Rural and urban patterns of severe injuries and hospital mortality in Australia: An analysis of the Australia New Zealand Trauma Registry: 2015–2019

Heathcote, Kathy; Devlin, Anna; McKie, Emily; Cameron, Peter; Earnest, Arul; Morgan, Geoffrey G.; Gardiner, Ben; Campbell, Don; Wullschleger, Martin; Warren, Jacelle

doi:10.1016/j.injury.2022.03.044

Cited by 8 publications

(7 citation statements)

References 58 publications

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“…With the reasonable assumption that most patients are injured in the area in which they reside, the patients injured in the trauma center’s primary area will in general have a lower NCI than the patients injured in the secondary area. Heathcote et al concluded in a recent study that compared to major cities, injuries occurring in rural areas of Australia often involve different mechanisms and result in different types of severe injury (Heathcote et al 2022 ). Injuries occurring outside peoples’ homes and traffic-related injuries ‘off road’ were more likely (Heathcote et al 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…Heathcote et al concluded in a recent study that compared to major cities, injuries occurring in rural areas of Australia often involve different mechanisms and result in different types of severe injury (Heathcote et al 2022 ). Injuries occurring outside peoples’ homes and traffic-related injuries ‘off road’ were more likely (Heathcote et al 2022 ). This could indicate a higher proportion of high-energy traumas and more severe injuries in less central areas.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study

et al. 2023

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Background Previous studies have demonstrated that the trauma population has needs for rehabilitation services that are best provided in a continuous and coordinated way. The discharge destination after acute care is the second step to ensuring quality of care. There is a lack of knowledge regarding the factors associated with the discharge destination for the overall trauma population. This paper aims to identify sociodemographic, geographical, and injury-related factors associated with discharge destination following acute care at trauma centers for patients with moderate-to-severe traumatic injuries. Methods A multicenter, population-based, prospective study was conducted with patients of all ages with traumatic injury [New Injury Severity Score (NISS) > 9] admitted within 72 h after the injury to regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Results In total, 601 patients were included; a majority (76%) sustained severe injuries, and 22% were discharged directly to specialized rehabilitation. Children were primarily discharged home, and most of the patients ≥ 65 years to their local hospital. Depending on the centrality of their residence [Norwegian Centrality Index (NCI) 1–6, where 1 is most central], we found that patients residing in NCI 3–4 and 5–6 areas sustained more severe injuries than patients residing in NCI 1–2 areas. An increase in the NISS, number of injuries, or a spinal injury with an Abbreviated Injury Scale (AIS) ≥ 3 was associated with discharge to local hospitals and specialized rehabilitation than to home. Patients with an AIS ≥ 3 head injury (RRR 6.1, 95% Confidence interval 2.80–13.38) were significantly more likely to be discharged to specialized rehabilitation than patients with a less severe head injury. Age < 18 years was negatively associated with discharge to a local hospital, while NCI 3–4, preinjury comorbidity, and increased severity of injuries in the lower extremities were positively associated. Conclusions Two-thirds of the patients sustained severe traumatic injury, and 22% were discharged directly to specialized rehabilitation. Age, centrality of the residence, preinjury comorbidity, injury severity, length of hospital stay, and the number and specific types of injuries were factors that had the greatest influence on discharge destination.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study

et al. 2023

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“…Finally, although hospitals in resource-rich populations have access to advanced imaging, this is not the case for health centers in resource-limited regions, such as rural towns or countries with many isolated or austere villages. In these locations, it is therefore imperative that patients with proximal aortic dissections are rapidly transported to centers with imaging and treatment capabilities 25 . Therefore, a means of accurately identifying patients with proximal aortic dissections is important for rural USA, Tanzania, or Australian Outback.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, we discovered that the systematic assessment of each sonographic feature has the potential to lower suspicion for proximal aortic dissections considering its reasonably high sensitivity (90.6%), high diagnostic odds ratio (25), low likelihood ratio (0.30), and low number needed to treat (1.58). Future studies should therefore investigate the development of pretest probability in the manner similar to the PERC and Wells score 22 , where the identification of a particular group in combination with negative ultrasound findings following the systematic assessment of any sonographic feature can efficiently rule out proximal aortic dissections with a high degree of confidence.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of transthoracic echocardiography for the identification of proximal aortic dissection: a systematic review and meta-analysis

Sutarjono

Ahmed

Иванова

et al. 2023

Sci Rep

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This systematic review and meta-analysis evaluated the performance of transthoracic echocardiography (TTE) for diagnosis of proximal aortic dissections based on the identification of specific sonographic features. A systematic literature search of major databases was conducted on human studies investigating the diagnostic accuracy of TTE for proximal aortic dissection. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of studies was evaluated using Quality Assessment of Diagnostic Accuracy Studies 2 tool. Data were gathered for the following sonographic findings: intimal flap, tear, or intramural hematoma; enlargement of aortic root or widening of aortic walls; aortic valve regurgitation; or pericardial effusion. Sensitivity, specificity, diagnostic odds ratio, number needed to diagnose values, and likelihood ratios were determined. Fourteen studies were included in our final analysis. More than half of the included studies demonstrated low risk of bias. The identification of intimal flap, tear, or intramural hematoma was shown to have an exceptional ability as a diagnostic tool to rule in proximal aortic dissections. TTE should be considered during the initial evaluation of patients presenting to the emergency department with suspected proximal aortic dissection. Positive sonographic findings on TTE may aid in rapid assessment, coordination of care, and treatment of individuals awaiting advanced imaging.

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“…Likewise, more rural hospitals may have patients with poorer baseline health and different patterns of disease presentation. [11,12] To adjust for these factors, some models include hospital complexity as a variable, or report adjusted hospital mortality within peer-ranked categories based on size or services offered. [13] Both resource availability and geographical location are important factors to consider when attempting to compare mortality rates between SA hospitals.…”

Section: Introductionmentioning

confidence: 99%

A critical analysis of Discovery Health’s claims-based risk adjustment of mortality rates in South African private sector hospitals

Rodseth

Smith²,

Maslo³

et al. 2022

S Afr Med J

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In 2019, Discovery Health published a risk adjustment model to determine standardised mortality rates across South African privatehospital systems, with the aim of contributing towards quality improvement in the private healthcare sector. However, the model suffers from limitations due to its design and its reliance on administrative data. The publication’s aim of facilitating transparency is unfortunately undermined by shortcomings in reporting. When designing a risk prediction model, patient-proximate variables with a sound theoretical or proven association with the outcome of interest should be used. The addition of key condition-specific clinical data points at the time of hospital admission will dramatically improve model performance. Performance could be further improved by using summary risk prediction scores such as the EUROSCORE II for coronary artery bypass graft surgery or the GRACE risk score for acute coronary syndrome. In general, model reporting should conform to published reporting standards, and attempts should be made to test model validity by using sensitivity analyses. In particular, the limitations of machine learning prediction models should be understood, and these models should be appropriately developed, evaluated and reported.

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Rural and urban patterns of severe injuries and hospital mortality in Australia: An analysis of the Australia New Zealand Trauma Registry: 2015–2019

Cited by 8 publications

References 58 publications

Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study

Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study

Diagnostic accuracy of transthoracic echocardiography for the identification of proximal aortic dissection: a systematic review and meta-analysis

A critical analysis of Discovery Health’s claims-based risk adjustment of mortality rates in South African private sector hospitals

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