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We aim to improve major trauma services by learning from variation that exists in our current systems and identifying best practice.


There is evidence from many countries that patients with severe injuries should be treated in specialist hospitals. In 2012, trauma services across England underwent a major re-organisation; 22 hospitals were designated as 'Major Trauma Centres' (MTCs) that would treat the most severely injured adult patients, even if this meant ambulances by passing other hospitals. Although this restructuring required considerable financial investment, it is unknown whether it has improved care for these severely injured patients. The diversity and complexity of treatment for patients with major trauma is a significant challenge to the design of research studies in this field. An alternative approach is to select an exemplar tracer injury that can yield valuable insights about whole system structures of care. Open fractures are broken bones that have punctured through the skin or been exposed by the initial injury. Open fractures are well-suited as an exemplar injury for changes in care quality because they are relatively common, involve co-ordinated treatment by healthcare professionals from a range of specialist disciplines, and there is a national consensus (the BOAST4 guideline) about how they should ideally be treated. Crucially the national audit (TARN) collect specific information about the degree of compliance with the BOAST4 guideline & health outcomes from patients sustaining open fractures.


To explore the effect of reorganisation of trauma services into MTCs on patient outcomes.


How have treatments and outcomes of open fractures changed over time – 'before' and 'after' MTCs were established?


This study will draw on data that has already been collected by different systems. Firstly, the Trauma Audit and Research Network (TARN) collects information about patients that are severely injured and taken to hospital in England. Second, Hospital Episode Statistics (HES) contains data on all hospital admissions and outpatient appointments at NHS hospitals. This study will identify all cases of open lower limb fracture recorded by TARN and link these to data for the same patients in HES. The outcomes that will be used are death, length of stay, complications, disability level, need for re-operation or re-admission to hospital, and quality of life. In this way, it will be possible to understand how service design has responded to national best practice guidelines and how these clinical pathways predict clinical outcomes and cost across England. At each stage, the study will use statistical techniques to account for differences (e.g. age and injury severity) between the patients treated in each MTC.


This study can improve major trauma services by learning from variation that exists in our current systems. Crucially, the system in England may soon be replicated in other UK countries.


The principal source of patient data will be from the national audit of major trauma - TARN. Information relevant to the injury is collected within this audit about all patients admitted to hospital having sustained major trauma in England, Wales and Northern Ireland. Only data from patients who have sustained an open fracture will be used. Patient's identifiers will be only used by NHS Digital to link the different databases and thereafter a participant number will be used for each of the patients whose data will be used. The University of Oxford will be the data controller and will be processing personal sensitive data. Participant's data will be kept confidential and will be stored under the University of Oxford Information Governance Policies. Data will be stored for a maximum of 5 years.


The General Data Protection Regulations (GDPR)

The General Data Protection Regulations apply to the processing of the data that the University of Oxford will carry out in order to be able to conduct this study. The legal basis for the processing of the data for this study is that the task is in the public interest (Article 6 paragraph 1(e)). The University will also be processing some special categories of data under the definitions of the Regulations. The legals basis for this processing task is that the study is part of scientific research (Article 9 paragraph 2(j)).



Any patient who would prefer not to have their data used for the purposes of this study can opt out.

The contact details to register to opt out are:


Telephone: 01865 737837

Big Health Data Group


Windmill Road