Surviving Major Trauma in the U.K :
Are we prepared?
V Teoh , M Khan, K Sindali, R Alamouti, N Cavale
Department of Plastic Surgery, St Thomas’ Hospital, London
victoriasteoh@gmail.com
INTRODUCTION
INTERVENTION
Trauma is the leading cause of death across age
groups and is responsible for 16,000 deaths in
the U.K. annually.
On reviewing the data from the first audit cycle, the
Trust improved funding for trauma services with the
establishment of dedicated trauma operating lists
and the appointment of a dedicated cross-site
Orthoplastic consultant.
Following a national review in 2011, Regional
Trauma Networks were established to reform and
replace the ad hoc, unstructured trauma service.
Comprehensive, evidence-based (BOAST-4)
guidelines were produced. They are now the
standard to which all practitioners involved in
major trauma should adhere to.
Collaboration between Orthopaedic and Plastic
surgery has proved central to re-defining care,
particularly in the management of open lower
limb fractures with extensive soft tissue damage.
Referral pathways between the 2 specialties were
improved at local and regional level.
The audit cycle was repeated with prospective data
collection from January to December 2012.
RESULTS
The time taken from point of injury to transfer to a
Major Trauma Centre improved from 17.5 to 6.2
days.
20
17.5
AIM
To evaluate performance of the South East
London Kent & Medway Trauma Network in the
management of open lower limb fractures,
against parameters set by the BOAST guidelines.
10
All patients with high energy, open fractures of
the lower limb should have :
The time taken for definitive skeletal stabilization and
soft tissue reconstruction improved from 9.47 to 5.43
days.
“Early referral and transfer of care to a
Major Trauma Centre unless the patient is
unstable”
“Definitive skeletal stabilization and soft
tissue reconstruction achieved within 72
hours and not exceed 7 days.”
‘Clear documentation of a combined
orthopaedic and plastic surgical plan.”
METHODS
Retrospective data was collected on all open
lower limb fractures admitted to Kings College
Hospital with off-site plastic surgery cover at St
Thomas’ Hospital (Jan-Dec 2011).
6.2
0
10
9.47
5.43
5
0
Documentation improved from 0 to 100% from 2011
to 2012.
CONCLUSIONS
Collaboration between Orthopaedic and Plastic
surgery is key in managing Major Trauma.
Unstructured management of this patient group has
been associated with avoidable death and significant
disability. A further study is underway to determine
the impact of our audit on patient outcomes.
Reference
1. BOA/ BAPRAS BOAST-4 Guidelines: The management of severe open lower limb fractures.