title: A major trauma centre is a specialty hospital not a hospital of specialties.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Institution of a specialist trauma service and performance improvement programme was associated with significant improvements in outcomes that exceeded national variations.
authors.affiliation: Trauma Clinical Academic Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Royal London Hospital, London, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Davenport
authors.forename: N
authors.initials: N
authors.lastname: Tai
authors.forename: A
authors.initials: A
authors.lastname: West
authors.forename: O
authors.initials: O
authors.lastname: Bouamra
authors.forename: C
authors.initials: C
authors.lastname: Aylwin
authors.forename: M
authors.initials: M
authors.lastname: Woodford
authors.forename: A
authors.initials: A
authors.lastname: McGinley
authors.forename: F
authors.initials: F
authors.lastname: Lecky
authors.forename: M S
authors.initials: MS
authors.lastname: Walsh
authors.forename: K
authors.initials: K
authors.lastname: Brohi
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000458:organization & administration*; D014852:Wales / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy