Excerpt

A trauma service provides care for people who have sustained physical injuries. These injuries are often the result of an accident but can be sustained in other circumstances. Injuries range from minor to serious life-threatening trauma. The scope of this guidance is the delivery of services for people with major trauma in the initial phase of care, exploring areas of uncertainty and variation.

Contents

• Guideline Development Group full members
• Guideline Development Group expert members
• Project Executive Team members
• NCGC technical team members
• Acknowledgements
• 1. Foreword
• 2. Introduction
• 3. Development of the guideline
  • 3.1. What is NICE service delivery guidance?
  • 3.2. Remit
  • 3.3. Who developed this guideline?
• 4. Methods
  • 4.1. Developing the review questions and outcomes
  • 4.2. Searching for evidence
  • 4.3. Evidence gathering and analysis
  • 4.4. Evidence of cost-effectiveness
  • 4.5. Developing recommendations
• 5. Guideline summary
  • 5.1. Full list of recommendations
  • 5.2. Key research recommendations
• 6. Pre-hospital triage to the appropriate destination
  • 6.1. Introduction
  • 6.2. Review question: What is the accuracy of ambulance triage tools in people with major trauma?
  • 6.3. Clinical evidence
  • 6.4. Economic evidence
  • 6.5. Evidence statements
  • 6.6. Recommendations and link to evidence
• 7. Pre-alert processes
  • 7.1. Introduction
  • 7.2. Review question: What is the accuracy of pre-alert?
  • 7.3. Clinical evidence
  • 7.4. Economic evidence
  • 7.5. Evidence statements
  • 7.6. Recommendations and link to evidence
• 8. Receiving trauma teams
  • 8.1. Introduction
  • 8.2. Review question: What is the clinical and cost effectiveness of providing a tiered response to patients arriving at a MTC or TU?
  • 8.3. Clinical evidence
  • 8.4. Economic evidence
  • 8.5. Evidence statements
  • 8.6. Recommendations and link to evidence
• 9. Transfer between emergency departments
  • 9.1. Introduction
  • 9.2. Review question: Is it clinically and cost effective to provide a retrieval service?
  • 9.3. Clinical evidence
  • 9.4. Economic evidence
  • 9.5. Evidence statements
  • 9.6. Recommendations and link to evidence
• 10. A trauma service providing continuity of care
  • 10.1. Introduction
  • 10.2. Review question: Is there a benefit of multidisciplinary trauma ward care versus specialist ward care?
  • 10.3. Clinical evidence
  • 10.4. Economic evidence
  • 10.5. Evidence statements
  • 10.6. Recommendations and link to evidence
• 11. Continuity of care: the trauma coordinator role
  • 11.1. Introduction
  • 11.2. Review question: What trauma coordination approach is the most clinically and cost effective?
  • 11.3. Clinical evidence
  • 11.4. Economic evidence
  • 11.5. Evidence statements
  • 11.6. Recommendations and link to evidence
• 12. Documentation and transfer of information
  • 12.1. Introduction
  • 12.2. Review question: What are the barriers to the transfer of information and documentation from a) pre-hospital to the ED b) from the ED to surgery, other departments?
  • 12.3. Clinical evidence
  • 12.4. Economic evidence
  • 12.5. Evidence statements
  • 12.6. Recommendations and link to evidence
• 13. Trauma audit
  • 13.1. Introduction
  • 13.2. Review question: Is audit and feedback effective for improving health provider performance and healthcare outcomes?
  • 13.3. Review question: What features are needed in a national audit system to ensure that audit improves service performance as measured by patient outcomes?
  • 13.4. Clinical evidence
  • 13.5. Economic evidence
  • 13.6. Evidence statements
  • 13.7. Recommendations and link to evidence
• 14. Paediatric trauma training
  • 14.1. Introduction
  • 14.2. Review question: What aspects (type and frequency) of paediatric training for trauma improve outcomes for providers which experience high volumes of adult trauma and experience of trauma in children?
  • 14.3. Clinical evidence
  • 14.4. Economic evidence
  • 14.5. Evidence statements
  • 14.6. Recommendations and link to evidence
• 15. Information and support
  • 15.1. Introduction
  • 15.2. Review question: How should information and support be provided to families and carers?
  • 15.3. Clinical evidence
  • 15.4. Economic evidence
  • 15.5. Evidence statements
  • 15.6. Recommendations and link to evidence
• 16. Rehabilitation
  • 16.1. Introduction
  • 16.2. Review question: What are the barriers to providing early rehabilitation following early rehabilitation assessment? What are the implications for service delivery?
  • 16.3. Clinical evidence
  • 16.4. Economic evidence
  • 16.5. Evidence statements
  • 16.6. Recommendations and link to evidence
• 17. Access to services and the skills required to deliver the service
  • 17.1. Introduction
  • 17.2. Service delivery implications
  • 17.3. Additional Reviews undertaken based on the service delivery impact
  • 17.4. Trauma service systems model
  • 17.5. Access to services and skills
• 18. Acronyms and abbreviations
• 19. Glossary
• References
• Appendices
  • Appendix A. Scope
  • Appendix B. Declarations of interest
  • Appendix C. Review protocols
  • Appendix D. Clinical article selection
  • Appendix E. Economic article selection
  • Appendix F. Literature search strategies
  • Appendix G. Clinical evidence tables
  • Appendix H. GRADE tables
  • Appendix I. Forest plots
  • Appendix J. Excluded clinical studies
  • Appendix K. Excluded economic studies
  • Appendix L. Delay to intervention reviews
  • Appendix M. Major trauma service delivery systems model
  • Appendix N. Research recommendations
  • Appendix O. NICE technical team
  • Appendix P. Qualitative study checklist (per theme)

Disclaimer: Those responsible and accountable for commissioning trauma services should take this guideline fully into account. However, this guideline does not override the need for, and importance of, using professional judgement to make decisions appropriate to the circumstances.