The Trauma Audit and Research Network

Performance Comparison: Information For Patients

Information for Patients

This website tells you what we know about the rate of survival for patients who undergo treatment of their injuries in England and Wales. You can use this website to look up a particular hospital and find out what percentage of their patients leave hospital alive after being injured compared to those expected to survive.

You can also find out whether the rate of survival is within the range that we would expect, taking into account the type of patients treated and how old the patients are before their injury. We continually assess the quality of care across England and Wales and you will be reassured to know that doctors themselves use this information to monitor the services they provide and to understand how they compare to other hospitals.

The website has been designed in collaboration with patients. It is intended to provide useful information about care of the injured:

Why we assess the quality of care for different types of injury

A person can be injured in many different ways. A car driver may be in a road traffic incident and sustains a head injury, an injury to the thigh bone and part of the spleen is torn. A person could be stabbed in the chest and suffer an injury to the heart. Another person may fall downstairs and suffer a serious fracture to the leg. All these examples are very different and require varying treatments by a range of specialist doctors at the right time and in the right hospital. This will result in the best possible outcomes.

Injuries to the Brain & Skull

Evidence from the UK and Europe has shown improved survival in head injury patients treated in specialised units as opposed to general hospitals. The introduction of specific therapies within neuro-intensive care units has also been shown to improve outcome.

There are several different types of head injury which require different types of treatment. Patients with blood clots may require emergency surgery whilst those with diffuse brain swelling require specialist care to maintain blood flow and oxygen delivery to the brain. A prompt diagnosis of traumatic brain injury from a CT scan is critical so that the correct treatment can be administered to minimise further injury to the brain.

Injuries to the Spine

Spinal injuries are a major cause of disability in the young. Once the patient has been brought to the Emergency Department, resuscitated and stabilised then early transfer to a hospital with spinal surgeons is very important. An early transfer maximises the chances of the often young patient, in terms of survival with the least possible disability because spinal surgeons can operate to stabilise the spine.

This early spinal stability allows a specialist spinal nursing and physiotherapy team to move and rehabilitate the patient as soon as possible without fear of causing further damage to the spinal cord.

Injuries to the Chest

Chest injuries are often difficult to assess and require skilled recognition of life threatening injuries to the heart and lungs which require immediate action. For this reason it is important that a senior doctor (above the level of Senior House Officer) is present in the team assessing the patient when they arrive in the Emergency Department.

Injuries to the Limbs & Pelvis - Open Fractures

Early wound excision to reduce dead tissue and bacterial contamination is critical in avoiding both primary and hospital acquired infection. This should be undertaken promptly and thoroughly by a senior experienced surgeon.

Concurrent reduction and stabilisation of an open fracture will reduce further ongoing damage and swelling and allow optimum and prompt soft tissue reconstruction; these are the most important measures in reducing the potential for infection. In achieving the above, there is strong evidence to support the combined early involvement of Orthopaedic and Plastic surgery.

How to read the rates of survival on this site

This website shows information about rates of survival for hospitals in England and Wales. Information is available for all hospitals who are members of The Trauma Audit & Research Network although other hospitals could provide this information if data about injured patients was collected. This information for these hospitals may be available in the future.

On this website information about rates of survival is presented in the following way:

In this chart the comment box (1) shows that there were 2.8 more deaths of injured patients than would be expected each time 100 severely injured patients are treated. In other words, an additional 28 injured people would have been expected to survive at this hospital for every 1000 injured patients treated. Some patients are more likely to survive from their injuries than others, depending on factors such as age and their general health and these are therefore taken into account.

The black band in the chart above (2) indicates that when age, gender, initial physiology and severity of injury of the actual patients treated at this hospital were taken into account, the expected rate of survival was between -3.5 and -2.1 and represents 2 Standard Errors of the mean. So, in this example, the unit is performing worse than expected.

The red block (block to the left of the bar) and green block (block to the right of the bar) on the chart represent 3 Standard Deviations. This is an important statistical measure of the spread of the rates of survival at all of the hospitals.

The Yearly Figures for Rates of Survival

It is important to review how injured patients are cared for at regular intervals since treatment and practice at the hospital may change. Therefore we show the rates of survival in 2 year intervals so that the hospital staff are able to closely monitor the effectiveness of their trauma care.

The Breakdown Rate of Survival

This is presented to help hospital clinicians and managers to assess their system of trauma care - providing good care or require some improvement.

How patients and the public have been involved in the development of this site

The Trauma Audit & Research Network are keen to supply useful information. We welcome your suggestions about how we can improve this website and the information we provide. If you have any views about the information presented please let us know using the Evaluation Form or sending general feedback via email.

How good are the data we use?

The information provided on this website is collected in different ways by different hospitals. Some hospitals have better resources than others for collecting data, and this may affect the quality and completeness of the data.

Quality Assurance

We ensure that the data submitted to the Trauma Audit & Research Network are checked by internal system validation and coding regulations. We encourage all hospitals to check their data so that the information presented is as accurate as possible. TARN has helped many hospitals to do this.

Fair Processing

In order to make the calculations displayed on these pages as accurate as possible, we check how complete each hospital’s dataset is. We do this using Hospital Episode Statistics (HES) data provided by NHS Digital (formerly known as the Health and Social Care Information Centre. NHS Digital supply annual extracts of HES data containing the details of hospital admissions and outcomes potentially related to trauma injuries and we use this to work out an estimated number of cases so that we can work with hospitals to improve quality and completeness of the data they submit to the Trauma Audit & Research Network. Part of this process involves sending identifiable patient lists to hospitals for them to check. Patient’s details are only shared with the hospitals that treated them. If you think you may be included on one of these lists and wish to remove your details, you can opt out by contacting us:

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            Salford Royal NHS Foundation Trust
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