An observational study evaluating the demand of major trauma on different surgical specialities in a UK Major Trauma Centre

  • Patrick Quinn
  • Benjamin Walton
  • David LockeyEmail author
Original Article



Major Trauma Centres (MTCs) should ideally have all key surgical specialities on site. This may not always be the case since trauma is only one factor influencing speciality location. The implications of this can only be understood when the demands on specific specialities are established and this is not well documented. We investigated surgical speciality demand by quantifying the frequency and urgency of surgical trauma interventions.

Patients and methods

Data on adult trauma admissions for a UK MTC were retrieved from the UK Trauma Audit and Research Network for a 2-year period and analysed to establish the frequency and urgency of surgical interventions.


Of 1285 trauma patients with an ISS > 15 presenting in the study year period 713 (55.5%) required surgery. Neurosurgical (59.9%) and orthopaedic (55.1%) operations were most frequent. Cardiothoracic, general surgery, plastic surgery and maxillofacial operations were required infrequently. General surgery was commonly needed urgently, 45% within 4 h of MTC arrival. Urgency was also common in interventional radiology and vascular surgery. Cardiothoracic interventions were mainly urgent interventions (thoracotomy 1/3) and less urgent (rib fixation 2/3).


Neurosurgery and orthopaedic surgery are key on-site trauma specialities and required frequently. General surgery, interventional radiology and cardiothoracic interventions are required less frequently but often urgently. This confirms a need for MTC on-site capability and possibly training to maintain competency in occasional trauma operators, particularly in general surgery. Maxillofacial surgery, ENT and urology are required neither frequently nor urgently and on-site presence may be less critical.


Demand for specific surgical specialities was reported in a cohort of UK trauma patients. This confirmed the need for rapid on-site capability in key specialities and highlights possible training requirements for occasional trauma operators in specialities with low frequency but high urgency.


Trauma Major Trauma Centre Surgery UK Quality improvement Emergency surgery 


Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest.


  1. 1.
    Davenport RA, Tai N, West A, Bouamra O, Aylwin C, Woodford M, et al. A major trauma centre is a specialty hospital not a hospital of specialties. Br J Surg. 2010;97(1):109–17.CrossRefGoogle Scholar
  2. 2.
    Jansen JO, Tai NR, Midwinter MJ. Planning trauma care services in the UK: surgical workforce development remains a challenge. BMJ. 2013;346:738.CrossRefGoogle Scholar
  3. 3.
    Lane P. Trauma is not a surgical disease. Arch Emerg Med. 1989;6(2):85–9.CrossRefGoogle Scholar
  4. 4.
    Acker S, Stovall R, Moore E, Patrick D, Burlew CC. Trauma remains a surgical disease from cradle to grave. J Trauma Acute Care Surg. 2014;77(2):219–25.CrossRefGoogle Scholar
  5. 5.
    Galante JM, Phan HH, Wisner DH. Trauma surgery to acute care surgery: defining the paradigm shift. J Trauma. 2010;68(5):1024–31.CrossRefGoogle Scholar
  6. 6.
    England RCoSo. Emergency surgery: standards for unscheduled care. Royal College of Surgeons of England, London 2011.Google Scholar
  7. 7.
    Surgeons CoT-ACo. Resources for optimal care of the injured patient. 6th ed. Chicago: American College of Surgeons; 2014.Google Scholar
  8. 8.
    Major trauma. service delivery | Guidance and guidelines | NICE: NICE; 2018 [cited 2018 10/02]. Available from:
  9. 9.
    England N (2013) NHS Standard contract for major trauma service.
  10. 10.
    Boudourakis LD, Wang TS, Roman SA, Desai R, Sosa JA. Evolution of the surgeon-volume, patient-outcome relationship. Ann Surg. 2009;250(1):159–65.CrossRefGoogle Scholar
  11. 11.
    Chowdhury MM, Dagash H, Pierro A. A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg. 2007;94(2):145–61.CrossRefGoogle Scholar
  12. 12.
    West JG, Cales RH, Gazzaniga AB. Impact of regionalization. The Orange County experience. Arch Surg. 1983;118(6):740–4.CrossRefGoogle Scholar
  13. 13.
    Nathens AB, Jurkovich GJ, Rivara FP, Maier RV. Effectiveness of state trauma systems in reducing injury-related mortality: a national evaluation. J Trauma. 2000;48(1):25–30CrossRefGoogle Scholar
  14. 14.
    Patel HC, Bouamra O, Woodford M, King AT, Yates DW, Lecky FE Trends in head injury outcome from 1989 to 2003 and the effect of neurosurgical care: an observational study. Lancet. 2005;366(9496):1538–44.CrossRefGoogle Scholar
  15. 15.
    Kehoe A, Smith JE, Edwards A, Yates D, Lecky F. The changing face of major trauma in the UK. BMJ 2015;5:6Google Scholar
  16. 16.
    Moya MD, Nirula R, Biffl W. Rib fixation: who, what, when? BMJ 2017;63:96Google Scholar
  17. 17.
    Rehn M, Davies G, Lockey D. A practical approach to resuscitative thoracotomy. Surgery. 2015;33(9):455–8.Google Scholar
  18. 18.
    Whittaker G, Norton J, Densley J, Bew D. Epidemiology of penetrating injuries in the United Kingdom: a systematic review. Int J Surg. 2017;41:65–9.CrossRefGoogle Scholar
  19. 19.
    Tai N, Bircher M. Trauma systems in England: a strategy for major trauma workforce generation and sustainability. Royal College of Surgeons of England, London 2014Google Scholar
  20. 20.
    National Confidential Enquiry into Perioperative Outcome. and Death. Accessed May 21 2018

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.University of BristolBristolUK
  2. 2.North Bristol NHS TrustBristolUK

Personalised recommendations