Preliminary analysis of the care of injured patients in 33 British hospitals: first report of the United Kingdom major trauma outcome study.
OBJECTIVE
To measure the effectiveness of management of major trauma in the United Kingdom.


METHODS
Review of the care of all seriously injured patients seen over two years.


METHODS
33 hospitals which receive patients who have sustained major trauma.


METHODS
14,648 injured patients admitted for more than three days, transferred or admitted into an intensive care bed, or dying from their injuries.


METHODS
Death or survival in hospital within three months of the injury.


RESULTS
21% of seriously injured patients (1299) took longer than one hour to reach hospital. Time before arrival at hospital was not related to severity of injury. A senior house officer was in charge of initial hospital resuscitation in 57% (826/1445) of patients with an injury severity score > or = 16. More senior staff were commonly responsible for definitive operations, but only 46% (165/355) of patients judged to require early operation arrived in theatre within two hours. Mortality for 6111 patients sustaining blunt trauma and treated in the 14 busiest hospitals was significantly higher (actual 408, predicted 295.6, p < 0.001) than in a comparable North American dataset. Large differences in the 14 hospitals assessed could not be explained by variations in case load or facilities. In contrast, the outcome of the 4.1% (597) of patients with penetrating injuries was better than that of a comparable group in the United States. Analysis of the 415 penetrating injuries with complete data showed that 15 patients died (19.3 predicted; p = 0.04).


CONCLUSIONS
The initial management of major trauma in the United Kingdom remains unsatisfactory. There are delays in providing experienced staff and timely operations. Mortality varies inexplicably between hospitals and, for blunt trauma, is generally higher than in the United States.
Yates
D W
DW
University of Manchester, Hope Hospital, Salford.
Woodford
M
M
Hollis
S
S
D004632:Emergency Medical Services / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D014852:Wales / Q000453:epidemiology; D000078329:Workforce; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*