The Influence of Medical Care on the Death Rate from Trauma in England and South Moravia

Abstract

Background: Trauma is the leading course of death in humans from 5 to 45 years and one of the major causes of death and disability in all age groups. Medical care for trauma victims is burdensome and expensive. Aim of this study was to examine differences in trauma care and their effects on outcome in hospitals in England and South Moravia, Czech Republic. Patients and Methods: The data base of the Trauma Audit & Research Network was used to provide anonymous data of the process of trauma care in England and South Moravia. Admissions were analyzed over a 3-year period 1993–1995. In the study were included 1,853 patients directly admitted to Brno Traumatologic Hospital and 10,827 patients directly admitted to 15 hospitals in England. Patient characteristics were broadly similar (age 6–98, median 42 years, in Brno vs. 0–103, median 44 years, in England), and injury severity comparable in the two groups (Injury Severity Score [ISS] 1–75, median 9, in both Brno and England). Results: There were no differences in time to admission – in both groups was 62% of patients admitted to hospital within 60 min after injury. More senior doctors initially examined the patients in South Moravia than in England (92% vs. 32%). Transfer to the operating theater was more rapid in South Moravia (77% vs. 43% in < 2 h). The standardized W statistic (a measure of survival variation from the expected mean, per 100 patients) was +2.60 (95% confidence intervals [CI] +1.40 to +3.80) for the South Moravian patients and −0.61 (CI −1.04 to −0.18) for the English patients. Conclusion: These results suggest that the organization of medical care in the Brno Traumatologic Hospital in South Moravia is more effective in preventing death after trauma than that provided by a representative sample of 15 English hospitals.