World Journal of Surgery

, Volume 37, Issue 7, pp 1544–1549 | Cite as

Utilisation of a Level 1 Trauma Centre in KwaZulu-Natal: Appropriateness of Referral Determines Trauma Patient Access

  • Timothy Craig HardcastleEmail author
  • Matthew Giles Reeds
  • David James Jackson Muckart



Appropriate referral of major trauma patients to an accredited Level 1 Trauma facility is associated with improved outcome. A new Level 1 Trauma Centre was opened at Inkosi Albert Luthuli Central Hospital in March 2007. This study sought to audit the referral pattern of external consults to the trauma unit and ascertain whether the unit was receiving appropriate referrals and has adequate capacity.


An audit was performed of the referral proformas used in the unit to record admission decisions and of the computerised trauma database. The audit examined referral source (scene vs. interhospital), regional distribution, and final decision regarding admission of the injured patients. The study was approved by the UKZN Ethics Committee (BE207/09 and 011/010).


Of the 1,212 external consults, 540 were accepted for admission while the rest were not accepted for various reasons. These included 206 cases where no bed was available, 233 did not meet admission criteria (minor injury or futile situation), and 115 were for subspecialty management of a single-system injury. Finally, 115 were initially refused pending stabilisation for transfer at a regional facility. Twenty-six percent of the cases were referrals from the scene, with an acceptance rate of 96 %. Most patients (59 %) were from the local eThekwini region.


Major multiorgan system trauma remains a significant public health burden in KwaZulu-Natal. A Level 1 Trauma Service is used appropriately in most circumstances. However, the additional need for more hospital facilities that provide such services across the whole province to enable effective geographical coverage for those trauma patients requiring such specialised trauma care is essential.


Trauma System Motor Vehicle Collision Inclusive System Trauma Unit Major Trauma Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The role of the rotating trainees in surgery, orthopaedics, and anaesthesia is acknowledged in the comprehensive completion of the referral proformas at the time of each external referral. The GIS Unit of the Department of Health population density map is used with the permission of the Provincial Research Office. This study was part of the PhD on Trauma Systems at UKZN for Dr. T. Hardcastle and is both a Trauma Unit Class Approval Study BREC-BE207/09 and a PhD approval BE011/010.


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Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Timothy Craig Hardcastle
    • 1
    Email author
  • Matthew Giles Reeds
    • 1
  • David James Jackson Muckart
    • 1
  1. 1.Department of SurgeryUKZN, Trauma Unit, Inkosi Albert Luthuli Central Hospital (IALCH)Malvern, DurbanSouth Africa

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