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Anaesth Crit Care Pain Med. 2018 Feb 21. pii: S2352-5568(17)30354-5. doi: 10.1016/j.accpm.2018.01.006. [Epub ahead of print]

Evolution and organisation of trauma systems.

Author information

1
Department of anaesthesia and intensive care, Lyon Sud university hospital, Hospices Civils de Lyon, 69495 Pierre Bénite, France; Lyon Est medicine faculty, Claude Bernard Lyon 1 university, 69008 Lyon, France; SOS-Trauma Network, Réseau des Urgences de la Vallée du Rhône (RESUVAL), 38200 Vienne, France. Electronic address: jean-stephane.david@chu-lyon.fr.
2
Department of anaesthesia and intensive care, Grenoble-Alpes university hospital, 38700 La Tronche, France; TRENAU, Réseau Nord Alpin des urgences (RENAU), 74374 Pringy, France.
3
Department of anaesthesia and intensive care, Pitié-Salpêtrière Charles Foix hospital, Assistance publique Hôpitaux de Paris, 75013 Paris, France; UMRS 1158, neurophysiologie respiratoire expérimentale et clinique, Pierre et Marie-Curie-Paris 6 university, 75877 Paris, France; TraumaBase, France.

Abstract

Over the last 20 years, numerous studies have fairly consistently reported an improvement in the prognosis of patients with severe trauma after the establishment of a trauma network. These systems can be either exclusive, in which all patients are referred only to a small number of specifically designated centres that meet strict criteria, or inclusive, in which patients may be referred to any hospital of a particular area according to capacity, which is observed in France. Hospitals are classified (level 1 to level 3) according to their technical facilities and the number of patients admitted for severe trauma, knowing that studies have also shown an improvement of the outcome for the most severely injured patients (haemorrhagic shock, severe head trauma), in hospitals with the greatest technical facilities and the most important activity. The triage of the patients to a suitable centre must be done after careful prehospital evaluation, which is made on clinical criteria (mechanism, injury, medical history), measurement of vital signs, calculation of scores (RTS, MGAP) or based on classifications. According to this assessment, the patients will then be triaged to a centre that has the capacity for the optimal and definitive management of these injuries. The goal is then to avoid under triage which is synonymous of retransfer, loss of time, and probably also prognosis worsening, and to avoid over triage that may induce an inadequate use of resources, activity overload and cost increase. Thus, it seems essential to develop trauma networks to improve mortality and morbidity of patients that undergone a severe injury. These trauma networks will then have to be evaluated and a register set up.

KEYWORDS:

Network; Outcome; System; Trauma

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