Despite important improvements in the treatment of the severely injured, in the Netherlands just as many people are dying after an accident as fifteen years ago. This has been revealed by PhD research by Annemarie Nijboer. Although Dutch trauma care is very high quality, patients are getting older and have more serious injuries, concludes the researcher. ‘We need to improve the treatment before reaching the hospital and concentrate even more on the prevention of accidents and injury. Perhaps it’s time that all cyclists were made to wear helmets.’ Nijboer will be awarded a PhD in Medical Sciences on 18 November 2009.
Of all the patients who were treated in the UMCG Trauma Center Noord Nederland between 2002 and 2005 for serious injuries, 25% eventually died from them. An analysis of more than 1300 patients has revealed that this is just as many as twenty years ago. On the bright side, however, a greater percentage of the patients who survive recover well or reasonably well - 67% now as opposed to 40% twenty years ago.
More cycle helmets
Analysis has revealed that more and more of the seriously injured have severe head and neck injuries – 62% of patients twenty years ago and 73% now. The prospects for these patients are very poor, despite optimum treatment. ‘If we want to improve results we will have to concentrate on better prevention,’ according to the PhD student. ‘Perhaps it’s time to make wearing a cycle helmet compulsory in the Netherlands, just like in many other Western countries.’
More attention for older people
It is noticeable that the average age of patients admitted to the trauma centre has risen over the last twenty years – from 33 to 41 years of age. This change in the patient population reflects the general ageing of Dutch society. Nijboer thinks that too little attention is paid to this ageing. It is well known that the consequences of even minor accidents are usually much more serious for older people than for younger victims. However, international guidelines for emergency treatment are primarily based on the seriousness of the accident. Older patients who at first sight may have had a less serious accident thus perhaps do not receive optimum treatment. Nijboer is proposing a review of the existing guidelines, with the patient’s age and pre-existing illnesses playing an important role.
More mobile medical teams
Important advances could be made by improving treatment at the scene of the accident and during transport to hospital, states Nijboer. Dutch ambulance personnel is thoroughly trained, but the acute treatment of a severely injured patient usually needs the intervention of a specialized physician. This is the case, for example, in life-threatening situations where the patient is having difficulty breathing. Nijboer: ‘Mobile medical teams have the necessary specialized knowledge. Sadly, however, not all severely injured people are cared for by a mobile medical team. There are still areas in the Netherlands that are not covered by a mobile medical team. That is a serious deficiency. Germany, for instance, is much better at this than we are.’
Fewer anti-coagulants
Nijboer states that the increase in serious head injuries is possibly a result of the current use of anti-coagulants by people with cardiovascular disease. ‘This medication reduces the chances of complications from cardiovascular disease, but can also be harmful for older patients. Older people fall relatively often. The anti-coagulants in combination with more vulnerable blood vessels in the head increase the risk of cerebral haemorrhage. The individual risk for each patient must be assessed – which is greater, the chance of a cardiovascular complication or the chance of an accident.’
Curriculum Vitae
Annemarie Nijboer (Wijhe, 1977) studied medicine at the University of Groningen. She conducted her PhD research at the Surgery department of the University Medical Center Groningen (UMCG). Her supervisors were Prof. H.J. ten Duis and Prof. H.J. Oestern (Germany). Nijboer is training to be a surgeon at the Isala Hospital [Isala Klinieken] in Zwolle. The title of her thesis is ‘New Insights in Outcome after Major Trauma’.
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