Introduction

Major trauma remains the leading cause of death among children over the age of 1 year,1 with 47% of all non-natural deaths in children between 28 days and 18 years of age occurring as a result of road traffic accidents.2 The unintentional injury death rate in children has declined since the 1980s.3 Despite this there are 1120 deaths from unintentional injury among 0–19-year-olds in England per annum (rate of 8.6 per 100 000 population).4

Compared with the adult population, the absolute number of cases of major trauma in children is small, which has implications for how their trauma care should best be structured. Data are incomplete, but this may account for as few as 300 cases per year in the UK.5

Currently, children suffering major trauma are delivered from the scene of injury to the nearest emergency department and subsequently transferred to specialist centres as necessary for definitive treatment, with the attendant delays which that entails. Children who sustain very serious traumatic injuries in England each year could be treated in any one of 181 emergency departments across England.6 The low numbers of such injuries seen in each facility is likely to increase the risk of poor or adverse outcomes as a result of occasional practice.7 Specialist major trauma management for children is located variously within stand-alone children's hospitals or integrated with adult major trauma centres, and trauma pathways for transfer of seriously injured children are mostly based on historical relationships rather than being part of a managed system, with the exception of the Paediatric Intensive Care networked service.8 9

The development of major trauma networks has sought to address the quality of overall trauma …