title: Regionalisation of trauma care in England.
abstract: OBJECTIVE
  We aimed to determine whether there is evidence of improved patient outcomes in Major Trauma Centres following the regionalisation of trauma care in England.
  
  
  METHODS
  An observational study was undertaken using the Trauma Audit and Research Network (TARN), Hospital Episode Statistics (HES) and national death registrations. The outcome measures were indicators of the quality of trauma care, such as treatment by a senior doctor and clinical outcomes, such as mortality in hospital.
  
  
  CONCLUSIONS
  A total of 20 181 major trauma cases were reported to TARN during the study period, which was 270 days before and after each hospital became a Major Trauma Centre. Following regionalisation of trauma services, all indicators of the quality of care improved, fewer patients required secondary transfer between hospitals and a greater proportion were discharged with a Glasgow Outcome Score of "good recovery". In this early post-implementation analysis, there were a number of apparent process improvements (e.g. time to CT) but no differences in either crude or adjusted mortality. The overall number of deaths following trauma in England did not change following the national reconfiguration of trauma services. Evidence from other countries that have regionalised trauma services suggests that further benefits may become apparent after a period of maturing of the trauma system. Cite this article: Bone Joint J 2016;98-B:1253-61.
authors: University of Oxford, NDORMS, Oxford, OX3 7HE, UK.
authors: D
authors: D
authors: Metcalfe
authors: University of Liverpool, Liverpool, Institute of Translational Medicine, Liverpool, L12 2AP, UK.
authors: D C
authors: DC
authors: Perry
authors: University of Manchester, Trauma Audit and Research Network, Salford, Manchester, M6 8HD, UK.
authors: O
authors: O
authors: Bouamra
authors: Harvard Medical School, Center for Surgery and Public Health, Boston, MA 02115, USA.
authors: A
authors: A
authors: Salim
authors: University of Manchester, Trauma Audit and Research Network, Salford, Manchester, M6 8HD, UK.
authors: M
authors: M
authors: Woodford
authors: University of Manchester, Trauma Audit and Research Network, Salford, Manchester, M6 8HD, UK.
authors: A
authors: A
authors: Edwards
authors: University of Sheffield, School of Health and Related Research, Sheffield, S1 4DA, UK.
authors: F E
authors: FE
authors: Lecky
authors: University of Oxford, NDORMS, Oxford, OX3 7HE, UK.
authors: M L
authors: ML
authors: Costa
mesh_terms: D004739:England; D005260:Female; D006801:Humans; D008297:Male; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D012040:Regional Health Planning / Q000458:organization & administration*; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000628:therapy*
keywords: Major trauma regionalisation; Trauma centres; Trauma systems