THE MAJOR TRAUMA MANAGEMENT STUDY - AN ANALYSIS OF THE EFFICACY OF CURRENT TRAUMA CARE

Background: An audit of the management and outcome of major trauma pat ients was carried out to determine ways in which the system of care ma y be improved. Methods: The Major Trauma Management Study (MTMS) colle cted data prospectively on all consecutively admitted major trauma pat ients at eight major hospitals during a 12-month period. Outcome was s tudied using trauma and injury severity score (TRISS) and a severity c haracterization of trauma (ASCOT) analyses, as well as a preventable o utcome analysis, which looked at survivors with complications or with a Glasgow Coma Score < 15 on discharge from hospital, as well as study ing deaths. Results: The group of 859 patients was more severely injur ed than most described previously, with a mortality of 14.8% and a mea n injury severity score of 19.8. Formal ASCOT; analysis indicated 2.25 % fewer survivors than would be predicted by Major Trauma Outcome Stud y norms. Extrapolating the TRISS and ASCOT process ro include those pa tients with missing data, and then comparing groups of matched severit y with the norms, gave no statistically different outcome in the MTMS group of patients. Preventable outcome analysis revealed rates of prev entable and potentially preventable (P/PP) outcomes of 32% among death s and 8% among survivors. The types of management deficiencies respons ible for P/PP outcomes are identified. Conclusions: The points of defi ciency in a system of care have been identified, and the development o f an integrated trauma system in Victoria, based upon these facts, is recommended, Children, the elderly, patients with head injuries and pa tients bring transferred between hospitals would benefit from improvem ents to the system of care. The calculation of efficacy rate (0.95 for the MTMS patients) is recommended to accurately assess the system of care. Preventable Outcome Analysis is more relevant to auditing a syst em of trauma care in detail, than is ASCOT or TRISS. The MTMS has refi ned and defined the process so that it is reproducible in further comp arative studies.