Changes to trauma care ‘could increase survival rates by 30%’

Audit finds 45% with severe head injuries did not receive care at a neurological centre

‘We are seeing heroic work being done at hospital level, but it shouldn’t take heroism to deliver standard quality trauma care.’ Photograph: iStock

‘We are seeing heroic work being done at hospital level, but it shouldn’t take heroism to deliver standard quality trauma care.’ Photograph: iStock

 

Changing how care is delivered to people who suffer major trauma, such as through falls and road crashes, could improve survival rates by 30 per cent, clinical experts have suggested.

The National Office of Clinical Audit (Noca) report on major trauma services in 2016 examined data from 4,426 patients across 26 hospitals in the State.

The Major Trauma Audit (MTA) focused specifically on the most severely injured patients in the Irish healthcare system and found that more than a quarter (28 per cent) of patients were transferred elsewhere for ongoing trauma care because the necessary services were not available on site.

Some 45 per cent of those with a severe head injury did not receive care at a neurological centre and 58 per cent of patients arrived to an emergency department between 4pm and 8am outside of “normal working hours”.

Launching the report at the Noca national conference in the Royal College of Surgeons in Ireland, clinical lead for major trauma audit Dr Conor Deasy said the report highlighted the need to reconfigure major trauma services in Ireland.

Dr Deasy said that when trauma care in the UK was reconfigured in 2012 there was an increase of 30 per cent in the odds of survival.

If patients suffering major trauma were treated the way they should be, he said their chances of survival would increase by that much.

“That is a significant lives saved. That is a lot of lives saved here in Ireland,” he told RTÉ’s Morning Ireland on Wednesday.

Almost nine out of 10 (89 per cent) of patients suffering major trauma are not brought directly to a neurological centre, the audit found.

“Patients with major trauma are not being assessed by trauma teams and senior clinicians on arrival to emergency departments,” Dr Deasy said.

“Key investigations and management are being delayed. Only one-third of patients with head injuries requiring a CT scan received one within one-hour in line with international best practice standards.”

“What we are seeing across the 26 hospitals is heroic work being done at hospital level, but it shouldn’t take heroism to deliver standard quality trauma care.

“We noticed that only 8 per cent of patients were received by a trauma team and a similar proportion had input from a consultant in the first 30 minutes.

“Because that 30 minutes is so important in terms of critical life saving interventions that just isn’t good enough. We need to work towards reforming that model of care delivery,” he told Morning Ireland.

Older patients

Dr Deasy said presentation of trauma had changed in recent years from predominantly younger males with “high energy” traumas to now, most commonly, older patients sustaining major trauma from falls at home (72 per cent).

He noted that in the 1990s, road trauma accounted for some 60 per cent of major trauma but that this was now down to 18 per cent. Thirty-one per cent of major trauma patients had multiple injuries.

The audit found that a high incidence (40 per cent) of major trauma is sustained by older patients aged 65 years and older. Low falls (of less than two metres) were the leading cause of injury for more than half (51 per cent) of all major trauma patients, and for 77 per cent of patients aged 65 and older.

Some 47 per cent of patients were injured in the home and 72 per cent of those suffered a low fall.

The audit says older major trauma patients have more complex medical needs and that the report shows they do not receive the same level of management by senior clinicians.

They are also more likely to die and suffer higher levels of disability and require more ongoing care in rehabilitation or long-term care.

Dr Deasy said 96 per cent of the patients in the report had survived, but that this was “no cause for celebration”.

The data was not yet capturing how long it took people to get back to work, to their lives and to “life as they knew it”, he said.

Dr Deasy commended the work of the trauma steering group established by Minister for Health Simon Harris which was informed by the data collected for the audit.

Noca was established in 2012 to create sustainable clinical audit programmes at national level.