Over view of major traumatic injury in Australia--Implications for trauma system design

P A Cameron; M C Fitzgerald; K Curtis; E McKie; B Gabbe; A Earnest; G Christey; C Clarke; J Crozier; M Dinh; D Y Ellis; T Howard; A P Joseph; K McDermott; J Matthew; R Ogilvie; C Pollard; S Rao; M Reade; N Rushworth; S Zalstein; Australian Trauma Quality Improvement Program (AusTQIP) collaboration

doi:10.1016/j.injury.2019.09.036

Over view of major traumatic injury in Australia--Implications for trauma system design

Injury. 2020 Jan;51(1):114-121. doi: 10.1016/j.injury.2019.09.036. Epub 2019 Oct 3.

Authors

P A Cameron¹, M C Fitzgerald², K Curtis³, E McKie⁴, B Gabbe⁵, A Earnest⁴, G Christey⁶, C Clarke⁷, J Crozier⁸, M Dinh⁹, D Y Ellis¹⁰, T Howard¹¹, A P Joseph¹², K McDermott¹³, J Matthew¹⁴, R Ogilvie¹⁵, C Pollard¹⁶, S Rao¹⁷, M Reade¹⁸, N Rushworth¹⁹, S Zalstein²⁰; Australian Trauma Quality Improvement Program (AusTQIP) collaboration

Affiliations

¹ Emergency & Trauma Centre, The Alfred, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. Electronic address: peter.cameron@monash.edu.
² National Trauma Research Institute, The Alfred, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Australia; Trauma Service, The Alfred, Melbourne, Victoria, Australia.
³ Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia; George Institute for Global Health, Sydney, Australia; Illawarra Shoalhaven Local Health District, New South Wales, Australia.
⁴ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁵ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, UK.
⁶ Midland Trauma System, New Zealand; Waikato Clinical School, University of Auckland, New Zealand.
⁷ Royal Adelaide Hospital, Australia; University of Adelaide, Australia.
⁸ Royal Australasian College of Surgeons, Australia; Liverpool Hospital, Sydney, NSW, Australia.
⁹ Emergency, Royal Prince Alfred Hospital, Australia; NSW Institute of Trauma and Injury Management, Agency for Clinical Innovation, Australia; Sydney Medical School, The University of Sydney, Australia.
¹⁰ Trauma Centre, Royal Adelaide Hospital, South Australia, Australia; SAAS MedSTAR, Emergency Medical Retrieval Service, Australia; School of Public Health and Tropical Medicine, James Cook University.
¹¹ National Trauma Research Institute, The Alfred, Melbourne, Victoria, Australia; Central Clinical School, Monash University.
¹² Sydney Medical School, The University of Sydney, Australia; Emergency Department and Trauma Service, Royal North Shore Hospital, Sydney NSW.
¹³ National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia.
¹⁴ Emergency & Trauma Centre, The Alfred, Melbourne, Victoria, Australia; National Trauma Research Institute, The Alfred, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Australia; Trauma Service, The Alfred, Melbourne, Victoria, Australia.
¹⁵ School of Nursing Midwifery & Public Health, University of Canberra, Australian Capital Territory, Australia; ACT Trauma Service, Canberra Hospital & Health Services, Australian Capital Territory, Australia.
¹⁶ Jamieson Trauma Institute, RBWH, Australia.
¹⁷ Royal Perth Hospital, Western Australia, Australia.
¹⁸ Faculty of Medicine, University of Queensland, Brisbane, Australia and Joint Health Command, Australian Defence Force, Canberra, Australia.
¹⁹ Brain Injury Australia, Australia.
²⁰ Trauma Centre, Royal Hobart Hospital, Hobart, Tasmania, Australia.

PMID: 31607442
DOI: 10.1016/j.injury.2019.09.036

Abstract

Background: Trauma registries are known to drive improvements and optimise trauma systems worldwide. This is the first reported comparison of the epidemiology and outcomes at major centres across Australia.

Methods: The Australian Trauma Registry was a collaboration of 26 major trauma centres across Australia at the time of this study and currently collects information on patients admitted to these centres who die after injury and/or sustain major trauma (Injury Severity Score (ISS) > 12). Data from 1 July 2016 to 30 June 2017 were analysed. Primary endpoints were risk adjusted length of stay and mortality (adjusted for age, cause of injury, arrival Glasgow coma scale (GCS), shock-index grouped in quartiles and ISS).

Results: There were 8423 patients from 24 centres included. The median age (IQR) was 48 (28-68) years. Median (IQR) ISS was 17 (14-25). There was a predominance of males (72%) apart from the extremes of age. Transport-related cases accounted for 45% of major trauma, followed by falls (35.1%). Patients took 1.42 (1.03-2.12) h to reach hospital and spent 7.10 (3.64-15.00) days in hospital. Risk adjusted length of stay and mortality did not differ significantly across sites. Primary endpoints across sites were also similar in paediatric and older adult (>65) age groups.

Conclusion: Australia has the capability to identify national injury trends to target prevention and reduce the burden of injury. Quality of care following injury can now be benchmarked across Australia and with the planned enhancements to data collection and reporting, this will enable improved management of trauma victims.

Keywords: Epidemiology; Injury burden; Major trauma; Older adults; Quality improvement; Risk adjustment; System of care; Trauma registries; Trauma system.

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Aged, 80 and over
Australia / epidemiology
Female
Humans
Incidence
Injury Severity Score
Length of Stay / statistics & numerical data*
Male
Middle Aged
Registries*
Retrospective Studies
Trauma Centers / statistics & numerical data*
Wounds and Injuries / diagnosis
Wounds and Injuries / epidemiology*