Major Trauma in NSW: 2016-17 · NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 iv Minor soft tissue injury is defined as a superficial injury including

NSW ITIM Major Trauma in NSW: 2016 - 2017 i

Major Trauma in NSW: 2016-17 A Report from the NSW Trauma Registry

NSW Institute of Trauma and Injury Management

NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 i

AGENCY FOR CLINICAL INNOVATION

Level 4, 67 Albert Avenue

Chatswood NSW 2067

PO Box 699 Chatswood NSW 2057

T +61 2 9464 4666 | F +61 2 9464 4728

E [email protected] | www.aci.health.nsw.gov.au

SHPN (ACI) 180677, ISBN 978-1-76000-990-8.

Produced by: NSW Institute of Trauma and Injury Management

Further copies of this publication can be obtained from

the Agency for Clinical Innovation website at www.aci.health.nsw.gov.au

Suggested citation: NSW Agency for Clinical Innovation. Major Trauma in NSW: 2016-17. Sydney: ACI; 2018.

Disclaimer: Content within this publication was accurate at the time of publication. This work is copyright. It may be

reproduced in whole or part for study or training purposes subject to the inclusion of an acknowledgment of the source.

It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above,

requires written permission from the Agency for Clinical Innovation.

Version: 1 Trim: ACI/D18/4085

© Agency for Clinical Innovation 2018

The Agency for Clinical Innovation (ACI) works with clinicians, consumers and managers to design and

promote better healthcare for NSW. It does this by:

service redesign and evaluation – applying redesign methodology to assist healthcare providers and

consumers to review and improve the quality, effectiveness and efficiency

of services

specialist advice on healthcare innovation – advising on the development, evaluation and adoption of

healthcare innovations from optimal use through to disinvestment

initiatives including guidelines and models of care – developing a range of evidence-based healthcare

improvement initiatives to benefit the NSW health system

implementation support – working with ACI Networks, consumers and healthcare providers to assist

delivery of healthcare innovations into practice across metropolitan and rural NSW

knowledge sharing – partnering with healthcare providers to support collaboration, learning capability

and knowledge sharing on healthcare innovation and improvement

continuous capability building – working with healthcare providers to build capability

in redesign, project management and change management through the Centre for Healthcare

Redesign.

ACI Clinical Networks, Taskforces and Institutes provide a unique forum for people to collaborate across

clinical specialties and regional and service boundaries to develop successful healthcare innovations.

A priority for the ACI is identifying unwarranted variation in clinical practice and working in partnership

with healthcare providers to develop mechanisms to improve clinical practice

and patient care.

www.aci.health.nsw.gov.au

http://www.aci.health.nsw.gov.au/

http://www.aci.health.nsw.gov.au/

NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 ii

Acknowledgements

The NSW Institute of Trauma and Injury Management wishes to acknowledge the NSW Trauma Services for their contribution of data to the NSW Trauma Registry.

ACI team

Hardeep Singh, Data Officer, NSW Institute of Trauma and Injury Management

Glenn Sisson, Project Officer, NSW Institute of Trauma and Injury Management

Pooria Sarrami, Research Officer, NSW Institute of Trauma and Injury Management

NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 iii

Glossary

Abbreviated Injury Scale (AIS) is an anatomically-based, consensus-derived, global severity

scoring system that classifies each injury by body region, according to its relative importance on a

six point ordinal scale. The AIS is the basis for the Injury Severity Score (ISS) calculation of the

multiply injured patient.

Case fatality rate is the proportion of deaths for a designated population expressed as a

percentage. The NSW Trauma Minimum Data Set does not include all survivors with an ISS of less

than or equal to 12. The case fatality rate in this report is only calculated on patients with an ISS of

greater than 12, and will be expressed as ‘case fatality rate for ISS >12’.

Definitive care is defined as the hospital providing the highest level of care to meet all the clinical

needs of the patient. Many patients receive definitive care at regional trauma services, but a small

number of patients are transferred to a major trauma service (higher level) for specialised care.

Geriatric population is defined as those aged 65 years or older.

Location of injury is defined as either metropolitan or rural based on the recorded postcode of

injury. The process used to define the two categories is outlined in Section 2 - Methodology.

Injury Severity Score (ISS) assesses the combined effects of the multiply injured patient and is

based on an anatomical injury severity classification, the AIS. The ISS is an internationally

recognised scoring system which correlates with mortality, morbidity and other measures of

severity. The ISS is calculated as the sum of the squares of the highest AIS code in each of the

three most severely injured ISS body regions.

ISS body regions consists of six anatomical regions as defined in the AIS dictionary:

head or neck

face

chest

abdominal or pelvic contents

extremities or pelvic girdle

external.

Isolated fractured neck of femur is defined as the AIS codes 853161.3 and 853162.3 and where

no other injury is recorded.

Major trauma is defined as all patients of any age, who were admitted to a designated NSW

trauma service within seven days of sustaining an injury, and:

had an ISS>12 (moderate to critically injured), or

were admitted to an intensive care unit (irrespective of ISS) following injury, or

died in hospital (irrespective of ISS) following injury, except those with an isolated fractured

neck of femur injury sustained from a fall from a standing height (<1 metre) and those aged

65 years or older who die with minor soft tissue injury only.

Major trauma services can provide the full spectrum of care for major and moderately injured

patients, from initial resuscitation through to rehabilitation and discharge. There are currently seven

adult and three paediatric designated major trauma services in NSW.

Mechanism of injury refers to the mechanisms whereby energy is transferred from the

environment to the person.

NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 iv

Minor soft tissue injury is defined as a superficial injury including abrasions, contusions, and

lacerations (AIS codes: 910000.1; 910200.1; 910400.1; 910600.1, 810099.1, 810202.1, 810402.1,

810600.1, 810602.1, 710099.1, 710202.1, 710402.1, 710600.1, 710602.1, 510099.1, 510202.1,

510402.1, 510600.1, 510602.1, 410099.1, 410202.1, 410402.1, 410600.1, 410602.1, 310099.1,

310202.1, 310402.1, 310600.1, 310602.1, 210099.1, 210202.1, 210402.1, 210600.1, 210602.1).

Other transport incident is defined as a patient involved in an accident involving a device

designed primarily for, or being used at the time primarily for, conveying persons or goods from

one place to another (ICD 10 codes: V00 – V99 inclusive) that did not meet place of occurrence

road trauma criteria.

Polytrauma is defined as serious injury (AIS severity >2) in two or more ISS body regions.

Regional trauma services can provide all aspects of care to patients with minor to moderate

trauma, and definitive care to a limited number of major trauma patients in collaboration with the

major trauma service. A regional trauma service provides initial assessment, stabilisation, definitive

care and initiates transfer to a major trauma service when a patient requires services not available

at the regional trauma service. There are currently ten designated regional trauma services in

NSW.

Road trauma is defined as a patient involved in an accident involving a device designed primarily

for, or being used at the time primarily for, conveying persons or goods from one place to another

(ICD 10 codes: V00 – V89 inclusive) AND had a street, highway and other paved roadways as the

place of occurrence of the external cause (ICD 10 codes: Y92.4 inclusive).

Revised Trauma Score is a physiological scoring system used for predicting death. It consists of

the first set of vital signs data obtained on the patient after arrival at hospital including Glasgow

Coma Scale, systolic blood pressure and respiratory rate. Values for the Revised Trauma Score

are in the range 0 to 7.8408. The lower the score, the higher the likelihood of death.

Standardised Mortality Ratio is a ratio between the observed number of deaths in a study

population and the number of deaths that would be expected, based on the age or ISS specific

rates in a standard population and the age or ISS distribution of the study population.

NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 v

Abbreviations

ASGS-RA Australian Statistical Geography Standard Remoteness Areas

AIS Abbreviated Injury Scale

ARIA+ Accessibility and Remoteness Index of Australia

ED Emergency department

ICD International Classification of Diseases

ICU Intensive care unit

ISS Injury Severity Score

ITIM NSW Institute of Trauma and Injury Management

LOS Length of stay

MTS Major trauma service

ORIF Open reduction internal fixation

PTS Paediatric trauma service

RTS Regional trauma service

NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 vi

Executive summary

Each year approximately 4,000 people are admitted to a NSW trauma service for injuries defined

as major trauma. How the NSW trauma system responds to these patients is critical for their

long-term outcome and quality of life and for reducing the overall financial and social cost of

trauma to individuals and the community as a whole.

A key priority for the NSW Institute of Trauma and Injury Management (ITIM), within the Agency for

Clinical Innovation, is to monitor the effectiveness of the NSW trauma system response to these

major trauma patients. This group of patients places the greatest demand on the trauma system

and on other agencies and services, not simply for health care, but for a wide range of needs.

This report describes how the NSW trauma system responded to major trauma patients, from the

time of injury and provision of pre-hospital services, through to in-hospital services provided at a

NSW trauma service. The report investigates the data to determine whether the NSW trauma

system is functioning effectively, to ensure that the right patient arrived at the right hospital in a

timely matter.

The report helps us understand the nature of the injuries sustained and how they occurred. The

findings are used by various agencies concerned with minimising the likelihood and effects of

traumatic injury and contributing to safety and injury prevention efforts. Data from the NSW Trauma

Registry is used by ITIM to provide advice and feedback to clinicians and other stakeholders and

enables research into patterns of service demand and staffing. This data also supports

benchmarking and performance improvement activities.

It is important to note that this report does not represent all injuries in NSW, nor does it represent

the full work or caseload of trauma services in hospitals or the full set of data recorded in hospital

trauma registries.

2016-17 report highlights for major trauma in NSW

3845 major trauma patients resulted in 3961 major trauma admissions.

Average age was 52 years old.

Males were 2.5 times more likely to be injured than females.

Case fatality rate for ISS>12 was 10.2%.

Females had a higher case fatality rate (13.2%) compared to males (9.0%).

Falls accounted for 44.2% of all major traumas, exceeding transport incidents (37.6%).

‘Three or more fractured ribs without flail’ was the most common serious injury (15.7%).

25.5% of major traumas were sustained in a rural area.

The greatest proportion of traumatic injuries was falls in the metro setting (50.2%), and

transport incidents in the rural setting (52.2%).

Pedestrian traumas had a significantly higher case fatality rate (17.0%) than all other

forms of road trauma.

61.0% of major trauma patients sustained injuries to the head or neck body region, and

49.2% the chest region.

NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 vii

Contents

Acknowledgements ...................................................................................................................... ii

Glossary ....................................................................................................................................... iii

Abbreviations ................................................................................................................................ v

Executive summary ..................................................................................................................... vi

Contents ...................................................................................................................................... vii

List of tables ......................................................................................................................... ix

List of figures ......................................................................................................................... x

Monitoring the NSW trauma system ............................................................................................ 1

NSW trauma system .............................................................................................................. 1

Mandate for trauma data ........................................................................................................ 1

NSW Trauma Registry ........................................................................................................... 1

NSW trauma services ............................................................................................................ 2

Methodology ................................................................................................................................. 3

Inclusion criteria ..................................................................................................................... 3

Exclusion criteria .................................................................................................................... 3

Data quality ............................................................................................................................ 3

The Injury Severity Score and Abbreviated Injury Score ........................................................ 4

Revised Trauma Score .......................................................................................................... 5

Metropolitan and rural categorisation ..................................................................................... 5

Major trauma patients ................................................................................................................... 6

Introduction ............................................................................................................................ 6

Summary profile ..................................................................................................................... 6

Age and gender ..................................................................................................................... 8

Mechanism of injury ............................................................................................................. 11

Transport incidents by place of occurrence .......................................................................... 19

Time and day of injury .......................................................................................................... 21

Injuries ................................................................................................................................. 22

Injury Severity Score ............................................................................................................ 24

Pre-hospital time .................................................................................................................. 25

Mode of transport ................................................................................................................. 26

NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 viii

Major trauma admissions ........................................................................................................... 28

Introduction .......................................................................................................................... 28

Facility overview .................................................................................................................. 28

Admission type .................................................................................................................... 29

Revised Trauma Score ........................................................................................................ 29

Trauma team activation ....................................................................................................... 30

Vital signs on arrival to the emergency department .............................................................. 32

Intensive care unit admissions ............................................................................................. 33

Length of stay ...................................................................................................................... 34

Procedures .......................................................................................................................... 36

Discharge destination of survivors ....................................................................................... 37

Appendices ................................................................................................................................. 39

Appendix 1: Data completeness........................................................................................... 40

Appendix 2: Adult major trauma service summaries............................................................. 43

Appendix 3: Paediatric major trauma service summaries ..................................................... 57

Appendix 4: Regional trauma service summaries ................................................................ 63

Appendix 5: Calculation of the Injury Severity Score ............................................................ 83

Appendix 6: Australian Statistical Geography Standard Remoteness Areas ........................ 84

NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 ix

List of tables

Table 1: Record of data exclusions ................................................................................................................... 4

Table 2: Revised Trauma Score points system ................................................................................................. 5

Table 3: Summary statistics for major trauma and mortality ............................................................................. 6

Table 4: Major trauma patients, injury and mortality by age group ................................................................... 8

Table 5: Type of injury ..................................................................................................................................... 11

Table 6: Mechanism of injury by age ............................................................................................................... 13

Table 7: Mechanism of injury by location ........................................................................................................ 16

Table 8: Falls in detail ...................................................................................................................................... 17

Table 9: Transport incidents in detail ............................................................................................................... 17

Table 10: Assaults in detail .............................................................................................................................. 18

Table 11: All other mechanisms in detail ......................................................................................................... 18

Table 12: Transport incidents by location of injury .......................................................................................... 19

Table 13: Road trauma in detail ...................................................................................................................... 19

Table 14: Other transport incidents in detail .................................................................................................... 20

Table 15: Top 5 injuries with an AIS severity >2 ............................................................................................. 22

Table 16: Number of ISS body regions injured with an AIS severity >2 ......................................................... 23

Table 17: Single body region versus polytrauma with an AIS severity >2 ...................................................... 23

Table 18: Major trauma patients by ISS group ................................................................................................ 24

Table 19: Median time of injury to arrival at a designated trauma service ...................................................... 25

Table 20: Median time of injury to arrival at definitive care ............................................................................. 26

Table 21: Mode of transport to definitive care ................................................................................................. 26

Table 22: Overview of trauma service admissions .......................................................................................... 28

Table 23: Number of admissions by type ........................................................................................................ 29

Table 24: Overview of ICU and hospital length of stay ................................................................................... 34

Table 25: ICU and hospital length of stay by ISS ............................................................................................ 34

Table 26: ICU and hospital length of stay by age ............................................................................................ 35

Table 27: Procedures performed by type ........................................................................................................ 36

Table 28: Detailed data completeness by facility ............................................................................................ 41

Table 29: Trauma data profile, John Hunter Hospital ...................................................................................... 43

Table 30: Trauma data profile, Liverpool Hospital ........................................................................................... 45

Table 31: Trauma data profile, Royal North Shore Hospital............................................................................ 47

Table 32: Trauma data profile, Royal Prince Alfred Hospital .......................................................................... 49

Table 33: Trauma data profile, St George Hospital ......................................................................................... 51

Table 34: Trauma data profile, St Vincent’s Hospital ...................................................................................... 53

Table 35: Trauma data profile, Westmead Hospital ........................................................................................ 55

Table 36: Trauma data profile, John Hunter Children’s Hospital .................................................................... 57

Table 37: Trauma data profile, Sydney Children’s Hospital ............................................................................ 59

Table 38: Trauma data profile, The Children’s Hospital at Westmead ............................................................ 61

Table 39: Trauma data profile, Coffs Harbour Health Campus ....................................................................... 63

Table 40: Trauma data profile, Gosford Hospital ............................................................................................ 65

Table 41: Trauma data profile, Lismore Base Hospital ................................................................................... 67

Table 42: Trauma data profile, Nepean Hospital ............................................................................................. 69

Table 43: Trauma data profile, Orange Health Service ................................................................................... 71

Table 44: Trauma data profile, Port Macquarie Base Hospital........................................................................ 73

Table 45: Trauma data profile, Tamworth Rural Referral Hospital .................................................................. 75

Table 46: Trauma data profile, The Tweed Hospital ....................................................................................... 77

Table 47: Trauma data profile, Wagga Wagga Rural Referral Hospital .......................................................... 79

Table 48: Trauma data profile, Wollongong Hospital ...................................................................................... 81

Table 49: ISS calculation example .................................................................................................................. 83

NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 x

List of figures

Figure 1: Five year trend in the number of major trauma patients .................................................................... 7

Figure 2: Five year trend in the number of major trauma patients by facility type............................................. 7

Figure 3: Number of major trauma patients by age, gender and mortality ........................................................ 9

Figure 4: Age-specific injury rate by age and gender ........................................................................................ 9

Figure 5: Case fatality rate by age and gender (ISS>12) ................................................................................ 10

Figure 6: Age-specific mortality rate by age and gender ................................................................................. 10

Figure 7: Five year trend of mortality rate by facility type (ISS>12) ................................................................ 11

Figure 8: Mechanism of injury ......................................................................................................................... 12

Figure 9: Five year trend in the number of falls and transport incidents ......................................................... 14

Figure 10: Mechanism of injury by age ............................................................................................................ 14

Figure 11: Mechanism of injury as a percentage by age ................................................................................. 15

Figure 12: Age-specific injury rate by mechanism of injury ............................................................................. 15

Figure 13: Mechanism of injury by location ..................................................................................................... 16

Figure 14: Mechanism of injury as a percentage by location .......................................................................... 16

Figure 15: Number of patients by time of injury ............................................................................................... 21

Figure 16: Number of patients by day of injury ................................................................................................ 21

Figure 17: All injuries by ISS body region ........................................................................................................ 22

Figure 18: Number of major trauma patients by ISS group and gender ......................................................... 24

Figure 19: Case fatality rate by ISS and gender ............................................................................................. 25

Figure 20: Mode of transport to definitive care when transported direct from the scene of injury, by injury

location............................................................................................................................................................. 27

Figure 21: Mode of transport to definitive care when transferred from another acute care facility, by injury

location............................................................................................................................................................. 27

Figure 22: Average Revised Trauma Score by ISS group .............................................................................. 29

Figure 23: Trauma team activation by admission type .................................................................................... 30

Figure 24: Trauma team activation by ISS group ............................................................................................ 31

Figure 25: Initial systolic blood pressure on arrival to the ED and mortality .................................................... 32

Figure 26: Initial Glasgow Coma Scale on arrival to the ED and mortality ...................................................... 32

Figure 27: Initial temperature on arrival to ED and mortality ........................................................................... 33

Figure 28: ICU admission by ISS group .......................................................................................................... 33

Figure 29: Procedures performed by ISS group .............................................................................................. 36

Figure 30: Five year trend of procedures performed ....................................................................................... 37

Figure 31: Discharge destination of survivors ................................................................................................. 37

Figure 32: Discharge destination of survivors by ISS group ........................................................................... 38

Figure 33: Overall data completeness by facility ............................................................................................. 40

Figure 33: Map of 2016 Remoteness areas for Australia ................................................................................ 84

NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 1

Monitoring the NSW trauma system

NSW trauma system

The primary function of the NSW trauma system is to facilitate and coordinate an organised

multidisciplinary system response with the aim of reducing the burden of injury. The system

encompasses a continuum of care that provides traumatically injured patients with the greatest

likelihood of returning to their pre-injury level of function within the community.

This continuum of care includes injury prevention, pre-hospital coordination and care, appropriate

triage and transport, emergency department trauma care, trauma service team activation, surgical

intervention, intensive or critical and general in-hospital care, rehabilitation services, allied health

and medical care follow up.

The overall goal of the NSW trauma system is to decrease the incidence and severity of injury and

to ensure optimal, accessible and equitable care to improve health outcomes for those who are

injured. The main objective of the trauma system is to get the ‘right patient to the right hospital in

the right time, receiving the right care.’ To meet this objective, designated trauma services need to

have appropriate resources to meet the complex needs of the injured patient.

Mandate for trauma data

The NSW Trauma Services Plan (2009) outlines the role of the NSW Institute of Trauma and Injury

Management (ITIM), including monitoring and reporting on the performance of individual trauma

services to ensure that performance is consistent with the standard of care and to manage a

statewide clinical injury data collection process.

The plan also positions ITIM to develop partnerships with injury stakeholders, such as the local

health districts, NSW Ambulance, State Insurance Regulatory Authority, State Coroner, Clinical

Excellence Commission and universities. These partnerships aim to build an improved critical

mass for research and education across the spectrum of trauma prevention care and rehabilitation.

The collection of trauma data is an important aspect of these activities.

NSW Trauma Registry

ITIM is responsible for managing the collection of data about moderate to critically injured people

admitted to trauma services in NSW. Data collected is held securely in the NSW Trauma Registry.

Data in the registry is submitted from each of the designated NSW trauma services.

The NSW Trauma Registry contains de-identified patient records, but does not hold data for every

injured person admitted to hospital in NSW. Data is only included for patients with the greatest

needs, the most seriously injured, who are treated at a designated NSW trauma service. This data

is known as the NSW Trauma Minimum Data Set and forms the basis of data analysis and

reporting activities at ITIM. As the scope of the current data collection is restricted to these

designated hospitals, there may be some data for trauma admissions to other hospitals that are not

included in the NSW Trauma Registry.


NSW trauma services

The NSW trauma system consists of seven adult major trauma services, three paediatric major

trauma services and ten regional trauma services. All of the services contributed data to the NSW

Trauma Registry used in this report.

Adult major trauma services

John Hunter Hospital

Liverpool Hospital

Royal North Shore Hospital

Royal Prince Alfred Hospital

St George Hospital

St Vincent's Hospital

Westmead Hospital

Paediatric major trauma services

John Hunter Children's Hospital

Sydney Children's Hospital

The Children's Hospital at Westmead

Regional trauma services

Coffs Harbour Health Campus

Gosford Hospital

Lismore Base Hospital

Nepean Hospital

Orange Health Service

Port Macquarie Base Hospital

Tamworth Hospital

The Tweed Hospital

Wagga Wagga Rural Referral Hospital

Wollongong Hospital


Methodology

This report is compiled from data submitted by reporting facilities to the NSW Trauma Registry in

accordance with the inclusion and exclusion criteria detailed below. Data for this report was

extracted from the NSW Trauma Registry on 19 May 2018.

Inclusion criteria

All major trauma patient records from the NSW Trauma Registry, where the date of injury occurred

between 1 July 2016 and 30 June 2017, are included in this report.

Major trauma is defined as all patients of any age, who were admitted to a NSW trauma service

within seven days of sustaining an injury, and who:

had an Injury Severity Score (ISS)>12 (moderate to critically injured), or

were admitted to an intensive care unit (irrespective of ISS) following injury, or

died in hospital (irrespective of ISS) following injury.

As a result of these criteria, patient records submitted for inclusion in this report do not represent

all injuries in NSW, nor do they represent the full work or caseload of trauma services in hospitals,

nor the full set of data recorded in hospital trauma registries.

Exclusion criteria

The criteria for excluding a patient record from this report are as follows.

Patients not admitted to a designated NSW trauma service.

Patients admitted to a designated NSW trauma service greater than seven days after

sustaining an injury.

Patients who die with an isolated fractured neck of femur injury sustained from a fall from a

standing height (<1 metre)1

Patients aged 65 years or older who die with minor soft tissue injury only.2

Records have also been excluded from this report if the Outcome (survived or died) data element

is missing or invalid data recorded in the registry.

Based on the criteria outlined above, a total of 61 records were excluded as outlined in Table 1.

Data quality

Data submitted to the NSW Trauma Registry is subject to rigorous checking and validation by ITIM

and the reporting facilities while missing or invalid data is flagged and returned to individual trauma

services for completion and validation.

The average data completeness by the trauma facilities was 87.4%. A detailed breakdown of data

completeness by trauma facility is available in Appendix 1.

1 See Glossary for definition of an isolated fractured neck of femur injury.

2 See Glossary for definition of a minor soft tissue injury.


Table 1: Record of data exclusions

Data criteria Excluded Remaining records

Data extracted (19 May 2018) ISS>12, or had ICU admission, or died

N/A 4022

Exclusions

Date of admission >7 days from injury 48 3974

Isolated neck of femur injuries (with outcome = died) 11 3963

Over 65yrs old and died with minor soft tissue injury only 0 3963

Missing outcome 2 3961

Total remaining records 3961

The Injury Severity Score and Abbreviated Injury Score

One of the key criteria for inclusion in this report is an Injury Severity Score (ISS) >12. The ISS is

an internationally recognised scoring system which correlates with mortality, morbidity and other

measures of severity. The ISS is calculated based on an anatomical injury severity classification,

the Abbreviated Injury Scale (AIS). The AIS classifies individual injuries by body region on a six

point severity scale from minor (1) to maximum (6 - currently untreatable injury). The NSW Trauma

Registry uses the AIS 2005 (Update 2008) dictionary.

The AIS is used by accredited staff at each hospital to score individual patient injuries and their

severity. It provides a common tool for comparing and selecting patient records for inclusion in the

NSW Trauma Registry. Scoring is undertaken retrospectively but usually within 24-48 hours after

admission to allow for identification of all injuries. On initial evaluation, these patients typically have

abnormal vital signs or a significant anatomical injury.

Injuries are individually allocated to one of six body regions and the severities of the top three

injuries in different body regions are used to calculate the ISS. The ISS along with the body regions

and injury and severity codes used in this calculation are recorded in the NSW Trauma Registry

(see Appendix 5 for further detail).

The calculated ISS value ranges from 1-75. Serious to critically injured trauma patients are defined

as those patients with an ISS >15, which is an internationally recognised indicator of serious injury.

In this report the ISS is reported in ranges:

13-15 (moderate injury)

16-24 (serious injury)

25-40 (severe injury)

41-75 (critical injury).


Revised Trauma Score

The Revised Trauma Score is a physiological scoring system used as a predictor of mortality in

trauma populations. It consists of data from the first set of vital signs obtained on arrival at hospital,

including the Glasgow Coma Scale, systolic blood pressure and respiratory rate. Each element is

scored with a weighting as outlined in Table 2.3 Values for the Revised Trauma Score are in the

range 0 to 7.8408. The lower the score, the higher the likelihood of death.

Table 2: Revised Trauma Score points system

Glasgow Coma Scale

Systolic blood pressure

Respiratory rate Points

15-13 >89 10-29 4

12-9 76-89 >29 3

8-6 50-75 6-9 2

5-4 1-49 1-5 1

3 0 0 0

Revised Trauma Score = 0.9368 Glasgow Coma Scale + 0.7326 systolic blood pressure + 0.2908 respiratory rate

Metropolitan and rural categorisation

Various data elements within the report are categorised as either ‘Metropolitan’ or ‘Rural’. These

categories are derived using the postcode of injury and the Australian Statistical Geography

Standard (ASGS) Remoteness Areas (RA). The ASGS-RA is based on the Accessibility and

Remoteness Index of Australia which defines locations in terms of remoteness, i.e. the physical

distance of a location from the nearest urban centre (access to goods and services) based on

population size.

The ASGS-RA (2016) consists of five categories:

major cities

inner regional

outer regional

remote

very remote.

For the purpose of this report, all locations with the ASGS-RA classification of ‘Major cities’ are

listed as ‘Metropolitan’. All other ASGS-RA classified locations are combined and listed as ‘Rural’.

For further information and an overview map of the ASGS-RA categorisation of NSW, please see

Appendix 6.

3 Champion HR et al, "A Revision of the Trauma Score", J Trauma, 1989; 29:623-629.


Major trauma patients

Introduction

The information in this section of the report is based on the number of major trauma patients who

received care in a NSW trauma service (n=3845), not the number of trauma admissions (n=3961),

as some patients were treated in more than one NSW reporting facility. Trauma admission data

(hospital activity) is discussed in detail in the Major trauma admissions section.

Summary profile

During the period 1 July 2016 to 30 June 2017, there were 3845 major trauma patients treated at

NSW trauma services. Of these, 74.5% (n=2709)4 were injured in a metropolitan location and 428

died (case fatality rate for ISS >12 of 10.2%). The age-standardised injury rate was 47.8 per

100,000 persons5 and the age-standardised death rate was 4.4 per 100,000 persons.5 The

standardised mortality ratio6 was 4.1, indicating that the proportion of deaths in major trauma

patients during the reporting period was more than four times greater than that of the general

Australian population (Table 3).

Table 3: Summary statistics for major trauma and mortality

Summary statistics Value

Total number of patients injured overall 3845

Total number of patients injured with ISS >12 3363

Injury rate per 100,000 persons (age-standardised)5 48.9 (95% CI 47.8 - 50)

Location of injury (metropolitan / rural)4 2709 (74.5%) / 929 (25.5%)

Total number of deaths overall 428

Total number of deaths with ISS >12 (case fatality rate) 343 (10.2%)

Death rate per 100,000 persons (age-standardised)5 4.4 (95% CI 3.6 - 5.1)

Standardised mortality ratio 4.1 (95% CI 3.6 – 4.5)

Average age (years) 52

Average Injury Severity Score (ISS) 19.0

4 207 records were excluded due to location of injury being recorded as overseas, not applicable or not recorded. 5 Annualised rate given as per 100,000 persons, standardised to the Australian population at 30 June 2001. Source: Australian Bureau

of Statistics. Australian Demographic Statistics, Mar 2013. Catalogue No. 3101. Canberra: ABS, Dec 2013. 6 See Glossary for definition of the standardised mortality ratio. Standardised to the Australian population at 30 June 2001. Source:

Australian Bureau of Statistics. Australian Demographic Statistics, Jun 2013. Catalogue No. 3101. Canberra: ABS, Dec 2013.


Over the previous four years, there has been a steady increase in the number of major trauma

patients, but in the 2016-17 financial year there was a 4.9% decrease (Figure 1).

Figure 1: Five year trend in the number of major trauma patients (n=19,168)

The largest proportional decrease in 2016-17 was seen in the paediatric trauma services (-14.0%),

compared to adult major trauma services (-4.3%) and regional trauma services (-3.9%), as seen in

Figure 2.

Figure 2: Five year trend in the number of major trauma patients by facility type (n=19,168)

3611

3776

3893

4043

3845

3300

3400

3500

3600

3700

3800

3900

4000

4100

2012-13 2013-14 2014-15 2015-16 2016-17

Financial year

Num

ber

of

patients

0

500

1000

1500

2000

2500

3000

3500

2012-13 2013-14 2014-15 2015-16 2016-17

Num

ber

of

patients

Financial year

MTS

PTS

RTS


Age and gender

The average age of a major trauma patient in NSW during the reporting period was 52 years old.

Table 4 outlines the age distribution, which demonstrates a sharp rise in the incidence of major

trauma in the geriatric population,7 especially those aged 75 years and older, as it has in previous

years. The 75 years and older age group also had a higher case fatality rate for ISS >12 (17.7%,

n=779) compared with the under 75 years age group (7.9%, n= 2583).

Table 4: Major trauma patients, injury and mortality by age group (n=3844)8

Age group (years)

Number of injured

(% of total)

Cumulative number of

injured (% of total)

Age-specific injury rate

per 100,0009

Age-specific death rate

per 100,0009

Case fatality rate

(ISS >12)

0-4 90 (2.3%) 90 (2.3%) 18.2 1.8 12.5%

5-9 43 (1.1%) 133 (3.5%) 8.5 0.6 8.8%

10-14 56 (1.5%) 189 (4.9%) 12.0 0.4 4.3%

15-19 206 (5.4%) 395 (10.3%) 43.8 3.4 8.5%

20-24 269 (7%) 664 (17.3%) 49.8 3.1 6.8%

25-29 226 (5.9%) 890 (23.2%) 38.3 3.1 8.9%

30-34 210 (5.5%) 1100 (28.6%) 36.0 2.2 7.1%

35-39 206 (5.4%) 1306 (34%) 38.7 2.4 7.5%

40-44 214 (5.6%) 1520 (39.5%) 41.9 1.2 3.1%

45-49 235 (6.1%) 1755 (45.7%) 45.7 2.9 5.7%

50-54 246 (6.4%) 2001 (52.1%) 50.5 3.5 6.5%

55-59 284 (7.4%) 2285 (59.4%) 58.5 3.7 6.1%

60-64 221 (5.7%) 2506 (65.2%) 51.2 3.9 7.0%

65-69 220 (5.7%) 2726 (70.9%) 57.0 7.0 12.7%

70-74 220 (5.7%) 2946 (76.6%) 70.0 10.8 15.3%

75-79 231 (6%) 3177 (82.6%) 103.0 18.7 12.9%

80-84 247 (6.4%) 3424 (89.1%) 156.2 28.5 15.2%

85 and over 420 (10.9%) 3844 (100%) 247.2 68.3 22.0%

7 Geriatric defined as aged 65 years and older. 8 1 record excluded due to age not recorded. 9 Annualised rate given as per 100,000 persons, based on the estimated NSW population at 30 June 2017. Source: Australian Bureau

of Statistics. Australian Demographic Statistics, Catalogue No. 31010. Canberra: ABS, Sept 2017.


Males have a higher number of major trauma injuries (n=2741) compared to females (n=1103),

except in the 85 years old and over age groups (Figure 3). Overall, males are 2.5 times more likely

to be injured than females.

Figure 3: Number of major trauma patients by age, gender and mortality (n=3844)8

The age-specific injury rate for males ranged from 5.2 to 114.8 per 100,000 persons and in

females ranged 3.4 to 132.4 per 100,000 persons (Figure 4).9

Figure 4: Age-specific injury rate by age and gender (n=3844)8,9

0

20

40

60

80

100

120

140

160

180

200

220

Num

ber

of

patients

Age group

Died - Male

Died - Female

Survived - Male

Survived - Female

0

20

40

60

80

100

120

140

Age-s

pecific

rate

(in

jury

/100,0

00)

Age group

Males

Females


The case fatality rate for ISS >12 (n=3363) was higher for females (13.2%, n=127) than for males

(9.0%, n=216), with the overall case fatality rate being 10.2% (Figure 5).

Figure 5: Case fatality rate by age and gender (ISS>12) (n=3363)

While females have a higher case fatality rate for ISS >12, males have a higher age-specific

mortality rate per 100,000 persons (Figure 6).9

Figure 6: Age-specific mortality rate by age and gender (n=3844)8,9

0%

5%

10%

15%

20%

25%

30%

Case f

ata

lity

rate

Age group

Males

Females

0

20

40

60

80

100

120

Age-s

pecific

rate

(in

jury

/100,0

00)

Age group

Males

Females


Figure 7 shows the five year trend of mortality rates (ISS>12) for the three facility types. Overall,

the mortality rate has decreased from 10.7% to 10.2% during the last five years.

Figure 7: Five year trend of mortality rate by facility type (ISS>12) (n=16,764)

Mechanism of injury

The vast majority of major trauma in NSW in the reporting period was caused by blunt injuries

(95.8%), such as falls and motor vehicle collisions (Table 5).

Table 5: Type of injury (n=3728)10

Type of injury Number of patients

(% of total) Case fatality rate

(ISS >12)

Blunt 3570 (95.8%) 9.5%

Penetrating 158 (4.2%) 12.3%

The top three mechanisms of major trauma were:

falls (44.2%, n=1699)

transport incidents (37.6%, n=1447) out of which 1112 were road trauma incidents11

assaults (7.0%, n=268).

All other mechanisms combined accounted for 11.2% (n=431) (Figure 8). The distribution of these

mechanisms of injury by age group is demonstrated in Table 6.

10 Only blunt and penetrating injury types are reported. Other injury types (n=117) are recorded as ‘N/A’ or ‘Unknown'.

11 See Glossary for the definition of road trauma.

4%

5%

6%

7%

8%

9%

10%

11%

12%

2012-13 2013-14 2014-15 2015-16 2016-17

Mort

alit

y ra

te

Financial year

MTS

PTS

RTS

Overall


Figure 8: Mechanism of injury (n=3485)

1699

1447

268

431

0

200

400

600

800

1000

1200

1400

1600

1800

Falls Transport incident Assault All other mechanisms

Num

ber

of

patients

Mechanism of injury


Table 6: Mechanism of injury by age (n=3844)8

Age group

Number of patients (age-specific rate per 100,000)9

Falls Transport incident

Assault All other

mechanisms

0-4 38 (7.7) 14 (2.8) 6 (1.2) 32 (6.5)

5-9 14 (2.8) 18 (3.6) 0 (0) 11 (2.2)

10-14 23 (4.9) 24 (5.2) 0 (0) 9 (1.9)

15-19 31 (6.6) 102 (21.7) 24 (5.1) 49 (10.4)

20-24 59 (10.9) 135 (25) 38 (7) 37 (6.9)

25-29 42 (7.1) 110 (18.6) 31 (5.3) 43 (7.3)

30-34 47 (8.1) 108 (18.5) 27 (4.6) 28 (4.8)

35-39 54 (10.2) 93 (17.5) 30 (5.6) 29 (5.5)

40-44 56 (11) 106 (20.8) 25 (4.9) 27 (5.3)

45-49 73 (14.2) 106 (20.6) 29 (5.6) 27 (5.3)

50-54 77 (15.8) 121 (24.8) 20 (4.1) 28 (5.7)

55-59 93 (19.2) 137 (28.2) 22 (4.5) 32 (6.6)

60-64 99 (22.9) 93 (21.5) 6 (1.4) 23 (5.3)

65-69 133 (34.5) 65 (16.8) 4 (1) 18 (4.7)

70-74 130 (41.4) 74 (23.5) 2 (0.6) 14 (4.5)

75-79 174 (77.6) 49 (21.9) 3 (1.3) 5 (2.2)

80-84 202 (127.7) 32 (20.2) 1 (0.6) 12 (7.6)

85 and over 354 (208.4) 60 (35.3) 0 (0) 6 (3.5)

Total 1699 1447 268 430


Figure 9 shows the five year trend of the increasing percentage of falls and the decreasing

percentage of transport incidents resulting in major trauma.

Figure 9: Five year trend in the number of falls and transport incidents (n=16,124)

The greatest burden of major trauma for people aged 65 years and older is falls (74.2%, n=993),

whilst for those aged under 65 years it is transport incidents (46.6%, n=1167).

The highest incidence of assaults are in the 20-24 years age group (14%, n=38). See Table 6 and

Figures 10-12.

Figure 10: Mechanism of injury by age (n=3844)8

35%

36%

37%

38%

39%

40%

41%

42%

43%

44%

45%

2012-13 2013-14 2014-15 2015-16 2016-17

Perc

enta

ge b

y m

echanis

m

Financial year

Falls

Transportincident

0

50

100

150

200

250

300

350

400

Num

ber

of

patients

Age group

Falls

Transport incident

Assault

All other mechanisms


Figure 11: Mechanism of injury as a percentage by age (n=3844)8

Figure 12: Age-specific injury rate by mechanism of injury (n=2042)8,9

Falls were responsible for 50.2% of the injuries in the metropolitan area, compared to 29% in rural

areas.

Transport incidents accounted for a higher percentage of injuries in rural areas, 52.2%, than in

metropolitan areas, 32.1% (Table 7, Figures 13-14).

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Perc

enta

ge b

y age

Age group

Falls

Transport incident

Assault

All othermechanisms

0

20

40

60

80

100

120

140

160

180

200

220

Age-s

pecific

rate

(in

jury

/100,0

00)

Age group

Falls

Transport incident

Assault

All other mechanisms


Table 7: Mechanism of injury by location (n=3638)4

Mechanism of Injury Metropolitan

(% of metropolitan) Rural

(% of rural)

Falls 1360 (50.2%) 269 (29.0%)

Transport incident 870 (32.1%) 485 (52.2%)

Assault 197 (7.3%) 48 (5.2%)

All other mechanisms 282 (10.4%) 127 (13.7%)

Total 2709 (74.5%) 929 (25.5%)

Figure 13: Mechanism of injury by location (n=3638)4

Figure 14: Mechanism of injury as a percentage by location (n=3638)4

1360

870

197282269

485

48127

0

200

400

600

800

1000

1200

1400

1600


Num

ber

of

patients

Mechanism of injury

Metro

Rural

50.2%

32.1%

7.3%10.4%

29.0%

52.2%

5.2%

13.7%

0%

10%

20%

30%

40%

50%

60%


Perc

enta

ge b

y lo

cation

Mechanim of injury

Metro

Rural


The mechanisms of injury are outlined in more detail in Tables 7-10.

Falls from a standing height (lowest level, <1m) accounted for the greatest burden of all heights.

They accounted for 61.4% of all falls, 26.6% of all trauma mechanisms, 41.4% of all trauma

deaths, and had case fatality rate for ISS >12 of 13.7% (Table 8).

Table 8: Falls in detail (n=1669)

Mechanism Number injured

(% of all mechanisms)

Number of deaths, ISS >12

(case fatality rate)

Percentage of all trauma deaths

Low (<1m) 1024 (26.6%) 121 (13.7%) 41.4%

Medium (1-5m) 488 (12.7%) 37 (8.3%) 10.5%

High (>5m) 123 (3.2%) 12 (10.2%) 2.8%

Unspecified 34 (0.9%) 0 (0%) 0%

Total 1669 (43.4%) 170 (11.5%) 54.7%

Pedestrian trauma had the highest case fatality rate for ISS >12 (17%), well above other forms of

road trauma (Table 9).

Table 9: Transport incidents in detail (n=1447)






Car occupant 522 (13.6%) 38 (8.2%) 9.8%

Motorcycle rider 410 (10.7%) 13 (3.4%) 3%

Pedestrian 220 (5.7%) 35 (17%) 8.4%

Pedal cyclist 159 (4.1%) 1 (0.6%) 0.2%

All other transport 136 (3.5%) 3 (2.5%) 0.7%

Total 1447 (37.6%) 90 (6.7%) 22.2%

The most common mechanisms of injury in the assault group were assaults involving bodily force

(n=97, 2.5%), stabbing (n=43, 1.1%), and assault by blunt object (n=35, 0.9%). In comparison

there were only 13 recorded cases of shooting (0.3%), however these resulted in the highest case

fatality rate for ISS >12 in the assault group, at 23.1% (Table 10).


Table 10: Assaults in detail (n=225)






Bodily force 97 (2.5%) 3 (3.1%) 0.7%

Stabbing 43 (1.1%) 5 (11.6%) 1.2%

Blunt object 35 (0.9%) 2 (5.7%) 0.5%

Shooting 13 (0.3%) 3 (23.1%) 0.7%

All other assaults 37 (1%) 5 (13.5%) 1.4%

Total 225 (5.9%) 18 (8%) 4.4%

Of the other mechanisms of injury, self-harm was the most common (n=131, 3.4%). Drownings and

self-harm had the highest case fatality rate for ISS >12 in the ‘all other mechanisms’ group at 46.2%

and 33.3% respectively (Table 11).

Table 11: All other mechanisms in detail (n=431)






Self-harm 131 (3.4%) 31 (33.3%) 8.2%

Inanimate mechanical forces12

84 (2.2%) 4 (5.9%) 0.9%

Burns 76 (2%) 7 (18.4%) 2.3%

Animate mechanical forces13

61 (1.6%) (0%) 0%

Other 41 (1.1%) 6 (22.2%) 1.6%

Drownings 38 (1%) 12 (46.2%) 2.8%

Total 431 (11.2%) 60 (19.9%) 15.9%

12 Inanimate forces include contact with, struck by, striking against, thrown against, caught, crushed, jammed or pinched in or between

inanimate objects. 13 Animate forces include hit, struck, kicked, twisted, bitten or scratched by another person (accidental) or animal.


Transport incidents by place of occurrence

In order to provide a greater analysis of the burden road trauma has on the health system, a ‘place

of occurrence’ code qualifier was applied to all transport incidents resulting in two categories: road

trauma; and other transport incidents. For the purpose of this report, road trauma is defined as a

transport incident which occurred on a street, highway or other paved roadway.14

Road trauma accounts for 28.9% (n=1112) of all mechanisms of injury, the second highest behind falls

at 43.4% (n=1669). The rate of ‘road trauma’ and ‘other transport incidents’ were higher in rural areas,

36.3% and 13.1% respectively, than in metropolitan areas, 26.4% and 4.6% respectively (Table 12).

Table 12: Transport incidents by location of injury (n=1447)

Mechanism of Injury (place of occurrence)

Metropolitan (% of metropolitan)

Rural (% of rural)

Unknown location (% of unknown)

Road trauma 715 (26.4%) 337 (36.3%) 60 (29.0%)

Other transport incidents 124 (4.6%) 122 (13.1%) 12 (5.8%)

Unspecified place of occurrence

31 (1.1%) 26 (2.8%) 20 (9.7%)

Total 870 485 92

Injuries to car occupants remains the highest mechanism of injury in the road trauma group

(n=491, 12.8%) with pedestrian trauma having the highest case fatality rate for ISS >12 (16.5%),

well above other forms of road trauma (Table 13).

Table 13: Road trauma in detail14 (n=1112)






Car occupant 491 (12.8%) 37 (8.4%) 9.6%

Motorcycle rider (incl. passengers)

295 (7.7%) 12 (4.4%) 2.8%

Pedestrian 189 (4.9%) 29 (16.5%) 7.2%

Pedal cyclist 112 (2.9%) 1 (0.9%) 0.2%

All other road transport15

25 (0.7%) 2 (10%) 0.5%

Total 1112 (28.9%) 81 (7.9%) 19.6%

14 See Glossary for a detailed definition of ‘road trauma’ and ‘other transport incident’. 15 Includes other forms of land transport such as three-wheeler and quad bikes (all-terrain vehicles).


The most common mechanisms in the ‘other transport incidents’14 group were motorcycle collisions

(n=115), other land transport incidents (n=108), pedal cyclists (n=47), and pedestrians (n=31). Of

the ‘Other land transport’ group, animal-rider or animal-drawn vehicle were the most common

(n=61) followed by all-terrain vehicle incidents (n=34) (Table 14).

Table 14: Other transport incidents in detail14 (n=335)

Other transport incidents include incidents being reported as occurring NOT on a street, highway

or other paved roadway.






Motorcycle rider 115 (3%) 1 (0.9%) 0.2%

Other land transport 108 (2.8%) 2 (2.0%) 0.5%

Pedal cyclist 47 (1.2%) 0 (0%) 0%

Pedestrian 31 (0.8%) 5 (16.7%) 1.2%

Water transport 13 (0.3%) 0 (0%) 0%

Car occupant 11 (0.3%) 0 (0%) 0%

Air and space 8 (0.2%) 0 (0%) 0%

Occupant of heavy transport vehicle

1 (0%) 0 (0%) 0%

Occupant of pick-up truck or van

1 (0%) 0 (0%) 0%

Total 335 (8.7%) 8 (2.6%) 1.9%


Time and day of injury

Of note is that 56% of patients (n=1847) were injured between 11 am and 7 pm, which resulted in

peak activity in the hospitals during the afternoon and evening (Figure 15).

Figure 15: Number of patients by time of injury (n=3303)16

The mean daily number of persons injured on a weekday was 9.5. The number of persons injured

on weekends was higher, with a mean of 13.0 per day (Figure 16).17

Figure 16: Number of patients by day of injury (n=3845)17

16 542 records excluded due to no valid time of injury being recorded.

17 In the reporting period there were 261 week days and 104 weekend days.

0

50

100

150

200

250

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Num

ber

of

patients

Time of day

626

475456 473

522565

728

0

100

200

300

400

500

600

700

800

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Num

ber

of

patients

Day of the week


Injuries

Three or more fractured ribs without a flail segment18 continued to be the most common single

serious injury sustained (15.7%, n=603) where the AIS severity was greater than 2 (Table 15).

Cerebral haematomas occupied three of the top five injuries.

Table 15: Top 5 injuries with an AIS severity >2 (n=3845)

Injury description AIS

severity

Number of patients

(% of total)

Fractured ≥3 ribs without flail18 3 603 (15.7%)

Cerebrum hematoma - subdural - small; moderate 4 187 (4.9%)

Cerebrum hematoma - subdural - tiny 3 123 (3.2%)

Thoracic fracture without cord involvement - vertebral body - major 3 101 (2.6%)

Cerebrum hematoma - subdural - large; massive; extensive 5 65 (1.7%)

In addition, 61% of major trauma patients sustained injuries to the head or neck body region, with

the chest region injured in 49.2% of major trauma patients (Figure 17).

Figure 17: All injuries by ISS body region (n=3845)

18 Flail is defined as three or more ribs fractured in more than one location and/or resulting in paradoxical chest movement. Ref:

Abbreviated Injury Scale 2005 (Update 2008) Dictionary. Association of the Advancement of Automotive Medicine (AAAM). Barrington,

IL, 2008.

61.0%

17.9%

49.2%

24.9%

41.4%

57.1%

0%

10%

20%

30%

40%

50%

60%

70%

Head or neck Face Chest Abdominal or pelviccontents

Extremities orpelvic girdle

External

Perc

enta

ge o

f to

tal patients

ISS body region


The majority of major trauma patients (80.4%) sustained serious injury (AIS severity >2) to only

one ISS body region (Table 16).

Table 16: Number of ISS body regions injured with an AIS severity >2 (n=3845)

Number of ISS body regions injured with an

AIS severity >2

Number of patients (% of total)

(All ISS)

Number of patients (% of total) (ISS >12)

0 258 (7.2%) 1 (0.03%)

1 2884 (80.4%) 2659 (79.1%)

2 592 (16.5%) 592 (17.6%)

3 95 (2.6%) 95 (2.8%)

4 15 (0.4%) 15 (0.4%)

5 1 (0.03%) 1 (0.03%)

Moreover, 19.6% of major trauma patients sustained polytrauma, defined as sustaining serious injury

(AIS severity >2) in two or more ISS body regions19 (Table 17).

Table 17: Single body region versus polytrauma with an AIS severity >2 (n=3587)20

Number of patients – All ISS

(% of total) Case fatality rate

(ISS >12)

Single body region 2884 (80.4%) 8.6%

Polytrauma 703 (19.6%) 16.2%

19 Butcher, N.E. and Balogh, Z.J. AIS > 2 in at least two body regions: A potential new anatomical definition of polytrauma. Injury. 2012;

43(2): 196-199.

20 258 patients excluded due to sustaining no injuries with an AIS severity >2.


Injury Severity Score

An ISS of greater than 12 is a key identifier of a major trauma patient. The ISS correlates with

mortality – the higher the ISS, the higher the mortality rate (Table 18). It is important to note that

ISS is only calculated on injuries sustained and does not include other potential contributors to

mortality and morbidity such as patient’s age and comorbidities. The average ISS for all major

trauma patients was 19.0. This increased to 20.6 when excluding those with an ISS less than 13.

Table 18: Major trauma patients by ISS group (n=3840)21

ISS group Number of patients

(% of total) Number of deaths (case fatality rate)

ISS <13 477 (12.4%) 80 (16.8%)22

ISS 13-15 914 (23.8%) 14 (1.5%)

ISS 16-24 1497 (39%) 57 (3.8%)

ISS 25-40 842 (21.9%) 216 (25.7%)

ISS 41-75 110 (2.9%) 56 (50.9%)

The serious injury category (ISS 16-24) contained the highest number of injured at 1497 (39%),

followed by the moderate injury category (ISS 13-15) which had 914 (23.8%) injured and the

severe injury category (ISS 25-40) had 842 (21.9%) (Figure 18).

Figure 18: Number of major trauma patients by ISS group and gender (n=3840)24

21 5 records were excluded due to no ISS recorded. 22 Patients with an ISS <13 are included only if they had an ICU admission or died. Other survivors in this group are not collected,

therefore the case fatality rate for this group cannot be accurately calculated and may be misleading.

340

640

1109

569

81137

274

388

273

29

0

100

200

300

400

500

600

700

800

900

1000

1100

1200

ISS < 13 ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75

Num

ber

of

patients

ISS group

Male

Female


Females had a higher case fatality rate than males in all ISS groups (Figure 19). Overall the case

fatality rates were higher in females than males (13.2% versus 9.0%).

Figure 19: Case fatality rate by ISS and gender (n=3840)24

Pre-hospital time

The time from injury to arrival at a designated trauma service can have a significant impact on

morbidity and mortality in the major trauma patient cohort. The regional population and geography

of NSW is vastly spread and this impacts on the variation in the time of arrival to a designated

trauma service. Patients who were injured in a metropolitan region arrived at a designated trauma

service faster (74 mins) than those injured in a rural location (128 mins) (Table 19).

Table 19: Median time of injury to arrival at a designated trauma service (n=3638)23

Location of injury Direct from scene Transferred from another hospital

Overall

Metropolitan 74 mins (n=2358) 502 mins (n=351) 80 mins (n=2709)

Rural 128 mins (n=619) 538 mins (n=310) 181 mins (n=929)

NSW overall 80 mins (n=2977) 517 mins (n=661) 92 mins (n=3638)

See the methodology section of this report for more information regarding the definitions of

metropolitan and rural.

23 207 records excluded as location of injury (metro/rural) unknown.

1.1%3.3%

23.7%

45.7%

2.6%5.2%

29.7%

65.5%

0%

10%

20%

30%

40%

50%

60%

70%

ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75

Case F

ata

lity

Rate

ISS group

Male

Female


A number of major trauma patients (n=230), who arrived at a designated trauma service, needed to

be transferred to a higher level of care for specialised treatment. While vital, this transfer prolongs the

time before the required (definitive) care can be provided, such as specialised surgery, interventional

radiology or paediatric services. Overall, 835 major trauma patients were transferred from another

acute care facility with a median time of injury to definitive care of 548 minutes (Table 20).

Table 20: Median time of injury to arrival at definitive care (n=3638)23

Location of injury Direct from scene Transferred from another hospital

Overall

Metropolitan 74 mins (n=2255) 512 mins (n=439) 82 mins (n=2709)

Rural 130 mins (n=530) 605 mins (n=396) 229 mins (n=929)

NSW overall 80 mins (n=2785) 548 mins (n=835) 97 mins (n=3638)

Mode of transport

Major trauma patients are transported to a designated trauma service from either the scene of the

injury or from another hospital. Road ambulance was by far the most common mode of transport

(75.9%), with helicopter, fixed wing and private transport also used (Table 21, Figures 20-21).

Table 21: Mode of transport to definitive care24 (n=3814)25

Transport mode Direct from scene of

injury

Transfer from another

acute care facility Total

Road ambulance 2359 (81.1%) 606 (67.3%) 2965 (77.8%)

Fixed wing 1 (0%) 110 (12.2%) 111 (2.9%)

Helicopter 362 (12.4%) 162 (18%) 524 (13.8%)

Private vehicle 183 (6.3%) 2 (0.2%) 185 (4.9%)

Unknown 14 (0.5%) 0 (0%) 14 (0.4%)

Other 4 (0.1%) 11 (1.2%) 15 (0.4%)

Total 2923 891 3814

24 See Glossary for definition of definitive care 25 31 records were excluded where location of injury was recorded as overseas, same facility, or transport mode missing.


Figure 20: Mode of transport to definitive care when transported direct from the scene of

injury, by injury location (n=2785)

Figure 21: Mode of transport to definitive care when transferred from another acute care

facility, by injury location (n=827)

87.5%

0.0%

7.1%4.9%

0.4% 0.1%

59.1%

0.2%

34.7%

5.7%

0.2% 0.2%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ambulance Fixed wing Helicopter Private vehicle Unknown Other

Perc

enta

ge o

f to

tal

Mode of transport

Metro

Rural

89.0%

1.1%

8.9%

0.2% 0.0% 0.7%

45.9%

24.6%27.2%

0.3% 0.0% 2.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ambulance Fixed wing Helicopter Private vehicle Unknown Other

Perc

enta

ge o

f to

tal

Mode of transport

Metro

Rural


Major trauma admissions

Introduction

The information in this section of the report is based on the number of major trauma admissions to

NSW trauma services (n=3961), not the number of major trauma patients (n=3845), as some

patients were treated in more than one NSW reporting facility. Trauma patient data is discussed in

detail in the Major trauma patients section.

Facility overview

The table below provides an overview of the major trauma admissions for each designated trauma

service together with averages from the three trauma service types (Table 22).

Table 22: Overview of trauma service admissions (n=3961)

Facility Number of admissions

Average age

Average ISS

Case fatality rate (ISS >12)

Adult major trauma services 3004 54.0 19.4 9.7%

John Hunter Hospital 497 50.2 19.5 9.2%

Liverpool Hospital 449 51.8 19.8 9.0%

Royal North Shore Hospital 615 57.4 20.1 11.1%

Royal Prince Alfred Hospital 332 56.0 19.7 7.5%

St George Hospital 347 55.0 20.2 12.3%

St Vincent's Hospital 214 51.9 18.4 7.1%

Westmead Hospital 550 54.2 17.8 9.8%

Paediatric major trauma services 173 7.1 19.1 11.1%

John Hunter Children’s Hospital 25 8.3 14.8 5.9%

Sydney Children's Hospital 64 7.7 17.9 4.0%

The Children's Hospital at Westmead 84 6.3 21.3 17.6%

Regional trauma services 784 53.1 17.8 10.4%

Coffs Harbour Base Hospital 66 48.5 20.2 10.7%

Gosford Hospital 58 59.1 17.6 9.8%

Lismore Base Hospital 65 48.0 20.8 17.2%

Nepean Hospital 114 56.9 13.5 9.3%

Orange Health Service 104 52.3 17.1 8.1%

Port Macquarie Base Hospital 53 52.7 17.4 16.7%

Tamworth Rural Referral Hospital 79 49.9 17.7 3.0%

The Tweed Hospital 40 48.1 21.5 12.5%

Wagga Wagga Base Hospital 59 45.5 16.7 5.7%

Wollongong Hospital 146 59.1 19.0 12.4%


Admission type

The majority of major trauma patients (76.6%, n=3035) were admitted to a trauma service direct

from the scene of injury, however, there were differences in the admission type between adult and

paediatric patient groups (Table 23).

Table 23: Number of admissions by type (n=3961)

Admission type Number of admissions

(paediatric / adult)

Percentage of admissions

(paediatric / adult)

Direct from scene 139 / 2895 58.4% / 77.8%

Transfer from another acute care facility

99 / 805 41.6% / 21.6%

Unknown and other 0 / 22 0% / 0.6%


The Revised Trauma Score26 is an early (<24 hours) indicator of trauma outcomes. The lower the

score, the higher is the likelihood of death. There was a negative correlation between the Revised

Trauma Score and ISS, showing that the higher the ISS, the lower the Revised Trauma Score. The

average Revised Trauma Score was 7.1 (Figure 22).

Figure 22: Average Revised Trauma Score by ISS group (n=3689)27

26 See the Glossary for a definition of the Revised Trauma Score.

27 272 records excluded as no Revised Trauma Score was recorded.

7.1

7.77.4

6.3

4.7

0

1

2

3

4

5

6

7

8

All admissions ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75

Avera

ge R

evis

ed T

raum

a S

core

ISS group


Trauma team activation

Major trauma patients require rapid, thorough and systematic assessment and resuscitation. This

is conducted on arrival by a multidisciplinary team known as a trauma team. The activation of the

trauma team is based on a locally derived set of criteria including mechanism of injury and

physiological parameters. 48.7% of patients who arrived at a trauma service direct from scene

received a full trauma team activation compared to 21.0% of those who were transferred from

another acute care facility (Figure 23).

Figure 23: Trauma team activation by admission type (n=3961)

42.2%

48.7%

21.0%

15.5%

13.7%

21.7%

7.2%

7.3%

6.7%

23.6%20.0%

35.5%

4.7% 3.9%7.6%

6.9% 6.4% 7.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All admissions (n=3961) Direct from scene (n=3035) Transfer from another acute carefacility (n=904)

Perc

enta

ge o

f adm

issio

ns

Unknown and other

Trauma Team not activated and required

Trauma Team not activated and not required

Trauma Consult

Modified Trauma Team Activation

Full Trauma Team Activation


The activation of the trauma team increased with severity of injury as expected with 34.0% (n=317)

of the ISS 13-15 group receiving a full trauma team activation compared to 89.6% (n=103) of the

ISS 41-75 group (Figure 24).

Figure 24: Trauma team activation by ISS group (n=3961)

42.2% 42.7%

34.0%

39.5%

48.9%

89.6%

15.5%

11.0%

22.1% 17.0%9.7%

5.2%

7.2%

5.4%

10.1%8.3%

3.8%

23.6% 29.2%

18.9%

23.8%27.9%

4.7%3.3%

3.9%

5.2%5.9%

6.9% 8.3% 11.0% 6.1% 3.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All admissions ISS < 13 ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75

Perc

enta

ge o

f adm

issio

ns

Unknown and Other

Trauma Team not activated and required

Trauma Team not activated and not required

Trauma Consult

Modified Trauma Team Activation (MTTA)

Full Trauma Team Activation (FTTA)


Vital signs on arrival to the emergency department

The initial vital signs on arrival to the Emergency Department (ED) are useful indicators of injury

severity and predictors of death. Major trauma patients who presented with hypotension (systolic

blood pressure <100mmHg), a Glasgow Coma Scale <13 or hypothermia (temperature <35°C)

represented a higher proportion of those who died compared to all patients (Figures 25-27).

Figure 25: Initial systolic blood pressure on arrival to the ED and mortality (n=3827) 28

Figure 26: Initial Glasgow Coma Scale on arrival to the ED and mortality (n=3755)29

28 134 records excluded due to systolic blood pressure not being recorded.

29 206 records excluded due to Glasgow Coma Scale not being recorded.

90.7%92.7%

73.6%

9.3% 7.3% 26.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All patients n=3827 Survived n=3430 Died n= 397

Perc

enta

ge o

f adm

issio

ns

Under 100mmHg

100mmHg and over

17.8%

13.0%

59.4%

5.4%5.2%

6.9%

20.8%

21.3%

16.8%

56.0% 60.6% 17.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All patients n=3755 Survived n=3361 Died n= 394

Perc

enta

ge o

f adm

issio

ns

15

13-14

9-12

3-8


Figure 27: Initial temperature on arrival to ED and mortality (n=2747)30

Intensive care unit admissions

Overall 41.7% (n=1648) of major trauma patients received an intensive care unit (ICU) admission,

with the percentage increasing with the level of injury severity (Figure 28). Whilst the number of

ICU admissions may be explained by the level of severity of injury, the complexity of injury and

other factors such as comorbidities may also influence the requirement for an ICU admission.

It is important to note that the ISS <13 group is only included in the report if they have been

admitted to ICU or died, hence the high proportion of ICU admissions in this group.

Figure 28: ICU admission by ISS group (n=3956)31

30 1214 records excluded due to initial temperature not recorded. 31 5 records excluded due to no ISS recorded

88.1% 89.4%

76.3%

5.8% 4.3% 19.5%6.1% 6.3%

4.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All patients n=2747 Survived n=2481 Died n=266

Perc

enta

ge o

f adm

issio

ns

>37.5°C

< 35°C

35-37°C

2316

60

790

1037

392

38

1640 420 141 519 482 77

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All ISS ISS < 13 ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75

ICU admissions

Non ICU admissions

ISS group

Perc

enta

ge

of IS

S g

roup


Length of stay

The length of stay (LOS) in hospital, and in particular the LOS in an ICU, is an indicator of the

severity and complexity of the injury. The average hospital LOS for major trauma patients was 12.2

days (Table 24).

Table 24: Overview of ICU and hospital length of stay (n=3959)32

Number of patients Average days Median days

ICU LOS 1640 5.4 2.0

Total hospital LOS 3959 12.2 7.0

The average ICU length of stay increased with severity, with ISS 13-15 group being 4.3 days and

ISS 41-75 group being 10.5 days. A similar increasing pattern was also shown in the hospital length

of stay as expected (Table 25).

Table 25: ICU and hospital length of stay by ISS (n=3956)31

ISS group Average ICU LOS

Median ICU LOS

Average hospital LOS

Median hospital LOS

ISS <13 2.61 1.0 9.74 6.0

ISS 13-15 4.30 2.0 8.94 5.0

ISS 16-24 5.02 3.0 11.82 7.0

ISS 25-40 7.81 4.0 16.97 9.0

ISS 41-75 10.53 6.0 17.62 6.0

32 2 records excluded due to missing hospital LOS


No considerable change was observed in the median values of ICU LOS and hospital LOS across

different age groups (Table 26).

Table 26: ICU and hospital length of stay by age (n=3960)8

Age group Average ICU LOS

Median ICU LOS

Average hospital LOS

Median hospital LOS

0-4 5.9 2.0 9.6 4

5-9 8.3 3.0 11.8 5

10-14 3.1 1.0 7.8 4

15-19 5.2 2.0 10.2 5

20-24 4.5 2.0 9.6 6

25-29 4.6 2.0 12.2 5

30-34 4.9 3.0 12.8 7

35-39 5.1 2.0 12.8 5

40-44 8.0 3.0 13.5 6

45-49 5.2 2.0 11.7 6

50-54 5.1 3.0 12.1 7

55-59 5.6 2.0 14.2 6

60-64 7.1 3.0 12.8 7

65-69 5.7 2.5 13.2 7

70-74 6.8 4.0 14.0 8

75-79 5.5 3.0 14.0 9

80-84 4.5 3.0 13.6 8

85 and over 3.6 2.0 10.1 7


Procedures

Despite the serious nature of the injuries sustained by major trauma patients, the number of

surgical or interventional radiology procedures performed was very low. 795 procedures were

performed on 714 patients (18% of all admissions). The highest percentage of procedures were

performed in the ISS 41-75 group (Table 27, Figure 29).

Table 27: Procedures performed by type (n=3961)

Procedure Number of procedures Percentage of total

admissions

Laparotomy 153 3.9%

Open reduction internal fixation 380 9.6%

Thoracotomy 47 1.2%

Craniotomy 147 3.7%

Embolisation 68 1.7%

Total 795 18.0%33

A sharp rise in the proportion of laparotomy and open reduction internal fixation and embolisation

procedures performed is noted in the ISS 41-75 group (Figure 29).

Figure 29: Procedures performed by ISS group (n=3956)31

33 The total percentage of admissions where a surgical procedure(s) was performed is based on the number of admissions where one

or more procedures were performed (n=714), not the total number of procedures performed (n=795).

0%

5%

10%

15%

20%

25%

All ISS ISS < 13 ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75

Laparotomy

ORIF

Thoracotomy

Craniotomy

Embolisation

ISS group

Perc

enta

ge

of IS

S g

roup


Over the last five years there has been an increased use of embolisation and open reduction

internal fixation procedures, along with a decrease in craniotomy procedures (Figure 30).

Figure 30: Five year trend of procedures performed

Discharge destination of survivors

Survivors of major trauma (n=3533) were discharged to various locations, with home being the

most common (65.8%) followed by rehabilitation at 14.3%. ‘Other’ incorporates locations such as

board and care, burns centre, foster care, residential institution, missing and unknown (Figure 31).

Figure 31: Discharge destination of survivors (n=3532)34

34 1 record excluded due to missing discharge destination

0

50

100

150

200

250

300

350

400

450

2012-13 2013-14 2014-15 2015-16 2016-17

Num

ber

of

pro

cedure

s

Financial years

Laparotomy

ORIF

Thoracotomy

Craniotomy

Embolisation

65.8%

8.1% 8.0%

3.9%

14.3%

0%

10%

20%

30%

40%

50%

60%

70%

Home Acute care facility Intermediate carefacility

Other Rehabilitation

Home

Acute care facility

Intermediate care facility

Other

Rehabilitation

Discharge destination

Perc

enta

ge

of to

tal


The rate of discharge home decreased as the injury severity increased, coinciding with an increase

in the rate of discharge to rehabilitation services (Figure 32).

Figure 32: Discharge destination of survivors by ISS group (n=3532)34

74.0%79.2%

66.9%

43.0%

27.1%

3.5%

4.1%

9.6%

12.2%

15.3%

8.5%

5.1%

7.5%

12.8%

10.2%

5.8% 3.1%

3.5%

4.4%

5.1%

8.3% 8.5%12.5%

27.7%

42.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ISS < 13 ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75

Rehabilitation

Other

Intermediate carefacility

Acute care facility

Home

ISS group

Perc

enta

ge o

f IS

S g

roup


Appendices

List of appendices

Appendix 1: Data completeness

Appendix 2: Adult major trauma service summaries

Appendix 3: Paediatric major trauma service summaries

Appendix 4: Regional trauma service summaries

Appendix 5: Calculation of the Injury Severity Score

Appendix 6: Australian Statistical Geography Standard Remoteness Areas


Appendix 1: Data completeness

High levels of data accuracy and entry completion, as entered by the trauma facilities, is crucial in

enabling accurate and thorough data analysis as part of a broader trauma quality assurance

program. The average overall data completion of mandatory data elements completed was 87.4%

with completion rates ranging from 81% to 93.5% (Figure 33).

Figure 33: Overall data completeness by facility

A detailed breakdown of data completion by facility, showing each mandatory data element can be

seen in Table 28.

89.2%

81.0%

84.1%

84.5%

85.2%

86.5%

84.5%

85.2%

89.3%

87.5%

93.5%

88.7%

91.2%

90.5%

89.5%

87.6%

84.0%

90.1%

88.9%

88.7%

70% 75% 80% 85% 90% 95%


Gosford Hospital

John Hunter Children's Hopsital



Liverpool Hospital

Nepean Hospital





St George Hospital



Tamworth Hospital

Children's Hospital at Westmead

The Tweed Hospital

Wagga Wagga Rural Referral Hospital

Westmead Hospital

Wollongong Hospital

Overall datacompleteness

Average (87.4%)


Table 28: Detailed data completeness by facility

Legend: Percentage complete 100% 80-99% 60-79% Less than 60%

Data field


Gosford Hospital




Liverpool Hospital

Nepean Hospital





St George Hospital



Tamw

orth Hospital

Children's Hospital at Westm

ead

The Tweed Hospital

Wagga W

agga Rural Referral Hospital

Westm

ead Hospital

Wollongong Hospital

Trauma ID

Age

Gender

Post code home

Post code injury

Injury date

Injury time

Primary cause of injury

Injury type

Injury place

Injury activity

Fall height

Scene agency

Scene mode

PH agency Run No.

PH agency call received date

PH agency call received time

PH agency arrive at patient date

PH agency arrive at patient time

Ph agency depart location date

PH agency depart location time

Admission date

Admission time

System access

ED arrival date

ED arrival time

ED depart date

ED depart time

Trauma response

Post ED disposition

Resp assisted

Resp assit type

Intubated

Intubation method

Paralytic agent

Sedation


Legend: Percentage complete 100% 80-99% 60-79% Less than 60%

Data field


Gosford Hospital




Liverpool Hospital

Nepean Hospital





St George Hospital



Tamw

orth Hospital

Children's Hospital at Westm

ead

The Tweed Hospital

Wagga W

agga Rural Referral Hospital

Westm

ead Hospital

Wollongong Hospital

ED vitals - Heart rate

ED vitals - Resp rate

ED vitals - DBP

ED vitals - SBP

ED vitals - Temperature

ED vitals - SA02

ED vitals - GCS eye

ED vitals - GCS verbal

ED vitals - GCS motor

ED vitals - GCS total

ED vitals - RTS total

Ref hospital 1 arrival date

Ref hospital 1 arrival time

Ref hosp 1 trnfer rationale

Ref hosp 1 hospital procedures

Ref hospital 2 arrival date

Ref hospital 2 arrival time

Ref hosp 2 trnfer rationale

Ref hosp 2 procedures

Inter-facility 1 trnfer agency

Inter-facility 1 mode

Inter-facility 2 trnfer agency

Inter-facility 2 mode

Location tracking depts

Location tracking arrival dates

Location tracking arrival times

Procedure date/time

AIS codes

ISS

Outcome (discharge disposition)

Location of death

Discharge date

Discharge time

ICU length of stay

Hospital length of stay

Discharge to

Discharge facility

QA filter codes


Appendix 2: Adult major trauma service summaries

Table 29: Trauma data profile, John Hunter Hospital

Facility Peer

Total admissions 497 429

Mean monthly admissions 41.4 36

Case fatality rate (ISS >12) 9.2% 9.7%

Gender

Female / Male 129 / 368 124 / 305

Age ranges

Mean age 50.2 54.0

0-4 0 (0.0%) 1 (0.3%)

5-9 0 (0.0%) 0 (0.0%)

10-14 0 (0.0%) 0 (0.1%)

15-19 30 (6.0%) 21 (4.9%)

20-24 46 (9.3%) 33 (7.8%)

25-29 30 (6.0%) 28 (6.6%)

30-34 35 (7.0%) 26 (6.1%)

35-39 34 (6.8%) 24 (5.6%)

40-44 36 (7.2%) 25 (5.9%)

45-49 39 (7.8%) 28 (6.4%)

50-54 37 (7.4%) 29 (6.7%)

55-59 38 (7.6%) 32 (7.4%)

60-64 28 (5.6%) 26 (6.0%)

65-69 41 (8.2%) 27 (6.2%)

70-74 26 (5.2%) 25 (5.9%)

75-79 20 (4.0%) 27 (6.2%)

80-84 21 (4.2%) 28 (6.6%)

85 and over 36 (7.2%) 49 (11.4%)

Injury Severity Score ranges

Mean ISS 19.5 19.4

ISS <13 29 (5.8%) 46 (10.7%)

ISS 13-15 121 (24.3%) 102 (23.8%)

ISS 16-24 216 (43.5%) 170 (39.7%)

ISS 25-40 117 (23.5%) 97 (22.6%)

ISS 41-75 14 (2.8%) 14 (3.2%)

Mechanisms of injury

Assault 32 (6.4%) 31 (7.2%)

Falls 162 (32.6%) 194 (45.3%)

Falls (≥65 years) 98 (19.7%) 116 (27.0%)

Road trauma 162 (32.6%) 126 (29.5%)

Other transport incident 87 (17.5%) 33 (7.7%)

All other injuries 54 (10.9%) 44 (10.3%)


Facility Peer

Types of injury

Blunt 463 (93.2%) 401 (93.5%)

Penetrating 21 (4.2%) 17 (4.0%)

Other and unknown 13 (2.6%) 11 (2.5%)

Admission type

Direct admission 339 (68.2%) 329 (76.7%)

Transfer in 158 (31.8%) 98 (22.7%)

Unknown 0 (0.0%) 2 (0.5%)

Arrival modes

Ambulance 355 (71.4%) 335 (78.2%)

Helicopter 90 (18.1%) 47 (10.9%)

Other (private vehicle, fixed wing, unknown) 52 (10.5%) 47 (10.9%)


Mean - overall 7.1 7.1

ISS <13 6.8 6.8

ISS 13-15 7.7 7.6

ISS 16-24 7.5 7.4

ISS 25-40 6.3 6.4

ISS 41-75 4.7 4.7


Total bed days 5723 5780


ISS <13 10.5 10.4

ISS 13-15 8.3 9.5

ISS 16-24 10.3 12.8

ISS 25-40 16.3 19.6

ISS 41-75 19.1 18.0

ICU length of stay

ICU total bed days (number of ICU admissions) 921 (186) 1,055 (181)


ISS <13 1.6 2.8

ISS 13-15 2.5 4.4

ISS 16-24 4.6 5.3

ISS 25-40 6.8 8.2

ISS 41-75 9.9 9.6

Hospital ventilation days

Total ventilation bed days (number of ventilated cases) 826 (108) 769 (123)


ISS <13 2.1 2.9

ISS 13-15 3.2 4.6

ISS 16-24 5.2 5.8

ISS 25-40 11.1 8.5

ISS 41-75 9.7 7.1


Table 30: Trauma data profile, Liverpool Hospital

Facility Peer




Gender

Female / Male 121 / 328 124 / 305

Age ranges

Mean age 51.8 54.0

0-4 0 (0.0%) 1 (0.3%)

5-9 0 (0.0%) 0 (0.0%)

10-14 1 (0.2%) 0 (0.1%)

15-19 29 (6.5%) 21 (4.9%)

20-24 45 (10.0%) 33 (7.8%)

25-29 32 (7.1%) 28 (6.6%)

30-34 27 (6.0%) 26 (6.1%)

35-39 25 (5.6%) 24 (5.6%)

40-44 30 (6.7%) 25 (5.9%)

45-49 25 (5.6%) 28 (6.4%)

50-54 24 (5.3%) 29 (6.7%)

55-59 31 (6.9%) 32 (7.4%)

60-64 26 (5.8%) 26 (6.0%)

65-69 32 (7.1%) 27 (6.2%)

70-74 21 (4.7%) 25 (5.9%)

75-79 34 (7.6%) 27 (6.2%)

80-84 27 (6.0%) 28 (6.6%)

85 and over 40 (8.9%) 49 (11.4%)


Mean ISS 19.8 19.4

ISS <13 34 (7.7%) 46 (10.7%)

ISS 13-15 112 (25.2%) 102 (23.8%)

ISS 16-24 190 (42.8%) 170 (39.7%)

ISS 25-40 89 (20.0%) 97 (22.6%)

ISS 41-75 19 (4.3%) 14 (3.2%)


Assault 43 (9.6%) 31 (7.2%)

Falls 189 (42.1%) 194 (45.3%)

Falls (≥65 years) 109 (24.3%) 116 (27.0%)

Road trauma 155 (34.5%) 126 (29.5%)




Facility Peer

Types of injury

Blunt 426 (94.9%) 401 (93.5%)

Penetrating 22 (4.9%) 17 (4.0%)

Other and Unknown 1 (0.2%) 11 (2.5%)

Admission type


Transfer in 70 (15.6%) 98 (22.7%)

Unknown 0 (0.0%) 2 (0.5%)

Arrival modes

Ambulance 335 (74.6%) 335 (78.2%)

Helicopter 50 (11.1%) 47 (10.9%)




ISS <13 6.5 6.8

ISS 13-15 7.7 7.6

ISS 16-24 7.3 7.4

ISS 25-40 6.2 6.4

ISS 41-75 5.4 4.7




ISS <13 12.7 10.4

ISS 13-15 8.3 9.5

ISS 16-24 13.6 12.8

ISS 25-40 16.4 19.6

ISS 41-75 14.7 18.0

ICU length of stay

ICU total bed days (number of ICU admissions) 908 (138) 1055 (181)


ISS <13 3.6 2.8

ISS 13-15 6.9 4.4

ISS 16-24 7.1 5.3

ISS 25-40 7.6 8.2

ISS 41-75 8.2 9.6




ISS <13 3.0 2.9

ISS 13-15 7.0 4.6

ISS 16-24 4.5 5.8

ISS 25-40 5.9 8.5

ISS 41-75 5.3 7.1


Table 31: Trauma data profile, Royal North Shore Hospital

Facility Peer




Gender

Female / Male 184 / 431 124 / 305

Age ranges

Mean age 57.4 54.0

0-4 3 (0.5%) 1 (0.3%)

5-9 1 (0.2%) 0 (0.0%)

10-14 1 (0.2%) 0 (0.1%)

15-19 25 (4.1%) 21 (4.9%)

20-24 37 (6.0%) 33 (7.8%)

25-29 35 (5.7%) 28 (6.6%)

30-34 28 (4.6%) 26 (6.1%)

35-39 31 (5.0%) 24 (5.6%)

40-44 26 (4.2%) 25 (5.9%)

45-49 43 (7.0%) 28 (6.4%)

50-54 39 (6.3%) 29 (6.7%)

55-59 46 (7.5%) 32 (7.4%)

60-64 48 (7.8%) 26 (6.0%)

65-69 27 (4.4%) 27 (6.2%)

70-74 38 (6.2%) 25 (5.9%)

75-79 43 (7.0%) 27 (6.2%)

80-84 52 (8.5%) 28 (6.6%)

85 and over 92 (15.0%) 49 (11.4%)


Mean ISS 20.1 19.4

ISS <13 100 (16.3%) 46 (10.7%)

ISS 13-15 101 (16.4%) 102 (23.8%)

ISS 16-24 206 (33.5%) 170 (39.7%)

ISS 25-40 184 (29.9%) 97 (22.6%)

ISS 41-75 24 (3.9%) 14 (3.2%)


Assault 22 (3.6%) 31 (7.2%)

Falls 319 (51.9%) 194 (45.3%)

Falls (≥65 years) 198 (32.2%) 116 (27.0%)

Road trauma 154 (25.0%) 126 (29.5%)




Facility Peer

Types of injury

Blunt 553 (89.9%) 401 (93.5%)

Penetrating 14 (2.3%) 17 (4.0%)


Admission type


Transfer in 213 (34.6%) 98 (22.7%)

Unknown 0 (0.0%) 2 (0.5%)

Arrival modes

Ambulance 459 (74.6%) 335 (78.2%)

Helicopter 78 (12.7%) 47 (10.9%)




ISS <13 7.3 6.8

ISS 13-15 7.6 7.6

ISS 16-24 7.4 7.4

ISS 25-40 6.8 6.4

ISS 41-75 4.4 4.7


Total bed days 10,780 5,780


ISS <13 11.2 10.4

ISS 13-15 9.7 9.5

ISS 16-24 15.4 12.8

ISS 25-40 26.9 19.6

ISS 41-75 23.8 18.0

ICU length of stay

ICU total bed days (number of ICU admissions) 2,262 (395) 1,055 (181)


ISS <13 2.9 2.8

ISS 13-15 4.2 4.4

ISS 16-24 4.2 5.3

ISS 25-40 8.8 8.2

ISS 41-75 9.9 9.6


Total ventilation bed days (number of ventilated cases) 1,251 (177) 769 (123)


ISS <13 3.9 2.9

ISS 13-15 6.2 4.6

ISS 16-24 5.3 5.8

ISS 25-40 9.2 8.5

ISS 41-75 7.3 7.1


Table 32: Trauma data profile, Royal Prince Alfred Hospital

Facility Peer




Gender

Female / Male 112 / 220 124 / 305

Age ranges

Mean age 56.0 54.0

0-4 0 (0.0%) 1 (0.3%)

5-9 0 (0.0%) 0 (0.0%)

10-14 0 (0.0%) 0 (0.1%)

15-19 14 (4.2%) 21 (4.9%)

20-24 23 (6.9%) 33 (7.8%)

25-29 21 (6.3%) 28 (6.6%)

30-34 22 (6.6%) 26 (6.1%)

35-39 19 (5.7%) 24 (5.6%)

40-44 13 (3.9%) 25 (5.9%)

45-49 17 (5.1%) 28 (6.4%)

50-54 21 (6.3%) 29 (6.7%)

55-59 30 (9.0%) 32 (7.4%)

60-64 20 (6.0%) 26 (6.0%)

65-69 18 (5.4%) 27 (6.2%)

70-74 22 (6.6%) 25 (5.9%)

75-79 29 (8.7%) 27 (6.2%)

80-84 25 (7.5%) 28 (6.6%)

85 and over 38 (11.4%) 49 (11.4%)


Mean ISS 19.7 19.4

ISS <13 26 (7.8%) 46 (10.7%)

ISS 13-15 63 (19.0%) 102 (23.8%)

ISS 16-24 165 (49.7%) 170 (39.7%)

ISS 25-40 68 (20.5%) 97 (22.6%)

ISS 41-75 10 (3.0%) 14 (3.2%)


Assault 19 (5.7%) 31 (7.2%)

Falls 181 (54.5%) 194 (45.3%)

Falls (≥65 years) 110 (33.1%) 116 (27.0%)

Road trauma 84 (25.3%) 126 (29.5%)




Facility Peer

Types of injury

Blunt 308 (92.8%) 401 (93.5%)

Penetrating 20 (6.0%) 17 (4.0%)


Admission type


Transfer in 36 (10.8%) 98 (22.7%)

Unknown 0 (0.0%) 2 (0.5%)

Arrival modes

Ambulance 298 (89.8%) 335 (78.2%)

Helicopter 1 (0.3%) 47 (10.9%)




ISS < 13 7.0 6.8

ISS 13-15 7.7 7.6

ISS 16-24 7.6 7.4

ISS 25-40 6.7 6.4

ISS 41-75 3.9 4.7




ISS <13 7.5 10.4

ISS 13-15 11.4 9.5

ISS 16-24 10.8 12.8

ISS 25-40 17.5 19.6

ISS 41-75 17.1 18.0

ICU length of stay



ISS <13 2.4 2.8

ISS 13-15 4.5 4.4

ISS 16-24 3.7 5.3

ISS 25-40 7.2 8.2

ISS 41-75 9.3 9.6




ISS < 13 2.5 2.9

ISS 13-15 1.5 4.6

ISS 16-24 4.6 5.8

ISS 25-40 7.7 8.5

ISS 41-75 7.5 7.1


Table 33: Trauma data profile, St George Hospital

Facility Peer




Gender

Female / Male 100 / 247 124 / 305

Age ranges

Mean age 55.0 54.0

0-4 2 (0.6%) 1 (0.3%)

5-9 0 (0.0%) 0 (0.0%)

10-14 1 (0.3%) 0 (0.1%)

15-19 16 (4.6%) 21 (4.9%)

20-24 26 (7.5%) 33 (7.8%)

25-29 21 (6.1%) 28 (6.6%)

30-34 25 (7.2%) 26 (6.1%)

35-39 12 (3.5%) 24 (5.6%)

40-44 16 (4.6%) 25 (5.9%)

45-49 23 (6.6%) 28 (6.4%)

50-54 27 (7.8%) 29 (6.7%)

55-59 27 (7.8%) 32 (7.4%)

60-64 15 (4.3%) 26 (6.0%)

65-69 24 (6.9%) 27 (6.2%)

70-74 24 (6.9%) 25 (5.9%)

75-79 19 (5.5%) 27 (6.2%)

80-84 21 (6.1%) 28 (6.6%)

85 and over 48 (13.8%) 49 (11.4%)


Mean ISS 20.2 19.4

ISS <13 31 (8.9%) 46 (10.7%)

ISS 13-15 84 (24.2%) 102 (23.8%)

ISS 16-24 137 (39.5%) 170 (39.7%)

ISS 25-40 82 (23.6%) 97 (22.6%)

ISS 41-75 13 (3.7%) 14 (3.2%)


Assault 17 (4.9%) 31 (7.2%)

Falls 172 (49.6%) 194 (45.3%)

Falls (≥65 years) 96 (27.7%) 116 (27.0%)

Road trauma 124 (35.7%) 126 (29.5%)




Facility Peer

Types of injury

Blunt 330 (95.1%) 401 (93.5%)

Penetrating 12 (3.5%) 17 (4.0%)


Admission type


Transfer in 100 (28.8%) 98 (22.7%)

Unknown 0 (0.0%) 2 (0.5%)

Arrival modes

Ambulance 275 (79.3%) 335 (78.2%)

Helicopter 42 (12.1%) 47 (10.9%)




ISS <13 6.0 6.8

ISS 13-15 7.8 7.6

ISS 16-24 7.1 7.4

ISS 25-40 5.4 6.4

ISS 41-75 3.4 4.7




ISS <13 9.7 10.4

ISS 13-15 13.5 9.5

ISS 16-24 15.6 12.8

ISS 25-40 19.2 19.6

ISS 41-75 10.3 18.0

ICU length of stay



ISS <13 2.1 2.8

ISS 13-15 3.9 4.4

ISS 16-24 7.1 5.3

ISS 25-40 12.4 8.2

ISS 41-75 8.0 9.6




ISS < 13 2.5 2.9

ISS 13-15 3.7 4.6

ISS 16-24 7.3 5.8

ISS 25-40 12.2 8.5

ISS 41-75 5.9 7.1


Table 34: Trauma data profile, St Vincent’s Hospital

Facility Peer




Gender

Female / Male 54 / 160 124 / 305

Age ranges

Mean age 51.9 54.0

0-4 3 (1.4%) 1 (0.3%)

5-9 0 (0.0%) 0 (0.0%)

10-14 0 (0.0%) 0 (0.1%)

15-19 4 (1.9%) 21 (4.9%)

20-24 16 (7.5%) 33 (7.8%)

25-29 19 (8.9%) 28 (6.6%)

30-34 15 (7.0%) 26 (6.1%)

35-39 16 (7.5%) 24 (5.6%)

40-44 16 (7.5%) 25 (5.9%)

45-49 20 (9.3%) 28 (6.4%)

50-54 14 (6.5%) 29 (6.7%)

55-59 17 (7.9%) 32 (7.4%)

60-64 10 (4.7%) 26 (6.0%)

65-69 3 (1.4%) 27 (6.2%)

70-74 15 (7.0%) 25 (5.9%)

75-79 9 (4.2%) 27 (6.2%)

80-84 12 (5.6%) 28 (6.6%)

85 and over 25 (11.7%) 49 (11.4%)


Mean ISS 18.4 19.4

ISS <13 32 (15.0%) 46 (10.7%)

ISS 13-15 56 (26.2%) 102 (23.8%)

ISS 16-24 78 (36.4%) 170 (39.7%)

ISS 25-40 43 (20.1%) 97 (22.6%)

ISS 41-75 5 (2.3%) 14 (3.2%)


Assault 25 (11.7%) 31 (7.2%)

Falls 115 (53.7%) 194 (45.3%)

Falls (≥65 years) 50 (23.4%) 116 (27.0%)

Road trauma 44 (20.6%) 126 (29.5%)




Facility Peer

Types of injury

Blunt 203 (94.9%) 401 (93.5%)

Penetrating 7 (3.3%) 17 (4.0%)


Admission type


Transfer in 1 (0.5%) 98 (22.7%)

Unknown 0 (0.0%) 2 (0.5%)

Arrival modes

Ambulance 199 (93.0%) 335 (78.2%)

Helicopter 0 (0.0%) 47 (10.9%)




ISS <13 6.7 6.8

ISS 13-15 7.7 7.6

ISS 16-24 7.6 7.4

ISS 25-40 6.3 6.4

ISS 41-75 6.4 4.7




ISS <13 8.2 10.4

ISS 13-15 6.9 9.5

ISS 16-24 12.1 12.8

ISS 25-40 14.0 19.6

ISS 41-75 17.4 18.0

ICU length of stay



ISS <13 1.9 2.8

ISS 13-15 4.3 4.4

ISS 16-24 3.8 5.3

ISS 25-40 5.3 8.2

ISS 41-75 15.3 9.6




ISS <13 2.3 2.9

ISS 13-15 2.6 4.6

ISS 16-24 5.2 5.8

ISS 25-40 6.0 8.5

ISS 41-75 10.3 7.1


Table 35: Trauma data profile, Westmead Hospital

Facility Peer




Gender

Female / Male 167 / 383 124 / 305

Age ranges

Mean age 54.2 54.0

0-4 1 (0.2%) 1 (0.3%)

5-9 0 (0.0%) 0 (0.0%)

10-14 0 (0.0%) 0 (0.1%)

15-19 30 (5.5%) 21 (4.9%)

20-24 41 (7.5%) 33 (7.8%)

25-29 41 (7.5%) 28 (6.6%)

30-34 31 (5.6%) 26 (6.1%)

35-39 30 (5.5%) 24 (5.6%)

40-44 39 (7.1%) 25 (5.9%)

45-49 26 (4.7%) 28 (6.4%)

50-54 40 (7.3%) 29 (6.7%)

55-59 33 (6.0%) 32 (7.4%)

60-64 32 (5.8%) 26 (6.0%)

65-69 41 (7.5%) 27 (6.2%)

70-74 30 (5.5%) 25 (5.9%)

75-79 33 (6.0%) 27 (6.2%)

80-84 39 (7.1%) 28 (6.6%)

85 and over 63 (11.5%) 49 (11.4%)


Mean ISS 17.8 19.4

ISS <13 70 (12.7%) 46 (10.7%)

ISS 13-15 176 (32.0%) 102 (23.8%)

ISS 16-24 198 (36.0%) 170 (39.7%)

ISS 25-40 96 (17.5%) 97 (22.6%)

ISS 41-75 10 (1.8%) 14 (3.2%)


Assault 58 (10.5%) 31 (7.2%)

Falls 223 (40.5%) 194 (45.3%)

Falls (≥65 years) 151 (27.5%) 116 (27.0%)

Road trauma 162 (29.5%) 126 (29.5%)




Facility Peer

Types of injury

Blunt 525 (95.5%) 401 (93.5%)

Penetrating 25 (4.5%) 17 (4.0%)


Admission type


Transfer in 105 (19.1%) 98 (22.7%)

Unknown 16 (2.9%) 2 (0.5%)

Arrival modes

Ambulance 427 (77.6%) 335 (78.2%)

Helicopter 66 (12.0%) 47 (10.9%)




ISS <13 6.4 6.8

ISS 13-15 7.6 7.6

ISS 16-24 7.2 7.4

ISS 25-40 5.9 6.4

ISS 41-75 5.1 4.7




ISS <13 10.7 10.4

ISS 13-15 9.3 9.5

ISS 16-24 12.3 12.8

ISS 25-40 17.2 19.6

ISS 41-75 19.8 18.0

ICU length of stay

ICU total bed days (number of ICU admissions) 1,278 (190) 1,055 (181)


ISS <13 3.7 2.8

ISS 13-15 5.8 4.4

ISS 16-24 8.1 5.3

ISS 25-40 7.9 8.2

ISS 41-75 9.9 9.6




ISS < 13 3.1 2.9

ISS 13-15 4.2 4.6

ISS 16-24 7.1 5.8

ISS 25-40 6.3 8.5

ISS 41-75 6.5 7.1


Appendix 3: Paediatric major trauma service summaries

Table 36: Trauma data profile, John Hunter Children’s Hospital

Facility Peer




Gender

Female / Male 7 / 18 22 / 35

Age ranges

Mean age 8.3 7.1

0-4 9 (36.0%) 24 (40.8%)

5-9 6 (24.0%) 13 (21.8%)

10-14 5 (20.0%) 14 (24.7%)

15-19 5 (20.0%) 7 (12.1%)


Mean ISS 14.8 19.1

ISS <13 8 (32.0%) 13 (22.0%)

ISS 13-15 3 (12.0%) 7 (12.7%)

ISS 16-24 12 (48.0%) 21 (35.8%)

ISS 25-40 1 (4.0%) 14 (24.9%)

ISS 41-75 1 (4.0%) 3 (4.6%)


Assault 2 (8.0%) 3 (4.6%)

Falls 8 (32.0%) 21 (36.8%)

Road trauma 6 (24.0%) 14 (23.6%)



Types of injury

Blunt 18 (72.0%) 46 (79.3%)

Penetrating 2 (8.0%) 1 (2.3%)


Admission type


Transfer in 8 (32.0%) 29 (49.7%)

Unknown 0 (0.0%) 0 (0.0%)


Facility Peer

Arrival modes

Ambulance 16 (64.0%) 31 (53.4%)

Helicopter 3 (12.0%) 8 (13.2%)




ISS <13 7.8 6.3

ISS 13-15 7.8 7.0

ISS 16-24 7.2 6.6

ISS 25-40 0.0 5.1

ISS 41-75 4.1 5.4




ISS <13 5.9 6.6

ISS 13-15 4.7 4.5

ISS 16-24 3.8 11.8

ISS 25-40 1.0 17.0

ISS 41-75 11.0 26.5

ICU length of stay



ISS <13 1.5 2.6

ISS 13-15 0.0 1.2

ISS 16-24 2.3 4.5

ISS 25-40 0.0 8.8

ISS 41-75 3.0 21.4




ISS <13 3.5 3.1

ISS 13-15 0.0 1.8

ISS 16-24 4.0 4.6

ISS 25-40 0.0 8.4

ISS 41-75 3.0 20.6


Table 37: Trauma data profile, Sydney Children’s Hospital

Facility Peer




Gender

Female / Male 20 / 44 22 / 35

Age ranges

Mean age 7.7 7.1

0-4 26 (40.6%) 24 (40.8%)

5-9 9 (14.1%) 13 (21.8%)

10-14 20 (31.3%) 14 (24.7%)

15-19 9 (14.1%) 7 (12.1%)


Mean ISS 17.9 19.1

ISS <13 14 (21.9%) 13 (22.0%)

ISS 13-15 12 (18.8%) 7 (12.7%)

ISS 16-24 19 (29.7%) 21 (35.8%)

ISS 25-40 19 (29.7%) 14 (24.9%)

ISS 41-75 0 (0.0%) 3 (4.6%)


Assault 3 (4.7%) 3 (4.6%)

Falls 28 (43.8%) 21 (36.8%)

Road trauma 16 (25.0%) 14 (23.6%)



Types of injury

Blunt 64 (100.0%) 46 (79.3%)

Penetrating 0 (0.0%) 1 (2.3%)


Admission type


Transfer in 42 (65.6%) 29 (49.7%)

Unknown 0 (0.0%) 0 (0.0%)


Facility Peer

Arrival modes

Ambulance 30 (46.9%) 31 (53.4%)

Helicopter 7 (10.9%) 8 (13.2%)




ISS <13 5.5 6.3

ISS 13-15 6.6 7.0

ISS 16-24 6.0 6.6

ISS 25-40 5.6 5.1

ISS 41-75 0.0 5.4




ISS <13 4.6 6.6

ISS 13-15 3.3 4.5

ISS 16-24 14.6 11.8

ISS 25-40 18.2 17.0

ISS 41-75 0.0 26.5

ICU length of stay



ISS <13 2.1 2.6

ISS 13-15 1.3 1.2

ISS 16-24 5.1 4.5

ISS 25-40 8.0 8.8

ISS 41-75 0.0 21.4




ISS < 13 2.0 3.1

ISS 13-15 2.0 1.8

ISS 16-24 5.9 4.6

ISS 25-40 5.3 8.4

ISS 41-75 0.0 20.6


Table 38: Trauma data profile, The Children’s Hospital at Westmead

Facility Peer




Gender

Female / Male 40 / 44 22 / 35

Age ranges

Mean age 6.3 7.1

0-4 36 (42.9%) 24 (40.8%)

5-9 23 (27.4%) 13 (21.8%)

10-14 18 (21.4%) 14 (24.7%)

15-19 7 (8.3%) 7 (12.1%)


Mean ISS 21.3 19.1

ISS <13 16 (19.0%) 13 (22.0%)

ISS 13-15 7 (8.3%) 7 (12.7%)

ISS 16-24 31 (36.9%) 21 (35.8%)

ISS 25-40 23 (27.4%) 14 (24.9%)

ISS 41-75 7 (8.3%) 3 (4.6%)


Assault 3 (3.6%) 3 (4.6%)

Falls 28 (33.3%) 21 (36.8%)

Road trauma 19 (22.6%) 14 (23.6%)



Types of injury

Blunt 56 (66.7%) 46 (79.3%)

Penetrating 2 (2.4%) 1 (2.3%)


Admission type


Transfer in 36 (42.9%) 29 (49.7%)

Unknown 0 (0.0%) 0 (0.0%)


Facility Peer

Arrival modes

Ambulance 47 (56.0%) 31 (53.4%)

Helicopter 13 (15.5%) 8 (13.2%)




ISS <13 6.5 6.3

ISS 13-15 7.3 7.0

ISS 16-24 6.7 6.6

ISS 25-40 4.8 5.1

ISS 41-75 5.6 5.4


Total bed days 1,179 674


ISS <13 8.7 6.6

ISS 13-15 6.4 4.5

ISS 16-24 13.2 11.8

ISS 25-40 16.7 17.0

ISS 41-75 28.7 26.5

ICU length of stay



ISS <13 3.6 2.6

ISS 13-15 1.0 1.2

ISS 16-24 4.3 4.5

ISS 25-40 9.4 8.8

ISS 41-75 24.5 21.4




ISS <13 4.2 3.1

ISS 13-15 1.0 1.8

ISS 16-24 3.5 4.6

ISS 25-40 10.4 8.4

ISS 41-75 23.5 20.6


Appendix 4: Regional trauma service summaries

Table 39: Trauma data profile, Coffs Harbour Health Campus

Facility Peer




Gender

Female / Male 17 / 49 20 / 59

Age ranges

Mean age 48.5 53.1

0-4 2 (3.0%) 2 (1.9%)

5-9 0 (0.0%) 1 (0.8%)

10-14 2 (3.0%) 2 (1.9%)

15-19 2 (3.0%) 4 (5.5%)

20-24 4 (6.1%) 5 (5.8%)

25-29 5 (7.6%) 3 (4.2%)

30-34 5 (7.6%) 4 (4.5%)

35-39 4 (6.1%) 5 (5.9%)

40-44 4 (6.1%) 5 (5.9%)

45-49 4 (6.1%) 5 (6.7%)

50-54 5 (7.6%) 6 (7.1%)

55-59 8 (12.1%) 7 (9.0%)

60-64 6 (9.1%) 5 (6.4%)

65-69 5 (7.6%) 4 (5.4%)

70-74 2 (3.0%) 5 (6.2%)

75-79 2 (3.0%) 5 (6.0%)

80-84 2 (3.0%) 5 (6.9%)

85 and over 4 (6.1%) 8 (10.5%)


Mean ISS 20.2 17.8

ISS <13 10 (15.2%) 12 (15.3%)

ISS 13-15 13 (19.7%) 20 (25.0%)

ISS 16-24 23 (34.8%) 30 (38.8%)

ISS 25-40 17 (25.8%) 15 (19.4%)

ISS 41-75 3 (4.5%) 1 (1.5%)


Assault 3 (4.5%) 5 (6.4%)

Falls 19 (28.8%) 31 (39.2%)

Falls (≥65 years) 9 (13.6%) 19 (24.5%)

Road trauma 33 (50.0%) 24 (31.2%)




Facility Peer

Types of injury

Blunt 59 (89.4%) 74 (94.4%)

Penetrating 3 (4.5%) 3 (4.2%)


Admission type


Transfer in 1 (1.5%) 14 (17.2%)

Unknown 0 (0.0%) 1 (0.6%)

Arrival modes

Ambulance 60 (90.9%) 64 (81.8%)

Helicopter 3 (4.5%) 5 (5.8%)




ISS <13 7.8 7.4

ISS 13-15 7.8 7.8

ISS 16-24 7.5 7.5

ISS 25-40 5.4 6.5

ISS 41-75 6.3 3.8




ISS <13 3.8 8.8

ISS 13-15 7.8 7.3

ISS 16-24 5.5 7.8

ISS 25-40 2.1 5.0

ISS 41-75 4.0 8.8

ICU length of stay



ISS <13 1.4 2.2

ISS 13-15 9.0 4.3

ISS 16-24 4.6 3.9

ISS 25-40 2.8 3.0

ISS 41-75 7.0 4.5




ISS <13 2.0 2.8

ISS 13-15 6.5 6.4

ISS 16-24 2.2 3.7

ISS 25-40 2.0 2.2

ISS 41-75 2.3 1.7


Table 40: Trauma data profile, Gosford Hospital

Facility Peer




Gender

Female / Male 12 / 46 20 / 59

Age ranges

Mean age 59.1 53.1

0-4 0 (0.0%) 2 (1.9%)

5-9 2 (3.4%) 1 (0.8%)

10-14 2 (3.4%) 2 (1.9%)

15-19 4 (6.9%) 4 (5.5%)

20-24 1 (1.7%) 5 (5.8%)

25-29 0 (0.0%) 3 (4.2%)

30-34 1 (1.7%) 4 (4.5%)

35-39 1 (1.7%) 5 (5.9%)

40-44 4 (6.9%) 5 (5.9%)

45-49 2 (3.4%) 5 (6.7%)

50-54 6 (10.3%) 6 (7.1%)

55-59 4 (6.9%) 7 (9.0%)

60-64 6 (10.3%) 5 (6.4%)

65-69 2 (3.4%) 4 (5.4%)

70-74 2 (3.4%) 5 (6.2%)

75-79 4 (6.9%) 5 (6.0%)

80-84 4 (6.9%) 5 (6.9%)

85 and over 13 (22.4%) 8 (10.5%)


Mean ISS 17.6 17.8

ISS <13 7 (12.1%) 12 (15.3%)

ISS 13-15 14 (24.1%) 20 (25.0%)

ISS 16-24 24 (41.4%) 30 (38.8%)

ISS 25-40 13 (22.4%) 15 (19.4%)

ISS 41-75 0 (0.0%) 1 (1.5%)


Assault 5 (8.6%) 5 (6.4%)

Falls 29 (50.0%) 31 (39.2%)

Falls (≥65 years) 18 (31.0%) 19 (24.5%)

Road trauma 13 (22.4%) 24 (31.2%)




Facility Peer

Types of injury

Blunt 56 (96.6%) 74 (94.4%)

Penetrating 2 (3.4%) 3 (4.2%)


Admission type


Transfer in 0 (0.0%) 14 (17.2%)

Unknown 0 (0.0%) 1 (0.6%)

Arrival modes

Ambulance 54 (93.1%) 64 (81.8%)

Helicopter 0 (0.0%) 5 (5.8%)




ISS <13 7.8 7.4

ISS 13-15 7.8 7.8

ISS 16-24 7.5 7.5

ISS 25-40 6.9 6.5

ISS 41-75 0.0 3.8




ISS <13 10.4 8.8

ISS 13-15 4.1 7.3

ISS 16-24 7.2 7.8

ISS 25-40 6.5 5.0

ISS 41-75 0.0 8.8

ICU length of stay



ISS <13 16.0 2.2

ISS 13-15 0.0 4.3

ISS 16-24 1.0 3.9

ISS 25-40 0.0 3.0

ISS 41-75 0.0 4.5




ISS <13 0.0 2.8

ISS 13-15 0.0 6.4

ISS 16-24 0.0 3.7

ISS 25-40 0.0 2.2

ISS 41-75 0.0 1.7


Table 41: Trauma data profile, Lismore Base Hospital

Facility Peer




Gender

Female / Male 14 / 51 20 / 59

Age ranges

Mean age 48.0 53.1

0-4 1 (1.5%) 2 (1.9%)

5-9 2 (3.1%) 1 (0.8%)

10-14 2 (3.1%) 2 (1.9%)

15-19 3 (4.6%) 4 (5.5%)

20-24 4 (6.2%) 5 (5.8%)

25-29 4 (6.2%) 3 (4.2%)

30-34 3 (4.6%) 4 (4.5%)

35-39 8 (12.3%) 5 (5.9%)

40-44 2 (3.1%) 5 (5.9%)

45-49 5 (7.7%) 5 (6.7%)

50-54 5 (7.7%) 6 (7.1%)

55-59 7 (10.8%) 7 (9.0%)

60-64 2 (3.1%) 5 (6.4%)

65-69 2 (3.1%) 4 (5.4%)

70-74 6 (9.2%) 5 (6.2%)

75-79 2 (3.1%) 5 (6.0%)

80-84 3 (4.6%) 5 (6.9%)

85 and over 4 (6.2%) 8 (10.5%)


Mean ISS 20.8 17.8

ISS <13 7 (10.8%) 12 (15.3%)

ISS 13-15 12 (18.5%) 20 (25.0%)

ISS 16-24 22 (33.8%) 30 (38.8%)

ISS 25-40 23 (35.4%) 15 (19.4%)

ISS 41-75 1 (1.5%) 1 (1.5%)


Assault 5 (7.7%) 5 (6.4%)

Falls 20 (30.8%) 31 (39.2%)

Falls (≥65 years) 12 (18.5%) 19 (24.5%)

Road trauma 23 (35.4%) 24 (31.2%)




Facility Peer

Types of injury

Blunt 60 (92.3%) 74 (94.4%)

Penetrating 4 (6.2%) 3 (4.2%)


Admission type


Transfer in 7 (10.8%) 14 (17.2%)

Unknown 0 (0.0%) 1 (0.6%)

Arrival modes

Ambulance 52 (80.0%) 64 (81.8%)

Helicopter 7 (10.8%) 5 (5.8%)




ISS <13 6.8 7.4

ISS 13-15 7.8 7.8

ISS 16-24 7.5 7.5

ISS 25-40 5.7 6.5

ISS 41-75 1.5 3.8




ISS < 13 5.3 8.8

ISS 13-15 30.3 7.3

ISS 16-24 3.9 7.8

ISS 25-40 5.5 5.0

ISS 41-75 1.0 8.8

ICU length of stay



ISS <13 1.3 2.2

ISS 13-15 3.0 4.3

ISS 16-24 1.7 3.9

ISS 25-40 1.3 3.0

ISS 41-75 0.0 4.5




ISS < 13 1.6 2.8

ISS 13-15 0.0 6.4

ISS 16-24 1.4 3.7

ISS 25-40 1.3 2.2

ISS 41-75 1.0 1.7


Table 42: Trauma data profile, Nepean Hospital

Facility Peer




Gender

Female / Male 31 / 83 20 / 59

Age ranges

Mean age 56.9 53.1

0-4 2 (1.8%) 2 (1.9%)

5-9 0 (0.0%) 1 (0.8%)

10-14 0 (0.0%) 2 (1.9%)

15-19 6 (5.3%) 4 (5.5%)

20-24 8 (7.0%) 5 (5.8%)

25-29 2 (1.8%) 3 (4.2%)

30-34 3 (2.6%) 4 (4.5%)

35-39 7 (6.1%) 5 (5.9%)

40-44 6 (5.3%) 5 (5.9%)

45-49 8 (7.0%) 5 (6.7%)

50-54 6 (5.3%) 6 (7.1%)

55-59 11 (9.6%) 7 (9.0%)

60-64 5 (4.4%) 5 (6.4%)

65-69 5 (4.4%) 4 (5.4%)

70-74 10 (8.8%) 5 (6.2%)

75-79 16 (14.0%) 5 (6.0%)

80-84 9 (7.9%) 5 (6.9%)

85 and over 10 (8.8%) 8 (10.5%)


Mean ISS 13.5 17.8

ISS <13 39 (34.2%) 12 (15.3%)

ISS 13-15 36 (31.6%) 20 (25.0%)

ISS 16-24 30 (26.3%) 30 (38.8%)

ISS 25-40 8 (7.0%) 15 (19.4%)

ISS 41-75 1 (0.9%) 1 (1.5%)


Assault 9 (7.9%) 5 (6.4%)

Falls 59 (51.8%) 31 (39.2%)

Falls (≥65 years) 38 (33.3%) 19 (24.5%)

Road trauma 17 (14.9%) 24 (31.2%)




Facility Peer

Types of injury

Blunt 106 (93.0%) 74 (94.4%)

Penetrating 8 (7.0%) 3 (4.2%)


Admission type


Transfer in 21 (18.4%) 14 (17.2%)

Unknown 0 (0.0%) 1 (0.6%)

Arrival modes

Ambulance 91 (79.8%) 64 (81.8%)

Helicopter 1 (0.9%) 5 (5.8%)




ISS <13 7.5 7.4

ISS 13-15 7.8 7.8

ISS 16-24 7.8 7.5

ISS 25-40 6.3 6.5

ISS 41-75 0.0 3.8


Total bed days 1,367 575


ISS < 13 14.4 8.8

ISS 13-15 8.9 7.3

ISS 16-24 14.5 7.8

ISS 25-40 5.8 5.0

ISS 41-75 3.0 8.8

ICU length of stay



ISS < 13 2.6 2.2

ISS 13-15 1.2 4.3

ISS 16-24 2.8 3.9

ISS 25-40 2.2 3.0

ISS 41-75 2.0 4.5




ISS < 13 2.0 2.8

ISS 13-15 0.0 6.4

ISS 16-24 0.0 3.7

ISS 25-40 0.0 2.2

ISS 41-75 0.0 1.7


Table 43: Trauma data profile, Orange Health Service

Facility Peer




Gender

Female / Male 22 / 82 20 / 59

Age ranges

Mean age 52.3 53.1

0-4 1 (1.0%) 2 (1.9%)

5-9 0 (0.0%) 1 (0.8%)

10-14 3 (2.9%) 2 (1.9%)

15-19 4 (3.8%) 4 (5.5%)

20-24 7 (6.7%) 5 (5.8%)

25-29 5 (4.8%) 3 (4.2%)

30-34 5 (4.8%) 4 (4.5%)

35-39 5 (4.8%) 5 (5.9%)

40-44 9 (8.7%) 5 (5.9%)

45-49 9 (8.7%) 5 (6.7%)

50-54 5 (4.8%) 6 (7.1%)

55-59 10 (9.6%) 7 (9.0%)

60-64 7 (6.7%) 5 (6.4%)

65-69 9 (8.7%) 4 (5.4%)

70-74 7 (6.7%) 5 (6.2%)

75-79 4 (3.8%) 5 (6.0%)

80-84 9 (8.7%) 5 (6.9%)

85 and over 5 (4.8%) 8 (10.5%)


Mean ISS 17.1 17.8

ISS <13 18 (17.3%) 12 (15.3%)

ISS 13-15 30 (28.8%) 20 (25.0%)

ISS 16-24 36 (34.6%) 30 (38.8%)

ISS 25-40 18 (17.3%) 15 (19.4%)

ISS 41-75 2 (1.9%) 1 (1.5%)


Assault 5 (4.8%) 5 (6.4%)

Falls 30 (28.8%) 31 (39.2%)

Falls (≥65 years) 19 (18.3%) 19 (24.5%)

Road trauma 33 (31.7%) 24 (31.2%)




Facility Peer

Types of injury

Blunt 101 (97.1%) 74 (94.4%)

Penetrating 3 (2.9%) 3 (4.2%)


Admission type


Transfer in 26 (25.0%) 14 (17.2%)

Unknown 3 (2.9%) 1 (0.6%)

Arrival modes

Ambulance 74 (71.2%) 64 (81.8%)

Helicopter 17 (16.3%) 5 (5.8%)




ISS <13 7.4 7.4

ISS 13-15 7.8 7.8

ISS 16-24 7.5 7.5

ISS 25-40 6.8 6.5

ISS 41-75 6.9 3.8




ISS <13 4.3 8.8

ISS 13-15 4.3 7.3

ISS 16-24 7.3 7.8

ISS 25-40 5.6 5.0

ISS 41-75 42.5 8.8

ICU length of stay



ISS <13 1.8 2.2

ISS 13-15 4.0 4.3

ISS 16-24 6.3 3.9

ISS 25-40 7.3 3.0

ISS 41-75 0.0 4.5




ISS <13 1.5 2.8

ISS 13-15 9.0 6.4

ISS 16-24 7.5 3.7

ISS 25-40 3.0 2.2

ISS 41-75 1.0 1.7


Table 44: Trauma data profile, Port Macquarie Base Hospital

Facility Peer




Gender

Female / Male 11 / 42 20 / 59

Age ranges

Mean age 52.7 53.1

0-4 0 (0.0%) 2 (1.9%)

5-9 0 (0.0%) 1 (0.8%)

10-14 1 (1.9%) 2 (1.9%)

15-19 3 (5.7%) 4 (5.5%)

20-24 6 (11.3%) 5 (5.8%)

25-29 3 (5.7%) 3 (4.2%)

30-34 2 (3.8%) 4 (4.5%)

35-39 2 (3.8%) 5 (5.9%)

40-44 3 (5.7%) 5 (5.9%)

45-49 3 (5.7%) 5 (6.7%)

50-54 6 (11.3%) 6 (7.1%)

55-59 4 (7.5%) 7 (9.0%)

60-64 1 (1.9%) 5 (6.4%)

65-69 3 (5.7%) 4 (5.4%)

70-74 3 (5.7%) 5 (6.2%)

75-79 3 (5.7%) 5 (6.0%)

80-84 2 (3.8%) 5 (6.9%)

85 and over 8 (15.1%) 8 (10.5%)


Mean ISS 17.4 17.8

ISS <13 11 (20.8%) 12 (15.3%)

ISS 13-15 12 (22.6%) 20 (25.0%)

ISS 16-24 20 (37.7%) 30 (38.8%)

ISS 25-40 8 (15.1%) 15 (19.4%)

ISS 41-75 2 (3.8%) 1 (1.5%)


Assault 1 (1.9%) 5 (6.4%)

Falls 14 (26.4%) 31 (39.2%)

Falls (≥65 years) 8 (15.1%) 19 (24.5%)

Road trauma 19 (35.8%) 24 (31.2%)




Facility Peer

Types of injury

Blunt 45 (84.9%) 74 (94.4%)

Penetrating 2 (3.8%) 3 (4.2%)


Admission type


Transfer in 3 (5.7%) 14 (17.2%)

Unknown 0 (0.0%) 1 (0.6%)

Arrival modes

Ambulance 43 (81.1%) 64 (81.8%)

Helicopter 1 (1.9%) 5 (5.8%)




ISS <13 7.3 7.4

ISS 13-15 7.8 7.8

ISS 16-24 7.8 7.5

ISS 25-40 6.6 6.5

ISS 41-75 2.4 3.8




ISS <13 2.3 8.8

ISS 13-15 6.5 7.3

ISS 16-24 5.9 7.8

ISS 25-40 2.0 5.0

ISS 41-75 1.0 8.8

ICU length of stay



ISS <13 1.5 2.2

ISS 13-15 1.8 4.3

ISS 16-24 3.2 3.9

ISS 25-40 2.0 3.0

ISS 41-75 0.0 4.5




ISS <13 1.3 2.8

ISS 13-15 0.0 6.4

ISS 16-24 7.0 3.7

ISS 25-40 2.0 2.2

ISS 41-75 0.0 1.7


Table 45: Trauma data profile, Tamworth Rural Referral Hospital

Facility Peer




Gender

Female / Male 18 / 61 20 / 59

Age ranges

Mean age 49.9 53.1

0-4 4 (5.1%) 2 (1.9%)

5-9 0 (0.0%) 1 (0.8%)

10-14 1 (1.3%) 2 (1.9%)

15-19 7 (8.9%) 4 (5.5%)

20-24 2 (2.5%) 5 (5.8%)

25-29 1 (1.3%) 3 (4.2%)

30-34 3 (3.8%) 4 (4.5%)

35-39 6 (7.6%) 5 (5.9%)

40-44 5 (6.3%) 5 (5.9%)

45-49 5 (6.3%) 5 (6.7%)

50-54 9 (11.4%) 6 (7.1%)

55-59 9 (11.4%) 7 (9.0%)

60-64 7 (8.9%) 5 (6.4%)

65-69 5 (6.3%) 4 (5.4%)

70-74 4 (5.1%) 5 (6.2%)

75-79 2 (2.5%) 5 (6.0%)

80-84 3 (3.8%) 5 (6.9%)

85 and over 6 (7.6%) 8 (10.5%)


Mean ISS 17.7 17.8

ISS <13 13 (16.5%) 12 (15.3%)

ISS 13-15 19 (24.1%) 20 (25.0%)

ISS 16-24 36 (45.6%) 30 (38.8%)

ISS 25-40 10 (12.7%) 15 (19.4%)

ISS 41-75 1 (1.3%) 1 (1.5%)


Assault 6 (7.6%) 5 (6.4%)

Falls 24 (30.4%) 31 (39.2%)

Falls (≥65 years) 14 (17.7%) 19 (24.5%)

Road trauma 25 (31.6%) 24 (31.2%)




Facility Peer

Types of injury

Blunt 72 (91.1%) 74 (94.4%)

Penetrating 3 (3.8%) 3 (4.2%)


Admission type


Transfer in 24 (30.4%) 14 (17.2%)

Unknown 0 (0.0%) 1 (0.6%)

Arrival modes

Ambulance 52 (65.8%) 64 (81.8%)

Helicopter 14 (17.7%) 5 (5.8%)


Revised trauma Score


ISS <13 7.0 7.4

ISS 13-15 7.8 7.8

ISS 16-24 7.5 7.5

ISS 25-40 7.3 6.5

ISS 41-75 1.9 3.8




ISS <13 8.5 8.8

ISS 13-15 4.6 7.3

ISS 16-24 11.4 7.8

ISS 25-40 5.9 5.0

ISS 41-75 1.0 8.8

ICU length of stay



ISS <13 1.6 2.2

ISS 13-15 6.0 4.3

ISS 16-24 3.4 3.9

ISS 25-40 2.4 3.0

ISS 41-75 0.0 4.5




ISS <13 6.3 2.8

ISS 13-15 0.0 6.4

ISS 16-24 4.8 3.7

ISS 25-40 0.0 2.2

ISS 41-75 0.0 1.7


Table 46: Trauma data profile, The Tweed Hospital

Facility Peer




Gender

Female / Male 10 / 30 20 / 59

Age ranges

Mean age 48.1 53.1

0-4 1 (2.5%) 2 (1.9%)

5-9 0 (0.0%) 1 (0.8%)

10-14 2 (5.0%) 2 (1.9%)

15-19 3 (7.5%) 4 (5.5%)

20-24 2 (5.0%) 5 (5.8%)

25-29 2 (5.0%) 3 (4.2%)

30-34 4 (10.0%) 4 (4.5%)

35-39 2 (5.0%) 5 (5.9%)

40-44 2 (5.0%) 5 (5.9%)

45-49 2 (5.0%) 5 (6.7%)

50-54 3 (7.5%) 6 (7.1%)

55-59 3 (7.5%) 7 (9.0%)

60-64 5 (12.5%) 5 (6.4%)

65-69 1 (2.5%) 4 (5.4%)

70-74 1 (2.5%) 5 (6.2%)

75-79 2 (5.0%) 5 (6.0%)

80-84 1 (2.5%) 5 (6.9%)

85 and over 4 (10.0%) 8 (10.5%)


Mean ISS 21.5 17.8

ISS <13 0 (0.0%) 12 (15.3%)

ISS 13-15 7 (17.5%) 20 (25.0%)

ISS 16-24 21 (52.5%) 30 (38.8%)

ISS 25-40 11 (27.5%) 15 (19.4%)

ISS 41-75 1 (2.5%) 1 (1.5%)


Assault 4 (10.0%) 5 (6.4%)

Falls 12 (30.0%) 31 (39.2%)

Falls (≥65 years) 7 (17.5%) 19 (24.5%)

Road trauma 21 (52.5%) 24 (31.2%)




Facility Peer

Types of injury

Blunt 38 (95.0%) 74 (94.4%)

Penetrating 2 (5.0%) 3 (4.2%)


Admission type


Transfer in 3 (7.5%) 14 (17.2%)

Unknown 0 (0.0%) 1 (0.6%)

Arrival modes

Ambulance 34 (85.0%) 64 (81.8%)

Helicopter 1 (2.5%) 5 (5.8%)



Mean – overall 7.2 7.3

ISS <13 0.0 7.4

ISS 13-15 7.8 7.8

ISS 16-24 7.5 7.5

ISS 25-40 6.8 6.5

ISS 41-75 0.0 3.8




ISS <13 0.0 8.8

ISS 13-15 3.3 7.3

ISS 16-24 3.4 7.8

ISS 25-40 4.7 5.0

ISS 41-75 1.0 8.8

ICU length of stay



ISS <13 0.0 2.2

ISS 13-15 0.0 4.3

ISS 16-24 3.0 3.9

ISS 25-40 11.0 3.0

ISS 41-75 0.0 4.5




ISS <13 0.0 2.8

ISS 13-15 0.0 6.4

ISS 16-24 0.0 3.7

ISS 25-40 10.0 2.2

ISS 41-75 1.0 1.7


Table 47: Trauma data profile, Wagga Wagga Rural Referral Hospital

Facility Peer




Gender

Female / Male 19 / 40 20 / 59

Age ranges

Mean age 45.5 53.1

0-4 2 (3.4%) 2 (1.9%)

5-9 2 (3.4%) 1 (0.8%)

10-14 1 (1.7%) 2 (1.9%)

15-19 5 (8.5%) 4 (5.5%)

20-24 4 (6.8%) 5 (5.8%)

25-29 5 (8.5%) 3 (4.2%)

30-34 4 (6.8%) 4 (4.5%)

35-39 4 (6.8%) 5 (5.9%)

40-44 2 (3.4%) 5 (5.9%)

45-49 8 (13.6%) 5 (6.7%)

50-54 3 (5.1%) 6 (7.1%)

55-59 2 (3.4%) 7 (9.0%)

60-64 1 (1.7%) 5 (6.4%)

65-69 1 (1.7%) 4 (5.4%)

70-74 3 (5.1%) 5 (6.2%)

75-79 3 (5.1%) 5 (6.0%)

80-84 2 (3.4%) 5 (6.9%)

85 and over 7 (11.9%) 8 (10.5%)


Mean ISS 16.7 17.8

ISS <13 6 (10.2%) 12 (15.3%)

ISS 13-15 13 (22.0%) 20 (25.0%)

ISS 16-24 34 (57.6%) 30 (38.8%)

ISS 25-40 6 (10.2%) 15 (19.4%)

ISS 41-75 0 (0.0%) 1 (1.5%)


Assault 5 (8.5%) 5 (6.4%)

Falls 18 (30.5%) 31 (39.2%)

Falls (≥65 years) 10 (16.9%) 19 (24.5%)

Road trauma 20 (33.9%) 24 (31.2%)




Facility Peer

Types of injury

Blunt 55 (93.2%) 74 (94.4%)

Penetrating 4 (6.8%) 3 (4.2%)


Admission type


Transfer in 12 (20.3%) 14 (17.2%)

Unknown 0 (0.0%) 1 (0.6%)

Arrival modes

Ambulance 49 (83.1%) 64 (81.8%)

Helicopter 0 (0.0%) 5 (5.8%)




ISS <13 7.8 7.4

ISS 13-15 7.2 7.8

ISS 16-24 7.8 7.5

ISS 25-40 7.8 6.5

ISS 41-75 0.0 3.8




ISS <13 7.7 8.8

ISS 13-15 3.5 7.3

ISS 16-24 5.1 7.8

ISS 25-40 1.0 5.0

ISS 41-75 0.0 8.8

ICU length of stay



ISS <13 3.3 2.2

ISS 13-15 1.5 4.3

ISS 16-24 3.1 3.9

ISS 25-40 1.0 3.0

ISS 41-75 0.0 4.5




ISS <13 2.0 2.8

ISS 13-15 1.0 6.4

ISS 16-24 1.0 3.7

ISS 25-40 1.0 2.2

ISS 41-75 0.0 1.7


Table 48: Trauma data profile, Wollongong Hospital

Facility Peer




Gender

Female / Male 43 / 103 20 / 59

Age ranges

Mean age 59.1 53.1

0-4 2 (1.4%) 2 (1.9%)

5-9 0 (0.0%) 1 (0.8%)

10-14 1 (0.7%) 2 (1.9%)

15-19 6 (4.1%) 4 (5.5%)

20-24 7 (4.8%) 5 (5.8%)

25-29 6 (4.1%) 3 (4.2%)

30-34 5 (3.4%) 4 (4.5%)

35-39 7 (4.8%) 5 (5.9%)

40-44 9 (6.2%) 5 (5.9%)

45-49 6 (4.1%) 5 (6.7%)

50-54 7 (4.8%) 6 (7.1%)

55-59 12 (8.2%) 7 (9.0%)

60-64 10 (6.8%) 5 (6.4%)

65-69 9 (6.2%) 4 (5.4%)

70-74 10 (6.8%) 5 (6.2%)

75-79 9 (6.2%) 5 (6.0%)

80-84 19 (13.0%) 5 (6.9%)

85 and over 21 (14.4%) 8 (10.5%)


Mean ISS 19.0 17.8

ISS <13 9 (6.2%) 12 (15.3%)

ISS 13-15 40 (27.4%) 20 (25.0%)

ISS 16-24 58 (39.7%) 30 (38.8%)

ISS 25-40 38 (26.0%) 15 (19.4%)

ISS 41-75 1 (0.7%) 1 (1.5%)


Assault 7 (4.8%) 5 (6.4%)

Falls 81 (55.5%) 31 (39.2%)

Falls (≥65 years) 56 (38.4%) 19 (24.5%)

Road trauma 39 (26.7%) 24 (31.2%)




Facility Peer

Types of injury

Blunt 144 (98.6%) 74 (94.4%)

Penetrating 2 (1.4%) 3 (4.2%)


Admission type


Transfer in 38 (26.0%) 14 (17.2%)

Unknown 2 (1.4%) 1 (0.6%)

Arrival modes

Ambulance 129 (88.4%) 64 (81.8%)

Helicopter 1 (0.7%) 5 (5.8%)




ISS <13 7.8 7.4

ISS 13-15 7.8 7.8

ISS 16-24 7.4 7.5

ISS 25-40 6.9 6.5

ISS 41-75 0.0 3.8




ISS <13 10.1 8.8

ISS 13-15 5.7 7.3

ISS 16-24 9.1 7.8

ISS 25-40 6.3 5.0

ISS 41-75 1.0 8.8

ICU length of stay



ISS <13 2.5 2.2

ISS 13-15 10.0 4.3

ISS 16-24 6.9 3.9

ISS 25-40 1.7 3.0

ISS 41-75 0.0 4.5




ISS <13 3.4 2.8

ISS 13-15 9.0 6.4

ISS 16-24 5.6 3.7

ISS 25-40 2.3 2.2

ISS 41-75 0.0 1.7


Appendix 5: Calculation of the Injury Severity Score

An ISS is calculated for each patient based on the AIS injury severity classification of their specific

injuries. The ISS value ranges from 1-75 and is calculated as:

ISS = A2 + B2 + C2

Where A, B, and C are the highest AIS severity codes in each of the (up to) three most severely

injured ISS body regions.

The six ISS body regions are:

head or neck

face

chest

abdominal or pelvic contents

extremities or pelvic girdle

external.

The following example shows how an ISS is calculated from a set of injuries.

Table 49: ISS calculation example

ISS body region Injury AIS severity

code

Include in

ISS

calculation?

Head or neck Small subdural haematoma AIS-4 Yes

Chest Bilateral lung contusion AIS-4 No

Chest Bilateral flail chest AIS-5 Yes

Abdominal or pelvic contents Superficial spleen laceration AIS-2 Yes

Extremities or pelvic girdle Left phalange (little toe) fracture AIS-1 No

On the basis of the above injuries, the ISS is calculated as:

ISS = 42 + 52 + 22

ISS = 45 (critical injury)


Appendix 6: Australian Statistical Geography Standard Remoteness Areas

The Australian Statistical Geography Standard (ASGS) Remoteness Areas (RA) is based on the

Accessibility and Remoteness Index of Australia (ARIA+) which defines locations in terms of

remoteness, i.e. the physical distance of a location from the nearest urban centre (access to goods

and services) based on population size.

Figure 33: Map of 2016 Remoteness areas for Australia

Source: ABS, http://www.abs.gov.au/websitedbs/d3310114.nsf/home/remoteness+structure

For further information on ASGS-RA please see The Australian Statistical Geography Standard

(ASGS) Remoteness Structure on the Australian Bureau of Statistics website.

http://www.abs.gov.au/websitedbs/d3310114.nsf/home/remoteness+structure



Documents

Major Trauma in NSW: 2016-17 · NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 iv Minor soft tissue injury is defined as a superficial injury including