Highlights
- •Patterns of trauma presenting to lower level trauma units appear reproducible year on year.
- •This study contains one of the largest datasets for all the trauma admissions to a level III trauma unit in the UK.
- •The results show seasonal patterns in the patient demographics, site of injury, treatment received, and length of hospital stay for trauma patients.
- •The results can be used to develop algorithms to improve healthcare provision by matching the service delivery to the demand.
- •Implementing a national database for trauma admissions could further develop our understanding of the patterns of trauma admissions and further optimise healthcare delivery.
Abstract
Introduction
Major trauma centres have improved morbidity and mortality for moderate and severely
injured patients. Less injured patients may be treated in facilities less resourced
for trauma care. In these units, understanding the variations in injury presentation
and treatment over time allows service delivery to be tailored to demand. This study
set out to describe seasonal variations in trauma over a 10-year period at a level
III trauma unit.
Materials and methods
Patient demographics, admission frequency, site of injury, season of admission, management,
complications, onward transfers, and length of stay were extracted on consecutive
patients admitted with traumatic injuries between January 2009 and December 2018 and
recorded on a prospectively maintained database. Analysis was undertaken to determine
if there were reproducible patterns in trauma presentation across seasons, based on
the patient's age and gender, type of injury, management and length of stay.
Results
There were 13,007 ‘first admissions’ over 10 years, with a mean (SD) age of 55.6 (27.7)
years. Admissions were higher in summer (27%) and lower in winter (23.6%) and patients
were on average younger in the summer (52.8 years) and older in winter (59.2 years).
The proportion of female and male patients remained relatively constant across seasons
(CV=6% and 8%, respectively). There was seasonal variation in the incidence of forearm
(36%) elbow (19%), and multi-sites injuries (17%) compared with hip and wrist injuries
(CV=5% for both). A lower proportion of patients underwent operations in summer (72%)
compared with other seasons with winter having the highest at 77%. More patients aged
less than 60 years stayed in hospital during winter than summer (13.2% vs. 11.6–12.4%)
although often for a day. Patients aged 60 years stayed longer in spring and winter.
Conclusion
The results of this study demonstrate trends in the admission and management of trauma
patients to a level III trauma unit. Some of the patterns in admission, treatment
and length of stay had not been identified previously. The results can be used to
enhance patient care and minimise health care costs by reducing unwarranted variations
and enabling service delivery to match the demand in all trauma units.
Keywords
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Article info
Publication history
Published online: July 08, 2020
Accepted:
July 7,
2020
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier Ltd. All rights reserved.
