An observational study evaluating the demand of major trauma on different surgical specialities in a UK Major Trauma Cen
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ORIGINAL ARTICLE
An observational study evaluating the demand of major trauma on different surgical specialities in a UK Major Trauma Centre Patrick Quinn1 · Benjamin Walton2 · David Lockey1,2 Received: 5 September 2018 / Accepted: 3 January 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Introduction Major Trauma Centres (MTCs) should ideally have all key surgical specialities on site. This may not always be the case since trauma is only one factor influencing speciality location. The implications of this can only be understood when the demands on specific specialities are established and this is not well documented. We investigated surgical speciality demand by quantifying the frequency and urgency of surgical trauma interventions. Patients and methods Data on adult trauma admissions for a UK MTC were retrieved from the UK Trauma Audit and Research Network for a 2-year period and analysed to establish the frequency and urgency of surgical interventions. Results Of 1285 trauma patients with an ISS > 15 presenting in the study year period 713 (55.5%) required surgery. Neurosurgical (59.9%) and orthopaedic (55.1%) operations were most frequent. Cardiothoracic, general surgery, plastic surgery and maxillofacial operations were required infrequently. General surgery was commonly needed urgently, 45% within 4 h of MTC arrival. Urgency was also common in interventional radiology and vascular surgery. Cardiothoracic interventions were mainly urgent interventions (thoracotomy 1/3) and less urgent (rib fixation 2/3). Discussion Neurosurgery and orthopaedic surgery are key on-site trauma specialities and required frequently. General surgery, interventional radiology and cardiothoracic interventions are required less frequently but often urgently. This confirms a need for MTC on-site capability and possibly training to maintain competency in occasional trauma operators, particularly in general surgery. Maxillofacial surgery, ENT and urology are required neither frequently nor urgently and on-site presence may be less critical. Conclusion Demand for specific surgical specialities was reported in a cohort of UK trauma patients. This confirmed the need for rapid on-site capability in key specialities and highlights possible training requirements for occasional trauma operators in specialities with low frequency but high urgency. Keywords Trauma · Major Trauma Centre · Surgery · UK · Quality improvement · Emergency surgery
Introduction The introduction of major trauma networks (MTNs) into UK practice has improved trauma mortality in the UK [1]. This is likely to be due to system improvements as well as changes in clinical trauma management [2]. Trauma is a surgical disease and a significant proportion of major trauma patients require surgical intervention, many urgently [3–5]. It is estimated that between 40 and * David Lockey [email protected] 1
University of Bristol, Bristol, UK
North Bristol NHS Trust, Bristol, UK
2
50% of a surgeon’s workload comprises emergency surgery, w
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