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Improved trauma care after reorganisation: a retrospective analysis
K A Alberts1, B M Bellander, G Modin
1Department of Orthopaedics, Karolinska Hospital, Stockholm, Sweden.
Objective:
To shorten the time to make a diagnosis and to begin definitive treatment of severely injured patients, thereby improving their medical care.
Design:
Retrospective analysis.
Setting:
Teaching hospital, Sweden.
Subjects:
61 patients who had sustained high-energy injuries, including head injury which required surgical intervention, and fracture of the femoral shaft before (1987-1988 n = 23) and after (1991-1993 n = 38) the reorganisation.
Intervention:
Trauma care was reorganised during the year 1989-1990 and the concept of early multidisiplinary treatment with the general surgeon as trauma-leader was adopted.
Main Outcome Measures:
The time required to make a diagnosis and begin definitive treatment as well as the assessment of medical care taking account of the patient's general condition and other injuries.
Result:
The immediate medical care was classified as delayed or inappropriate in 9 of 23 patients before, and in 2 of 38 patients after, the reorganisation (p = 0.001). The time needed to make a diagnosis was less than 4 hours in all cases. The time needed to start definitive treatment of head injuries was less than four hours in 9 of 12 patients before, and in 18 of 21 patients after the reorganisation. The internal fixation of femoral fractures was started within four hours in 2 of 11 femoral fractures before, compared with 12 of 17, after the reorganisation.
Conclusion:
The time to beginning definitive treatment of severe injuries was shorter after the reorganisation, as a result of early participation of members of the trauma team.
