Universität zu Köln

Boehmer, Andreas B., Poels, Marcel, Kleinbrahm, Kathrin, Lefering, Rolf, Paffrath, Thomas, Bouillon, Bertil, Defosse, Jerome Michel, Gerbershagen, Mark U., Wappler, Frank and Joppich, Robin (2016). Change of initial and ICU treatment over time in trauma patients. An analysis from the TraumaRegister DGUA (R). Langenbecks Arch. Surg., 401 (4). S. 531 - 541. NEW YORK: SPRINGER. ISSN 1435-2451

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Abstract

Clinical guidelines have been standardized for pre- and in-hospital trauma management in the last decades. Therefore, it is known that prehospital management has changed significantly. Furthermore, in-hospital course may be altered to reduce complications and length of stay (LOS). However, the development of trauma patient in-hospital management as well as LOS in the intensive care unit (ICU) has not been investigated systematically over a long-term period in Germany. Aim of our study is to examine the changes in in-hospital management and LOS in the ICU in moderately and severely injured patients. Patients documented in the TraumaRegister DGUA (R) (TR-DGU) of the German Trauma Society from 2000 to 2011 and admitted to ICU were included in this study. Demographic data, the pattern of injury, injury severity, duration of mechanical ventilation, LOS in the ICU, hospital LOS, and discharge destination were evaluated. The mean values and the standard deviations are shown. The constant variables were calculated with changes over time analyzed by linear regression analysis, and categorical variables were calculated with the chi-square test. A total of 18,048 patients were analyzed. The rate of patients being intubated at the time of ICU admission decreased from 86.8 % in 2000 to 60.0 % in 2011 (p < 0.001). The time of mechanical ventilation decreased from 7.5 +/- 10.5 to 4.7 +/- 8.7 days. The intensive care unit LOS was reduced from 11.7 +/- 12.8 to 9.0 +/- 11.3 days and the length of hospital stay from 27.9 +/- 28.7 to 21.1 +/- 20.4 days (both p < 0.01). The ICU LOS remained stable in the subgroup of mechanically ventilated patients (12.7 +/- 13.2 day in 2000, 12,6 +/- 12.9 in 2011, p = 0.6), whereas it was reduced in non-mechanically ventilated patients (5.5 +/- 6.8 days in 2000, 3.6 +/- 4.5 days in 2011; p < 0.001). The reduction LOS in the analyzed dataset is mainly explained by the relevantly reduced rate of patients being intubated at the time of ICU admission. Our data demonstrate that trauma patients' in-hospital course is influenced by reduced intubation rate at the time of ICU admission.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Boehmer, Andreas B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Poels, Marcel UNSPECIFIED UNSPECIFIED UNSPECIFIED Kleinbrahm, Kathrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Lefering, Rolf UNSPECIFIED UNSPECIFIED UNSPECIFIED Paffrath, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Bouillon, Bertil UNSPECIFIED UNSPECIFIED UNSPECIFIED Defosse, Jerome Michel UNSPECIFIED UNSPECIFIED UNSPECIFIED Gerbershagen, Mark U. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wappler, Frank UNSPECIFIED UNSPECIFIED UNSPECIFIED Joppich, Robin UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-273633
DOI:	10.1007/s00423-016-1428-x
Journal or Publication Title:	Langenbecks Arch. Surg.
Volume:	401
Number:	4
Page Range:	S. 531 - 541
Date:	2016
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1435-2451
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PROSPECTIVE PAYMENT SYSTEM; NONINVASIVE VENTILATION; PREHOSPITAL INTUBATION; CHEST TRAUMA; MANAGEMENT; CARE; INJURY; IMPLEMENTATION; POLYTRAUMA; QUALITY Multiple languages Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/27363