One year's experience of major trauma outcome study methodology

To assess the feasibility and the validity of an audit using major trauma outcome study methods in an accident and emergency department.

Prospective audit of all cases of trauma in patients admitted to a hospital from an accident and emergency department.

Accident and emergency department in a teaching hospital.

1577 Patients admitted with trauma, of whom 695 met the inclusion criteria for the study--that is, were admitted for more than three days, or admitted to intensive care, or died. 17 Patients were excluded because of failure to trace their notes.

Review of case notes with TRISS (trauma score, injury severity score) methodology to compare expected and observed survival.

Most (421/678) admissions were due to single orthopaedic injury. Serious injury was uncommon with only 43 patients having injury severity scores greater than 15. The calculated probability of survival matched the observed outcome for most of the seriously injured patients, with only two unexpected deaths. However, 36 of the 61 deaths in the 678 patients occurred in elderly patients with a fractured neck of the femur, and all of these patients had a high probability of survival predicted by TRISS methodology.

Application of TRISS methodology seems to be valid for seriously injured patients except for elderly patients with single orthopaedic injuries, in whom there were major differences between observed and expected outcomes. Using outcome norms from the United States may not be applicable for this group.

Audit of management of major injuries should be carried out by every hospital, and the methodology of the major trauma outcome study is an excellent system for carrying out such audit. The study of all patients admitted with trauma requires appreciable extra resources, but most hospitals should be able to monitor the care of seriously injured patients as their numbers are much fewer.