Audit
and quality assurance
Injury
severity scoring systems
Statistical analysis of injury severity and the most effective means of
managing injured patients is relatively recent and is slowly replacing anecdote
and unfounded assumptions. An example is the GCS, to which reference has already
been made. The most widely applied is the Revised Trauma Score (RTS). Data
combined from vital signs and level of consciousness are mathematically
combined into a single variable that correlates with outcome (Table
18.4). There
is a myriad of others. Readers are referred to Professor Yates’ paper in the
publication ABC of Major Trauma.
Major
trauma outcome study (MTOS)
First developed in the USA, MTOS is an ongoing audit of the
effectiveness of injury management and is now in widespread use in the UK.
Utilising the TRISS (combination of the RTS and Injury Severity Score weighted
for age and premorbidity) method with additional input on prehospital events,
initial management including time to resuscitative interventions and the grading
of medical staff, MTOS is applied to patients with severe injury and to those
who die or are transferred to specialist units. The benefits are summarised in
Box 18.11.
Box
18.11 Benefits of MTOS
• Measures injury severity
• Records management and outcome
• Provides a database for audit
• Allows comparison of performance