Trauma mortality declines in regional and remote NSW

7 November 2016

Hospital inpatient deaths caused by major trauma have fallen in regional NSW following changes to the state trauma management system, new research shows.

The study led by University of Sydney emergency medicine experts, Associate Professor Michael Dinh and Professor Kate Curtis and colleagues, analysed NSW trauma registry data to determine crude and risk-adjusted major trauma mortality rates in rural and metropolitan NSW between 2009 and 2014.

Patients included in the research were aged 16 years or more and had been hospitalised with major trauma.

The registry, established and maintained by the NSW Institute of Trauma and Injury  Management, receives data from seven major trauma centres and ten regional trauma centres, including the Abbreviated Injury Scale score, which codes injuries and their severity according to anatomic location and the likelihood of causing disability or death.

Overall, 11,423 patients were identified in the registry who met the inclusion criteria, 77 per cent of whom were injured in metropolitan areas. The average age of the patients was 53.5 years; 71.9 per cent were men, who were mostly injured in falls and road accidents.

The lack of overall improvement in major trauma mortality in metropolitan NSW remains a cause for concern.

The revised NSW State Trauma Plan, implemented in 2009, formalised rural and regional referral networks for each of the seven adult major trauma centres. The aim of these networks was to improve the timely transfer of severely injured patients from sparsely populated rural and remote areas of NSW to major trauma centres in metropolitan areas along the east coast.

The researchers found that the crude injury mortality rate had most markedly declined since the introduction of the revised plan among patients severely injured in outer regional and remote locations in NSW. There was also a reduction in risk-adjusted mortality associated with rural location of injury.

The authors suggest that the decrease could be explained by the establishment of trauma referral networks, which has resulted in more efficient transfers between rural facilities and major trauma centres.

Improved clinical care in regional trauma centres and rural referral centres may also have contributed to the decline. A core mission of the NSW Institute for Trauma and Injury Management over the past decade has been to coordinate and improve access to clinical expertise and education resources in these centres.

The lack of overall improvement in major trauma mortality in metropolitan NSW, however, was highlighted by the researchers as a cause for concern.

The researchers point to an ongoing need for quality improvements in the major trauma system in NSW, including improved networking of trauma centres with rural and remote regions and models of care that sustainably manage the growing proportion of older major trauma patients.

Dan Gaffney

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