Antibiotic usage in maxillofacial trauma: the need for a national protocol?

Abstract

Introduction: The London Major Trauma System went live in 2010. In April 2014, the second roof-based helipad was installed on one of the four centres. Previously, major trauma cases requiring air transport were diverted elsewhere or landed nearby, necessitating interim land-based transfer. The aim of this study is to evaluate the overall effect of the helipad on major trauma caseload, casemix and hospital resources. Methods: All cases were identified by analysis of the prospectively maintained major trauma spreadsheet for two months preand post-helipad. Demographics, mechanism, type and severity of injury, length of stay (LoS), and operative episodes were recorded. Results: Overall major trauma cases per two months increased from 290 before the helipad to 395 after. 40 helipad patients (30 male), with average age 35years (range 0–91) were included. Road traffic collisions (RTCs) accounted for the majority (60%), followed by falls >2 m (25%). Average Injury Severity Score was 24 (range 0–50). 23 patients had chest/abdominal injuries, 18 had orthopaedic and 17 suffered traumatic brain injury. 25% of patients required maxillofacial attention, including two mandible, and four orbital floor/frontal bone fractures. 21 patients underwent at least one operation (13 multiple). Average LoS was 18 days (range 0–160), including 262 ITU patient-bed days. Ten patients died. Conclusions: Major trauma activity across all ambulance modes has increased since the helipad’s installation, possibly reflecting the increased catchment area. Most patients suffered polytrauma secondary to RTC, with the majority of helipad cases requiring operative intervention and/or ITU. Maxillofacial injuries are common in this cohort.