The Major Trauma Management Study: An Analysis of the Efficacy of Current Trauma Care

Abstract

Background: An audit of the management and outcome of major trauma patients was carried out to determine ways in which the system of care may be improved. Methods: The Major Trauma Management Study (MTMS) collected data prospectively on all consecutively admitted major trauma patients at eight major hospitals during a 12-month period. Outcome was studied using trauma and injury severity score (TRISS) and a severity characterization of trauma (ASCOT) analyses, as well as a preventable outcome analysis, which looked at survivors with complications or with a Glasgow Coma Score < 15 on discharge from hospital, as well as studying deaths. Results:The group of 859 patients was more severely injured than most described previously, with a mortality of 14.8% and a mean injury severity score of 19.8. Formal ASCOT analysis indicated 2.25% fewer survivors than would be predicted by Major Trauma Outcome Study norms. Extrapolating the TRISS and ASCOT process to include those patients with missing data, and then comparing groups of matched severity with the norms, gave no statistically different outcome in the MTMS group of patients. Preventable outcome analysis revealed rates of preventable and potentially preventable (PPP) outcomes of 32% among deaths and 8% among survivors. The types of management deficiencies responsible for P/PP outcomes are identified. Conclusions: The points of deficiency in a system of care have been identified, and the development of an integrated trauma system in Victoria, based upon these facts, is recommended. Children, the elderly, patients with head injuries and patients being transferred between hospitals would benefit from improvements to the system of care. The calculation of efficacy rate (0.95 for the MTMS patients) is recommended to accurately assess the system of care. Preventable Outcome Analysis is more relevant to auditing a system of trauma care in detail, than is ASCOT or TRISS. The MTMS has refined and defined the process so that it is reproducible in further comparative studies.

TRISS: Does It Get Better than This?

“…When TRISS is compared with the peer-review process in determining whether deaths are unexpected or potentially preventable, findings vary. Poor agreement 39 and acceptable agreement 40 have both been found when comparing the predictive ability of TRISS with that of multidisciplinary review panels of trauma deaths.…”

Trauma training in Australia and New Zealand: Results of a survey of advanced surgical trainees

“…Trainees may need to be rotated through these units to obtain adequate trauma care exposure. Furthermore the management of trauma patients is constantly being reviewed as outlined in three recent Australasian papers 1–3 . In this new climate surgical trainees may not be receiving adequate exposure and supervision in trauma surgery.…”

‘Talk and Die’ patients presenting to a major trauma centre over a 10 year period: A critical review

“…Deficiencies in emergency management and delays in neurosurgical intervention due to logistical problems (53% or eight patients were transferred from a peripheral hospital prior to definitive treatment), remain important issues. 31,32 One of our patients (a young patient with fixed and dilated pupils) took 4 h (a 1.5 hour journey) to arrive at the tertiary hospital. Although there are roles for a general surgeons in remote environments to perform emergent neurosurgery, 33,34 this should not be the case when the referring hospital is less than 2 h away.…”