title: Transatlantic perspectives of trauma systems.
abstract: The need for centralized management of acute trauma was evaluated in a 1-year prospective study in Northern Ireland. All patients with an Injury Severity Score > 15 who reached hospital alive were included. The sample population was approximately 1 million people. A total of 239 patients entered the study, of whom 74 died. An audit panel considered that 3-15 per cent of deaths were preventable. There was no significant difference in the preventable mortality rate between any hospital or groups of hospitals. There was a high level of consultant involvement, especially in small hospitals. A system in which patients with acute trauma bypass the nearest hospital to reach a trauma centre may be neither beneficial nor cost-effective in Northern Ireland. Upgrading of the present system with stabilization of the patient and emergency surgery at the nearest hospital before transfer is recommended.
authors.affiliation: Accident and Emergency Department, Royal Victoria Hospital, Belfast, UK.
authors.forename: B P
authors.initials: BP
authors.lastname: McNicholl
authors.forename: R B
authors.initials: RB
authors.lastname: Fisher
authors.forename: C H
authors.initials: CH
authors.lastname: Dearden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006780:Hospitals, Rural / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009660:Northern Ireland / Q000453:epidemiology; D015588:Observer Variation; D014193:Trauma Centers / Q000592:standards / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality / Q000601:surgery / Q000628:therapy*