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

doi:10.1016/j.injury.2019.09.036

Injury

Volume 51, Issue 1, January 2020, Pages 114-121

https://doi.org/10.1016/j.injury.2019.09.036 Get rights and content

Highlights

•
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.
•
The Australian Trauma Registry collected data on 8423 patients with a major injury (ISS > 12 or death after injury) from collaborating major trauma centres across Australia at the time of this study.
•
The median (IQR) ISS was 17 (14–25) with 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.
•
Australia has the capability to identify national injury trends to target prevention and reduce the burden of injury.

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.

Introduction

Historically, systems for trauma care have been predicated on a military model. Military trauma has a high rate of penetrating injury and mostly involves young men. In the United States (US), in the 1970s, these systems were modified for inner city trauma, which also involved young men with penetrating injury. As the epidemiology evolved, systems were further modified to manage high-energy blunt trauma, which was mostly due to motor vehicle collisions. The epidemiology of major trauma and trauma deaths is continuing to evolve, as older patients injured from low falls are increasingly the predominant group experiencing major injury and death [1,2].

Ensuring the system of care is targeted, efficient, accessible, safe and responsive to clinical demands requires accurate data. The importance of trauma registries in driving improvements to trauma systems has been well documented [3,4]. There is consensus internationally that accurate data integrated into clinical care systems drives change. After state-wide developments and calls for a national trauma registry, Australia now has a national registry, which produces regular reports [5,6,7]. The importance of this registry has been recognised in a publication from the Australian Commission on Safety and Quality in Healthcare (ACSQHS), on the prioritisation of registries [8]. This registry has recently combined with New Zealand to become the Australia New Zealand Trauma Registry (ATR) (https://atr.org.au/ accessed 24 March 2019).

The aim of this study was to describe the current epidemiology of major trauma across Australia, and identify opportunities for improvement and future directions in the system of trauma care in Australia, using data from the ATR.

Section snippets

Data

ATR data were submitted according to the bi-national trauma minimum dataset for Australia and New Zealand with 67 data items [9]. Initially 26 collaborating major trauma centres participated, however 24 sites provided data for this report, either directly from the site or via State-based registries. Data have been mapped to the minimum data set according to standard definitions and if data items were not already collected by existing data sources, they were not otherwise obtained by the ATR.

Inclusion/exclusion

The

Results

Over the 12 month period 1 July 2016 to 30 June 2017 8423 records were submitted to the ATR from 24 trauma centres across seven states and territories.

Discussion

Australia now has a robust method for assessing the system of major trauma care across Australia. It is clear that major trauma in Australia involves a large percentage of older people following low falls. Although high energy mechanisms make up a substantial proportion of cases, older persons contribute to the largest number of deaths and adverse outcomes in hospital. This group of patients has more complex needs with pre-existent medical conditions, frailty, and frequently a lack of

Limitations

There are several limitations to data collected in the initial stages of the ATR development. Despite cooperation from centres, we have ongoing problems with timeliness and completeness of data submissions using current data entry and collation methods. This is primarily related to local resourcing [12].

The data collected only applies to major trauma admitted to major trauma services. This is not linked to non-trauma centre data, prehospital/scene data and post discharge data. All these data

Future directions

Strong federal government leadership of a coordinated evidence-based national response to injury prevention must be enacted and resourced to achieve real reductions in injury hospitalisation rates [24].

For targeted evidence-based injury prevention strategies, we need more granular data on injury type, precipitating causes, geospatial mapping and social context. Routine, Australia-wide injury surveillance using record linkage of existing administrative data sources, such as police crash

Conclusions

Australia now has the capability to identify national injury trends in patients admitted to major trauma services, optimising prevention and treatment strategies and potentially reducing the burden of injury. Quality of care following injury can now be benchmarked across Australia to improve management of trauma victims.

Funding

Commonwealth funding was provided by the Department of Infrastructure, Regional Development & Cities, Bureau of Infrastructure, Transport and Regional Economics and the Department of Health.

Alfred Health and the National Trauma Research Institute (NTRI) also provided funding for the ATR, along with the in-kind support of all contributing sites and state-based registries. PC is supported by an MRFF practitioner fellowship and BG is supported by an ARC future fellowship.

The Royal Australasian

Declaration of Competing Interest

None.

Acknowledgements

The authors would like to thank: the front-line registry staff and data managers who collect and submit data to the ATR, the New Zealand Major Trauma National Clinical Network, and the site investigators for their ongoing cooperation, the Department of Infrastructure, Regional Development & Cities, Bureau of Infrastructure, Transport and Regional Economics and the Department of Health for their continued support, the Australian Automobile Association, the members of the AusTQIP Steering

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The leading global cause of death for people aged 5–29 years is road traffic injury, a quarter of which is borne by pedestrians. The epidemiology of major hospitalised pedestrian injury across Australia is not reported. This study aims to address this gap using data from the Australia New Zealand Trauma Registry.
The registry hosts information on patients admitted to 25 major trauma centres across Australia who sustain a major injury (ISS > 12) or die following injury. Patients were included if they were injured due to pedestrian injury from 1st July 2015–30 th June 2019. Analysis included patient and injury characteristics, injury patterns and in-hospital outcomes. Primary endpoints included risk-adjusted mortality and length of stay.
There were 2159 injured pedestrians; of these, 327 died. Young adults (20–25 years) were the largest group, especially on weekends. Older adults (70 + years) were the largest cohort in pedestrian deaths. The most common injuries were head (42.2 %). One-third of patients were intubated prior to or on ED arrival (n = 731, 34.3 %).
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Estudio observacional retrospectivo a partir de los datos recogidos prospectivamente en el RNP. Se incluyen pacientes mayores de 14 años, con ISS ≥ 15 o mecanismo de trauma penetrante, atendidos en 17 hospitales de tercer nivel de España.
Del 1/1/17 al 1/1/22 se han registrado un total de 2.069 pacientes politraumatizados. El 76,4% son varones; edad media: 45 años; ISS medio: 22,8 y mortalidad: 10,2%. El mecanismo de lesión más frecuente es el cerrado (80%) con mayor incidencia de accidentes de moto (23%). Un 12% de los pacientes sufren un traumatismo penetrante, por arma blanca en el 84%.
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In 2017 the Spanish National Polytrauma Registry (SNPR) was initiated in Spain, its goal was to improve the quality of severe trauma management and evaluate the use of resources and treatment strategies. The objective of this study is to present the information obtained with the SNPR since it was initiated.
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Sixteen percent of patients are hemodynamically unstable on hospital arrival. Massive transfusion protocol is activated in 14% of patients and 53% are operated. Median hospital stay is 11 days. There is a 73.4% of patients who need intensive care unit (ICU) admission, with a median ICU stay of 5 days.
Trauma patients registered in the SNPR are predominantly middle-aged males who experience blunt trauma with a high incidence of thoracic injuries. Early and addressed detection of these kind of injuries would probably improve trauma quality of care in our environment.
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The epidemiology of injured patients has changed, with an increasing predominance of severe injury and deaths in older (65 years and above) patients after low falls. There is little evidence of the models of care that optimise outcomes for injured older patients. This study aims to describe clinician perspectives of existing models of acute care for injured older patients in Australia and New Zealand.
This cross-sectional online survey of healthcare professionals (HCP) managing injured older patients in Australia or New Zealand hospitals was conducted between November 2nd and December 12th, 2020. Recruitment was via survey link and snowball sampling to professional organisations and special interest groups via email and social media. HCP were asked, using a Likert scale, how likely four typical case vignettes were to be admitted to one of twelve options for ongoing care. Additional questions explored usual care components.
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Citation Excerpt :
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View full text

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

Highlights

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Data

Inclusion/exclusion

Results

Discussion

Limitations

Future directions

Conclusions

Funding

Declaration of Competing Interest

Acknowledgements

Surgery

Injury

Injury

Injury

Major trauma in older persons

Br J Surg

Trends in hospitalisations due to falls by older people, Australia 1999–00 to 2010–11

A statewide system of trauma care in Victoria: effect on patient survival

Med J Aust

AusTQIP consortium. The Australian trauma registry

ANZ J Surg

Developing Australia's first statewide trauma registry – what are the lessons

ANZ J Surg

Addressing the burden of injury in Australasia: developing a bi-national trauma registry

Med J Aust

Prioritised list of clinical domains for clinical quality registry developmentFinal report

The abbreviated injury scale 2005.