Evaluating Surgical Response Times in Category 1 Major Trauma.

Background Patients who activate a Category 1 (Cat1) trauma call have life-threatening injuries and require an immediate, coordinated response from a multidisciplinary trauma team. National guidelines emphasise prompt surgical review; however, in practice, surgical teams are not always alerted at the point of trauma activation. Delays may contribute to missed interventions, prolonged intensive care unit (ICU) stays, and increased mortality. Aim This study aims to evaluate surgical team attendance and the time interval to surgical input in Cat1 trauma cases, and to assess their association with injury severity and patient mortality. The audit also aimed to explore whether implementing a structured bleep system could improve early surgical input. Methods A retrospective audit was conducted at Royal Stoke University Hospital (a tertiary major trauma centre), including Cat1 trauma cases from October 2024 to April 2025. Thirty-seven patients were identified, of whom 30 (81%) met Cat1 criteria upon retrospective review. Data was extracted from electronic patient records and operative reports. Key measures included the time from the patient's arrival in the emergency department to surgical review, specialty attendance, ICU admission and length of stay, and 30-day mortality. Analyses were stratified by Abbreviated Injury Scale (AIS) scores and Injury Severity Score (ISS). Results Of the 30 Cat1 patients (mean age: 49.6 years, male: 77%), road traffic collisions (RTCs) were the leading mechanism of injury. The 30-day mortality rate of Cat1 trauma cases was 46.7%. Anaesthetic attendance was the highest (83%), followed by trauma and orthopaedics (T&O) (73%), cardiothoracic surgery (53%), general surgery (40%), and neurosurgery (40%). Mean arrival times varied: general surgery, 86.8 minutes; cardiothoracic surgery, 140.3 minutes; T&O, 160.4 minutes; and neurosurgery, 177.6 minutes. Damage control surgery occurred earliest in cardiothoracic cases (mean: 69 minutes) and was most delayed in T&O (mean: 231 minutes). Patients reviewed by ≤1 surgical specialty had four-fold higher mortality compared with those seen by ≥2 (66.7% versus 33.3%; odds ratio (OR): 4.0, p = 0.12). Mortality patterns differed across specialities, with delayed surgical review generally associated with poorer outcomes, although most associations did not reach statistical significance due to the limited sample size. Conclusion This audit highlights variable surgical response times in Cat1 trauma, with a trend towards poorer outcomes when specialist review was delayed or limited to a single team. Although most findings did not reach statistical significance, the results suggest potential clinical benefit from earlier and broader surgical involvement. Implementing a structured bleep system for immediate activation of relevant surgical specialities may improve coordination, reduce delays, and ultimately enhance outcomes in Cat1 trauma.