EuroTrauma, delays in access to bleeding control. A comparison between a conventional and a hybrid trauma center, both European military trauma centers

Hilaire de Malleray; Lisa Hackenberg; Michael Cardinale; Erwin Kollig; Robert Schwab; Julien Bordes; Dan Bieler

doi:10.1007/s00068-024-02455-5

EuroTrauma, delays in access to bleeding control. A comparison between a conventional and a hybrid trauma center, both European military trauma centers

Eur J Trauma Emerg Surg. 2024 Jan 30. doi: 10.1007/s00068-024-02455-5. Online ahead of print.

Authors

Hilaire de Malleray^#¹, Lisa Hackenberg^#², Michael Cardinale³, Erwin Kollig², Robert Schwab⁴, Julien Bordes³, Dan Bieler^{2

5}

Affiliations

¹ ICU, Sainte Anne Military Teaching Hospital, Toulon, France. hmalleray@hotmail.fr.
² Department for Trauma Surgery and Orthopedics, Reconstructive and Hand Surgery, Burn Medicine, German Armed Forces Central Hospital, Koblenz, Germany.
³ ICU, Sainte Anne Military Teaching Hospital, Toulon, France.
⁴ Department of Visceral and Thorax Surgery, German Armed Forces Central Hospital, Koblenz, Germany.
⁵ Department of Orthopedics and Trauma Surgery, Heinrich Heine University Hospital, Düsseldorf, Germany.

^# Contributed equally.

PMID: 38289419
DOI: 10.1007/s00068-024-02455-5

Abstract

Purpose: Comparison of access times to CT and surgical/radiological bleeding control between two European military trauma centers.

Methods: Retrospective and observational study conducted in two military level 1 trauma centers in Toulon (France) and Koblenz (Germany) between 2013 and 2018. Inclusion of severe trauma patients with ISS > 15 with clinical and biological criteria of bleeding.

Results: Inclusion of 607 patients (318 in Toulon and 289 in Koblenz). Mean ISS 30. Median access time to CT significantly lower for Koblenz, 14 vs. 30 min; p < 0.001. Median access time to the emergency bleeding control lower in Toulon 84 min vs. 92 (p = 0.114). No impact on mortality at 24 h 9% in Koblenz and 11% in Toulon. Mortality at 28 days identical 17%.

Conclusion: The organizational innovation at the military hospital in Koblenz saves time in the injury assessment. However, it has no impact on the access time to the scanner and on the mortality at 24 and 28 days. This fight against hemorrhage is a management bundle including delays, transfusion, and team training.

Clinical trial registration: 2,002,878 v 0.

Keywords: French-German cooperation; Military health service; Trauma room; Trauma workflow; Whole-body computed tomography.