Effectiveness of a regional trauma system in reducing mortality from major trauma: before and after study

To assess the effect of the development of an experimental trauma centre and regional trauma system on the survival of patients with major trauma.

Controlled before and after study examining outcomes between 1990 and 1993, spanning the introduction of the system in 1991-2.

Trauma centre in North Staffordshire Royal Infirmary and five associated district general hospitals in the North West Midlands regional trauma system, and two control regions in Lancashire and Humberside.

All trauma patients taken by the ambulance services serving the regions or arriving other than by ambulance with injury severity scores > 15, whether or not they had vital signs on arrival at hospital.

Survival rates standardised for age, severity of injury, and revised trauma score.

In 1990, 33% of major trauma patients in the experimental region were taken to the trauma centre, and by 1993 this had risen to only 39%. Crude death rates changed by the same amount in the control regions (46.5% in 1990-1 to 44.4% in 1992-3) as in the experimental region (44.8% to 41.3%). After standardisation, the estimated change in the probability of dying in the experimental region compared with the control regions was -0.8% per year (95% confidence interval -3.6% to 2.2%); for out of hours care, the change was 1.6% per year (-2.3% to 5.6%), and, for multiply injured patients, the change was -1.6% (-6.1% to 2.6%).

Any reductions in mortality from regionalising major trauma care in shire areas of England would probably be modest compared with reports from the United States.