Prehospitale zorg aan polytraumapatiënten in Nederland

Abstract

This thesis evaluates the prehospital care and outcomes of severely injured patients. Chapter 1 addresses the impact of trauma on society and presents a brief outline of this thesis with description of the different studies that are reported. Chapter 2 describes the patients who were studied and the methods that were used. The studies had a prospective cohort design. Data were collected on 507 trauma patients with multiple injuries, with a Hospital Trauma Index-Injury Severity Score (HTI-ISS) of 16 or more. Data were also collected on 574 victims of non-natural death during the same period (1999, 2000). Chapter 3 describes the history of prehospital care from ancient times to the present with emphasis on the Dutch situation. Chapter 4 presents the results of the study on non-natural deaths. included 361 (63%) men and 213 women who had died from non-natural causes. Suicide was the most frequent cause, followed by traffic accidents and accidents at home. Chapter 5 reports on the study entitled 'Ambulance care for seriously injured patients: do intensive training and examinations result in better outcome for patients?' The study compared the ambulance services offered by the RAVU, whose staff had been receiving additional intensified in-house training and other services whose staff at the time were receiving only the compulsory national training for all Dutch ambulance staff. Patients handled by RAVU staffs were more likely to receive intravenous infusion therapy and painkillers. Treatment time at the scene of the accident was 4.7 minutes shorter for those handled by RAVU. There was no relation between these measures and ultimate mortality rates or morbidity. Chapter 6 describes the value and reliability of the Triage-Revised Trauma Score in ambulance care. The time patients spent in the crashroom and duration of ICU admission were highly dependent on the T-RTS. There was a good correlation between the T-RTS and the HTI-ISS. The T-RTS was a good predictor of a patient's probability of survival. Chapter 7 reports on a study of the changes in Triage-Revised Trauma Score between first assessment in the field and arrival at the hospital, as a predictor of mortality. Intubation and deteriorating T-RTS values are powerful predictors of mortality after presentation in the hospital. Chapter 8 discusses a study with the objective to determine which factors predict death in trauma patients who are alive on arrival in hospital. There was a clear relationship between the base excess (BE) and haemoglobin levels measured at arrival in the ER and the risk of death. The risk of death was 3.4 times higher in cases with isolated neurotrauma. Chapter 9 discusses a study to determine the background and consequences of failing to diagnose certain injuries in severely injured accident victims in prehospital care. The percentage of diagnoses missed varied from 9 to 55%. Failing to diagnose an injury did not in itself increase the risk of death. Spine injuries were more frequently missed if associated injuries were more serious.