Pathways and factors that influence time to definitive trauma care for injured children in New South Wales, Australia

Kate Curtis; Belinda Kennedy; Mary K Lam; Rebecca J Mitchell; Deborah Black; Brian Burns; Michael Dinh; Andrew Ja Holland

doi:10.1016/j.injury.2021.02.036

Pathways and factors that influence time to definitive trauma care for injured children in New South Wales, Australia

Injury. 2022 Jan;53(1):61-68. doi: 10.1016/j.injury.2021.02.036. Epub 2021 Feb 17.

Authors

Kate Curtis¹, Belinda Kennedy², Mary K Lam², Rebecca J Mitchell³, Deborah Black⁴, Brian Burns⁵, Michael Dinh⁶, Andrew Ja Holland⁷

Affiliations

¹ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia; Emergency Services, Illawarra Shoalhaven LHD, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; George Institute for Global Health, King St, Newtown, NSW, Australia. Electronic address: Kate.curtis@sydney.edu.au.
² Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia.
³ Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Rd, North Ryde NSW 2113, Australia.
⁴ Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia.
⁵ Greater Sydney Area HEMS, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport NSW 2200, Australia; The University of Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia.
⁶ The University of Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia; NSW Institute of Trauma and Injury Management, Agency for Clinical Innovation, 1 Reserve Rd, St Leonards NSW 2065, Australia.
⁷ The University of Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Science Rd, Camperdown NSW 2006, Australia; The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia.

PMID: 33632604
DOI: 10.1016/j.injury.2021.02.036

Abstract

Background: Timely definitive paediatric trauma care influences patient and parental physical and emotional outcomes. New South Wales (NSW) covers a large geographical area with all three NSW paediatric trauma centres (PTC) located in two approximated major cities, meaning it is inevitable that some injured children receive initial treatment locally and then require transfer. Little is known about the factors that then impact timely arrival of injured children to definitive care.

Methods: This included children admitted between July 2015 and September 2016, <16 years with an injury severity (ISS) ≥9; or requiring intensive care admission; or deceased following injury. Children were identified through the three PTCs, NSW Trauma Registry and NSW Medical Retrieval Registry.

Results: There were 593 children admitted following injury and 46% required transfer to a PTC. There was no significant difference in age, ISS, ICU admission or head injury (AIS >2) between transferred and directly transported cohorts. There were significant differences in mechanism of injury between the two groups (χ²(9) = 45.9, p < 0.001). The median (IQR) time to book a transfer from arrival at the referring facility, was 146.5 (86-238) minutes. Time from injury to arrival at the PTC more than doubled for children transferred, with significant and unwarranted variability between transporting agencies resulting in unwarranted delays to surgical intervention. For example, time spent at the referring facility by Aeromedical Retrieval Service was less than half that of the Newborn & paediatric Emergency Transport Service [53 (IQR:47-61) vs 115 (84-155) minutes (p <0.001)].

Conclusion: Clinicians caring for paediatric trauma patients in facilities outside trauma centres require the capability and opportunity to identify and notify early those requiring transfer for ongoing management. The provision of a streamlined referral and transfer process for all paediatric trauma patients requiring treatment in NSW PTCs would reduce the burden on the referring facility, reduce variation amongst transport providers and improve time to definitive care.

Keywords: Injury; Interhospital transfer; Paediatric.

MeSH terms

Australia / epidemiology
Child
Emergency Medical Services*
Humans
Infant, Newborn
Injury Severity Score
New South Wales / epidemiology
Retrospective Studies
Trauma Centers
Wounds and Injuries* / therapy