INSTITUTE OF
TRAUMA AND INJURY
MANAGEMENTNE W
S OU
TH W
AL ES
The NSW Trauma Registry Profile of Serious to Critical Injuries
2007
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Suggested citation New South Wales Institute of Trauma and Injury Management. The NSW Trauma Registry Profi le of Serious to Critical Injuries: 2007. 2010. NSW Health
Prepared by David Martens NSW Trauma Data Manager New South Wales Institute of Trauma and Injury Management
Any enquiries about or comments on this publication should be directed to: Trish McDougall Executive Manager NSW Institute of Trauma and Injury Management PO Box 6314 Level 3, 51 Wicks Road NORTH RYDE NSW 2113 Phone: 02 9887 5726 Fax: 02 9887 5843 International: +61 2 9887 5726 Email: itim@nsccahs.health.nsw.gov.au Website: www.itim.nsw.gov.au
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 i
Contents Executive Summary .......................................................................................................................................................... 1
Key observations in the 2007 dataset ........................................................................................................................ 1
Overview ......................................................................................................................................................................... 2
Main themes of this report ........................................................................................................................................ 2
Methodology ............................................................................................................................................................ 3
How data in this report is used .................................................................................................................................. 4
Injury Severity Scoring ...................................................................................................................................................... 5
The Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) ............................................................................... 5
Introduction of AIS 2005 ........................................................................................................................................... 6
Monitoring the NSW Trauma System ................................................................................................................................ 7
The NSW Trauma system ........................................................................................................................................... 7
The NSW Trauma Registry ......................................................................................................................................... 7
The State-wide Trauma Registry project ..................................................................................................................... 8
Dimensions of the 2007 data ........................................................................................................................................... 9
General observations ................................................................................................................................................. 9
Summary charts and tables ......................................................................................................................................11
People Injured ....................................................................................................................................................11
Trauma service Admissions ................................................................................................................................ 12
Age and gender distribution .................................................................................................................................... 13
Mechanisms of injury .............................................................................................................................................. 15
Geographic distribution ........................................................................................................................................... 17
Time and day of injury ............................................................................................................................................. 18
Injuries .................................................................................................................................................................... 19
Triage and transport ................................................................................................................................................ 21
Admission type ................................................................................................................................................. 21
Modes of transport ........................................................................................................................................... 23
Times to defi nitive care ..................................................................................................................................... 24
Surgical procedures ................................................................................................................................................. 26
Intensive Care Unit admissions ................................................................................................................................. 28
Hospital lengths of stay ........................................................................................................................................... 29
Appendix 1: Hospital data summaries ............................................................................................................................ 31
Gosford Hospital ..................................................................................................................................................... 31
John Hunter Hospital/John Hunter Children’s Hospital ............................................................................................. 32
Liverpool Hospital .................................................................................................................................................... 33
Nepean Hospital ...................................................................................................................................................... 34
Prince of Wales Hospital .......................................................................................................................................... 35
Royal North Shore Hospital ...................................................................................................................................... 36
Royal Prince Alfred Hospital ..................................................................................................................................... 37
St George Hospital .................................................................................................................................................. 38
St Vincent’s Hospital ................................................................................................................................................ 39
Sydney Children’s Hospital ....................................................................................................................................... 40
The Children’s Hospital at Westmead ...................................................................................................................... 41
Westmead Hospital ................................................................................................................................................. 42
Wollongong Hospital ............................................................................................................................................... 43
Appendix 2: Trauma data collection tool ........................................................................................................................ 44
Appendix 3: Calculation of the Injury Severity Score (ISS) ............................................................................................... 45
Index of fi gures .............................................................................................................................................................. 46
Index of tables ............................................................................................................................................................... 47
ii ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 1
Executive Summary The key priority for trauma data collection by the NSW Institute of Trauma and Injury Management (NSW ITIM) is to
monitor the effectiveness of the NSW Trauma System as it responds to the most seriously injured patients in the state.
The numbers of patients described in this report are relatively small in contrast to the large numbers of people admitted
to hospital or attending emergency departments in NSW hospitals following traumatic injury. However, this group of
patients, the serious to critically injured, place 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.
How the NSW trauma system responds to these patients is critical to the long term outcome and quality of life for these
patients, as well as reducing the overall cost to the individual and the community of the injury.
This report, the seventh annual report drawn from the NSW Trauma Registry, provides a snapshot of the trauma system’s
response to these patients during 2007, arranged by key performance indicator areas including triage and transport, times
to defi nitive care and other in-hospital indicators.
Numerous other dimensions of the spectrum of trauma for 2007 are also included to assist agencies concerned with injury
and health prevention strategies. These illustrate how and where trauma occurred during the year and which groups of
people in the community appear most vulnerable to trauma.
Key observations in the 2007 dataset The number of people recorded as serious to critically injured was 2271 J
The case fatality rate for 2007 was 12.15%, down from 12.6% in 2006 J
Road trauma numbers fell by almost 17% from 2006 to 2007 J
Numbers of falls and assaults continued to rise J
Mean monthly fi gures for the 15-44 years age group (which dominates the age distribution of trauma) in 2007 were J the lowest in the fi ve year period from 2003-2007.
70% of arrivals at trauma services were by ambulance J
The proportion of patients with an ISS in the 41-75 range (critical injuries) fell from 7.6% to 6.3% J
Over 87% of people injured in metropolitan areas in 2007 were admitted directly from the scene of their injury to a J defi nitive trauma service within 2 hours of their injury. The average time taken for these patients (arriving within 2
hours) was 56 minutes, representing just over 50% of all people injured in 2007
2 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Overview Main themes of this report This report presents data concerning the most seriously injured patients admitted to hospitals in NSW, collected from
thirteen trauma registries across the state.
The report describes the way in which the NSW trauma system responded to these patients, from the time of the injury
and provision of pre-hospital services, through to in-hospital services provided at a trauma service. The report analyses
dimensions of the data which indicate whether the system is working as it should, to ensure that the right patient gets to
the right hospital in a timely manner.
The data in this report also provides an insight into the nature of the injuries sustained by those people and how they
occurred. This spectrum of trauma as well as trends and social indicators contribute to safety and injury prevention efforts
and assists other agencies concerned with minimising the likelihood and effects of traumatic injury.
A variety of trauma system and demographic/injury prevention indicators are presented in this report, within the following
broader categories:
Demographic/injury prevention
Age and gender distribution J
Mechanisms of injury J
Geographic distribution J
Time/day of injury J
Injuries J
Trauma system
Triage and transport J
Times to defi nitive care J
Surgical procedures J
Intensive Care Unit admissions J
Hospital lengths of stay J
Case fatality rates, which are important key indicators, are examined within other dimensions of data in this report, while
overall case fatality rates for the year are described in the Summary charts and tables section.
As described later in this report, a particular strength of the NSW Trauma Registry is its ability to distinguish distinct
people (injured people) from their subsequent hospital admission(s) – by recording separate hospital admissions for
patients transferred between hospitals for treatment.
Generally, numbers of injured people are used in this report to describe people, their injuries, and how, when and where
they sustained them (social and health prevention indicators), while numbers of admissions are used to describe pre-
hospital and in-hospital treatments and services (trauma system indicators).
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 3
Overview
Methodology Data for this report is drawn from the NSW Trauma Registry, which contains de-identifi ed patient records submitted by
thirteen trauma registries in NSW. The NSW Trauma Registry does not hold data for every injured person admitted to
hospital in NSW. Rather, data is only submitted on behalf of patients with the greatest needs – the most seriously injured
– who are treated at one of the thirteen hospitals with a trauma registry.
As the scope of the current data collection is restricted to these thirteen hospitals, which are located within the Sydney
Greater Metropolitan area, there may be some data for trauma admissions to other hospitals – particularly in rural areas –
which is not included in the NSW Trauma Registry.
To correct this, future trauma data collection will be enhanced with data collected at rural hospitals. The NSW Rural
Trauma Clinical Nurse Consultant Pilot Project commenced in 2007 to enable data collection of serious to critical trauma
admissions to hospitals in a rural region. After project evaluation this will enable a process which may be adapted in other
areas to provide data, and monitoring of patient outcomes and trauma system function in rural areas of NSW.
The key criterion for including a patient record in the NSW Trauma Registry is a classifi cation of injuries as serious to
critical. This classifi cation relies upon an internationally recognised anatomical scoring system known as the Abbreviated
Injury Scale (AIS), and the Injury Severity Score (ISS). The AIS and ISS is used by accredited staff at each hospital trauma
registry to score individual patient injuries and their severity, and provides a common tool for comparing and selecting
patient records for inclusion in the NSW Trauma Registry.
Patients with injuries classifi ed as serious to critical are identifi ed for the NSW Trauma Registry when they have an Injury
Severity Score of greater than 15 (ISS > 15).
As well as describing the nature of injuries sustained by patients, the AIS and ISS also indicate mortality, quality of life, and
trauma care, across such dimensions as:
Hospitalisation and need for intensive care J
Length of hospital stay J
Treatment cost J
Treatment complexity J
Length of treatment J 1
Improvements and changes in trauma care practices and treatments in these dimensions can have effects on the
estimation of severity of different injuries. AIS 2005, an update to the injury scoring standard, was introduced in NSW in
July 2007 to ensure trauma data collections in the state would refl ect such changes and improvements in trauma care.
Several other criteria are also used to select or fi lter trauma patient records for the state-wide trauma registry. They
include the following:
The patient must be admitted to a trauma service in NSW J
The patient must be admitted within fourteen days of sustaining an injury J
For deceased patients, the injuries must not include an isolated fractured neck of femur injury J
As a result of these criteria patient records submitted for inclusion in the NSW Trauma Registry do not represent all injuries
in NSW, nor do they represent the full work or caseload of trauma teams in hospitals, or the full set of data recorded in
hospital trauma registries.
1 Abbreviated Injury Scale 2005: Association for the Advancement of Automotive Medicine, 2005, p5
4 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Overview
The data is however, a very complete and accurate record of the serious to critically injured group of patients. Data
submitted for inclusion in the state-wide trauma registry is subject to rigorous checking and validation prior to inclusion in
the registry, while missing or invalid data is fl agged and returned to individual trauma services for completion.
Missing data however is rare and the state-wide trauma registry has an extremely low rate of incomplete records. In 2007
there was a missing or invalid data rate of less than 1% for records with an ISS > 15.
Records may also be excluded from this report if the following key data elements have missing or invalid data recorded in
the registry:
Date of injury J
Injury Severity Score J
Date of admission J
In 2007, no records with an ISS > 15 were excluded from this report.
How data in this report is used Data from the Trauma Minimum Data Set is used to provide advice and feedback to clinicians and other stakeholders, and
enables research into patterns of service demand and staffi ng. This data also supports benchmarking and performance
improvement activities. In addition it is used in the following important areas of practice:
Provides information to NSW Health, Area Health Services, Injury Prevention Groups, Motor Accidents Authority, Road J Traffi c Authority and other injury stakeholders
Supports current and future trauma service planning in NSW J
Identifi es specifi c areas of need for education programs for pre hospital providers, clinicians, administrators and J consumers
Illustrates the Rural – Metropolitan trauma transfer patterns J
Is a resource for the development of identifi ed Clinical Practice Guidelines J
Assists in the evaluation of inter-rater reliability Scoring Systems across the trauma environment. J
Recommends topics for potential research projects. J
Contributes to the National Trauma Registry Consortium J
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 5
Injury Severity Scoring The Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) The Injury Severity Score (ISS) is an internationally recognised anatomical scoring system that provides an overall score for
patients with multiple injuries. The ISS is a calculated number which is based on an anatomical injury severity classifi cation,
the Abbreviated Injury Scale (AIS)2. The AIS classifi es individual injuries by body region on a 6 point severity scale from
Minor to Maximum (currently untreatable injury).
Scoring is undertaken retrospectively, but usually within 24-48 hours after admission to allow for identifi cation of all
injuries. On initial evaluation these patients typically have abnormal vital signs or a signifi cant anatomical injury.
The calculated ISS value ranges from 1-75. (See Appendix 3) Serious to critically injured trauma patients are defi ned as
those patients with an ISS > 15, which is an internationally recognised indicator of serious injury. In this report ISS is
reported in ranges: 16-24 (serious injury), 25-40 (severe injury) and 41-75 (critical injury).
The ISS score correlates linearly with mortality, morbidity and other measures of severity. The correlation between ISS and
case fatality rates is evident in the NSW Trauma Registry dataset (see table 1). Case fatality rates rise with each ISS range
group and are the highest in the critically injured category of patients.
ISS range Case fatality rate Average hospital length of stay (days)3
16-24 3.8 % 12.82
25-40 20.52 % 18.72
41-75 45.34 % 21.53
Table 1: Case fatality rate and average hospital length of stay by ISS range, 2002-2007
The dataset also demonstrates a relationship between severity of injury and length of stay in hospital as an acute care
patient. Patients classifi ed as critically injured (ISS 41-75) have an average length of stay almost 70% longer than patients
classifi ed as seriously injured (ISS 16-24).
2 Abbreviated Injury Scale (AIS) 2005: Association for the Advancement of Automotive Medicine 3 Length of stay while classifi ed as an acute care patient
6 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Injury Severity Scoring
Introduction of AIS 2005 From 1st July 2007 trauma registries in NSW adopted an updated AIS standard, the AIS 2005, replacing the previous
standard, the AIS 1990 Update, ‘98 Revision. Trauma staff responsible for coding injures were trained and accredited in
the new standard prior to its introduction.
The AIS 2005 features a revised and expanded set of injury descriptors, enabling greater specifi city when coding injuries
as well as a wider range of injuries to select from. The AIS 2005 also features adjustments to severity scores for numerous
injuries. These code adjustments refl ect changes and greater sophistication in diagnosis and treatment of injuries.4
As the Injury Severity Score is a key criterion for the inclusion of patients in the NSW Trauma Registry, the new standard
may be expected to have an effect on the profi le of this group. As some injuries are no longer scored or rated as highly
as in the previous AIS standard, patients with those injuries may not have an Injury Severity Score warranting inclusion in
the registry. There are also some new items or injuries in the AIS 2005 permitting inclusion of some patients in the registry
who would not have been included previously, eg drowning.
It should be emphasised again that this report does not present a complete profi le of all people injured following
trauma in NSW. It is concerned only with the group of most seriously injured patients. The introduction of the AIS 2005
recognises that the identifying clinical features or injury characteristics of this group of patients have changed over time,
and that this should be refl ected in updated coding standards.
The new AIS 2005 coding standard was introduced on 1st July 2007 in NSW. Patients admitted before 1st July 2007 had
injuries scored with the AIS 1990 Update, ‘98 Revision, and patients admitted on or after that date had injuries which
were scored using the new AIS 2005.
Analysis of changes or trends in the data between this and previous reports should therefore be approached cautiously,
and it should not be presumed that the injury characteristics of the group have remained unchanged over time.
4 Abbreviated Injury Scale (AIS) 2005: Association for the Advancement of Automotive Medicine, pages 3,4
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 7
Monitoring the NSW Trauma System The NSW Trauma System The NSW trauma system consists of an organised approach to facilitate and coordinate a multidisciplinary system response
to provide care to injured patients. The system encompasses a continuum of care that provides injured people with the
greatest likelihood of returning to their prior 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 / critical and general
in-hospital care, rehabilitation services, allied health and medical care follow up.
The overall goal of the NSW State Trauma System is to decrease the incidence and severity of injury; as well as to ensure
optimal and accessible care to improve health outcomes for those who are injured. Furthermore the trauma system
aims to facilitate the treatment of the ‘right patient at the right hospital’, ensuring that designated trauma services have
appropriate resources to meet the complex needs of the injured patient.
The NSW Trauma Registry NSW ITIM is responsible for managing the collection of data about seriously to critically injured people admitted to trauma
services in NSW. Data collected about these patients is held securely in the NSW Trauma Registry. Data in the registry is
submitted regularly from trauma registries at the following hospitals (see Appendix 1):
Gosford Hospital J
John Hunter Hospital/John Hunter Children’s Hospital J
Liverpool Hospital J
Nepean Hospital J
Prince of Wales Hospital J
Royal North Shore Hospital J
Royal Prince Alfred Hospital J
St George Hospital J
St Vincent’s Hospital J
Sydney Children’s Hospital J
The Children’s Hospital at Westmead J
Westmead Hospital J
Wollongong Hospital J
As shown in the following chart, the NSW Trauma Registry has grown by about 2000 records each year since it’s inception
in 2002, and currently holds around 16,000 records of serious to critically injured people (fi gure 1). As the registry has
continued to grow, its importance as a source for trend analysis and supporting trauma research has also grown.
8 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
0
2000
4000
6000
8000
10000
12000
14000
16000
18000 Records held in NSW Trauma Registry (cumulative), 2002-2007
2002 2003 2004 2005 2006 2007
Figure 1: Records held in the NSW Trauma Registry (cumulative) 2002-2007
The registry itself contains simple, non-identifi able information about each injured person, the nature and location of
the incident resulting in injury, the main injuries sustained, and details of pre-hospital and in-hospital treatments and
services provided to each person. In addition, some data about other (earlier) hospital admissions is collected for patients
transferred to a trauma service for trauma services. The trauma data collection tool from which this data is derived is
provided at Appendix 2.
When a patient is transferred from one trauma service to another, the NSW Trauma Registry records the transfer as an
additional hospital admission for that patient. The number of patients remains as it is – only one person has been injured -
but an additional record has been created for the additional admission.5
This feature of the NSW Trauma Registry allows for counts of distinct people, generally referred to as ‘people injured’ in
the report, to be distinguished from counts of hospital admissions. By defi nition, the number of hospital admissions is
always equal to or greater than the number of people injured.
The State-wide Trauma Registry project In 2007 NSW ITIM initiated a major project to provide trauma services in NSW with a single trauma registry to
accommodate present and future needs of trauma data collection in the state. The project has delivered a trauma registry
which implements current standards in trauma data in NSW, in a user friendly application that is available wherever
trauma data is collected in NSW. The project is set for completion in early 2010.
Additional modules to be added to the registry feature rich reporting tools for trauma service staff in hospitals across
the state, enabling easy analysis of data and trends at each participating hospital. The application itself is highly secure,
ensuring absolute privacy of data, and access to the registry is strictly controlled and monitored by NSW ITIM.
The state-wide trauma registry is the cornerstone of future trauma data collection in NSW. Now established, it provides
the foundation for a highly validated and rigorous data collection enabling trauma service staff and NSW ITIM to more
effectively monitor and review the performance of the NSW trauma system.
This project addressed the state’s current and future trauma data needs – including an expansion of the dataset collected
and key performance indicators. This is an exciting development for trauma data in NSW, and a key component in NSW
ITIM’s ongoing commitment to the development of trauma services and trauma data in NSW.
5 Admissions to hospitals other than trauma services are generally not included in admission fi gures in this report unless specifi cally mentioned
Monitoring the NSW Trauma System
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 9
Dimensions of the 2007 data General observations In 2007 the number people with injuries classifi ed as serious to critical who were admitted to trauma services in NSW fell
to 2,271 people. This was the fi rst decrease in annual numbers since the NSW Trauma Registry was established in 2002.
The case fatality rate for all patients also fell to 12.15% (down from 12.6% in 2006).
The large reduction in numbers in 2007 corresponded to a fall in road trauma injuries recorded in the registry - the lowest
road trauma fi gures since 2002 (fi gure 2). Road trauma includes motorcycle trauma, motor vehicle collisions (drivers and
passengers), pedestrian trauma, and pedal cycle trauma. In contrast, the number of falls rose to almost equal road trauma
fi gures in 2007. Assaults fi gures also grew by 9% in 2007.
0
200
400
600
800
1,000
1,200
Road Trauma
Falls
Assault
Major Mechanisms of injury, 2003-2007
2003 2004 2005 20072006
Figure 2: Major mechanisms of injury 2003-2007
The decrease in road trauma fi gures was not confi ned to any particular category of road trauma, with numbers falling
in motor vehicle collisions, motorcycle trauma, pedal cycle and pedestrian trauma in 2007. It is also pleasing to note a
substantial fall in the young drivers group, where the number of injured people (63 people, a 33% fall from 2006) was
the lowest annual fi gure in fi ve years (fi gure 3).
10 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
0
20
40
60
80
100
120
2003 2004 2005 2006 2007
Motor Vehicle Drivers aged between 15 and 24 years, 2003-2007
Figure 3: Motor Vehicle Drivers aged between 15 and 24 years, 2003-2007
Postcodes of injury are recorded for the vast majority of records in the NSW Trauma Registry (approximately 95%).
Analysis of the 2007 data available shows that road trauma fi gures fell predominantly in Sydney South West and Sydney
West Area Health Service districts, and to a lesser extent within South Eastern Sydney/Illawarra Area Health Service
districts in 2007 (fi gure 4).
0
50
100
150
200
250
300
350
400
450
500
All other areas
Sydney West
Sydney South West
South Eastern Sydney/ Illawarra
Northern Sydney/ Central Coast
Hunter/ New England
Area Health Service District in which injury occurred, 2003-2007
2003 2004 2005 20072006
Figure 4: Area Health Service where injury occurred, 2003-2007
The overall numbers of injuries fell in most districts, with the exception of Northern Sydney/Central Coast Area Health
Service districts, where the overall fi gure rose to 391 injured people, the highest annual fi gure recorded for this Area
Health Service since 2002. Much of this rise is accounted for by an increase in falls, which rose from 159 in 2006 to 189
injured people in 2007. In analysing this data it should be noted that some data is not available for patients injured in
rural areas who were not transferred to a trauma service for treatment.
Dimensions of the 2007 data
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 11
Summary charts and tables People Injured
The NSW Trauma Registry recorded 2,271 people injured with an ISS > 15 in 2007 (table 2). This represented a decrease in
the number of people injured for this group of patients from 2006 of approximately 5%.
Total people injured 2271 people
Survived 1995 people 87.85% of people injured
Died 276 people 12.15% of people injured
Table 2: Injured people and outcomes
As data in the following pages demonstrates, this fall occurred primarily in road trauma numbers, which were almost 17%
lower than the previous year. This contrasted to assault and falls fi gures, which rose from 2006 fi gures.
The case fatality rate6 within this entire group of patients in 2007 was 12.15%, down slightly from the 2006 rate of
12.6% (fi gure 5). The rate also compares favourably with the mean monthly case fatality rate for the full 2003-2007
period (12.98%). The case fatality rate and number of deaths also remained within control limits during 2007. The NSW
case fatality rate was comparable to the Australasian rate for this population of 12%.7
0
500
1000
1500
2000
2500
3000
Survived
Died
2003 2004 2005 2006 2007
People injured, 2003-2007 (including deaths)
Figure 5: People injured, 2003-2007 (including deaths)
6 Death rates in this report are case fatality rates, calculated as follows: Case fatality rate = number of deaths divided by the number of patients in this data collection X 100
7 The National Trauma Registry Consortium (Australia and New Zealand). The National Trauma Registry (Australia and New Zealand) Report: 2005.2008. Herston
Dimensions of the 2007 data
12 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Trauma service Admissions
Trauma service admissions totalled 2,371 for this group of patients (table 3). This represented a decrease in the number of
admissions to trauma services for this group of patients from 2006 of approximately 5%.
Total trauma service admissions 2371 admissions
Monthly average admissions 198 admissions
Minimum monthly admissions 151 October
Maximum monthly admissions 247 April
Table 3: Trauma service admissions and deaths
Table 4 shows the distribution of admissions to trauma services within Area Health Services. These numbers include
admissions of transferred patients, as the same patient may be admitted to more than one trauma service in the same or
different Area Health Services.
Area Health Service Admissions %
Hunter/New England 400 16.9
Northern Sydney/Central Coast 478 20.2
South Eastern Sydney/Illawarra 575 24.3
Sydney South West 475 20
Sydney West 378 15.9
The Children’s Hospital at Westmead 65 ≤ 5
Table 4: Admissions by Area Health Service
Variation in admission numbers between the areas may be attributed in part to the location of specialist services, such
as the Spinal Injuries services at Prince of Wales and Royal North Shore Hospitals, paediatric services at Sydney Children’s
Hospital, and the burns service at Royal North Shore Hospital.
There were changes in the distribution of admissions to individual trauma services in 2007 (table 5). Admissions to
Westmead and Nepean Hospitals in the Sydney West Area Health Service fell by over 23%, and the number of admissions
to Nepean Hospital fell by 36.7%. Admissions also fell slightly at Liverpool Hospital, down by 7.6% from the previous year.
In contrast, admissions to Royal North Shore Hospital in 2007 grew by 16.9% and admissions to Royal Prince Alfred
Hospital rose by almost 9% in the same period.
Dimensions of the 2007 data
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 13
2003 2004 2005 2006 2007
Gosford Hospital 74 112 112 134 103
John Hunter Hospital 346 401 400 402 400
Liverpool Hospital 252 265 282 276 255
Nepean Hospital 122 146 150 164 120
Prince of Wales Hospital 135 116 61 71 49
Royal North Shore Hospital 281 309 330 320 375
Royal Prince Alfred Hospital 185 202 204 202 220
St George Hospital 182 223 221 228 230
St Vincent’s Hospital 136 112 126 130 149
Sydney Children’s Hospital 55 57 73 50 56
The Children’s Hospital at Westmead 74 103 78 76 65
Westmead Hospital 311 290 304 330 258
Wollongong Hospital 42 72 95 106 91
Table 5: Admissions to trauma services, 2002-2007
Major trauma admissions to John Hunter Hospital/John Hunter Children’s Hospital remained almost unchanged from 2006
to 2007, and as in previous years were greater than any other single trauma service during the past 5 years. This is largely
due to the hospital being the only trauma service in the Hunter/New England Area Health Service (in contrast to other
Area Health Services which host multiple trauma services).
Age and gender distribution
The pattern of age distribution of injured people in 2007 was similar to previous years (fi gure 6), although some changes
can be observed in age distribution data for the period from 2003-2007.
Although the group of injured people aged 15-44 years has dominated the age distribution pattern in all years, mean
monthly fi gures for this group in 2007 were the lowest in the fi ve year period (88 injured people per month). As a
proportion of the whole trauma population this group has been steadily declining since 2003, from 48.2% of all injured
people per month in 2003 to 43.8% in 2007.
In contrast, the group of serious to critically injured people aged 75 years and over has grown during the fi ve year period.
In 2003 an average of 23.25 people in this age group were injured each month. By 2007 this rate had grown to 37.2
injured people per month in this age group, accounting for an average of 18.3% of all people injured each month.
Dimensions of the 2007 data
14 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
0
50
100
150
200
250
300
350
400
Male
Female
95 and older
85-9475-8465-7455-6445-5435-4425-3415-240-14
People injured by Age and Gender
Figure 6: People injured, by age and gender
As fi gure 6 demonstrates, serious trauma is still predominantly a male health problem, with males outnumbering females
almost 3 to 1, although the proportion of females in the data rose to 27.4% in 2007.
Female
Male
2003 2004 2005 20072006 9
10
11
12
13
14
15
16
17
Case Fatality Rate by Gender, 2003-2007
Figure 7: Case fatality rate (%) by gender, 2003-2007
Case fatality rates for each gender fell slightly in 2007 (fi gure 7) and as observed in previous years the case fatality rate
was higher for females than for males (table 6).
Gender Survived(% of gender) Died All (% of total)
Female 530 (85.1%) 93 (14.9%) 623 (27.4%)
Male 1460 (88.6%) 187 (11.4%) 1647 (72.6%)
Table 6: Outcome by Gender8
8 Excludes records where gender recorded as indeterminate
Dimensions of the 2007 data
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 15
Mechanisms of injury While assaults and fall numbers continued to rise in 2007 as in previous years, road trauma fi gures fell by almost 17%
(fi gure 8). For the fi rst time in the NSW Trauma Registry, the number of people sustaining serious to critical injuries as a
result of a fall was almost the same as the number of people injured due to road trauma.
Major Mechanisms of Injury
Falls 38%
Road Trauma 39%
Assault 12%
Other 11%
Figure 8: Major mechanisms of injury
Road trauma numbers fell in all categories in 2007, as well as the overall case fatality rate for road trauma. The case
fatality rate improved most noticeably for pedestrian trauma, which fell from 20.9% in 2006 to 15.3% in 2007 (table 7).
Road Trauma Count % of Total Deaths (% of
mechanism)
MVC 413 people 18.2% 45 people (10.9%)
MBC 201 people 8.9% 11 people (5.5%)
Pedestrian 189 people 8.3% 29 people (15.3%)
Pedal Cyclist 78 people ≤ 5% ≤ 5 people (≤ 5%)
Total Road Trauma 881 people 38.8% 88 people (10%)
Table 7: Mechanism of Injury - Road Trauma
Unlike road trauma, numbers of fall-related injuries and assaults continued to rise in 2007, reaching their highest fi gures in
the fi ve years from 2003 – 2007 (table 8). Case fatality rates for falls in 2007 were comparable to the previous year, with
an overall rate of 15.2% (compared to 15.4% in 2006).
Dimensions of the 2007 data
16 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Fall Count % of Total Deaths (% of mechanism)
Low/Medium Fall (<5m) 777 people 34.2% 120 people (15.4%)
High Fall (>5m) 95 people 4.2% 13 people (13.7%)
Fall Unspecifi ed Height 7 people <1% ≤ 5 people (14.3%)
Total All Falls 879 people9 38.7% 134 people (15.2%)10
Table 8: Mechanism of Injury - Falls
The overall case fatality rate for assaults fell during the year (table 9); however the case fatality rate for the largest assault
category (blunt assault) was similar to the 2006 rate (5.8% in 2007 compared to 6% in 2006).
Case fatality rates in shooting and stabbing categories are affected by small changes in small numbers. Nevertheless far
fewer people died following shooting or stabbing incidents in 2007 than in 2006 (12 people in 2007 compared to 22
people in 2006).
Assault Count % of Total Deaths (% of mechanism)
Blunt Assault 190 people 8.4% 11 people (5.8%)
Shooting 12 people ≤ 5% ≤ 5 people (8.3%)
Stabbing 66 people ≤ 5% 11 people (16.7%)
Total All Assaults 268 people 11.8% 23 people (8.6%)
Table 9: Mechanism of Injury - Assaults
As fi gure 9 demonstrates, the highest case fatality rates during the 2003-2007 period were recorded for shooting injuries,
pedestrian accidents and low/medium falls (<5m). The rate for shooting injuries was 35.6%, well above the mean
monthly case fatality rate for the full 2003-2007 period which was 12.98%.
Case Fatality Rate by Mechanism of Injury, 2003-2007
0
10
20
30
40
% R
at ee
Sh oo
tin g
Pe de
st ria
n
Lo w
/ m
ed iu
m f
al l
Bu rn
s
St ab
bi ng
A ll
O th
er s
In du
st ria
l
Fa ll
> 5
m
M VA
M BA
Bl un
t A
ss au
lt
Pe da
l C
yc lis
t
Re cr
ea tio
n
H or
se
Sp or
t
Figure 9: Case fatality rate by mechanism, 2003-2007
9 Includes 3 falls of unspecifi ed height 10 Includes 1 death from a fall of unspecifi ed height
Dimensions of the 2007 data
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 17
Geographic distribution The collection of postcodes in the NSW Trauma Registry allows for an analysis of where people were injured. Aggregation
of the geographical location of injury (represented by postcode of injury in the dataset) into Area Health Service districts,
based on the boundaries of each Area Health Service, provides a snapshot of where traumatic injury occurred in NSW
during the year.
As table 10 demonstrates, people injured in Sydney South West Area Health Service district were the largest group in the
2007 dataset, representing over 20% of serious to critically injured people in NSW in 2006.
Area Health Service Admissions % of all patients11
Greater Southern 49 ≤ 5%
Greater Western 66 ≤ 5%
Hunter/New England 380 18.5%
North Coast 52 ≤ 5%
Northern Sydney/Central Coast 391 19.1%
South Eastern Sydney/Illawarra 363 17.7%
Sydney South West 416 20.3%
Sydney West 332 16.2%
Table 10: Geographical location of injury by Area Health Service (people injured)12
Signifi cantly fewer people were recorded as sustaining serious to critical injuries in non-metropolitan Area Health Services;
however these numbers do not include patients who may have been treated interstate. In addition, as the NSW Trauma
Registry does not collect data directly from rural area health services, the actual fi gures for rural areas may be higher than
indicated here. People injured in or treated in the ACT are also excluded from these fi gures.
11 Percentage of all patients where postcode of injury is known (N=2049) 12 Excludes 222 records where the postcode of injury is unknown.
Dimensions of the 2007 data
18 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Time and day of injury As fi gure 10 and table 11 demonstrate, noon to late afternoon was the most common time of day for serious to critical
trauma in 2007, with 35.3% of people injured between the hours of 12 noon and 6pm. The next peak times were
between noon and 1pm (128 people) and between 4pm and 5pm (129 people).
0
20
40
60
80
100
120
140
160
Pe op
le in
ju re
d
Hour (24 hr)
People injured by hour of day
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Figure 10: People injured by hour of day when injury occurred
Hour of Day Count (People Injured) % of Total
15:00 140 6.2%
16:00 129 5.7%
12:00 128 5.6%
Table 11: Injury Time - Top 3 Hours of the Day Injury Occurred (excludes patients where time of injury is
unknown)
As table 12 shows, the greatest numbers of patients were admitted to a trauma service between 5pm and 7pm (284
admissions).
Hour of Day Count (Admissions) % of Total
17:00 146 6.6%
18:00 138 6.2%
15:00 135 6.1%
Table 12: Admission Time - Top 3 Hours of the Day of Admission to Defi nitive Trauma service13
The most common days for traumatic injuries in 2007 were Friday, Saturday, and Sunday, with Saturday the busiest day
of the week (400 patients). In total, 1115 people were injured on these three days, or 49.1% of all people injured in 2007
(table 13).
13 The defi nitive trauma service is considered to be the trauma service where a patient is provided with all treatment and care required for their injuries.
Dimensions of the 2007 data
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 19
Day of Week Count (People injured)14 % of Total
Saturday 400 17.6%
Sunday 363 16%
Friday 352 15.5%
Thursday 292 12.9%
Monday 290 12.8%
Tuesday 288 12.7%
Wednesday 274 12.1%
Table 13: Injury Day of Week
Injuries There was a small change in the distribution of Injury Severity Scores (ISS) in 2007. The proportion of people injured with
an ISS in the 16-24 range (serious injuries) increased slightly from 56.3% to 58.5%, while the proportion of patients with
an ISS in the 41-75 range (critical injuries) fell from 7.6% to 6.3%. The ISS 25-40 range remained almost the same at
35.3% (table 14).
ISS Range Count (People injured) % of Total
16-24 1328 patients 58.5%
25-40 801 patients 35.3%
41-75 142 patients 6.3%
Table 14: Injury Severity Score (ISS)
As in previous years the head and neck body region continued to be the most frequently recorded injury region in the
NSW Trauma Registry in 2007 (fi gure 11), followed by the chest body region and extremities body region15. For the fi ve
year period from 2003-2007, the head body region was recorded for 71.2% of people injured.
Head injuries were recognised by NSW ITIM as a signifi cant issue in trauma, and consequently “The Initial Management
of Closed Head Injury in Adults” trauma clinical practice guideline was released by NSW ITIM and distributed statewide in
May 2007. The guideline discusses the initial management phase of mild to severe head injuries.
Injuries to the head and neck body region were recorded for 72.4% of injured people in 2007, similar to the 2006 fi gure
of 72.2%, and a little higher than the 2003-2007 average for this AIS body region. Injuries to the head and neck body
region were most frequent in the falls mechanism category, recorded for 85% of patients in this group.
The chest body region was the second most frequently recorded body region in 2007, recorded for 41.4% of all people
injured. Injuries to the chest region were most frequently recorded in relation to road trauma, where 64.1% of patients
had injuries to this body region.
14 Excludes 11 records where date of injury not recorded 15 While the body region provides an indication of the location of injuries for each patient, it does not necessarily indicate the nature of the injury. The Head or Neck
ISS Region for example may include cervical spine injuries as well as traumatic brain injuries and skull fractures.
Dimensions of the 2007 data
20 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
0
10
20
30
40
50
60
70
80
% p
eo pl
e in
ju re
d
ExternalExtremityAbdomenChestFaceHead
AIS Body Regions
Figure 11: AIS body regions
Higher ISS scores often result from injuries to more than one body region. In addition patients with injuries to more than
one body region have a higher average length of stay in hospital (for the period of acute care admission) as demonstrated
in table 15.
Number of body regions injured ISS 41-75 Case fatality rate Average LOS
Single body region 3.4%16 16% 13.43 days
Two or more body regions 7.3% 10.7% 16.87 days
Table 15: Single vs. multiple body regions, critically injured patients (%), case fatality rate and average
LOS, 2007
Case fatality rates are shown to be lower for people with injuries to more than one body region. This refl ects the ISS
scoring system, where although a single serious injury may warrant inclusion in the NSW Trauma Registry, higher ISS
scores may be derived from multiple less severe injuries.
16 Percentage of specifi ed body region category, ie, single or multiple body regions
Dimensions of the 2007 data
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 21
Triage and transport Admission type
NSW ITIM monitors rates and patterns of inter-hospital patient transfers in the NSW Trauma system, to ascertain the
effectiveness of the Ambulance Service of NSW (ASNSW) Protocol 4 early notifi cation and bypass system, and tertiary
referral networks17 in NSW. Much progress has been made in review of this protocol and implementation of a new
pre-hospital triage tool, Protocol T1, implemented in July 2008 to enhance and improve the performance of the NSW
trauma system.
Patients may be admitted to a trauma service directly from the scene of injury, or following a transfer from another
trauma service or a non-trauma service. In particular, patients requiring the services of a clinical super-specialty network
such as the NSW Acute Spinal Cord Injury Service (Adult), NSW Severe Burn Injury Service (Adult), or a paediatric trauma
service may be transferred.
Data regarding transfers is only recorded in the NSW Trauma Registry when a patient is transferred for acute care in
another hospital, i.e., when a patient is transferred for ‘defi nitive care’. Other transfers, for example transferring a patient
for rehabilitation services, are not recorded.
At 73.4%, the rate of ‘direct from scene’ admissions to trauma services in 2007 was comparable to the 2006 rate of
74.3% (table 16). Dissimilar rates of change in patient and trauma service admission numbers would indicate a change in
the direct from scene admission rate. The remainder of patients in the data admitted to a trauma service were transferred
from either another trauma service or non-trauma service.
Admission Type Count % of Total Deaths (% of mechanism)
Transfer In18 630 admissions 26.6% 59 (9.4%)
Direct From Scene 1741 admissions 73.4% 217 (12.4%)19
Table 16: Admission Types
Patients injured in rural districts are less likely to be admitted directly to a trauma service from the scene of the injury than
their metropolitan counterparts (table 17). Patients injured in rural districts may be admitted to a facility such as a base
hospital initially, where transfer to a major trauma service is arranged.
Admission Type Metropolitan Districts Rural Districts
Transfer In 332 admissions (17.7% of metropolitan patients) 240 admissions
(66.8% of rural patients)
Direct From Scene 1546 admissions (82.3%) 119 admissions (33.2%)
Table 17: Admission Type by geographical location of injury20
17 See NSW Health Policy Directive - Care Adult Tertiary Referral Networks - Intensive Care Default Policy (Doc No. PD2006_046) 18 Transfer In fi gures may include secondary transfers from another trauma service 19 This fi gure does not include patients directly admitted to a trauma service who were later transferred to another trauma and died 20 Numbers in this table are included only where postcode of injury is known. Totals in this table may be less than total admission fi gures for 2007
Dimensions of the 2007 data
22 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Transfer reasons recorded in the NSW Trauma Registry illustrate the progress of patients into the NSW Acute Spinal Cord
Injury Service (Adult) and NSW Severe Burn Injury Service (Adult) super-specialty networks and paediatric trauma services
(table 18). Other reasons for transferring patients may include specialist neurological services, specialist interventional
radiology services, etc.
Transfer reason Transfers
Burns 21
Other 60
Paediatric 41
Spinal 19
Table 18: Secondary transfers between trauma services - transfer reasons
Table 19 shows the transfer patterns to individual trauma services from other trauma services and non-trauma services
grouped by area health services in NSW. Most trauma services receive a large majority of transfers from within their own
area health service. Transfers to the clinical super-specialty networks are also represented by a broader distribution of
transfers to the following trauma services:
Prince of Wales (Spinal Cord Injury Service) J
Royal North Shore Hospital (Spinal Cord Injury Service, Severe Burn Injury Service) J
Sydney Children’s Hospital (paediatric trauma service) J
The Children’s Hospital at Westmead (paediatric trauma service) J
Table 19 also demonstrates out-of-area links between referring rural area health services and trauma services. For
example, as the closest trauma service in NSW to the North Coast Area Health Service, 15.3% of transfers of serious
to critically injured patients to John Hunter Hospital in 2007 were referred from hospitals in the North Coast Area
Health Service.
Dimensions of the 2007 data
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 23
G re
at er
S o
u th
er n
G re
at er
W es
te rn
H u
n te
r /
N ew
E n
g la
n d
N o
rt h
C o
as t
N o
rt h
er n
S yd
n ey
/ C
en tr
al C
o as
t
S o
u th
E as
te rn
S yd
n ey
/ Il
la w
ar ra
S yd
n ey
S o
u th
W es
t
S yd
n ey
W es
t
Gosford Hospital 100
John Hunter Hospital 81.6 15.3 ≤ 5 ≤ 5
Liverpool Hospital ≤ 5 ≤ 5 ≤ 5 85.1 6
Nepean Hospital 28.6 14.3 57.1
Prince of Wales Hospital 13.3 6.7 20 13.3 13.3 20 6.7 6.7
Royal North Shore Hospital ≤ 5 ≤ 5 11.7 17.5 62.3 ≤ 5 ≤ 5 ≤ 5
Royal Prince Alfred Hospital 9.1 42.4 6.1 6.1 6.1 12.1 15.2 ≤ 5
St George Hospital 6.6 9.2 7.9 6.6 6.6 63.2
St Vincent’s Hospital 50 8.3 8.3 33.3
Sydney Children’s Hospital 6.7 ≤ 5 6.7 ≤ 5 20 26.7 22.2 8.9
The Children’s Hospital at Westmead 6.8 20.5 6.8 18.2 4.5 29.5 11.4
Westmead Hospital ≤ 5 21.7 76.1
Wollongong Hospital 100
Table 19: Transfer in admissions to trauma services by referring Area Health Service
Modes of transport
Arrival modes recorded in the NSW Trauma Minimum Data Set refer to the way in which serious to critically injured
patients are delivered to an admitting trauma service. For patients transferred to a trauma service, arrival modes describe
the manner in which they were transferred.
Arrival modes include:
Ambulance J
Fixed Wing J 21
Helicopter J
NETS J 22
Private Vehicle J
Other J 23
21 For fi xed wing arrival modes, the data represents the primary mode of transport used to deliver the patient to an admitting trauma service. 22 NETS = NSW Newborn & Paediatric Emergency Transport Service. ‘NETS’ is the emergency service for medical retrieval of critically ill newborns, infants and
children in NSW. NETS does not transport from the scene (pre-hospital), but assists with transport for patients too sick for care to continue in their current hospital (source: http://www.nets.org.au)
23 Other modes of arrival may include taxis, buses, bicycles etc, as well as patients arriving on foot.
Dimensions of the 2007 data
24 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Arrival modes recorded in the NSW Trauma Minimum Data Set are only recorded for admissions to trauma services
in NSW.
In 2007, the proportion of ambulance arrivals24 at trauma services rose from 67.4% in 2006 to 70% (table 20). Arrivals by
helicopter remained similar; however the proportion of private vehicle arrivals fell from 6.5% to 5.8%.
Arrival Mode Admissions % of Total
Ambulance 1661 admissions 70%
Helicopter 397 admissions 16.7%
Private Vehicle 137 admissions 5.8%
Table 20: Arrival Mode - Top 3 Arrival Modes
Times to defi nitive care
Times to defi nitive care for patients with an ISS > 15 admitted to a trauma service provide an indicator of the effectiveness
of the NSW trauma system’s response to a trauma incident, encompassing the progress of the patient from the scene of
injury to admission to their defi nitive trauma service. This is considered to be the hospital where the patient is provided
with all treatment and care required for their injuries.
In 2007, 58.5% of all serious to critically injured patients arrived at a defi nitive trauma service within 2 hours of their
injury. This was slightly higher than the rate for 2003-2007 (57.3%). For critically injured patients (ISS 41-75) this rate was
higher, with 68.8% of patients in this group arriving at a defi nitive care hospital within 2 hours of their injury (65.6% for
2003-2007).
Numerous factors may impact on the time to defi nitive care, including:
How quickly emergency services are notifi ed J
Distance from trauma services J
Diffi culties at the scene of the injury, such as entrapment J
Whether or not patients are transported directly from the scene of their injury to a defi nitive care hospital J
Due to these and other factors, a single calculated average time to defi nitive care25 does not provide a reasonable
indication of the effectiveness of the NSW trauma system. Times to defi nitive care are therefore analysed in several
dimensions in order to minimise these factors. The key dimensions are:
Whether an injury occurred in a metropolitan or rural district J 26, and
Whether the patient was admitted to a defi nitive care hospital directly from the scene of their injury. J
A patient may be admitted to a hospital for treatment following a traumatic injury, however access to specialist treatment
or facilities may require transfer of the patient to a trauma service for defi nitive care, for example a child may be
transferred to a children’s hospital for specialised defi nitive care.
24 Arrival modes recorded in the NSW Trauma Minimum Data Set refer to the manner in which a patient is delivered to the admitting trauma service. For patients transferred to a trauma service, arrival modes also describe the manner in which they were transferred.
25 The time taken to defi nitive care is a value calculated from the date and time (where known) of injury to the date and time of admission to the trauma service where defi nitive care was provided to the patient.
26 This grouping is performed using the postcode where injury occurred (where known). Metropolitan locations include Greater Metropolitan Sydney, extending from Newcastle City in the North to Wollongong in the South.
Dimensions of the 2007 data
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 25
The data in table 21 demonstrates consistently that a signifi cantly higher proportion of rural patients were transferred
to a defi nitive care hospital (66% in 2007), compared to patients injured in a metropolitan area (17.5% in 2007). These
transferred rural patients were often fi rst admitted to a base hospital, where transfer to a major trauma service was
arranged.
In order to accommodate other factors, in particular how quickly (or whether) emergency services are notifi ed and time
required by emergency services at the scene of an injury, times to defi nitive care are further aggregated into time periods.
Individual times to defi nitive care are calculated for each patient and grouped into these time periods.
Time period Rural (n=99) Metropolitan (n=1315)
0-2 hours 48 patients (48.5%)Average 1 hour 27 min 1146 patients (87.1%)
Average 56 min
2-6 hours 36 patients (36.4%)Average 3 hours 1 min 79 patients (6%)
Average 3 hours 13 min
6-12 hours 7 patients (7.1%)Average 9 hours 39 min 32 patients (≤ 5%)
Average 8 hours 20 min
12-24 hours ≤ 5 patients (5.1%)Average 15 hours 45 min 24 patients (≤ 5%)
Average 16 hours 17 min
Greater than 24 hours ≤ 5 patients (≤ 5%)Average 120 hours 41 min 34 patients (≤ 5%)
Average 87 hours 48 min
Table 21: Time to defi nitive care for patients admitted directly to a defi nitive trauma service, rural vs.
metropolitan location of injury
Table 21 shows that a high proportion (87.1%) of people injured in metropolitan areas in 2007 were admitted directly
from the scene of their injury to a defi nitive trauma service within 2 hours of their injury. The average time taken for these
patients in 2007 was 56 minutes. This large group represented just over 50% of all people injured in 2007.27
Time period Rural (n=201) Metropolitan (n=279)
0-2 hours ≤ 5 patients (≤ 5%)Average 1 hour 42 min 11 patients (≤ 5%)
Average 1 hour 11 min
2-6 hours 33 patients (16.4%)Average 4 hours 38 min 82 patients (29.4%)
Average 4 hours 45 min
6-12 hours 75 patients (37.3%)Average 8 hours 39 min 86 patients (30.8%)
Average 8 hours 20 min
12-24 hours 55 patients (27.4%)Average 16 hours 35 min 42 patients (15.1%)
Average 17 hours 7 min
Greater than 24 hours 35 patients (17.4%)Average 110 hours 22 min 58 patients (20.8%)
Average 96 hours 59 min
Table 22: Time to defi nitive care for patients transferred to a defi nitive trauma service, rural vs
metropolitan location of injury28
Table 22 confi rms that patients transferred to a defi nitive trauma service within metropolitan locations generally arrive
sooner than their rural counterparts, however in general approximately 80% of both groups of transferred patients arrive
within 24 hours of their injury.
27 As numbers in this table only include patients where postcode and time of injury is known, actual fi gures may be larger. 28 Figures in this table represent patients transferred to a defi nitive trauma service from another hospital, including patients transferred from non-trauma services to
trauma services, and patients who may have been transferred between trauma services for defi nitive care.
Dimensions of the 2007 data
26 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
The data also shows that more critically injured patients (ISS 41-75) are transported to a defi nitive care hospital on average
more quickly than less seriously injured patients (table 23). In 2007 over 68% of critically injured patients arrived at a
defi nitive care hospital (whether direct from scene or transferred) within two hours of their injury in an average time of
50.4 minutes.
ISS Range 2007 2003-2007
16-24 59.1% (of ISS group)Average 59 min 58.8%
Avg 59 min
25-40 55.2%Avg 56 min 52.7%
Avg 58 min
41-75 68.8%Avg 50.4 min 68.8%
Avg 52.2 min
Table 23: Average times to defi nitive care for patients arriving within 2 hours of injury by ISS range
Surgical procedures The following surgical procedures are recorded in the Trauma Minimum Data Set, if the procedure was performed within
24 hours of admission to a trauma service:
Craniotomy J
Laparotomy J
Open (compound) fractures (called Open Ext# in the Trauma Minimum Data Set) J
Thoracotomy J
All other surgical procedures are recorded as ‘Other’ in the Trauma Minimum Data Set. J
27.8% of all patients (632 people) underwent surgery (745 procedures) within 24 hours of admission to a trauma
service in 2007, which was lower than the 2006 rate of 32.1%. Craniotomy continued to be the most common surgical
procedure (table 24), which concurs with the head and neck ISS body region being the most commonly injured ISS body
region in the data set.
Surgical Procedure Count %
Craniotomy 245 32.9%
Laparotomy 139 18.7%
Open Ext# 119 16%
Thoracotomy 25 3.4%
All other procedures 217 29.1%
Table 24: Operating procedures performed in fi rst 24 hours
The rate of surgical procedures is observed to increase with the severity of injury, as demonstrated in table 25. In 2007 the
surgery rate fell for the ISS groups ranging from 16 to 40; however the rate for critically injured patients remained close to
the 2003-2007 average at almost 50%.
Dimensions of the 2007 data
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 27
ISS Range 2007 2003-2007
16-24 17.5% 21.3%
25-40 37.9% 39.9%
41-75 49.7% 50.5%
Table 25: Rate of surgical procedures performed by ISS Range
The surgery rate was also higher for the group of patients with injuries to two or more body regions. For 2003-2007, the
group with injuries to a single body region had a surgery rate of 26.9%, and those with injuries to two or more body
regions had a higher rate of 31.3%. For 2007 these fi gures were lower (23.7% and 28% respectively) correlating to the
overall lower rate of surgical procedures in that year.
Average hospital lengths of stay (for the period of acute care admission) for patients requiring surgery have been
consistently longer than that for patients not requiring surgery (table 26). On average for the period from 2003-2007,
patients having surgery remained in hospital approximately 80% longer than those not having surgery.
Surgical Procedure 2007 2003-2007
Procedure performed 22.52 days 22.50 days
Not performed 13.51 days 12.61 days
Table 26: Average hospital lengths of stay, for patients having surgery and patients not having surgery
It is also interesting to observe different surgical rates for patients arriving at hospital by different modes of transport
(table 27). Helicopter arrivals had the highest surgery rate for the period from 2003-2007, although the rate for fi xed wing
arrivals was higher in 2007.29
This data helps illustrate the effectiveness of the pre-hospital components of the NSW Trauma System and the trauma
triage process, as more critically injured patients requiring urgent surgical attention are provided speedy transport to an
appropriate hospital.
Arrival mode 2007 2003-2007
Ambulance 26% 28.8%
Fixed Wing 38.4% 36.4%
Helicopter 33.1% 39.2%
Private transport 14.6% 18.1%
Table 27: Surgery rate by arrival mode, 2007 and 2003-2007
This is also illustrated in the rate of patients arriving directly from the scene of injury at a trauma service within two hours
of their injury. In 2007, 85.7% of patients requiring surgery arrived at a trauma service directly from the scene of their
accident within two hours. For patients not requiring surgery, this rate was lower at 77.6%.
Dimensions of the 2007 data
29 Fixed wing transport is generally used to transport patients from rural and remote regions to trauma services.
28 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Intensive Care Unit admissions Due to the severity of their injuries, patients in this data collection are often admitted to an intensive care unit at a
trauma service. An intensive care unit (ICU) is a designated ward of a hospital which is specially staffed and equipped to
provide observation, care and treatment to patients with critical injuries. The ICU provides special expertise and facilities
for the support of vital functions and utilises the skills of medical, nursing and other staff trained and experienced in the
management of these problems.30
In 2007 44.6% of injured people (1,013 people) recorded in the NSW Trauma Registry were admitted to an ICU (table
28). This was higher than the 2006 fi gures (1,018 people or 42.7% of injured people).
Admission to ICU Count % of Total
Yes 1013 people/ 1024 ICU admissions 44.6% of people/43.2% of hospital admissions31
No 1314 people/ 1347 hospital admissions 57.9% of people/ 56.8% of hospital admissions
Table 28: ICU Admissions
The case fatality rate for this group was 12.9%, contrasting with the case fatality rate of 10.7% for people not admitted
to an intensive care unit (table 29). In general this refl ects a higher severity of injury for patients requiring intensive care
unit admission.
Admission to ICU Outcome – Survived Outcome – Died
Yes 892 admissions (87.1%) 132 admissions (12.9%)
No 1203 admissions (89.3%) 144 admissions (10.7%)
Table 29: ICU Admission by Outcome
The average length of stay in an ICU in 2006 was 7.98 days (table 30). The length of stay in an ICU varied with outcome –
patients who survived stayed in ICU an average 8.29 days, while patients who died stayed an average 5.9 days in an ICU.
Outcome - All Outcome – Survived Outcome – Died
7.98 Days 8.29 days 5.9 days
Table 30: ICU Average Length of Stay (LOS)
The data also shows a higher rate of ICU admission for more seriously injured patients (table 31). Over two thirds of
critically injured patients (ISS 41-75) were admitted to an intensive care unit in 2007, compared to just over one third of
patients with an ISS in the 16-24 range. Average ICU lengths of stay and average hospital lengths of stay (for the period
of acute care admission) were also correspondingly higher for the critically injured group admitted to an ICU.32
Dimensions of the 2007 data
30 National Health Data Committee 2003. National Health Data Dictionary.Version 12, Volume 1, AIHW cat. No. HWI 43. Canberra: Australian Institute of Health and Welfare
31 The lower percentage of hospital admissions admitted to ICU (compared to the percentage of distinct people injured admitted to an ICU) is due to the effect of transferred patients who were admitted in the defi nitive care trauma service but not admitted in the fi rst trauma service. This is not unusual for patients transferred soon after arrival at a trauma service
32 Outcome is recorded for the entire period of acute care admission. Patients who died and who were admitted to an ICU may not necessarily have died in an ICU.
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 29
ISS Range ICU admission rate (%) Average ICU LOS Average hospital LOS (patients admitted to ICU)
16-24 34% 5.37 days 18.11 days
25-40 55% 9.94 days 25.02 days
41-75 64% 11.20 days 29.75 days
Table 31: ICU admission statistics by ISS range
There is also a marked difference between case fatality rates for the ISS 41-75 group when comparing those patients
admitted to an intensive care unit and those who are not (table 32). Almost 80% of patients with an ISS 41-75 who were
not admitted to an ICU died in 2007, compared to 24.2% of patients in this ISS group who were admitted to an ICU.
There is a similarly marked difference in average hospital lengths of stay for these groups, which may correlate to the high
case fatality rate for those not admitted to an ICU in the 41-75 ISS range group.
ISS range 41-75 Case fatality Rate (%) Average hospital LOS
Admitted to ICU 24.2% 29.75 days
Not admitted to ICU 79.6% 3.67 days
Table 32: ISS range 41-75 statistics, admitted/not admitted to an ICU
Hospital lengths of stay The hospital length of stay recorded in the NSW Trauma Minimum Data Set is the length of stay in a trauma service while
classifi ed as an acute care patient. Additional days in hospital, for example while attending rehabilitation, are not included
in these fi gures. For patients admitted to more than one trauma service, lengths of stay in each centre are counted
separately.
The average overall hospital length of stay (for the period of acute care admission) for 2007 was 15.92 days, slightly
higher than the 2006 average of 15.69 days (table 33). The average hospital length of stay for patients admitted directly
to a trauma service from the scene of their injury was 14.76 days, which was similar to the 2006 average (14.88 days).
Died Survived All
Length of stay 5.15 days 17.37 days 15.92 days
Table 33: Average length of stay in hospital (LOS)
Hospital length of stay is associated with severity of injury, as table 34 shows. As the calculated severity of injury rises,
so does the average hospital length of stay. The most seriously injured people with an ISS between 41 and 75 had the
longest average length of stay, at 20.3 days in 2007.
ISS range 2007 Five year period
16-24 12.91 Days 12.82 days
25-40 20.06 days 18.72 days
41-75 20.30 days 21.53 days
Table 34: Average length of stay in hospital (LOS) by ISS Range, 2007 and 2003-2007
People with injuries in more than one AIS body region also have longer average lengths of stay (table 35). This remains
true in other dimensions of the data, including ISS ranges, where for example the average length of stay in 2007 for
people with an injury in two or more body regions with an ISS between 16 and 24 was 13.63 days, while for a single
body region the average was 10.97 days. This pattern was repeated for all ISS ranges, and can be observed across the
entire NSW Trauma Registry dataset.
Dimensions of the 2007 data
30 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Body regions 2007 Five year period
Single body region 13.43 days 12.93 days
Two or more body regions 16.87 days 16.51 days
Table 35: Average length of stay in hospital (LOS) by AIS body regions (single vs. multiple) 2007 and
2003-2007
There is an even greater difference in average lengths of stay for patients requiring a surgical procedure. As table 36
demonstrates, patients requiring surgery have a markedly longer average length of stay. In 2007 the average length of
stay for these patients was almost identical to the 2003-2007 average for this group at 22.52 days, while the average
length of stay for patients not requiring surgery was much lower at 15.92 days.
Surgical procedures 2007 Five year period
Procedure(s) performed 22.52 days 22.5 days
No procedure performed 15.92 days 15.6 days
Table 36: Average length of stay in hospital (LOS) for people requiring/not requiring a surgical procedure
2007 and 2003-2007
Patients admitted to an intensive care unit also have longer average lengths of stay in hospital. In 2007, the average
hospital length of stay for patients admitted to an ICU was approximately double the length of stay for those not
admitted to an ICU (an average of 22.33 days for those admitted to an ICU compared to 11.1 days for those not admitted
to an ICU).
Dimensions of the 2007 data
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 31
Appendix 1: Hospital data summaries Gosford Hospital Summary data
Total Admissions 103
Monthly Average 8.6 admissions/month
Case fatality rate 9.7%
Gender
Female / male 22.3% / 77.7%
Age ranges
0-14 10.7%
15-24 18.4%
25-34 12.6%
35-44 14.6%
45-54 11.7%
55-64 9.7
65-74 ≤ 5%
75-84 9.7%
85-94 8.7%
Injury Severity Score ranges (inc. case fatality rate)
16-24 65% (6%)
25-40 31.1% (14.3%)
41-75 3.9% (100%)
Mechanisms of injury (inc. case fatality rate)
Assault 15.5% (18.75%)
High Fall ≤ 5% (0%)
Low/Medium Fall 29.1% (10%)
Motorcycle 12.6% (7.7%)
MVC 14.6% (0%)
Pedal Cycle 7.8% (0%)
Pedestrian ≤ 5% (0%)
All other injuries 15.5% (18.75%)
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 97.1%
Ambulance 78.64%
Helicopter ≤ 5%
Private Vehicle 19.42%
Other ≤ 5%
Hospital system indicators
ICU admissions 27.2% (of patients)
ICU average length of stay 5.61 days
Hospital average length of stay 4.96 days
Table 37: Trauma data profi le, Gosford Hospital
32 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
John Hunter Hospital/John Hunter Children’s Hospital Summary data
Total Admissions 400
Monthly Average 33.3 admissions/month
Case fatality rate 13.5%
Gender
Female / male 27.5% / 72.5%
Age ranges
0-4 ≤ 5%
5-9 ≤ 5%
10-12 ≤ 5%
13-14 ≤ 5%
(15) ≤ 5%
15-24 5.75%
25-34 8%
35-44 15.5%
45-54 14.75%
55-64 9.75%
65-74 11.25%
75-84 7.75%
85-94 11%
95 and older ≤ 5%
Injury Severity Score ranges (inc. case fatality rate)
16-24 67.25% (≤ 5%)
25-40 26.5% (24.5%)
41-75 6.25% (72%)
Mechanisms of injury (inc. case fatality rate)
Assault 11.25% (15.6%)
High Fall ≤ 5% (5.3%)
Low/Medium Fall 24.75% (18.2%)
Motorcycle 13.75% (≤ 5%)
MVC 24% (16.7%)
Pedal Cycle 5.75% (8.7%)
Pedestrian 5.75% (21.7%)
All other injuries 10% (10%)
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 75.5%
Ambulance 59%
Helicopter 33.25%
Fixed wing ≤ 5%
Private Vehicle 7%
Hospital system indicators
ICU admissions 35.5% (of patients)
ICU average length of stay 5.49 days
Hospital average length of stay 12.28 days
Table 38: Trauma data profi le, John Hunter Hospital/John Hunter Children’s Hospital
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 33
Liverpool Hospital Summary data
Total Admissions 255
Monthly Average 21.2 admissions/month
Case fatality rate 12.2%
Gender
Female / male 30.6% / 69.4%
Age ranges
0-14 ≤ 5%
15-24 16.5%
25-34 13.3%
35-44 13.7%
45-54 12.9%
55-64 11%
65-74 10.6%
75-84 12.5%
85-94 ≤ 5%
95 and older ≤ 5%
Injury Severity Score ranges (inc. case fatality rate)
16-24 51.8% (≤ 5%)
25-40 41.2% (22.9%)
41-75 7.1% (22.2%)
Mechanisms of injury (inc. case fatality rate)
Assault 15.3% (10.3%)
High Fall ≤ 5% (10%)
Low/Medium Fall 29.4% (16%)
Motorcycle ≤ 5% (0%)
MVC 22% (8.9%)
Pedal Cycle ≤ 5% (0%)
Pedestrian 9.8% (16%)
All other injuries 11% (17.9%)
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 73.7%
Ambulance 85.9%
Helicopter 7.45%
Fixed wing ≤ 5%
Private Vehicle ≤ 5%
Other ≤ 5%
Hospital system indicators
ICU admissions 48.6% (of patients)
ICU average length of stay 13.92 days
Hospital average length of stay 19.87 days
Table 39: Trauma data profi le, Liverpool Hospital
Hospital Summary
34 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Hospital Summary
Nepean Hospital Summary data
Total Admissions 120
Monthly Average 10 admissions/month
Case fatality rate 15%
Gender
Female / male 34.3% / 65.8%
Age ranges
0-14 6.7%
15-24 21.7%
25-34 10.8%
35-44 14.2%
45-54 7.5%
55-64 10.8%
65-74 10%
75-84 11.7%
85-94 5.8%
95 and older ≤ 5%
Injury Severity Score ranges (inc. case fatality rate)
16-24 60% (8.3%)
25-40 35.8% (20.9%)
41-75 ≤ 5% (40%)
Mechanisms of injury (inc. case fatality rate)
Assault ≤ 5% (0%)
High Fall 5.8% (28.6%)
Low/Medium Fall 32.5% (23.9%)
Motorcycle 14.2% (5.9%)
MVC 20.8% (≤ 5%)
Pedal Cycle ≤ 5% (0%)
Pedestrian 7.5% (11.1%)
All other injuries 12.5% (26.7%)
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 88.3%
Ambulance 70.8%
Helicopter 16.7%
Private Vehicle ≤ 5%
Other 10%
Hospital system indicators
ICU admissions 35.8% (of patients)
ICU average length of stay 5.6 days
Hospital average length of stay 14.48 days
Table 40: Trauma data profi le, Nepean Hospital
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 35
Prince of Wales Hospital Summary data
Total Admissions 49
Monthly Average 4.1 admissions/month
Case fatality rate 6.1%
Gender
Female / male 12.2% / 87.8%
Age ranges
15-24 24.5%
25-34 30.6%
35-44 14.3%
45-54 8.2%
55-64 10.2%
65-74 6.1%
75-84 -
85-94 6.1%
Injury Severity Score ranges (inc. case fatality rate)
16-24 63.3% (≤ 5%)
25-40 36.7% (≤ 5%)
41-75 -
Mechanisms of injury (inc. case fatality rate)
Assault 14.3% (0%)
High Fall ≤ 5% (0%)
Low/Medium Fall 12.3% (0%)
Motorcycle 12.3% (0%)
MVC 30.6% (6.7%)
Pedal Cycle ≤ 5% (0%)
Pedestrian 8.2% (25%)
All other injuries 18.4% (11.1%)
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 69.4%
Ambulance 51%
Helicopter 32.6%
Fixed wing 10.2%
Other 6.1%
Hospital system indicators
ICU admissions 63.3% (of patients)
ICU average length of stay 8.32 days
Hospital average length of stay 24.33 days
Table 41: Trauma data profi le, Prince of Wales Hospital
Hospital Summary
36 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Royal North Shore Hospital Summary data
Total Admissions 375
Monthly Average 31.2 admissions/month
Case fatality rate 14.1%
Gender
Female / male 30.4% / 69.6%
Age ranges
0-14 ≤ 5%
15-24 12.5%
25-34 13.6%
35-44 11.7%
45-54 7.5%
55-64 8.5%
65-74 13.1%
75-84 17.9%
85-94 11.5%
95 and older ≤ 5%
Injury Severity Score ranges (inc. case fatality rate)
16-24 48.5% (≤ 5%)
25-40 45.9% (20.3%)
41-75 5.6% (57.1%)
Mechanisms of injury (inc. case fatality rate)
Assault 7.2% (7.4%)
High Fall ≤ 5% (14.3%)
Low/Medium Fall 48.8% (16.4%)
Motorcycle 5.3% (≤ 5%)
MVC 14.1% (15.2%)
Pedal Cycle ≤ 5% (0%)
Pedestrian 6.7% (24%)
All other injuries 11.5% (11.6%)
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 57.1%
Ambulance 67.5%
Helicopter 18.9%
Fixed wing 8.8%
Private vehicle ≤ 5%
Other ≤ 5%
Hospital system indicators
ICU admissions 52.3% (of patients)
ICU average length of stay 8.2 days
Hospital average length of stay 21.23 days
Table 42: Trauma data profi le, Royal North Shore Hospital
Hospital Summary
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 37
Royal Prince Alfred Hospital Summary data
Total Admissions 220
Monthly Average 18.3 admissions/month
Case fatality rate 10%
Gender
Female / male 24.1% / 75.9%
Age ranges
0-14 ≤ 5%
15-24 12.7%
25-34 13.6%
35-44 14.5%
45-54 10%
55-64 7.7%
65-74 14.1%
75-84 14.5%
85-94 9.1%
95 and older ≤ 5%
Injury Severity Score ranges (inc. case fatality rate)
16-24 55.5% (0%)
25-40 34.5% (17.1%)
41-75 10% (40.9%)
Mechanisms of injury (inc. case fatality rate)
Assault 15.5% (11.8%)
High Fall ≤ 5% (11.1%)
Low/Medium Fall 44.1% (11.3%)
Motorcycle 6.4% (7.1%)
MVC 11.4% (8%)
Pedal Cycle ≤ 5% (0%)
Pedestrian 9.1% (10%)
All other injuries 6.4% (7.1%)
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 84.1%
Ambulance 75%
Helicopter 11.8%
Fixed wing -
Private vehicle 8.6%
Other ≤ 5%
Hospital system indicators
ICU admissions 53.6% (of patients)
ICU average length of stay 8.08 days
Hospital average length of stay 16.82 days
Table 43: Trauma data profi le, Royal Prince Alfred Hospital
Hospital Summary
38 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
St George Hospital Summary data
Total Admissions 230
Monthly Average 19.2 admissions/month
Case fatality rate 11.7%
Gender
Female / male 26.1% / 73.9%
Age ranges
0-14 ≤ 5%
15-24 17.4%
25-34 14.3%
35-44 13%
45-54 11.3%
55-64 12.2%
65-74 7.4%
75-84 13.9%
85-94 7.8%
95 and older ≤ 5%
Injury Severity Score ranges (inc. case fatality rate)
16-24 55.2% (4.7%)
25-40 35.2% (16%)
41-75 9.6% (36.4%)
Mechanisms of injury (inc. case fatality rate)
Assault 10.4% (≤ 5%)
High Fall ≤ 5% (0%)
Low/Medium Fall 35.7% (13.4%)
Motorcycle 9.1% (9.5%)
MVC 17% (10.3%)
Pedal Cycle ≤ 5% (16.7%)
Pedestrian 10.9% (16%)
All other injuries 10% (17.4%)
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 67%
Ambulance 68.3%
Helicopter 15.6%
Fixed wing 9.1%
Private vehicle 6.5%
Other ≤ 5%
Hospital system indicators
ICU admissions 43% (of patients)
ICU average length of stay 8.43 days
Hospital average length of stay 17.1 days
Table 44: Trauma data profi le, St George Hospital
Hospital Summary
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 39
St Vincent’s Hospital Summary data
Total Admissions 149
Monthly Average 12.4 admissions/month
Case fatality rate 10.1%
Gender
Female / male 43% / 57%
Age ranges
0-14 -
15-24 20.1%
25-34 23.5%
35-44 15.4%
45-54 12.1%
55-64 6.7%
65-74 5.4%
75-84 9.4%
85-94 28.9%
95 and older ≤ 5%
Injury Severity Score ranges (inc. case fatality rate)
16-24 63.1% (≤ 5%)
25-40 32.2% (16.7%)
41-75 ≤ 5% (57.1%)
Mechanisms of injury (inc. case fatality rate)
Assault 22.1% (0%)
High Fall 8.7% (38.5%)
Low/Medium Fall 32.9% (12.2%)
Motorcycle ≤ 5% (16.7%)
MVC ≤ 5% (0%)
Pedal Cycle -
Pedestrian 20.1% (6.7%)
All other injuries 7.4% (9.1%)
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 91.9%
Ambulance 95.3%
Helicopter -
Fixed wing ≤ 5%
Private vehicle ≤ 5%
Other ≤ 5%
Hospital system indicators
ICU admissions 46.3% (of patients)
ICU average length of stay 6.28 days
Hospital average length of stay 15.44 days
Table 45: Trauma data profi le, St Vincent’s Hospital
Hospital Summary
40 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Sydney Children’s Hospital Summary data
Total Admissions 56
Monthly Average 4.7 admissions/month
Case fatality rate 10.7%
Gender
Female / male 32.1% / 67.9%
Age ranges
0-4 41.8%
5-9 25.4%
10-12 14.5%
13-14 14.5%
(15) ≤ 5%
Injury Severity Score ranges (inc. case fatality rate)
16-24 61.8% (5.9%)
25-40 36.4% (15%)
41-75 ≤ 5% (50%)
Mechanisms of injury (inc. case fatality rate)
Assault 20% (0%)
High Fall ≤ 5% (50%)
Low/Medium Fall 23.6% (0%)
Motorcycle 5.5% (0%)
MVC 7.3% (50%)
Pedal Cycle 12.7% (0%)
Pedestrian 9.1% (40%)
All other injuries 20% (9.1%)
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 17.9%
Ambulance 33.9%
Helicopter 12.5%
Fixed wing 5.4%
NETS 32.1%
Private vehicle 8.9%
Other 7.1%
Hospital system indicators
ICU admissions 58.9% (of patients)
ICU average length of stay 4.48 days
Hospital average length of stay 12.18 days
Table 46: Trauma data profi le, Sydney Children’s Hospital
Hospital Summary
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 41
The Children’s Hospital at Westmead Summary data
Total Admissions 65
Monthly Average 5.4 admissions/month
Case fatality rate 4.6%
Gender
Female / male 41.5% / 58.5%
Age ranges
0-4 23.1%
5-9 38.5%
10-12 12.3%
13-14 13.8%
(15) 12.3%
Injury Severity Score ranges (inc. case fatality rate)
16-24 69.2% (0%)
25-40 29.2% (10.5%)
41-75 ≤ 5% (100%)
Mechanisms of injury (inc. case fatality rate)
Assault ≤ 5% (0%)
High Fall ≤ 5% (50%)
Low/Medium Fall 29.2% (0%)
Motorcycle ≤ 5% (0%)
MVC 20% (7.7%)
Pedal Cycle ≤ 5% (0%)
Pedestrian 9.2% (16.7%)
All other injuries 26.2% (5.9%)
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 29.2%
Ambulance 26.1%
Helicopter 15.4%
Fixed wing 3.1%
NETS 49.2%
Private vehicle 6.1%
Other -
Hospital system indicators
ICU admissions 36.9% (of patients)
ICU average length of stay 3.83 days
Hospital average length of stay 12.35 days
Table 47: Trauma data profi le, The Children’s Hospital at Westmead
Hospital Summary
42 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Westmead Hospital Summary data
Total Admissions 258
Monthly Average 21.5 admissions/month
Case fatality rate 9.7%
Gender
Female / male 26.7% / 73.3%
Age ranges
0-14 -
15-24 16.3%
25-34 15.9%
35-44 14.7%
45-54 16.3%
55-64 10.5%
65-74 8.1%
75-84 12.4%
85-94 5.4%
95 and older ≤ 5%
Injury Severity Score ranges (inc. case fatality rate)
16-24 57.8% (4%)
25-40 35.3% (16.5%)
41-75 7% (22.2%)
Mechanisms of injury (inc. case fatality rate)
Assault 10.1% (7.7%)
High Fall ≤ 5% (0%)
Low/Medium Fall 31% (17.5%)
Motorcycle 12.4% (6.25%)
MVC 27.9% (6.9%)
Pedal Cycle ≤ 5% (0%)
Pedestrian 6.6% (5.9%)
All other injuries 8.9% (4.3%)
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 82.2%
Ambulance 75.6%
Helicopter 18.6%
Fixed wing ≤ 5%
Private vehicle ≤ 5%
Other ≤ 5%
Hospital system indicators
ICU admissions 34.5% (of patients)
ICU average length of stay 8.15 days
Hospital average length of stay 16.05 days
Table 48: Trauma data profi le, Westmead Hospital
Hospital Summary
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 43
Wollongong Hospital Summary data
Total Admissions 91
Monthly Average 7.6 admissions/month
Case fatality rate 8.9%
Gender
Female / male 20.9% / 79.1%
Age ranges
0-14 12.1%
15-24 12.1%
25-34 15.4%
35-44 17.6%
45-54 16.5%
55-64 5.5%
65-74 9.9%
75-84 5.5%
85-94 5.5%
95 and older -
Injury Severity Score ranges (inc. case fatality rate)
16-24 57.1% (≤ 5%)
25-40 38.5% (20%)
41-75 4.4% (25%)
Mechanisms of injury (inc. case fatality rate)
Assault 9.9% (0%)
High Fall 8.8% (0%)
Low/Medium Fall 27.5% (24%)
Motorcycle 9.9% (11.1%)
MVC 13.2% (8.3%)
Pedal Cycle ≤ 5% (0%)
Pedestrian ≤ 5% (0%)
All other injuries 22% (≤ 5%)
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 87.9%
Ambulance 73.6%
Helicopter 11%
Fixed wing -
Private vehicle 11%
Other ≤ 5%
Hospital system indicators
ICU admissions 30.8% (of patients)
ICU average length of stay 7.79 days
Hospital average length of stay 8.81 days
Table 49: Trauma data profi le, Wollongong Hospital
Hospital Summary
44 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Appendix 2: Trauma data collection tool NSW Trauma System - Minimum Data Set Criteria: All trauma admissions with ISS > 15 or ICU Admission or Death (Excluding #NOF Death)
Data Collection Form
Hospital Name
Gender male / female Age
Residential Postcode Injury Postcode
Date and time of Injury
Mechanism
Place of Injury Home/Not at Home
Date and time of arrival
Mode of arrival (At your hospital)
Transfer in yes / no
Transfer From
Op suite at 1st hospital yes / no
If Yes, Type of OS at 1st Hospital
Transfer out yes / no
Transferred to
Transfer out Reason Burns, Paediatric, Spinal, Other
Op Suite 1st 24 hrs yes / no
If yes, Type of OS
ICU admit yes / no
ICU LOS Total ICU LOS in Patient days
Outcome survived / died
AIS body regions
ISS
Length of Stay Total Hospital LOS in Patient days
Data Dictionary
Mechanism MVC driver, MVC pass, MBC rider, MBC pillion, Pedestrian, Pedal Cyclist, fall<1m, fall 1-5m, fall>5m, shooting, stabbing, blunt assault, organised sport, recreational sport, burns, Industrial -includes all work related, Horse, Other - specify
Mode of arrival Ambulance, Helicopter, Private vehicle, Fixed Wing, NETS, Other
AIS body regions list 3 most injured i.e. used to calculate the ISS
Type of OS craniotomy, thoracotomy, laparotomy, open ext#, other
Length of stay If LOS is > 6 weeks then put >42 days
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 45
Appendix 3: Calculation of the Injury Severity Score (ISS) An injury severity score (ISS) is calculated for each patient based on the AIS injury severity classifi cation of their specifi c
injuries. The ISS value ranges from 1-75 and is calculated as:
ISS = A2 + B2 + C2
Where A, B, and C the highest AIS severity codes in each of the (up to) three most severely injured ISS body regions33.
The six ISS body regions are:
1. Head or neck
2. Face
3. Chest
4. Abdominal or pelvic contents
5. Extremities or pelvic girdle
6. External
The following example shows how an ISS is calculated from a set of injuries.
ISS Body region Injury AIS Severity Code Include in ISS calculation?
Head or Neck Small Sub dural haematoma AIS-4 Yes
Chest Bilateral lung contusion AIS-4 No
Chest Bilateral fl ail chest AIS-5 Yes
Abdominal or pelvic contents Superfi cial 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
Therefore ISS = 45
33 Abbreviated Injury Scale (AIS) 2005: Association for the Advancement of Automotive Medicine, p29
46 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
Index of fi gures Figure 1: Records held in the NSW Trauma Registry (cumulative) 2002-2007 .................................................................... 8
Figure 2: Major mechanisms of injury 2003-2007 ............................................................................................................. 9
Figure 3: Motor Vehicle Drivers aged between 15 and 24 years, 2003-2007 ................................................................... 10
Figure 4: Area Health Service where injury occurred, 2003-2007 .................................................................................... 10
Figure 5: People injured, 2003-2007 (including deaths) ...................................................................................................11
Figure 6: People injured, by age and gender .................................................................................................................. 14
Figure 7: Case fatality rate (%) by gender, 2003-2007 .................................................................................................... 14
Figure 8: Major mechanisms of injury ............................................................................................................................. 15
Figure 9: Case fatality rate by mechanism, 2003-2007 ................................................................................................... 16
Figure 10: People injured by hour of day when injury occurred ....................................................................................... 18
Figure 11: AIS body regions ............................................................................................................................................ 20
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 47
Index of tables Table 1: Case fatality rate and average hospital length of stay by ISS range, 2002-2007 .............................................. 5 Table 2: Injured people and outcomes .......................................................................................................................11 Table 3: Trauma service admissions and deaths ......................................................................................................... 12 Table 4: Admissions by Area Health Service............................................................................................................... 12 Table 5: Admissions to trauma services, 2002-2007 .................................................................................................. 13 Table 6: Outcome by Gender .................................................................................................................................... 14 Table 7: Mechanism of Injury - Road Trauma ............................................................................................................. 15 Table 8: Mechanism of Injury - Falls ........................................................................................................................... 16 Table 9: Mechanism of Injury - Assaults .................................................................................................................... 16 Table 10: Geographical location of injury by Area Health Service (people injured) ...................................................... 17 Table 11: Injury Time - Top 3 Hours of the Day Injury Occurred (excludes patients where time of injury is unknown) ... 18 Table 12: Admission Time - Top 3 Hours of the Day of Admission to Defi nitive Trauma service .................................... 18 Table 13: Injury Day of Week ...................................................................................................................................... 19 Table 14: Injury Severity Score (ISS) ............................................................................................................................. 19 Table 15: Single vs. multiple body regions, critically injured patients (%), case fatality rate and average LOS, 2007 ...... 20 Table 16: Admission Types .......................................................................................................................................... 21 Table 17: Admission Type by geographical location of injury ....................................................................................... 21 Table 18: Secondary transfers between trauma services - transfer reasons .................................................................. 22 Table 19: Transfer in admissions to trauma services by referring Area Health Service ................................................... 23 Table 20: Arrival Mode - Top 3 Arrival Modes ............................................................................................................. 24 Table 21: Time to defi nitive care for patients admitted directly to a defi nitive trauma service, rural vs. metropolitan
location of injury ......................................................................................................................................... 25 Table 22: Time to defi nitive care for patients transferred to a defi nitive trauma service, rural vs metropolitan location of
injury ........................................................................................................................................................... 25 Table 23: Average times to defi nitive care for patients arriving within 2 hours of injury by ISS range ........................... 26 Table 24: Operating procedures performed in fi rst 24 hours ....................................................................................... 26 Table 25: Rate of surgical procedures performed by ISS Range .................................................................................... 27 Table 26: Average hospital lengths of stay, for patients having surgery and patients not having surgery ...................... 27 Table 27: Surgery rate by arrival mode, 2007 and 2003-2007 ..................................................................................... 27 Table 28: ICU Admissions............................................................................................................................................ 28 Table 29: ICU Admission by Outcome ......................................................................................................................... 28 Table 30: ICU Average Length of Stay (LOS) ................................................................................................................ 28 Table 31: ICU admission statistics by ISS range ............................................................................................................ 29 Table 32: ISS range 41-75 statistics, admitted/not admitted to an ICU ......................................................................... 29 Table 33: Average length of stay in hospital (LOS) ....................................................................................................... 29 Table 34: Average length of stay in hospital (LOS) by ISS Range, 2007 and 2003-2007 ............................................... 29 Table 35: Average length of stay in hospital (LOS) by AIS body regions (single vs. multiple) 2007 and 2003-2007 ....... 30 Table 36: Average length of stay in hospital (LOS) for people requiring/not requiring a surgical procedure 2007 and
2003-2007 .................................................................................................................................................. 30 Table 37: Trauma data profi le, Gosford Hospital.......................................................................................................... 31 Table 38: Trauma data profi le, John Hunter Hospital/John Hunter Children’s Hospital .................................................. 32 Table 39: Trauma data profi le, Liverpool Hospital ........................................................................................................ 33 Table 40: Trauma data profi le, Nepean Hospital .......................................................................................................... 34 Table 41: Trauma data profi le, Prince of Wales Hospital .............................................................................................. 35 Table 42: Trauma data profi le, Royal North Shore Hospital .......................................................................................... 36 Table 43: Trauma data profi le, Royal Prince Alfred Hospital ......................................................................................... 37 Table 44: Trauma data profi le, St George Hospital ....................................................................................................... 38 Table 45: Trauma data profi le, St Vincent’s Hospital .................................................................................................... 39 Table 46: Trauma data profi le, Sydney Children’s Hospital ........................................................................................... 40 Table 47: Trauma data profi le, The Children’s Hospital at Westmead ........................................................................... 41 Table 48: Trauma data profi le, Westmead Hospital...................................................................................................... 42 Table 49: Trauma data profi le, Wollongong Hospital ................................................................................................... 43
48 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 49
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50 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 NSW Health
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