| Titre : | Trends in trauma care in England and Wales 1989-97. (2000) |
| Auteurs : | F. LECKY ; M. WOODFORD ; D.W. YATES ; Uk Trauma Audit and Research Network. GBR ; Uk Trauma Audit and Research Network. North Western Injury Research Collaboration. University of Manchester. Hope Hospital. Salford. GBR |
| Type de document : | Article |
| Dans : | Lancet (The) (vol. 355, n° 9217, 2000) |
| Pagination : | 1771-1775 |
| Langues: | Anglais |
| Mots-clés : | Traumatisme ; Epidémiologie ; Soins intégrés ; Audit ; Grande Bretagne ; Royaume Uni ; Europe ; Pays de Galles ; Homme ; Résultat |
| Résumé : | [BDSP. Notice produite par INIST UR0xz6Za. Diffusion soumise à autorisation]. Background In 1988, the Royal College of Surgeons reported major deficiencies in trauma care in UK hospitals. We investigated whether and how that care has changed in the last decade by use of data collected by the UK Trauma Audit and Research Network. Methods We analysed injury-severity, process, and outcome variables from 91 602 patients'records on the database at the end of 1997, collected from 97 (49% of trauma-receiving) hospitals in England, Wales, and two in Ireland. We did longitudinal analyses of odds of death, process variables, and individual hospitals'performance. We took account of potential selection bias from missing data and recruitment of new hospitals. Findings The severity-adjusted odds of death after trauma declined gradually from 1989 (odds ratio 1997/1989 0.63 [95% Cl [0.49-0.82]). In 1997, the reduction in odds of death was significant even after adjustment for missing data (ratio 1997/1989 0.72 [0.55-0.92]) and recruitment of new hospitals (0.64 [0.44-0.93]). There was significant variability in the proportion of survivors (adjusted for severity of injury and age) between the highest and lowest 10% of UK hospitals. The time between the call to the emergency services and arrival at hospital increased from 32 min in 1989 to 45 min in 1997, irrespective of injury severity. The proportion of severely injured patients seen first by senior doctors increased from 32% to 60%. (...) |
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