Evaluation of the interhospital patient transfer after implementation of a regionalized trauma care system (TraumaNetzwerk DGU®) in Germany

C Spering; D Bieler; S Ruchholtz; B Bouillon; R Hartensuer; W Lehmann; R Lefering; H Düsing; for Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU)

doi:10.3389/fmed.2023.1298562

Evaluation of the interhospital patient transfer after implementation of a regionalized trauma care system (TraumaNetzwerk DGU^®) in Germany

Front Med (Lausanne). 2023 Nov 15:10:1298562. doi: 10.3389/fmed.2023.1298562. eCollection 2023.

Authors

C Spering¹, D Bieler^{2

3}, S Ruchholtz⁴, B Bouillon⁵, R Hartensuer⁶, W Lehmann¹, R Lefering⁷, H Düsing⁸; for Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU)

Affiliations

¹ Department of Trauma Surgery, Orthopedics and Plastic Surgery, Göttingen University Medical Center, Göttingen, Germany.
² Department of Orthopaedics and Trauma Surgery, Heinrich Heine University Medical School, Düsseldorf, Germany.
³ Department of Orthopaedics and Trauma Surgery, Reconstructive Surgery, Hand Surgery, Plastic Surgery and Burn Medicine, German Armed Forces Central Hospital, Koblenz, Germany.
⁴ Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
⁵ Department of Trauma Surgery, Orthopedics and Sports Traumatology, University of Witten/Herdecke, Cologne, Germany.
⁶ Center for Orthopaedics, Trauma Surgery, Hand Surgery and Sports Medicine, Surgical Clinic II, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany.
⁷ Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany.
⁸ Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany.

Abstract

Purpose: The aim of the study was to evaluate how many patients are being transferred between trauma centers and and their characteristics in the 2006 initiated TraumaNetzwerk DGU^® (TNW). We further investigated the time point of transfer and differences in outcome, compared to patients not being transferred. We wanted to know how trauma centers judged the performance of the TNW in transfer.

Method: (1) We analyzed the data of the TraumaRegister DGU^® (TR-DGU) from 2014-2018. Included were patients that were treated in German trauma centers, maximum AIS (MAIS) >2 and MAIS 2 only in case of admission on ICU or death of the patient. Patients being transferred were compared to patients who were not. Characteristics were compared, and a logistic regression analysis performed to identify predictive factors. (2) We performed a survey in the TNW focussing on frequency, timing and communication between hospitals and improvement through TNW.

Results: Study I analyzed 143,195 patients from the TR-DGU. Their mean ISS was 17.8 points (SD 11.5). 56.4% were admitted primarily to a Level-I, 32.2% to a Level-II and 11.4% to a Level-III Trauma Center. 10,450 patients (7.9%) were transferred. 3,667 patients (22.7%) of the admitted patients of Level-III Center and 5,610 (12.6%) of Level-II Center were transferred, these patients showed a higher ISS (Level-III: 18.1 vs. 12.9; Level-II: 20.1 vs. 15.8) with more often a severe brain injury (AIS 3+) (Level-III: 43.6% vs. 13.1%; Level-II: 53.2% vs. 23.8%). Regression analysis showed ISS 25+ and severe brain injury AIS 3+ are predictive factors for patients needing a rapid transfer. Study II: 215 complete questionnaires (34%) of the 632 trauma centers. Transfers were executed within 2 h after the accident (Level-III: 55.3%; Level-II: 25.0%) and between 2-6 h (Level-III: 39.5%; Level-II: 51.3%). Most trauma centers judged that implementation of TNW improved trauma care significantly (Level III: 65.0%; Level-II: 61.4%, Level-I: 56.7%).

Conclusion: The implementation of TNW has improved the communication and quality of comprehensive trauma care of severely injured patients within Germany. Transfer is mostly organized efficient. Predictors such as higher level of head injury reveal that preclinical algorithm present a potential of further improvement.

Keywords: TraumaNetwork DGU®; TraumaRegister DGU®; interhospital transfer; polytrauma management; trauma; trauma care; trauma care system.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. We acknowledge support from the Open Access Publishing Fund of University of Muenster.