Implementation and evaluation

Abstract

This study aimed to determine whether there is evidence of improved patient outcomes in Major Trauma Centres following the regionalisation of trauma care in England. An observational study was undertaken using the Trauma & Audit Research Network (TARN), Hospital Episode Statistics (HES), and national death registrations. The outcome measures were trauma care quality indicators (e.g. treatment by a senior doctor) and clinical outcomes (e.g. in-hospital mortality). There were 20,181 major trauma cases reported to TARN during the study period. Following regionalisation of trauma services, all measured care quality indicators 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 no differences in either crude or adjusted mortality. The overall number of traumatic deaths in England did not change following the national reconfiguration of trauma services. Evidence from other countries that have regionalised trauma services suggest that further benefits may become apparent after a period of trauma system maturation.