Evaluation of a small trauma team for major resuscitation.
Deo SD., Knottenbelt JD., Peden MM.
There has been a great improvement in the early management of trauma patients, encapsulated by ATLS. Initial in-hospital management of significant trauma is undertaken by a trauma team, the number and content of which varies. No study has demonstrated that large trauma teams per se improve patient survival, compared to smaller teams working in the same tertiary referral centre environment. This is a retrospective study of pedestrian road traffic accident patients, who were major resuscitation cases admitted over a 6-month period to this hospital, which is a Level I Trauma Centre. Most major trauma resuscitations are undertaken by a small trauma team, led by one doctor. The performance of the small trauma team was evaluated by applying TRISS methodology and comparing our patient group with MTOS (US). There were 77 patients. The majority (52 per cent) had polytrauma, 80 per cent required intubation, the median ISS was 27 and the median RTS was 5.03. Ten per cent required resuscitative procedures and 75 per cent required urgent surgery. Using TRISS methodology the Z statistic was +0.54 and the Unit's M statistic was 0.492. There were more unexpected survivors than deaths. Seventy-one per cent were initially treated by one doctor. Only two patients had three or more doctors at the initial resuscitation. The use of small trauma teams within this Level I Trauma Centre does not appear to give results that are any worse than those of units that routinely use larger teams. This could be evaluated in other centres and may have implications for training, manpower and costing.