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Observational Study
. 2016 Sep;98-B(9):1253-61.
doi: 10.1302/0301-620X.98B9.37525.

Regionalisation of trauma care in England

D Metcalfe  1 , D C Perry  2 , O Bouamra  3 , A Salim  4 , M Woodford  3 , A Edwards  3 , F E Lecky  5 , M L Costa  1
Affiliations
Free article
Observational Study

Regionalisation of trauma care in England

D Metcalfe et al. Bone Joint J. 2016 Sep.
Free article

Abstract

Aims: We aimed to determine whether there is evidence of improved patient outcomes in Major Trauma Centres following the regionalisation of trauma care in England.

Patients and methods: An observational study was undertaken using the Trauma Audit and Research Network (TARN), Hospital Episode Statistics (HES) and national death registrations. The outcome measures were indicators of the quality of trauma care, such as treatment by a senior doctor and clinical outcomes, such as mortality in hospital.

Results and conclusion: A total of 20 181 major trauma cases were reported to TARN during the study period, which was 270 days before and after each hospital became a Major Trauma Centre. Following regionalisation of trauma services, all indicators of the quality of care improved, fewer patients required secondary transfer between hospitals and a greater proportion were discharged with a Glasgow Outcome Score of "good recovery". In this early post-implementation analysis, there were a number of apparent process improvements (e.g. time to CT) but no differences in either crude or adjusted mortality. The overall number of deaths following trauma in England did not change following the national reconfiguration of trauma services. Evidence from other countries that have regionalised trauma services suggests that further benefits may become apparent after a period of maturing of the trauma system. Cite this article: Bone Joint J 2016;98-B:1253-61.

Keywords: Major trauma regionalisation; Trauma centres; Trauma systems.

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