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

^a Medical Care Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA

Contributing authors are listed at the end of the articleCorrespondence to: Professor Jon Nicholl

Objective: To assess the effect of the development of an experimental trauma centre and regional trauma system on the survival of patients with major trauma.
Design: Controlled before and after study examining outcomes between 1990 and 1993, spanning the introduction of the system in 1991-2.
Setting: 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.
Subjects: 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.
Main outcome measures: Survival rates standardised for age, severity of injury, and revised trauma score.
Results: 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%).
Conclusion: 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.

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Relevant Article

Effectiveness of regional trauma systems

P A Oakley, R M Kirby, A D Redmond, J Templeton, M J A Parr, J P Nolan, John Wright, Jon Nicholl, and Janette Turner
BMJ 1998 316: 1383. [Extract] [Full Text]

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Alexander Siegmeth
bmj.com, 14 Oct 2000 [Full text]