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.

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.

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.

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.

Quad bike injuries in Waikato, New Zealand: an institutional review from 2007-2011.

BACKGROUND: The aim of this study was to assess the burden of all-terrain vehicle (ATV) injuries within the Waikato region of New Zealand. METHODS: From the local database of 13 400 trauma patients, 101 patients with ATV-related injury or death were identified. We analysed data on demographics, location and mechanism of accident, helmet use, length of hospital stay, injury severity score and type of injury. Only admissions to Waikato Hospital trauma centre between February 2007 and March 2011 were included. RESULTS: A total of 84% of patients were male, 16% were female. The mean age was 38.8 years (range 4-82). Twelve per cent of patients were within the paediatric age range (<16 years). No age group was at particular risk for an ATV injury. An increase in ATV injuries year-on-year within the Waikato area was found. A large number of head injuries were found. Helmet compliance was low. Injury severity score was significantly higher in Maori than in NZ Europeans (mean 16.8 versus 10.0 (P = 0.04)) and was comparable between children and adults as well as men and women. Our results display a 42% rise in admission incidence from 2009 to 2010, resulting in increased hospital bed occupancy. If the current trend of a growing number of quad bike accidents was to continue, this could amount to a cost of NZ$1 467 344 in 2012 from ATV injuries in Waikato hospital alone. CONCLUSIONS: Quad bike injuries are an increasing burden on Waikato health care. The best strategy to tackle this epidemic needs to be further debated.

Trauma care in New Zealand: it's time to move ahead.

The quality of trauma care in New Zealand is good, but not optimal; it is characterized by skilled and dedicated staff relying on personal knowledge and institutional guidelines to deliver care. Quality assessment, standardization, and coordination of care continue to be hampered by the absence of a national trauma registry within the framework of a national trauma system. There is some hope that a planned regional pilot of the national trauma database will lead to more robust trauma system development, although this will only be achievable with solid governmental support.

Blunt cerebrovascular injury: an evaluation from a major trauma centre.

BACKGROUND: Blunt cerebrovascular injury (BCVI), although uncommon, is associated with substantial morbidity and mortality and remains poorly understood. This study was conducted to determine the pattern and outcome of BCVI at a major trauma centre. METHODS: A retrospective review of all trauma admissions between 1996 and 2004 at Liverpool Hospital, the major trauma service for south-west Sydney, was undertaken using the hospital's computerized trauma registry. RESULTS: Fourteen of the 7788 (0.18%) admitted blunt trauma patients sustained BCVI. Blunt carotid injury occurred in 10 of 14 and blunt vertebral injury occurred in 4 of 14 patients. Road trauma accounted for 9 of 14 cases. The median time to diagnosis was 2 days (range 1-45 days). The stroke rate was 36%, and the overall mortality was 29%. CONCLUSION: This study identified BCVI as a relatively infrequent occurrence but with significant mortality and morbidity rates. Practice guidelines for both the screening and management of this patient group need to be developed and introduced in this major trauma centre.