Planning trauma care services in the UK

The authors state that orthopaedic surgery is the only specialty that recognises trauma as a sub-specialty interest in the UK. However, trauma is also a large sub-specialty of neurosurgery and increasingly neurotrauma is being managed by a small group of neurosurgeons within larger neurosurgical units. The British Neurotrauma Group (BNTG) was established as a sub-specialty group of the Society of British Neurological Surgeons (SBNS) in 2010 and aims to promote education and research focused on cranial and spinal neurotrauma [1].

Cranial trauma features at all training stages of the UK neurosurgical curriculum (initial, intermediate and final). The objective of the final training stage is to “achieve competence in all aspects of the advanced operative management of head-injured patients” [2]. Spinal trauma also features at all training stages of the UK neurosurgical curriculum, although competence in the advanced operative care of patients with spinal trauma is usually achieved during special interest training [2]. The “Head Injury” course, which is run at the Royal College of Surgeons of England and covers core topics of the curriculum, is now in its second successful year [3].

In the USA, the Acute Care Surgery/Trauma Fellowship curriculum mainly focuses on thoracic, abdominal and extremity vascular trauma. The core skill of insertion of an intracranial pressure monitor on the other hand, is not an essential element of the curriculum. The same applies to spinal and extremity bony injuries [4].

We agree with the authors that the development of training programmes for general surgeons wishing to specialise in the care of trauma patients is highly desirable. However, head injury remains the cause of approximately half of trauma deaths and recent evidence suggests that management of severe head injury in neuroscience centres is associated with reduced mortality [5]. Hence, patients with severe head injury should be managed in trauma centres with neurosurgical expertise.

It needs to be emphasised that trauma care has to be tailored to the individual’s pattern of injuries – one size clearly doesn’t fit all. Injuries affecting multiple anatomical regions require the ongoing close collaboration of clinicians with an interest in trauma from different surgical disciplines and intensive care medicine.

1. http://www.sbns.org.uk/index.php/councils/
2. https://www.iscp.ac.uk/surgical/SpecialtySyllabus.aspx?stage_id=143&spec...
3. http://www.rcseng.ac.uk/courses/course-search/head-injury-an-integrated-...
4. Acute Care Surgery Fellowship Training Curriculum,American Association for the Surgery of Traumahttp://www.aast.org/AcuteCareSurgery/ProgramRequirements.aspx
5. Fuller G, Bouamra O, Woodford M, Jenks T, Patel H, Coats TJ, Oakley P, Mendelow AD, Pigott T, Hutchinson PJ, Lecky F. The effect of specialist neurosciences care on outcome in adult severe head injury: a cohort study. J Neurosurg Anesthesiol 2011; 23:198-205