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Changing the System - Major Trauma Patients and Their Outcomes in the NHS (England) 2008-17
Christopher G Moran1, Fiona Lecky2, Omar Bouamra3
1University of Nottingham, Derby Rd, Nottingham NG7 2UH, UK.
Eclinicalmedicine
|June 14, 2019
Summary
England's major trauma networks improved survival rates for severe injuries by 19% after 2012. This national reorganisation led to better patient flow, faster treatment, and improved clinical care, enhancing outcomes for trauma patients.
Area of Science:
- Trauma care systems
- Health services research
- Clinical outcomes analysis
Background:
- England reorganised trauma care in 2012, centralising treatment in Major Trauma Centres (MTCs).
- Controversy persists regarding optimal organisation of care for severe injury patients.
- The national clinical audit of major trauma care provided the data source.
Purpose of the Study:
- To evaluate the impact of the national trauma care reorganisation on patient outcomes.
- To analyse changes in care processes and survival rates following the implementation of Major Trauma Networks.
- To assess the effectiveness of a whole-system approach to severe injury management.
Main Methods:
- Longitudinal analysis of annual cross-sectional studies from April 2008 to March 2017.
- Inclusion of 110,863 patients admitted to 35 consistently reporting hospitals.
- Primary outcome measure was longitudinal analysis of risk-adjusted survival.
Main Results:
- Major Trauma Networks correlated with changes in patient flow, treatment systems, patient demographics, and clinical interventions.
- Risk-adjusted odds of survival for severe injury increased by 19% (95% CI 3%-36%) over the study period.
- Interrupted time series analysis revealed a significant positive trend in survival post-April 2012 (0.08% excess survivors per quarter, p=0.023).
Conclusions:
- The national implementation of Major Trauma Networks was associated with significant improvements in care processes.
- A whole-system approach to trauma care resulted in demonstrable improvements in patient outcomes.
- The findings support the effectiveness of integrated trauma networks in enhancing survival from severe injury.
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