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A major trauma centre is a specialty hospital not a hospital of specialties. BJS 2010; 97: 109-117.

Published: 10th December 2009

Authors: R. A. Davenport, N. Tai, A. West, O. Bouamra, C. Aylwin, M. Woodford et al.

Background

High estimates of preventable death rates have renewed the impetus for national regionalization of trauma care. Institution of a specialist multidisciplinary trauma service and performance improvement programme was hypothesized to have resulted in improved outcomes for severely injured patients.

Method

This was a comparative analysis of data from the Royal London Hospital (RLH) trauma registry and Trauma Audit and Research Network (England and Wales), 2000–2005. Preventable mortality was evaluated by prospective analysis of the RLH performance improvement programme.

Results

Mortality from critical injury at the RLH was 48 per cent lower in 2005 than 2000 (17·9 versus 34·2 per cent; P = 0·001). Overall mortality rates were unchanged for acute hospitals (4·3 versus 4·4 per cent) and other multispecialty hospitals (8·7 versus 7·3 per cent). Secondary transfer mortality in critically injured patients was 53 per cent lower in the regional network than the national average (5·2 versus 11·0 per cent; P = 0·001). Preventable death rates fell from 9 to 2 per cent (P = 0·040) and significant gains were made in critical care and ward bed utilization.

Conclusion

Institution of a specialist trauma service and performance improvement programme was associated with significant improvements in outcomes that exceeded national variations. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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