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In 1988, the Royal College of Surgeons (England) Committee on Trauma—chaired by Professor Sir Miles Irving—reviewed the anonimised case notes of 1000 UK patients with major injuries who had died after reaching hospital alive. Each patient record was scrutinised by four clinical experts in trauma care with a brief to state whether or not the death could have been prevented by better care—such as that available in a late 1980s North American level 1 trauma centre. The majority of reviewers found that one-third of trauma deaths were preventable by this yard stick—two-thirds of those dying from haemorrhage. This ‘preventable death review’ has since been consigned to a 20th century research technique as it is highly prone to bias (impossible not to conclude errors were contributory if death is the known outcome)—however, it is nevertheless a seminal study—not least because the authors understood the limitations of their findings. In making their recommendations the Committee highlighted failings throughout the trauma patient pathway (scene to rehabilitation) and a general lack of evidence on institutional (hospital/network/system) performance.1 Their recognition of the need to address this gap led David Yates (DWY)—Professor of Emergency Medicine and Maralyn Woodford (MW)—co-author on the RCS report; both from Hope (now Salford Royal) Hospital—to pick up the baton.
To this end Hope Hospital became the sole subscribing UK member of the then USA Major Trauma Outcome Study (US MTOS)—at that time in the vanguard of using risk-adjusted mortality rates to inform quality of care comparisons. The US MTOS led by Howard Champion, Wayne Sacco, William Boyd and colleagues at the Washington Hospital Centre built on the extraordinary development of the Injury Severity Score (ISS) by Susan Baker et al and the Abbreviated Injury Scale (AIS) from the Association for the Advancement of Automotive Medicine.2 ,3 We all …
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