A decade of trauma care in the North of Scotland: Impact of an inclusive network.

Abstract

Trauma care in Scotland is organised into four networks and the North of Scotland Trauma Network, covering 60 % of Scotland's landmass, was the first of the four regions to go live in October 2018. The trauma demographics, journeys and outcomes over the decade of 2013-2023, five years and nine months prior to and five years post implementation were examined. Data prospectively collected by Scottish Trauma Audit Group (STAG) during the time period was analysed. Patients of all ages, Injury Severity Score (ISS) > 8 and head injury Abbreviated Injury Scale (AIS) > 1 were included. The primary outcome was mortality. Multivariate logistic regression compared factors associated with mortality pre- and post - network. Post-network, 47.8 % of ISS>15 presented at non-Major Trauma Centre (MTC) hospitals, of which 47.4 % underwent secondary transfer. Half (50.5 %) of serious head injuries (AIS>2) presented to the Trauma Unit (TU) / Local Emergency Hospitals (LEH), of which 34.4 % were transferred to the MTC. Of those transferred to the MTC, moving vehicle was the commonest mechanism (44.7 %) and median ISS was 22 (IQR 17 - 29). Ultimately, the majority (75 %) of major trauma patients were treated at the MTC post network. Whilst overall mortality was 7.8 %; this rose to 18.3 % for ISS > 15, and 20.6 % for serious head injury. Mortality for ISS > 15 first presenting outside of the MTC and then subsequently transferred was 8.3 %. There was significant difference in 30-day mortality in those presenting after network implementation (OR 0.76 [0.6 - 0.97], p = 0.03) adjusting for age, ISS, head injury severity and mechanism of injury. A sensitivity analysis of the two consistently contributing hospitals (TU and MTC) was performed and mortality improvement was maintained (OR 0.71, 95 % CI 0.55 - 0.93, p = 0.011) although this could have been due to improved data capture of lower acuity trauma, or other confounding variables. In a geographically dispersed network, the contributions of TUs and LEHs and subsequent secondary transfers are substantial. Network investment in training, communication pathways and transfer governance is essential.