Survival after trauma--experience at an acute-care general hospital

To assess the effectiveness of the management of acute traumatic illness at an acute-care general hospital.

The study was conducted prospectively for the calendar year 1989. The Trauma Score (TS) and the revised Trauma Score (RTS) were calculated on arrival at hospital. These clinical indices were used, with the Injury Severity Score (ISS) and the age, to predict the probability of survival (Ps) and the probability of mortality. The predicted probabilities were compared with the probabilities of survival and mortality derived from a recognised baseline.

The Trauma Service of The Sutherland Hospital Caringbah, including the Emergency and Intensive Care Departments and the Departments of Surgery and Anaesthetics.

74 patients of all ages who were brought to the Emergency Department because of acute traumatic illness with an ISS greater than 16. Only patients with signs of life on arrival were included in the study group. Data were complete in all 74 patients.

There were 60 survivors and 14 deaths compared to figures predicted using data from the baseline group of 52.6 survivors and 21.4 deaths. There were no preventable deaths. There were five survivors whose probability of survival was less than 0.50. Three cases of late diagnosis were noted; the late diagnoses did not significantly affect the outcomes--they occurred because specialist assessment was delayed.

It is possible, with few resources, to quantitatively and qualitatively assess the effectiveness of a trauma care service.