NCEPOD: Trauma - Who Cares? - London Health Programmes

MethodMethodStudy aimThe aim of this study was to examine the process of care forseverely injured patients and identify variations that affect theachievement of agreed endpoints.The expert group identifi ed six main thematic areasthat would address the overall aim of the study:1. Timeliness of events making up the clinicalmanagement process.2. Issues associated with prehospital care at the siteof injury and transfer to hospital.3. Issues associated with the care team that performsthe initial resuscitation.4. Processes and procedures associated withsecondary transfers.5. Issues associated with pathways, handoversand communication.6. Membership of the Trauma Audit Research Network(TARN).Expert groupA multidisciplinary group of experts comprising cliniciansfrom emergency medicine, general surgery, neurosurgery,radiology, anaesthetics, and lay representatives contributedto the design of the study and reviewed the combinedanalysis of the data; both from the questionnaires and theextra information from the advisory groups.Case identificationPatients were identifi ed prospectively. A nominated contactin the emergency department identifi ed patients as severelyinjured based primarily on their, and their colleagues’, clinicaljudgement. A list of patients (which included a patientidentifi er and the date and time of admission) was thenforwarded to the NCEPOD local reporter who completed amonthly spreadsheet which contained additional information(for example, the name of the admitting clinician). Datacollection ran for three months from February 1st 2006to April 30th 2006. Patients of all ages were eligible forinclusion. After each month of sampling, a spreadsheetwas returned, password-protected, to NCEPOD along withphotocopies of all of the casenotes for the fi rst 72 hoursin hospital. The casenotes were used by NCEPOD staffto calculate an injury severity score (ISS) for each patient(see Appendix B). Patients with an ISS of 16 or more wereincluded in the study. The casenotes of included patientswere subsequently used for the peer review process.ExclusionsThe following patient groups were excluded:• Death by hanging or drowning (the pathology isasphyxia rather than trauma); and• Patients brought in for confirmation of death.17