Major trauma: service delivery

Why this is important

The UK has a national audit of trauma services in place for adults (Trauma Audit Research Network [TARN]) and entry to this audit is linked to best practice tariff for major trauma centres. An equivalent audit, TARNlet, has been developed for children (under 16s). Data are collected on clinical observations, timing and staffing in the acute phase in patients who are treated at a major trauma centre. Data on longer‑term outcomes, for example return to normal activities, after the acute phase are not collected, despite acknowledgement that outcomes are important to monitor the effectiveness of interventions.

Why this is important

Major trauma often results in people living with disability that results in a reduced quality of life. It is thus imperative to maximise access to rehabilitation to speed physical and psychological recovery after injury.

A proportion of patients will have complex needs necessitating inpatient rehabilitation from a multidisciplinary team with expertise. A larger group of patients will need ongoing support, rehabilitation and re‑enablement once they are discharged home. The major trauma best practice tariff advises that every patient with an Injury Severity Score of 9 or more in either a major trauma centre or a trauma unit should have their rehabilitation needs assessed, and that a rehabilitation prescription should be provided for all patients with rehabilitation needs. The rehabilitation prescription is used to document the rehabilitation needs of patients and identify how their needs should be addressed. It is unclear whether adequate inpatient and outpatient rehabilitation services for patients with major trauma exist or, if they do exist, what barriers prevent people from using them.

Why this is important

Patients with major trauma may need rapid transfer from the local emergency department to a major trauma centre for specialist care. The local trauma unit's clinical team can transfer them without delay but may not be able to provide specialist treatment during the transfer. A specialist team sent by the receiving centre can provide this specialist care during transfer but the transfer may be delayed while waiting for the specialist team to arrive at the local trauma unit.

Why this is important

Pre‑hospital triage tools identify patients who need to be taken to a major trauma centre, bypassing the local emergency department. They are also used to generate pre‑alert or standby calls for a trauma team. Most triage tools in the UK use physiological parameters with diagnostic cut‑offs and categorical variables such as mechanism of injury. However, the parameters used, and the weighting given to each parameter, differ across the tools. A national pre‑hospital triage tool should be developed and validated that will accurately identify where a patient needs to be taken. This should lead to improved patient outcomes and reduced costs.