University of Leicester
Browse
Changing the System - Major Trauma Patients and Their Outcomes in the NHS (England) 2008-17.pdf (764.08 kB)

Changing the System - Major Trauma Patients and Their Outcomes in the NHS (England) 2008-17.

Download (764.08 kB)
journal contribution
posted on 2019-10-14, 08:47 authored by Christopher G. Moran, Fiona Lecky, Omar Bouamra, Tom Lawrence, Antoinette Edwards, Maralyn Woodford, Keith Willett, Timothy J. Coats
Background: Trauma care in England was re-organised in 2012 with ambulance bypass of local hospitals to newly designated Major Trauma Centres (MTCs). There is still controversy about the optimal way to organise health series for patients suffering severe injury. Methods: A longitudinal series of annual cross-sectional studies of care process and outcomes from April 2008 to March 2017. Data was collected through the national clinical audit of major trauma care. The primary analysis was carried out on the 110,863 patients admitted to 35 hospitals that were 'consistent submitters' throughout the study period. The main outcome was longitudinal analysis of risk adjusted survival. Findings: Major Trauma networks were associated with significant changes in (1) patient flow (with increased numbers treated in Major Trauma Centres), (2) treatment systems (more consultant led care and more rapid imaging), (3) patient factors (an increase in older trauma), and (4) clinical care (new massive transfusion policies and use of tranexamic acid). There were 10,247 (9.2%) deaths in the 110,863 patients with an ISS of 9 or more. There were no changes in unadjusted mortality. The analysis of trends in risk adjusted survival for study hospitals shows a 19% (95% CI 3%-36%) increase in the case mix adjusted odds of survival from severe injury over the 9-year study period. Interrupted time series analysis showed a significant positive change in the slope after the intervention time point of April 2012 (+ 0.08% excess survivors per quarter, p = 0.023), in other words an increase of 0.08 more survivors per 100 patients every quarter. Interpretation: A whole system national change was associated with significant improvements in both the care process and outcomes of patients after severe injury. Funding: This analysis was carried out independently and did not receive funding. The data collection for the national clinical audit was funded by subscriptions from participating hospitals.

History

Citation

EClinicalMedicine, 2018, 2-3, pp. 13-21

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences

Version

  • VoR (Version of Record)

Published in

EClinicalMedicine

Publisher

Elsevier

eissn

2589-5370

Acceptance date

2018-07-09

Copyright date

2018

Available date

2019-10-14

Publisher version

https://www.sciencedirect.com/science/article/pii/S2589537018300075?via=ihub

Notes

Data sharing: patient level data are available, subject to a standard data sharing agreement (which can be found at www.tarn.ac.uk), from the corresponding author at chris.moran@nuh.nhs.uk. Individual participant consent for data sharing was not obtained, but the presented data are anonymised, risk of identification is low and approval is in place from the UK Department of Health's Patient Information Advisory Group.

Language

en

Usage metrics

    University of Leicester Publications

    Categories

    Licence

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC