Trends in admission timing and mechanism of injury can be used to improve general surgical trauma training
OA Location
Author(s)
Type
Journal Article
Abstract
INTRODUCTION: The temporal patterns and unit-based distributions of trauma patients requiring surgical intervention are poorly described in the UK. We describe the distribution of trauma patients in the UK and assess whether changes in working patterns could provide greater exposure for operative trauma training. METHODS: We searched the Trauma Audit and Research Network database to identify all patients between 1 January 2014 to 31 December 2016. Operative cases were defined as all patients who underwent laparotomy, thoracotomy or open vascular intervention. We assessed time of arrival, correlations between mechanism of injury and surgery, and the effect of changing shift patterns on exposure to trauma patients by reference to a standard 10-hour shift assuming a dedicated trauma rotation or fellowship. RESULTS: There were 159,719 patients from 194 hospitals submitted to the Network between 2014 and 2016. The busiest 20 centres accounted for 57,568 (36.0%) of cases in total. Of these 2147/57,568 patients (3.7%) required a general surgical operation; 43% of penetrating admissions (925 cases) and 2.2% of blunt admissions (1222 cases). The number of operations correlated more closely with the number of penetrating rather than blunt admissions (r = 0.89 vs r = 0.51). A diurnal pattern in trauma admissions enabled significant increases in trauma exposure with later start times. CONCLUSIONS: Centres with high volume and high penetrating rates are likely to require more general surgical input and should be identified as locations for operative trauma training. It is possible to improve the number of trauma patients seen in a shift by optimising shift start time.
Date Issued
2020-01-01
Date Acceptance
2019-07-13
Citation
Annals of the Royal College of Surgeons of England, 2020, 102 (1), pp.36-42
ISSN
0035-8843
Publisher
Royal College of Surgeons of England
Start Page
36
End Page
42
Journal / Book Title
Annals of the Royal College of Surgeons of England
Volume
102
Issue
1
Copyright Statement
© 2020 The Royal College of Surgeons of England.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31660752
Subjects
General surgery
Trauma centres
Trauma units
Adult
Aged
Aged, 80 and over
Education, Medical, Graduate
England
Female
General Surgery
Hospitals, High-Volume
Humans
Ireland
Male
Middle Aged
Patient Admission
Personnel Staffing and Scheduling
Retrospective Studies
Shift Work Schedule
Time Factors
Trauma Centers
Traumatology
Wales
Workplace
Wounds and Injuries
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2019-10-29