National Institute for Health and Clinical Excellence (NICE)
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Ensuring trauma care is delivered effectively and consistently

NICE has launched a suite of guidelines to ensure that trauma services are delivered effectively and consistently.

The guidelines cover fracturescomplex fracturesspinal injury assessmentmajor trauma and trauma services.

Trauma cases result in around 5,400 deaths each year in England, and are the most common cause of death in patients under 40 in the UK.

In 2010, a report from the National Audit Office found inadequacies in the level of trauma care delivered in the country. Following this, a number of regional trauma networks were developed, led by doctors, nurses, and allied health professionals. The aim of these networks was to ensure patients are taken to the right hospital for them and to get the treatment they need.

These trauma networks have been fundamental in helping to reduce variation across England, and they have been estimated to save an extra 600 lives every year.

NICE’s latest suite of guidelines aim to support these current systems and further reduce variation in trauma care.

Tackling bleeding in trauma injuries

Estimates suggest that nearly 5,000 trauma patients sustain major haemorrhage in England and Wales each year, and of these, a third are likely to die. Recent research also has shown that, in England and Wales, some patients who suffer a life-threatening bleed after serious injury do not receive optimal blood transfusion treatment.

The new suite of trauma guidance includes recommendations on the best method to stop bleeding in different injuries and which are most effective for the situation – for example at the scene of the accident.

They also give recommendations about how to locate where the bleed is sited, so that surgeons can operate quickly to stop it.

Professor Karim Brohi, Chair of Trauma Sciences at Queen Mary University of London and Chair of the major trauma guideline said: “Stopping a patient from bleeding is vital for their survival, yet the techniques we adopt across England are inconsistent. They must be improved.

“The new NICE trauma guidelines are based upon the latest scientific evidence. They will bring clarity to this challenging area of trauma care and undoubtedly save lives.”

Advice on communication and support

Ensuring good communication and support is a common feature that runs across all five guidelines.

NICE recommends that there should be a designated contact within the trauma team for the patient, their families and carers.

The trauma team should also aim to give the patient’s GP a written summary including, diagnosis, management plan, and expected outcome within 24 hours of admission.

Professor Chris Moran, National Clinical Director for Trauma and a trauma surgeon in Nottingham added: “Every shred of information is precious in trauma cases. It is crucial that we talk not only to each other in the trauma team, but that we also speak to those involved in and those who witnessed the accident.

“I am very happy to see patient information feature so prominently in NICE’s trauma guidelines. We know that a good experience in hospital and an understanding of their targets for recovery can help patients get better more quickly.”

Clarification on treatment for common fractures

Nearly 4 in every 100 people will have a fracture each year, with likelihood increasing for men who are middle-aged and women over the age of 75.

The majority are non-complex, yet still present challenges to the NHS due to the number of treatment options available, and the fact that unnecessary time and effort can be spent on fractures that are likely to get better without treatment.

The new fractures guideline aim to help clinicians achieve a balance between making sure that injuries needing treatment are not missed and that treatment is avoided for injuries that are likely to get better on their own.

Mr Iain McFadyen, Consultant Trauma and Orthopaedic Surgeon, Royal Stoke University Hospital and Chair of the fracture guideline development team, said “If not managed appropriately and efficiently, non-complex fractures place an unnecessary burden on patients, healthcare services, employers and communities.

“These new guidelines will support medical teams in their assessments about how best to treat and manage these common injuries.”

Trauma care should be best for everyone “no matter where you live”

Commenting on the publication of the guidelines, Professor Mark Baker, Director for the Centre of Clinical Practice at NICE, said: “2,000 trauma patients are alive today because of the steps taken to ensure that the right patient gets to the right hospital in the quickest time possible. This is fantastic news and something we should all be proud of.

“However, major trauma remains the most common cause of death in patients under 40 years of age in the UK, and despite seeing an 85% reduction in variation of trauma care, we still have work to do to ensure that the care we provide is the best it can be for everyone, no matter where you live.” 


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