PhD defence J.C. (Jan) van Ditshuizen

Below is a brief summary of the dissertation:

Modern society faces an ongoing challenge with five million trauma-related deaths annually, and approximately ten percent loss of disability adjusted life years due to injuries worldwide. Trauma can result in impaired quality of life, limited return to work, post-traumatic stress, and social limitations. Dutch acute trauma care is organised in networks. Within these networks a trauma registry is maintained. Major trauma care in a network was evaluated in this thesis, based on trauma registry data.

The quality of trauma care evaluation based on registrations can be improved. Missed registrations occur frequently, which requires a human touch. Using a standardized radiologic report can improve quality of injury coding, thus classification of trauma populations. And, the definition of major trauma is subject to time, especially if a new coding book is implemented or if the time span of a study overlaps different revisions this codebook.

With the implementation of trauma networks, levels of trauma care were introduced. This has been linked to improvements in survival and other outcomes. Two systematic reviews confirmed a survival benefit for major trauma populations, when admitted to a level I trauma centre. These results were not found in a local network, suggesting most major trauma patients with a high mortality probability were adequately triaged.

Major trauma patients admitted to a level I trauma centre reported a health-related quality of life that is below populations norms. Many report elements of depression, anxiety, and post-traumatic stress, and are not able to return to work. Adjusted analysis displayed homogeneous results across trauma networks, which is a performance of a matured network ready for further development in the near future.