• R B Fisher and C H Dearden.
• Accident and Emergency Department, Royal Victoria Hospital, Belfast.
• BMJ. 1990 Jun 16;300(6739):1560-3.

ObjectiveTo determine whether improvement in the care of victims of major trauma could be made by using the revised trauma score as a triage tool to help junior accident and emergency doctors rapidly identify seriously injured patients and thereby call a senior accident and emergency specialist to supervise their resuscitation.DesignComparison of results of audit of management of all seriously injured patients before and after these measures were introduced.SettingAccident and emergency department in an urban hospital.PatientsAll seriously injured patients (injury severity score greater than 15) admitted to the department six months before and one year after introduction of the measures.ResultsManagement errors were reduced from 58% (21/36) to 30% (16/54) (p less than 0.01). Correct treatment rather than improvement in diagnosis or investigation accounted for almost all the improvement.ConclusionsThe management of seriously injured patients in the accident and emergency department can be improved by introducing two simple measures: using the revised trauma score as a triage tool to help junior doctors in the accident and emergency department rapidly identify seriously injured patients, and calling a senior accident and emergency specialist to supervise the resuscitation of all seriously injured patients.ImplicationsCare of patients in accident and emergency departments can be improved considerably at no additional expense by introducing two simple measures.

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