Injury, Int. J. Care Injured 45S (2014) S4–S5
Contents lists available at ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
Preface
The reason to start a German Trauma Registry more than 20 years ago was a controversial discussion on how to best define a polytrauma patient. Advantages and disadvantages of scoring systems like the Trauma Score, Injury Severity Score, TRISS and the German Hannover Polytrauma Score were debated. Studies performed by single hospitals evaluating the accuracy of these scores had limitations as the number of patients treated in each hospital was too small for validation. Multicenter studies sharing data between hospitals were unusual as research in those days was rather competitive. Most hospitals treating trauma patients wanted to show that they performed best. Three trauma leaders Schmit-Neuerburg, Schweiberer and Tscherne suggested to aggregate the research potential in that field under the auspices of the German Trauma Society. The first meeting took place in 1992 at the Trauma Department of the University Hospital in Essen. Under the leadership of Oestern, Nast-Kolb and Neugebauer a task force on ‘‘scoring systems’’ was founded. In order to evaluate scoring systems it became clear that a trauma registry was needed. There was a controversial discussion which and how many variables should be included in such a registry. Another important question was how participating hospitals could get comparative feedback on their performance while anonymity of the data would be ensured? Finally three main goals of the trauma registry were defined [1]: - Documentation of epidemiology and monitor changes over time - Support of a quality improvement programmes - Establishing a data bank for scientific evaluation At that time results from the Major Trauma Outcome Study (MTOS) initiated by the American College of Surgeons (ACS) were published [2]. These results were considered when designing the TraumaRegister DGU1. Additionally, the group suggested to also include data on the timing of diagnostics and treatment. This would enable feedback not only on outcome but also on the process of care. In 1993 the TraumaRegister DGU1 started and 260 severely injured patients from five trauma centres were included in that first year. Since then the registry has grown to more than 30.000 patients included in 2013. In the first years effort was put on increasing the quality of data, the definition of each variable and the acquisition of more participating hospitals. In 1997 the first standardised annual report was fed back to each hospital and since then annual meetings of all participating hospitals were established. http://dx.doi.org/10.1016/j.injury.2014.08.010 0020–1383/ß 2014 Published by Elsevier Ltd.
The most important achievement of the task force was that it established confidence between group members and participating hospitals. This was a solid base of trust that helped to overcome daily problems like lack of resources, work load and quality assurance. With time the task force as well as board members of the German Trauma Society realised that the registry had real impact. Research projects resulted in publications and changed daily practice. Today less fluids are administered during prehospital care, the use of whole body CT scan in the initial evaluation of trauma patients has been established and early treatment of coagulopathy has resulted in reduced mortality rates. Follow-up studies on these topics are presented in the present supplement. The German Trauma Society also realised the high potential of the task force [3]. Therefore, they also gave responsibility to the group to initiate the ATLS1 program in Germany in 2002 and to establish evidence based clinical practice guidelines in 2004 [4]. In 2006 insufficient financial compensation for trauma centres threatened the quality of trauma care in Germany. At that time the German Trauma Society decided to go one step further and initiated the TraumaNetzwerk DGU1. The aim was to establish a nation wide comprehensive trauma system in order to maintain or improve the quality of trauma care by improving communication and establishing standards of care [5,6]. Designated trauma centres were audited and certified every three years. Today more than 600 trauma centres cooperate in 45 regional trauma networks nationwide. They report data on all their severely injured patients to the TraumaRegister DGU1. This enables continuous feedback and supports strategies for further improvement of the quality of care. In this supplement, Ruchholtz and colleagues expand on the current development and status of the TraumaNetzwerk DGU1 with focus on optimising patient flow and management. It all started with the initiation of the TraumaRegister DGU1 20 years ago. Today Germany has a comprehensive nationwide trauma system. The success of the project was only possible due to the excellent network provided by the task force that originally started the TraumaRegister DGU1 and the confidence they established. The many enthusiasts working in the task force over the many years, their responsibility under the guidance of the German Trauma Society and the response of those caring for trauma patients in the pre-hospital emergency services, trauma and rehabilitation centres had a profound impact on the clinical care of polytrauma patients in Germany.
Preface / Injury, Int. J. Care Injured 45S (2014) S4–S5
Bertil Bouillon1,* Reinhard Hoffmann2 Hartmut Siebert3 German Trauma Society, Germany
Conflict of interest None. References [1] Mathis-Edenhofer L, Piso B. Types of medical registries – definitions, methodological aspects and quality of the scientific work with registries. Wien Med Wochenschr 2011;161:580–90. [2] Champion HR, Copes WS, Sacco WJ, Lawnick MM, Keast SL, Bain LW, et al. The major trauma outcome study: establishing national norms for trauma care. JTrauma 1990;11:1356–65. [3] Fingerhut A, Boffard KD. Impact of trauma societies on the clinical care of polytrauma patients. Eur J Trauma Emerg Surg 2012;38:223–9. [4] German Trauma Society. Clinical Practice Guidelines Polytrauma;http:// www.awmf.org/leitlinien/detail/ll/012-019.html. 2012. [5] German Trauma Society. Whitebook Medical Care of the Severely Injured;http://www.dgu-online.de/fileadmin/published_content/5.Qualitaet_und_Sicherheit/PDF/2012_DGU_Whitebook_Medical_Care_2ndEdition.pdf. 2012. [6] Ruchholtz S, Mands C, Lewan U, Debus F, Dankowski C, et al., AKUT-Steering Committee. Regionalization of trauma care in Germany: the ‘‘TraumaNetwork DGU1-Project’’. Eur J Trauma Emerg Surg 2012;38:11–7.
S5
Johannes Sturm AUC – Academy for Trauma Surgery, Germany *Corresponding author E-mail addresses: [email protected], [email protected] (B. Bouillon). 1 President of the German Trauma Society. Secretary General of the German Trauma Society. 3 Served as Secretary General of the German Trauma Society from 2005 to 2013. 2
Contents lists available at ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
Preface
The reason to start a German Trauma Registry more than 20 years ago was a controversial discussion on how to best define a polytrauma patient. Advantages and disadvantages of scoring systems like the Trauma Score, Injury Severity Score, TRISS and the German Hannover Polytrauma Score were debated. Studies performed by single hospitals evaluating the accuracy of these scores had limitations as the number of patients treated in each hospital was too small for validation. Multicenter studies sharing data between hospitals were unusual as research in those days was rather competitive. Most hospitals treating trauma patients wanted to show that they performed best. Three trauma leaders Schmit-Neuerburg, Schweiberer and Tscherne suggested to aggregate the research potential in that field under the auspices of the German Trauma Society. The first meeting took place in 1992 at the Trauma Department of the University Hospital in Essen. Under the leadership of Oestern, Nast-Kolb and Neugebauer a task force on ‘‘scoring systems’’ was founded. In order to evaluate scoring systems it became clear that a trauma registry was needed. There was a controversial discussion which and how many variables should be included in such a registry. Another important question was how participating hospitals could get comparative feedback on their performance while anonymity of the data would be ensured? Finally three main goals of the trauma registry were defined [1]: - Documentation of epidemiology and monitor changes over time - Support of a quality improvement programmes - Establishing a data bank for scientific evaluation At that time results from the Major Trauma Outcome Study (MTOS) initiated by the American College of Surgeons (ACS) were published [2]. These results were considered when designing the TraumaRegister DGU1. Additionally, the group suggested to also include data on the timing of diagnostics and treatment. This would enable feedback not only on outcome but also on the process of care. In 1993 the TraumaRegister DGU1 started and 260 severely injured patients from five trauma centres were included in that first year. Since then the registry has grown to more than 30.000 patients included in 2013. In the first years effort was put on increasing the quality of data, the definition of each variable and the acquisition of more participating hospitals. In 1997 the first standardised annual report was fed back to each hospital and since then annual meetings of all participating hospitals were established. http://dx.doi.org/10.1016/j.injury.2014.08.010 0020–1383/ß 2014 Published by Elsevier Ltd.
The most important achievement of the task force was that it established confidence between group members and participating hospitals. This was a solid base of trust that helped to overcome daily problems like lack of resources, work load and quality assurance. With time the task force as well as board members of the German Trauma Society realised that the registry had real impact. Research projects resulted in publications and changed daily practice. Today less fluids are administered during prehospital care, the use of whole body CT scan in the initial evaluation of trauma patients has been established and early treatment of coagulopathy has resulted in reduced mortality rates. Follow-up studies on these topics are presented in the present supplement. The German Trauma Society also realised the high potential of the task force [3]. Therefore, they also gave responsibility to the group to initiate the ATLS1 program in Germany in 2002 and to establish evidence based clinical practice guidelines in 2004 [4]. In 2006 insufficient financial compensation for trauma centres threatened the quality of trauma care in Germany. At that time the German Trauma Society decided to go one step further and initiated the TraumaNetzwerk DGU1. The aim was to establish a nation wide comprehensive trauma system in order to maintain or improve the quality of trauma care by improving communication and establishing standards of care [5,6]. Designated trauma centres were audited and certified every three years. Today more than 600 trauma centres cooperate in 45 regional trauma networks nationwide. They report data on all their severely injured patients to the TraumaRegister DGU1. This enables continuous feedback and supports strategies for further improvement of the quality of care. In this supplement, Ruchholtz and colleagues expand on the current development and status of the TraumaNetzwerk DGU1 with focus on optimising patient flow and management. It all started with the initiation of the TraumaRegister DGU1 20 years ago. Today Germany has a comprehensive nationwide trauma system. The success of the project was only possible due to the excellent network provided by the task force that originally started the TraumaRegister DGU1 and the confidence they established. The many enthusiasts working in the task force over the many years, their responsibility under the guidance of the German Trauma Society and the response of those caring for trauma patients in the pre-hospital emergency services, trauma and rehabilitation centres had a profound impact on the clinical care of polytrauma patients in Germany.
Preface / Injury, Int. J. Care Injured 45S (2014) S4–S5
Bertil Bouillon1,* Reinhard Hoffmann2 Hartmut Siebert3 German Trauma Society, Germany
Conflict of interest None. References [1] Mathis-Edenhofer L, Piso B. Types of medical registries – definitions, methodological aspects and quality of the scientific work with registries. Wien Med Wochenschr 2011;161:580–90. [2] Champion HR, Copes WS, Sacco WJ, Lawnick MM, Keast SL, Bain LW, et al. The major trauma outcome study: establishing national norms for trauma care. JTrauma 1990;11:1356–65. [3] Fingerhut A, Boffard KD. Impact of trauma societies on the clinical care of polytrauma patients. Eur J Trauma Emerg Surg 2012;38:223–9. [4] German Trauma Society. Clinical Practice Guidelines Polytrauma;http:// www.awmf.org/leitlinien/detail/ll/012-019.html. 2012. [5] German Trauma Society. Whitebook Medical Care of the Severely Injured;http://www.dgu-online.de/fileadmin/published_content/5.Qualitaet_und_Sicherheit/PDF/2012_DGU_Whitebook_Medical_Care_2ndEdition.pdf. 2012. [6] Ruchholtz S, Mands C, Lewan U, Debus F, Dankowski C, et al., AKUT-Steering Committee. Regionalization of trauma care in Germany: the ‘‘TraumaNetwork DGU1-Project’’. Eur J Trauma Emerg Surg 2012;38:11–7.
S5
Johannes Sturm AUC – Academy for Trauma Surgery, Germany *Corresponding author E-mail addresses: [email protected], [email protected] (B. Bouillon). 1 President of the German Trauma Society. Secretary General of the German Trauma Society. 3 Served as Secretary General of the German Trauma Society from 2005 to 2013. 2
