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The effect of a new in-hospital trauma care model on the outcomes of severely injured trauma patients in the emergency department: a retrospective observational study in China

BMC Emergency Medicine volume 25, Article number: 47 (2025) Cite this article

Abstract

Background

The mortality and disability rates among severely injured trauma patients are very high. This study aimed to investigate whether a new in-hospital trauma care model can improve emergency care efficiency and enhance the prognosis of severely injured trauma patients.

Methods

This retrospective observational study included 366 severely injured trauma patients (ISS ≥ 16) who were admitted to the emergency department of a tertiary hospital between 2023 and 2024. Based on the emergency care model used, patients were divided into the traditional model group (n = 213) from January to April 2023 and the new model group (n = 153) from January to April 2024. The general clinical data, prognosis information, as well as seven emergency quality control indicators for both groups were collected and analyzed.

Results

The study included 270 male patients (73.8%) and 96 female patients (26.2%), with a mean age of 56 (44, 69) years. No significant differences were found between the two groups regarding gender, age, time since injury, mechanism of injury, and vital signs upon admission (P > 0.05). The new model group had significantly shorter times for establishing effective circulation access (15.66 ± 3.36 vs. 9.44 ± 3.18 min), establishing an artificial airway (36.90 ± 12.23 vs. 23.91 ± 9.07 min), preparing blood transfusion (48.84 ± 5.73 vs. 31.0 ± 64.67 min), completing whole-body CT scans (57.18 ± 8.26 vs. 42.17 ± 7.28 min), and developing a definitive treatment plan (77.45 ± 6.26 vs. 56.50 ± 6.35 min) compared to the traditional model group. Additionally, the new model group had a significantly higher rate of bedside FAST completion (92.8% vs. 53.1%) and a higher success rate of resuscitation within the first hour (70.9% vs. 85.0%) than the traditional model group. Regarding prognosis, the new model group had a lower overall in-hospital mortality rate (12.1% vs. 5.9%) and a lower incidence of complications such as DIC and ARDS (23.9% vs. 9.2%, all P < 0.05).

Conclusion

The new in-hospital trauma care model significantly enhanced the in-hospital emergency care efficiency, reduced in-hospital mortality, and decreased the incidence of complications for severely injured patients, which may serve as a useful reference for developing countries in similar settings.

Clinical trial number

Not applicable.

Peer Review reports

Introduction

In China, approximately 60 million individuals suffer from trauma each year due to traffic accidents, falls, natural disasters, and other causes, with severe trauma accounting for up to 800,000 fatalities, which represents 10% of total annual deaths [1]. Trauma is also the leading cause of death among individuals under the age of 45, and the direct medical costs associated with trauma treatment amount to 65 billion RMB annually [2, 3]. The high rates of disability and mortality resulting from severe trauma not only significantly impact the quality of life of affected individuals and their families but also impose long-term negative effects on socio-economic development [4,5,6]. These factors make trauma care and treatment a critical challenge for healthcare systems in China.

Compared with developed countries, which began establishing trauma care systems in the 1970s, China initiated its trauma care system much later. The China Trauma Care Alliance and the first National Trauma Medical Center was established in 2016 and 2019, respectively, accompanied by a series of policies [7]. Unlike the independent trauma center model implemented in developed countries like the United States, China relies on existing hospitals to build a “China Regional Trauma Care System”. This system is organized by administrative regions, with one large tertiary hospital serving as the trauma center and five to six secondary hospitals functioning as trauma care sites within each region [8]. Currently, this system has been implemented in approximately two-thirds of China’s cities [9]. However, despite the fact that all of these hospitals can receive patients with severe multiple injuries, most of them still lack specialty construction and specialized treatment teams in terms of discipline configuration [10]. Furthermore, China’s vast geographical area results in significant regional variation in trauma care models. During the prehospital phase, three primary modes exist: (1) the command mode: Emergency medical services (EMS) system oversees operations but does not perform the rescue; (2) the affiliation mode: EMS is integrated within a hospital department that manages both prehospital and in-hospital emergency care; (3) the collaborative mode: EMS handles prehospital care, while the hospital manages in-hospital care (This study was conducted in a region that uses a collaborative mode and therefore focuses on improving in-hospital trauma care). In the in-hospital phase, the most common mode in China is specialist consultation, where diagnosis and treatment are organized through ad hoc specialist consultations [11].

In addition to the late initiation of trauma center development, trauma training in China has also progressed slowly. The earliest Advanced Trauma Life Support (ATLS) training course, was introduced in 1997 by the American College of Surgeons (ACS) Hong Kong China Chapter in collaboration with the University of Hong Kong. Although ATLS is the most widely recognized trauma care training program globally, its accessibility to trainees in mainland China was very limited due to its English-language delivery and high cost [12]. It was not until 2016 that the first Mandarin version of the ATLS course was launched in China, achieving positive training outcomes. In the same year, the Chinese Trauma Surgeon Association officially initiated the China Trauma Care Training (CTCT) program, encompassing prehospital first aid, trauma scoring, and standardized trauma care protocols [10]. Currently, CTCT serves as the primary training initiative for first responders across China.

Overall, China’s trauma care system and education have made some progress but continue to face significant challenges in the treatment of patients with severe multiple injuries. A study that included data on 3 million patients found that, compared to developed countries, the mortality rates during in-hospital emergency care for patients with severe trauma in China was significantly higher. However, the difference of mortality rate after hospitalization for specialized care was not significant [13]. Previous research has identified several issues within the current in-hospital emergency care system in China. For instance, the lack of information exchange between pre-hospital and in-hospital emergencies can easily lead to prolonged emergency department (ED) stays or secondary referrals [11]. Moreover, The traditional specialist consultation model is less time-sensitive and inadequate for addressing the immediate treatment needs of severe trauma cases [14]. Therefore, Therefore, a more efficient in-hospital emergency care management model is urgently required.

Research has shown that the trauma-related mortality is negatively correlated with the reduction in time to emergency intervention, especially for severely injured trauma patients who require surgical intervention, where the timing of early surgical intervention is crucial to the patient’s prognosis [15, 16]. Adhering to the principle of “time is life”, we have developed a new model of in-hospital trauma care by improving the traditional methods used in our institution in terms of manpower, methods, materials and management (4 M). The core concept of this model is to maximize the efficiency of emergency care during the first “golden hour” of admission through refined process management and effective multidisciplinary teamwork.

Notably, unlike previous studies that focused on the impact of multidisciplinary collaboration or trauma team activation on clinical outcomes [17,18,19], this study aimed to evaluate the effects of a comprehensive in-hospital emergency care improvement protocol centered on multidisciplinary teamwork. To achieve this, time-dependent emergency care quality control indicators were included as part of the outcome variables. Furthermore, given the differences in trauma care systems across regions, this study may offer a complementary strategy for optimizing trauma care under varying healthcare resource allocations and provide a scientific basis for improving in-hospital trauma care management, particularly in developing countries. We hypothesized that this newly implemented model significantly enhances the efficiency of in-hospital emergency care for severely injured patients, ultimately improving their prognosis.

Methods

Study design and setting

This retrospective observational study utilized data from the First Affiliated Hospital of Wenzhou Medical University, a provincial-level tertiary teaching hospital located in the eastern coastal region of China. The hospital receives over 1,000 trauma patients annually.

Participants

This study included the severely injured trauma patients admitted to the ED of the First Affiliated Hospital of Wenzhou Medical University, with all patients having an Injury Severity Score (ISS) of ≥ 16 [20]. Patients under 18 years of age and those with injuries occurring more than 24 h prior to admission were excluded from the study.

The hospital started to implement the new in-hospital trauma care model since May 2023, and it was basically perfected in October. Therefore, severely injured trauma patients admitted to the ED from January to April 2023 were selected as the traditional model group; while patients from January to April 2024 were included in the new model group. Figure 1 provides a flowchart of the participant enrollment process.

Fig. 1
figure 1

Patient enrollment flowchart

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Intervention

Traditional model group

Manpower: There is no fixed team. Emergency care tasks are led by rotating doctors assigned by the Department of Surgery. Specialists from trauma surgery, neurosurgery, or other departments are consulted as needed. The trauma resuscitation team follows a “one doctor and multiple nurses” model, with no clear division of responsibilities among the nurses. Doctors and nurses undergo monthly assessments of theoretical knowledge and skills; however, no team collaboration training is conducted. The qualification requirements for medical staff are relatively non-strict, and only a few had received ACLS training.

Methods: (1) Trauma alert: Upon arriving at the scene, EMS assesses the patient’s condition and issues a phone alert to the hospital. After the patient arrives at the hospital, the ED nurse evaluated the patient using the Modified Early Warning Score (MEWS) and notifies the on-duty physician. (2) Initial assessment and management: The on-duty doctor conducts a routine specialist examination and arranges for an expert consultation. (3) Subsequent examination and treatment: The ED prioritizes the examination and treatment of severely injured patients, but these kind of fast-track services are limited to within ED.

Materials and management: No trauma resuscitation unit (TRU) is available in the resuscitation room. Medical staff must retrieve necessary emergency items and equipment from a designated room. Additionally, there is no dedicated digital trauma care management system for time control, item reconciliation, or other functions.

The traditional trauma emergency care process: After arriving by ambulance or self-presenting, the patient is triaged and sent to the resuscitation room. The nurse then notifies the on-call emergency surgeon to initiate immediate care, while also informing the patient’s family to complete registration. Once registered, the doctor orders routine tests and laboratory work. Based on the results, specialty consultations are arranged, and decisions are made regarding surgery or further treatment in specialized departments or the ICU.

New model group

Manpower: A trauma multidisciplinary team (MDT) consisting of emergency medicine, trauma surgery, orthopedics, general surgery, neurosurgery, cardiothoracic surgery, and urology was established. The trauma resuscitation team follows a “two doctors and three nurses” model, which includes one emergency surgeon, one trauma surgeon, one trauma nurse, one airway nurse, and one intravenous access nurse. Doctors and nurses underwent monthly theoretical knowledge and skills assessments. Monthly in-situ simulation drills and emergency drills were conducted to enhance teamwork between the medical staff. Additionally, medical staff were sent in batches to participate in advanced training programs, such as CTCT and Advanced Cardiovascular Life Support (ACLS) [21]. Besides, caregivers received specialized training in patient transportation to minimize unnecessary secondary injuries.

Methods: (1) Trauma alert and activation: EMS notifies the hospital and traffic police after assessing the patient’s condition on-site. Trauma early warning and triage are rapidly performed based on the ATMIST alert form (as shown in Table S1), MEWS, and trauma classification, which in turn triggers the activation of trauma MDT prior to the patient’s arrival. (2) Initial assessment and management: The ABCDE assessment is systematically performed, followed by the corresponding first aid measures. (3) Subsequent examination and treatment: A hospital-wide fast-track service system is established for severely injured patients, ensuring that all departments prioritize these patients. In cases requiring emergency blood transfusion, the on call emergency surgeon or nurse notifies the blood bank by phone, and a blood transfusion certificate is issued after the resuscitation is completed. For computed tomography (CT) scans, the trauma surgeon accompanies the patient to the CT room to prioritize the examination and minimize waiting times. A dedicated emergency surgery operating room is set up, with elective surgeries not allowed to occupy it. Life-threatening patients have priority for surgery, and the on call physician arranges for the procedure to be carried out as quickly as possible. Additionally, if there is a delay in securing medical payment, the principle of “emergency care first, payment later” is applied to avoid delaying life-saving treatment.

Materials: A one-stop TRU is established. Within the TRU, there are designated areas for trauma emergency care and trauma equipment preparation. The trauma emergency care area is equipped with trauma resuscitation-specific beds, and bedside units are permanently placed with blood and fluid warmers, warming blankets, FAST ultrasound machines, defibrillators, and other necessary equipment. The trauma preparation area is equipped with trauma cabinets, wound cleaning carts, intubation carts, and preparation tables for procedures. All instruments and items are clearly labeled and arranged according to their frequency of use.

Management: A digital trauma care management platform is established. The alert system is enhanced to include electronic handover forms of patients’ information, enabling pre-hospital online trauma alerts. Personal digital assistant (PDA) devices are used to document emergency care timepoints and manage inventory of medical supplies. An emergency trauma resuscitation checklist is designed for on-site verification. Additionally, the TRU is equipped with high-definition cameras to facilitate review and analysis of resuscitation experiences. A digital trauma case database is also created, serving as a template repository for training and simulations.

The trauma emergency care process for the new model: (A) Five minutes prior to admission: EMS arrived at the scene and quickly assessed the situation, issued an early warning message based on ATMIST and notified the traffic police and the hospital. The hospital initially activates the MDT and supplies preparation after receiving the electronic 120 handover form and early warning message 5 min prior to the patient’s admission. (B) Admission 0 min: Upon admission, the patient is immediately assessed using MEWS and trauma classification. Based on the triage results, the patient is then transferred to the trauma resuscitation unit (TRU), and the MDT is rapidly activated. (C) Admission 5 min: Within the TRU, the trauma care team conducts an initial assessment (ABCDE assessment) and initial treatment (including immobilization, hemostasis, oxygen therapy, IV access, blood transfusion, etc.). Once the patient’s vital signs are stable, a second comprehensive assessment (ABCDE, ISS, FAST, AMPLE) is performed. (D) Admission 20–30 min: Based on the assessment results, the MDT specialists work together to develop an appropriate treatment plan. The next steps in diagnostics (CT, DR, etc.) and treatment (urinary catheterization, chest drainage, medication, etc.) are determined. (E) Admission 30–60 min: The patient is transferred to the operating room for emergency surgery or trauma intensive care unit (TICU)/trauma ward for further treatment. The specific flow chart is shown in Fig. 2. And the differences between traditional and new models are summarized in Table 1.

Fig. 2
figure 2

Flowchart of new in-hospital trauma care model. MEWS, modified Early Warning Score. MTD, multi-disciplinary teams. AMPLE (A: Allergies; M: Medications; P: Past medical history; L: Last meal; E: Events leading to present illness/injury). FAST, focused assessment sonography in trauma

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Table 1 Comparison of traditional in-hospital trauma care model and new in-hospital trauma care model
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Data collection

Clinical data were collected from the hospital’s electronic medical record system, including age, gender, ISS, time since injury, mechanism of injury, and vital signs upon admission (heart rate, respiratory rate, oxygen saturation, and systolic blood pressure). The primary outcome variables included in-hospital mortality. The secondary outcome variables included disposition of emergency patients, complications (disseminated intravascular coagulation, DIC; multiple organ dysfunction syndrome, MODS; acute respiratory distress syndrome, ARDS), length of stay, and the following seven quality control indicators:

  1. (1)

    Time to establishment of artificial airway: The time from the patient’s first medical contact to the establishment of an artificial airway.

  2. (2)

    Time to establishment of effective circulatory access: The time from the patient’s first medical contact to the establishment of effective circulatory access.

  3. (3)

    Emergency transfusion preparation time: The time from the physician’s order for blood transfusion to the initiation of the first unit of blood transfusion.

  4. (4)

    Time to complete whole-body CT scan: The time from the patient’s departure from the resuscitation room to the completion of the CT scan.

  5. (5)

    Time to definitive treatment plan: The time from the patient’s first medical contact to the time the physician establishes a definitive treatment plan.

  6. (6)

    Bedside FAST completion rate: The proportion of patients who completed bedside FAST (or bedside ultrasound) out of the total number of patients, calculated as: (Number of severe trauma patients completing bedside FAST or ultrasound / Total number of severe trauma patients) × 100%.

  7. (7)

    First-hour resuscitation rate: The proportion of patients who achieved successful resuscitation (systolic blood pressure ≥ 80 mmHg) and had no contraindications for transport (cardiac or respiratory arrest, or unstable vital signs without adequate respiratory, circulatory, and other life-support measures) within one hour of admission, calculated as: (Number of severe trauma patients meeting resuscitation and transport criteria / Total number of severe trauma patients) × 100%.

Statistical analysis

Categorical data are presented as frequencies (percentages), and univariate analysis was performed using the chi-square test. For quantitative data, those with a normal distribution are expressed as mean ± standard deviation, and univariate analysis was performed using the independent two-sample t-test. For data that do not follow a normal distribution, the median (interquartile range) is presented, and univariate analysis was performed using non-parametric tests. A P-value of < 0.05 is considered statistically significant.

Results

Characteristics of participants

A total of 366 patients who met the inclusion criteria were enrolled in this study, including 270 males (73.8%) and 96 females (26.2%), with a median age of 56 years (range 44–69). The mean ISS and median time since injury for the patients were 26 and 3 h, respectively. The traditional model group consisted of 213 patients, while the new model group included 153 patients. There were no statistically significant differences between the traditional and new model groups in terms of gender, age, ISS, time of injury, mechanism of injury, or vital signs upon admission (P > 0.05). Participant characteristics are shown in Table 2.

Table 2 Baseline characteristics of severely injured trauma patients (n = 366)
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The comparison of emergency care metrics between the two groups

The average time to establish effective circulatory access in the new model group was 9.44 ± 3.18 min, significantly shorter than the 13.66 ± 3.36 min in the traditional model group (P < 0.001). Similarly, compared to the traditional model group, the new model group showed significantly shorter times for the establishment of artificial airways, blood transfusion preparation, and completion of whole-body CT, formulation of definitive treatment plans (all P < 0.05, Table 3). Additionally, the new model group had a significantly higher bedside FAST completion rate and a higher resuscitation success rate within the first hour compared to the traditional model group (P < 0.05, Table 3).

Table 3 The comparison of emergency care metrics between the traditional and new model groups (n = 366)
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The comparison of clinical outcomes between the two groups

The prognosis of patients in the new and traditional model groups was compared. The results indicated that the proportions of patients who were discharge against medical advice, transferred to a trauma ward/TICU, or had other outcomes were similar between the two groups. The proportion of patients undergoing emergency surgery was slightly higher in the new model group (n = 44, 28.8%) compared to the traditional model group (n = 46, 21.6%). Additionally, the proportion of patients who died in the ED was lower in the new model group (n = 7, 4.6%) than in the traditional model group (n = 21, 9.9%), while the differences were not statistically significant (P > 0.05). In terms of complications, the incidence of DIC and ARDS was significantly lower in the new model group (P < 0.05). Furthermore, the overall in-hospital mortality rate was significantly lower in the new model group (P < 0.05). However, there was no significant difference in the median length of hospital stay between the two groups (Table 4).

Table 4 The comparison of clinical outcomes between the traditional and new model groups (n = 366)
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Discussion

This study introduced a new trauma care model in the ED and validated its effectiveness in improving the efficiency of in-hospital emergency care and outcomes of severely injured trauma patients. Our results demonstrated that the new model significantly improves various emergency care indicators and helps reduce in-hospital mortality and complication rates in severely injured patients. Therefore, the implementation of this model is of great significance for optimizing the emergency care process for such patients.

Timely emergency care is critical to the prognosis of trauma patients, especially those with severe multiple injuries, as delays can lead to deterioration or death. Trauma-related deaths typically occur in three peaks: the first peak, or “immediate death,” happens within seconds to minutes of injury, where most patients cannot be saved; the second peak occurs within minutes to hours; and the third peak happens days to weeks later, due to complications or worsening conditions [22]. The second peak is the most critical window for life-saving intervention, which is why the “golden hour” has become the ideal target in trauma emergency care systems. However, our study found that the median time from injury to hospital admission for severely injured patients was 3 h. This delay is significantly longer than the response times in developed countries, and is a common issue in China and other developing nations [23, 24]. Factors such as late detection, long distances, traffic congestion, and limited emergency resources (e.g., helicopter ambulances) contribute to these delays [25, 26]. As a result, the time left in the golden window of treatment after the injury is already very limited for these patients. Moreover, our study indicated that under the traditional trauma care model, the time from the first medical contact to the finalization of definitive treatment plan was 77.45±6.26 min, which is longer than reported in other studies [27, 28]. Therefore, improving in-hospital emergency care efficiency is crucial.

This study demonstrated that the implementation of the new in-hospital trauma care model significantly shortened the time required for patient treatment, particularly in trauma assessment, resuscitation preparation, and treatment initiation. Specifically, ED physicians and nurses immediately initiate the trauma early alert before or upon patient admission, enabling rapid MDT consultations and unified treatment planning. This approach effectively reduces treatment delays caused by waiting for consultations and prevents the shirking of responsibility between departments [29]. Particularly in the management of polytrauma patients, the team is able to quickly reach a consensus and develop a unified resuscitation plan tailored to the patient’s overall condition, ensuring that each treatment measure is promptly implemented, thereby reducing mortality and improving patient prognosis [30]. Regionally, similar initiatives, such as those at the Second Affiliated Hospital of Zhejiang University, have focused on improving traditional models, with emergency and critical care departments leading the efforts, supported by other surgical departments [11]. In contrast, our MDT-based model emphasizes integration across departments to ensure more seamless trauma care. Internationally, Altamirano et al. reported that improving acute trauma surgery models reduced mortality and length of stay; however, their strategy primarily involved increasing staffing and establishing dedicated surgical facilities, addressing challenges distinct from ours, which focused on personnel training and process optimization [31]. Although this study did not include a cost-effectiveness analysis, existing research highlights the economic impact of trauma care improvements. Zhou et al. found that establishing trauma centers significantly improved outcomes for polytrauma patients but increased hospital costs, with median expenses rising from ¥72,620.70 to ¥99,616.10 (P = 0.004) [32]. This underscores the need for future research on cost-effectiveness in similar settings.

This study has several limitations. First, as a retrospective observational study, the lack of randomization may introduce potential bias or confounders, despite the fact that there were no significant differences in key baseline characteristics between groups. Second, being a single-center study, its findings were influenced by the medical practices of a specific region or hospital, making it of limited generalizability. Finally, the study did not include a cost-effectiveness analysis of the two models, which could provide valuable insights into resource allocation, economic feasibility, and strategies to optimize healthcare resource utilization. This represents a critical direction for future research.

Conclusion

The new in-hospital trauma care model significantly enhanced the in-hospital emergency care efficiency for severely injured patients, reduced in-hospital mortality, and decreased the incidence of complications, which may serve as a useful reference for developing countries in similar settings.

Data availability

The data of this study are available from the corresponding author upon reasonable request.

References

  1. Watts G. Jiang Baoguo: one, two, three against trauma in China. Lancet. 2017;390:1729.

    PubMed  Google Scholar 

  2. Zhou J, et al. Current situation and development of Chinese trauma care system. Chin J Surg. 2022;60:1045–8.

    CAS  PubMed  Google Scholar 

  3. Fu X, et al. Prevention and control of serious trauma and accidental injury in China: timely but difficult. Burns Trauma. 2013;1:2–4.

    PubMed  Google Scholar 

  4. David SD, et al. Measuring post-discharge socioeconomic and quality of life outcomes in trauma patients: a scoping review. J Patient Rep Outcomes. 2021;5:68.

    PubMed  PubMed Central  Google Scholar 

  5. Umo I, et al. The direct medical cost of trauma aetiologies and injuries in a resource limited setting of Papua new Guinea: A prospective cost of illness study. Lancet Reg Health West Pac. 2022;20:100379.

    PubMed  PubMed Central  Google Scholar 

  6. Goddard SD, et al. Societal burden of trauma and disparities in trauma care. Surg Clin North Am. 2024;104:255–66.

    PubMed  Google Scholar 

  7. Jiang BG. [Status and thinking of trauma rescue and treatment system in China]. Zhonghua Yi Xue Za Zhi. 2019;99:3382–4.

    CAS  PubMed  Google Scholar 

  8. Zhou J, et al. [Current situation and development of Chinese trauma care system]. Zhonghua Wai Ke Za Zhi. 2022;60:1045–8.

    CAS  PubMed  Google Scholar 

  9. Group ECotCSfCsUTTSE. Expert consensus on the construction standards for urban trauma treatment system in China. (2024 edition). Chin J Orthop. 2024;44:1–5.

  10. Zhang LY, et al. Current trauma care system and trauma care training in China. Chin J Traumatol. 2018;21:73–6.

    PubMed  Google Scholar 

  11. Liu T, et al. Trauma care system in China. Chin J Traumatol. 2018;21:80–3.

    PubMed  Google Scholar 

  12. Chen HJ, et al. Current trauma care training for nurses. J Trauma Surg. 2020;22:78–81.

    Google Scholar 

  13. Kou YH, et al. [Research and promotion of severe trauma rescue standard]. Beijing Da Xue Xue Bao Yi Xue Ban. 2015;47:207–10.

    CAS  PubMed  Google Scholar 

  14. Jiang B. [The challenges faced in the field of trauma care in China]. Zhonghua Wai Ke Za Zhi. 2015;53:401–4.

    PubMed  Google Scholar 

  15. Monchal T, et al. Hospital care in severe trauma: initial strategies and life-saving surgical procedures. J Visc Surg. 2016;153:3–12.

    CAS  PubMed  Google Scholar 

  16. Meyer DE, et al. Every minute counts: time to delivery of initial massive transfusion cooler and its impact on mortality. J Trauma Acute Care Surg. 2017;83:19–24.

    PubMed  PubMed Central  Google Scholar 

  17. Nonis M, et al. Trauma team activation: improved care of major trauma patients. N Z Med J. 2022;135:78–94.

    PubMed  Google Scholar 

  18. Hagebusch P, et al. Trauma-team-activation in Germany: how do emergency service professionals use the activation due to trauma mechanism? Results from a nationwide survey. Eur J Trauma Emerg Surg. 2022;48:393–9.

    PubMed  Google Scholar 

  19. Young AM, et al. Outcomes of injured patients before and after the institution of a Third-Tier activation at a level 1 trauma center. Am Surg. 2024;90:427–35.

    PubMed  Google Scholar 

  20. Schurr LA et al. Diaphragmatic injuries among severely injured patients (ISS ≥ 16)-An indicator of injury pattern and severity of abdominal trauma. Med (Kaunas). 2022;58.

  21. Dai SS, et al. Application of blended online and offline teaching mode in emergency medicine teaching. Continuing Med Educ. 2024;38:5–8.

    Google Scholar 

  22. Asim M, et al. Time and risk factors of trauma-Related mortality: A 5-Year retrospective analysis from a National level I trauma center. J Intensive Care Med. 2024;39:672–82.

    PubMed  Google Scholar 

  23. Carr BG, et al. A meta-analysis of prehospital care times for trauma. Prehosp Emerg Care. 2006;10:198–206.

    PubMed  Google Scholar 

  24. Chen CH, et al. Association between prehospital time and outcome of trauma patients in 4 Asian countries: A cross-national, multicenter cohort study. PLoS Med. 2020;17:e1003360.

    PubMed  PubMed Central  Google Scholar 

  25. Lapidus O, et al. Trauma patient transport to hospital using helicopter emergency medical services or road ambulance in Sweden: a comparison of survival and prehospital time intervals. Scand J Trauma Resusc Emerg Med. 2023;31:101.

    PubMed  PubMed Central  Google Scholar 

  26. Galvagno SM Jr et al. Helicopter emergency medical services for adults with major trauma. Cochrane Database Syst Rev. 2013:Cd009228.

  27. Xiang S, et al. Practice of multidisciplinary collaborative chain management model in constructing nursing path for acute trauma treatment. Emerg Med Int. 2022;2022:1342773.

    PubMed  PubMed Central  Google Scholar 

  28. Hall AB, et al. Advanced trauma life support time standards. Mil Med. 2017;182:e1588–90.

    PubMed  Google Scholar 

  29. Zhang HS, et al. The application of an integrated model in the management of emergency hospital admissions. J Traditional Chin Med Manage. 2021;29:49–50.

    Google Scholar 

  30. Du Z, et al. [Application of multidisciplinary team (MDT) in the treatment of severe trauma]. Beijing Da Xue Xue Bao Yi Xue Ban. 2020;52:298–301.

    CAS  PubMed  Google Scholar 

  31. Sarmiento Altamirano D, et al. The successful implementation of a trauma and acute care surgery model in Ecuador. World J Surg. 2020;44:1736–44.

    PubMed  Google Scholar 

  32. Zhou J, et al. Management of severe trauma worldwide: implementation of trauma systems in emerging countries: China, Russia and South Africa. Crit Care. 2021;25:286.

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Not applicable.

Funding

This work was supported by the Project of Wenzhou Science and Technology Bureau (Y2023726).

Author information

Authors and Affiliations

  1. Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China

    Qiu Zhao, Yue Zhao, Tingting Ke, Caili Lin, Yao Xu, Yuanyuan Xu & Xinqun Li

  2. Intensive Care Unit, Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, China

    Shuli Liu

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  1. Qiu Zhao
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  2. Yue Zhao
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  3. Tingting Ke
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  4. Caili Lin
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  5. Yao Xu
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  6. Yuanyuan Xu
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  7. Shuli Liu
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Contributions

Q.Z. and Y.Z.: Funding acquisition, Investigation, Methodology, Writing - original draft. T.K. and C.L.: Investigation, Data curation, Formal analysis, Writing - review & editing. Y.X.: Resources, Software, Writing - original draft. Y.X. and S.L.: Supervision, Validation, Writing - original draft. X.L.: Conceptualization, Project administration, Writing - review & editing. All authors have reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Shuli Liu or Xinqun Li.

Ethics declarations

Ethical approval and consent to participate

This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University (KY2024-R341). Informed consent from participants was waived due to the retrospective nature of the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Zhao, Q., Zhao, Y., Ke, T. et al. The effect of a new in-hospital trauma care model on the outcomes of severely injured trauma patients in the emergency department: a retrospective observational study in China. BMC Emerg Med 25, 47 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12873-025-01203-1

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12873-025-01203-1

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BMC Emergency Medicine

ISSN: 1471-227X

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