title: Trauma scoring systems and databases.
abstract: This review considers current trauma scoring systems and databases and their relevance to improving patient care. Single physiological measures such as systolic arterial pressure have limited ability to diagnose severe trauma by reflecting raised intracranial pressure, or significant haemorrhage. The Glasgow coma score has the greatest prognostic value in head-injured and other trauma patients. Trauma triage tools and imaging decision rules-using combinations of physiological cut-off measures with mechanism of injury and other categorical variables-bring both increased sophistication and increased complexity. It is important for clinicians and managers to be aware of the diagnostic properties (over- and under-triage rates) of any triage tool or decision rule used in their trauma system. Trauma registries are able to collate definitive injury descriptors and use survival prediction models to guide trauma system governance, through individual patient review and case-mix-adjusted benchmarking of hospital and network performance with robust outlier identification. Interrupted time series allow observation in the changes in care processes and outcomes at national level, which can feed back into clinical quality-based commissioning of healthcare. Registry data are also a valuable resource for trauma epidemiological and comparative effectiveness research studies.
authors.affiliation: EMRiS Group, Health Services Research, School of Health and Related Research, University of Sheffield, Regent's Court, Regent Street, Sheffield S1 4DA, UK Trauma Audit and Research Network, Manchester Academic Health Sciences Network, Institute of Population Health, University of Manchester, Salford Royal Hospital, 3rd Floor, Mayo Building, Eccles Old Road, Salford M6 8HD, UK f.e.lecky@sheffield.ac.uk.
authors.forename: F
authors.initials: F
authors.lastname: Lecky
authors.affiliation: Trauma Audit and Research Network, Manchester Academic Health Sciences Network, Institute of Population Health, University of Manchester, Salford Royal Hospital, 3rd Floor, Mayo Building, Eccles Old Road, Salford M6 8HD, UK.
authors.forename: M
authors.initials: M
authors.lastname: Woodford
authors.affiliation: Trauma Audit and Research Network, Manchester Academic Health Sciences Network, Institute of Population Health, University of Manchester, Salford Royal Hospital, 3rd Floor, Mayo Building, Eccles Old Road, Salford M6 8HD, UK.
authors.forename: A
authors.initials: A
authors.lastname: Edwards
authors.affiliation: Trauma Audit and Research Network, Manchester Academic Health Sciences Network, Institute of Population Health, University of Manchester, Salford Royal Hospital, 3rd Floor, Mayo Building, Eccles Old Road, Salford M6 8HD, UK.
authors.forename: O
authors.initials: O
authors.lastname: Bouamra
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Level G, Jarvis Building RMO, Infirmary Square, Leicester LE1 5WW, UK.
authors.forename: T
authors.initials: T
authors.lastname: Coats
mesh_terms: D061906:Advanced Trauma Life Support Care / Q000145:classification; D016208:Databases, Factual; D003952:Diagnostic Imaging; D015600:Glasgow Coma Scale; D006801:Humans; D011237:Predictive Value of Tests; D012042:Registries; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014218:Triage / Q000379:methods; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000453:epidemiology
keywords: clinical governance; epidemiology; medical audit; wounds and injuries