Abstract
This study examined the trends and patterns of major trauma (MT) activities, causes, mortality and survival at the Aintree Major Trauma Centre (MTC), Liverpool, between 2011 and 2018. The number of trauma team activations (TTAs) rose sharply over time (n = 699 in 2013; n = 1522 in 2018). The proportion of TTAs that involved MT patients decreased from 75.1% in 2013 to 67.4% in 2018. The leading cause of MT was a fall from less than 2 m (36%). There has been a fivefold increase in the overall number of trauma procedures between 2011 and 2018. Orthopaedic surgeons have performed 80% of operations (n = 7732), followed by neurosurgeons, oral and maxillofacial surgeons, and general trauma surgeons. Both types of fall (> 2 m and < 2 m) and road traffic accidents were the three leading causes of death during the study period. The observed mortality rates exceeded that of expected rates in years 2012, 2014, 2016 and 2017. The all-cause observed to expected mortality ratio was 1.08 between 2012 and 2018. A change in care for MT patients was not directly associated with improved survival, although the marginally ascending trend line in survival rates between 2012 and 2018 reflects a gradual positive change.
Highlights
This study examined the trends and patterns of major trauma (MT) activities, causes, mortality and survival at the Aintree Major Trauma Centre (MTC), Liverpool, between 2011 and 2018
The total number of accepted major trauma patients at Aintree hospital increased from 230 in 2011 to 1,025 in 2018 in the years following its establishment as a MTC
The proportion of trauma team activations that were accepted as major trauma patients decreased over this time period, from 75.1% in 2011 to 67.4% in 2018 (Fig. 1B)
Summary
This study examined the trends and patterns of major trauma (MT) activities, causes, mortality and survival at the Aintree Major Trauma Centre (MTC), Liverpool, between 2011 and 2018. Orthopaedic surgeons have performed 80% of operations (n = 7732), followed by neurosurgeons, oral and maxillofacial surgeons, and general trauma surgeons Both types of fall (> 2 m and < 2 m) and road traffic accidents were the three leading causes of death during the study period. The latest version of the guidelines (2017) includes a pre-hospital trauma triage protocol, ’Paramedic Pathfinder’, and suggests 23 potential triggers for activation of the major trauma team. They are as follows: three physiological (respiratory rate < 9 or > 30, systolic blood pressure < 110 mm Hg, and GCS < 12), eight anatomical, seven mechanical (by the mechanism of injury), and five various criteria (elderly or frail patient, significant comorbidities, pregnancy, paediatrics, other clinical concern). The aim of this study was to highlight and assess the trends and patterns of major trauma activities, causes, mortality and survival at a MTC in North West England over the period of 2011 to 2018
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