In the United Kingdom,
trauma kills approximately 16,000 people per year1 and is the leading cause of death in those aged under 40.2
NHS choice defines major trauma as multiple,
serious injuries that could result in disability or death.
Seriously injured patients (SIPs) describe patients who have suffered from a major trauma (multiple traumatic injuries).
This is measured on a scale known as the Injury Severity Score (ISS) which scores injuries from 1 to 75,
the latter being the most serious.
Patients who have an ISS>15 are defined as having suffered from major trauma.3 However,
the ISS can only be used retrospectively and in the acute setting SIPs are identified by mechanism of injury and physiological parameters at the scene of injury.
The treatment of patient suffering major trauma in designated Major Trauma Centres (MTCs) and their networked Trauma Units (TUs) is a relatively new service with the NHS (formalised in England and Wales in 2012),4 in Scotland networks should be formalised by 20205 and Northern Ireland has 1 major trauma centre in Belfast with its Helicopter Emergency Medical Service due to start flying soon.6 The treatment of SIPs in Major Trauma Centres has led to improved survival outcomes.7
The majority of these patients need expedient CT scanning with timely reporting of the imaging.
The number of documented major trauma cases in 2000 in the UK was 3215 with 1709 (53.2%) of patients having a CT scan,
in 2013 there were 17 238 reported major trauma cases with 14 963 (86.8%) of patients being scanned.8
In the MTC setting this has meant reconfiguration of both Emergency Departments (ED) and Radiology to provide the best service for patients.
In Trauma Units there are small numbers of patients being scanned because of primary bypass of SIP by ambulance service and helicopter emergency medical services to MTCs.
However,
a significant number of SIPs are still seen and scanned in TUs prior to transfer to a MTC.
Therefore,
TUs need to be able to offer timely imaging for these patients and there needs to be robust methods for image and report transfer between hospitals.
Both NHS England and the RCR have written standards for the radiological management of these patients.
Updated RCR Standards (BFCR (15)59 have been published in 2015.
NICE Major Trauma services guidelines were published in February 2016 (NG39).10
NHS England carries out an annual national peer review of major trauma in England.11 The Scottish Trauma Audit Group produces annual reports for Scotland12 and in NI the Northern Ireland Trauma Audit reports annually.13
In 2015 the NHS England Peer Review highlighted main themes leading to serious concerns in the reception and resuscitation of the SIP.
In MTCs this included “issues with CT reporting,
including delays in availability of reports,
seniority of reporting and transfer of images from Trauma Unit to Major Trauma Centre (MTC)“ and in TUs “access and availability of CT scanning and reporting” in particular reporting of CT scans out of hours was not available within 60 minutes.
The report suggested ongoing “audit of CT reporting including time-lines and seniority of radiological report” and “timely access to CT and where possible use agreed network guidelines for scanning” in trauma units.7
This audit looks at current radiology provision for SIPs in MTCs,
TUs and other hospitals with emergency departments.
Are we able to meet the new RCR standards? The audit will give us the data to help plan radiology services for major trauma and the severely injured patient to meet these standards.