A comparison of major trauma patient transport destination in metropolitan Perth, Western Australia

Abstract

Background: Despite evidence of a lower risk of death, major trauma patients are not always transported to Trauma Centres. This study compares and examines the characteristics and outcomes of major trauma patients between transport destinations. Methods: We undertook a retrospective cohort study of major trauma patients (Injury Severity Score >15) transported by ambulance. Cases were divided into three transport destination groups: (1) Direct, those who were transported to the Trauma Centre directly from the scene; (2) Indirect, those who were transported to another hospital prior to Trauma Centre transfer and (3) Non-transfers, those who were transported to a non-Trauma Centre and never subsequently transferred. Median and interquartile range (IQR) were used to describe the groups and group differences were assessed using the Kruskal-Wallis test for continuous variables and Pearson chi-square for categorical variables. Results: A total of 1,625 patients were included. The median age was oldest in the non-transfers cohort (72 years IQR 46-84). This group also had the highest proportion of falls from standing and major head injuries (n=298/400, 75%, p<0.001). The non-transfers had the highest proportion of 30day mortality (n=134/400, 34%). Conclusions: There were significant differences between the transport groups with older adults, falls and head injuries over-represented in the non-transfer group. Considering the ageing population, trauma systems will need to adapt.

Hospitalisations and in‐hospital deaths following moderate to severe traumatic brain injury in Australia, 2015–20: a registry data analysis for the Australian Traumatic Brain Injury National Data (ATBIND) project

“…The impetus for the ATBIND project was the dearth of recent national data on hospital discharge outcomes for people with moderate to severe TBI, particularly for Australia. [18][19][20][21] We found no change during 2015-20 in the in-hospital mortality…”

“…The impetus for the ATBIND project was the dearth of recent national data on hospital discharge outcomes for people with moderate to severe TBI, particularly for Australia 18‐21 . We found no change during 2015–20 in the in‐hospital mortality rate for people with moderate to severe TBI, nor evidence that injury prevention strategies and trauma care system interventions during this period reduced the incidence of moderate to severe TBI or the associated mortality rate.…”

Head injury in older adults presenting to the ambulance service: who do we convey to the emergency department, and what clinical variables are associated with an intracranial bleed? A retrospective case–control study

“…Older adults have gained considerable attention in trauma care research and remain a high priority; in the context of TBI, older adults typically find their care under-triaged and are more likely to suffer poor outcomes [ 4 ]. In addition, this growing patient population typically present with mild symptoms, even when they suffer significant tICH [ 5 ].…”