Introduction. Compartment syndrome can be a life changing consequence of injury to a limb. If not diagnosed and treated early it can lead to permanent disability. Neurovascular observations done on the ward by nursing staff, are often our early warning system to those developing compartment syndrome. But are these adequate for detecting the early signs of compartment syndrome? Our aim was to compare the quality and variability of charts across the UK major trauma network. Materials & Methods. All major trauma centres in England and Scotland were invited to supply a copy of the neurovascular chart routinely used. We assessed how such charts record relevant information. Specific primary data points included were pain scores, analgesia requirements, pain on passive stretch and decreased sensation in the first web space specifically. As secondary objectives, we assessed how late signs were recorded, whether clear instructions were included, quantitative scores and the use of regional blocks recorded. Results. A response rate of 46% was achieved. Of the charts reviewed, 25% documented pain scores or pain on passive movement. Pain on movement and analgesia requirements were documented in 33% and 8% respectively. Specific sensation within the 1. st. webspace was recorded in 16%. No charts recorded use of regional block. All charts recorded global sensation, movement (unspecified), pulse and colour whilst 66% documented capillary refill and 83% temperature. Instructions were included in 41% of charts. Conclusions. In 2016, the BOA supported publication of an observation chart for this purpose however, it is not widely used. In our study, late signs of compartment syndrome were generally well recorded. However, documentation of early signs and regional blocks was poor. This may lead to delays in diagnosis with significant clinical and medicolegal consequences. Standardisation of documentation by updating and promoting the use of the pre-existing chart would ensure highest quality care across the network

Abstract. Background. University Hospital of Wales (UHW) went live as a Major Trauma Centre (MTC) on the 14th September 2020. New guidelines have been set up by the Wales Trauma Network. Aim. Prospective audit to see how many admissions, correct pathways were followed?. Materials & Methods. Prospective data collection prospective over a period of 3 months: starting from 8.11.2020 to 31.01.2021. Results. Spinal admissions represent around 22% of MTC admissions. The closing loop showed higher amount of admission (45 in comparison with the first audit 28). 42 patients had fractures where three had cord syndromes. 13 patients out of the 45 (29%) were managed operatively. After changing to MTC, more indirect referral from other hospitals representing 64% of total admission with one wrong referral (2.2%) that came to the MTC and could have been managed locally. On the other hand, repatriation rate has improved from 61% to 84%, however, repatriation time was longer than expected with >1 week represents 78%. Conclusions. Changing to MTC had a great impact with increased work load in the trust. Repatriation would be aimed for within 72 hours from treatment either conservative or postoperative. More attention should be paid towards the appropriate referral pathways to avoid wrong referral

Aims. The BOA/BAPRAS guidelines for the management of open tibial fractures (2009) recommend early senior combined orthoplastics input and appropriate facilities to manage a high caseload. St Georges Hospital is one of four London Trauma Centres fulfilling these criteria. Our aim is to determine whether becoming a trauma centre has affected the management of patients with open tibial fractures. Methods. Data were obtained prospectively on consecutive open tibial fractures during two 8 month periods: before and after becoming a Major Trauma Centre (May 2009–Dec 2009 and April 2010–Oct 2010 respectively). Data on patient pathway including, admitting hospital, length of stay, timing and number of operations were recorded. Results. 29 open tibial fractures were admitted during the 8 months after designation as a major trauma centre compared to 15 before. 72% of patients came directly, or as A&E hot transfers (previously 60%). Of the eight tertiary transfers, six were from hospitals outside the South West Trauma Network. The time to transfer patients initially admitted to local orthopaedic departments has fallen from 8.6 to 1.6 days. Despite this improvement as a trauma centre, these patients remained in hospital longer (16.3 vs 14.9) and had more operations (3.7 vs 2.6) than direct admissions. As a trauma centre there were improvements in time to definitive skeletal stabilisation (4.7 to 2.2), skin coverage (8.3 to 3.7 days), average number of operations (4.2 to 2.3) and average length of hospital admission fell from 23 to 16 days. Conclusions. The volume and management of open tibial fractures has been directly affected by introduction of a trauma centre within the London Trauma Network. Implementation of BOAST guidelines has resulted in improved management of open lower limb fractures independent of fracture grade. Our data strongly support the continuing development of trauma networks

Applying the concept of a regional trauma network to the UK paediatric trauma population has unique difficulties in terms of low patient volume and variation in paediatric service provision. In addition, no consensus exists as to which radiological investigations should be employed and an increasing trend towards computerised tomography raises concerns over radiation exposure. We carried out a retrospective review of all paediatric trauma calls from April 2010 and March 2013 around becoming a Major Trauma Centre. We aim to analyse the impact this has on trauma calls and assess the radiological investigations currently used in this population. The number of yearly paediatric trauma calls doubled during our study and totalled 132. The commonest mechanisms of injury were road traffic collisions, fall from a height or fall off a horse. 91.7% of children had some form of radiological investigation; 67% plain radiograph, 37.1% trauma CT, 21.2% focused CT and 5.3% abdominal ultrasound scan. Of the 77 CT scans performed 57.1% were reported as normal and 54.5% of these patients were discharged home the same day. Five children re-attended the emergency department within 30 days with two positive findings; a subdural haematoma and a tibial plateau fracture. The current use of harmful radiological investigations in paediatric trauma patients is not uniform. We propose implementation of radiology protocols and clinical guidance to imaging in paediatric trauma to limited radiation exposure

Aims

The current global pandemic due to COVID-19 is generating significant burden on the health service in the UK. On 23 March 2020, the UK government issued requirements for a national lockdown. The aim of this multicentre study is to gain a greater understanding of the impact lockdown has had on the rates, mechanisms and types of injuries together with their management across a regional trauma service.