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High estimates of preventable death rates have renewed the impetus for national regionalization of trauma care. Institution of a specialist multidisciplinary trauma service and performance improvement programme was hypothesized to have resulted in improved outcomes for severely injured patients.

This was a comparative analysis of data from the Royal London Hospital (RLH) trauma registry and Trauma Audit and Research Network (England and Wales), 2000–2005. Preventable mortality was evaluated by prospective analysis of the RLH performance improvement programme.

Mortality from critical injury at the RLH was 48 per cent lower in 2005 than 2000 (17·9 versus 34·2 per cent; P = 0·001). Overall mortality rates were unchanged for acute hospitals (4·3 versus 4·4 per cent) and other multispecialty hospitals (8·7 versus …