NCEPOD: Trauma - Who Cares? - London Health Programmes

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CHAPTER 5 - Hospital receptionThese data provide a clear association between grade of fi rstreviewer and the advisors’ assessments of appropriatenessof response.Table 44. Time to first consultant reviewNumber of patients %On arrival 108 29.0> 0 ≤ 30 minutes 34 9.1> 30 minutes ≤ 1 hour 12 3.2> 1 hour ≤ 6 hours 96 25.7> 6 hours ≤ 12 hours 53 14.2> 12 hours 70 18.8Subtotal 373Insuffi cient data 422Total 795care process. It was recently shown in a study of severelyinjured patients 5 that consultant presence in the emergencydepartment reduced the mean time to operating theatre inthese patients: (43.8 minutes (+/-20.1) when a consultantwas present and 109.4 minutes (+/-10.7) when a consultantwas not present, p
5Hospital receptionPrimary survey and overallassessmentPrimary surveyIn 88.8% (706/795) of cases a primary survey wasdocumented on arrival in the emergency department(Table 45). In the opinion of the advisors this primary surveywas performed suffi ciently early enough in 680/706 (96.3%)cases, not suffi ciently early enough in 26 cases (3.7%)and there was insuffi cient data to comment in 89 cases(Table 46).Table 45. Documentation of a primary surveyNumber of patients %Yes 706 88.8No 89 11.2Total 795Appropriateness of initial responseThe advisors were asked to assess the initial response tothe trauma patient. Table 47 shows that of the 699 casesthat could be assessed, 94 (13.4%) were graded as havingan inappropriate initial response. In a further 96/795 cases,there was insuffi cient data to comment.Table 47. Appropriateness of initial responseNumber of patients %Yes 605 86.6No 94 13.4Subtotal 699Insuffi cient data 96Total 795Table 46. Timeliness of a primary surveyNumber of patients %Yes 680 96.3No 26 3.7Subtotal 706Insuffi cient data 89Total 795Despite the widespread adoption of the ATLS system noprimary survey was documented in 11.2% (89/795) of cases.Immediate management of life-threatening emergencies andidentifi cation of major injuries is a key to good outcomes forseverely injured patients and it is diffi cult to see how this canreliably happen in the absence of a primary survey.59
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Trauma: Who cares?A report of the N
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ContentsAcknowledgements 4Foreword
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AcknowledgementsThis is the twenty
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AcknowledgementsThe organisations t
Page 10 and 11: ForewordSevere injury - a car crash
Page 12 and 13: Summary of fi ndingsThis study show
Page 14 and 15: Principal recommendationsOrganisati
Page 16 and 17: IntroductionTrauma remains the four
Page 18 and 19: IntroductionReferences1. Chaira 0,
Page 20 and 21: MethodQuestionnaires and casenotesT
Page 22 and 23: MethodQuality and confidentialityA
Page 24 and 25: CHAPTER 1 - Data overviewFigure 2.
Page 26 and 27: CHAPTER 1 - Data overviewMode of ar
Page 28 and 29: CHAPTER 2 - Organisational dataTabl
Page 36 and 37: CHAPTER 3 - Overall assessmentAll c
Page 38 and 39: CHAPTER 3 - Overall assessmentKey f
Page 40 and 41: CHAPTER 4 - Prehospital careRespons
Page 42 and 43: CHAPTER 4 - Prehospital careFigure
Page 44 and 45: CHAPTER 4 - Prehospital careTranspo
Page 46 and 47: CHAPTER 4 - Prehospital careAdequac
Page 48 and 49: CHAPTER 4 - Prehospital careIn 40/5
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Page 52 and 53: CHAPTER 5 - Hospital receptionIntro
Page 54 and 55: CHAPTER 5 - Hospital receptionTable
Page 56 and 57: CHAPTER 5 - Hospital receptionTraum
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CHAPTER 8 - Head injury managementK
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CHAPTER 8 - Head injury management1
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CHAPTER 9 - Paediatric careOrganisa
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CHAPTER 9 - Paediatric careClinical
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CHAPTER 9 - Paediatric careKey find
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CHAPTER 10 - TransfersIntroductionM
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CHAPTER 10 - TransfersArrangement o
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CHAPTER 10 - TransfersFigure 52. De
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CHAPTER 10 - TransfersKey findingsR
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CHAPTER 11 -Incidence of trauma and
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CHAPTER 11 - Incidence of trauma an
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APPENDIX B - Injury severity scoreA
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APPENDIX C - Adult and paediatric G
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APPENDIX D - An example of an excel
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APPENDIX E - Level 1 trauma careAs
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APPENDIX F - ParticipationTrustCase
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APPENDIX G - Corporate structureThe
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Published November 2007 by the Nati
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NCEPOD: Trauma - Who Cares? - London Health Programmes

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