Background While the global burden continues to rise, injury-related mortality rates have declined in many high-income countries. A key contributor to reduced mortality has been implementation of trauma systems with improved care of injured patients substantially enhancing the likelihood of surviving serious injury. The focus has now shifted to improving the quality of survival and reducing the burden of non-fatal injury. However, there is limited understanding of how well patients recover, how long this takes, and the proportion of the injured population who go on to experience lifelong disability.

Methods The state of Victoria, Australia, using the population-based Victorian State Trauma Registry as a data spine, is using coordinated data linkage, longitudinal qualitative studies, and routine long-term patient follow-up to evaluate trauma care through acute care, rehabilitation and community reintegration.

Results Key findings include: i) demonstrated reduced burden, measured in Disability Adjusted Life Years, of road traffic injury following implementation of an organised trauma system; ii) improved mortality and functional outcomes for patients following redesign of the state’s retrieval system; iii) improvement in patient-reported outcomes to 2-years post-injury but variable recovery trajectories for key patient groups; and iv) profound issues with discharge planning, and post-discharge care coordination of trauma patients.

Conclusions Clinical data represents only a component of what we need to know to understand the impact of clinical practice and healthcare policy in trauma. Insight into patient experiences and pathways, healthcare and disability service needs, and factors that facilitate and impede recovery are needed to improve trauma system design and better meet the needs of injured patients.