TY  - JOUR
PY  - 2011//
TI  - The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services
JO  - Philosophical transactions of the Royal Society of London. Series B, Biological sciences
A1  - Russell, R. J.
A1  - Hodgetts, T. J.
A1  - McLeod, J.
A1  - Starkey, K.
A1  - Mahoney, P.
A1  - Harrison, K.
A1  - Bell, E.
SP  - 171
EP  - 191
VL  - 366
IS  - 1562
N2  - 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.<p />  <p>Language: en</p>
LA  - en
SN  - 0962-8436
UR  - http://dx.doi.org/10.1098/rstb.2010.0232
ID  - ref1
ER  -