The "weekend effect" does not impact on outcome of trauma laparotomy - Experience from a level 1 trauma centre in New Zealand.

PURPOSE: Trauma centres have been proven to provide better outcomes in developed countries for overall trauma, but there is limited literature on the systematic factors that describe any discrepancies in outcomes for trauma laparotomies in these centres. This study was conducted to examine and interrogate the effect of systematic factors on patients undergoing a trauma laparotomy in a developed country, intending to identify potential discrepancies in the outcome. METHODS: This was a retrospective study of all laparotomies performed for trauma at a level 1 trauma centre in New Zealand. All adult patients who had undergone an index laparotomy for trauma between February 2012 and November 2020 were identified and laparotomies for both blunt and penetrating trauma were included. Repeat laparotomies and trauma laparotomies in children were excluded. The primary clinical outcomes reviewed included morbidity, length of hospital stay, and mortality. All statistical analysis was performed using R v.4.0.3. RESULTS: During the 9-year study period, 204 trauma laparotomies were performed at Waikato hospital. The majority (83.3%) were performed during office hours (170/204), and the remaining 16.7% were performed after hours (34/204). And 61.3% were performed on a weekday (125/204), whilst 38.7% were performed on the weekend/public holiday (79/204). Most of the parameters in office hours and after hours groups had no statistically significant difference, except lactate (p = 0.026). Most of the variables in weekday and weekend groups had no statistically significant difference, except pH, lactate, length of stay, and gastrointestinal complications (p = 0.012, p < 0.001, p = 0.003, p = 0.020, respectively). CONCLUSION: The current trauma system at Waikato hospital is capable of delivering care for trauma laparotomy patients with the same outcome regardless of working hours or after hours, weekday or weekend. This confirms the importance of a robust trauma system capable of responding to the sudden demands placed on it.

Paediatric playground and tree-related injuries: Hospital admissions in the Midland region of New Zealand.

AIM: To examine the incidence and outcomes of paediatric playground and tree-related injuries in the Midland region of New Zealand. METHODS: A retrospective review of Midland Trauma Registry hospitalisation data between January 2012 and December 2018 was undertaken. Cases included children aged 0-14 years hospitalised for playground and tree-related injuries. Demographic and event information, injury severity and hospital-related outcomes were examined. RESULTS: Playground and tree-related hospitalisations (n = 1941) occurred with an age-standardised rate of 144.3/100 000 (confidence interval (CI) 127.3-161.3) and increased 1.4% (CI 1.3-4.2%) annually. The highest incidence was observed in 5-9-year olds (248.8/100 000) with 0-4 and 10-14-year olds at 86.0 and 89.2/100 000, respectively. Injuries most commonly occurred at home, school or pre-school (77.1%), 93.7% were due to falls and, the upper extremity was the most frequently injured body region (69.9%), particularly due to forearm (55.6%) and upper arm (34.7%) fractures. Tree-related incidents comprised 11.6% of all injuries and explained 57.1% of injuries classified as major severity. Fifty-eight percent of children were hospitalised for 1 day and 97.0% for less than 5 days. Estimated hospital costs were NZ$1.2 million annually with a median of NZ$3898 per incident. Injuries classified as minor severity accounted for 86.5% of the total estimated cost. CONCLUSION: Children aged 5-9 years' experience high rates of costly hospitalisation for playground and tree-related injuries. Targeted injury prevention initiatives, particularly in the home and school environments, are imperative to reduce the incidence and burden of playground and tree-related injuries to affected children, their families and hospital resources.

Characteristics of low, moderate and high severity trauma hospitalisations in a health region of Aotearoa New Zealand-10-year review.

AIM: To describe the incidence, characteristics, outcomes and hospital costs of patients admitted to hospital following trauma in a health region in Aotearoa New Zealand over a 10-year period. METHODS: A retrospective, observational study used data from the Te Manawa Taki (TMT) regional trauma registry to identify patients of all ages and injury severities that were admitted to hospital following injuries from 2013 to 2022, inclusive. This study reports on incidence of injuries with regard to age, gender, ethnicity, injury severity score (ISS), injury characteristics and direct cost to TMT facilities. RESULTS: Searches identified 60,753 trauma events leading to patient admission to hospitals in the TMT region. Of these, 81.9% were low-severity trauma, 10.2% were moderate-severity trauma and 7.9% were high-severity trauma. There were statistically significant relationships between gender, ethnicity and ISS category. Males were more likely to be hospitalised for any traumatic injuries. High-severity trauma is dominated by road traffic injuries and low-severity trauma is dominated by falls. Advanced age was associated with higher injury severity. The direct cost of trauma care to TMT hospitals increased by 122% during the 10-year period. CONCLUSIONS: The study has identified the incidence, demographic features, severity, costs and outcomes for trauma patients admitted to hospitals in the TMT region of Aotearoa New Zealand over a continuous 10-year period. The volumes and costs of injury represent a significant burden on the health system, individuals and communities. Detailed understanding of the causes and costs of injuries of all severities will inform prevention activities, clinical quality improvement and health service planning.

Falls at home: hospital admissions in a health region of Aotearoa New Zealand.

AIM: To report on the descriptive epidemiology and costs of trauma admissions to the Te Manawa Taki Trauma System (TMT) hospitals in Aotearoa New Zealand following falls at home. METHODS: A retrospective, observational study was conducted using data from the TMT trauma registry to identify patients of all ages who presented following falls at home from 2012 to 2022. This study reports on incidence of Fall Related Injuries (FRIs) that occurred at home with regard to age, gender, ethnicity, Injury Severity Score (ISS), injury characteristics and direct cost to TMT facilities. RESULTS: Searches identified 13,142 events to the TMT trauma system following falls at home. Most events were classified as non-major trauma. There were statistically significant relationships between gender, ethnicity and district, and ISS category. There were two distinctive age band incidence peaks: ≤9 years and 60+ years. Males were more likely to sustain major trauma. The most common cause was fall on the same level from slipping, tripping and stumbling. The average length of stay per event was 5.5 days. The average cost per event was NZ$9,792. CONCLUSIONS: The study has identified the demography, injury types, risk factors and outcomes for FRIs that occurred in the TMT region of Aotearoa New Zealand. The volumes and costs of injury represent a significant burden on the health system, individuals and communities. More detailed understanding of causative factors will allow targeting of prevention strategies to address high risk activities and demographic groups.

Development of a standardized minimum dataset for including low-severity trauma patients in trauma registry collections in Australia and Aotearoa New Zealand.

BACKGROUND: Trauma continues to place a burden on individuals, communities and health care systems around the world. To help reduce this burden and improve care, trauma registries in Australia and Aotearoa New Zealand collect standardized data on patients admitted with Injury Severity Scores greater than 12. There is currently no agreed minimum data set for trauma patients with Injury Severity Score less than 13, representing an opportunity to provide more data for quality improvement and injury prevention. METHODS: A binational, expert, advisory group assessed the value of potential fields for a minimum dataset for low severity trauma. Existing trauma registries in Australia and Aotearoa New Zealand were assessed to ensure compatibility. RESULTS: Thirty-five data fields met criteria for inclusion in the low-severity minimum dataset. The fields comprised a subset of the Australia New Zealand Major Trauma Registry and were included in existing low-severity registries. CONCLUSION: A minimum data set for low severity has been defined for use in Australia and Aotearoa New Zealand. In addition to high severity trauma data this will provide a standard for data collection that will contribute to quality improvement and injury prevention.

Fatal sepsis from appendicitis caused by an impacted tooth.

Acute appendicitis is one of the most common causes of acute abdominal pain globally. The pathophysiology of acute appendicitis is due to occlusion of the appendiceal lumen commonly from a faecolith. Obstruction of the appendiceal lumen by ingested foreign bodies is possible albeit rare. Here, we present an extremely rare case of acute appendicitis caused by impaction of the patients tooth within the lumen of the appendix. There have been only seven reported cases of impacted teeth causing appendicitis in the literature. There are no evidence-based guidelines for the management of appendicitis caused by tooth impaction. The authors suggest operative management with appendicectomy should be considered in the first instance.

Characteristics of patients hospitalised with traumatic brain injuries.

AIM: To investigate the volume, injury characteristics and journey of Te Manawa Taki/Midland (TMT) residents hospitalised with a traumatic brain injury (TBI). METHODS: A retrospective review of TMT Trauma Registry data between 1 January 2012 and 31 December 2019 was conducted. Eligible patients (n=4,875) were TMT residents hospitalised with an injury to the brain parenchyma. RESULTS: An average 609 residents were hospitalised with a TBI diagnosis per year, increasing by an average of 7.0% annually. Males, Maori and 0-4- and 15-34-year-olds were proportionately over-represented. Transport incidents and falls were key mechanisms. Mild, moderate and severe TBI, derived by Abbreviated Injury Scale severity scores, were classified in 72.1%, 22.6% and 5.3% of patients, respectively. Concomitant injuries occurred in 78.1% of patients. Brain surgery was required by 3.5%, other surgery by 25.5% and intensive care by 14.9%, and 3.7% died. Mean length of hospitalisation was 5.8±9.3 days. There were 1,118 inter-facility transfers: 41.9% to designated out-of-region acute care and rehabilitation centres, an annual average of 59 TMT-domiciled patients. CONCLUSION: The increasing volume of diverse TBI hospitalisations represents a major burden on individuals, communities and health services. Effective strategies are needed to prevent injury and ensure treatment and rehabilitation are equitable and patient focused.

Contemporary management of isolated free fluid on computed tomography scan in blunt abdominal trauma-experience from a Level 1 trauma centre in New Zealand.

AIMS: The management of patients with blunt abdominal trauma (BAT) who have isolated free fluid (IFF) with no solid organ injury (SOI) on computed tomography (CT) remains controversial. This study aims to determine if the volume of free fluid (FF) is a predictor of the need for operative management of traumatic intra-abdominal injuries, by reviewing the local cumulative experience with IFF at a major trauma centre in New Zealand. METHODS: A retrospective study was undertaken over nine years at a Level 1 trauma centre in New Zealand. Patients aged over 15 years who sustained BAT and had IFF with no SOI demonstrated on CT were included. All CT scans and patient notes were reviewed. The volume of free fluid was classified by the local interpreting radiologist on the CT report. RESULTS: Eighty-two out of 1,177 BAT patients (7%) had IFF with no SOI on CT. Thirty-eight percent were males, with a median age of 31 years. Nineteen (23%) underwent immediate operative management (OM) at the time of presentation. The remaining 63 patients had a trial of non-operative management (NOM), 10 (16%) of which were unsuccessful and required an operation. Overall, 29 patients (35%) required operative management. Eighty-nine percent of the OM group and 90% who failed NOM had positive operative findings, giving an overall true positive of 32%. CONCLUSIONS: The presence of IFF in itself is not an absolute indication for operative exploration and many patients with trace IFF can be managed non-operatively. Small amounts of IFF should be regarded with suspicion, and moderate or large amounts of fluid are likely to require operative exploration. Further work must make use of clinical scoring systems and laparoscopy or laparotomy to assess patients at high risk of surgically remediable intra-abdominal injury post BAT.

Blood alcohol screening and outcomes in trauma team activation patients at a level 1 trauma centre in New Zealand.

OBJECTIVE: A causal relationship between alcohol consumption and injury exists and the prevalence of harmful alcohol intakes in New Zealand adults is high. The present study investigates compliance to blood alcohol (BA) screening policy and the epidemiological profile and hospital-related outcomes of trauma team activation (TTA) patients with positive BA at a New Zealand level 1 trauma centre. METHODS: A retrospective review of Midland Trauma Registry hospitalisation data between January 2012 and December 2019 was conducted. Eligible patients (n = 2168) were ≥15 years who received TTA at Waikato Hospital. BA screening rates, demographic and event information, injury severity and hospital-related outcomes were examined. RESULTS: The average BA screening rate was 94.0% (95% confidence interval 92.9-95.0%) and 17.9% of screened patients were BA+ . BA+ patients were younger than BA- (34.7 and 40.5 years, P < 0.0001). More males than females (20.6 and 12.4%, P < 0.0001), Maori (30.8%) compared to non-Maori (<16.0%) and unemployed/beneficiaries (33.4%) compared to employed patients (15.5%) were BA+ . Road transport crashes accounted for the highest proportion (45.2%) but, in comparison there were higher odds of BA+ from interpersonal violence (odds ratio 4.48, P < 0.0001). No difference between BA+ and BA- was observed in survival rate, injury severity scores, length of intensive care and total hospital stay. CONCLUSION: Between 2012 and 2019, Waikato Hospital demonstrated high compliance to BA screening policy for TTA patients. Appropriate alcohol awareness initiatives that focus on road safety and interpersonal violence are required to reduce the preventable prevalence and burden of alcohol-related trauma in the Waikato region.

Admission to hospital for injury during COVID-19 alert level restrictions.

AIM: To assess the effects of the community lockdown phases on trauma-related admissions to Midland region hospitals over the period 15 February to 10 July 2020, and to compare volume variation with the same period in the previous three years. METHODS: A retrospective, descriptive study of prospectively collected data from the Midland Trauma Registry in New Zealand. RESULTS: There was a 36.7% (p<.00001) reduction in injury admissions during Alert Level 4 ('Lockdown') compared with the same period in 2017, 2018 and 2019. This was in the context of volume increases during the pre-lockdown period (17.8%, p<.00001) and a 'rebound' as restrictions eased. There was an increase in injuries occurring at home (28.3%, p<.00001) and on footpaths (37.9%, p=0.00076), while there was a decline in events on roads (33.0%, p=0.017), at schools (75.0%, p<.00001) and in sports areas (79.7%, p<.00001). Falls remained the dominant mechanism of injury in 2020, contributing 39.9% of all hospitalisations. CONCLUSIONS: The reduction in hospital admissions during alert levels 4 and 3 was short lived, with a rebound evident when restrictions eased. Hospital resources have been strained because this rebound coincided with a planned 'catch up' on healthcare that was delayed during the higher community restriction levels.

Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 in New Zealand.

AIM: The aims of this study were to describe the variation in volumes and types of injuries admitted to a level one trauma centre in New Zealand over two 14-day periods before and during the national level 4 lockdown for COVID-19; and highlight communities at risk of preventable injury that may impact negatively on hospital resources. METHOD: A retrospective, descriptive study of prospectively collected data in the Midland Trauma Registry in New Zealand. RESULTS: Overall there was a reduction of 43% in all injury-related admissions with significant reductions seen in major injury (50% reduction), males (50% reduction) and children aged 0-14 years (48% reduction). Results for ethnicity and persons aged over 14 years were within 3% deviation of this overall 43% reduction. Injuries at home, particularly falls, predominate. CONCLUSION: Despite the significant reduction in admissions during level 4 lockdown, hospitals should continue to provide full services until resource limitations are unavoidable. Immediate messaging is recommended to reduce rates of injury on the farm and at home, specifically falls prevention. Ongoing attention of road users to road safety is essential to reduce the incidence of preventable major injury. These immediate measures can potentially reduce unnecessary pressure on hospital beds and resources during the pandemic.

Priorities for trauma quality improvement and registry use in Australia and New Zealand.

INTRODUCTION: The Australia New Zealand Trauma Registry enables the collection and analysis of standardised data about trauma patients and their care for quality improvement, injury prevention and benchmarking. Little is known, however, about the needs of providers and clinicians in relation to these data, or their views on trauma quality improvement priorities. As clinical experts, trauma clinicians should have input to these as ultimately their practice may be influenced by report findings. This paper presents the perspectives of multidisciplinary trauma care professionals in Australia and New Zealand about the use of the Australia New Zealand Trauma Registry data and trauma quality improvement priorities. METHODS: An exploratory survey of trauma professionals from relevant Australia and New Zealand professional organisations was conducted using the Snowballing Method between September 2018 and February 2019. Participants were recruited via a non-random sampling technique to complete an online survey. Descriptive statistical and content analyses were conducted. RESULTS: The data use priorities identified by 102 trauma professionals from a range of locations participated were clinical improvement and system/process improvement (86.3%). Participants reported that access to trauma data should primarily be for clinicians (93.1%) and researchers (87.3%). Having a standardised approach to review trauma cases across hospitals was a priority in trauma quality improvement. CONCLUSION: Trauma registry data are under-utilised and their use to drive clinical improvement and system/process improvement is fundamental to trauma quality improvement in Australia and New Zealand.

Challenges to trauma care delivery for Australian and New Zealand trauma clinicians.

INTRODUCTION: The availability and implementation of evidence-based care is essential to achieving safe, quality trauma patient outcomes. Little is documented, however, about the challenges trauma clinicians face in their day-to day practice, or their views on the availability of evidence. This paper presents the most significant clinical practice challenges reported by multidisciplinary trauma care professionals in Australia and New Zealand, in particular those that may be resolved with focussed research or enhanced implementation activity. METHODS: An exploratory survey of trauma professionals from relevant Australia and New Zealand professional organisations was conducted between September 2018 and February 2019 using the Snowballing Method. Participants were recruited via a non-random sampling technique to complete an online survey. Thematic analyses were conducted. RESULTS: There were nine significant clinical practice challenge themes in trauma care, arising from 287 individual clinical practice challenges reported. The most reported being clinical management (bleeding, spinal, older patients) and operationalisation of the trauma system. There was no consensus as to the availability of evidence to guide each theme. CONCLUSION: Future research should seek to address the clinical practice challenge of Australian and New Zealand trauma community to enable safe, quality trauma patient outcomes.

Identifying the priority challenges in trauma care delivery for Australian and New Zealand trauma clinicians.

INTRODUCTION: Injury is a leading cause of death and disability world-wide. Little is known about the day-to-day challenges the trauma clinicians face in their practice that they feel could be improved through an increased evidence base. This study explored and ranked the trauma clinical practice research priorities of trauma care professionals across Australia and New Zealand. METHODS: A modified-Delphi study was conducted between September 2019 and January 2020. The study employed two rounds of online survey of trauma professionals from relevant Australia and New Zealand professional organisations using snowballing method. Participants were asked to rank the importance of 29 recommendations, each corresponding to a key challenge in trauma care delivery. Decisions on the priorities of the challenges were determined by a consensus of >70% of respondents ranking the challenge as important or very important. RESULTS: One hundred and fifty-five participants completed Round One, and 106 participants completed Round Two. A total of 15 recommendations reached >70% in Round One. Nine recommendations also reached >70% consensus in Round Two. Recommendations ranked highest were 'Caring for elderly trauma patients', 'Identifying and validating key performance indicators for trauma system benchmarking and improvement', and 'Management of traumatic brain injury'. CONCLUSION: This study identified the priority areas for trauma research as determined by clinician ranking of the most important for informing and improving their practice. Addressing these areas generates potential to improve the quality and safety of trauma care in Australian and New Zealand.

A six-year review of patients admitted to hospital with injuries related to quad bike use.

AIM: To describe quad bike injury-related hospitalisations in the Midland region over a six-year period. METHOD: A retrospective review of anonymised, prospectively-collected trauma registry data from 1 July 2012 to 30 June 2018 was undertaken. Cases include patients hospitalised with quad bike-related injuries. Non-major injuries are included to provide a clearer picture of the trauma burden. RESULTS: Three hundred and forty-six injuries resulted in hospitalisation with 70.2% of events occurring on a farm. Males outnumbered females 3.7:1. Forty-six children (<16 years) were hospitalised, of which 23 were injured on-farm and seven on a road. Over six years there was an annual average increase of 7.3% for all events occurring on a farm, 2.6% for injuries occurring during a farming activity and 4.7% for off-farm recreational injuries. CONCLUSION: Despite continued public debate and education on the safe use of quad bikes, injuries severe enough to require hospitalisation continue to occur. Children continue to be injured, both as riders and passengers. Ageing farmers are a developing area for concern. While workplace safety garners most of the safety attention, two other areas also deserve injury prevention consideration; injuries that occur on-farm but not during farming activities and those occurring off-farm to recreational riders.

Cycling-related injuries and cycling promotion: a trauma service perspective.

AIM: Current policy direction seeks to promote participation in both recreational and active transport cycling. We evaluate cycling-related injuries resulting in hospital admission across the Midland Region of New Zealand to establish injury trends. METHOD: A retrospective review of anonymised prospectively-collected trauma registry data from 1 June 2012 to 31 July 2016 in the Midland Region. Cases include patients hospitalised with cycling-related injuries. RESULTS: Nine hundred and ninety-eight cyclists were admitted to hospital (2012-2016). Admission volumes increased approximately 16.8% per year, major trauma by 11.9% and non-major trauma by 17.8%. Overall, 66.7% of admissions were for people aged over 20 years and 73.4% were for males. The participation-adjusted annual injury rate was 78.4 per 100,000. This masked considerable variation by gender, age group and injury severity. CONCLUSION: Hospital admission volumes and rates are rising with underlying variation in patient demography, place and severity of injury. Current policy direction to grow cycling participation based on the health, environmental and economic benefits is ahead of the implementation of safer cycling infrastructure, creating a timing lag. From a regional hospital-based trauma service perspective, this timing lag needs due consideration if the full benefits of increasing participation are to be realised.

Improving patient experience and outcomes following serious injury.

AIM: To explore injured patients' experiences of care to identify areas for improvement in routine service delivery from surgical teams in the transition from inpatient to community-based care. METHODS: Qualitative study drawing on 17 in-depth, semi-structured interviews, conducted from 1 October 2017 to 31 November 2017, with trauma patients (and patient-nominated key support people and health or social care professionals) registered by the Midland Trauma System Registry (New Zealand). RESULTS: All patient respondents had been under the primary care of surgical sub-specialty teams at Waikato Hospital rather than the specialised trauma service that primarily cares for patients with major multi-system trauma. Patients perceived their pre-hospital and emergency care as high quality and highly valued the compassion of staff during their inpatient phase of care. Exceptions were the perception of communication gaps across the spectrum of care from admission to discharge and beyond, limited access to psychosocial services to manage ongoing psychological trauma and a lack of preparedness for discharge. Following discharge, respondents reported the high level of reliance on key support people, inadequate information provision about what to expect in relation to the journey through the health system after discharge, and a lack of coordination of post-discharge care. CONCLUSION: This study highlights perceived issues in the patient care pathway in the transition from inpatient to community-based care, especially communication and discharge information provided by surgical clinical teams and Accident Compensation Corporation (ACC). Comprehensive inpatient care and clinical handover to primary care (rather than discharge planning processes) by dedicated clinical trauma services may provide more holistic models for surgical services to improve their influence on the transition of trauma patients into the community, assisted by organisation changes and support to enable effective service delivery. Specifically, trauma patients and their carers perceived the need for better screening and treatment for psychological trauma in the inpatient and outpatient setting; better information exchange prior to the transition from inpatient to primary care; more convenient and accessible follow-up services including a single point of contact for coordination of post-discharge care; and acknowledgement and practical support to relieve the significant and pervasive carer burden identified in this study. These findings provide the opportunity to implement focused system changes to provide more equitable and effective support in the transition to community care and beyond. The end result will be better experiences for patients and whanau, and improved health and vocational outcomes following serious injury.

Equine-related injuries requiring hospitalisation in the Midland Region of New Zealand: a continuous five-year review.

AIM: To examine the pattern and outcomes of equine-related injuries for hospitalised patients in the Midland Region of New Zealand over a five-year period. METHOD: A retrospective review of all patients admitted to hospitals within the Midland region of New Zealand with an injury date 1 January 2012-31 December 2016, as a direct result of equine-related trauma. RESULTS: Seven hundred and one patients were admitted due to equine-related injuries, 6.6% were major trauma events (Injury Severity Scale >12), with nearly half of all injuries (47.3%) to the extremities. Mean age was 36 years (median 38 years), and 69% were females. The most common mechanisms of injury were falls from horse (70.6%), kicked (12.7%) and knocked (6.7%) by the horse. Males were more likely to have a non-fall injury. Average length of stay (all patients) was 3.4 days, and half of all patients required surgery. All patients survived. At Waikato Hospital, the largest district hospital in the region, the average inpatient cost was NZ$7,805/patient. CONCLUSION: The study has identified the demography, injury types, risk factors and outcomes for equine-related injuries in the Midland Region of New Zealand. Indications are that the severity of such injuries may be less than previously reported. However, the volumes and costs of injury represent a significant burden on the health system, individuals and communities. More detailed understanding of causative factors will allow targeting of prevention strategies to address high-risk activities and demographic groups.

Livestock-related injuries in the Midland region of New Zealand.

AIM: To assess the incidence and patterns of injury resulting from force transferred from large livestock in the Midland Region of New Zealand, and to identify foci for prevention. METHOD: Data was sourced from the Midland Trauma System Registry. Patients admitted to Midland hospitals from 2012 to 2015 were evaluated. Data included patient demography, location, mechanism, and time of the injury, type of animals involved, injuries sustained, interventions, outcomes and hospital costs. The final sample included 168 injury events. RESULTS: 75.6% were due to interactions with cattle. The remainder were from sheep, pigs and deer. Most of the injuries were either 'hit', 'crush' or 'kick' injuries. Moving and loading stock resulted in 38% of the injuries, and 29% occurred near fences, gates or poles. Cattle-related injuries peaked during September and October. Sheep-related injuries peaked in December. These months correspond to calving season in cows and shearing season in sheep. Injury peaks were observed in the 20-29 and 50-59 age groups. CONCLUSION: This study has identified high-risk animals, activities, age intervals and times during which large livestock-related injuries may occur, and revealed the significant impact on hospitals and communities that these injuries result in.

Monitoring pre-hospital transport of severely injured patients in the Midland Region of New Zealand.

AIM: Pre-hospital triage strategies aim to identify the type and extent of patient injuries and ensure that they are transferred to the most appropriate trauma centres. Despite the importance of appropriate pre-hospital transport, there is little evidence base to assist medical staff on optimal destination policy for emergent pre-hospital transport. This paper explores the spatial relationship of patient transfers prior to the implementation of the Midland Pre-Hospital Trauma Destination Matrix in New Zealand, and is a retrospective view of practice against a destination policy that was applied after the study period. METHODS: We use data obtained from the Midland Trauma Registry merged with Global Positioning System (GPS) data from St John and Land Information New Zealand Data Service on major trauma occurring in 2014 and 2015. Using ArcGIS, data were analysed for spatial relationships between factors associated with major trauma events and pre-hospital transportation. RESULTS: In the retrospective analysis of 162 major trauma patients, 107 (66%) were transported to a hospital that matched the destination specified in the Matrix, and 55 (34%) were transported to a non-Matrix designated hospital. CONCLUSION: Approximately one-third of patients were not directly transported to the preferred definitive care hospital subsequently defined in the Midland Pre-Hospital Trauma Destination Matrix. Ongoing monitoring of the pre-hospital transportation system and the implementation of a formal pre-hospital transport policy may improve the efficiency of the Midland Trauma System. Future studies should examine the possible reasons for variations in triage decisions across the Midland Region.