title: Improving outcomes in the early phases after major trauma.
abstract: OBJECTIVE
  The scope of this review is to describe what is known about injury outcomes and the principles by which they can be improved by acute phase interventions. Assessing which outcomes matter to trauma patients is important both for the evaluation of existing and novel acute interventions and to assess the delivery of care within trauma systems' performance improvement frameworks.
  
  
  RESULTS
  Trauma care is moving away from the straightforward assessment of simple endpoints such as mortality or amputation. These have limited applicability and may not truly demonstrate the effectiveness of some acute interventions. Other intermediate or long-term measures are more patient-centred but are harder to measure, collect and interpret. Acute interventions improve outcomes through a combination of early definitive care concurrent with techniques to maintain homeostasis and preserve cells and tissues. These interventions need to be delivered within a regional systems framework. Trauma systems improve outcomes by reducing randomness and error from trauma care pathways.
  
  
  CONCLUSIONS
  Improving outcomes in the acute phase of trauma care requires the timely delivery of complex interventions with an organized trauma system. Research is needed both in developing novel interventions and in developing and validating patient-centred and surrogate outcome tools.
authors.affiliation: Trauma Outcomes Core, Trauma Sciences, Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University London, London, UK. k.brohi@qmul.ac.uk
authors.forename: Karim
authors.initials: K
authors.lastname: Brohi
authors.forename: Elaine
authors.initials: E
authors.lastname: Cole
authors.forename: Karen
authors.initials: K
authors.lastname: Hoffman
mesh_terms: D003422:Critical Care / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D017063:Outcome Assessment, Health Care; D013997:Time Factors; D014947:Wounds and Injuries / Q000628:therapy*