National audit of the management of injured patients in 20 Scottish hospitals.

The Scottish Trauma Audit Group was established in 1991 to observe and improve the management of seriously injured patients in four Scottish teaching hospitals. There are currently 25 hospitals contributing to the national database. This prospective audit monitors the management of approximately 98% of seriously injured patients in Scotland. This report presents an analysis of the management of 23479 patients who were admitted to hospital for at least three days or who died in hospital as a result of their injuries. The audit has specifically addressed the concerns raised by the working party of the Royal College of Surgeons in 1988 and the National Audit Office in 1992. National standards were agreed and implemented by STAG in 1997. STAG has demonstrated that 73.5% of seriously injured patients presented outwith 'normal' working hours when staffing and support services are at their lowest level. Seniority of accident and emergency doctor was associated with improved outcome in injured patients. An increase in the presence of consultants in accident and emergency medicine, anaesthetics and surgery has been demonstrated and a reduction in the mortality of seriously injured patients is evident. There was no evidence of a trimodal distribution of death as a result of injury. There has been a significant increase in the survival of seriously injured patients over the last six years from 65.3% to 75.6%. In terms of survival, the management of injured patients in Scotland is significantly better than that of the rest of the UK.