THE EPIDEMIOLOGY OF MAJOR INJURIES IN MERSEY REGION AND NORTH WALES

A prospective epidemiological study was undertaken to determine the wo rkload and patient characteristics for a putative trauma centre in a l arge defined area. One thousand and eighty-eight patients were include d: 430 brought in dead, 309 hospital deaths and 349 survivors. Types o f injury were, blunt 76 per cent, penetrating 3.6 per cent, burns 5.8 per cent, other 14 per cent. The incidence of blunt injury was 19/100 000 for patients arriving alive at hospital and accounted for 0.08 per cent of new A & E attendances. Eight per cent of blunt injury patient s were children, 68 per cent were adults and 24 per cent elderly. Majo r causes of injury were: road accidents 67 per cent and falls 26 per c ent. In patients arriving alive after blunt injuries, those who subseq uently died were significantly older, more severely injured and more p hysiologically impaired. Hospital mortality was 45 per cent for blunt, 43 per cent for penetrating injuries, and 67 per cent for burns. TRIS S methodology indicated 53 per cent of hospital deaths from blunt inju ries were unexpected. Practically, it is questionable whether the inci dence of major injuries is sufficient to provide the volume of patient s necessary to sustain a Level I Trauma Centre. Nevertheless, concentr ation of injury service is essential, since no hospital receives suffi cient patients to develop and maintain expertise.