Effectiveness of regional trauma systems

BMJ 1998;316:1383 ( 2 May )

Letters

Effectiveness of regional trauma systems

Improvements have occurred since study*

Wrong comparisons were made*

Data do not support conclusions

Authors' reply*

Improvements have occurred since study*

*Longer versions of three of these letters appear on the BMJ's website (www.bmj.com)

The first 150 words of the full text of this article appear below.

EDITOR $---$ Nicholl and Turner's attempt to perform a definitive before and after study on regionalised trauma care was beset bylogistical problems.¹ Firstly, ambulance workers were not empoweredto bypass the surrounding hospitals, who in turn were reluctantto be bypassed during the vulnerable period of health servicereforms. Secondly, similar systems were compared. The centralhospitals in Stoke, Hull, and Preston are all large hospitalswith neurosurgical units on site. Thirdly, data were not collectedprospectively. The researchers trawled the patients' case recordsoften years after admission. Notes from 1990 were not requestedfor initial examination until 1993, by which time many had beenreduced and put on to microfiche.

Fourthly, the local researcher was not trained on the nationally recognised injury scaling course. There were no intra-observervariability checks to confirm consistent application of scoringmethods over the four years. Lastly, significant discrepanciesin data accuracy were evident. When . . . [Full text of this article]

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