Injury Near-Miss and Quality of Trauma Care Lateef OA Thanni * Department of Orthopaedics and Traumatology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria * Corresponding author: Lateef OA Thanni, Department of Orthopaedics and Traumatology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, Tel: +2348023721022; E-mail: loathanni@yahoo.com Received date: July 20, 2018; Accepted date: September 19, 2018; Published date: September 26, 2018 Citaon: Thanni LOA (2018) Injury Near-Miss and Quality of Trauma Care. J Intensive Crit Care Vol.4 No.3:14 Commentary Violence and injury remains a contemporary trauma care subject. The burden, characteriscs and outcome of injury vary from low/middle income to high income countries [1]. However, the prevalence is increasing, especially in low and middle income countries. This is due to increasing motorisaon and firearm injuries [2]. Hitherto, outcome of trauma care has been assessed by mortality rates which range from 2 to 32 %. Due to improvements in pre-hospital and in-hospital care, mortality rate has declined over the years but the usefulness of this measure of quality of care has also reduced. The realisaon that death occurs from inadequate or subopmal trauma care; has resulted in the need to develop care performance measures that truly reflect the burden of the condion as well as areas of necessary improvement such as policy making, treatment guidelines and post hospital care. There are different scores for measuring the severity of injury. Scores such as AIS (Abbreviated Injury Score) and ISS (Injury Severity Score) quanfies anatomical injury while others such as TRISS (Trauma and Injury Severity Score) measure physiological impact of trauma in addion to anatomical injury. These scores are designed to predict mortality outcome thus liming their value. There are different aspects of trauma care. These include injury prevenon, pre-hospital care including transportaon, in- hospital care, rehabilitaon and reintegraon into the community. Performance indicators have been introduced to beer measure trauma care and its outcome. These indicators measure these aspects which can be grouped into three; the structure of trauma care systems, the process of trauma care as well as outcome of care [3]. However, none of these indicators are universally acceptable. Over one thousand five hundred performance indicators had been idenfied but a systemac review shows no strong evidence to support their use as measure of quality of trauma care [4]. Trauma is not a single disease enty or condion. It is a collecon of diverse condions of ill health which outcome depends on trauma care systems, care processes and paent characteriscs such as age, physiologic and comorbid condions in addion to the severity of injury. Some injuries are severe enough to result in complicaons that threaten life and survival depends on adequate and mely intervenon. If paents with such injuries and complicaons can be idenfied using simple markers that are involved in roune care, then intervenon can be beer planned and implemented in a clinical seng. This is the basis for introducing the concept of severe acute injury morbidity SAIM (also called “near-miss injury morbidity”) [2]. The indicators proposed for idenfying SAIM are categorised into two: organ system dysfuncon and treatment intervenon. Preliminary findings indicate that there are twice as many injured persons at risk of death as there are those who died. The burden of the problem is at least twice what mortality stasc suggests. Severe acute injury morbidity index tends to be higher than mortality index [2]. This concept takes into consideraon that outcome depends on combinaon of the severity of injury/ physiological response of the body as well as the quality of care available. As such results are likely to be comparable for different trauma care sengs. References 1. Charles M, Catherine J, Susan B, Jacques G, Manjul J (2009) Guidelines for trauma quality improvement programmes 2009; WHO and IATSIC. Pp: 1-114. 2. Lateef O.A. Thanni, Sunday O. Sofola-Orukotan (2015) Severe acute injury morbidity: A study to define injury near-miss. World Journal of Trauma and Crical Care Medicine 3: 1-8. 3. Gruen RL, Gabbe BJ, Stelfox HT, Cameron PA (2012) Indicators of the quality of trauma care and the performance of trauma systems. Br J Surg 99: 97-104. 4. Stelfox HT, Bobranska-Aruch B, Nathens A, Straus SE (2010) Quality indicators for evaluang trauma care: A scoping review. Arch Surg 145: 286-295. Commentary iMedPub Journals http://www.imedpub.com/ DOI: 10.21767/2471-8505.100116 Journal of Intensive and Critical Care ISSN 2471-8505 Vol.4 No.3:14 2018 © Under License of Creative Commons Attribution 3.0 License | This article is available from: http://criticalcare.imedpub.com/ 1