The Evolution of Trauma Systems

Abstract

Major Trauma Networks in the United Kingdom are a recent development. Since the Second World War a number of reports highlighted significant deficits in trauma care but their recommendations were largely not implemented. At the same time other countries (most notably the US) demonstrated improved outcomes where trauma systems were in use. The establishment of the Trauma Audit Research Network (TARN) further demonstrated a stagnation in improving outcomes. A number of critical English reviews at the start of the twenty-first century finally provoked action and in 2010 plans were put in place for a hub and spoke system of major trauma care across the country with bypass to the Major Trauma Centres for patients identified by pre-hospital triage tools. Similar plans followed for the devolved regions. The Major Trauma Networks appear to have improved mortality and have provided opportunities for large scale trauma research. Improved prospective data collection has identified the extent of trauma in older patients and the persistent challenges of non-accidental injury in the young. More work is needed to determine if improvements in outcome beyond mortality have occurred. The nature of NHS funding is such that further development of trauma care may be difficult as the political spotlight has moved on.