This edition publishes an analysis from the TARN database suggesting that the case mix fatality for major trauma patients reaching hospital alive has not improved in England and Wales since 1994 even though a 40% reduction occurred in the preceding five years (1989–94). This lack of change in outcome occurred in parallel with a plateau in the level of consultant involvement in the most severely injured patients.¹ Two important issues arise from this observational study. The first concerns the validity of the analysis and the second if the analysis is valid, the response of emergency physicians.

The TARN sensitivity analysis has adjusted the observed lack of change in outcome for most potential weaknesses in the data, this did not change the main results. Furthermore, there are very few if any data in international literature that have commented in trends in trauma outcome after 1995 therefore it is possible that this plateau in case mix fatality is not just a trend in England and Wales but one that extends throughout the developed world. The implementation of evidence based medicine may secure …