The NSW Trauma Registry Profile of Serious to Critical Injuries
2009
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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: 2009. 2012. 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 – 2009 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 ................................................................................................................................................... 7
2009 data ...................................................................................................................................................................... 9
Demographic profi le ................................................................................................................................................ 9
Mechanisms of injury ............................................................................................................................................. 11
Time and day of injury ........................................................................................................................................... 13
Triage and transport .............................................................................................................................................. 14
Admission type ................................................................................................................................................ 14
Times to defi nitive care ................................................................................................................................... 16
Trauma admissions ............................................................................................................................................... . 17
Time and day of admission .................................................................................................................................... 19
Injuries .................................................................................................................................................................. 19
Treatments and outcomes ..................................................................................................................................... 22
Intensive Care Unit admissions ........................................................................................................................ 22
Hospital lengths of stay ................................................................................................................................... 22
Appendix 1: Hospital data summaries .......................................................................................................................... 24
Gosford Hospital ................................................................................................................................................... 24
John Hunter Hospital / John Hunter Children’s Hospital .......................................................................................... 25
Liverpool Hospital .................................................................................................................................................. 26
Nepean Hospital .................................................................................................................................................... 27
Prince of Wales Hospital ........................................................................................................................................ 28
Royal North Shore Hospital .................................................................................................................................... 29
Royal Prince Alfred Hospital ................................................................................................................................... 30
St George Hospital ................................................................................................................................................ 31
St Vincent’s Hospital .............................................................................................................................................. 32
Sydney Children’s Hospital ..................................................................................................................................... 33
Tamworth Base Hospital ........................................................................................................................................ 34
The Children’s Hospital at Westmead .................................................................................................................... 35
Westmead Hospital ............................................................................................................................................... 36
Wollongong Hospital ............................................................................................................................................. 37
Appendix 2: Trauma data collection tool ...................................................................................................................... 38
Appendix 3: Calculation of the Injury Severity Score (ISS) ............................................................................................. 39
Index of fi gures ............................................................................................................................................................ 40
Index of tables ............................................................................................................................................................. 41
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ii ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 3
Executive Summary Each year more than 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 2009 dataset we found the following:
J The numbers of falls recorded in the dataset continued to rise - the total numbers of falls exceeded those of road trauma injuries
J Injuries to the head continue to be the most common injury in the data. Over 70% of serious to critically injured people in 2009 sustained a head injury.
J Age specifi c rates of injury following trauma rise steeply from the age of 70 years and over. Injuries in this group are particularly associated with falls.
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.
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4 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 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.
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 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 defi nitive trauma care. 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.
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6 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 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 is 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
trauma 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, 2009
ISS range Case fatality rate Mean hospital length of stay (days)2
16-24 4.0 % 15.0
25-40 23.0 % 21.3
41-75 50.0 % 28.0
1 Abbreviated Injury Scale 2005 Update 2008: Association for the Advancement of Automotive Medicine, 2008
2 Length of stay while classifi ed as an acute care patient
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 7
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 twice as long as patients
classifi ed as seriously injured (ISS 16-24).
The version of AIS in use in 2009 was the Abbreviated Injury Scale 2005, Update 2008.
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 of 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 2009 were excluded from this report.
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.
Monitoring the NSW Trauma System
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8 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
In 2009, adult major trauma service registries included:
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 included:
J John Hunter Children’s Hospital
J Sydney Children’s Hospital, and
J The Children’s Hospital at Westmead, and
Regional trauma service registries included:
J Gosford Hospital
J Nepean Hospital
J Tamworth 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
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 9
2009 data Demographic profi le The NSW Trauma Registry recorded 2098 people injured with an ISS > 15 in 2009 (Table 2). The overall incidence of
serious to critical injuries in NSW for 2009 was approximately 28 people injured per 100,000 in the NSW population3.
Table 2: Injured people, summary statistics
Summary statistics, injured people Summary
Total people injured 2098
Died Case fatality rate:14.4%
95% CI 13.0, 16.0 (303 people)
Incidence (ISS>15) per 100,000 people (age standardised)4 28.2
95% CI 27.5, 29.0
Deaths (ISS>15) per 100,000 people (age standardised) 3.9
95% CI 3.6, 4.2
Age standardised mortality ratio (SMR)5 682
The age standardised mortality ratio (SMR) for this group of patients in 2009 was 682, indicating the proportion 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 2009 was 3.9 deaths per 100,000 people.
The case fatality rate for this group of patients is the percentage of deaths recorded in this group of serious to critically
injured patients6. The case fatality rate for 2009 was 14.4%.
The age distribution within the dataset of people with serious to critical injuries in the NSW Trauma Registry shows a
higher proportion of injured people in the 65 years and older age groups than in previous years (Table 3).
Table 3: Age distribution of serious to critically injured people
Age range Proportion of all people (%)
Age 0 – 15 years 7.8 %
Age 16 – 64 years 59.6 %
Age 65 years and older 32.6 %
The age-standardised rate of injuries in 2009 was 28.2 people injured per 100,000 people (Table 2); however age-specifi c
rates varied across age groups from 9.7 in the 5-9 years age group to a high of 114.6 in the 85 years and older group of
people7. The steep rise in rates from the age of 75 years shows that trauma continues to be an issue for people as they
reach this age (Figure 1).
3 Source: Australian Bureau of Statistics. Australian Demographic Statistics. Catalogue no. 3101.0. Canberra: ABS, 2009
4 Incidence rates, given as per 100,000 persons, were standardised to the Australian population at 30 June 2001. Source: Australian Bureau of Statistics. Australian Historical Population Statistics 2008. Catalogue no. 3105.0.65.001. Canberra: ABS, 2009
5 Standardised to the Australian population at June 2001
6 These are calculated as follows: Case fatality rate = number of deaths divided by the number of patients in this data collection X 100
7 Rates of injuries per 100,000 people in age group
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10 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
Age-specific rates of injury
0
20
40
60
80
100
120
140 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
A ge
-s pe
ci fic
ra te
/1 00
,0 00
Figure 1: Age-specifi c rates of injury
Males have higher rates of injury in every age group (Figure 2). This correlates with the overall gender distribution of
the dataset, where in 2009, 71.6% of people with serious to critical injuries were male. Figure 2 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 14 (injured people per 100,000 in NSW), while for males the age-specifi c rate was over 54 (injured people
per 100,000 in NSW). Figure 2 also shows that age-specifi c rates for both males and females increase from the age of
70 years and over.
Age-specific rates of injury by gender
0 20 40 60 80
100 120 140 160
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
A ge
-s pe
ci fic
ra te
(in
ju rie
s/ 10
0, 00
0)
Female Male
Figure 2: Age-specifi c rates of injury by gender
The crude death rate for males in 2009 was more than double that of females (6.0 deaths per 100,000 males in NSW
compared to 2.6 deaths per 100,000 females). The age-standardised mortality ratio (SMR) for males was 763, and for
females 488, 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.
The age-specifi c death rate for males in the 20-24 years age group also exceeded females in the group by approximately
3.5 to 1 (4.2 males deaths per 100,000 males compared to 1.2 female deaths per 100,000 females in NSW).
2009 data
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 11
Age-specific death rates by gender
0 5
10 15 20 25 30 35 40 45
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
A ge
-s pe
ci fic
d ea
th ra
te
(d ea
th s/
10 0,
00 0)
Female Male
Figure 3: Age-specifi c death rates by gender
The gender disparity noted above is also apparent in the age distribution within the dataset (Figure 3). 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 2009 proportion of males of 71.6%. In the 25 - 29 years
age group the proportion of males is greater than 85%.
Mechanisms of injury The general distribution of mechanisms of injury in 2009 was similar to previous years, although the number and
proportion of falls increased in 2009. Falls and road trauma together are the mechanisms of injury for the vast majority of
records in the dataset (Figure 4).
Mechanisms of injury
Road Trauma 39%
Falls 41%
Assault 8%
Other 12%
Figure 4: Mechanisms of injury
2009 data
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12 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
There were proportionately fewer people injured in rural districts in 2009 due to assaults or falls, compared to their
metropolitan counterparts (Table 4)14. Conversely, the rural group recorded road trauma as the mechanism of injury in
over 49% of records, compared to 37.2% for the metropolitan group. In the metropolitan group falls were the most
common mechanism of injury, recorded for 43.5% of patients.
Table 4: Mechanism of injury, rural vs metropolitan place of injury8
Mechanism Metropolitan (% of patients)
Rural (% of patients)
Assault 129 (8.2) 30 (6.7)
Falls 680 (43.5) 128 (28.8)
Road Trauma 581 (37.2) 221 (49.7)
All other mechanisms 173 (11.1) 66 (14.8)
Total 1563 (100.0) 445 (100.0)
The breakdown of specifi c categories of mechanisms of injury was similar in 2009 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 mechanisms of injury in 2009 were low to medium fall (<5m). This mechanism was recorded for 34%
of serious to critically injured people in the 2009 dataset (Table 5). 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 75% of patients. In contrast,
falls were recorded as the mechanism of injury for approximately 30% of people aged between 15 and 65 years, and
approximately 40% of paediatric patients between 0 and 15 years of age.
Table 5: Mechanism of Injury – main mechanisms and categories9
Mechanism People injured % of Total Deaths (% of mechanism)
Road Trauma
MVC 357 17.0% 34 (9.5%)
MBC / trike 230 11% 15 (6.5%)
Pedestrian 171 8.2% 32 (18.7%)
Pedal Cyclist 67 ≤ 5% 7 (10.5%)
Total Road Trauma 825 39.3% 88 (10.7%)
Fall
Low / Medium Fall (<5m) 713 34.0% 132 (18.5%)
High Fall (>5m) 77 3.7% 8 (10.4%)
Fall Unspecifi ed Height 67 ≤ 5% 10(14.9%)
Total All Falls 857 40.8% 150 (17.5%)
Assault
Blunt Assault 106 5.1% 14 (13.2%)
Shooting ≤ 5 ≤ 5% ≤ 5 (33%) Stabbing 32 ≤ 5% ≤ 5 (12.5%) Other assaults 24 ≤ 5% ≤ 5 (16.7%)
Total All Assaults 165 7.9% 23 (13.9%)
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.
8 Includes only records where postcode of injury is known (N=2008)
9 Excludes mechanisms not broadly categorised as assault, fall, or road trauma
2009 data
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 13
The average age for falls in 2009 was approximately 62 years (the median was 68 years), and age-specifi c rates of
mechanism of injury demonstrate clearly that falls in the elderly are a serious issue in trauma (Figure 5). Rates of falls for
elderly people are the highest in the dataset, rising to over 97 people injured per 100,000 people in the NSW population
for people aged 85 years and over.
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.
Age-specific rates of mechanism of injury
0 10 20 30 40 50 60 70 80 90
100
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
A ge
-s pe
ci fic
ra te
/1 00
,0 00
Assault Falls Road trauma
Figure 5: 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 2009 (Figure 6). 37.1% of
people were injured between the hours of 12 noon and 6pm, with a peak time between 5pm and 6pm (136 people).
People injured by hour of day
0
20
40
60
80
100
120
140
160
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Hour (24 hr)
Pe op
le in
ju re
d
Figure 6: People injured by hour of day when injury occurred
2009 data
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14 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
10 Excludes 3 records where day of injury was unknown
11 For 2009, there were 104 days falling on weekends, and 261 other days (Mondays-Fridays)
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
Table 6 demonstrates that serious to critical injuries occurred more frequently on weekends than on other days of the
week in 2009, consistent with data from previous years.
Table 6: People injured and admitted, Monday-Friday and weekends10
Weekly period People injured Mean daily admissions11
Monday - Friday 1357 5.2
Weekends 738 7.1
Total 209510 5.7
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 2009 was 69.9% (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.
Table 7: Admission Types
Admission Type Admissions %
Transfer In13 653 30.1
Direct From Scene 1518 69.9
Total admissions 2171 100.0
The proportion of direct admissions to a major adult trauma service for defi nitive care in 2009 was 70.4%, slightly
higher than the overall rate of direct from scene admissions to all trauma services combined (Table 8). Direct from scene
admissions to paediatric major trauma services was lower at 40%, refl ecting the high proportion of transfers of children
for specialist services at these centres.
Table 8: Direct admissions for defi nitive care by trauma registry type
Trauma registry type Direct admissions %
Major adult (N=1791) 1261 70.4
Paediatric major (N=140) 56 40.0
Regional (N=167) 136 81.4
Total for defi nitive care (N=2098) 1453 69.3
2009 data
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 15
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 9)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.
Table 9: Defi nitive care admission type by geographical location of injury15
Admission Type Metropolitan Districts Rural Districts
Transfer In 297 admissions
(18.9% of metropolitan patients)
301
(67.6% of rural patients)
Direct From Scene 1272 (81.1%) 144 admissions (32.4%)
Total 1569 445
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 65.5% in 2009 (Table 10). Just over 85%
of patients arrived at defi nitive care facilities by either ambulance or helicopter during the year.
Table 10: Arrival mode at defi nitive care facility - Top 3 Arrival Modes
Arrival mode Admissions %
Ambulance 1375 65.5%
Helicopter 427 20.4%
All other modes of transport 296 14.1%
Total all modes 2098 100.0
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.
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 2009
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.
2009 data
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16 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
Almost 80% of ambulance journeys recorded in the NSW Trauma Registry in 2009 provided transport directly from
the scene of injury to the defi nitive care trauma service (Table 11). 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 11: Modes of transport to defi nitive care by admission type
Arrival mode Direct from scene (%) Transferred
Ambulance (N=1375) 79.7 20.3
Helicopter (N=427) 52.0 48.0
Other mode of transport (N=296) 45.6 54.4
Total (N=2098) 69.3 30.7
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 12). Helicopter transport was more frequently provided in rural districts to assist patients to
defi nitive care.
Table 12: 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=1272) 82.4 % 9.0 %
Rural location of injury (N=144) 25.0 % 66.7%
Transferred to defi nitive care
Metropolitan location of injury (N=297) 70.4 % 15.8 %
Rural location of injury (N=301) 20.9 % 47.2 %
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 2009, 58.4% 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 61.9% 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.
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.
2009 data
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 17
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 2009 data shows that a much higher proportion of rural patients were transferred to a defi nitive care hospital
(67.6%, table 8), compared to patients injured in a metropolitan area (18.9% in 2009). 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.
In 2009 a high proportion (84%) of people injured in metropolitan areas who were admitted directly from the scene
of their injury to a defi nitive trauma service arrived within 2 hours of injury (Table 13). The average time taken for these
patients in 2009 was 59 minutes. This large group represented almost 45% of all people injured in 2009.20
Table 13: 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=121) Metropolitan (n=1122)
0-2 hours 59 patients (48.8%)
Average 1 hour 22 min
942 patients (84.0%)
Average 59 min
2-6 hours 49 patients (40.5%)
Average 2 hours 54 min
79 patients (7.0%)
Average 3 hours 2 min
6-12 hours 6 patients (≤ 5%) Average 8 hours 37 min
14 patients (≤ 5%) Average 8 hours 21 min
12-24 hours ≤ 5 patients (≤ 5%) Average 13 hours 15 min
25 patients (≤ 5%) Average 16 hours 11 min
Greater than 24 hours ≤ 5 patients (≤ 5%) Average 175 hours 29 min
62 patients (≤ 5.5%) Average 85 hours 30 min
Trauma admissions Trauma admissions submitted by trauma service registries in 2009 totalled 2,171 for this group of serious to critically
injured patients (Table 14). Average daily admissions for the full year were 5.9 admissions per day. In November, the
busiest month for trauma admissions, the daily average rose to 6.8 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 2009 there were 2098 recorded defi nitive care admissions.
Table 14: Trauma service admissions summary
Summary statistics, trauma service admissions Summary
Total trauma admissions 2171
Mean daily admissions21 5.9
Mean monthly admissions 181
Minimum monthly admissions 162 (June)
Maximum monthly admissions 205 (November)
Defi nitive care admissions 2098
20 As numbers in this table only include patients where postcode and time of injury is known, actual fi gures may be larger.
21 There were 365 days in 2009
2009 data
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18 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
In 2009 over 90% of all records in the NSW Trauma Registry were provided by an adult major trauma service or paediatric
major trauma service registry (Table 15). 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.
Table 15: All admissions recorded in major trauma service registries, paediatric major trauma registries
and other trauma registries
Trauma Registry Admissions
Adult Major Trauma Service Registries 1826
Paediatric Major Trauma Registries 140
Regional Trauma Registries 205
Total 2171
Table 16 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 16: 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=1826) 55.0 % 39.0 % 6.0 % 24.2
Paediatric Major Trauma Registries (N=140) 57.9 % 39.3 % ≤ 5 % 22.3 Other Trauma Registries (N=205) 55.4 % 39.7 % ≤ 5 % 23.8 Other Trauma Registries (not transferred for acute care) (N=167) 54.5 % 40.1 % 5.4 % 23.9
Table 17 shows admissions recorded in all trauma registries for 2009. 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 17: Admissions to trauma services
Trauma registry Admissions
Gosford Hospital 36
John Hunter Hospital 399
Liverpool Hospital 231
Nepean Hospital 78
Prince of Wales Hospital 50
Royal North Shore Hospital 373
Royal Prince Alfred Hospital 207
St George Hospital 257
St Vincent’s Hospital 117
Sydney Children’s Hospital 39
Tamworth Base Hospital 35
The Children’s Hospital at Westmead 72
Westmead Hospital 221
Wollongong Hospital 56
Total 2171
2009 data
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 19
22 ISS range proportions and age range proportions are calculated for group of people injured (N=2098)
23 N=2098
Time and day of admission 65% of admissions of serious to critically injured people during 2009 occurred between 4pm and overnight to 8am
(Table 18). The busiest times for trauma services were the four hours between 5pm and 9pm, with 686 admissions or
almost 32% of all admissions during the year.
Table 18: Admissions by time of day
Time of day Admissions (%)
Midnight – 8am 21.0%
8am – 4pm 35.0%
4pm - Midnight 44.0%
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 19 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 2009 was similar to previous years.
Table 19: ISS Range22
ISS Range People (%) Mean / median
ISS 16 – 24 53.3 18 / 17
ISS 25 – 40 39.0 28 / 26
ISS 41 - 75 5.7 53 / 50
Table 20 shows the top 5 specifi c injuries recorded for all patients with serious to critical injuries, where the injury has an
AIS severity greater than 2. The immediate post-dot numeral indicates the injury severity in the AIS code.
Table 20: Top fi ve specifi c injuries where injury severity code is greater than 2
Specifi c injury Injury severity People with injuries %23
Three or more rib fractures 3 276 13.2
Small or moderate subdural haematoma – cerebral 4 274 13.1
Large; massive or extensive subdural haematoma – cerebral 5 232 11.1
Tiny Subdural haematoma – cerebral 3 90 4.3
Bilateral lung contusion 4 85 4.1
The table above shows that three of the top fi ve specifi c injuries were head injuries. In total, with all other injuries to the
head included, injuries to the head were recorded for 1486 people in the 2009 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 Figure 7 below, which shows the ISS body regions recorded in 2009. These body
regions 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.
2009 data
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20 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
ISS Body Regions
0
10
20
30
40
50
60
70
80
Head Face Chest Abdomen Extremity External
% Pe
o pl
e
Figure 7: ISS body regions
Table 21 lists the top fi ve injuries for people who died in 2009. Four of the fi ve injuries were brain injuries. Large subdural
haematomas were the most frequently recorded injury for 22% of people who died in 2009.
Table 21: Top 5 injuries for deceased patients where injury severity code is greater than 2
Injury Injury severity People with injuries %24
Large; massive or extensive subdural haematoma –cerebral 5 66 21.8%
Subarachnoid haemorrhage (with coma > 6 hours) cerebral 3 31 10.2%
Small or moderate subdural haematoma – cerebral 4 27 8.9%
Three or more rib fractures 3 27 8.9%
Brain stem compression 5 21 6.9%
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 2009 (especially blunt assaults) and with falls, in particular falls
from less than 5m (Table 22). Thoracic injuries were associated strongly with motor vehicle and motorcycle accidents, and
head injuries were a strong feature of pedestrian accidents.
24 Rate of injury recorded in the group of deceased patients (where AIS code recorded, N=303). Note that a single patient may have injuries recorded twice in this table, eg patient may have a subdural haematoma as well as three or more rib fractures.
2009 data
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 21
Table 22: Main mechanisms of injury and categories, top 3 injury groups
Mechanism Top 3 injury groups People %
Assault
Blunt assault (N=106) Subdural haematoma
Skull fractures
Extradural haematoma
55
36
14
51.9
34.0
13.2
Shooting (N≤5) Lung contusion
Liver injury
Fractured femur
≤5
≤5
≤5
-
-
-
Stabbing (N=32) Haemothorax
Pneumothorax
Haemopneumothorax
7
≤5
≤5
21.9
-
-
Falls
Low / medium fall (<5m) (N=713) Subdural haematoma
Skull fractures
Extradural haematoma
445
113
76
62.4
15.8
10.7
High fall (>5m) (N=77) Thoracic dislocation and / or fracture (no cord)
Subdural haematoma
Three or more rib fractures
19
17
17
24.7
22.1
22.1
Road trauma
Motorcycle (N=230) Three or more rib fractures
Pneumothorax
Lumbar dislocation and / or fracture (no cord)
49
39
27
22.6
17.0
11.7
Motor vehicle (N=357)
Three or more rib fractures Pneumothorax Cervical
dislocation and / or fracture (no cord)
83
57
51
23.2
16.0
14.3
Pedal cycle (N=67) Three or more rib fractures
Skull fractures
Subdural haematoma
14
12
12
20.9
17.9
17.9
Pedestrian (N=171) Subdural haematoma
Skull fractures
Three or more rib fracture
46
41
36
26.9
24.0
21.1
2009 data
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22 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
Treatments and outcomes
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.25
In 2009 44.1% 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 2009 (Table 23).
The ICU admission rate in Major Trauma Services was 42.4%, 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.
Table 23: Intensive Care Unit admissions, major trauma service registries, paediatric major trauma
registries and other trauma registries
Registry ICU admissions (%) Average ICU length
of stay (days)
Major Trauma Service Registries 775 (42.4) 8.0
Paediatric Major Trauma Registries 81 (57.9) 7.4
Other Trauma Registries 70 (34.3) 4.8
The data also shows a higher rate of ICU admission for more seriously injured patients (Table 24). Nearly two thirds of
critically injured patients (ISS 41-75) were admitted to an intensive care unit in 2009, compared to just over 34% 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 admissions (%) Mean ICU
LOS (days)
Mean hospital LOS for patients
admitted to ICU (days)
16-24 34.4 6.0 22.1
25-40 53.1 8.6 28.2
41-75 63.0 12.9 33.1
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 2009 was 17.5 days. The average
hospital length of stay for patients admitted to a Major Trauma Service was 17.8 days, which was higher than the average
hospital length of stay for patients recorded in other trauma registries (excluding paediatric trauma registries, Table 25).
25 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
2009 data
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 23
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 17.8
Paediatric Trauma Registries 21.0
Other Trauma Registries 12.3
Total all registries 17.5
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 24.8 days in 2009 (Table 26).
Table 26: Mean length of stay in hospital (LOS) by ISS Range
ISS Range Mean hospital length of stay (days)
16-24 15.0
25-40 21.3
41-75 24.8
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 2009 had the longest average length of stay in hospital at 21.4 days (Table 27).
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 14.0
Two body regions 16.7
Three body regions 21.4
2009 data
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24 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
Appendix 1: Hospital data summaries Gosford Hospital Table 28: Trauma data profi le, Gosford Hospital
Summary data
Total admissions 36
Mean monthly admissions 3
Case fatality rate 11.1%
Gender
Female / male 33.3% / 66.6%
Age ranges
0-14 8.8 %
15-24 14.7 %
25-34 ≤ 5% 35-44 11.8%
45-54 11.8%
55-64 17.6 %
65-74 8.8 %
75-84 14.7 %
85-94 8.8 %
Mean / Median age 51.3 / 53.5 years
Injury Severity Score ranges
16-24 58.3%
25-40 38.9%
41-75 ≤ 5% Mean / Median ISS 22.2 / 22
Mechanisms of injury
Assault -
Falls 41.7%
Road trauma 47.2%
All other injuries 11.1%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 100%
Ambulance 91.7%
Helicopter ≤ 5% Private vehicle / other 5.6%
Other ≤ 5%
Hospital system indicators
ICU admissions 30.6% (of patients)
Mean ICU length of stay 0 days
Mean Hospital length of stay 10.04 days
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 25
John Hunter Hospital / John Hunter Children’s Hospital Table 29: Trauma data profi le, John Hunter Hospital / John Hunter Children’s Hospital
Summary data
Total admissions 399
Mean monthly admissions 33.2
Case fatality rate 9.8%
Gender
Female / male 29.6% / 70.4%
Age ranges
0-4 ≤ 5% 5-9 ≤ 5% 10-12 ≤ 5% 13-14 ≤ 5% (15 years – included in paediatric group) ≤ 5% 15-24 (includes patients aged 15 years) 18.8%
25-34 11.0%
35-44 14.3%
45-54 15.5%
55-64 9.3%
65-74 9.0%
75-84 10.3%
85-94 5.0 %
95 and older ≤ 5% Mean / median age 46.0 / 44.0 years
Injury Severity Score ranges
16-24 63.4%
25-40 30.3%
41-75 6.3%
Mean / median ISS 23.2 / 20
Mechanisms of injury
Assault 8.5%
Falls 31.6%
Road trauma 46.1%
All other injuries 13.8%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 67.7%
Ambulance 58.1%
Helicopter 35.6%
Fixed wing ≤ 5% Private vehicle / other 5.8%
Hospital system indicators
ICU admissions 36.8% (of patients)
Mean ICU length of stay 2.13 days
Mean hospital length of stay 14.14 days
Hospital Summary
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26 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
Liverpool Hospital Table 30: Trauma data profi le, Liverpool Hospital
Summary data
Total admissions 231
Mean monthly admissions 19.2
Case fatality rate 16.0%
Gender
Female / male 27.7% / 72.3%
Age ranges
0-14 ≤ 5% 15-24 20.8%
25-34 11.3%
35-44 12.1%
45-54 14.3%
55-64 7.4%
65-74 10.4%
75-84 14.7%
85-94 7.4%
95 and older ≤ 5% Mean / median age 49.6 / 47.0 years
Injury Severity Score ranges
16-24 55.8%
25-40 37.2%
41-75 6.9%
Mean / median ISS 25.1 / 22
Mechanisms of injury
Assault 9.5%
Falls 32.5%
Road trauma 46.3%
All other injuries 11.7%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 74.9%
Ambulance 80.1%
Helicopter 14.7%
Fixed wing ≤ 5% Private vehicle / other ≤ 5%
Hospital system indicators
ICU admissions 26.0% (of patients)
Mean ICU length of stay 2.47 days
Mean Hospital length of stay 19.02 days
Hospital Summary
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 27
Nepean Hospital Table 31: Trauma data profi le, Nepean Hospital
Summary data
Total admissions 78
Mean monthly admissions 6.5
Case fatality rate 5.1%
Gender
Female / male 26.9% / 73.1%
Age ranges
0-14 5.1%
15-24 23.6%
25-34 18.0%
35-44 10.3%
45-54 16.7%
55-64 7.7%
65-74 10.3%
75-84 10.3%
85-94 ≤ 5% 95 and older -
Mean / median age 42.5 / 36.5 years
Injury Severity Score ranges
16-24 55.1%
25-40 39.7%
41-75 5.1%
Mean / median ISS 23.7 / 22
Mechanisms of injury
Assault 12.8%
Falls 24.4%
Road trauma 51.3%
All other injuries 11.5%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 87.2%
Ambulance 87.1%
Helicopter ≤ 5% Other 10.0%
Hospital system indicators
ICU admissions 30.8% (of patients)
Mean ICU length of stay 1.45 days
Mean hospital length of stay 13.99 days
Hospital Summary
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28 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
Prince of Wales Hospital Table 32: Trauma data profi le, Prince of Wales Hospital
Summary data
Total admissions 50
Mean monthly admissions 4.2
Case fatality rate 28.0%
Gender
Female / male 20.0% / 80.0%
Age ranges
0-14 -
15-24 16.0%
25-34 12.0%
35-44 8.0%
45-54 14.0%
55-64 20.0%
65-74 12.0%
75-84 16.0%
85-94 ≤ 5% 95 and older -
Injury Severity Score ranges
16-24 54%
25-40 40%
41-75 6%
Mean / median ISS 25.0 / 22.0
Mechanisms of injury
Assault 8%
Falls 42%
Road trauma 36%
All other injuries 14%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 62.0%
Ambulance 72.1%
Helicopter 18%
Fixed wing ≤ 5% Private vehicle / other 6%
Hospital system indicators
ICU admissions 60.0% (of patients)
Mean ICU length of stay 8.94 days
Mean hospital length of stay 27.92 days
Hospital Summary
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 29
Royal North Shore Hospital Table 33: Trauma data profi le, Royal North Shore Hospital
Summary data
Total admissions 373
Mean monthly admissions 31.1
Case fatality rate 14.7%
Gender
Female / male 24.9% / 75.1%
Age ranges
0-14 ≤ 5% 15-24 12.9%
25-34 11.8%
35-44 11.0%
45-54 12.3%
55-64 12.9%
65-74 8.8%
75-84 18.8%
85-94 10.5%
95 and older -
Mean / median age 54.6/ 56.0 years
Injury Severity Score ranges
16-24 49.3%
25-40 44.0%
41-75 6.7%
Mean / median ISS 25.1 / 25
Mechanisms of injury
Assault 5.4%
Falls 49.9%
Road trauma 32.7%
All other injuries 12.0%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 55.8%
Ambulance 60.1%
Helicopter 23.6%
Fixed wing 9.1%
Private vehicle / other 7.2%
Hospital system indicators
ICU admissions 57.9% (of patients)
Mean ICU length of stay 5.38 days
Mean hospital length of stay 24.55 days
Hospital Summary
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30 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
Royal Prince Alfred Hospital Table 34: Trauma data profi le, Royal Prince Alfred Hospital
Summary data
Total admissions 207
Mean monthly admissions 17.2
Case fatality rate 13.0%
Gender
Female / male 30.0% / 70.0%
Age ranges
0-14 ≤ 5% 15-24 14.5%
25-34 11.6%
35-44 9.2%
45-54 17.4%
55-64 12.1%
65-74 14.5%
75-84 14.0%
85-94 ≤ 5% 95 and older ≤ 5% Mean / median age 52.7 / 52 years
Injury Severity Score ranges
16-24 51.7%
25-40 42.0%
41-75 6.3%
Mean / median ISS 24.2 / 22
Mechanisms of injury
Assault 8.7%
Falls 51.2%
Road trauma 31.9%
All other injuries 8.2%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 76.3%
Ambulance 72.9%
Helicopter 13.5%
Fixed wing ≤ 5% Private vehicle / other 9.7%
Hospital system indicators
ICU admissions 41.1% (of patients)
Mean ICU length of stay 3.00 days
Mean hospital length of stay 13.29 days
Hospital Summary
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 31
St George Hospital Table 35: Trauma data profi le, St George Hospital
Summary data
Total admissions 257
Mean monthly admissions 21.4
Case fatality rate 19.8%
Gender
Female / male 33.1% / 66.9%
Age ranges
0-14 ≤ 5% 15-24 16.3%
25-34 11.3%
35-44 8.2%
45-54 10.5%
55-64 8.9%
65-74 10.9%
75-84 19.8%
85-94 10.9%
95 and older 1
Mean / median age 54.1 / 56 years
Injury Severity Score ranges
16-24 56.0%
25-40 36.2%
41-75 7.8%
Mean / median ISS 24.5 / 22
Mechanisms of injury
Assault 5.8%
Falls 46.7%
Road trauma 38.5%
All other injuries 8.9%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 74.3%
Ambulance 71.2%
Helicopter 16.7%
Fixed wing 5.8%
Private vehicle / other 6.2%
Hospital system indicators
ICU admissions 37.7% (of patients)
Mean ICU length of stay 2.42 days
Mean hospital length of stay 14.57 days
Hospital Summary
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32 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
St Vincent’s Hospital Table 36: Trauma data profi le, St Vincent’s Hospital
Summary data
Total admissions 117
Mean monthly admissions 9.7
Case fatality rate 10.3%
Gender
Female / male 26.5% / 73.2%
Age ranges
0-14 -
15-24 12.8%
25-34 19.7%
35-44 15.4%
45-54 7.7%
55-64 8.5%
65-74 13.7%
75-84 13.7%
85-94 8.5%
95 and older -
Mean / median age 51.4 / 49 years
Injury Severity Score ranges
16-24 53.8%
25-40 42.7%
41-75 ≤ 5% Mean / median ISS 23.0 / 22.0
Mechanisms of injury
Assault 13.7%
Falls 51.3%
Road trauma 26.5%
All other injuries 8.5%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 89.7%
Ambulance 79.5%
Helicopter -
Fixed wing ≤ 5% Private vehicle / other 18.8%
Hospital system indicators
ICU admissions 52.1% (of patients)
Mean ICU length of stay 2.78 days
Mean hospital length of stay 14.55 days
Hospital Summary
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 33
Sydney Children’s Hospital Table 37: Trauma data profi le, Sydney Children’s Hospital
Summary data
Total admissions 39
Mean monthly admissions 3.2
Case fatality rate 7.7%
Gender
Female / male 33.3% / 66.6%
Age ranges
0-4 25.6%
5-9 35.9%
10-12 20.5%
13-14 12.8%
(15) ≤ 5% Mean / median age 8.2 / 8 years
Injury Severity Score ranges
16-24 59.0%
25-40 38.5%
41-75 ≤ 5% Mean / median ISS 22.2 / 21
Mechanisms of injury
Assault 17.9%
Falls 35.9%
Road trauma 23.1%
All other injuries 23.1%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 17.9%
Ambulance 25.6%
Helicopter 35.9%
Fixed wing 7.7%
Private vehicle / other 30.8%
Hospital system indicators
ICU admissions 71.8% (of patients)
ICU average length of stay 3.69 days
Hospital average length of stay 14.44 days
Hospital Summary
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34 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
Tamworth Base Hospital Table 38: Trauma data profi le, Tamworth Base Hospital
Summary data
Total admissions 35
Mean monthly admissions 2.9
Case fatality rate 8.6%
Gender
Female / male 5.7% / 94.3%
Age ranges
0-14 4
15-24 14.3%
25-34 17.1%
35-44 11.4%
45-54 5.7%
55-64 22.8%
65-74 14.3%
75-84 ≤ 5% 85-94 -
95 and older -
Mean / median age 41.8 / 42 years
Injury Severity Score ranges
16-24 65.7%
25-40 31.4%
41-75 ≤ 5% Mean / median ISS 23.6 / 22
Mechanisms of injury
Assault ≤ 5% Falls 22.8%
Road trauma 62.8%
All other injuries 11.4%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 60.0%
Ambulance 48.6%
Helicopter 34.3%
Fixed wing 5.7%
Private vehicle / other 11.4%
Hospital system indicators
ICU admissions 45.7%
Mean ICU length of stay 2.80 days
Mean hospital length of stay 12.38 days
Hospital Summary
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 35
The Children’s Hospital at Westmead Table 39: Trauma data profi le, The Children’s Hospital at Westmead
Summary data
Total admissions 72
Mean monthly admissions 6.0
Case fatality rate 11.1%
Gender
Female / male 34.7% / 65.3%
Age ranges
0-4 33.3%
5-9 27.8%
10-12 20.8%
13-14 11.1%
(15) 6.9%
Mean / median age 7.7 / 7.5 years
Injury Severity Score ranges
16-24 58.3%
25-40 38.9%
41-75 ≤ 5% Mean / median ISS 22.2 / 20
Mechanisms of injury
Assault ≤ 5% Falls 19.4%
Road trauma 40.3%
All other injuries 38.9%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 40.3%
Ambulance 48.6%
Helicopter 34.7%
Fixed wing 9.7%
Private vehicle / other 6.9%
Hospital system indicators
ICU admissions 58.3% (of patients)
Mean ICU length of stay 5.24 days
Mean hospital length of stay 27.96 days
Hospital Summary
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36 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
Westmead Hospital Table 40: Trauma data profi le, Westmead Hospital
Summary data
Total admissions 221
Mean monthly admissions 18.4
Case fatality rate 16.3%
Gender
Female / male 24.0% / 76.0%
Age ranges
0-14 ≤ 5% 15-24 12.8%
25-34 17.4%
35-44 13.3%
45-54 9.6%
55-64 10.1%
65-74 11.5%
75-84 18.3%
85-94 5.0%
95 and older ≤ 5% Mean / median age 51.9 / 51.0 years
Injury Severity Score ranges
16-24 51.1%
25-40 46.6%
41-75 ≤ 5% Mean / median ISS 23.7 / 24
Mechanisms of injury
Assault 7.7%
Falls 42.5%
Road trauma 37.1%
All other injuries 12.7%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 77.4%
Ambulance 70.4%
Helicopter 22.3%
Fixed wing ≤ 5% Private vehicle ≤ 5% Other ≤ 5%
Hospital system indicators
ICU admissions 41.6% (of patients)
Mean ICU length of stay 3.85 days
Mean hospital length of stay 18.29 days
Hospital Summary
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 37
Wollongong Hospital Table 41: Trauma data profi le, Wollongong Hospital
Summary data
Total admissions 56
Mean monthly admissions 4.7
Case fatality rate 17.9%
Gender
Female / male 33.9% / 66.1%
Age ranges
0-14 ≤ 5% 15-24 26.8%
25-34 12.5%
35-44 5.4%
45-54 ≤ 5% 55-64 8.9%
65-74 14.3%
75-84 21.4%
85-94 5.4%
95 and older -
Mean / median age 49.7 / 51.5 years
Injury Severity Score ranges
16-24 63.4%
25-40 30.3%
41-75 6.3%
Mean / median ISS 23.2 / 20
Mechanisms of injury
Assault ≤ 5% Falls 41.1%
Road trauma 48.2%
All other injuries 7.1%
Admission type and arrival modes (pre hospital system indicators)
Direct Admission 78.6%
Ambulance 67.9%
Helicopter 8.9%
Private vehicle / other 23.2%
Hospital system indicators
ICU admissions 33.9% (of patients)
Mean ICU length of stay 2.23 days
Mean hospital length of stay 10.89 days
Hospital Summary
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38 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 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 from a standing height)
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
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 39
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 regions26.
The six ISS body regions are:
Head or neck
Face
Chest
Abdominal or pelvic contents
Extremities or pelvic girdle
External
The following example shows how an ISS is calculated from a set of injuries.
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 (critical injury)
26 Abbreviated Injury Scale (AIS) 2005 Update 2008: Association for the Advancement of Automotive Medicine, p29
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40 ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 NSW Health
Index of fi gures Figure 1: Age-specifi c rates of injury ............................................................................................................................ 10
Figure 2: Age-specifi c rates of injury by gender ............................................................................................................ 10
Figure 3: Age-specifi c death rates by gender ................................................................................................................. 11
Figure 4: Mechanisms of injury ..................................................................................................................................... 11
Figure 5: Age-specifi c rates of mechanism of injury ....................................................................................................... 13
Figure 6: People injured by hour of day when injury occurred ....................................................................................... 13
Figure 7: ISS body regions ............................................................................................................................................ 20
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2009 41
Index of tables Table 1: Case fatality rate and mean hospital length of stay by ISS range, 2009 ............................................................ 6
Table 2: Injured people, summary statistics ................................................................................................................... 9
Table 3: Age distribution of serious to critically injured people ...................................................................................... 9
Table 4: Mechanism of injury, rural vs metropolitan place of injury ............................................................................... 12
Table 5: Mechanism of Injury – main mechanisms and categories ................................................................................. 12
Table 6: People injured and admitted, Monday-Friday and weekends ........................................................................... 14
Table 7: Admission Types ............................................................................................................................................. 14
Table 8: Direct admissions for defi nitive care by trauma registry type ........................................................................... 14
Table 9: Defi nitive care admission type by geographical location of injury .................................................................... 15
Table 10: Arrival mode at defi nitive care facility - Top 3 Arrival Modes ......................................................................... 15
Table 11: Modes of transport to defi nitive care by admission type ................................................................................ 16
Table 12: Proportion of ambulance and helicopter arrivals at defi nitive care, direct from scene and transfer admissions, metropolitan vs rural location of injury .......................................................................................................... 16
Table 13: Time to defi nitive care for patients admitted directly to a defi nitive trauma service, rural vs metropolitan location of injury ...................................................................................................................... 17
Table 14: Trauma service admissions summary ............................................................................................................. 17
Table 15: All admissions recorded in major trauma service registries, paediatric major trauma registries and other trauma registries ........................................................................................................................................... 18
Table 16: Admissions recorded in major trauma service registries, paediatric major trauma registries and other trauma registries by ISS range ................................................................................................................................... 18
Table 17: Admissions to trauma services ....................................................................................................................... 18
Table 18: Admissions by time of day ............................................................................................................................ 19
Table 19: ISS Range ...................................................................................................................................................... 19
Table 20: Top fi ve specifi c injuries where injury severity code is greater than 2 ............................................................. 19
Table 21: Top 5 injuries for deceased patients where injury severity code is greater than 2 ........................................... 20
Table 22: Main mechanisms of injury and categories, top 3 injury groups ..................................................................... 21
Table 23: Intensive Care Unit admissions, major trauma service registries, paediatric major trauma registries and other trauma registries ........................................................................................................................................... 22
Table 24: ICU admission statistics by ISS range ............................................................................................................. 22
Table 25: Admissions recorded in major trauma service registries, paediatric trauma registries and other trauma registries, mean hospital length of stay (days) ............................................................................................... 23
Table 26: Mean length of stay in hospital (LOS) by ISS Range ....................................................................................... 23
Table 27: Mean length of stay in hospital (LOS) by count of ISS body regions ............................................................... 23
Table 28: Trauma data profi le, Gosford Hospital ........................................................................................................... 24
Table 29: Trauma data profi le, John Hunter Hospital / John Hunter Children’s Hospital ................................................. 25
Table 30: Trauma data profi le, Liverpool Hospital ......................................................................................................... 26
Table 31: Trauma data profi le, Nepean Hospital ............................................................................................................ 27
Table 32: Trauma data profi le, Prince of Wales Hospital ................................................................................................ 28
Table 33: Trauma data profi le, Royal North Shore Hospital ........................................................................................... 29
Table 34: Trauma data profi le, Royal Prince Alfred Hospital .......................................................................................... 30
Table 35: Trauma data profi le, St George Hospital ........................................................................................................ 31
Table 36: Trauma data profi le, St Vincent’s Hospital ..................................................................................................... 32
Table 37: Trauma data profi le, Sydney Children’s Hospital ............................................................................................. 33
Table 38: Trauma data profi le, Tamworth Base Hospital ............................................................................................... 34
Table 39: Trauma data profi le, The Children’s Hospital at Westmead ............................................................................ 35
Table 40: Trauma data profi le, Westmead Hospital ....................................................................................................... 36
Table 41: Trauma data profi le, Wollongong Hospital ..................................................................................................... 37
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NOTES
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NSW Health ITIM – The NSW Trauma Registry Profi le of Serious to Critical Injuries – 2007 43
NOTES
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