Dw. Yates et al., TRAUMA AUDIT - CLINICAL JUDGMENT OR STATISTICAL-ANALYSIS, Annals of the Royal College of Surgeons of England, 75(5), 1993, pp. 321-324
Comparisons have been made between two methods currently used to asses
s the effectiveness of management of major trauma. These are the revie
w of fatal cases by senior clinicians and the use of statistical analy
sis of severity scores. The former was assessed by a re-examination of
the Coroners' reports of 508 patients reviewed by senior clinicians a
t the request of The Royal College of Surgeons of England Working Part
y on the Management of Patients with Major Injuries. The latter was ba
sed on the 665 fatalities on the files of the UK Major Trauma Outcome
Study. The two groups of patients had comparable age and sex profiles
and broadly similar ranges of injury severity. There were major differ
ences between and inconsistencies within the two assessments. Clinicia
ns more frequently judged death avoidable in those with very severe in
juries. In contrast, the statistical analysis suggested, paradoxically
, that the proportion of avoidable deaths in those patients who had mi
nor injuries was less than the proportion of avoidable deaths in those
who had more serious injuries. These variations underline the limited
values of retrospective peer review and will not encourage clinicians
to adopt currently available statistical methods. Further refinements
of anatomical and physiological scoring systems and their integration
to provide a statistically valid and clinically acceptable measure of
outcome are essential prerequisites to the wider introduction and suc
cess of trauma audit.