JRSM >
Volume 94, Number 7 >
Pp. 365-366
Accident and Emergency Department, King's College Hospital, London SE5 9RS, UK
Editors: Frederick P Rivara, Peter Cummings, Thomas D Koepsell, David C
Grossman, Ronald V Maier
304 pp Price £60/US$95 ISBN 0-521-66152-8 (h/b)
Cambridge: Cambridge University Press, 2001
Because serious injury is still quite uncommon in the UK, research on the subject presents difficulties of design and data collection. Now that simple preventive measures such as seat belts and helmets have achieved large falls in mortality, attention is switching to other sorts of outcome. In the published work worldwide, outcome studies of high quality are few: the focus is on medical management of trauma, and psychosocial aspects of injury suffer particular neglect. For the UK, guidelines have been issued on the management of trauma and on the design of trauma systems, but there is scant evidence that these will improve outcomes. What we need is good-quality evidence, and any help that we can get in designing the necessary studies is welcome. Injury Control contains much useful guidance. The focus on injury prevention and control allows helpful reallife illustrations and the reference lists are comprehensive.
The introduction reviews the history of injury research and is followed by a comprehensive review of existing scoring and coding systems, including current drawbacks and possible ways to avoid them. Further chapters look at data collection methods and the difficulties of data presentation, with examples from the literature. The text explores the benefits and drawbacks of each method and offers advice on when and how to use them. Statistical analysis is not addressed—a pity since the rest of the coverage is so comprehensive. Several chapters deal with research methodologies, including qualitative methods and systematic reviews. Although by no means complete in the descriptions, these are well referenced and are generic enough to be helpful resumés of the important features. The brief explanations allow the reader to gather an overview and to select a method; further reading is then indicated from the references listed. Guidelines or care pathways are very much in the news and the chapter on developing clinical decision rules is a clear account of the process, including a helpful checklist. Again, this is generic enough to be of use in many areas, both in emergency care and in elective work. Trauma performance improvement can be likened to clinical governance, with a need to be continually evaluating and improving performance. The chapter on this subject is the least helpful in the book, the authors failing to link what they say to the contents of other chapters.
Although outwardly the book is about injury, its style and breadth make it valuable to many other researchers. I anticipate that it will be borrowed many times by my colleagues to get ideas and general advice. I recommend it to anyone interested in trauma and to all A&E colleagues who have £60 to spare.
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