ABC of major trauma. Scoring systems for trauma.

Previous articles in this series have emphasised the importance of an aggressive, integrated, interdisciplinary approach to trauma care by an experienced team that has immediate access to operating theatres and intensive care facilities. Many of the recommendations can be expected to incur appreciable additional costs. Will this money be well spent? Which changes are most effective in improving patient care and are there any which Cost-benefit analysis of trauma care produce unexpected delays or complications? Input To answer these questions about a system which has to respond to Anatomical injury patients with an almost infinite constellation of injuries is a major challenge Physiological derangement in clinical measurement and audit. Clearly, statistical analysis must replace Treatment anecdote and dogma, but the complexity of the task should not be Variations in the system of care underestimated. Variations in patient care The effects of injury may be defined in terms of input-an anatomical Output component and the physiological responseand output-mortality and Survival: alive or dead? morbidity. These must be coded numerically before we can comment with Disability: temporary or permanent? confidence on treatment. Elderly people and young children survive trauma Neurological? Musculoskeletal? less well than others, so age must be taken into account. The mechanism of Visceral? injury is also important: the effect of a blunt impact from a fall or a car crash is quite different from that of a stab or gunshot wound. Most recent work has been concerned with the measurement of injury severity and its relation to mortality. The assessment of morbidity has been largely neglected, yet there are two seriously impaired survivors for every person who dies owing to trauma.