News from the Swiss Trauma Registry

7th Swiss Trauma & Acute Care Surgery Days, 16th March 2018

Kai Oliver Jensen, Kai Sprengel University Hospital Zürich

Members of the Swiss Trauma Board: Hôpitaux universitaires de Genève, Centre Hospitalier Universitaire Vaudois, Inselspital Bern, Universitätsspital Basel, Universitätsspital Zürich, Kantonsspital St. Gallen, Luzerner Kantonsspital, Kantonsspital Aarau, Kantonsspital Graubünden, Kantonsspital Winterthur, Ente Ospedaliero Cantonale ‐ Standort Ospedale Regionale di Lugano, Gesundheitsnetzwerk Wallis ‐ Standort Sion The Swiss Trauma Registry

Introduction

Annual Report / First results

Audit 2017

Outlook The Swiss Trauma Registry

Introduction

Annual Report / First results

Audit 2017

Outlook Introduction: HSM Trauma Centers

Basel Bern Geneva Lausanne Zürich Aarau Chur Luzern St. Gallen Winterthur Sion Lugano Introduction: Time Line Introduction: Time Line The Swiss Trauma Registry

Introduction

Annual Report / First results

Audit 2017

Outlook Annual Report / First Results Annual Report / First Results

Inclusion criteria

STR criteria HSM criteria

Age (years) ≥ 16 ≥ 16

AND AIS Head (points) ≥ 3 ≥ 3

OR ISS (points) ≥ 16 ≥ 20 Annual Report / First Results

• Base data Parameter Percent / mean (Range) Total number of patients (2016) ‐ STR criteria n = 2451 ‐ HSM criteria n = 2159 Transferred (no HSM Trauma center) 24.6 % (n = 603) Transferred (HSM Trauma center) 1.5 % (n = 36) Primary admitted 73.9 % (n = 1812) Age 57.9 years (16 ‐ 113) Gender Male 72.8 % ; Female 27.2 % Trauma mechanism Blunt 96.3 % ; Penetrating 3.7 % Top 3 Fall < 3m (42.5%) Type and cause of accident Fall > 3m (13.2%) Traffic – bicycle (9%) Case Load STR criteria

600

528

500 473

411 396 400

300 265 260 221 204 193 200 189

140 138 123 132 131 110 112 93 95 97 99 100 83 82 60

0 all patients referred to STR criteria(ISS≥16, AISHead≥3, Age ≥16y); n=2181, 2451 Case Load HSM criteria

500 458 450 408 400 390 370

350

300

247 250 234

200 185 169 173 172

150 114 120 101 109 108 93 88 100 79 84 84 81 68 71 58 50

0 all patients referred to HSM criteria(ISS≥20, AISHead≥3, Age ≥16y); n=1905, 2159 Annual Report / First Results

• Distribution STR 2016 [%] DGU 2016 [%]

Head 51.0 51.9

Face 21.5 18.5

Neck 2.6 2.6

Thorax 73.8 79.2

Abdomen 33.0 28.0

Spine 48.7 45.8

Arms 41.8 42.0

Pelvis 31.2 28.8

Legs 28.9 34.5

DGU: «Benchmark group» 2016, n=6021, AIS≥2; STR: all patients, n=1092, AIS≥2 Annual Report / First Results

Injury Severity Score

N= 2451 ; median= 25; mean= 22.5 all patients 2016 referred to STR criteria(ISS≥16, AISHead≥3, Age ≥16y) Annual Report / First Results

Length of stay

N= 1812 ; median= 14; mean= 13 all patients 2016 referred to STR criteria(ISS≥16, AISHead≥3, Age ≥16y) only primary admitted Annual Report / First Results

• Further parameters

Parameter STR 2015 STR 2016 AIS Head ≥3 69.5 % 69,4 % GCS ≤8 on scene 21 % 20.8 % Intubation on scene/with GCS ≤8 22.4 % / 82.7 % 24.2 % / 71 % Shock on scene 7.4 % 7.1 % Shock on admission 8.5 % 6.2 % Transfusion of EC 1.4 % 0.9 % Massive transfusion (≥10 EC) 0.2 % 0.2 % Mortality 14.3 % 16.2 % Pre‐hospital time 75min (median), 72min (median), 163min (mean) 122 (mean)

all patients 2016 referred to STR criteria(ISS≥16, AISHead≥3, Age ≥16y) only primary admitted Annual Report / First Results

• Data quality

Parameter STR 2015

RRsys on scene *66%

GCS on scene *70%

INR resusc. room *75%

Base Excess 36% resusc. room Hb resusc. room *76%

*mandatory field STR Annual Report / First Results

• Data quality

Parameter STR 2015 STR 2016 DGU 2016

RRsys on scene *66% *88% 88%

GCS on scene *70% *78% 95%

INR resusc. room *75% *79% 94%

Base Excess 36% 51% 88% resusc. room Hb resusc. room *76% *80% 98%

*mandatory field STR Annual Report / First Results

• Data quality

Parameter STR 2015 STR 2016 STR 2017

RRsys on scene *66% *88% ??%

GCS on scene *70% *78% ??%

INR resusc. room *75% *79% ??%

Base Excess 36% 51% ??% resusc. room Hb resusc. room *76% *80% ??%

*mandatory field STR The Swiss Trauma Registry

Introduction

Annual Report / First results

Audit 2017

Outlook Audit 2017 Audit 2017

• 12 hospitals

• Patients admitted from 01/2016‐12/2016

• 10 patients

• 2 patients: AIS Head ≥ 3 • 4 patients: ISS 16‐19 • 4 patients: ISS 20+ Audit 2017

• Tolerances were defined before

• Results presented as: • Correct / complete • Incomplete / wrong • Missing value • Inconsistant Audit 2017 Audit 2017 Audit 2017

• Each hospital received his own audit report • One summarizing report for the STR • Results were presented in the STB Audit 2017

• Each hospital received his own audit report • One summarizing report for the STR • Results were presented in the STB • In total: High quality • Sources of errors identified • Changes/ adjustments made

• full auditing planned The Swiss Trauma Registry

Introduction

Annual Report / First results

Audit 2017

Outlook Outlook

• Further increase in data quality • Harmonisation of mandatory parameters to TR‐ DGU® • Changes / adjustments due to Audit 2017

• First studies planned

• Full auditing planned [email protected]

Technical Questions Registry ‐ [email protected] Medical Questions Registry ‐ [email protected] Questions Annual Report ‐ [email protected] Chairperson STB ‐ [email protected] Chairperson Advisory Board STB ‐ [email protected] AG Registerfragen STB ‐ [email protected]