title: Improved trauma care after reorganisation: a retrospective analysis.
abstract: OBJECTIVE
  To shorten the time to make a diagnosis and to begin definitive treatment of severely injured patients, thereby improving their medical care.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Teaching hospital, Sweden.
  
  
  METHODS
  61 patients who had sustained high-energy injuries, including head injury which required surgical intervention, and fracture of the femoral shaft before (1987-1988 n = 23) and after (1991-1993 n = 38) the reorganisation.
  
  
  METHODS
  Trauma care was reorganised during the year 1989-1990 and the concept of early multidisiplinary treatment with the general surgeon as trauma-leader was adopted.
  
  
  METHODS
  The time required to make a diagnosis and begin definitive treatment as well as the assessment of medical care taking account of the patient's general condition and other injuries.
  
  
  RESULTS
  The immediate medical care was classified as delayed or inappropriate in 9 of 23 patients before, and in 2 of 38 patients after, the reorganisation (p = 0.001). The time needed to make a diagnosis was less than 4 hours in all cases. The time needed to start definitive treatment of head injuries was less than four hours in 9 of 12 patients before, and in 18 of 21 patients after the reorganisation. The internal fixation of femoral fractures was started within four hours in 2 of 11 femoral fractures before, compared with 12 of 17, after the reorganisation.
  
  
  CONCLUSIONS
  The time to beginning definitive treatment of severe injuries was shorter after the reorganisation, as a result of early participation of members of the trauma team.
authors.affiliation: Department of Orthopaedics, Karolinska Hospital, Stockholm, Sweden.
authors.forename: K A
authors.initials: KA
authors.lastname: Alberts
authors.forename: B M
authors.initials: BM
authors.lastname: Bellander
authors.forename: G
authors.initials: G
authors.lastname: Modin
mesh_terms: D000058:Accidental Falls; D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000628:therapy; D005260:Female; D005264:Femoral Fractures / Q000628:therapy; D005593:Fracture Fixation, Internal; D015600:Glasgow Coma Scale; D006754:Hospital Restructuring; D006784:Hospitals, Teaching / Q000458:organization & administration / Q000592:standards; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D013548:Sweden; D014193:Trauma Centers / Q000458:organization & administration* / Q000592:standards