The Trauma Audit and Research Network

Performance Comparison: Information For Hospitals

Survival rates of major injury for patients who have been admitted to hospital

To review expected survival rates across England and Wales, or your own area, use the navigation menu on the left hand side of this page.

The Trauma Audit and Research Network, the independent monitor of trauma care in England and Wales, is committed to making a real difference to the delivery of the care of those who are injured. One of the ways we do this is by promoting improvements in care through national comparative clinical audit.

The information on this website has been collected from many hospitals that treat patients with injury in England and Wales. Other hospitals, which do not currently collect this information are also listed for completion. It shows information about rates of survival after injury in patients admitted to hospital. Please use the hyperlinks below for further information upon this page:

Presenting rates of survival

Injury is a major cause of death and disability in this country. Preventing the incident is obviously important and other groups continually work towards this end. However, when someone is injured it is natural for patients and their families to want to know that they will receive the best possible care in hospital. On this website, we present the results as rates of survival, rather than rates of death. This is the same approach that is used to present rates of survival for cancer patients and heart surgery.

Reporting crude rates of survival takes no account of potential risk factors for patients. On this website, we present survival data that takes account of potential risk factors including age, gender, severity of injury and a patient’s own response to a certain injury. This is the first time that rates of survival have been presented in this way in the UK. These rates of survival will be updated annually.

Adjusting for risk

Rates of survival can be displayed in the following chart:

The expected rates of survival are calculated using logistic regression modelling. The model allows calculation of the likely rates of survival for particular injuries or combination of injuries, taking into account the age, gender and the persons response to the type of injuries. It is a popular and internationally recognised model because it is relatively simple and each hospital treating trauma can be represented on the chart above.

The black bar in the chart above represents a 95% confidence Interval. That means that we can be 95% confident that the outcome prediction of this hospital will lie within this line. The length of the confidence interval usually depends upon the amount of completed cases that this hospital has sent TARN during a four year period. The greater number of cases sent over time the 'smaller' the interval will be and a more accurate and robust prediction can be made. The longer the line (fewer cases) - the less likely it is to make an accurate prediction.

Therefore the black band in the chart above 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. This 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.

Using this model provides a good starting point. However, all measures should be reviewed and revised as new processes for the treatment of different injuries become available. The Trauma Audit and Research Network will regularly review the techniques used for risk adjustment and modify them to take account of changes where appropriate.

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.

Standards of Care

Injuries to the Brain & Skull
RCS/BOA Standards 13.2: Patients with severe head injuries* or focal signs should be transferred to the care of neurosurgical units regardless of whether they need surgical intervention.

* Severe head injuries are defined as having an Abbreviated Injury Scale score of more than 2 in the head (with or without injuries to other body regions) with a recorded Glasgow Coma Score of less than 9 OR a recording of intubation and/or ventilation.

NICE Head Injury Guidelines June 2003: CT imaging of the head should be performed within 1 hour of arrival for patients with GCS<13 OR suspected open/depressed skull fracture OR basal skull fracture.

Injuries to the Spine
RCS/BOA Standard 13.5: Immediate referral must be made to the appropriate spinal injury service if there is evidence of partial or complete spinal cord or cauda equina lesion.

Injuries to the Chest
RCS/BOA Standard 13.3: Examination of the chest is a fundamental component of the cardiopulmonary assessment of the seriously injured and should be supervised by the most expeienced clinician.

Injuries to the Limbs & Pelvis
BOA: BOAST: All patients (adults and children) with high energy open tibial and/or fibular fractures. The wound, soft tissue and bone excision (debridement) should be performed by senior surgeons within 24 hours of injury.
Further data collection and analysis will address:
The initial procedure should be performed by senior plastic and orthopaedic surgeons and Vascular Impairment requires surgery within 6 hours.

How good is 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 is checked by internal system validation and coding regulations. Some hospitals request that we check their data so that the information presented is as accurate as possible.

To review expected survival rates across England and Wales, or your own area, use the navigation menu on the left hand side of this page.