Further memorandum from The College of
Emergency Medicine (RS 81A)
We have been asked to comment on whether the
quality of hospital treatment affects mortality following road
traffic accidents.
SOURCES
We have used three main sources of information:
(1) The Trauma Audit and Research Network is a national hospital-based
analysis of patient outcomes which is available to the public
at www.tarn.ac.uk; (2) The Cambridgeshire Trauma Research Project
(CTARP) which is the UK's only comprehensive population based
trauma dataset; (3) A search of the medical literature carried
out by the Academic Unit of Emergency Medicine at Leicester University.
CONCLUSIONS
— The effect of Primary Prevention
(preventing the collision) can be seen in the overall number of
collisions and severe collisions (killed and severe injury accidents).
— The effects of Secondary Prevention
(transport factors minimising the severity of injury that occurs
during the collision) and Tertiary Prevention (health factors
minimising the amount of death and disability that results from
that injury) are very difficult to disentangle.
— When current data systems show a
change in RTC deaths they do not allow us to say how much is due
to transport factors (improved vehicle/road design etc) and how
much is due to health factors (quicker ambulance response times,
improved trauma care etc)—for example an improvement in
ambulance response times might well reduce RTC mortality. This
makes the cost-effectiveness of transport injury reduction strategies
very difficult to assess.
— About one third of deaths following
road traffic injury occur in hospital. All of the patients suffering
long-term disability from road traffic injury will require hospital
treatment.
— Of the two thirds of RTC deaths that
occur before hospital care (at the roadside or dead on arrival)
only a few (2% to 5%) have potentially survivable injuries.
— There is evidence of a link between
the configuration of health services for trauma care and mortality
in injured patients in the international medical literature. There
is good evidence from the UK that trauma outcomes depend on the
configuration of the local health service.
— We therefore believe that the quality
of medical care (from the ambulance service and the hospital)
does have an influence on Road Traffic mortality. DoH agrees with
this, as medical care for the injured has been identified as a
priority in Lord Darzi's current review of the NHS.
— The hospital mortality following
injury improved between 1990 and 1994, but was then relatively
constant from 1994 to 2006. More recently there is some indication
of further improvement, however another year of data is required
to show if this is a real trend or just a statistical variation.
— At present health and transport injury
strategies are not joined up. Current injury data collection systems
in the UK do not integrate medical and emergency service/local
authority data, so it is difficult to separate the relative contributions
to changes in mortality rates of secondary prevention (vehicle
and road design) and tertiary prevention (treatment of injury).
Better integration of health service, emergency service and local
authority data would enable us to assess the cost-effectiveness
of both transport and health strategies to minimise the burden
of road traffic injuries.
— Research into improving healthcare
for the injured is <1% of the UK's total spend on medical research—which
is disproportionately low given the societal burden of this disease.
ADDITIONAL POINTS
1. Mortality rates for severely injured
patients treated in individual NHS Trusts can be found at www.tarn.ac.uk
2. There is no information available about
long term trends in place of death following injury. It might
be hoped that the in-hospital proportion of deaths would increase
with better vehicle and road design (ie, secondary prevention
means that more patients reach hospital alive), but there is no
data to analyse this.
3. Disability is an important outcome following
Road Traffic Collisions, with a huge cost to society. Discussion
on reduction of the burden of road traffic injury should also
focus on disability prevention—medical care and the organisation
of trauma care services (both pre-hospital and in-hospital) has
an obvious importance in the prevention of disability, in addition
to vehicle and road design.
4. There is some indication of considerable
variation around the UK in the place of death following Road Traffic
Collisions, however current injury information systems are not
able to give a clear picture.
September 2008
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