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Transatlantic perspectives of trauma systems
B P McNicholl1, R B Fisher, C H Dearden
1Accident and Emergency Department, Royal Victoria Hospital, Belfast, UK.
The British Journal of Surgery
|August 1, 1993
Summary
Centralized trauma care may not benefit Northern Ireland. Upgrading current systems with early stabilization and surgery at local hospitals is recommended for acute trauma patients.
Area of Science:
- Trauma surgery
- Emergency medicine
- Health services research
Background:
- Acute trauma management requires efficient systems.
- Centralized trauma care models are increasingly adopted.
- The effectiveness of trauma center bypass in Northern Ireland was unevaluated.
Purpose of the Study:
- To evaluate the need for centralized trauma care management in Northern Ireland.
- To assess the cost-effectiveness and benefits of a trauma center bypass system.
Main Methods:
- A 1-year prospective study included patients with Injury Severity Score > 15.
- The study population represented approximately 1 million people.
- An audit panel reviewed preventable deaths.
Main Results:
- 239 patients were included; 74 died.
- 3-15% of deaths were deemed preventable by an audit panel.
- No significant difference in preventable mortality was found between hospitals.
- Consultant involvement was high, even in smaller hospitals.
Conclusions:
- A trauma center bypass system may not be beneficial or cost-effective in Northern Ireland.
- Upgrading the current system with pre-transfer stabilization and emergency surgery is recommended.
- Improvements should focus on local hospital capabilities for acute trauma patients.