The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

S. Dijkink*, E.W. van Zwet, P. Krijnen, L.P.H. Leenen, F.W. Bloemers, M.J.R. Edwards, D. Den Hartog, P.A. Leenhouts, M. Poeze, W.R. Spanjersberg, K.W. Wendt, R.J. De Wit, S.W.A.M. Van Zuthpen, I.B. Schipper

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] >= 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008-2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63-74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.
Original languageEnglish
Pages (from-to)1035-1043
Number of pages9
JournalEuropean Journal of Trauma and Emergency Surgery
Issue number2
Early online date12 Mar 2021
Publication statusPublished - Apr 2022


  • Regionalization of care
  • The Netherlands
  • Trauma care
  • Trauma system
  • TIME
  • MAP

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