What Are Major Trauma Systems, Why Does the UK Need Them and How Can They Be Improved?

Abstract

Major trauma, defined by the World Health Organisation (WHO) as 'multiple, serious injuries that could result in disability or death' is a significant cause of death worldwide. Trauma is the leading cause of death for 15-45 years old. Major Trauma Systems (MTS) should follow defined, evidence-based trauma pathways to optimise patient outcomes. In 2010, the Major Trauma Care in England Report found significant variability in trauma mortality outcomes between hospitals, highlighting a need for the establishment of MTS. We will review the current models of UK MTS, with a particular focus on the London Trauma System (LTS) and propose strategies to optimise patient care within the current framework. MTS can be divided into Exclusive and Inclusive Systems. In the former, one standalone Major Trauma Centre (MTC) is capable of providing care from start to finish for any major trauma patient. Inclusive systems are comprised of a MTC acts as a central component in a network with smaller Trauma Units (TUs) working in tandem, taking advice or transferring patients, to get the best care for a trauma patient. The National Major Trauma Registry (NMTR), which keeps detailed records of all trauma patients has shown a 44% increase in "good overall care" to trauma patients since the service began. Close links to research allow rapid implementation of emerging evidence-based medicine into standard care, for example administration of tranexamic acid to haemorrhaging patients. Limitations of our current MTS include difficulty in transferring non-urgent patients from TUs to the MTCs; repatriating patients after treatment at an MTC; limited image transfer between hospitals; and a widespread lack of rehabilitation resources. For future improvement, it is imperative to implement trauma prevention methods and community outreach programmes, targeting the population demographics most affected by such trauma. Additional research is required to determine the effectiveness of changes in rehabilitation funding and policies. Particular attention should also be given to the benefit to long term outcomes, including quality of life and functional recovery scores.