title: The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services.
abstract: This paper discusses mathematical models of expressing severity of injury and probability of survival following trauma and their use in establishing clinical governance of a trauma system. There are five sections: (i) Historical overview of scoring systems--anatomical, physiological and combined systems and the advantages and disadvantages of each. (ii) Definitions used in official statistics--definitions of 'killed in action' and other categories and the importance of casualty reporting rates and comparison across conflicts and nationalities. (iii) Current scoring systems and clinical governance--clinical governance of the trauma system in the Defence Medical Services (DMS) by using trauma scoring models to analyse injury and clinical patterns. (iv) Unexpected outcomes--unexpected outcomes focus clinical governance tools. Unexpected survivors signify good practice to be promulgated. Unexpected deaths pick up areas of weakness to be addressed. Seventy-five clinically validated unexpected survivors were identified over 2 years during contemporary combat operations. (v) Future developments--can the trauma scoring methods be improved? Trauma scoring systems use linear approaches and have significant weaknesses. Trauma and its treatment is a complex system. Nonlinear methods need to be investigated to determine whether these will produce a better approach to the analysis of the survival from major trauma.
authors.affiliation: Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Russell
authors.forename: T J
authors.initials: TJ
authors.lastname: Hodgetts
authors.forename: J
authors.initials: J
authors.lastname: McLeod
authors.forename: K
authors.initials: K
authors.lastname: Starkey
authors.forename: P
authors.initials: P
authors.lastname: Mahoney
authors.forename: K
authors.initials: K
authors.lastname: Harrison
authors.forename: E
authors.initials: E
authors.lastname: Bell
mesh_terms: D006801:Humans; D008887:Military Medicine / Q000379:methods*; D008889:Military Personnel; D008962:Models, Theoretical; D017410:Practice Guidelines as Topic; D015599:Trauma Severity Indices; D006113:United Kingdom; D014857:Warfare; D014947:Wounds and Injuries / Q000145:classification* / Q000473:pathology* / Q000628:therapy