title: Utilisation of a Level 1 Trauma Centre in KwaZulu-Natal: appropriateness of referral determines trauma patient access.
abstract: BACKGROUND
  Appropriate referral of major trauma patients to an accredited Level 1 Trauma facility is associated with improved outcome. A new Level 1 Trauma Centre was opened at Inkosi Albert Luthuli Central Hospital in March 2007. This study sought to audit the referral pattern of external consults to the trauma unit and ascertain whether the unit was receiving appropriate referrals and has adequate capacity.
  
  
  METHODS
  An audit was performed of the referral proformas used in the unit to record admission decisions and of the computerised trauma database. The audit examined referral source (scene vs. interhospital), regional distribution, and final decision regarding admission of the injured patients. The study was approved by the UKZN Ethics Committee (BE207/09 and 011/010).
  
  
  RESULTS
  Of the 1,212 external consults, 540 were accepted for admission while the rest were not accepted for various reasons. These included 206 cases where no bed was available, 233 did not meet admission criteria (minor injury or futile situation), and 115 were for subspecialty management of a single-system injury. Finally, 115 were initially refused pending stabilisation for transfer at a regional facility. Twenty-six percent of the cases were referrals from the scene, with an acceptance rate of 96 %. Most patients (59 %) were from the local eThekwini region.
  
  
  CONCLUSIONS
  Major multiorgan system trauma remains a significant public health burden in KwaZulu-Natal. A Level 1 Trauma Service is used appropriately in most circumstances. However, the additional need for more hospital facilities that provide such services across the whole province to enable effective geographical coverage for those trauma patients requiring such specialised trauma care is essential.
authors.affiliation: Department of Surgery, UKZN, Trauma Unit, Inkosi Albert Luthuli Central Hospital (IALCH), 800 Bellair Road, Mayville, Postnet Suite 27, Private Bag X05, Malvern, Durban 4055, South Africa. timothyhar@ialch.co.za
authors.forename: Timothy Craig
authors.initials: TC
authors.lastname: Hardcastle
authors.forename: Matthew Giles
authors.initials: MG
authors.lastname: Reeds
authors.forename: David James Jackson
authors.initials: DJ
authors.lastname: Muckart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D006295:Health Resources / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008485:Medical Audit; D008875:Middle Aged; D010360:Patient Transfer / Q000458:organization & administration / Q000706:statistics & numerical data; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology; D014193:Trauma Centers / Q000458:organization & administration / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D055815:Young Adult