Trauma center need: the American College of Surgeons’ definition in contrast to Swiss highly specialized medicine regulations—a Swiss trauma center perspective

  • Thomas GrossEmail author
  • Philipp Braken
  • Felix Amsler
Original Article



According to the American College of Surgeons (ACS) recommendations, the benchmark for trauma center need (TCN) is an Injury Severity Score (ISS) > 15. In contrast, Swiss highly specialized medicine (HSM) regulations set out TCN for all patients with an ISS > 19 or an Abbreviated Injury Severity (AIS) of the head ≥ 3. This investigation assessed to what extent the modification might be justified.


Consecutive analysis of all significantly injured (new ISS, NISS ≥ 8) adults treated in a trauma center from 2010 to 2016 based on their ISS and AIS head and in respect to utilized resources and outcome.


Of 2171 patients (mean age 57.2 ± 21.6; ISS 15.0 ± 8.5) 40.1% fulfilled the ACS and 52.7% the HSM-definition of TCN. Comparative analysis of specified subgroups representing combinations of the ISS and the AIS head revealed that patients within the HSM but not within the ACS-definition of TCN achieved worse outcomes in mortality or on the Glasgow Outcome Score and had a higher inpatient rehabilitation rate than patients with an ISS < 15 and an AIS head < 3 compared to patients with an ISS > 15. Mortality for patients with an ISS 16–19 and AIS head < 3 (qualifying for the ACS but not the HSM-definition of TCN) was found to be twice as high for patients who were not in the ACS or the HSM group (ISS < 16 & AIS head < 3).


If confirmed by others, both the ACS and the Swiss-recommendations for TCN should be adapted accordingly, provided that the resultant increased workload is feasible for the trauma centers concerned.


Triage Major trauma Trauma center need Highly specialized medicine Trauma team activation Outcome 



The authors would like to thank all hospital collaborators, particularly Ms. F. Maeder, Ms. S. Morell and Mr. L. Meier for the reliable management of data and Ms J. Buchanan for linguistic assistance.


This study was funded by the Scientific Foundation of the Hospital.

Compliance with ethical standards

Conflict of interest

Thomas Gross, Philipp Braken, and Felix Amsler declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study following the study protocol approved by the regional ethical committee.

Supplementary material

68_2018_1027_MOESM1_ESM.docx (39 kb)
Supplementary material 1 (DOCX 39 KB)
68_2018_1027_MOESM2_ESM.docx (30 kb)
Supplementary material 2 (DOCX 29 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of TraumatologyCantonal Hospital AarauAarauSwitzerland
  2. 2.Amsler ConsultingBaselSwitzerland

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