Trauma network during COVID-19: perspective from the four designed major trauma centers in north-west Italy

Introduction Fractures of the pelvis and acetabulum (PAFs) are challenging injuries, requiring specialist surgical input. Since implementation of the major trauma network in England in 2012, little has been published regarding the available services, workforce organisation and burden of PAF workload. The aim of this study was to assess the recent trends in volume of PAF workload, evaluate the provision of specialist care, and identify variation in available resources, staffing and training opportunity. Methods Data on PAF volume, operative caseload, route of admission and time to surgery were requested from the Trauma Audit and Research Network. In order to evaluate current workforce provision and services, an online survey was distributed to individuals known to provide PAF care at each of the 22 major trauma centres (MTCs). Results From 2013 to 2019, 23,823 patients with PAF were admitted to MTCs in England, of whom 12,480 (52%) underwent operative intervention. On average, there are 3,971 MTC PAF admissions and 2,080 operative fixations each year. There has been an increase in admissions and cases treated operatively since 2013. Three-quarters (78%) of patients present directly to the MTC while 22% are referred from regional trauma units. Annually, there are on average 37 operatively managed PAF injuries per million population. Notwithstanding regional differences in case volume, the average number of annual PAF operative cases per surgeon in England is 30. There is significant variation in frequency of surgeon availability. There is also variation in rota organisation regarding consistent specialist surgeon availability. Conclusions This article describes the provision of PAF services since the reorganisation of trauma services in England. Future service development should take into account the current distribution of activity, future trends for increased volume and casemix, and the need for a PAF registry.

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The impact of the Major Trauma Network: will trauma units continue to treat complex foot and ankle injuries?

Injury ◽

10.1016/j.injury.2014.07.005 ◽

2014 ◽

Vol 45 (12) ◽

pp. 2005-2008 ◽

Cited By ~ 1

Author(s):

A.G.C. Hay-David ◽

S.A. Clint ◽

R.R. Brown

Keyword(s):

Major Trauma ◽

Ankle Injuries ◽

Trauma Network ◽

Foot And Ankle ◽

The Impact

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Abstract 183: Outcomes for Major Trauma Patients in Counties Without Trauma Centers Are Worse: Nationwide Population-Based Research in Taiwan

Circulation ◽

10.1161/circ.130.suppl_2.183 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Dorji Harnod ◽

Chu Hui Chang ◽

Ray E Chang

Keyword(s):

Major Trauma ◽

Injury Severity ◽

Total Mortality ◽

Data Bank ◽

Claim Data ◽

Population Based ◽

Trauma Patients ◽

Direct Transfer ◽

Trauma Centers ◽

Icu Admission

Background: Some articles proved indirect-transfer the major trauma patients to the trauma centers had non-significant different outcomes with the patients direct-transfer to the centers. But the outcomes for the major trauma patients in the counties without trauma centers still can be worse. So we did a population based research by using the NHIRD data for the results. Methods: From the claim data of one million beneficiaries of Taiwan National Health Insurance during the year of 2006 to 2008, all of the trauma patients were identified from the database by the ICD-9-CM system. ICDMAP-90 was used for calculating the Injury Severity Score (ISS) as the variable controlling the disease severity. The patients of major trauma were defined as ISS more than fifteen. We used the diagnosis one year before the trauma admission for calculating Charlson Comorbidity Index (CCI). The first hospitals and the second transferred hospitals that the major trauma patients admitted, and the areas of the first hospitals were recognized in our data bank. The condition of transfer, age, genders, intubation, ICU admission, ISS, CCI, and the triage classifications were adjusted in a logistic regression model for further analysis. Results: There were 2497 major trauma patients (ISS more then 15). The total mortality rate was 12.49%. The variables like age, intubation, ICU admission, ISS and CCI were significant for mortality, but the condition of transfer was not significant in our model. After controlling all the factors, the major trauma patients that first admitted in the areas with no trauma centers have a significant higher risk of mortality (OR=1.73, P=0.005). Conclusions: Our results hint that, although indirect-transfer for the major trauma patients have insignificant difference in mortality with the direct transfer patients, the counties with no trauma centers have significant higher mortality rates in major trauma patients. Further researches are needed for investigating the possible reasons.

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