Intended for healthcare professionals

Practice Guidelines

Assessment and initial management of major trauma: summary of NICE guidance

BMJ 2016; 353 doi: (Published 22 June 2016) Cite this as: BMJ 2016;353:i3051
  1. Jessica Glen, senior research fellow1,
  2. Margaret Constanti, senior health economist1,
  3. Karim Brohi, professor of trauma sciences, consultant trauma and vascular surgeon2
  4. on behalf of the Guideline Development Group
  1. 1National Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2Centre for Trauma Sciences, Barts and the London School of Medicine, Queen Mary University of London, UK
  1. Correspondence to: K Brohi k.brohi{at}

What you need to know

  • Use direct pressure dressings, tourniquets, and pelvic bindersand move rapidly to damage control surgery or interventional radiology

  • With actively bleeding patients, allow permissive hypotension and use blood rather than clear intravenous fluids

  • Use whole body computed tomography (CT) in adults with blunt trauma and multiple injuries, but avoid unnecessary CT use, especially in children

Trauma is a major contributor to the global burden of disease. Those who experience major trauma have serious and often multiple injuries associated with a strong possibility of death or disability. Nationally there are around 20 000 cases of major trauma per year in England, and over a quarter of these result in deaths.1 Trauma care is a developing field, and recent civilian and military research has led to changes in the assessment and management of severely injured patients. This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on the assessment and initial management of major trauma. These guidelines sit as part of a suite of trauma guidelines2 3 4 5 6 and alongside the previously published guidelines on head injury.7 They are written in the context of the NHS, where trauma care was reorganised into major trauma networks in 2012. Here we focus on two central themes of the guidelines—the assessment of a patient with major trauma and the management of patients who are actively bleeding.

What’s new in this guidance?

  • The immediate use of CT differs by groups and ages of trauma patients

  • Avoid preliminary imaging when patients will undergo an immediate CT scan

  • Transfusion targets, blood product ratios, and avoidance of crystalloids during active bleeding

Other topics covered in the NICE major trauma guideline

While this article summarises the two central themes of the guideline (streamlined assessment of the major trauma patient in hospital and the management of patients who are actively bleeding), the guideline also …

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