title: Destination healthcare facility of shocked trauma patients in Scotland: analysis of transfusion and surgical capability of receiving hospitals.
abstract: OBJECTIVE
  Haemorrhage is a leading cause of death from trauma. Management requires a combination of haemorrhage control and resuscitation which may incur significant surgical and transfusion utilisation. The aim of this study is to evaluate the resource provision of the destination hospital of Scottish trauma patients exhibiting evidence of pre-hospital shock.
  
  
  METHODS
  Patients who sustained a traumatic injury between November 2008 and October 2010 were retrospectively identified from the Scottish Ambulance Service electronic patients record system. Patients with a systolic blood pressure less than 110 mmHg or if missing, a heart rate greater than 120 bpm, were considered in shock. The level of the destination healthcare facility was classified in terms of surgical and transfusion capability. Patients with and without shock were compared.
  
  
  RESULTS
  There were 135,004 patients identified, 133,651 (99.0%) of whom had sustained blunt trauma, 68,411 (50.7%) were male and the median (IQR) age was 59 (46). There were 6721 (5.0%) patients with shock, with a similar age and gender distribution to non-shocked patients. Only 1332 (19.8%) of shocked patients were taken to facilities with full surgical capability, 5137 (76.4%) to hospitals with limited (general and orthopaedic surgery only) and 252 (3.7%) to hospitals with no surgical services. In terms of transfusion capability, 5556 (82.7%) shocked patients were admitted to facilities with full capability and 1165 (17.3%) to a hospital with minimal or no capability.
  
  
  CONCLUSIONS
  The majority of Scottish trauma patients are transported to a hospital with full transfusion capability, although the majority lack surgical sub-specialty representation.
authors: Department of Surgery, Monklands Hospital, Airdrie, UK.
authors: Christopher M
authors: CM
authors: Peach
authors: Jonathan J
authors: JJ
authors: Morrison
authors: Amy N
authors: AN
authors: Apodaca
authors: Gerry
authors: G
authors: Egan
authors: Henry G
authors: HG
authors: Watson
authors: Jan O
authors: JO
authors: Jansen
mesh_terms: D001803:Blood Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D012771:Shock, Hemorrhagic / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome; D014218:Triage; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000601:surgery*
keywords: Shock; Transfusion; Trauma; Trauma systems; Triage