Road accident, stabbing and shooting casualties receive "unacceptable" variations in care depending on the hospital they are taken to, a damning report said today.

The National Audit Office (NAO) said between 450 and 600 lives a year could be saved by improving the management of trauma cases.

Care given to trauma patients, who also include victims of falls, blasts, burns and assaults, has not "significantly improved" in more than 20 years, despite a series of criticisms, the NAO said.

Amyas Morse, head of the NAO, said: "Services for people who suffer major trauma are not good enough.

"There is unacceptable variation, which means that if you are unlucky enough to have an accident at night or at the weekend, in many areas, you are likely to receive worse quality of care and are more likely to die."

Currently, 193 hospitals treat trauma victims within their accident and emergency departments.

But it amounts to just 0.2 per cent of their total activity, meaning there is insufficient experience among some medics.

Gathering experts at regional centres would lead to improvements in the speed and quality of treatment given, despite increasing the distance travelled to receive care in some cases, the NAO said.

Research found there was a 20 per cent higher in-hospital mortality rate for patients in England compared to the United States.

Although it did not identify individual hospitals, it said the figures ranged from 5.12 unexpected survivors per 100 trauma patients, to 7.72 unexpected deaths per 100 trauma patients.

Mr Morse called on the Government to "get a grip" of the issue.

"The Department of Health and the NHS must get a grip on co-ordinating services through trauma networks, on costs and on information on major trauma care if they are to prevent unnecessary deaths," he said.

It is estimated there are at least 20,000 cases of major trauma each year in England, resulting in 5,400 deaths and many more cases of disability.

The NAO said 98 per cent of trauma cases resulted from "blunt force", mainly caused by road accidents and falls. Knife and gunshot wounds account for 2 per cent of the cases.

The NAO said only 59 per cent of the 193 hospitals delivering trauma care kept records of the treatment, meaning the performance of the others could not be measured.

Guidelines from the National Institute for Clinical Excellence state head injury casualties should have a CT scan within a hour of arriving at hospital.

But based on the figures collated, the current average waiting time is one-and-a-half hours - and more than two hours for 25 per cent of patients.

The NAO highlighted a network being set up in London, based on the principle that ambulances should be able to reach a trauma centre within 45 minutes, as an example of how the system could be improved.

Despite major trauma being most likely to happen at nights and weekends, only one hospital in England has 24-hour consultant care, the report found.

Conservative MP Edward Leigh, chairman of the public accounts committee, described the set-up as "lamentable" and added: "Major trauma services are currently provided in a disorganised and uncoordinated fashion."

Richard Collins, of the Royal College of Surgeons of England, said: "It is neither cost effective nor in the best interest of patients for all hospitals to treat victims of major trauma.

"There is indisputable evidence that the introduction of regional trauma centres would save thousands of lives every year, however, very little progress has been made."

Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: "It is well-known that specialist centres offer the best chance of recovery to trauma patients.

"However, by simply improving communication and cooperation between hospitals, survival rates would be boosted."

It is estimated the cost in lost economic impact from deaths and serious injuries caused by major trauma is between £3.3 billion and £3.7 billion.

Health Minister Mike O'Brien said work had been under way since 2007 to introduce regional trauma networks.

"These aim to ensure patients are delivered safely and rapidly to a specialist hospital where teams of experts, including trauma, orthopaedic and neurosurgeons, are on hand to care for patients 24 hours a day, seven days a week," he said.

"This programme will help to improve survival, outcomes and care for patients suffering life-threatening and complex injuries."