NCEPOD: Trauma - Who Cares? - London Health Programmes

7Management of circulationThe time to trauma laparotomy in the whole group didnot compare favourably to published data from a traumacentre 47 . In that study 47 median time to laparotomy was 127minutes compared to 200 minutes in this study. It can beseen that the use of CT scanning was associated with muchlonger times to trauma laparotomy but the reasons behindthis were not clear from the data collected.laparotomy was required. In 12 cases it was believed that theseverity of haemorrhage and urgency of the situation werenot appreciated. In two cases there was a delay in provisionof a staffed operating theatre.Lack of senior involvement and lack of appreciation of clinicalurgency have been found in many areas of medicine involvedwith acute care and the same problems have been found intrauma management.Timeliness of surgeryThe advisors were able to assess the timeliness of 87 ofthe 110 procedures for haemorrhage. The interventionsperformed were judged to be timely in 63/87 (72.4%) casesand delayed in 24/87 (27.6%) (Figure 31).Reasons given for delays in the initiation of the procedurewere multiple and often associated with the medical staffnot appreciating the urgency of the requirement to controlhaemorrhage. Five patients were believed to have hadunnecessary imaging (CT scan) as it was clear that a traumaImaging and delays to definitive careTable 62 shows more data for the patients who requiredsurgery and the relationship between imaging and timelinessof operation. As can be seen from the data, it was morelikely that delays were reported if imaging was performed asopposed to a clinical decision that the patient required animmediate operation. In the latter group, 19/20 patients wereconsidered to have received timely surgery.Figure 31. Procedure performed was timely (advisors’ view)7060Number of patients50403020100Yes No Insufficient data79