TRANSATLANTIC PERSPECTIVES OF TRAUMA SYSTEMS

The need for centralized management of acute trauma was evaluated in a 1-year prospective study in Northern Ireland. All patients with an In jury Severity Score > 15 who reached hospital alive were included. The sample population was approximately 1 million people. A total of 239 patients entered the study, of whom 74 died. An audit panel considered that 3-15 per cent of deaths were preventable. There was no significa nt difference in the preventable mortality rate between any hospital o r groups of hospitals. There was a high level of consultant involvemen t, especially in small hospitals. A system in which patients with acut e trauma bypass the nearest hospital to reach a trauma centre may be n either beneficial nor cost-effective in Northern Ireland. Upgrading of the present system with stabilization of the patient and emergency su rgery at the nearest hospital before transfer is recommended.