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Mon Nov 26 17:34:42 GMT 2007

Karim,

The German Registry uses the RISC model for outcome prediction (rather
than TRISS), so direct comparisons are difficult (although the data
fields are present that could enable some comparisons with other
registries). An annual report is published, but is not well known
outside Germany (I think that only the 2005 report has been translated
into english), which is a great pity as there is very interesting data.
My impression is that until recently the German Registry has been run on
a shoestring so has not had the resources to make its information more
widely known. However, this year it has just had success in finding
longer term funding through the German Society of Surgery. Rolf Lefering
is the key individual on the data side.

We are trying to set up a system for international comparisons within
Europe (which could be interesting as there are very diverse trauma care
systems). We have tried for an EU grant (unsuccessful so far) and are
currently revisiting some data definitions to facilitate comparisons
(next meeting in Utstein in early December).

A study of the feasibility of international trauma data sharing and
comparison in Europe has been recently published: Resuscitation (2007)
75, 286-297.

Finding the funding for international comparisons might be very useful.
I share some of the concerns that comparisons are not 'like for like' at
present, but it is potentially a good way of looking at what works and
what doesn't work in trauma care.

Tim. Coats.
Professor of Emergency Medicine
Leicester University
(Chair, Trauma Audit and Research Network www.tarn.ac.uk)

-----Original Message-----
From: Karim Brohi [mailto:karim at trauma.org] 
Sent: 25 November 2007 11:18
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Trauma Care in the UK

Matthias

Any politician or otherwise who believes that regionalising trauma care
is an excuse to close hospitals or emergency departments has simply not
done the maths.  Unfortunately that's exactly what's happening in many
areas.
Major trauma is a small fraction (15%ish) of all trauma, and for the UK
at least represents 1 in 1000 emergency department visits.  

Emergency departments do not close if that one patient goes elsewhere.
If every injured patient is taken to a specialist centre, and it has to
manage every limb fracture, every rib fracture or spleen injury, it'll
be overwhelmed and be unable to deliver optimal care to those who would
benefit
- those with severe or complex injury.   Further, rehabilitation is
optimally delivered in local institutions close to where patients live,
and again these patients cannot take up acute beds in the specialist
centres.
If local hospitals are threatened because of the implementation of a
trauma system, there is something wrong with the system.

Are there any published outcome figures from the German Trauma Registry?
Undoubtedly some of the changes currently taking place within Germany
may have a negative impact on trauma care - but you have had a system
longer than any of us.  Any idea on national outcomes?

Karim

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
On Behalf Of Mathias Kalkum
Sent: 23 November 2007 17:42
To: Trauma &amp; Critical Care mailing list
Subject: Re: Trauma Care in the UK

Karim,

> - snip - So how do you transition ATLS principles from 'knowing' to
'doing' -
> and how do you do it on a national level?  (This applies to medical 
> education in general, but ATLS is a great starting point as it has 
> been so extensively studied)
interesting discussion indeed! In my part of the world there are
fundamental changes to come in the attitude towards trauma care.
Traditionally the care for the injured was part of any hospitals duty
and there was a long fight to establish trauma surgery (Unfallchirurgie)
as a profession. Keep in mind that those trauma surgeons, once
established, recently decided to merge with orthopedic surgeons. In my
view, they will in short loose the close connection to anything besides
bone and joint surgery. A pity in a country where the bulk of trauma
still is blunt trauma.

Second, the DGU (German society of trauma surgery) licensed only a short
time ago the ATLS system. So there are still few of those staff members,
who deal with trauma, trained in ATLS.

Third, the DGU developed a national trauma registry, unfortunately not
mandatory.

And fourth, the plan is to establish local trauma networks with only few
dedicated trauma centres - about 15% of the hospitals now offering
trauma care shall do that in the future.

Now, will that  be good or bad? As a surgeon with interest in trauma,
living and working in a rural part of my country, my emotions are mixed:
in contrary to many "centres of excellence" my shop is a member of the
trauma registry since a couple of years and thus I now that at least
trauma care *can* be delivered in small hospitals at least as good as in
dedicated trauma centres. I encourage awareness to trauma, a *mandatory*
participation in a national registry and accepted training guidelines.
But I doubt, whether the separation of trauma care from general surgery
will do good at the long run and I have pretty much doubt if the
hospital companies are willing to pay for mandatory ATLS training (and
recertification, for that matter). My fear is, this will only speed up
the rapid change in my countries health care system and extinguish local
hospitals *without* thinking.

My 2 cents.

Mathias
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