Injury · 2025
A decade of trauma care in the North of Scotland: Impact of an inclusive network.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Tallach Rosel, Hannen Mark, Hooper Tim, Allen Lee, Cole Elaine
Аннотация
BACKGROUND: Trauma care in Scotland is organised into four networks and the North of Scotland Trauma Network, covering 60 % of Scotland's landmass, was the first of the four regions to go live in October 2018. The trauma demographics, journeys and outcomes over the decade of 2013-2023, five years and nine months prior to and five years post implementation were examined.
METHODS: Data prospectively collected by Scottish Trauma Audit Group (STAG) during the time period was analysed. Patients of all ages, Injury Severity Score (ISS) > 8 and head injury Abbreviated Injury Scale (AIS) > 1 were included. The primary outcome was mortality. Multivariate logistic regression compared factors associated with mortality pre- and post - network.
RESULTS: Post-network, 47.8 % of ISS>15 presented at non-Major Trauma Centre (MTC) hospitals, of which 47.4 % underwent secondary transfer. Half (50.5 %) of serious head injuries (AIS>2) presented to the Trauma Unit (TU) / Local Emergency Hospitals (LEH), of which 34.4 % were transferred to the MTC. Of those transferred to the MTC, moving vehicle was the commonest mechanism (44.7 %) and median ISS was 22 (IQR 17 - 29). Ultimately, the majority (75 %) of major trauma patients were treated at the MTC post network. Whilst overall mortality was 7.8 %; this rose to 18.3 % for ISS > 15, and 20.6 % for serious head injury. Mortality for ISS > 15 first presenting outside of the MTC and then subsequently transferred was 8.3 %. There was significant difference in 30-day mortality in those presenting after network implementation (OR 0.76 [0.6 - 0.97], p = 0.03) adjusting for age, ISS, head injury severity and mechanism of injury. A sensitivity analysis of the two consistently contributing hospitals (TU and MTC) was performed and mortality improvement was maintained (OR 0.71, 95 % CI 0.55 - 0.93, p = 0.011) although this could have been due to improved data capture of lower acuity trauma, or other confounding variables.
CONCLUSION: In a geographically dispersed network, the contributions of TUs and LEHs and subsequent secondary transfers are substantial. Network investment in training, communication pathways and transfer governance is essential.
METHODS: Data prospectively collected by Scottish Trauma Audit Group (STAG) during the time period was analysed. Patients of all ages, Injury Severity Score (ISS) > 8 and head injury Abbreviated Injury Scale (AIS) > 1 were included. The primary outcome was mortality. Multivariate logistic regression compared factors associated with mortality pre- and post - network.
RESULTS: Post-network, 47.8 % of ISS>15 presented at non-Major Trauma Centre (MTC) hospitals, of which 47.4 % underwent secondary transfer. Half (50.5 %) of serious head injuries (AIS>2) presented to the Trauma Unit (TU) / Local Emergency Hospitals (LEH), of which 34.4 % were transferred to the MTC. Of those transferred to the MTC, moving vehicle was the commonest mechanism (44.7 %) and median ISS was 22 (IQR 17 - 29). Ultimately, the majority (75 %) of major trauma patients were treated at the MTC post network. Whilst overall mortality was 7.8 %; this rose to 18.3 % for ISS > 15, and 20.6 % for serious head injury. Mortality for ISS > 15 first presenting outside of the MTC and then subsequently transferred was 8.3 %. There was significant difference in 30-day mortality in those presenting after network implementation (OR 0.76 [0.6 - 0.97], p = 0.03) adjusting for age, ISS, head injury severity and mechanism of injury. A sensitivity analysis of the two consistently contributing hospitals (TU and MTC) was performed and mortality improvement was maintained (OR 0.71, 95 % CI 0.55 - 0.93, p = 0.011) although this could have been due to improved data capture of lower acuity trauma, or other confounding variables.
CONCLUSION: In a geographically dispersed network, the contributions of TUs and LEHs and subsequent secondary transfers are substantial. Network investment in training, communication pathways and transfer governance is essential.