Major trauma workload within an English Health Region

The incidence, distribution and clinical patterns of life-threatening and multiple injuries were evaluated within an English Regional Health Authority area. Cases of major injury were identified retrospectively for the 12 month period October 1988 to September 1989 using data from the 16 Accident and Emergency (A&E) units within the Yorkshire Health Region, and coroners' records. There were 968 cases of fatal and serious injury, meeting the criterion of an injury severity score greater than 15, 67 per cent (645) being due to road traffic incidents. Thirty-five per cent (337) died at the scene or before reaching hospital, whilst 65 per cent (631) survived to reach an A&E unit (0.082 per cent of the Region's annual A&E case load), 75 per cent arriving outside of normal office hours. Eleven per cent (72) died prior to ward admission and 34 per cent (213) were immediately transferred to a secondary medical referral centre. Three hundred and sixty-seven patients (38 per cent) survived to be discharged from acute hospital care whilst 188 (19 per cent) died as in-patients. Major injuries were found to be distributed throughout the Authority area in rough proportion to district population density with a regional incidence of 27 cases per 100,000. This study has quantified a group of patients with very specific and specialized needs, but further research and debate is required to decide how these needs are best met.