Authors' objectives:

To summarise and critically analyse the current facts concerning the acute care, treatment and rehabilitation of trauma victims and evaluate the trauma care in Sweden.

Authors' results and conclusions: In Sweden around 800 persons are killed annually in traffic accidents and 14,000 are treated in hospital for injury caused by traffic accidents. The trauma care is decentralised; for a population of 8/7 million there are around 90 hospitals with emergency departments, and traffic victims are almost always brought to the nearest hospital. The quality of the care is not standardised. In hospitals with advanced equipment, the rate of avoidable deaths can be relatively high. A study from the north of Sweden shows that of 74 deaths in hospital due to trauma, 13 (17%) were judged as probably avoidable. The review of the scientific literature has shown that the quality of trauma care has increased after centralisation of the trauma care to trauma centres with specialised resources. However, the issue is multi-faceted, and many aspects have to be considered in the evaluation of the trauma care, i.e. the need for triage and treatment in the place of the accident, the means of transportation, and the qualifications of the personnel and the doctors in the emergency department, who primarily take care of the patient. The scientific literature on rehabilitation is scarce and there is an urgent need for more studies of good quality.

Authors' recommendations: The use of triage schemes is supported. Among other factors, it is important to know how the injuries were incurred. The use of transportation by helicopter should be considered to a greater extent where the distance to the nearest hospital is large. The cooperation between different units that take care of trauma victims should be systematically developed. In the largest cities the possibility to centralise the care of the severely injured to some of the hospitals should be considered. Criteria for qualifications of doctors and other personnel that are responsible for the care of trauma victims should be specified. All doctors that take part in the trauma care should have a basic special training. Severely damaged trauma patients should always be primarily judged by a specialist. The preliminary assessment of severe trauma cases should be done by specialists in anaesthesiology and surgery or orthopaedics. Hospitals which cannot meet this basic requirement should not receive severe trauma cases. The importance of the psychological treatment of trauma patients and their relatives must be observed. Each acute care hospital in Sweden should continuously evaluate its activities, as a necessity for maintaining sufficient quality of care. To compare quality, it is necessary to prospectively register the management of all severe trauma cases. This can be done by consistently using a common, international registry system to code individual injuries and their management. These data can then be transferred to a national trauma registry. Such a registry should include the long-term outcome concerning the scope of injury, which also requires registering information from insurance companies regarding the level of disability. Only a few rigorous studies exist on the rehabilitation of traffic victims, and the various methods used in this field often rest on poor scientific foundations. Therefore, we are in urgent need of rigorous prospective studies concerning rehabilitation methods for different types of injuries.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.sbu.se/Published

Year Published: 1994

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Sweden

Organisation Name: Swedish Agency for Health Technology Assessment and Assessment of Social Services

Contact Address: P.O. Box 3657, SE-103 59 Stockholm, Sweden. Tel: +46 8 4123200, Fax: +46 8 4113260

Contact Name: registrator@sbu.se

Contact Email: registrator@sbu.se

Copyright: The Swedish Council on Technology Assessment in Health Care