National trauma plan would cut infant deaths

Every year 10,000 children are left permanently disabled after accidents and 450 die in a toll that is made worse by "unacceptable" standards of care, surgeons said yesterday.

Every year 10,000 children are left permanently disabled after accidents and 450 die in a toll that is made worse by "unacceptable" standards of care, surgeons said yesterday.

Scores of lives could be saved and thousands of permanent injuries prevented if the high standards of care provided in some hospitals were offered nationwide.

A report by the Royal College of Surgeons highlights the "inexplicable variation" in death rates for both adults and children following severe injuries - mainly road accidents - among different hospital trusts. It calls for a national trauma service, based on 30 major hospitals round the country providing the full range of surgical services, to ensure injured patients are taken directly to the hospital most suited to their needs.

Death and disability rates following severe injuries are higher in Britain than in the US and are a cause of "major concern", Barry Jackson, president of the college, said. In 1988 a report by the college suggested one-third of all deaths occurring after major injury could be prevented but there was still no national strategy for the care of the severely injured.

Studies in the mid-1990s suggested that one in six deaths and one in nine cases of disability could be avoided with better care. In children, that would imply 75 fewer deaths and more than 1,000 fewer with permanent disabilities each year.

Hugh Phillips, president of the British Orthopaedic Association and chairman of the college working party that produced the new report Better Care for Severely Injured, said the problem carried a huge burden of human suffering and financial cost. Government estimates put the cost of all injuries to health and social services at £1.2bn.

"If you get injured you are likely to be taken to the nearest hospital but it may not have the necessary staff or equipment. There are 230 acute hospitals in the UK with accident and emergency departments but only 22 have neurosurgery and only five have the full range of surgical services. That is a rather low number, one might say."

The average hospital may only treat one severely injured person a week, which does not allow it to build up expertise. Instead the severely injured should be taken to major hospitals which act as regional trauma centres. The report cites North Staffordshire Hospital, Stoke-on-Trent, which has pioneered the care of accident victims, and whose death rates following severe injury have fallen by half in five years, from 26.5 per cent in 1992-3 to 13 per cent in 1997-8.

John Templeton, professor of trauma and orthopaedics at the hospital, said: "The Stoke system could be taken as the model. It is one of the five major hospitals with complete services. We need 27 for England, Wales and Northern Ireland."

Mr Phillips, consultant orthopaedic surgeon at the Norfolk and Norwich hospital, said: "There can be no doubt thatif these proposals are enacted by the Department of Health, more lives will be saved andthe quality of life of survivors will be improved."