Paper| Volume 26, ISSUE 1, P25-31, January 1995

Major trauma workload within an English Health Region

  • C.M. Airey
    Requests for reprints should be addressed to: Dr Mark Airey, University of Leeds, Nuffield Institute for Health, 71-75 Clarendon Road, Leeds LS2 9PL, UK.
    Nuffield Institute for Health, University of Leeds, Leeds, UK
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  • A.J. Franks
    Institute for Epidemiology and Health Services Research, University of Leeds, Leeds, UK
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      The incidence, distribution and clinical patterns of life-threatening and multiple injuries were evaluated within an English Regional Health Authority area. Cases of major injury were identified retrospectively for the 12 month period October 1988 to September 1989 using data from the 16 Accident and Emergency (A&E) units within the Yorkshire Health Region, and coroners' records. There were 968 cases of fatal and serious injury, meeting the criterion of an injury severity score greater than 15, 67 per cent (645) being due to road traffic incidents. Thirty-five per cent (337) died at the scene or before reaching hospital, whilst 65 per cent (631) survived to reach an A&E unit (0.082 per cent of the Region's annual A&E case load), 75 per cent arriving outside of normal office hours. Eleven per cent (72) died prior to ward admission and 34 per cent (213) were immediately transferred to a secondary medical referral centre. Three hundred and sixty-seven patients (38 per cent) survived to be discharged from acute hospital care whilst 188 (19 per cent) died as in-patients. Major injuries were found to be distributed throughout the Authority area in rough proportion to district population density with a regional incidence of 27 cases per 100 000. This study has quantified a group of patients with very specific and specialized needs, but further research and debate is required to decide how these needs are best met.
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      1. 3rd edn. Health of the Nation; A Strategy for Health in England. HMSO, London1992
      2. (Platt Report)
        • Standing Medical Advisory Committee
        3rd edn. Accident and Emergency Services. HMSO, London1962
      3. (Lewin Report)
        • Joint Consultants Committee
        3rd edn. Medical Staffing of Accident and Emergency Services. British Medical Association, London1978
        • British Orthopaedic Association
        3rd edn. Report of the Trauma Committee of the British Orthopaedic Association; The Management of Skeletal Trauma in the United Kingdom. BOA, London1992
        • Royal College of Surgeons of England
        3rd edn. Report of the Working Party on the Management of Patients with Major Injuries. RCSE, London1988
        • Cales RH
        Trauma mortality in Orange County; the effect of implementation of a regional trauma system.
        Ann Emerg Med. 1984; 13: 1
        • Shackford SR
        • Hollingworth-Fridlund P
        • Cooper GF
        • Eastman AB
        The effect of regionalisation upon the quality of trauma care as assessed by concurrent audit before and after the institution of a trauma system; a preliminary report.
        J Trauma. 1986; 26: 812
        • Yates DW
        • Woodford M
        • Hollis S
        Preliminary analysis of the care of injured patients in 33 British hospitals: first report of the United Kingdom major trauma outcome study.
        Br Med J. 1992; 305: 737
        • Templeton J
        (on behalf of the Trauma Research Group: Department of Orthopaedic Surgery))3rd edn. An Incidence Study of Trauma in the North Staffordshire Health District from April 1989 to April 1990. School of Post-Graduate Medicine and Biological Sciences, Keele University, 1991
        • OPCS
        3rd edn. Key Population and Vital Statistics; Local and Health Authority areas. England and Wales. HMSO, London1989
        • Association for the Advancement of Automotive Medicine
        3rd edn. The Abbreviated Injury Scale. AAAM, Des Plaines, IL1990 (1990 revision)
        • Yorkshire Regional Health Authority
        3rd edn. Principles for Emergency and Urgent Care in Yorkshire. A Consultation Policy Document. YRHA, Harrogate1992
        • OPCS
        Mortality Statistics; area, England and Wales.
        HMSO, London1988
        • OPCS
        Mortality Statistics; area, England and Wales.
        HMSO, London1989
        • Spence MT
        • Redmond AD
        • Edwards JD
        Trauma audit — the use of TRISS.
        Health Trends. 1988; 20: 94
        • Kinney SJ
        • Jones DHA
        Trauma services requirements in a District General Hospital serving a rural area.
        Br Med J. 1990; 300: 504
        • Phair IC
        • Barton DJ
        • Barnes MR
        • Allen MJ
        Deaths following trauma, an audit of performance.
        Ann R Coll Surg Engl. 1991; 73: 53
        • Burdett-Smith P
        Estimating trauma centre workload.
        J R Coll Surg Edinb. 1992; 37: 128
        • Burdett-Smith P
        • Airey CM
        • Franks AJ
        J R Coll Surg Edinb. 1993; 38: 180
        • Boot DA
        • Gorman DF
        • Teanby DN
        • et al.
        Audit of severely injured patients in the North West of Great Britain.
        J Bone Joint Surg [Br]. 1993; 75B
        • American College of Surgeons
        • Committe on Trauma
        Hospital resources for optimal care of the injured patient.
        Bull Am Coll Surg. 1979; 64: 43
        • Smith RF
        • Fratschi L
        • Sloan EP
        • et al.
        The impact of volume on outcome in seriously injured trauma patients; two years' experience of the Chicago trauma system.
        J Trauma. 1990; 30: 1066
        • O'Kelly TJ
        • Westaby SD
        Trauma centres and the efficient use of resources.
        Br J Surg. 1990; 77: 1142