Abstract
Abstract: To demonstrate trends in trauma care in England and Wales from 1989 to 2000.
Study population: Database of the Trauma Audit and Research Network that includes hospital patients admitted for three days or more, those who died, were transferred or admitted to an intensive care or high dependency area.
Method: To demonstrate trends in outcome, severity adjusted odds of death per year of admission to hospital were calculated for all hospitals (n=99) and 20 hospitals who had participated since 1989 (adjustments are for Injury Severity Score, age, and Revised Trauma Score). The grade of doctor initially seeing the injured patient in accident and emergency and median prehospital times per year of admission were calculated to demonstrate trends in the process of care. Trend analyses were carried out using simple linear regression (odds ratio versus year).
Results: The analysis shows a significant reduction in the severity adjusted odds of death of 3% per year over the 1989–2000 time period (p=0.001). During the period 1989–1994 the odds of death declined most steeply (on average 6% per year p=0.004). Between 1994 to 2000 no significant change occurred (p=0.35). This pattern was mirrored by the 20 permanent members where the odds of death also declined more steeply over the 1989–1994 period. The percentage of severely injured patients (ISS >15) seen by a consultant increased from 29 to 40 from 1989–1994 but has remained static subsequently. Median prehospital times for severely injured patients have not changed significantly since 1994 (51 to 45 minutes).
Conclusion: Most of the case fatality reduction for trauma patients reaching hospital over the 1989–2000 time period occurred before 1995 when there was most marked change in the initial care of severely injured patients.
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Selected References
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- Anderson I. D., Woodford M., de Dombal F. T., Irving M. Retrospective study of 1000 deaths from injury in England and Wales. Br Med J (Clin Res Ed) 1988 May 7;296(6632):1305–1308. doi: 10.1136/bmj.296.6632.1305. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Baker S. P., O'Neill B. The injury severity score: an update. J Trauma. 1976 Nov;16(11):882–885. doi: 10.1097/00005373-197611000-00006. [DOI] [PubMed] [Google Scholar]
- Champion H. R., Copes W. S., Sacco W. J., Lawnick M. M., Keast S. L., Bain L. W., Jr, Flanagan M. E., Frey C. F. The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma. 1990 Nov;30(11):1356–1365. [PubMed] [Google Scholar]
- Champion H. R., Sacco W. J., Copes W. S., Gann D. S., Gennarelli T. A., Flanagan M. E. A revision of the Trauma Score. J Trauma. 1989 May;29(5):623–629. doi: 10.1097/00005373-198905000-00017. [DOI] [PubMed] [Google Scholar]
- Copes W. S., Staz C. F., Konvolinka C. W., Sacco W. J. American College of Surgeons audit filters: associations with patient outcome and resource utilization. J Trauma. 1995 Mar;38(3):432–438. doi: 10.1097/00005373-199503000-00027. [DOI] [PubMed] [Google Scholar]
- Davis J. W., Hoyt D. B., McArdle M. S., Mackersie R. C., Eastman A. B., Virgilio R. W., Cooper G., Hammill F., Lynch F. P. An analysis of errors causing morbidity and mortality in a trauma system: a guide for quality improvement. J Trauma. 1992 May;32(5):660–666. doi: 10.1097/00005373-199205000-00020. [DOI] [PubMed] [Google Scholar]
- Hall J. R., Reyes H. M., Meller J. L., Loeff D. S., Dembek R. The outcome for children with blunt trauma is best at a pediatric trauma center. J Pediatr Surg. 1996 Jan;31(1):72–77. doi: 10.1016/s0022-3468(96)90322-x. [DOI] [PubMed] [Google Scholar]
- Hollis S., Yates D. W., Woodford M., Foster P. Standardized comparison of performance indicators in trauma: a new approach to case-mix variation. J Trauma. 1995 May;38(5):763–766. doi: 10.1097/00005373-199505000-00015. [DOI] [PubMed] [Google Scholar]
- Lecky F., Woodford M., Yates D. W. Trends in trauma care in England and Wales 1989-97. UK Trauma Audit and Research Network. Lancet. 2000 May 20;355(9217):1771–1775. doi: 10.1016/s0140-6736(00)02264-9. [DOI] [PubMed] [Google Scholar]
- Roberts I., Campbell F., Hollis S., Yates D. Reducing accident death rates in children and young adults: the contribution of hospital care. Steering Committee of the Major Trauma Outcome Study Group. BMJ. 1996 Nov 16;313(7067):1239–1241. doi: 10.1136/bmj.313.7067.1239. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sampalis J. S., Lavoie A., Boukas S., Tamim H., Nikolis A., Fréchette P., Brown R., Fleiszer D., Denis R., Bergeron E. Trauma center designation: initial impact on trauma-related mortality. J Trauma. 1995 Aug;39(2):232–239. doi: 10.1097/00005373-199508000-00008. [DOI] [PubMed] [Google Scholar]
- Shackford S. R., Mackersie R. C., Hoyt D. B., Baxt W. G., Eastman A. B., Hammill F. N., Knotts F. B., Virgilio R. W. Impact of a trauma system on outcome of severely injured patients. Arch Surg. 1987 May;122(5):523–527. doi: 10.1001/archsurg.1987.01400170029003. [DOI] [PubMed] [Google Scholar]
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