Citation

Russell RJ, Hodgetts TJ, McLeod J, Starkey K, Mahoney P, Harrison K, Bell E. Philos. Trans. R. Soc. Lond. B Biol. Sci. 2011; 366(1562): 171-191.

Affiliation

Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK.

Copyright

(Copyright © 2011, Royal Society of London)

DOI

10.1098/rstb.2010.0232

PMID

21149354

PMCID

PMC3013430

Abstract

This paper discusses mathematical models of expressing severity of injury and probability of survival following trauma and their use in establishing clinical governance of a trauma system. There are five sections: (i) Historical overview of scoring systems-anatomical, physiological and combined systems and the advantages and disadvantages of each. (ii) Definitions used in official statistics-definitions of 'killed in action' and other categories and the importance of casualty reporting rates and comparison across conflicts and nationalities. (iii) Current scoring systems and clinical governance-clinical governance of the trauma system in the Defence Medical Services (DMS) by using trauma scoring models to analyse injury and clinical patterns. (iv) Unexpected outcomes-unexpected outcomes focus clinical governance tools. Unexpected survivors signify good practice to be promulgated. Unexpected deaths pick up areas of weakness to be addressed. Seventy-five clinically validated unexpected survivors were identified over 2 years during contemporary combat operations. (v) Future developments-can the trauma scoring methods be improved? Trauma scoring systems use linear approaches and have significant weaknesses. Trauma and its treatment is a complex system. Nonlinear methods need to be investigated to determine whether these will produce a better approach to the analysis of the survival from major trauma.

Language: en