Using emergency trauma team activations to measure trauma activity and injury severity: 10 years of experience using an Australian major trauma centre registry

Abstract Aim The number of cyclists travelling on roads in the United Kingdom (UK) is increasing. The government has recently introduced initiatives to promote cycling uptake and so these numbers are likely to increase. This study aims to characterise cycling related injuries presenting to a major trauma centre located within a region with the highest rates of cycling in the UK. Method A retrospective review of cycling related trauma admissions occurring between January 2012 and June 2020 was performed. All patients were split into three groups based on the mechanism of injury. Our institution’s electronic patient record system was used to collect data including age, gender, mechanism of injury, Glasgow coma scale score on arrival, incident date and time, injured body regions, 30-day mortality, helmet use, and length of stay. Results A total of 606 cycling related trauma cases were identified, with 52 being excluded due to incomplete data. The ‘cyclist v vehicle’ group was associated with a significantly higher Injury Severity score (ISS), lower GCS and longer hospital stay than the other two groups. Helmet wearers were significantly older than non-wearers and helmet use was associated with a significantly reduced risk of head injury, lower ISS and higher GCS. Conclusions With a likely increase in future cycling uptake, it is crucial that effective interventions are put in place to improve the safety of cyclists. A multi-faceted strategy involving driver and cyclist education, road infrastructure changes and helmet promotion campaigns targeting the younger generation could be employed.

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The sensitivity of pre-hospital and in-hospital tools for the identification of major trauma patients presenting to a major trauma centre.

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-99-16 ◽

2013 ◽

Vol 99 (1) ◽

pp. 16-19

Author(s):

D Potter ◽

A Kehoe ◽

JE Smith

Keyword(s):

Major Trauma ◽

Injury Severity ◽

Trauma Centre ◽

Research Network ◽

Trauma Network ◽

Trauma Patients ◽

Major Trauma Centre ◽

Injury Assessment ◽

Trauma Response ◽

Retrospective Database

AbstractThe identification of major trauma patients before arrival in hospital allows the activation of an appropriate trauma response. The Wessex triage tool (WTT) uses a combination of anatomical injury assessment and physiological criteria to identify patients with major trauma suitable for triage direct to a major trauma centre (MTC), and has been adopted by the South-West Peninsula Trauma Network (PTN). A retrospective database review, using the Trauma Audit Research Network (TARN) database, was undertaken to identify a population of patients presenting to Derriford Hospital with an injury severity score (ISS) > 15. The WTT was then applied to this population to identify the sensitivity of the tool. The sensitivity of the WTT at identifying patients with an ISS>15 was 53%. One of the reasons for this finding was that elderly patients who are defined as having major trauma due to the nature of their injuries, but who did not have a mechanism to suggest they had sustained major trauma (such as a fall from standing height), were not identified by these triage tools. The implications of this are discussed.

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SEE AND TREAT FOR MAJOR TRAUMA? AN EVALUATION OF THE USE OF A TWO-TIERED TRAUMA TEAM ACTIVATION SYSTEM IN A UK MAJOR TRAUMA CENTRE

Emergency Medicine Journal ◽

10.1136/emermed-2013-203113.14 ◽

2013 ◽

Vol 30 (10) ◽

pp. 871.3-872

Author(s):

P E Jenkins ◽

J Rogers ◽

A Kehoe ◽

J Smith

Keyword(s):

Major Trauma ◽

Trauma Team ◽

Trauma Centre ◽

Trauma Team Activation ◽

Major Trauma Centre ◽

Activation System

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Prehospital critical care is associated with increased survival in adult trauma patients in Scotland

Emergency Medicine Journal ◽

10.1136/emermed-2019-208458 ◽

2020 ◽

Vol 37 (3) ◽

pp. 141-145 ◽

Cited By ~ 2

Author(s):

Alistair Maddock ◽

Alasdair R Corfield ◽

Michael J Donald ◽

Richard M Lyon ◽

Neil Sinclair ◽

...

Keyword(s):

Multivariate Analysis ◽

Critical Care ◽

Major Trauma ◽

Injury Severity ◽

Prehospital Care ◽

National Registry ◽

Trauma Centre ◽

Trauma Patients ◽

Data Set ◽

Major Trauma Centre

BackgroundScotland has three prehospital critical care teams (PHCCTs) providing enhanced care support to a usually paramedic-delivered ambulance service. The effect of the PHCCTs on patient survival following trauma in Scotland is not currently known nationally.MethodsNational registry-based retrospective cohort study using 2011–2016 data from the Scottish Trauma Audit Group. 30-day mortality was compared between groups after multivariate analysis to account for confounding variables.ResultsOur data set comprised 17 157 patients, with a mean age of 54.7 years and 8206 (57.5%) of male gender. 2877 patients in the registry were excluded due to incomplete data on their level of prehospital care, leaving an eligible group of 14 280. 13 504 injured adults who received care from ambulance clinicians (paramedics or technicians) were compared with 776 whose care included input from a PHCCT. The median Injury Severity Score (ISS) across all eligible patients was 9; 3076 patients (21.5%) met the ISS>15 criterion for major trauma. Patients in the PHCCT cohort were statistically significantly (all p<0.01) more likely to be male; be transported to a prospective Major Trauma Centre; have suffered major trauma; have suffered a severe head injury; be transported by air and be intubated prior to arrival in hospital. Following multivariate analysis, the OR for 30-day mortality for patients seen by a PHCCT was 0.56 (95% CI 0.36 to 0.86, p=0.01).ConclusionPrehospital care provided by a physician-led critical care team was associated with an increased chance of survival at 30 days when compared with care provided by ambulance clinicians.

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Can residents be effective trauma team leaders in a major trauma centre?

Injury ◽

10.1016/j.injury.2011.09.020 ◽

2013 ◽

Vol 44 (1) ◽

pp. 18-22 ◽

Cited By ~ 6

Author(s):

E.M. Cole ◽

A. West ◽

R. Davenport ◽

S. Naganathar ◽

T. Kanzara ◽

...

Keyword(s):

Major Trauma ◽

Trauma Team ◽

Trauma Centre ◽

Team Leaders ◽

Major Trauma Centre

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An evaluation of the use of a two-tiered trauma team activation system in a UK major trauma centre: Table 1

Emergency Medicine Journal ◽

10.1136/emermed-2013-203402 ◽

2014 ◽

Vol 32 (5) ◽

pp. 364-367 ◽

Cited By ~ 11

Author(s):

P Jenkins ◽

J Rogers ◽

A Kehoe ◽

J E Smith

Keyword(s):

Major Trauma ◽

Trauma Team ◽

Trauma Centre ◽

Trauma Team Activation ◽

Major Trauma Centre ◽

Activation System

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A profile of a major trauma centre of North West England between 2011 and 2018

Scientific Reports ◽

10.1038/s41598-021-84266-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Raimundas Lunevicius ◽

Mina Mesri

Keyword(s):

Traffic Accidents ◽

Major Trauma ◽

Road Traffic ◽

Survival Rates ◽

Trauma Team ◽

Trauma Centre ◽

North West ◽

Major Trauma Centre ◽

Mortality Ratio ◽

Expected Mortality

AbstractThis study examined the trends and patterns of major trauma (MT) activities, causes, mortality and survival at the Aintree Major Trauma Centre (MTC), Liverpool, between 2011 and 2018. The number of trauma team activations (TTAs) rose sharply over time (n = 699 in 2013; n = 1522 in 2018). The proportion of TTAs that involved MT patients decreased from 75.1% in 2013 to 67.4% in 2018. The leading cause of MT was a fall from less than 2 m (36%). There has been a fivefold increase in the overall number of trauma procedures between 2011 and 2018. Orthopaedic surgeons have performed 80% of operations (n = 7732), followed by neurosurgeons, oral and maxillofacial surgeons, and general trauma surgeons. Both types of fall (> 2 m and < 2 m) and road traffic accidents were the three leading causes of death during the study period. The observed mortality rates exceeded that of expected rates in years 2012, 2014, 2016 and 2017. The all-cause observed to expected mortality ratio was 1.08 between 2012 and 2018. A change in care for MT patients was not directly associated with improved survival, although the marginally ascending trend line in survival rates between 2012 and 2018 reflects a gradual positive change.

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Mortality in adolescent trauma: a comparison of children’s, mixed and adult major trauma centres

Emergency Medicine Journal ◽

10.1136/emermed-2020-210384 ◽

2021 ◽

pp. emermed-2020-210384

Author(s):

Jordan Evans ◽

Hannah Murch ◽

Roisin Begley ◽

Damian Roland ◽

Mark D Lyttle ◽

...

Keyword(s):

Major Trauma ◽

Injury Severity ◽

Pairwise Comparison ◽

Patient Characteristics ◽

Mortality Rates ◽

Trauma Centre ◽

Research Network ◽

Categorical Variables ◽

Adolescent Trauma ◽

Major Trauma Centre

ObjectiveWe aimed to compare adolescent mortality rates between different types of major trauma centre (MTC or level 1; adult, children’s and mixed).MethodsData were obtained from TARN (Trauma Audit Research Network) from English sites over a 6-year period (2012–2018), with adolescence defined as 10–24.99 years. Results are presented using descriptive statistics. Patient characteristics were compared using the Kruskal-Wallis test with Dunn’s post-hoc analysis for pairwise comparison and χ2 test for categorical variables.Results21 033 cases met inclusion criteria. Trauma-related 30-day crude mortality rates by MTC type were 2.5% (children’s), 4.4% (mixed) and 4.9% (adult). Logistic regression accounting for injury severity, mechanism of injury, physiological parameters and ‘hospital ID’, resulted in adjusted odds of mortality of 2.41 (95% CI 1.31 to 4.43; p=0.005) and 1.85 (95% CI 1.03 to 3.35; p=0.041) in adult and mixed MTCs, respectively when compared with children’s MTCs. In three subgroup analyses the same trend was noted. In adolescents aged 14–17.99 years old, those managed in a children’s MTC had the lowest mortality rate at 2.5%, compared with 4.9% in adult MTCs and 4.4% in mixed MTCs (no statistical difference between children’s and mixed). In cases of major trauma (Injury Severity Score >15) the adjusted odds of mortality were also greater in the mixed and adult MTC groups when compared with the children’s MTC. Median length of stay (LoS) and intensive care unit LoS were comparable for all MTC types. Patients managed in children’s MTCs were less likely to have a CT scan (46.2% vs 62.8% mixed vs 64% adult).ConclusionsChildren’s MTC have lower crude and adjusted 30-day mortality rates for adolescent trauma. Further research is required in this field to identify the factors that may have influenced these findings.

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