TRAUMA SERVICES REQUIREMENTS IN A DISTRICT GENERAL-HOSPITAL SERVING A RURAL AREA

Objective - To assess the demands made on a regional trauma centre by a district trauma unit. Design - Two part study. (1) Prospective analysis of one month's workload. (2) Retrospective analysis of one year's workload by using a computer based records system. Comparison of two sets of results. Setting - Accident unit in Gwynedd Hospital, Bangor. Patients - (1) All patients who attended the accident unit in August 1988. (2) All patients who attended the accident unit in the calendar year April 1988 - April 1989. Main outcome measure - Workload of a district trauma unit. Results - In August 1988 there were 2325 attendances; 2302 of these were analysed. In all, 1904 attendances were for trauma; 213 patients were admitted to the trauma ward and 103 required an operation that entailed incision. Patients who attended the unit had a mean (range) injury severity score of 2-13 (0-25). Only two patients had injuries that a district general hospital would not be expected to cope with (injury severity score >20). In the year April 1988 - April 1989, 21,007 patients attended the unit. In all, 17,958 attendances were for orthopaedic injuries or injuries caused by an accident; 1966 patients were admitted to the unit. Conclusions - Most trauma is musculoskeletal and relatively minor according to the injury severity score. All but a few injuries can be managed in district general hospitals. In their recent report the Royal College of Surgeons has overestimated the requirements that a British district general hospital would have a regional trauma centre.