Globally, road traffic collisions (RTCs) are a leading cause of death and serious injury with 1.35 million people dying each year and 20–50 million surviving with serious injury and disability . Despite overwhelming evidence of the devastating health and socio-economic consequences of RTCs, until recently their impact has been overlooked in government strategy and policy . In 2017, the Valletta Declaration on Road Safety established a target of halving the number of serious injuries in the EU by 2030 . In Ireland, there has been a dramatic change in the road safety landscape over the last 25 years. In 1998, the first government strategy for road safety was published followed by the establishment of the Road Safety Authority (RSA) in 2006 as a statutory organization created by the Road Safety Authority Act, 2006 with the aim to reduce collisions, deaths, and injuries . Since then, Ireland has improved from having the 11th lowest road mortality in the European Union (EU) in 2011, the year of the first Road Safety Performance Index (PIN) Report, to 2nd lowest in 2018 [4–6]. There have been 4 Road Safety Strategies with each one building on the progress and understanding provided by the previous strategies (1998–2002), (2004–2006), (2007–2012) with the objective of sustainably improving safety on Irish roads. The last strategy, ‘Closing the Gap’, covered the period 2013 to 2020 and in addition to continuing to reduce fatalities, several actions within the Strategy aimed to reduce the number of serious injuries.
A more recent development has been the National Office of Clinical Audit (NOCA) implementation of the Major Trauma Audit (MTA) in Ireland. The MTA is a clinically led audit established in 2013 using the well-established National Health Service (NHS) UK Trauma Audit and Research Network (TARN) . TARN is the UK National Clinical Audit for traumatic injury and is the largest European Trauma Registry. The MTA captures data on patients of any age who sustain an injury resulting in any of the following: hospital admission > 72hrs; intensive care or high dependency admission; transfer to a tertiary/specialist center and in-hospital death within 30 days . Irish MTA reports have been published from 2014–2018 [9–12]. The reports comment on road trauma and head injuries with a section on severe TBI and cause (Chap. 3). In the reports a severe TBI is defined as Abbreviated Injury Scale (AIS)3 + and Glasgow Coma Scale (GCS) < 8/9 (depending on the report).
In the UK, it was recognized that there was very little information available about the rehabilitation needs of patients leaving the Major Trauma Centers (MTCs) or how well these needs were being met. To address this gap, the TARN dataset was linked to the UK Rehabilitation Outcomes Collaborative (UKROC) dataset, in the National Clinical Audit of Specialist Rehabilitation following Major Injury (NCASRI) . Ireland thus far, does not have a Rehabilitation Outcomes Collaborative and therefore very little information is available about the rehabilitation needs of patients leaving trauma receiving hospitals or how well these needs are being met. Each part of the system currently collects its own measures which are siloed and fragmented with no common measure across the pathway.
There are also other sources of trauma and road traffic related data in Ireland including the Irish Hip Fracture Database, The Irish LongituDinal Study on Ageing (TILDA), the Road Safety Authority (RSA), the Health and Safety Authority (HSA), the Central Statistics Office (CSO), the Hospital Inpatient Enquiry (HIPE) system and An Garda Siochana (Irish police force) so the data landscape is complex. Data linkage between these administrative and health datasets does not currently exist but offers huge potential for understanding the trauma and rehabilitation ecosystem in detail.
In addition, in 2018, the vision for a national trauma system was set out in the Report of the Trauma Steering Group, A Trauma System for Ireland . This report introduced national standards for the delivery of trauma care with the aim of preventing unnecessary deaths, reducing disabilities, and significantly improving the patient’s chances of attaining the fullest possible recovery. With the implementation of the report, access to data across the continuum of care will be required to ensure the needs of all trauma patents are being met.
To understand how trauma systems and road safety policy impact on rehabilitation services, a desktop review of the literature using Google Scholar was undertaken. This revealed several recent systematic reviews and meta-analysis exploring the impact of trauma systems on injury outcomes [15–17]. Most studies looked at mortality as the primary outcome measure. These reviews recommend that further research is required to properly evaluate the different components of trauma systems and non-fatal outcomes and explore the impact of system component interactions. Although there are many publications that look at the impact of elements of road safety strategy there were none that evaluated implementation of road safety strategy as a complex intervention in a complex system and most publications agreed on the need for further research exploring long term and patient-centered outcomes [18–22]. Also of note is that there is currently no recommended standardized dataset for measuring disability or health outcome across the continuum of trauma care.
In the absence of an Irish Rehabilitation Outcomes Collaborative, and with the advent of the implementation of the new trauma report, this study aimed to review access to complex specialist rehabilitation for patients experiencing serious injury with the objectives of assessing if admissions with road traffic trauma related injury had changed over the course of the current road safety strategy and also how the numbers compared with those reported in the MTA reports.