How the changes in the system affect trauma care provision: The assessment of and implications for Lithuanian trauma service performance in 2007–2012

• Main Authors: Žilvinas Dambrauskas, Vytautas Aukštakalnis, Aurika Karbonskienė, Dmitrijus Kačiurinas, Jolanta Vokietienė, Robertas Lapka, Algimantas Pamerneckas, Narūnas Porvaneckas, Kęstutis Stašaitis, Nedas Jasinskas, Paulius Dobožinskas, Dinas Vaitkaitis, Raimundas Lunevičius
• Format: Article
• Language: English
• Published: MDPI AG 2017-01-01
• Series: Medicina
• Subjects: Trauma service; Emergency medical service; Emergency department; Trauma center; Trauma system
• Online Access: http://www.sciencedirect.com/science/article/pii/S1010660X16301112

Objective: The aim of this study was to identify and assess the effects of changes in the Lithuanian trauma service from 2007 to 2012. We postulate that the implications derived from this study will be of importance to trauma policy planners and makers in Lithuania and throughout other countries of Eastern and Central Europe. Materials and methods: Out of 10,390 trauma admissions to four trauma centers in 2007, 294 patients (2.8%) were randomly selected for the first arm of a representative study sample. Similarly, of 9918 trauma admissions in 2012, 250 (2.5%) were randomly chosen for comparison in the study arm. Only cases with a diagnosis falling into the ICD-10 “S” and “T” codes were included. A survey of whom regarding changes in quality of trauma care from 2007 to 2012 was carried out by emergency medical service (EMS) providers. Results: The Revised Trauma Score (RTS) mean value was 7.45 ± 1.04 for the 2007 year arm; it was 7.53 ± 0.93 for the 2012 year arm (P = 0.33). Mean time from the moment of a call from the site of the traumatic event to the patient's arrival at the trauma center did not differ between the arms of the sample: 49.95 min in 2007 vs. 51.6 min in 2012 (P = 0.81). An application of the operational procedures such as a cervical spine protection using a hard collar, oxygen therapy, infusion of intravenous fluids, and pain relief on the trauma scene was more frequent in 2012 than in 2007. Management of trauma patients in the emergency department improved regarding the availability of 24/7 computed tomography scanner facilities and an on-site radiographer. Time to CT-scanning was reduced by 38.8%, and time to decision-making was reduced by 16.5% in 2012. Conclusions: Changes in operational procedures in the Lithuanian pre-hospital care provision and management of trauma patients in emergency departments of trauma centers improved the efficiency of trauma care delivery over the 2007–2012 period.