Trauma systems and epidemiology

Question 1

Describe the tri-modal model of trauma mortality.

Answer 1

Described by Trunkey

1. 50% deaths occur <1hr due to non-survivable vascular, head or spinal injuries
2. 30% deaths occur over following days and are due to major truncal injuries -> respiratory and circulatory compromise
3. 20% occur weeks to months later and are due to MOF, ARDS, sepsis, diffuse brain injury

NB: In a mature trauma system, the %s of groups 2 and 3 are thought to be significantly smaller.

Question 2

List components of an effective trauma system.

Answer 2

Continuum of care: First aid -> pre-hospital care -> triage to appropriate facility -> ED trauma team -> damage control and definitive treatment/mgt -> rehabilitation.

Multi-disciplinary approach

Question 3

What are the following trauma scores?

• Glascow Outcome Score (GOSE)
• Short Form 36
• Trauma Injury Severity Score (TRISS)
• Injury Severity Score (ISS)
• Revised Trauma Score

Question 4

List the criteria for trauma team activation.

Answer 4

• Physiologic
  
  • BP < 90
  • RR <10 or >30
  • GCS < 12 or focal neuro deficit
• Anatomical
  
  • Major amputation
  • >=2 long bone #s
  • Major chest injuries
    
    • Flail
    • Haemothorax
    • PTX
  • Penetrating
  • Unstable pelvis
  • Suspected spinal injuries
• Mechanistic
  
  • Ejection from vehicle
  • Pedestrian >30kph
  • High speed or rollover
  • Fall >6m
  • Deceleration injury >30kph
  • >10% BSA
  • Inhalational burns
  • >60y, <16y, pregnant
• Logistic
  
  • Busy dept