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Citation
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Metcalfe D, Bouamra O, Parsons NR, Aletrari MO, Lecky FE, Costa ML. Br. J. Surg. 2014; 101(8): 959-964. |
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Affiliation
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Warwick Medical School, University of Warwick, Coventry, UK; College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK. |
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Abstract
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BACKGROUND: Centralization of complex healthcare services into specialist high-volume centres is believed to improve outcomes. For injured patients, few studies have evaluated the centralization of major trauma services. The aim of this study was to evaluate how a regional trauma network affected trends in admissions, case mix, and outcomes of injured patients.
METHODS: A retrospective before-after study was undertaken of severely injured patients attending four hospitals that became major trauma centres (MTCs) in March 2012. Consecutive patients with major trauma were identified from a national registry and divided into two groups according to injury before or after the launch of a new trauma network. The two cohorts were compared for differences in case mix, demand on hospital resources, and outcomes.
RESULTS: Patient volume increased from 442 to 1326 (200 per cent), operations from 349 to 1231 (253 per cent), critical care bed-days from 1100 to 3704 (237 per cent), and total hospital bed-days from 7910 to 22 772 (188 per cent). Patient age increased on MTC designation from 45·0 years before March 2012 to 48·2 years afterwards (P = 0·021), as did the proportion of penetrating injuries (1·8 versus 4·1 per cent; P = 0·025). Injury severity fell as measured by median Injury Severity Score (16 versus 14) and Revised Trauma Score (4·1 versus 7·8). Fewer patients required secondary transfer to a MTC from peripheral hospitals (19·9 versus 16·1 per cent; P = 0·100). There were no significant differences in total duration of hospital stay, critical care requirements or mortality. However, there was a significant increase, from 55·5 to 62·3 per cent (P < 0·001), in the proportion of patients coded as having a 'good recovery' at discharge after institution of the trauma network.
CONCLUSION: MTC designation leads to an increased case volume with considerable implications for operating theatre capacity and bed occupancy. Although no mortality benefit was demonstrated within 6 months of establishing this trauma network, early detectable advantages included improved functional outcome at discharge.
Language: en |