and 3.7% of those surveyed were children under 16 years of age. The cause of the accident was predominantly a traffic accident (60.2%), but it decreased over time, followed by falls from low heights (less than three meters), which are particularly common among seriously injured persons over 60 years of age. Penetrating injuries ( blow - stitch -, gunshot wounds ) are rare in Germany with 4.2%. Head injuries (with AIS> 3) were found in 55.3% of those recorded. The average hospital stay was 23 days, with a clear downward trend from an average of 30 days at the beginning (1990s) to 21 days (2012). The in-hospital mortality was 19.0% and there was a slight decrease.

In a further analysis of the results between 2002 and 2011 (35,432 seriously injured) it was found that most accidents occurred in the afternoon and early evening, with the highest value of over 7% at 5 p.m. The lowest values ​​below two percent per hour were between one o'clock and six in the morning.

For 2016, the trauma register recorded 33,374 seriously injured people, 70% were men, the mean age was 51 years. Almost half of all accidents warned of traffic accidents, the second most common cause of accidents was falls from a great height (at least three meters). Serious injuries to the head (48%) and chest (45%) were the most common. The proportion of seriously injured persons with an ISS of at least 16 points was 55%. On average, the patients reached the emergency room 63 minutes after the accident, where care lasted a mean 74 minutes for the third of the patients, who then had to be operated on directly, or a mean 82 minutes for the other patients until they were transferred to the intensive care unit. A full-body CT was available after an average of 22 minutes. The severely injured patients required an average of two operations, and the mean stay in an intensive care unit was six days and the mean hospital stay fifteen days. In 2016, 11.3% of patients died as a result of the accident while they were hospitalized.

Over the course of the week, Saturday was the day with the most accidents at 16.4%, while Tuesdays and Wednesdays had the lowest frequency (13.4% and 13.3%, respectively). On Sunday, the rate of motorcycle accidents was significantly increased (20.4% of accidents, 12.1% on weekdays), as was the rate of suicide (6.5%).

In the seasonal course, most accidents were recorded in June and July with 10.0% and 10.1%, while between December and February the frequency was only between 6.1 and 6.2%. A connection with the moon phases could not be found.

Results

In addition to the establishment of a nationwide trauma network with defined responsibilities and established cooperation, the trauma register has also medically influenced the care of the seriously injured through the scientific analyzes. The following are mentioned in particular:

By 2014, the trauma register had produced over 230 scientific publications.

Web links

Individual evidence

  1. ^ Working group "Scoring" of the German Society for Trauma Surgery: The trauma register of the German Society for Trauma Surgery . Trauma surgeon 1994; 97: 230-237
  2. ↑ White Paper Care for Severely Injured People (PDF; 220.40 KB) German Society for Trauma Surgery (Ed.). September 2006. Archived from the original on November 4, 2009. Info: The archive link was automatically inserted and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Retrieved February 12, 2010. @1@ 2Template: Webachiv / IABot / www.dgu-traumanetzwerk.de
  3. ↑ TraumaRegister DGU: 20 years TraumaRegister DGU: Development, aims and structure . Injury 2014, Volume 45, Supplement 3 from October 2014, Pages S6-S13, [DOI: 10.1016 / j.injury.2014.08.011]
  4. ↑ R. Lefering: Development and validation of the Revised Injury Severity Classification (RISC) score for severely injured patients . Europ. J. Trauma Emerg. Surg. 2009, 35: 437-447
  5. ↑ HC Pape et al: Documentation of blunt trauma in Europe . Europ. J. of Trauma 2000; 5: 233-247
  6. ↑ a b Annual report 2009 of the trauma register (PDF) German Society for Trauma Surgery (Ed.). 2009. Accessed on February 12, 2010.  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.@1@ 2Template: Toter Link / www.traumaregister.de  
  7. ↑ TraumaRegister DGU: 20 years of Trauma documentation in Germany - Actual Trends and developments . Injury 2014, Volume 45, Supplement 3 from October 2014, Pages S14-S19, [DOI: 10.1016 / j.injury.2014.08.012]
  8. ^ Carolina IA Pape-Koehler, Christian Simanski, Ulrike Nienaber, Rolf Lefering: External factors and the incidence of severe trauma: Time, date, Season and moon . Injury 2014, Volume 45, Supplement 3 from October 2014, Pages S93-S99, [DOI: 10.1016 / j.injury.2014.08.027]
  9. ↑ Susanne Herda, Swetlana Meier: TraumaRegister DGU annual report: Over 33,000 seriously injured people in 2016 . Orthopedics and Trauma Surgery 2018, Volume 8, Issue 1, page 78. Annual report as download ( memento of the original from March 12, 2018 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.traumaregister-dgu.de
  10. ^ Bertil Bouillon , Reinhard Hoffmann , Hartmut Siebert: Preface . Injury 2014, Volume 45, Supplement 3 from October 2014, Pages S4-S5, [DOI: 10.1016 / j.injury.2014.08.010]