NICE Major trauma: assessment and initial management guidelines - out today.

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http://www.nice.org.uk/guidance/ng39

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17 February 2016

NICE publishes five new guidelines to standardise trauma care in England
NICE – the National Institute for Health and Care Excellence – has published five new guidelines covering key areas of trauma care; fractures, complex fractures, spinal injury assessment, major trauma and major trauma services.

* An estimated 1.8 million fractures occur in England every year
* Major trauma is the most common cause of death in under 40 year olds
* Massive bleeding accounts for over 1,500 trauma deaths each year in England and Wales
* Each trauma death costs the nation in excess of £0.75 million

In 2010 a report by the National Audit Office found the management of major trauma patients was inadequate in England. They called for a service overhaul. This led to the development and implementation of countrywide major trauma networks (MTN) – groups of hospitals centred around 27 major trauma centres that are equipped to provide the specialist care a trauma patient requires.

Professor Mark Baker, Director for the Centre of Clinical Practice at NICE, said: “2,000 trauma patients are alive today because of the steps taken to ensure that the right patient gets to the right hospital in the quickest time possible. This is fantastic news and something we should all be proud of.

“However, major trauma remains the most common cause of death in patients under 40 years of age in the UK, and despite seeing an 85% reduction in variation of trauma care, we still have work to do to ensure that the care we provide is the best it can be for everyone, no matter where you live.”

Over 1,500 trauma patients die every year from severe bleeding. Recent research has shown that, in England and Wales, some patients who suffer life-threatening bleeding after serious injury do not receive optimal blood transfusion treatment.

This new suite of trauma guidance includes recommendations on the best method to stop bleeding in different injuries and which are most effective for the situation (e.g. at the scene of an accident). They also give recommendations about how best to locate the site(s) of bleed so that surgeons can operate quickly to stop it.

Professor Karim Brohi, Chair of Trauma Sciences at Queen Mary University of London and Deputy Chair of the NICE guideline project executive team said: “Stopping a patient from bleeding is vital for their survival, yet the techniques we adopt across England are inconsistent. They must be improved.

“The new NICE trauma guidelines are based upon the latest scientific evidence. They will bring clarity to this challenging area of trauma care and undoubtedly save lives.”

Every year in Britain, 3 in 100 people will suffer a fracture.7 Some of these may require urgent treatment to save the limb.

The two fracture guidelines aim to clarify when minimal medical intervention is the best option. They also include specific recommendations that will help clinicians effectively manage open fractures (fractures where the bone tears through the skin), which can be serious.

Mr Iain McFadyen, Consultant Trauma and Orthopaedic Surgeon, Royal Stoke University Hospital and member of the NICE guideline project executive team said: “If not managed appropriately and efficiently, non-complex fractures place an unnecessary burden on patients, healthcare services, employers and communities.

“These new guidelines will support medical teams in their assessments about how best to treat and manage these common injuries.”

Mr Bob Handley, Consultant Trauma and Orthopaedic Surgeon, John Radcliffe Hospital and member of the NICE guideline project executive team said: “Complex fractures require well-organised, expert attention to detail in order to avoid devastating complications such as chronic pain, permanent disability or amputation.”

“The two new NICE fracture guidelines contain recommendations based upon latest evidence, which has shown the impact of early diagnosis and effective treatment in avoiding these complications.”

All five trauma guidelines feature recommendations to promote better communication. They suggest a designated point of contact within the trauma team for the patient, their family members and carers. And an aim for the trauma team to give the patient’s GP a written summary including diagnosis, management plan and expected outcome, within 24 hours of admission.

Professor Chris Moran, National Clinical Director for Trauma and a front-line trauma surgeon in Nottingham said: “Every shred of information is precious in trauma cases. It is crucial that we talk not only to each other in the trauma team, but that we also speak to those involved in and those who witnessed the accident.

“I am very happy to see patient information feature so prominently in NICE’s trauma guidelines. We know that a good experience in hospital and an understanding of their targets for recovery can help patients get better more quickly.”

Together these new NICE trauma guidelines give a wide-range of recommendations based upon the latest evidence. They will support trauma teams across the country, promoting high quality, patient-focused care as standard.

Mr David Skinner, Emeritus Consultant in Emergency Medicine, Oxford, and Chair of the NICE guideline project executive team said: “’Thirty years ago UK trauma care was poor and patients suffered. A number of subsequent initiatives have progressively improved this.

“The recommendations in these new NICE guidelines will introduce the latest in evidence-based care across the entirety of our national trauma network.

“This will not only ensure a patient is taken to and treated in the best environment for them; it will ensure that this happens all the time, for every patient in England.”

Ends

http://www.nice.org.uk/news/press-and-media/nice-publishes-five-new-guidelines-to-standardise-trauma-care-in-England

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Remember that this is just a quick update. Please visit the NICE guideline site, look at the evidence for yourself.

The main document is a long (330 page) read so let’s be a bit abstract here and review the guidance with a vignette.

http://stemlynsblog.org/nice_major_trauma_guidelines_stemlyns/

[oma]

So NICE has published it’s guidelines on ‘Major trauma; assessment and initial management’, obviously it would be ideal for you to run through the full document yourself but to give you a flavour of the key points that we think will affect our practice here are what we consider to be the headlines;

http://www.heftemcast.co.uk/nice-guideline-major-trauma-assessment-and-initial-management/

[Joffry Ambu-Vpk]

http://stemlynsblog.org/nice_major_trauma_guidelines_stemlyns/

de tekst staat wel bol van de amerikaanse afkorting zeg, een US is ineens een ultrasound, TEG ROTEM PTX TXA   etc etc ja zo lust ik er nog wel n paar van die ''medische'' afkortingen...de leesbaarheid wordt er helaas niet beter van     maar de inhoud lijkt me wel erg relevant  

Bizar vind ik het schokkende filmpje wat de amerikaanse dokters bij hun PR artikeltje hebben geplakt en blijkbaar nodig vonden ter illustratie ....geen wonder dat men daar in de USA weinig heeft geleerd van wapenmisbruik door t ganse land.

[oma]

Bizar vind ik het schokkende filmpje wat de amerikaanse Britse dokters bij hun PR artikeltje hebben geplakt en blijkbaar nodig vonden ter illustratie ....geen wonder dat men daar in de USA weinig heeft geleerd van wapenmisbruik door t ganse land.

[Joffry Ambu-Vpk]

 Pardon Britse dokters....   het filmpje en wapengebruik hoort dan weer wel bij de USA