Survival rates of major injury for patients who have been admitted to hospital
To review expected survival rates across England and Wales, or your own
area, use the navigation menu on the left hand side of this page.
The Trauma Audit and Research Network, the independent monitor of trauma care
in England and Wales, is committed to making a real difference to the
delivery of the care of those who are injured. One of the ways we do this
is by promoting improvements in care through national comparative clinical
audit.
The information on this website has been collected from many hospitals
that treat patients with injury in England and Wales. Other hospitals,
which do not currently collect this information are also listed for completion.
It shows information about rates of survival after injury in patients
admitted to hospital. Please use the hyperlinks below for further information
upon this page:
Presenting rates of survival
Injury is a major cause of death and disability in this country. Preventing
the incident is obviously important and other groups continually work
towards this end. However, when someone is injured it is natural for patients
and their families to want to know that they will receive the best possible
care in hospital. On this website, we present the results as rates of
survival, rather than rates of death. This is the same approach that is
used to present rates of survival for cancer patients and heart surgery.
Reporting crude rates
of survival takes no account of potential risk factors for patients. On
this website, we present survival data that takes account of potential
risk factors including age, gender, severity of injury and a patient’s
own response to a certain injury. This is the first time that rates of
survival have been presented in this way in the UK. These rates of survival
will be updated annually.
Adjusting for risk
Rates of survival can be displayed in the following chart:
The expected rates
of survival are calculated using logistic regression modelling. The model
allows calculation of the likely rates of survival for particular injuries
or combination of injuries, taking into account the age, gender and the
persons response to the type of injuries. It is a popular and internationally
recognised model because it is relatively simple and each hospital treating
trauma can be represented on the chart above.
The black bar in the chart above represents a 95% confidence Interval.
That means that we can be 95% confident that the outcome prediction of
this hospital will lie within this line. The length of the confidence
interval usually depends upon the amount of completed cases that this
hospital has sent TARN during a four year period. The greater number of
cases sent over time the 'smaller' the interval will be and a more accurate
and robust prediction can be made. The longer the line (fewer cases) -
the less likely it is to make an accurate prediction.
Therefore the black band in the chart above indicates that when age, gender,
initial physiology and severity of injury of the actual patients treated
at this hospital were taken into account, the expected rate of survival
was between -3.5 and -2.1. This represents 2 Standard Errors of the mean.
So, in this example, the unit is performing worse than expected.
The
red block (block to the left of
the bar) and
green block (block to the
right of the bar) on the chart represent 3 Standard Deviations. This is
an important statistical measure of the spread of the rates of survival
at all of the hospitals.
The Yearly Figures for Rates
of Survival
It is important to review how injured patients are cared for at regular
intervals since treatment and practice at the hospital may change. Therefore
we show the rates of survival in 2 year intervals so that the hospital
staff are able to closely monitor the effectiveness of their trauma care.
Using this model provides a good starting point. However, all measures
should be reviewed and revised as new processes for the treatment of different
injuries become available. The Trauma Audit and Research Network will
regularly review the techniques used for risk adjustment and modify them
to take account of changes where appropriate.
The Breakdown Rate of Survival
This is presented to help hospital clinicians and managers to
assess their system of trauma care - providing good care or require some
improvement.
Standards of Care
Injuries to the Brain & Skull
RCS/BOA Standards 13.2: Patients with severe head injuries* or
focal signs should be transferred to the care of neurosurgical units regardless
of whether they need surgical intervention.
* Severe head injuries are defined as having an Abbreviated Injury Scale
score of more than 2 in the head (with or without injuries to other body
regions) with a recorded Glasgow Coma Score of less than 9 OR a recording
of intubation and/or ventilation.
NICE Head Injury Guidelines June 2003: CT imaging
of the head should be performed within 1 hour of arrival for patients
with GCS<13 OR suspected open/depressed skull fracture OR basal skull
fracture.
Injuries to the Spine
RCS/BOA Standard 13.5: Immediate referral must be made to the
appropriate spinal injury service if there is evidence of partial or complete
spinal cord or cauda equina lesion.
Injuries to the Chest
RCS/BOA Standard 13.3: Examination of the chest
is a fundamental component of the cardiopulmonary assessment of the seriously
injured and should be supervised by the most expeienced clinician.
Injuries to the Limbs & Pelvis
BOA: BOAST: All patients (adults and children) with high energy open tibial and/or fibular fractures. The wound, soft tissue and bone excision (debridement) should be performed by senior surgeons within 24 hours of injury.
Further data collection and analysis will address:
The initial procedure should be performed by senior plastic and orthopaedic surgeons and Vascular Impairment requires surgery within 6 hours.
How good is the data we use?
The information provided on this website is collected in different ways
by different hospitals. Some hospitals have better resources than others
for collecting data, and this may affect the quality and completeness
of the data.
Quality Assurance
We ensure that the data submitted to the Trauma Audit & Research
Network is checked by internal system validation and coding regulations.
Some hospitals request that we check their data so that the information
presented is as accurate as possible.
To review expected survival rates across England and Wales, or your own
area, use the navigation menu on the left hand side of this page.