The NSW Trauma Registry Profile of Serious to Critical Injuries
2008
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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: 2008. 2011. 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 – 2008 i
Contents Executive Summary .......................................................................................................................................................... 3
Monitoring the NSW Trauma System ................................................................................................................................ 4
The NSW Trauma system ........................................................................................................................................... 4
Mandate for trauma data in NSW .............................................................................................................................. 4
The NSW Trauma Registry ......................................................................................................................................... 5
Current scope of trauma data collection in New South Wales .................................................................................... 5
Methodology and inclusion criteria ............................................................................................................................ 6
The Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) ........................................................................ 6
Inclusion criteria .................................................................................................................................................. 7
Defi nitive care ..................................................................................................................................................... 8
2008 data ........................................................................................................................................................................ 9
General observations ................................................................................................................................................. 9
Demographic profi le ................................................................................................................................................ 10
Mechanisms of injury .............................................................................................................................................. 12
Time and day of injury ............................................................................................................................................. 14
Triage and transport ................................................................................................................................................ 15
Admission type ................................................................................................................................................. 15
Times to defi nitive care ..................................................................................................................................... 17
Trauma admissions .................................................................................................................................................. 18
Time and day of admission ...................................................................................................................................... 20
Injuries .................................................................................................................................................................... 20
Treatments and outcomes ....................................................................................................................................... 23
Surgical procedures ........................................................................................................................................... 23
Intensive Care Unit admissions .......................................................................................................................... 23
Hospital lengths of stay ..................................................................................................................................... 24
Rural dataset – Tamworth Hospital trauma registry .................................................................................................. 25
Appendix 1: Hospital data summaries ............................................................................................................................ 27
Gosford Hospital ..................................................................................................................................................... 27
John Hunter Hospital/John Hunter Children’s Hospital ............................................................................................. 28
Liverpool Hospital .................................................................................................................................................... 29
Nepean Hospital ...................................................................................................................................................... 30
Prince of Wales Hospital .......................................................................................................................................... 31
Royal North Shore Hospital ...................................................................................................................................... 32
Royal Prince Alfred Hospital ..................................................................................................................................... 33
St George Hospital .................................................................................................................................................. 34
St Vincent’s Hospital ................................................................................................................................................ 35
Sydney Children’s Hospital ....................................................................................................................................... 36
The Children’s Hospital at Westmead ...................................................................................................................... 37
Westmead Hospital ................................................................................................................................................. 38
Wollongong Hospital ............................................................................................................................................... 39
Appendix 2: Trauma data collection tool ........................................................................................................................ 40
Appendix 3: Calculation of the Injury Severity Score (ISS) ............................................................................................... 41
Index of fi gures .............................................................................................................................................................. 42
Index of tables ............................................................................................................................................................... 43
ii ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 3
Executive Summary Each year around 2000 people are seriously to critically injured in NSW and are admitted to a trauma service. How the
NSW trauma system responds to these patients is critical for their long term outcomes and quality of life, and for reducing
the overall fi nancial and social cost of trauma to individuals and the whole community.
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 response to these most seriously injured patients. 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.
This report describes how 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 investigates the data
to determine whether the NSW trauma system worked as it should, to ensure that the right patient arrived at the right
hospital in a timely manner.
The report helps us understand the nature of injuries sustained by those people and how they occurred. This spectrum
of trauma contributes to safety and injury prevention efforts and assists other agencies concerned with minimising the
likelihood and effects of traumatic injury.
In the 2008 dataset we found the following:
J The numbers of falls recorded in the dataset is rising – for the fi rst time the total numbers of falls and road trauma injuries were almost identical
J Injuries to the head were recorded for almost two thirds of people injured in 2008. Over 77% of injuries within this group were brain injuries (to the brain stem, cerebellum or cerebrum)
J Subdural haematomas were the single most common group of injures. A relatively high proportion of these injuries were sustained at home by people aged 65 years and older
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.
4 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
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.
Mandate for trauma data in NSW The NSW Trauma Services Plan requires NSW ITIM to monitor and report on the performance of individual Trauma
Services to ensure that performance is consistent with the standard of care, and to manage a state-wide clinical injury
data collection process.
The plan also positions NSW ITIM to develop partnerships with injury stakeholders in order to build an improved critical
mass for research and education across the spectrum of trauma prevention care and rehabilitation. The collection of
trauma data is an important aspect of these activities.
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 5
Monitoring the NSW Trauma System
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:
J 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 Tamworth Hospital
J The Children’s Hospital at Westmead
J Westmead Hospital
J Wollongong Hospital
The registry 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 some 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.
Current scope of trauma data collection in New South Wales Data for this report is drawn from the NSW Trauma Registry, which currently contains de-identifi ed patient records
submitted by 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 fourteen hospitals with a trauma registry. The submitted data is known as the NSW
Trauma Minimum Data Set, and forms the basis of this report.
As the scope of the current data collection is restricted to these hospitals, which are primarily 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.
A snapshot of trauma activity at Tamworth Hospital in 2008 has been included in this report. While not included in the
overall fi gures, Tamworth Hospital data will be included within general trauma activity fi gures in all future reports.
6 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
Monitoring the NSW Trauma System
Methodology and inclusion criteria
The Abbreviated Injury Score (AIS) and Injury Severity Score (ISS)
The key inclusion criterion for inclusion in the NSW Trauma Registry requires a classifi cation of injuries for trauma patients
and an Injury Severity Score (ISS). The 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). The AIS classifi es individual injuries by body region on a 6 point
severity scale from Minor to Maximum (currently untreatable injury).
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. 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.
Appendix 3 provides details and an example of how an ISS is derived from a set of injuries sustained by a patient. Injuries
are individually allocated to one of six body regions, and the severities of the top three injuries in different body regions
are used to calculate the ISS. The ISS along with the body regions and injury and severity codes used in this calculation are
recorded in the NSW Trauma Registry.
Injury severity ranges from 1 to 6, where 6 is currently an untreatable injury. Patients with an AIS injury code with a
severity of 6 are automatically assigned an ISS of 75, the highest possible score.
The calculated ISS value ranges from 1-75. 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).
As well as describing the nature of injuries sustained by patients, the AIS and ISS also indicate mortality, quality of life,
and rauma care, across such dimensions as:
J Hospitalisation and need for intensive care
J Length of hospital stay
J Treatment cost
J Treatment complexity
J Length of treatment1
The correlation between ISS and case fatality rates is evident in the NSW Trauma Registry data (Table 1). Case fatality rates
rise with each ISS range group and are the highest in the critically injured category of patients.
Table 1: Case fatality rate and mean hospital length of stay by ISS range, 2008
ISS range Case fatality rate Mean hospital length of stay (days)2
16-24 4.4 % 14.77
25-40 23.3 % 20.96
41-75 41.8 % 25.75
1 Abbreviated Injury Scale 2005: Association for the Advancement of Automotive Medicine, 2005, p5
2 Length of stay while classifi ed as an acute care patient
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 7
Monitoring the NSW Trauma System
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 more than one and a two thirds
as long as patients classifi ed as seriously injured (ISS 16-24).
The version of AIS in use in 2008 was the Abbreviated Injury Scale 2005. This was the fi rst full year that injuries were
scored using the AIS 2005 version, enabling a clearer view of the effect of the updated scoring standard on the profi le
of serious to critical injuries.
Inclusion criteria
The key criterion for including a patient record in the NSW Trauma Registry is a classifi cation of injuries as serious to
critical. Patients with injuries classifi ed as serious to critical are identifi ed for the NSW Trauma Registry when they have an
Injury Severity Score greater than 15 (ISS > 15).
Several other criteria are also used to select or fi lter trauma patient records for the state-wide trauma registry. They
include the following:
J The patient must be admitted to a trauma service in NSW
J The patient must be admitted within fourteen days of sustaining an injury
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.
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.
Records may also be excluded from this report if the following key data elements have missing or invalid data recorded in
the registry:
J Date of injury
J Injury Severity Score
J Date of admission
No records with an ISS > 15 in 2008 were excluded from this report.
8 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
Defi nitive care
The phrase ‘defi nitive care’ is used frequently throughout this report. The concept and dimension of defi nitive care is
important in analysing the progress of the trauma patient through the pre-hospital and hospital system. It also assists to
identify transfer patterns and problems, and to identify numbers of injured people, rather than admissions to hospital.
The defi nitive care hospital is considered to be the hospital where the patient is provided with all treatment and care
required for their injuries. Defi nitive care for serious to critically injured people is provided by an adult major trauma
service, paediatric major trauma service, or a regional trauma service.
In 2008, adult major trauma service registries were:
J John Hunter Hospital
J Liverpool 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 Westmead Hospital,
Paediatric major trauma service registries were:
J John Hunter Children’s Hospital
J Sydney Children’s Hospital, and
J The Children’s Hospital at Westmead, and
Regional trauma service registries were:
J Gosford Hospital
J Nepean Hospital, and
J Wollongong Hospital
For the most seriously injured patients, the hospital of defi nitive care for an adult is either an adult major trauma service or
regional trauma service, or a paediatric major trauma service for a paediatric patient under the age of 16 years.
Monitoring the NSW Trauma System
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 9
2008 data General observations The number of records included in the NSW Trauma registry with an ISS > 15 has fallen since the introduction of AIS 2005
in July 2007. Figure 1 below shows the fall appeared to occur immediately in the period after the introduction of the new
AIS 2005 scoring standard.
People injured, six monthly periods, 2006-2008
1400
1200
1000
800
600
400
200
0 Jan/Jun Jul/Dec Jan/Jun Jul/Dec Jan/Jun Jul/Dec 2006 2006 2007 2007 2008 2008
AIS 98 AIS 2005
Figure 1: People injured, six monthly periods, 2006-2008, with AIS coding version
Figure 2 indicates that the fall in serious to critical trauma numbers since July 2007 has been distributed across all major
mechanisms of injury3. While it appeared that road trauma (which includes motorcycle trauma, motor vehicle collisions
drivers and passengers), pedestrian trauma, and pedal cycle trauma) had been falling during the 2006/7 period, further
analysis and comparison with other datasets would be required to determine the extent to which the apparently large
fall in road trauma in the second half of 2007 is a refl ection of an actual decrease in road trauma statistics generally or a
result of AIS 2005.
Major Mechanisms of injury, six monthly, 2006-2008
600
500
400
300
200
100
0 Jan/Jun Jul/Dec Jan/Jun Jul/Dec Jan/Jun Jul/Dec 2006 2006 2007 2007 2008 2008
AIS 98 AIS 2005
Assault
Falls
Road Trauma
Figure 2: Major mechanisms of injury, six monthly, 2006-2008.
Monitoring the NSW Trauma System
3 This includes all blunt and penetrating assaults as a group (Assault), all falls of varying heights as a group (Falls), and motor cycle, motor vehicle, pedestrian and pedal cycle injuries as a group (Road Trauma).
10 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
Demographic profi le The NSW Trauma Registry recorded 2002 people injured with an ISS > 15 in 2008 (Table 2). This represented a decrease in
the number of people injured for this group of patients from 2007 of approximately 12%. The overall incidence of serious
to critical injuries in NSW for 2008 was approximately 29 people injured per 100,000 in the NSW population4.
Table 2: Injured people, summary statistics
Summary statistics, injured people Summary
Total people injured 2002
Died 13.1%
95% CI 11.6, 14.6 (262 people)
Incidence (ISS>15) per 100,000 NSW pop. (age standardised)5 27.9
95% CI 27.2, 28.6
Deaths (ISS>15) per 100,000 NSW pop. (age standardised) 3.4
95% CI 3.01, 3.87
Age standardised mortality ratio (SMR)6 690
The age standardised mortality ratio (SMR) for this group of patients in 2008 was 690, indicating the rate of deaths of
people in the group of serious to critically injured patients was more than 6 times greater than in the general (standard)
Australian population. The age standardised death rate for the group for 2008 was 3.4 deaths per 100,000 people in the
NSW population. In comparison the age standardised death rate for all deaths in NSW for 2008 was 600.17.
The case fatality rate for this group of patients is the percentage of deaths recorded in this group of serious to critically
injured patients.8 The case fatality rate for 2008 was 13.1%.
The age distribution within the dataset of people with serious to critical injuries in the NSW Trauma Registry was similar in
2008 to previous years (see Table 3).
Table 3: Age distribution of serious to critically injured people
Age range Proportion of serious to critically
injured people (%)
Age 0 – 15 years 7.1 %
Age 16 – 64 years 65 %
Age 65 years and older 27.9 %
The age-standardised rate of injuries in 2008 was 27.9 people injured per 100,000 people in the NSW population
(Table 2), however age-specifi c rates varied across age groups from 5.2 in the 5-9 years age group to a high of 107.3
in the 85 years and older group of people9. The steep rise in rates from the age of 75 years shows that trauma is an
increasing issue for people as they reach this age (Figure 3).
Monitoring the NSW Trauma System
4 Source: Australian Bureau of Statistics. Australian Demographic Statistics. Catalogue no. 3101.0. Canberra: ABS, 2009
5 Standardised with Australian standard population June 2001. Source: Australian Bureau of Statistics. Australian Historical Population Statistics 2008. Catalogue no. 3105.0.65.001. Canberra: ABS, 2009
6 Standardised with Australian standard population June 2001
7 Australian Bureau of Statistics. Causes of Death, Australia, 2008. Catalogue no. 3303.0. Canberra: ABS, 2010.
8 These are calculated as follows: Case fatality rate = number of deaths divided by the number of patients in this data collection X 100
9 Rates of injuries per 100,000 people in age group
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 11
Age-specific rates of injury
Age range
A g
e- sp
ec ifi
c ra
te /
1 00
,0 00
120
100
80
60
40
20
0
0 –
4
5 –
9
10 –
1 4
15 –
1 9
20 –
2 4
25 –
2 9
30 –
3 4
35 –
3 9
40 –
4 4
45 –
4 9
50 –
5 4
55 –
5 9
60 –
6 4
65 –
6 9
70 –
7 4
75 –
7 9
80 –
8 4
85 a
nd o
ld er
Figure 3: Age-specifi c rates of injury, NSW population June 2008
Males have higher rates of injury in every age group (fi gure 4). This correlates with the overall gender distribution of the
dataset, where in 2008, 71.6% of people with serious to critical injuries were male. Figure 4 also shows that the gender
disparity is pronounced from the ages of 15-29 years. In the 20-24 years group, the rate of injuries for females was
approximately 11, while for males the age-specifi c rate was over 58. Figure 4 also shows that age-specifi c rates for both
males and females increase from the age of 75 years and over.
0 –
4
5 –
9
10 –
1 4
15 –
1 9
20 –
2 4
25 –
2 9
30 –
3 4
35 –
3 9
40 –
4 4
45 –
4 9
50 –
5 4
55 –
5 9
60 –
6 4
65 –
6 9
70 –
7 4
75 –
7 9
80 –
8 4
85 a
nd o
ld er
Age-specific rates of injury by gender
A g
e- sp
ec ifi
c ra
te
(in ju
ri es
/ 1
00 ,0
00 )
180 160 140 120 100 80 60 40 20 0
Age range
Female Male
Figure 4: Age-specifi c rates of injury by gender
The crude death rate for males in 2008 was more than double that of females (5.3 deaths per 100,000 males in NSW
compared to 2.2 deaths per 100,000 females).
The age-standardised mortality ratio (SMR) for males was 763, and for females 506, confi rming the gender disparity in
mortality between the genders in NSW, as well as demonstrating the higher death rates in this population of serious to
critically injured people when compared to the standard population.
Monitoring the NSW Trauma System
12 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
Males aged between 20 and 24 years have rates of injury only exceeded by people age 75 years and older (fi gure 5).
The age-specifi c rate of injury for males aged 20-24 years was just over 58 males injured per 100,000 males in the NSW
population. Females in this age group had an age-specifi c rate of injury of 11.3 females injured per 100,000 females in the
NSW population. The age-specifi c death rate for males in the 20-24 years age group also exceeded females in the group
by almost 4 to 1 (4.8 males deaths per 100,000 males compared to 1.25 female deaths per 100,000 females in NSW).
Age-specific death rates by gender
A g
e- sp
ec ifi
c d
ea th
r at
e (d
ea th
s /
10 0,
00 0)
60
50
40
30
20
10
0
0 –
4
5 –
9
10 –
1 4
15 –
1 9
20 –
2 4
25 –
2 9
30 –
3 4
35 –
3 9
40 –
4 4
45 –
4 9
50 –
5 4
55 –
5 9
60 –
6 4
65 –
6 9
70 –
7 4
75 –
7 9
80 –
8 4
85 a
nd o
ld er
Age range
Female Male
Figure 5: Age-specifi c death rates by gender
The gender disparity noted above is also apparent in the age distribution within the dataset. People aged from 15-25
have consistently been the largest group represented in the group of patients with serious to critical injuries. For each age
band from 15-25 the proportion of males exceeds the 2008 proportion of males of 71.6%. In the 23 years age group the
proportion of males is greater than 91%.
Mechanisms of injury The distribution of mechanisms of injury in 2008 was similar to previous years. As in 2007, injuries caused by falls were
almost equal in number to road trauma in the 2008 dataset, and together are the mechanisms of injury for the great
majority of records in the dataset (Figure 6).
Falls 38%Road Trauma
39%
Assault 10%Other
13%
Mechanisms of injury
Figure 6: Mechanisms of injury
Monitoring the NSW Trauma System
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 13
There were proportionately fewer people injured in rural districts in 2008 following an assault or a fall, compared to
their metropolitan counterparts (Table 4)14. Conversely, the rural group recorded road trauma as the mechanism of injury
in over 45% of records, compared to 37.1% for the metropolitan group. In the metropolitan group falls were the most
common mechanism of injury, recorded for 40.4% of patients.
Table 4: Mechanism of injury, rural vs. metropolitan place of injury10
Mechanism Metropolitan Rural
Assault 167 27
Falls 652 104
Road Trauma 598 158
All other mechanisms 196 58
The breakdown of specifi c categories of mechanisms of injury was similar in 2008 to previous years, as shown in Table
5 below. Pedestrian trauma continued to have a higher case fatality rate than other road trauma mechanisms, although
motor vehicle collisions were the most frequent cause of injury in the road trauma group.
The most common mechanism of injury was a low to medium fall (<5m). This mechanism was recorded for 34% of
serious to critically injured people in the 2008 dataset. Low to medium falls were particularly common in the group of
patients aged 65 years and over, where they were recorded as the mechanism of injury for over 70% of patients. In
contrast, low to medium falls were recorded as the mechanism of injury for only 19.2% of people aged between 16 and
65 years, and 23.9% of paediatric patients between 0 and 15 years of age.
Table 5: Mechanism of Injury – main mechanisms and categories
Mechanism People injured % of Total Deaths (% of mechanism)
Road Trauma
MVC 355 17.7% 39 (11%)
MBC 204 10.2% 15 (7.4%)
Pedestrian 147 7.3% 23 (15.6%)
Pedal Cyclist 65 ≤ 5% (≤ 5) Total Road Trauma 771 38.5% 82 (10.6%)
Fall
Low/Medium Fall (<5m) 679 34% 101 (14.9%)
High Fall (>5m) 83 4.2% 13 (15.7%)
Fall Unspecifi ed Height 7 ≤ 5% (≤ 5) Total All Falls 769 38.5% 115 (14.9%)
Assault
Blunt Assault 109 5.4% 6 (5.5%)
Shooting 27 ≤ 5% 10 (37%) Stabbing 65 ≤ 5% 6 (9.2%) Total All Assaults 201 10% 22 (10.9%)
The average age for falls in 2008 was approximately 61 years (the median was 67 years), and age-specifi c rates of
mechanism of injury demonstrate clearly that falls in the elderly are a serious issue in trauma (see Figure 7). Rates of falls
for people aged 75 years and over are the highest in the dataset, rising to over 87 people injured per 100,000 people in
the NSW population.
It is also clear that road trauma has a large impact on people aged between 15 and 29 years of age. Rates of road
trauma per 100,000 people in the NSW population for this group are higher than all other age groups in the road trauma
population. The rate of assaults was also higher in the 15-29 years age groups than in other age groups.
Monitoring the NSW Trauma System
10 Includes only records where postcode of injury is known (N=1960)
14 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
11 For 2008, there were 104 days falling on weekends, and 262 other days (Mondays-Fridays)
Age-specific rates of mechanism injury A
g e-
sp ec
ifi c
ra te
/ 1
00 ,0
00
Assault Falls Road trauma
Age range
100 90 80 70 60 50 40 30 10 0
0 –
4
5 –
9
10 –
1 4
15 –
1 9
20 –
2 4
25 –
2 9
30 –
3 4
35 –
3 9
40 –
4 4
45 –
4 9
50 –
5 4
55 –
5 9
60 –
6 4
65 –
6 9
70 –
7 4
75 –
7 9
80 –
8 4
85 a
nd o
ld er
Figure 7: Age-specifi c rates of mechanism of injury
Time and day of injury Noon to late afternoon was the most common time of day for serious to critical trauma in 2008 (Figure 8). 37.7% of
people were injured between the hours of 12 noon and 6pm, with peak times between 5pm and 6pm (128 people) and
between noon and 1pm, and between 2pm and 3pm (120 people).
P eo
p le
in ju
re d
Hour (24 hr)
140
120
100
80
60
40
20
0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
People injured by hour of day
Figure 8: People injured by hour of day when injury occurred
Table 6 demonstrates that serious to critical injuries occurred more frequently on weekends than on other days of the
week in 2008, consistent with data from previous years.
Table 6: People injured and admitted, Monday-Friday and weekends
Weekly period People injured Mean daily admissions11
Monday - Friday 1372 5.2
Weekends 725 7
Monitoring the NSW Trauma System
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 15
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 pre-hospital triage tool, Protocol T1 pre-hospital management of major trauma, in the NSW trauma
system12.
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 major
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 the inter-hospital
transfer of a patient for rehabilitation services, are not recorded.
The rate of ‘direct from scene’ admissions to all trauma services in 2008 was 72% (table 7). The remainder of patients in
the data admitted to a trauma service were transferred from either another trauma service or non-trauma service.
The proportion of direct admissions to a major adult trauma service for defi nitive care in 2008 was 71.3%, slightly lower
than the overall rate of direct from scene admissions to all trauma services combined. Direct from scene admissions to
paediatric major trauma services was lower at 34.5%, refl ecting the high proportion of transfers of children for specialist
services at these centres.
Table 7: Admission Types
Admission Type Admissions %
Transfer In13 586 28%
Direct From Scene 1511 72%
Direct to defi nitive care: major adult (N=1728) 1232 71.3%
Direct to defi nitive care: paediatric major (N=116) 40 34.5%
Direct to defi nitive care: regional trauma registry (N=132) 120 90.9%
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 8) 14. 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.
Monitoring the NSW Trauma System
12 Ambulance Service of NSW (2010) Pre-Hospital Management of Major Trauma: Protocol T1. Ambulance Service of NSW
13 Transfer In fi gures may include secondary transfers from another trauma service
14 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.
16 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
Table 8: Defi nitive care admission type by geographical location of injury15
Admission Type Metropolitan Districts Rural Districts
Transfer In 325 admissions
(20.4% of metropolitan patients)
248 admissions
(71.3% of rural patients)
Direct From Scene 1272 admissions
(79.6%) 100 admissions (28.7%)
Arrival modes are also recorded in the NSW Trauma Registry. These refer to the ways 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 are only recorded for admissions to trauma services in NSW.
Arrival modes include:
J Ambulance
J Fixed Wing16
J Helicopter
J NETS17
J Private Vehicle
J Other18
The proportion of ambulance arrivals at trauma services for defi nitive care was 67.6% in 2008 (table 9). Almost 90% of
patients arrived at defi nitive care facilities by either ambulance or helicopter during the year.
Table 9: Arrival mode at defi nitive care facility - Top 3 Arrival Modes
Arrival mode Admissions % of Total
Ambulance 1336 admissions 67.6%
Helicopter 413 admissions 20.9%
All other modes of transport 227 admissions 11.5%
Over 80% of ambulance journeys recorded in the NSW Trauma Registry in 2008 provided transport directly from the
scene of injury to the defi nitive care trauma service (table 10). In comparison, helicopter arrivals were almost evenly
divided between transport direct from the scene of injury and transport for patients transferring from another hospital for
defi nitive care.
Table 10: Modes of transport to defi nitive care by admission type
Arrival mode Direct from scene Transferred
Ambulance (N=1336) 80.1 % 19.9 %
Helicopter (N=413) 52.3 % 47.7 %
Other mode of transport (N=227) 46.7 % 53.3 %
Ambulance was also the most frequently recorded form of transport for patients injured within metropolitan districts
surrounding Sydney, regardless of whether they were admitted directly from the scene of injury or transferred from
another hospital (table 11). Helicopter transport was more frequently provided in rural districts to assist patients to
defi nitive care.
Monitoring the NSW Trauma System
15 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 2008
16 For fi xed wing arrival modes, the data represents the primary mode of transport used to deliver the patient to an admitting trauma service.
17 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)
18 Other modes of arrival may include private vehicles, taxis, buses, bicycles etc, as well as patients arriving on foot.
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 17
Table 11: Proportion of ambulance and helicopter arrivals at defi nitive care, direct from scene and transfer
admissions, metropolitan vs. rural location of injury
Admission type Ambulance Helicopter
Direct from scene to defi nitive care
Metropolitan location of injury (N=1255) 82.1 % 11.2%
Rural location of injury (N=99) 26.3 % 71.7%
Case fatality rate 14.9 % 15.3 %
Transferred to defi nitive care
Metropolitan location of injury (N=324) 64.8 % 24.7%
Rural location of injury (N=246) 21.1 % 46.7 %
Case fatality rate 9.8 % 15.2 %
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.
In 2008, 56.2% of all serious to critically injured patients arrived at a defi nitive trauma service within 2 hours of their
injury. For critically injured patients (ISS 41-75) this rate was higher, with 70.6% of patients in this group arriving at a
defi nitive care hospital within 2 hours of their injury.
Numerous factors may impact on the time to defi nitive care, including:
J 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
Due to these and other factors, a single calculated average time to defi nitive care19 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:
J Whether an injury occurred in a metropolitan or rural district14, and
J Whether the patient was admitted to a defi nitive care hospital directly from the scene of their injury.
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.
The 2008 data shows that a much higher proportion of rural patients were transferred to a defi nitive care hospital (71.1%
in 2008), compared to patients injured in a metropolitan area (20% in 2008). 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.
Monitoring the NSW Trauma System
19 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.
18 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
In 2008 a high proportion (81.3%) of people injured in metropolitan areas were admitted directly from the scene of their
injury to a defi nitive trauma service within 2 hours of injury (Table 12). The average time taken for these patients in 2008
was 57 minutes. This large group represented just over 50% of all people injured in 2008.20
Table 12: Time to defi nitive care for patients admitted directly to a defi nitive trauma service, rural vs.
metropolitan location of injury
Time period Rural (n=94) Metropolitan (n=1241)
0-2 hours 45 patients (47.9%)
Average 1 hour 19 min
1009 patients (81.3%)
Average 57 min
2-6 hours 34 patients (36.2%)
Average 3 hours 7 min
82 patients (6.6%)
Average 3 hours 2 min
6-12 hours ≤ 5 patients (≤ 5%) Average 6 hours 59 min
30 patients (≤ 5%) Average 9 hours 4 min
12-24 hours ≤ 5 patients (≤ 5%) Average 15 hours 38 min
55 patients (≤ 5%) Average 16 hours 25 min
Greater than 24 hours ≤ 5 patients (≤ 5%) Average 176 hours 24 min
65 patients (≤ 5%) Average 107 hours 19 min
Trauma admissions Trauma admissions submitted by trauma service registries in 2008 totalled 2,097 for this group of serious to critically
injured patients (Table 13). Average daily admissions for the full year were 5.7 admissions per day. In November, the
busiest month for trauma admissions, the daily average rose to 6.7 admissions per day.
The hospital of defi nitive care is identifi ed in the data by the absence of a patient transfer to another hospital for acute
care. In 2008 there were 1976 recorded defi nitive care admissions21.
Table 13: Trauma service admissions summary
Summary statistics, trauma service admissions Summary
Total trauma admissions 2097
Mean daily admissions22 5.7
Mean monthly admissions 174
Minimum monthly admissions 155 (June)
Maximum monthly admissions 201 (November)
Defi nitive care admissions 1976
In 2008 over 80% of all records in the NSW Trauma Registry were provided by an adult major trauma service or paediatric
major trauma service registry (Table 14). The remaining records were provided by other trauma registries and generally
include less seriously injured patients who did not require a major or paediatric major trauma service, and a number of
other patients who were subsequently transferred to a major or paediatric major trauma service for acute care.
Monitoring the NSW Trauma System
20 As numbers in this table only include patients where postcode and time of injury is known, actual fi gures may be larger.
21 While the registry recorded 121 transfers of patients from a trauma service in 2008 (2097 trauma service admissions) to another trauma service for acute care, 26 records of 2002 people injured do not have a defi nitive care admission recorded. These records lack a matching record from the hospital where the patient was transferred to, which may result from differences in AIS scoring at the destination hospital (eg following further medical investigation) or because the patient was transferred to an acute care hospital where the Trauma MDS is not currently collected, including the Repatriation General Hospital at Concord, or an interstate or overseas hospital.
22 There were 366 days in 2008 as it was a leap year
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 19
Table 14: All admissions recorded in major trauma service registries, paediatric major trauma registries
and other trauma registries
Trauma Registry Admissions
Adult Major Trauma Service Registries 1770
Paediatric Major Trauma Registries 118
Other Trauma Registries 209
The following table shows that the most seriously injured people progress to an adult major or paediatric major trauma
service, while less seriously injured people are often managed in a non-major trauma service. A larger proportion of
patients remaining in hospitals other than major or paediatric major trauma services had an ISS in the less serious ISS
range of 16-24, a smaller proportion in the higher ISS ranges, and a lower mean ISS.
Table 15: Admissions recorded in major trauma service registries, paediatric major trauma registries and
other trauma registries by ISS range
Trauma registry ISS 16-24 ISS 25-40 ISS 41-75 Mean ISS
Adult Major Trauma Service Registries (N=1770) 54.5 % 39.4 % 6.0 % 24.13
Paediatric Major Trauma Registries (N=118) 58.5 % 40.7 % ≤ 5 % 21.78 Other Trauma Registries (N=209) 59.3 % 33.5 % 7.8 % 24.02
Other Trauma Registries (not transferred for acute care) (N=132) 68.2 % 26.5 % 5.3 % 22.65
Table 16 shows admissions recorded in all trauma registries for 2008. Admissions recorded in the John Hunter Hospital/
John Hunter Children’s Hospital trauma registry generally exceed those in other trauma registries each year as the hospital
is the only trauma service in the former Hunter/New England Area Health Service
Table 16: Admissions to trauma services
Trauma registry Admissions
Gosford Hospital 59
John Hunter Hospital 362
Liverpool Hospital 247
Nepean Hospital 96
Prince of Wales Hospital 39
Royal North Shore Hospital 348
Royal Prince Alfred Hospital 209
St George Hospital 231
St Vincent’s Hospital 133
Sydney Children’s Hospital 33
The Children’s Hospital at Westmead 64
Westmead Hospital 222
Wollongong Hospital 54
Monitoring the NSW Trauma System
20 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
Monitoring the NSW Trauma System
Time and day of admission Over 64% of admissions of serious to critically injured people during 2008 occurred between 4pm and overnight to 8am
(Table 17). The busiest times for trauma services were the four hours between 5pm and 9m, with 510 admissions or
almost 25% of all admissions during the year.
Table 17: Admissions by time of day
Time of day Admissions (%)
Midnight – 8am 21.3%
8am – 4pm 34.9%
4pm - Midnight 43.8%
Injuries An Injury Severity Score (ISS) greater than 15 (ISS>15) is a key criterion for inclusion of a patient record in the NSW Trauma
Registry. Table 18 below shows the distribution of ISS scores according to the ranges: 16-24 (serious injury), 25-40
(severe injury) and 41-75 (critical injury).
The distribution of ISS scores in 2008 was consistent with previous years, although there was a slight increase in the
proportions of people injured with an ISS in the 25-40 range and the 41-75 range.
Table 18: ISS Range
ISS Range People (%) Mean / median
ISS 16 – 2423 1130 (56 %) 18.3 / 17
ISS 25 – 40 768 (38.4 %) 28 / 26
ISS 41 - 75 112 (5.6 %) 50.8 / 45
Table 19 shows the top 5 specifi c injuries recorded for these patients, where the injury has an AIS severity code greater
than 2. The fi nal or post-dot code indicates the severity of the injury.
Table 19: Top fi ve specifi c injuries where injury severity code is greater than 2
Specifi c injury Injury severity People with injuries %24
Small or moderate subdural haematoma – cerebral 4 194 10.4
Large; massive or extensive subdural haematoma - cerebral 5 170 9.1
Three or more rib fractures 3 155 8.3
Small; moderate epidural or extradural haematoma - cerebral 4 66 3.5
Major spleen laceration [OIS IV] 4 49 2.6
The table above shows that three of the top fi ve specifi c injuries were head injuries, recorded for 23% of patients. In total,
with all other injuries to the head included, injuries to the head were recorded for 1182 people in the 2008 dataset.
After injuries to the head, the next most frequently recorded injuries were found in the thorax, and in the lower
extremities. This can also be seen in fi gure 9 below, which shows the ISS body regions recorded in 2008. These body
regions differ from the chapter groups used in the table above, and combine different groups of injuries for the purpose
of ISS calculation. For example injuries in the AIS head body region include injuries to the brain, skull, neck and cervical
spine fractures.
23 ISS range proportions and age range proportions are calculated for group of people injured (N=2002)
24 Rate injury appears in records where injury codes were recorded (N=1871)
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 21
ISS Body Regions
Head Face Chest Abdomen Extremety External
% P
eo p
le
80
70
60
50
40
30
20
10
0
Figure 9: ISS body regions
Table 20 lists the top fi ve injuries for people who died in 2008. These fi ve injuries alone were recorded for over 36%
of people who died (where injury recorded, N=247). Four of these fi ve injuries were brain injuries, with large subdural
haematomas the most frequent, recorded for 17% of people who died in 2008.
Table 20: Top 5 injuries for deceased patients
Injury Injury severity People with injuries %25
Large; massive or extensive subdural haematoma - cerebral 5 42 17
Large, bilateral subdural haematoma – cerebral 5 13 5.3
Drowning with cardiac arrest 5 12 4.9
Small or moderate subdural haematoma - cerebral 4 12 4.9
Large intracerebral haematoma 5 11 4.5
The following table shows the major mechanisms of injury – assault, falls and road trauma and their discreet categories,
with the top three groups of injuries for each mechanism. Grouping injuries can provide a better indication of the
type of injury that may be associated with a mechanism. The groups of injuries used in the table below however
are not exhaustive.
Head injuries were commonly associated with assaults in 2008 (especially blunt assaults) and with falls, in particular
falls from less than 5m (Table 21). Thoracic and pelvic injuries were associated strongly with motor vehicle and
motorcycle accidents, and pelvic injuries were a strong feature of pedestrian accidents.
Monitoring the NSW Trauma System
25 Rate injury recorded in the group of deceased patients (where AIS code recorded, N=247). Note that a single patient may have injuries recorded twice in this data, eg patient may have a subdural haematoma as well as a scalp laceration.
22 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
Table 21: Main mechanism of injury, top 3 injury groups
Mechanism Top 3 injury groups Injuries %
Assault
Blunt assault (N=99) Subdural haematoma
Extradural haematoma
Skull fractures
44
17
6
44.4
17.2
6.1
Shooting (N=27) Haemothorax
Liver injury
Haemopneumothorax/Spleen injury/ Subdural
haematoma
4
4
2
14.8
14.8
7.4
Stabbing (N=63) Haemopneumothorax
Liver injury
Pneumothorax
7
5
4
11.1
7.9
6.3
Falls
Low/medium fall (<5m)
(N=644)
Subdural haematoma
Extradural haematoma
Lumbar dislocation and/or fracture (no cord)
317
55
28
49.2
8.5
4.3
High fall (>5m)
(N=81)
Pelvic and acetabulum fractures
Lumbar dislocation and/or fracture (no cord)
Subdural haematoma
21
16
12
25.9
19.7
14.8
Road trauma
Motorcycle (N=186) Lung injury
Pelvic and acetabulum fractures
Three or more rib fractures
33
31
25
17.7
16.7
13.4
Motor vehicle (N=319) Lung injury
Three or more rib fractures
Pelvic and acetabulum fractures
66
55
52
20.7
17.2
16.3
Pedal cycle (N=60) Three or more rib fractures
Extradural haematoma
Thoracic dislocation and/or fracture (no cord)
11
8
8
18.3
13.3
13.3
Pedestrian (N=139) Pelvic and acetabulum fractures
Subdural haematoma
Three or more rib fractures
39
29
16
28%
20.9
11.5
Monitoring the NSW Trauma System
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 23
Treatments and outcomes
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:
J 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.
In 2008 over 32% of patients in the dataset required surgical procedures. The majority of surgical procedures were
performed in operating suites at Major Trauma Services (78.5%). Excluding ‘Other procedures’, the most common
procedure recorded were craniotomies (34.8%) which refl ects the high frequency of head injuries and subdural injuries
recorded in the 2008 data (Table 22).
Table 22: Admissions recorded in major trauma service registries, paediatric major trauma registries and
other trauma registries, patients for operating suite
Registry C ra
n io
to m
y
L ap
ar o
to m
y
O p
en E
xt #
T h
o ra
co to
m y
O th
er p
ro ce
d u
re
To ta
l p at
ie n
ts f
o r
O S
(p
ro ce
d u
re s)
Major Trauma Service Registries 20126 143 109 22 216 580
(626)
Paediatric Major Trauma Registries 25 ≤ 5 ≤ 5 - 34 54 (62) Other Trauma Registries 2427 1328 18 ≤ 5 37 22 (30)
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.29
In 2008 47.5% of injured people recorded in the NSW Trauma Registry were admitted to an ICU. The ICU length of stay
differed between Major Trauma Service, Paediatric Major Trauma Service and other Trauma registries in 2008 (Table 23).
The ICU admission rate in Major Trauma Services was 45.8%, and the average ICU length of stay was higher than the
Other Trauma Registry group, refl ecting the greater severity of injuries treated at Major Trauma Services.
Monitoring the NSW Trauma System
26 Count of procedures
27 Craniotomies recorded at other trauma registries: Nepean Hospital (2), Prince of Wales Hospital (2), St Vincent’s Hospital (19), Wollongong Hospital (1)
28 Laparotomies recorded at other trauma registries: Gosford Hospital (1), St Vincent’s Hospital (8), Wollongong Hospital (4)
29 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
24 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
Table 23: Intensive Care Unit admissions, major trauma service registries, paediatric trauma registries and
other trauma registries
Registry ICU admission (%) Average ICU length of stay (days)
Major Trauma Service Registries 836 (47.2%) 8.87
Paediatric Major Trauma Registries 72 (61%) 4.82
Other Trauma Registries 51 (24.4%) 7.88
The data also shows a higher rate of ICU admission for more seriously injured patients (Table 24). Over two thirds of
critically injured patients (ISS 41-75) were admitted to an intensive care unit in 2008, compared to just over 36% 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.
Table 24: ICU admission statistics by ISS range
ISS Range ICU admission (%) Mean ICU LOS Mean hospital LOS (patients admitted to ICU)
16-24 36.2% 6.77 days 22.43 days
25-40 56% 9.41 days 28.19 days
41-75 67.5% 12.33 days 35.61 days
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 2008 was 17.82 days. The average
hospital length of stay for patients admitted to a Major Trauma Service was 18.74 days, which was higher than the
average hospital length of stay than patients recorded in Paediatric and Other trauma registries (Table 25).
Table 25: Admissions recorded in major trauma service registries, paediatric trauma registries and other
trauma registries, mean hospital length of stay (days)
Registry Mean hospital length of stay (days)
Major Trauma Service Registries 18.8
Paediatric Trauma Registries 16.4
Other Trauma Registries 10.7
Hospital length of stay is associated with severity of injury, as the following table demonstrates. 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 25.75 days in 2008 (Table 26).
Table 26: Mean length of stay in hospital (LOS) by ISS Range
ISS Range Mean hospital length of stay (days)
16-24 14.77 days
25-40 20.96 days
41-75 25.75 days
People with injuries in more than one ISS body region also have longer average lengths of stay. People with injuries in
three ISS body regions in 2008 had the longest average length of stay in hospital at 20.49 days (Table 28).
Monitoring the NSW Trauma System
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 25
30 Includes transfers for specialist burns services at Repatriation General Hospital (Concord)
Table 27: Mean length of stay in hospital (LOS) by count of ISS body regions
ISS Body regions Mean hospital length of stay (days)
Single body region 13.92 days
Two body regions 17.03 days
Three body regions 20.49 days
Rural dataset – Tamworth Hospital trauma registry In 2007 the NSW Rural Trauma Clinical Nurse Consultant Pilot Project commenced at Tamworth Hospital. This project
enabled prospective data collection identifying the spectrum of serious trauma admissions to hospitals in the region. The
process will now be adapted in other areas to provide data, monitoring of patient outcomes and trauma system function
in rural areas of NSW.
The following table provides a snapshot of trauma activity at Tamworth Hospital in 2008. This data is not currently
included elsewhere in this report; however Tamworth Hospital fi gures will be included within general trauma activity
fi gures in all future reports.
Some of the features of the Tamworth Hospital data for 2008 include a higher than average proportion of road trauma
injuries than in the data elsewhere in this report (over 56% road trauma compared to 39% reported for all other trauma
services), and a higher proportion of horse related injuries.
Table 28: Trauma data profi le, Tamworth Hospital
Summary data
Total admissions 32
Mean monthly admissions 2.7
Case fatality rate ≤ 5%
Gender
Female / male 21.9% / 78.1%
Injury Severity Score ranges (inc. case fatality rate)
16-24 75%
25-40 21.8%
41-75 ≤ 5%
Mechanisms of injury
Assault 9.4%
Fall 18.7%
Horse 6.2%
Road trauma 56.2%
All other injuries 9.4%
Admission type and arrival modes (pre hospital system indicators)
Direct admission 62.5%
Transfer 37.5%
Hospital system indicators
ICU admissions 75% (of patients)
Mean ICU length of stay 4.5 days
Mean hospital length of stay 7.6 days
Transfers to major trauma services30 17 (53.1%)
Monitoring the NSW Trauma System
26 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
Over 53% of people in the Tamworth dataset were transferred from Tamworth Hospital to a major trauma service for
defi nitive care. Figure 10 demonstrates the ISS distribution for each of the groups that stayed or were transferred from this
hospital, and confi rms that more seriously injured people were transferred for defi nitive care services.
Tamworth Hospital, ISS distribution by transfer out status
41-75
25-40
16-24
100
80
60
40
20
0 Transferred to MTS Not transferred
%
Figure 10: Tamworth Hospital, ISS distribution by transfer out status
Monitoring the NSW Trauma System
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 27
Appendix 1: Hospital data summaries Gosford Hospital T able 29: Trauma data profi le, Gosford Hospital
Summary data
Total admissions 59
Mean monthly admissions 4.9
Case fatality rate 5.1%
Gender
Female / male 30.5% / 69.5%
Age ranges
0-14 16.9%
15-24 18.6%
25-34 18.6%
35-44 6.8%
45-54 6.8%
55-64 6.8%
65-74 6.8%
75-84 15.2%
85-94 ≤ 5% Mean / Median age 39.5 / 32 years
Injury Severity Score ranges
16-24 54.2%
25-40 37.3%
41-75 8.5%
Mean / Median ISS 24.4 / 21
Mechanisms of injury
Assault 5.1%
Falls 42.4%
Road trauma 35.6%
All other injuries 13.6%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 100%
Ambulance 84.7%
Helicopter -
Private Vehicle 13.6%
Other ≤ 5%
Hospital system indicators
Patients for operating suite 6
ICU admissions 10.2% (of patients)
Mean ICU length of stay 1.67 days
Mean Hospital length of stay 3.73 days
Monitoring the NSW Trauma System
28 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
John Hunter Hospital/John Hunter Children’s Hospital Table 30: Trauma data profi le, John Hunter Hospital/John Hunter Children’s Hospital
Summary data
Total admissions 362
Mean monthly admissions 30.2
Case fatality rate 10.5%
Gender
Female / male 21.5% / 78.5%
Age ranges
0-4 ≤ 5% 5-9 ≤ 5% 10-12 ≤ 5% 13-14 ≤ 5% (15 years – included in paediatric group) (5.8%)
15-24 (includes patients aged 15 years) 16.8%
25-34 13.5%
35-44 13%
45-54 14.9%
55-64 10.2%
65-74 9.1%
75-84 8%
85-94 ≤ 5% 95 and older ≤ 5% Mean / median age 46.8 / 46 years
Injury Severity Score ranges
16-24 60.2%
25-40 35.4%
41-75 ≤ 5% Mean / median ISS 23 / 20
Mechanisms of injury
Assault 9.1%
Falls 34%
Road trauma 46.7%
All other injuries 10.2%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 70.2%
Ambulance 60.8%
Helicopter 35.6%
Fixed wing ≤ 5% Private Vehicle ≤ 5%
Hospital system indicators
Patients for operating suite 83
ICU admissions 35.6% (of patients)
Mean ICU length of stay 4.98 days
Mean hospital length of stay 15.39 days
Monitoring the NSW Trauma System
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 29
Liverpool Hospital Table 31: Trauma data profi le, Liverpool Hospital
Summary data
Total admissions 247
Mean monthly admissions 20.6
Case fatality rate 11.7%
Gender
Female / male 33.6% / 66.4%
Age ranges
0-14 ≤ 5% 15-24 20.6%
25-34 12.5%
35-44 11.3%
45-54 10.9%
55-64 10.1%
65-74 9.3%
75-84 16.6%
85-94 6.1%
95 and older -
Mean / median age 48.6 49 years
Injury Severity Score ranges
16-24 54.7%
25-40 38.5%
41-75 6.9%
Mean / median ISS 24 / 24
Mechanisms of injury
Assault 8.9%
Falls 34.8%
Road trauma 46.2%
All other injuries 10.1%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 72.1%
Ambulance 87%
Helicopter 10.9%
Fixed wing -
Private Vehicle ≤ 5% Other -
Hospital system indicators
Patients for operating suite 104
ICU admissions 52.6% (of patients)
Mean ICU length of stay 7.84 days
Mean Hospital length of stay 16.85 days
30 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
Nepean Hospital Table 32: Trauma data profi le, Nepean Hospital
Summary data
Total Admissions 96
Monthly Average 8
Case fatality rate 12.5%
Gender
Female / male 22.9% / 77.1%
Age ranges
0-14 ≤ 5% 15-24 25%
25-34 18.7%
35-44 5.3%
45-54 18.7%
55-64 7.3%
65-74 ≤ 5% 75-84 9.4%
85-94 ≤ 5% 95 and older -
Mean / median age 40.6 / 38 years
Injury Severity Score ranges
16-24 67.7%
25-40 27.1%
41-75 5.2%
Mean / median ISS 22.7 / 21
Mechanisms of injury
Assault 10.4%
Falls 17.7%
Road trauma 58.3%
All other injuries 13.5%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 89.6%
Ambulance 54.2%
Helicopter 18.7%
Other 27.1%
Hospital system indicators
Patients for operating suite 7
ICU admissions 43.7% (of patients)
Mean ICU length of stay 9 days
Mean hospital length of stay 18.7 days
Hospital Summary
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 31
Prince of Wales Hospital Table 33: Trauma data profi le, Prince of Wales Hospital
Summary data
Total admissions 39
Mean monthly admissions 3.2
Case fatality rate 12.8%
Gender
Female / male 12.8% / 87.2%
Age ranges
0-14 -
15-24 17.9%
25-34 25.6%
35-44 23.1%
45-54 10.2%
55-64 10.2%
65-74 10.2%
75-84 -
85-94 ≤ 5% 95 and older -
Mean / median age 40.4 / 37 years
Injury Severity Score ranges
16-24 53.8%
25-40 38.4%
41-75 7.8%
Mean / median ISS 24.2 / 24
Mechanisms of injury
Assault 7.7%
Falls 28.2%
Road trauma 43.6%
All other injuries 20.5%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 69.2%
Ambulance 64.1%
Helicopter 25.6%
Fixed wing 10.3%
Other -
Hospital system indicators
Patients for operating suite 21
ICU admissions 69.2% (of patients)
Mean ICU length of stay 8.52 days
Mean hospital length of stay 25.44 days
Hospital Summary
32 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
Royal North Shore Hospital Table 34: Trauma data profi le, Royal North Shore Hospital
Summary data
Total admissions 348
Mean monthly admissions 29
Case fatality rate 16.4%
Gender
Female / male 32.2% / 67.8%
Age ranges
0-14 ≤ 5% 15-24 15.8%
25-34 13.8%
35-44 10.3%
45-54 10.1%
55-64 10.1%
65-74 11.5%
75-84 16.1%
85-94 10.9%
95 and older ≤ 5% Mean / median age 53.4 / 54 years
Injury Severity Score ranges
16-24 47.7%
25-40 46.5%
41-75 5.7%
Mean/ median ISS 24.6 / 25
Mechanisms of injury
Assault 5.2%
Falls 50.6%
Road trauma 30.2%
All other injuries 14.1%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 56%
Ambulance 59.5%
Helicopter 26.4%
Fixed wing 11.5%
Private vehicle ≤ 5% Other ≤ 5%
Hospital system indicators
Patients for operating suite 94
ICU admissions 66.4% (of patients)
Mean ICU length of stay 11.37 days
Mean hospital length of stay 26.21 days
Hospital Summary
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 33
Royal Prince Alfred Hospital Table 35: Trauma data profi le, Royal Prince Alfred Hospital
Summary data
Total admissions 209
Mean monthly admissions 17.4
Case fatality rate 10%
Gender
Female / male 26.8% / 73.2%
Age ranges
0-14 ≤ 5% 15-24 13.4%
25-34 15.8%
35-44 11%
45-54 12.4%
55-64 14.3%
65-7 11.5%
75-84 13.9%
85-94 5.3%
95 and older -
Mean / median age 50.4 / 52 years
Injury Severity Score ranges
16-24 62.2%
25-40 32.1%
41-75 5.7%
Mean / median ISS 23 / 20
Mechanisms of injury
Assault 17.7%
Falls 52.2%
Road trauma 20.6%
All other injuries 9.6%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 78.5%
Ambulance 70.8%
Helicopter 12%
Fixed wing -
Private vehicle ≤ 5% Other 12.9%
Hospital system indicators
Patients for operating suite 66
ICU admissions 38.3% (of patients)
Mean ICU length of stay 8.34days
Mean hospital length of stay 13.98 days
Hospital Summary
34 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
St George Hospital Table 36: Trauma data profi le, St George Hospital
Summary data
Total admissions 231
Mean monthly admissions 19.2
Case fatality rate 12.5%
Gender
Female / male 28.1% / 71.9%
Age ranges
0-14 ≤ 5% 15-24 19.5%
25-34 15.1%
35-44 13.4%
45-54 12.1%
55-64 10.4%
65-74 ≤ 5% 75-84 14.3%
85-94 6.9%
95 and older -
Mean / median age 46.7 / 44 years
Injury Severity Score ranges
16-24 51.9%
25-40 36.8%
41-75 11.2%
Mean / median ISS 26.2 / 24
Mechanisms of injury
Assault 8.7%
Falls 36.4%
Road trauma 40.7%
All other injuries 14.3%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 71.9%
Ambulance 69.7%
Helicopter 22.5%
Fixed wing ≤ 5% Private vehicle ≤ 5% Other ≤ 5%
Hospital system indicators
Patients for operating suite 73
ICU admissions 35.5% (of patients)
Mean ICU length of stay 9.85 days
Mean hospital length of stay 17.95 days
Hospital Summary
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 35
St Vincent’s Hospital Table 37: Trauma data profi le, St Vincent’s Hospital
Summary data
Total admissions 133
Mean monthly admissions 11.1
Case fatality rate 11.3%
Gender
Female / male 27.8% / 72.2%
Age ranges
0-14 ≤ 5% 15-24 15%
25-34 21.8%
35-44 16.5%
45-54 10.5%
55-64 11.3%
65-74 10.5%
75-84 8.3%
85-94 5.3%
95 and older -
Mean / median age 46.5 / 43 years
Injury Severity Score ranges
16-24 56.4%
25-40 38.3%
41-75 5.3%
Mean / median ISS 23.9 / 22
Mechanisms of injury
Assault 23.3%
Falls 45.9%
Road trauma 22.6%
All other injuries 8.3%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 92.5%
Ambulance 89.5%
Helicopter ≤ 5% Fixed wing ≤ 5% Private vehicle ≤ 5% Other ≤ 5%
Hospital system indicators
Patients for operating suite 44
ICU admissions 57.9% (of patients)
Mean ICU length of stay 7.78 days
Mean hospital length of stay 17.01 days
Hospital Summary
36 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
Sydney Children’s Hospital Table 38: Trauma data profi le, Sydney Children’s Hospital
Summary data
Total admissions 33
Mean monthly admissions 2.7
Case fatality rate 12.1%
Gender
Female / male 39.4% / 60.6%
Age ranges
0-4 54.5%
5-9 15.1%
10-12 15.1%
13-14 9.1%
(15) 6.1%
Mean / median age 5.9 / 4 years
Injury Severity Score ranges
16-24 54.5%
25-40 42.4%
41-75 ≤ 5% Mean / median ISS 22.4 / 21
Mechanisms of injury
Assault ≤ 5% Falls 42.4%
Road trauma 24.2%
All other injuries 30.3%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 21.2%
Ambulance 45.5%
Helicopter 18.2%
Fixed wing ≤ 5% NETS 18.2%
Private vehicle 12.1%
Other ≤ 5%
Hospital system indicators
Patients for operating suite 13
ICU admissions 57.6% (of patients)
ICU average length of stay 3.53 days
Hospital average length of stay 9.18 days
Hospital Summary
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 37
The Children’s Hospital at Westmead Table 39: Trauma data profi le, The Children’s Hospital at Westmead
Summary data
Total admissions 64
Mean monthly admissions 5.3
Case fatality rate ≤ 5%
Gender
Female / male 42.2% / 57.8%
Age ranges
0-4 46.9%
5-9 17.2%
10-12 10.9%
13-14 21.9%
(15) ≤ 5% Mean / median age 6.7 / 5 years
Injury Severity Score ranges
16-24 60.9%
25-40 39.1%
41-75 -
Mean / median ISS 21.7 / 19.5
Mechanisms of injury
Assault 7.8%
Falls 15.6%
Road trauma 35.9%
All other injuries 40.6%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 32.8%
Ambulance 25%
Helicopter 15.6%
Fixed wing ≤ 5% NETS 46.9%
Private vehicle 9.4%
Other -
Hospital system indicators
Patients for operating suite 36
ICU admissions 64.1% (of patients)
Mean ICU length of stay 5.51 days
Mean hospital length of stay 21.33 days
Hospital Summary
38 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
Westmead Hospital Table 40: Trauma data profi le, Westmead Hospital
Summary data
Total admissions 222
Mean monthly admissions 18.5
Case fatality rate 14.4%
Gender
Female / male 30.2% / 69.8%
Age ranges
0-14 ≤ 5% 15-24 16.7%
25-34 20.7%
35-44 11.3%
45-54 14.9%
55-64 9.5%
65-74 7.7%
75-84 14%
85-94 5.4%
95 and older ≤ 5% Mean / median ISS 47.6 / 46 years
Injury Severity Score ranges
16-24 50.4%
25-40 46.8%
41-75 ≤ 5% Mean / median ISS 24.2 / 24
Mechanisms of injury
Assault 9%
Falls 32.4%
Road trauma 45.9%
All other injuries 12.6%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 80.6%
Ambulance 73%
Helicopter 19.4%
Fixed wing ≤ 5% Private vehicle ≤ 5% Other ≤ 5%
Hospital system indicators
Patients for operating suite 101
ICU admissions 41.4% (of patients)
Mean ICU length of stay 9.51 days
Mean hospital length of stay 19.37 days
Hospital Summary
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 39
Wollongong Hospital Table 41: Trauma data profi le, Wollongong Hospital
Summary data
Total admissions 54
Mean monthly admissions 4.5
Case fatality rate 27.8%
Gender
Female / male 29.6% / 70.4%
Age ranges
0-14 9.3%
15-24 16.7%
25-34 9.3%
35-44 14.8%
45-54 13%
55-64 ≤ 5% 65-74 7.4%
75-84 14.8%
85-94 11.1%
95 and older -
Mean / median age 48.3 / 45.5 years
Injury Severity Score ranges
16-24 50%
25-40 40.7%
41-75 9.3%
Mean / median ISS 25.8 / 24.5
Mechanisms of injury
Assault ≤ 5% Falls 24.1%
Road trauma 53.7%
All other injuries 20.4%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 96.3%
Ambulance 83.3%
Helicopter 11.1%
Private vehicle ≤ 5% Other ≤ 5%
Hospital system indicators
Patients for operating suite 9
ICU admissions 5.6% (of patients)
Mean ICU length of stay 4.33 days
Mean hospital length of stay 3.93 days
Hospital Summary
40 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 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 isolated #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 the 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
Hospital Summary
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 41
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 are the highest AIS severity codes in each of the (up to) three most severely injured ISS body regions31.
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
ISS = 45
31 Abbreviated Injury Scale (AIS) 2005: Association for the Advancement of Automotive Medicine, p29
Hospital Summary
42 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
Index of fi gures Figure 1: People injured, six monthly periods, 2006-2008, with AIS coding version .......................................................... 9
Figure 2: Major mechanisms of injury, six monthly, 2006-2008 ........................................................................................ 9
Figure 3: Age-specifi c rates of injury, NSW population June 2008 ...................................................................................11
Figure 4: Age-specifi c rates of injury by gender ...............................................................................................................11
Figure 5: Age-specifi c death rates by gender .................................................................................................................. 12
Figure 6: Mechanisms of injury ...................................................................................................................................... 12
Figure 7: Age-specifi c rates of mechanism of injury ........................................................................................................ 14
Figure 8: People injured by hour of day when injury occurred ........................................................................................ 14
Figure 9: ISS body regions .............................................................................................................................................. 21
Figure 10: Tamworth Hospital, ISS distribution by transfer out status .............................................................................. 26
NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 43
Index of tables Table 1: Case fatality rate and mean hospital length of stay by ISS range, 2008 ............................................................. 6
Table 2: Injured people, summary statistics .................................................................................................................. 10
Table 3: Age distribution of serious to critically injured people ..................................................................................... 10
Table 4: Mechanism of injury, rural vs. metropolitan place of injury ............................................................................. 13
Table 5: Mechanism of Injury – main mechanisms and categories ................................................................................ 13
Table 6: People injured and admitted, Monday-Friday and weekends .......................................................................... 14
Table 7: Admission Types ............................................................................................................................................. 15
Table 8: Defi nitive care admission type by geographical location of injury .................................................................... 16
Table 9: Arrival mode at defi nitive care facility - Top 3 Arrival Modes ........................................................................... 16
Table 10: Modes of transport to defi nitive care by admission type ................................................................................. 16
Table 11: Proportion of ambulance and helicopter arrivals at defi nitive care, direct from scene and transfer admissions,
metropolitan vs. rural location of injury .......................................................................................................... 17
Table 12: Time to defi nitive care for patients admitted directly to a defi nitive trauma service, rural vs. metropolitan
location of injury ............................................................................................................................................ 18
Table 13: Trauma service admissions summary ............................................................................................................... 18
Table 14: All admissions recorded in major trauma service registries, paediatric major trauma registries and other
trauma registries ............................................................................................................................................ 19
Table 15: Admissions recorded in major trauma service registries, paediatric major trauma registries and other trauma
registries by ISS range ..................................................................................................................................... 19
Table 16: Admissions to trauma services ........................................................................................................................ 19
Table 17: Admissions by time of day .............................................................................................................................. 20
Table 18: ISS Range ....................................................................................................................................................... 20
Table 19: Top fi ve specifi c injuries where injury severity code is greater than 2 ............................................................... 20
Table 20: Top 5 injuries for deceased patients ................................................................................................................ 21
Table 21: Main mechanism of injury, top 3 injury groups ............................................................................................... 22
Table 22: Admissions recorded in major trauma service registries, paediatric major trauma registries and other trauma
registries, patients for operating suite ............................................................................................................. 23
Table 23: Intensive Care Unit admissions, major trauma service registries, paediatric trauma registries and other
trauma registries ............................................................................................................................................ 24
Table 24: ICU admission statistics by ISS range .............................................................................................................. 24
Table 25: Admissions recorded in major trauma service registries, paediatric trauma registries and other trauma
registries, mean hospital length of stay (days) ................................................................................................. 24
Table 26: Mean length of stay in hospital (LOS) by ISS Range ........................................................................................ 24
Table 27: Mean length of stay in hospital (LOS) by count of ISS body regions ................................................................ 25
Table 28: Trauma data profi le, Tamworth Hospital ......................................................................................................... 25
Table 29: Trauma data profi le, Gosford Hospital ............................................................................................................ 27
Table 30: Trauma data profi le, John Hunter Hospital/John Hunter Children’s Hospital .................................................... 28
Table 31: Trauma data profi le, Liverpool Hospital ........................................................................................................... 29
Table 32: Trauma data profi le, Nepean Hospital ............................................................................................................. 30
Table 33: Trauma data profi le, Prince of Wales Hospital ................................................................................................. 31
Table 34: Trauma data profi le, Royal North Shore Hospital ............................................................................................. 32
Table 35: Trauma data profi le, Royal Prince Alfred Hospital ............................................................................................ 33
Table 36: Trauma data profi le, St George Hospital ......................................................................................................... 34
Table 37: Trauma data profi le, St Vincent’s Hospital ....................................................................................................... 35
Table 38: Trauma data profi le, Sydney Children’s Hospital .............................................................................................. 36
Table 39: Trauma data profi le, The Children’s Hospital at Westmead.............................................................................. 37
Table 40: Trauma data profi le, Westmead Hospital ........................................................................................................ 38
Table 41: Trauma data profi le, Wollongong Hospital ...................................................................................................... 39
44 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
NOTES
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46 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
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48 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2008 NSW Health
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