The Development of Major Trauma Centers in the United Kingdom: Revisited Problems and Data from the First Year of Operation of a New Neurotrauma Center in St Mary’s Hospital in London

Aim: The recent restructuring of U.K. trauma services has resulted in the development of new major trauma centers (MTC) and in some circumstances, the development of neurotrauma services isolated from other neurosurgical subspecialties. Such development has proved very controversial within the neurosurgical community and it is unclear as to whether patients benefit.

Methods: With MTCs in North East (Royal London Hospital), South East (King’s College Hospital), and South West (St George’s Hospital), a large area of North West London would have been left poorly catered for. St Mary’s was therefore developed to provide major trauma care for this region. This required the development of dedicated services within the Emergency Department (e.g. a new lift and access to acute imaging), dedicated theater space, and a dedicated ward (16 beds Major Trauma Ward). In addition four beds in Intensive Care Unit were allocated to Major Trauma Ward. The neurosurgical service specifically comprises four consultants and six registrars. The registrars are integral members of the trauma team attending all trauma calls and are key to rapid decisions regarding surgery.

Results: In 2011, 1807 trauma calls were activated. Of these 702 (156 women, 546 men; mean age 37 years) had received head injuries that required neurosurgical services involvement. Additionally there were 201 spinally injured patients and 76 underwent surgical management. The commonest mechanism of injury was road traffic collision (246; pedestrian, vehicle occupant, cyclist), falls less than 2 m (173), and blunt assaults (104) being the next most common. 103 patients were brought to St Mary’s accompanied by London’s Air Ambulance with 5 brought by other air ambulance services. The vast majority of the remaining patients were brought either by London’s ambulance service or by another regions’ ambulance service. The majority of the patients (311) were transferred to the Major Trauma Ward. The patients who went directly to theatre were 53, 85 to intensive care unit, and 25 were transferred out (e.g., to Great Ormond Street for pediatric care). Most of those who went to theater subsequently went to intensive care unit.

RTC, road traffic accident.
Mechanism	RTC	Fall<2 m	Fall>2 m	Blunt Assault	Penetrating Assault	Gun Assault	Others
Number	246	173	96	104	28	2	53

Conclusions: Establishing an isolated neurotrauma service separate to other neurosurgical services is possible but is a controversial undertaking. It creates many logistical issues.