Assessing the capacity and equity of major trauma services for adult patients in the East of England Trauma Network a decade after its establishment (2013-2021)

Abstract

Background: The number of trauma patients in the East of England Trauma Network (EoE TN) has been steadily increasing since 2013, raising concerns about whether the existing design (one Major Trauma Centre (MTC) with twelve Trauma Units (TUs)), can effectively meet the region’s trauma care needs. This study assessed service capacity and patient pathway utilisation and outcomes to determine if the existing design serves the TN’s growing population and changing needs. Methods: We analysed nine years (2013-2021) of Trauma Audit and Research Network (TARN) data to evaluate bed occupancy trends, service outcomes (predicted and realised survival rates, and Glasgow Outcome Scale (GOS) scores), and patient pathway patterns (Direct-to-MTC, Transfer-to-MTC, and Direct-to-TU) by patient demographics (age, sex, and Index of Multiple Deprivation (IMD) 2019). We used Injury Severity Score (ISS) >15 to define major trauma. Results: MTC bed occupancy rose steadily, frequently exceeding the planned capacity of 75 beds since 2018. Notably, 61.8% of major trauma patients were managed entirely in TUs. Yet, the Direct-to-TU pathway showed a lower mean of realised survival rates compared to predictions despite managing less severe cases compared to Direct-to-MTC (mean ISS 21.2 vs. 26.2). Significant disparities in access to the MTC (including Transfer-to-MTC) were found for elderly patients (23.5% vs. 51.3% for younger patients), females (31.4% vs. 42.9% for males), and those residing in IMD deciles 1-2 (31.1% vs. 39.1% for the rest). Conclusion: The current network design shows significant capacity demands and disparities in access and outcomes. This highlights the need for strategic service redesign, enhanced TU capabilities and targeted policies to ensure equitable access to specialised trauma care across the network.