JISCMail - ACAD-AE-MED Archives

They probably are now, because of those early findings in both the US and UK. I was involved with the prospective pilot study for MTOS (87/88) in Manchester. Maralyn Woodford of UKTARN would be able to clarify the reasons/ criteria - I haven't got them to hand.

I thought # NOFs were supposed to be excluded from MTOS, UKTARN, TARN or whatever it is supposed to be called now?

----- Original Message -----

From: [log in to unmask]>Adrian Fogarty

Sent: Friday, November 10, 2000 12:13 AM

Subject: Re: Seniority of doctors

Yes Rob, I think the issue is bed sores and I also have my doubts in that regard. As to the MTOS unexpected deaths you mention, I don't deny there is a significant mortality in the elderly #NOF patient. I'm not sure how these patients score in MTOS however - surely the elderly have a significant expected mortality rate with this condition, while the younger population do not...are there any MTOS experts out there? Anyway, I'm still not convinced "fast-tracking" has a major influence on mortality, over and above fast-tracking any of our other patients, many of whom are just as deserving if you ask me. I just think it's a convenient, easily measurable, performance indicator that misses the point - these patients need analgesia, a bed and early surgery...the time they're warded is immaterial. Also it's a single issue performance indicator, and that worries me...if departments throw a lot of resources at such an issue, something else will suffer as a result. And if we must tackle a single issue then make it myocardium, lives or limbs in the first instance.

----- Original Message -----

From: [log in to unmask]>Robert Anthony COCKS

I seem to remember this started as an issue of bed-sores. Theory being that immobile NOF patients could develop sores within as little as an hour on an A&E trolley, but that a hospital bed would miraculously prevent these (I have my doubts - sore prevention has more to do with good nursing care than the exact type of hard surface !). Perhaps Ian Hepworth or one of the other nurses on the list can help us tell if this idea was evidence based or just guesswork.

The early MTOS work threw up a lot of "unexpected" trauma deaths with ISS 9 and perfect RTS (ie good physiology) - fractured neck of femur being one of the main culprits. Early treatment in A&E might well have a direct influence on whether the patient's final triage card is green or black. This needs more research though.