major trauma in nsw jan jun 2016 · nsw itim major trauma in nsw, jan – jun 2016 iv glossary...

NSW ITIM Major Trauma in NSW, Jan – Jun 2016 i

NSW Institute of Trauma and Injury Management

Major Trauma in NSW

Jan – Jun 2016 A Report from the NSW Trauma Registry

NSW ITIM Major Trauma in NSW, Jan – Jun 2016 ii

AGENCY FOR CLINICAL INNOVATION

Level 4, Sentral Building

67 Albert Avenue

Chatswood NSW 2067

PO Box 699 Chatswood NSW 2057

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

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

SHPN: (ACI) 170676 ISBN: 978-1-76000-770-6

Authors:

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

Benjamin Hall, Project Officer, NSW Institute of Trauma and Injury Management, ACI

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

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

Further copies of this publication can be obtained from

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

Suggested citation: NSW Institute of Trauma and Injury Management. Major Trauma in NSW: Jan – Jun 2016. Sydney: NSW

Agency for Clinical Innovation, 2017.

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

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

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

written permission from the Agency for Clinical Innovation.

Version: 1.1 Trim: ACI/D17/6735

© Agency for Clinical Innovation 2017

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

healthcare for NSW. It does this by:

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

review and improve the quality, effectiveness and efficiency

of services

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

innovations from optimal use through to disinvestment

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

initiatives to benefit the NSW health system

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

healthcare innovations into practice across metropolitan and rural NSW

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

sharing on healthcare innovation and improvement

continuous capability building – working with healthcare providers to build capability

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

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

and regional and service boundaries to develop successful healthcare innovations.

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

providers to develop mechanisms to improve clinical practice

and patient care.

www.aci.health.nsw.gov.au

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

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

NSW ITIM Major Trauma in NSW, Jan – Jun 2016 iii

Acknowledgements

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

NSW ITIM Major Trauma in NSW, Jan – Jun 2016 iv

Glossary

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

scoring system that classifies each injury by body region according to its relative importance on a 6

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

multiply injured patient. See Section 2 – Methodology for more information.

Adjusted mortality rate refers to the mortality rate that would have existed if each trauma service

had the same age distribution as the “standard” population. In this report, the total NSW trauma

patients (Injury Severity Score >12) were considered as the standard population. Adjusted

mortality rates were calculated based on the indirect standardisation method. See Appendix 5 for

more information.

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

percentage.

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

needs of the patient. Many patients receive definitive care at Regional Trauma Services, but a

small number of patients are transferred to a Major Trauma Service (higher level) for specialised

care.

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

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

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

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

based on an anatomical injury severity classification, the Abbreviated Injury Scale (AIS). The ISS is

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

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

each of the three most severely injured ISS body regions. See Section 2 – Methodology for more

information.

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

Head or neck

Face

Chest

Abdominal or pelvic contents

Extremities or pelvic girdle

External

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

no other injury is recorded.

NSW ITIM Major Trauma in NSW, Jan – Jun 2016 v

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

Trauma Service within seven days of sustaining an injury, and:

Had an Injury Severity Score (ISS) > 12 (moderate to critically injured); or

Admitted to an Intensive Care Unit (irrespective of ISS) following injury; or

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

neck of femur injury sustained from a fall from a standing height (<1 metre) and those aged 65

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

Major trauma services (MTS) can provide the full spectrum of care for major and moderately

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

currently seven adult and three paediatric designated MTS in NSW.

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

environment to the person.

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

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

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

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

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

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

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

one place to another (V0.01 – V99) that did not meet place of occurrence road trauma criteria.

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

Regional trauma services (RTS) can provide all aspects of care to patients with minor to

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

with the MTS. An RTS provides initial assessment, stabilisation, definitive care and initiates

transfer to an MTS when a patient requires services not available at the RTS. There are currently

ten designated RTS in NSW.

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

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

(V 0.01 – V88.9) and had a street, highway and other paved roadways as the place of occurrence

of the external cause (Y92.4 – Y92.448).

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

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

Coma Scale, Systolic Blood Pressure and Respiratory Rate. Values for the Revised Trauma Score

are in the range 0 to 7.8408. The lower the score, the higher the likelihood of death. See Section 2

– Methodology for more information.

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

population and the number of deaths that would be expected, based on the age or Injury Severity

Score (ISS) specific rates in a standard population and the age or ISS distribution of the study

population.

NSW ITIM Major Trauma in NSW, Jan – Jun 2016 vi

Executive summary

Each year more than 4,000 people are admitted to a NSW Trauma Service for injuries defined as

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

term outcome and quality of life and for reducing the overall financial and social cost of trauma to

individuals and the community as a whole.

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

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

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

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

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

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

NSW Trauma Service. The report investigates the data to determine whether the NSW trauma

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

timely matter.

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

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

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

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

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

benchmarking and performance improvement activities.

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

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

trauma registries.

January – Jun 2016 report highlights for major trauma in NSW:

2,043 major trauma patients resulting in 2,117 major trauma admissions.

Average age was 50.4 years old.

Males were three times more likely to be injured.

Case fatality rate (ISS >12) was 9.8%.

Females had higher case fatality rate (13.4%) compared to males (8.8%).

Falls accounted for 42.0% of all major trauma, exceeding road trauma (31.6%).

"Three or more fractured ribs without flail" was the most common serious injury (20.4%).

24.5% of major trauma was sustained in a rural area.

In the metro setting falls (47.7%) account for the greatest proportion of trauma injuries

and transport incidents (55.5%) in the rural setting.

Pedestrian trauma had a higher case fatality rate (23.6%) significantly above all other

forms of road trauma.

61.5% of major trauma patients sustained injuries to the head or neck body region, with

the chest region injured in 48.2% of patients.

NSW ITIM Major Trauma in NSW, Jan – Jun 2016 vii

Contents

Acknowledgements ..................................................................................................................... iii

Glossary ....................................................................................................................................... iv

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

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

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

List of figures ............................................................................................................................... xi

1. Monitoring the NSW Trauma System ................................................................................. 1

NSW Trauma System ..................................................................................................................... 1

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

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

NSW Trauma Services .................................................................................................................... 2

2. Methodology ........................................................................................................................ 3

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

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

Data quality ..................................................................................................................................... 4

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

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

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

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

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

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

Age and gender .............................................................................................................................. 7

Mechanism of injury ...................................................................................................................... 10

Transport incidents by place of injury ............................................................................................ 16

Time and day of injury ................................................................................................................... 18

Injuries .......................................................................................................................................... 19

Injury Severity Score ..................................................................................................................... 21

Pre-hospital time ........................................................................................................................... 23

Mode of transport .......................................................................................................................... 24

NSW ITIM Major Trauma in NSW, Jan – Jun 2016 viii

4. Major trauma admissions .................................................................................................. 26

Introduction ................................................................................................................................... 26

Facility overview ............................................................................................................................ 26

Admission type .............................................................................................................................. 27

Revised Trauma Score ................................................................................................................. 27

Trauma team activation ................................................................................................................. 28

Vital signs on arrival to the Emergency Department ...................................................................... 30

Intensive Care Unit admissions ..................................................................................................... 31

Length of stay ............................................................................................................................... 32

Surgical procedures ...................................................................................................................... 34

Discharge destination of survivors ................................................................................................. 35

5. Appendices ........................................................................................................................ 36

Appendix 1: Adult Major Trauma Service Summaries ................................................................... 37

Appendix 2: Paediatric Major Trauma Service summaries ............................................................ 51

Appendix 3: Regional Trauma Service summaries ........................................................................ 57

Appendix 4: Calculation of the Injury Severity Score ..................................................................... 77

Appendix 5: Calculation of adjusted mortality rate ......................................................................... 78

Appendix 6: Australian Statistical Geography Standard Remoteness Areas ................................. 80

NSW ITIM Major Trauma in NSW, Jan – Jun 2016 ix

List of tables

Table 1: Revised Trauma Score points system ............................................................................... 5

Table 2: Summary statistics for major trauma and mortality ............................................................ 6

Table 3: Major trauma patients, injury and death rate by age group ................................................ 7

Table 4: Type of injury .................................................................................................................. 10

Table 5: Mechanism of injury by age ............................................................................................. 11

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

Table 7: Falls in detail ................................................................................................................... 14

Table 8: Transport incidents in detail............................................................................................. 14

Table 9: Assaults in detail ............................................................................................................. 15

Table 10: All other mechanisms in detail ....................................................................................... 15

Table 11: Transport incidents by location of injury ......................................................................... 16

Table 12: Road trauma in detail .................................................................................................... 16

Table 13: Other transport incidents in detail .................................................................................. 17

Table 14: Top 5 injuries with an AIS severity >2 ............................................................................ 19

Table 15: Number of ISS body regions injured with an AIS severity >2 ......................................... 20

Table 16: Single body region versus polytrauma with an AIS severity >2 ...................................... 20

Table 17: Major trauma patients by ISS group .............................................................................. 21

Table 18: Time of injury to arrival at a designated trauma service ................................................. 23

Table 19: Time of injury to arrival at definitive care if transferred from another trauma service...... 23

Table 20: Mode of transport to definitive care ............................................................................... 24

Table 21: Overview of trauma service admissions ........................................................................ 26

Table 22: Number of admissions by type ...................................................................................... 27

Table 23: Overview of ICU and hospital length of stay .................................................................. 32

Table 24: ICU and hospital length of stay by ISS .......................................................................... 32

Table 25: ICU and hospital length of stay by age .......................................................................... 33

Table 26: Surgical procedures performed by type in total admissions ........................................... 34

Table 27: Trauma data profile, John Hunter Hospital .................................................................... 37

Table 28: Trauma data profile, Liverpool Hospital ......................................................................... 39

Table 29: Trauma data profile, Royal North Shore Hospital .......................................................... 41

Table 30: Trauma data profile, Royal Prince Alfred Hospital ......................................................... 43

Table 31: Trauma data profile, St George Hospital ....................................................................... 45

Table 32: Trauma data profile, St Vincent’s Hospital ..................................................................... 47

Table 33: Trauma data profile, Westmead Hospital ....................................................................... 49

Table 34: Trauma data profile, John Hunter Children’s Hospital .................................................... 51

Table 35: Trauma data profile, Sydney Children’s Hospital ........................................................... 53

Table 36: Trauma data profile, The Children’s Hospital at Westmead ........................................... 55

Table 37: Trauma data profile, Coffs Harbour Health Campus ...................................................... 57

NSW ITIM Major Trauma in NSW, Jan – Jun 2016 x

Table 38: Trauma data profile, Gosford Hospital ........................................................................... 59

Table 39: Trauma data profile, Lismore Base Hospital .................................................................. 61

Table 40: Trauma data profile, Nepean Hospital ........................................................................... 63

Table 41: Trauma data profile, Orange Health Service ................................................................. 65

Table 42: Trauma data profile, Port Macquarie Base Hospital....................................................... 67

Table 43: Trauma data profile, Tamworth Rural Referral Hospital ................................................. 69

Table 44: Trauma data profile, The Tweed Hospital ...................................................................... 71

Table 45: Trauma data profile, Wagga Wagga Rural Referral Hospital ......................................... 73

Table 46: Trauma data profile, Wollongong Hospital ..................................................................... 75

Table 47: ISS calculation example ................................................................................................ 77

Table 48: Calculation of adjusted mortality rate ............................................................................. 79

NSW ITIM Major Trauma in NSW, Jan – Jun 2016 xi

List of figures

Figure 1: Number of major trauma patients by age, gender and mortality ....................................... 8

Figure 2: Age-specific injury rate by age and gender ...................................................................... 8

Figure 3: Case fatality rate by age and gender (ISS>12) ................................................................. 9

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

Figure 5: Mechanism of injury ....................................................................................................... 10

Figure 6: Mechanism of injury by age ............................................................................................ 12

Figure 7: Mechanism of injury as a percentage by age ................................................................. 12

Figure 8: Age-specific rates of mechanism of injury ...................................................................... 13

Figure 9: Number of patients by time of injury ............................................................................... 18

Figure 10: Number of patients by day of injury .............................................................................. 18

Figure 11: All injuries by ISS body region ...................................................................................... 19

Figure 12: Number of major trauma patients by ISS group and gender ......................................... 21

Figure 13: Case fatality rate by ISS and gender (ISS >12) ............................................................ 22

Figure 14: Mode of transport to definitive care when transported direct from the scene of injury, by

injury location ................................................................................................................................ 24

Figure 15: Mode of transport to definitive care when transferred from another acute care facility, by

injury location ................................................................................................................................ 25

Figure 16: Average Revised Trauma Score by ISS group ............................................................. 27

Figure 17: Trauma team activation by admission type .................................................................. 28

Figure 18: Trauma team activation by ISS group .......................................................................... 29

Figure 19: Initial systolic blood pressure on arrival to the ED and mortality ................................... 30

Figure 20: Initial Glasgow Coma Scale (GCS) on arrival to the ED and mortality .......................... 30

Figure 21: Initial temperature on arrival to ED and mortality .......................................................... 31

Figure 22: ICU admission by ISS group ........................................................................................ 31

Figure 23: Surgical procedures performed by ISS group ............................................................... 34

Figure 24: Discharge destination of survivors ................................................................................ 35

Figure 25: Discharge destination of survivors by ISS group .......................................................... 35

Figure 26: Map of NSW showing ASGS-RA .................................................................................. 80

NSW ITIM Major Trauma in NSW, Jan – Jun 2016 1

1. Monitoring the NSW Trauma System

NSW Trauma System

The primary function of the NSW Trauma System is to facilitate and coordinate an organised

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

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

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

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

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

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

medical care follow up.

The overall goal of the NSW Trauma System is to decrease the incidence and severity of injury

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

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

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

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

Mandate for trauma data

The NSW Trauma Services Plan (2009) outlines the role of the NSW ITIM, including monitoring

and reporting on the performance of individual Trauma Services to ensure that performance is

consistent with the standard of care and to manage a state-wide clinical injury data collection

process.

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

Local Health Districts, NSW Ambulance, State Insurance Regulatory Authority (SIRA), State

Coroner, Clinical Excellence Commission (CEC) and universities, 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 Trauma Registry

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

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

Registry. Data in the registry is submitted from each of the designated NSW Trauma Services.

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

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

needs – the most seriously injured – who are treated at a NSW Trauma Service, a designated

hospital in NSW which contributes to the NSW Trauma Registry. This data is known as the NSW

Trauma Minimum Data Set and forms the basis of data analysis and reporting activities at NSW

ITIM. As the scope of the current data collection is restricted to these designated hospitals, there

may be some data for trauma admissions to other hospitals that are not included in the NSW

Trauma Registry.


NSW Trauma Services

The NSW Trauma System consists of seven adult Major Trauma Services, three Paediatric Major

Trauma Services and ten Regional Trauma Services. All of the services contributed data to the

NSW Trauma Registry used in this report.

The NSW Trauma Services are listed below:

Adult Major Trauma Services:

John Hunter Hospital

Liverpool Hospital

Royal North Shore Hospital

Royal Prince Alfred Hospital

St George Hospital

St Vincent's Hospital

Westmead Hospital

Paediatric Major Trauma Services:

John Hunter Children's Hospital

Sydney Children's Hospital

The Children's Hospital at Westmead

Regional Trauma Services:

Coffs Harbour Base Hospital

Gosford Hospital

Lismore Base Hospital

Nepean Hospital

Orange Health Service

Port Macquarie Base Hospital

Tamworth Rural Referral Hospital

The Tweed Hospital

Wagga Wagga Rural Referral Hospital

Wollongong Hospital


2. Methodology

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

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

extracted from the NSW Trauma Registry on 19th October 2017.

In the past, the reporting period for reports from the NSW Trauma Registry was calendar year (1st

January – 31st December). In a move to align ITIM reporting of data with the Australian Trauma

Registry as recommended and approved by the NSW ITIM Data Management Committee, this

report covers the transitional period of the six month period, 1st January to 30th June 2016.

Ongoing published reports will cover the financial year, 1st July to 30th of June.

Inclusion criteria

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

between 1st January and 30th June 2016, are included in this report.

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

within seven days of sustaining an injury, and who:

Had an Injury Severity Score (ISS) > 12 (moderate to critically injured); or

Admitted to an Intensive Care Unit (irrespective of ISS) following injury; or

Died in hospital (irrespective of ISS) following injury.

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

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

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

Exclusion criteria

The criteria for excluding a patient record from this report are:

Patients not admitted to a designated NSW Trauma Service

Patients admitted to a designated NSW Trauma Service greater than seven days after

sustaining an injury

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

standing height (<1 metre)1

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

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

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


Records have also been excluded from this report if any of the following key data elements have

missing or invalid data recorded in the registry:

Injury Severity Score

Date of injury

Date of admission.

The above exclusion criteria resulted in a total of 15 records were excluded from this report.

Data quality

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

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

services for completion and validation.

The Injury Severity Score and Abbreviated Injury Score

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

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

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

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

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

Registry uses the AIS 2005 (Update 2008) dictionary.

The AIS is used by accredited staff at each hospital 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 identification of all injuries. On initial evaluation, these

patients typically have abnormal vital signs or a significant anatomical injury.

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

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

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

(see Appendix 4 for further detail).

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

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

In this report the ISS is reported in ranges:

13-15 (moderate injury)

16-24 (serious injury)

25-40 (severe injury)

41-75 (critical injury).


Revised Trauma Score

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

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

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

scored with a weighting as outlined in Table 1.3 Values for the Revised Trauma Score are in the

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

Table 1: Revised Trauma Score points system

Glasgow Coma Scale (GCS)

Systolic blood pressure (SBP)

Respiratory rate (RR) Points

15-13 >89 10-29 4

12-9 76-89 >29 3

8-6 50-75 6-9 2

5-4 1-49 1-5 1

3 0 0 0

Revised Trauma Score = 0.9368 GCS + 0.7326 SBP + 0.2908 RR

Metropolitan and rural categorisation

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

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

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

Remoteness Index of Australia (ARIA+) which defines locations in terms of remoteness, i.e. the

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

on population size.

The ASGS-RA (2011) consists of 5 categories:

Major cities

Inner regional

Outer regional

Remote

Very remote.

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

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

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

Appendix 6.

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


3. Major trauma patients

Introduction

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

received care in a NSW Trauma Service (n=2,043), not the number of trauma admissions

(n=2,117), as some patients were treated in more than one NSW reporting facility. Trauma

admission data (hospital activity) is discussed in detail in Section 4.

Summary profile

During the period 1st January to 30th June 2016, there were 2,043 major trauma patients treated at

NSW Trauma Services, of which 70.7% (n=1,444)4 were injured in a metropolitan location and 204

died (overall case fatality rate of 10.0%).5 The age-standardised injury rate was 52.8 per 100,000

persons6 and the age-standardised death rate was 4.4 per 100,000 persons.6 The Standardised

Mortality Ratio (SMR)7 was 4.1, indicating that the proportion of deaths in major trauma patients

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

population (Table 2).

Table 2: Summary statistics for major trauma and mortality

Summary statistics Value

Total number of patients injured overall 2,043

Total number of patients injured with ISS >12 1,804

Injury rate per 100,000 persons (age-standardised)6 52.8

Location of injury (metropolitan / rural)4 1,444 (70.7%) / 501 (24.5%)

Total number of deaths overall (case fatality rate)5 204 (10.0%)

Total number of deaths with ISS >12 (case fatality rate)5 175 (9.8%)

Death rate per 100,000 persons (age-standardised)6 4.4 (95% CI 4.1 – 4.7)

Standardised Mortality Ratio (SMR) 4.1 (95% CI 3.6 – 4.7)

Average age (years) 50.4

Average Injury Severity Score (ISS) 18.9

4 98 records were excluded due to being recorded as overseas, not applicable or not recorded.

5 Case fatality rate is the proportion of deaths for a designated population expressed as a percentage. Caution should be used when

referring to the case fatality rate (all ISS) as patients with an ISS <13 are included only if they had an ICU admission or died. Other survivors in this group are not collected, therefore the case fatality rate for this group cannot be accurately calculated and may be misleading. It is contained in this report only to facilitate comparison to reports from previous years. It is recommended that you only refer to the case fatality rate (ISS >12). 6 Annualised rate given as per 100,000 persons, standardised to the Australian population at 30 June 2001. Source: Australian Bureau

of Statistics. Australian Demographic Statistics, Mar 2013. Catalogue No. 3101. Canberra: ABS, Dec 2013. 7 See Glossary for definition of the Standardised Mortality Ratio (SMR). Standardised to the Australian population at 30 June 2001.

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


Age and gender

The average age of a major trauma patient in NSW during the reporting period was 50.4 years old.

Table 3 outlines the age distribution which demonstrates a sharp rise in the incidence of major

trauma in the geriatric population,8 especially those aged 75 years and older, as it has in previous

years. The 75 years and older age group also has a higher case fatality rate for ISS >12 (24.4%,

n=398) versus the less than 75 years age group (5.6%, n= 1,386).

Table 3: Major trauma patients, injury and death rate by age group (n=2,042)9

Age group (years)

Number of injured

(% of total)

Cumulative number of

injured (% of total)

Age-specific

injury rate per

100,00010

Age-specific

death rate per

100,00010

Case fatality

rate (All ISS)

Case fatality

rate (ISS >12)

0-4 51 (2.5%) 51 (2.5%) 20.4 2.4 11.8% 14.6%

5-9 30 (1.5%) 81 (4.0%) 12.0 0.0 0.0% 0.0%

10-14 44 (2.2%) 125 (6.1%) 19.4 0.4 2.3% 2.8%

15-19 112 (5.5%) 237 (11.6%) 48.1 3.4 7.1% 8.8%

20-24 142 (7.0%) 379 (18.6%) 53.6 3.0 5.6% 6.6%

25-29 147 (7.2%) 526 (25.8%) 51.0 1.4 2.7% 3.3%

30-34 120 (5.9%) 646 (31.6%) 42.0 3.2 7.5% 8.9%

35-39 110 (5.4%) 756 (37.0%) 42.7 2.3 5.5% 5.3%

40-44 112 (5.5%) 868 (42.5%) 43.3 0.8 1.8% 2.2%

45-49 128 (6.3%) 996 (48.8%) 51.2 2.0 3.9% 4.4%

50-54 143 (7.0%) 1,139 (55.8%) 57.9 1.2 2.1% 2.3%

55-59 111 (5.4%) 1,250 (61.2%) 46.5 4.6 9.9% 9.8%

60-64 115 (5.6%) 1,365 (66.8%) 54.5 2.8 5.2% 5.8%

65-69 112 (5.5%) 1,477 (72.3%) 58.0 2.1 3.6% 3.8%

70-74 119 (5.8%) 1,596 (78.2%) 81.1 6.8 8.4% 6.5%

75-79 116 (5.7%) 1,712 (83.8%) 106.9 17.5 16.4% 14.0%

80-84 119 (5.8%) 1,831 (89.7%) 154.4 44.1 28.6% 27.5%

85 and over 211 (10.3%) 2,042 (100%) 254.1 80.7 31.8% 28.6%

8 Geriatric defined as aged 65 years and older.

9 1 record excluded due to age not recorded.

10 Annualised rate given as per 100,000 persons, based on the NSW population at 30 June 2016. Source: Australian Bureau of

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


Males have a higher number of major trauma injuries (n=1,533) compared to females (n=509), except in the 85 years old and over age groups (Figure 1). Overall, males are three times more likely to be injured than females.

Figure 1: Number of major trauma patients by age, gender and mortality (n=2,042)9

The age-specific injury rate for males ranged from 4.8 to 58.4 per 100,000 persons and in females

ranged 1.2 to 68.6 per 100,000 persons (Figure 2).10

Figure 2: Age-specific injury rate by age and gender (n=2,042) 9, 10

0

20

40

60

80

100

120

140

Num

ber

of P

atie

nts

Age group

Survived - Male

Survived - Female

Died - Male

Died - Female

0

20

40

60

80

Age

-sp

eci

fic

rate

(in

jury

/10

0,0

00

)

Age group

Male

Female


The case fatality rate (the proportion of deaths of a designated population) where the ISS was

greater than 12 (n=1,784) was higher for females (12.6%, n=57) than for males (8.9%, n=118) with

the overall case fatality rate in this group of 9.8% (Figure 3).

Figure 3: Case fatality rate by age and gender (ISS>12) (n=1,784)

Whilst females have a higher case fatality rate, males have a higher age-specific mortality rate per

100,000 persons (Figure 4).10

Figure 4: Age-specific mortality rate by age and gender (n=204)9,10

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Case fata

lity r

ate

Age group

Males

Females

0

20

40

60

80

100

120

140

160

Age-s

pecific

rate

(in

jury

/100,0

00)

Age group

Males

Females


Mechanism of injury

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

(96.2%), such as falls and motor vehicle collisions (Table 4).

Table 4: Type of injury (n=1,989)11

Type of injury Number of patients

(% of total) Case fatality rate

(overall) Case fatality rate

(ISS >12)

Blunt 1,913 (96.2%) 10.2% 9.9%

Penetrating 76 (3.8%) 3.9% 5.1%

The top three mechanisms of major trauma were:

Falls (42.0%, n=859)

Transport incidents (40.5%, n=828) out of which 635 were road trauma incidents12

Assaults (6.2%, n=127).

All other mechanisms combined accounted for 11.2% (n=229) (Figure 5). The distribution of these

mechanisms of injury by age group is demonstrated in Table 5.

Figure 5: Mechanism of injury (n=2,043)

11

Only blunt and penetrating injury types are reported. Other injury types (n=54) are recorded as ‘N/A’ or ‘Unknown'. 12

See Glossary for the definition of road trauma.

6.2%

42.0%

40.5%

11.2%

Assault

Falls

Transport Incident

All Other Mechanism


Table 5: Mechanism of injury by age (n=2,042)9

Age group

Number of patients (age-specific rate per 100,000)10

Assault Falls Transport incident

All other mechanisms

0-4 7 (2.8) 17 (6.8) 13 (5.2) 14 (5.6)

5-9 1 (0.4) 11 (4.4) 10 (4) 8 (3.2)

10-14 0 (0) 6 (2.6) 30 (13.2) 8 (3.5)

15-19 8 (3.4) 21 (9) 70 (30.1) 13 (5.6)

20-24 13 (4.9) 31 (11.7) 78 (29.4) 20 (7.5)

25-29 21 (7.3) 27 (9.4) 78 (27.1) 21 (7.3)

30-34 14 (4.9) 13 (4.6) 66 (23.1) 27 (9.5)

35-39 17 (6.6) 25 (9.7) 57 (22.1) 11 (4.3)

40-44 14 (5.4) 24 (9.3) 54 (20.9) 20 (7.7)

45-49 11 (4.4) 35 (14) 62 (24.8) 20 (8)

50-54 12 (4.9) 44 (17.8) 67 (27.1) 20 (8.1)

55-59 4 (1.7) 47 (19.7) 42 (17.6) 18 (7.5)

60-64 1 (0.5) 49 (23.2) 56 (26.5) 9 (4.3)

65-69 1 (0.5) 64 (33.1) 40 (20.7) 7 (3.6)

70-74 2 (1.4) 79 (53.8) 32 (21.8) 6 (4.1)

75-79 0 (0) 86 (79.2) 26 (24) 4 (3.7)

80-84 0 (0) 102 (132.4) 17 (22.1) 0 (0)

85 and over 1 (1.2) 178 (214.4) 29 (34.9) 3 (3.6)

Total 127 859 193 229


Falls account for 75.2% (n=509) of major trauma patients aged 65 years and older. Overall transport incidents remain the greatest burden of trauma (50%, n=683) in those under 65 years of age. Assaults have the highest incidence (17%, n=21) in the 25 – 29 years age group (Figures 6-8).

Figure 6: Mechanism of injury by age (n=2,042)9

Figure 7: Mechanism of injury as a percentage by age (n=2,042)9

0

20

40

60

80

100

120

140

160

180

200

No o

f patie

nts

Age group

Assault

Falls

Transport Incident

All Other Mechanisms

0%

5%

10%

15%

20%

25%

Perc

enta

ge o

f in

jury

/ a

ge g

roup

Age group

Assault

Falls

Transport incident



Figure 8: Age-specific rates of mechanism of injury per 100,000 (n=2,042)9, 10

Falls were responsible for 47.7% of the injuries in the metropolitan area, compared to 28.1% in

rural areas. Transport incidents were higher in rural areas, 55.5%, than in metropolitan areas,

34.6% (Table 6).

Table 6: Mechanism of injury by location (n=2,043)4

Mechanism of Injury Metropolitan

(% of metropolitan) Rural

(% of rural)

Assault 97 (6.7%) 24 (4.8%)

Falls 689 (47.7%) 141 (28.1%)

Transport incident 499 (34.6%) 278 (55.5%)

All other mechanisms 159 (11%) 58 (11.6%)

Total 1,444 501

0

50

100

150

200

250

Age-s

pecific

rate

/ 1

00,0

00

Age group

Assault

Falls

Transport Incident



The mechanisms of injury are outlined in more detail in Tables 7-10. Falls from a standing height

(<1m) accounted for 61.1% of all falls, 25.7% of all trauma mechanisms, 16.8% of all trauma

deaths and had an ISS >12 case fatality rate of 15.1% (Table 7).

Table 7: Falls in detail (n=859)

Mechanism Number injured

(% of all mechanisms)

Number of deaths, all ISS

(case fatality rate)

Percentage of all trauma deaths

Number of deaths, ISS >12


Low (<1m) 525 (25.7%) 88 (16.8%) 43.1% 69 (15.1%)

Medium (1-5m) 255 (12.5%) 23 (9%) 11.3% 21 (8.9%)

High (>5m) 47 (2.3%) 4 (8.5%) 2.0% 4 (9.8%)

Unspecified 32 (1.6%) 2 (6.3%) 1.0% 2 (7.4%)

Total 859 (42%) 117 (13.6%) 57.4% 96 (12.6%)

Pedestrian trauma had the highest ISS >12 case fatality rate (21.3%), well above other forms of

road trauma (Table 8).

Table 8: Transport incidents in detail (n=828)








Motor vehicle collision

282 (13.8%) 27 (9.6%) 13.2% 21 (8.9%)

Motorcycle collision

234 (11.5%) 4 (1.7%) 2.0% 4 (1.9%)

Pedestrian 128 (6.3%) 27 (21.1%) 13.2% 26 (21.3%)

Pedal cyclist 99 (4.8%) 2 (2%) 1.0% 2 (2.2%)

All other transport

13 85 (1.4%) 2 (2.4%) 1.0% 1 (1.3%)

Total 828 (40.5%) 62 (7.5%) 30.4% 54 (7.3%)

13

Includes other forms of land transport such as 3 wheeler and quad bikes (all-terrain vehicles), together with water and air transport

incidents.


There were only seven recorded cases of shooting (0.3%) compared with assaults involving bodily

force (n=51, 2.5%) or a blunt object (n=16, 0.8%), accounting for 67 patients (3.3%), remaining the

most common mechanisms of injury in the assault group (Table 9).

Table 9: Assaults in detail (n=127)








Bodily force 51 (2.5%) 1 (2%) 0.5% 1 (2.3%)

All other assaults 28 (1.4%) 2 (7.1%) 1.5% 2 (10%)

Stabbing 25 (1.2%) 3 (12%) 0.0% 3 (15%)

Blunt object 16 (0.8%) 0 (0%) 0.0% 0 (0%)

Shooting 7 (0.3%) 0 (0%) 0.0% 0 (0%)

Total 127 (6.2%) 6 (4.7%) 2.9% 6 (5.9%)

Of the other mechanisms of injury, self-harm was the most common recorded mechanism (n=61,

3%) with burns (n=39, 1.9%), exposure to inanimate forces14 (n=46, 2.3%), exposure to animate

forces15 (n=32, 1.6%) and drowning (n=23, 1.1%). Self-harm (21.3%) and drownings (21.1%) have

the highest case fatality rate (ISS >12) in the all other mechanisms group (Table 10).

Table 10: All other mechanisms in detail (n=229)








Self-Harm 61 (3%) 10 (16.4%) 4.9% 10 (21.3%)

Inanimate Mechanical

Forces14

46 (2.3%) 0 (0%) 0.0% 0 (0%)

Burns 39 (1.9%) 1 (2.6%) 0.5% 1 (3.7%)

Animate Mechanical

Forces15

32 (1.6%) 1 (3.1%) 0.5% 1 (4%)

Other 28 (1.4%) 3 (10.7%) 0.5% 3 (13%)

Drownings 23 (1.1%) 4 (17.4%) 2.0% 4 (21.1%)

Total 229 (11.2%) 19 (8.3%) 9.3% 19 (10.4%)

14

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

inanimate objects. 15

Animate forces includes hit, struck, kicked, twisted, bitten or scratched by another person (accidental) or animal.


Transport incidents by place of occurrence

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

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

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

transport incident which occurred on a street, highway or other paved roadway.16

Road trauma accounts for 31.1% (n=635) of all mechanisms of injury, the second highest behind

falls at 42.0% (n=859). The rate of ‘road trauma’ and ‘other transport incidents’ were higher in rural

areas, 39.1% and 16.4% respectively, than in metropolitan areas, 27.8% and 6.7% respectively

(Table 11).

Table 11: Transport incidents by location of injury (n=777)17

Mechanism of Injury Metropolitan

(% of metropolitan) Rural

(% of rural)

Road trauma 402 (27.8%) 196 (39.1%)

Other transport incident 97 (6.7%) 82 (16.4%)

Total 499 278

Motor vehicle collision remains the highest mechanism of injury in the road trauma group with

pedestrian trauma having the highest ISS >12 case fatality rate (23.5%), well above other forms of

road trauma (Table 12).

Table 12: Road trauma in detail16 (n=635)









271 (13.3%) 26 (9.6%) 12.7% 20 (8.7%)


177 (8.7%) 4 (2.3%) 2.0% 4 (2.4%)

Pedestrian 106 (5.2%) 25 (23.6%) 12.3% 24 (23.5%)

Pedal cyclist 61 (3%) 1 (1.6%) 0.5% 1 (1.8%)

All other road transport

18 20 (1%) 2 (10%) 1.0% 1 (7.7%)

Total 635 (31.1%) 58 (9.1%) 28.4% 50 (8.8%)

16

See Glossary for a detailed definition of ‘road trauma’ and ‘other transport incident’. 17

51 patients excluded due to being recorded as overseas, not applicable or not recorded. 18

Includes other forms of land transport such as 3 wheeler and quad bikes (all-terrain vehicles).


The most common mechanisms in the other transport incidents16 group were motorcycle collisions

(29.5%), pedal cyclist (19.6%) and animal-rider or animal-drawn vehicle (17.1%) which included 13

incidents (39.4%) involving a fall from or being thrown from a horse (Table 13).

Table 13: Other transport incidents in detail16 (n=193)

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

other paved roadway.









57 (2.8%) 0 (0%) 0.0% 0 (0%)

Pedal cyclist 38 (1.9%) 1 (2.6%) 0.5% 1 (2.9%)

Animal-rider or animal-drawn

vehicle 33 (1.6%) 0 (0%) 0.0% 0 (0%)

Pedestrian 22 (1.1%) 2 (9.1%) 1.0% 2 (10.0%)

All other transport 18 (0.9%) 0 (0%) 0.0% 0 (0%)

All-Terrain Vehicle (ATV)

19

14 (0.7%) 0 (0%) 0.0% 0 (0%)


11 (0.5%) 1 (9.1%) 0.5% 1 (12.5%)

Total 193 (9.4%) 4 (2.1%) 2.0% 4 (2.3%)

19

Includes quad bikes.


Time and day of injury

It is notable that 56.6% of patients (n=1,244) were injured between 10 am and 9 pm resulting in

peak activity in the hospitals during the afternoon and evening (Figure 9).

Figure 9: Number of patients by time of injury (n=2,043)

The mean daily number of persons injured on a weekday was 10.2. The number of persons injured

on weekends was higher at a mean of 13.8 per day (Figure 10).20

Figure 10: Number of patients by day of injury (n=2,043)20

20

In the reporting period (01 Jan – 30 Jun) there were 130 week days and 52 weekend days.

0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Num

ber

of patie

nts

Time of Day

256

279

246 262

285

356 359

0

50

100

150

200

250

300

350

400

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Num

ber

of P

atie

nts

Day of the week


Injuries

Three or more fractured ribs without a flail segment21 continues to be the most common single

serious injury sustained (20.4%, n=417) where the AIS severity was greater than 2 (Table 14).

Cerebral haematomas occupy three out of the top five injuries.

Table 14: Top 5 injuries with an AIS severity >2 (n=2,043)

Injury description AIS severity Number of patients

(% of total)

Fractured ≥3 ribs without flail21

3 417 (20.4%)

Cerebrum hematoma - subdural - small; moderate 4 181 (8.9%)

Cerebrum hematoma - subdural - large; massive; extensive 5 123 (6.0%)

Cerebrum hematoma - subdural - tiny 3 105 (5.1%)

Thoracic fracture without cord involvement - vertebral body - major 3 97 (4.7%)

In addition, 61.5% of major trauma patients sustained injuries to the head or neck body region, with

the chest region injured in 48.2% of major trauma patients (Figure 11).

Figure 11: All injuries by ISS body region (n=2,043)

21

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

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

IL, 2008.

61.5%

16.8%

48.2%

23.6%

41.0%

55.8%

0%

10%

20%

30%

40%

50%

60%

70%

Head Face Chest Abdominal orpelvic contents

Extremities orpelvic girdle

External

Perc

enta

ge o

f to

tal patie

nts

ISS body region


The majority of major trauma patients (75.1%) sustained serious injury (AIS severity >2) to only

one ISS body region (Table 15).

Table 15: Number of ISS body regions injured with an AIS severity >2 (n=2,043)

Number of ISS body regions injured

Number of patients (% of total) (All ISS)

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

0 138 (6.8%) 3 (0.2%)

1 1534 (75.1%) 1410 (79%)

2 314 (15.4%) 314 (17.6%)

3 50 (2.4%) 50 (2.8%)

4 7 (0.3%) 7 (0.4%)

Moreover, 19.5% of major trauma patients sustained polytrauma, defined as sustaining serious

injury (AIS severity >2) in two or more ISS body regions22 (Table 16).

Table 16: Single body region versus polytrauma with an AIS severity >2 (n=1,905)23

Number of patients – All ISS

(% of total) Case fatality rate

(All ISS) Case fatality rate

(ISS >12)

Single body region 1534 (80.5%) 9.1% 8.9%

Polytrauma 371 (19.5%) 13.5% 13.5%

22

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

43(2): 196-199.

23 138 patients excluded due to sustaining no injuries AIS severity >2.


Injury Severity Score

An Injury Severity Score (ISS) of greater than 12 is a key identifier of a major trauma patient. The

ISS correlates with mortality – the higher the ISS, the higher the mortality rate (Table 17). It is

important to note that ISS is only calculated on injuries sustained and does not include other

potential contributors to mortality and morbidity such as patient’s age and comorbidities. The

average ISS for all major trauma patients was 18.9. This increased to 20.6 when excluding those

with an ISS less than 13.

Table 17: Major trauma patients by ISS group (n=2,043)

ISS group Number of patients

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

ISS <13 259 (12.7%) 29 (11.2%)

ISS 13-15 480 (23.5%) 9 (1.9%)

ISS 16-24 801 (39.2%) 32 (4%)

ISS 25-40 440 (21.5%) 106 (24.1%)

ISS 41-75 63 (3.1%) 28 (44.4%)

The serious injury category (ISS 16-24) contained the highest number of injured at 801 (39.2%),

followed by the moderate injury category (ISS 13-15) which had 480 (23.5%) injured and the

severe injury category (ISS 25-40) had 440 (21.5%) (Figure 12).

Figure 12: Number of major trauma patients by ISS group and gender (n=2,043)

Females had a higher case fatality rate than males in all ISS groups except the ISS 41-75 group (Figure 13). In the ISS group 41-75 the case fatality rates were similar between the sexes (44.7%

200

362

588

336

47 59

118

213

104

16

0

100

200

300

400

500

600

700

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

Num

ber

of P

atie

nts

ISS Group

Male

Female


male and 43.8% female), this was the closest that the case fatality rates were between males and females. Overall the case fatality rates were higher in females than males (13.5% versus 8.8%).

Figure 13: Case fatality rate by ISS and gender (ISS >12) (n=2,043)

8.5%

1.4% 3.2%

21.7%

44.7%

20.3%

3.4%

6.1%

31.7%

43.8%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

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

Num

ber

of P

atie

nts

ISS Group

Male

Female


Pre-hospital time

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

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

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

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

service faster (83 mins) than those injured in a rural location (210 mins) (Table 18).

Table 18: Time of injury to arrival at a designated trauma service (n=1,945)24

Location of injury Median time of injury to arrival at a

designated trauma service

Metropolitan 83 mins (n=1,444)

Rural 210 mins (n=501)

NSW overall 97 mins (n=1,945)

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

metropolitan and rural.

A number of major trauma patients (n=108) who arrived at a designated trauma service needed to

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

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

interventional radiology or paediatric services. The overall median time to definitive care was 685

minutes. An injury in a rural area took 256 minutes longer to reach definitive care compared to a

metropolitan area if transferred from a designated trauma service (Table 19).

Table 19: Time of injury to arrival at definitive care if transferred from another trauma

service (n=108)25

Location of injury Median time of injury to arrival at definitive care

if transferred from another trauma service

Metropolitan 553 mins (n=57)

Rural 809 mins (n=51)

NSW overall 685 mins (n=108)

24

98 records excluded due to data being incomplete relating time of injury or admission, was injured overseas, or location of injury

unknown. 25

9 records were excluded due to data being incomplete relating to time of injury or admission or location of injury.


Mode of transport

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

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

(75.9%), with helicopter, fixed wing and private transport also used (Table 20, Figure 14 and 15).

Table 20: Mode of transport to definitive care26 (n=2,000)27

Transport mode Direct from scene of

injury Transfer from another

acute care facility Total

Road Ambulance 1,243 (79.8%) 298 (63%) 1,541 (75.9%)

Fixed Wing 0 (0%) 66 (14%) 66 (3.2%)

Helicopter 203 (13%) 74 (15.6%) 277 (13.6%)

Private Vehicle 108 (6.9%) 3 (0.6%) 111 (5.5%)

Unknown 1 (0.1%) 32 (6.8%) 33 (1.6%)

Other 3 (0.2%) 0 (0%) 3 (0.1%)

Total 1,558 442 2,000

Figure 14: Mode of transport to definitive care when transported direct from the scene of

injury, by injury location (n=1,558)

26

See Glossary for definition of definiative care 27

43 records were excluded where location of injury was recorded as overseas, same facility, or transport mode missing.

86.0%

7.7% 6.0%

0.2%

56.1%

37.5%

6.4%

0.0% 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ambulance Helicopter Private Vehicle Other and Unknown

Perc

enta

ge o

f to

tal

Mode of Transport

Metro

Rural


Figure 15: Mode of transport to definitive care when transferred from another acute care

facility, by injury location (n=473)

82.8%

0.0%

11.3%

0.9% 5.0%

44.3%

27.6%

20.4%

0.5%

6.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ambulance Fixed Wing Helicopter Private Vehicle Other and Unknown

Perc

enta

ge o

f to

tal

Mode of Transport

Metro

Rural


4. Major trauma admissions

Introduction

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

NSW Trauma Services (n=2,117), not the number of major trauma patients (n=2,043), as some

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

detail in Section 3.

Facility overview

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

service together with averages from the three trauma service types (Table 21).

Table 21: Overview of trauma service admissions (n=2,117)

Facility Number of admissions

Average age

Average ISS

Case fatality rate (All ISS)

28

Case fatality rate (ISS >12)

Adult Major Trauma Services 1,636 52.7 19.3 9.8% 9.4%

John Hunter Hospital 344 49.5 20.0 9.6% 9.8%

Liverpool Hospital 207 51.4 19.6 10.1% 10.6%

Royal North Shore Hospital 328 55.4 19.1 9.1% 9.7%

Royal Prince Alfred Hospital 153 53.1 18.7 4.6% 5.0%

St George Hospital 169 53.7 20.5 11.2% 11.1%

St Vincent's Hospital 106 49.9 19.6 9.4% 8.7%

Westmead Hospital 329 54.4 18.1 12.2% 9.4%

Paediatric Major Trauma Services 105 7.4 18.0 18.9% 3.2%

John Hunter Children’s Hospital 23 8.6 18.3 4.3% 5.6%

Sydney Children's Hospital 37 6.8 18.7 8.1% 10.0%

The Children's Hospital at Westmead 45 7.2 20.9 6.7% 8.6%

Regional Trauma Services 376 52.7 17.9 9.8% 4.6%

Coffs Harbour Base Hospital 34 48.2 24.0 17.6% 18.8%

Gosford Hospital 37 58.9 18.0 18.9% 3.2%

Lismore Base Hospital 25 48.4 20.4 20.0% 8.9%

Nepean Hospital 58 55.8 13.7 10.3% 6.3%

Orange Health Service 54 48.6 14.6 3.7% 2.7%

Port Macquarie Base Hospital 23 44.3 21.7 13.0% 5.7%

Tamworth Rural Referral Hospital 35 51.6 20.3 11.4% 4.7%

The Tweed Hospital 26 51.8 19.7 3.8% 2.3%

Wagga Wagga Base Hospital 28 50.4 13.1 0.0% 0.0%

Wollongong Hospital 56 58.4 18.7 5.4% 2.5%

28

Patients with an ISS <13 are included only if they had an ICU admission or died. Other survivors in this group are not collected,

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


Admission type

The majority of major trauma patients (76.4%, n=1,617) were admitted to a trauma service direct from the scene of injury, however, there were differences in the admission type between adult and paediatric patient groups (Table 22).

Table 22: Number of admissions by type (n=2,117)

Admission type Number of admissions

(paediatric / adult)

Percentage of admissions

(paediatric / adult)

Direct from scene 49 / 1,568 46.7% / 77.9%

Transfer from another acute care facility

56 / 432 53.3% / 21.5%

Unknown and other 0 / 12 0% / 0.6%


The Revised Trauma Score29 is an early (<24 hours) indicator of trauma outcomes. The lower the

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

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

average Revised Trauma Score was 7.0 (Figure 16).

Figure 16: Average Revised Trauma Score by ISS group (n=2,005)30

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

30 112 records excluded as no Revised Trauma Score was recorded.

7.0

7.7 7.3

6.4

4.3

0

1

2

3

4

5

6

7

8

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

Avera

ge R

evis

ed T

raum

a S

core

ISS Group


Trauma team activation

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

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

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

physiological parameters. 52.7% of patients who arrived at a trauma service direct from scene

received a full trauma team activation compared to 23.6% of those who were transferred from

another acute care facility (Figure 17).

Figure 17: Trauma team activation by admission type (n=2,117)

45.7%

52.7%

23.6%

15.7%

14.6%

19.7%

6.6%

5.9%

8.8%

21.3%

17.6%

33.0%

4.1% 3.1% 7.6%

6.1% 5.9% 5.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All Admissions (n=2,117) Direct from scene (n=1,617) Transfer from another acute carefacility (n=488)

Perc

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f adm

issio

ns

Full Trauma Team Activation Modified Trauma Team Activation

Trauma Consult Trauma Team not activated and not required

Trauma Team not activated and required Unknown and other


The activation of the trauma team increased with severity of injury as expected with 35.7% (n=176) of the ISS 13-15 group receiving a full trauma team activation compared to 87.0% (n=60) of the ISS 41-75 group (Figure 18).

Figure 18: Trauma team activation by ISS group (n=2,117)

45.7% 48.3%

35.7%

44.9%

50.1%

87.0%

15.7% 11.4%

24.1%

15.0%

12.1%

5.8%

6.6%

3.0%

9.1% 7.4% 5.2%

1.4%

21.3%

25.1%

17.8%

22.4% 23.8%

4.1%

2.7% 5.1%

4.8% 2.8% 2.9%

6.6% 9.5% 8.1% 5.5% 6.0% 4.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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

Perc

enta

ge o

f adm

iissio

ns

Full Trauma Team Activation (FTTA) Modified Trauma Team Activation (MTTA)

Trauma Consult Trauma Team not activated and not required

Trauma Team not activated and required Unkonwn and other


Vital signs on arrival to the Emergency Department

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

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

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

<35°C) represented a higher proportion of those who died compared to all patients (Figures 19-21).

Figure 19: Initial systolic blood pressure on arrival to the ED and mortality (n=2,056) 31

Figure 20: Initial Glasgow Coma Scale (GCS) on arrival to the ED and mortality (n=2,029)32

31

61 records excluded due to Systolic Blood Pressure not being recorded. 32

88 records excluded due to Glasgow Coma Scale not being recorded.

88.5% 90.3%

71.3%

11.5% 9.7%

28.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All patients n=2,056 Survived n=1,861 Died n=195

Perc

enta

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ns

<100mmHg

>=100mmHg and Over

54.8% 59.3%

12.8%

19.9%

20.4%

14.8%

5.1%

4.6%

9.7%

20.2% 15.7%

62.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Perc

enta

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f adm

issio

ns

3-8

9-12

13-14

15


Figure 21: Initial temperature on arrival to ED and mortality (n=1,746)33

Intensive Care Unit admissions

Overall 40.5% (n=857) of major trauma patients received an Intensive Care Unit (ICU) admission,

with the percentage increasing with the level of injury severity (Figure 22). Whilst the number of

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

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

Figure 22: ICU admission by ISS group (n=2,117)

33

371 records excluded due to initial temperature not recorded.

92.2% 94.0%

70.9%

5.1% 3.5%

23.4%

2.7% 2.5% 5.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Perc

enta

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f adm

issio

ns

>37.5°C< 35°C35-37°C

40.5%

16.0%

30.5%

51.0%

71.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

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

Perc

enta

ge o

f IS

S g

roup

ISS group


Length of stay

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

an indicator of the severity and complexity of the injury. The average hospital LOS for major

trauma patients was 12.3 days (Table 23).

Table 23: Overview of ICU and hospital length of stay (n=2,117)

Number of patients Average days Median days

ICU LOS 855 5.2 2.0

Total Hospital LOS 2117 12.3 6.0

The average ICU length of stay increased with severity with ISS 13-15 group being 3.8 days and

ISS 41-75 group being 12.7 days. A similar increasing pattern was also shown in the hospital

length of stay as expected (Table 24).

Table 24: ICU and hospital length of stay by ISS (n=2,117)

ISS group Average ICU LOS

Median ICU LOS

Average hospital LOS

Median hospital LOS

ISS <13 2.5 1 9.6 5.0

ISS 13-15 3.8 2 9.2 5.0

ISS 16-24 5.3 3 12.5 7.0

ISS 25-40 6.8 3 14.3 7.0

ISS 41-75 12.7 11 30.0 15.0


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

different age groups (Table 25).

Table 25: ICU and hospital length of stay by age (n=2,114)9

Age group Average ICU LOS

Median ICU LOS

Average hospital LOS

Median hospital LOS

0-4 2.4 2 8.6 5.0

5-9 6.0 1 13.0 5.0

10-14 5.0 1.5 18.0 5.0

15-19 4.5 2 11.1 6.0

20-24 5.2 2 10.8 6.0

25-29 5.2 2 12.1 6.0

30-34 5.3 2 13.6 6.0

35-39 5.3 2 13.4 6.0

40-44 6.6 3 12.2 6.0

45-49 6.6 3 15.3 7.0

50-54 5.3 3 14.5 6.0

55-59 6.1 2 10.7 8.0

60-64 6.8 3 13.9 7.0

65-69 4.2 3 12.3 8.0

70-74 6.8 4 14.7 6.0

75-79 5.2 2 12.5 6.5

80-84 2.9 2 9.0 8.0

85 and over 3.2 1 9.9 7.0


Surgical procedures

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

surgical procedures performed was very low with 356 procedures performed on 336 patients

(16.8% of all admissions) with highest percentage of procedures performed in the ISS 41-75 group

(Table 26).

Table 26: Surgical procedures performed by type in total admissions (n=2,117)

Procedure Number of procedures Percentage of total admissions

Laparotomy 75 3.5%

Open Reduction Internal Fixation (ORIF)

207 9.8%

Thoracotomy 20 0.9%

Craniotomy 54 2.6%

Total 356 16.8%34

A sharp rise in the proportion of Laparotomy and procedures performed is noted from the ISS 16-

24 group to the ISS 25-40 group (Figure 23).

Figure 23: Surgical procedures performed by ISS group (n=2,117)

34

The total percentage of surgical procedures performed is based on the number of admissions where one or more procedures were

performed (n=336), not the total number of procedures performed (n=356).

0%

5%

10%

15%

20%

25%

30%

35%


Perc

enta

ge o

f IS

S g

roup

ISS group

Laparotomy

ORIF

Thoracatomy

Craniotomy


Discharge destination of survivors

Survivors of major trauma (n=2,117) were discharged to various locations, with home being the

most common (66.8%). In addition, 6.8% of patients were discharged to an acute care hospital for

a higher level of care and 15% of patients were discharged to rehabilitation. ‘Other’ incorporates

locations such as board and care, burns centre, foster care, residential institution, missing and

unknown (Figure 24).

Figure 24: Discharge destination of survivors (n=2,117)

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

in the rate of discharge to rehabilitation services (Figure 25).

Figure 25: Discharge destination of survivors by ISS group (n=2,117)

66.8%

6.8% 7.8%

3.7%

15.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Home Acute Care Hospital Intermediate CareFacility

Other Rehabilitation

Perc

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Discharge location

66.8%

78.6% 78.1%

66.1%

50.7%

17.1%

6.8%

2.6% 4.3%

7.0%

11.2%

17.1%

7.8%

6.8% 5.6%

7.9%

11.2%

9.8%

3.7%

4.7% 3.7%

2.9%

4.5%

4.9%

15.0% 7.3% 8.3%

16.1% 22.4%

51.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Perc

enta

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f IS

S g

roup

ISS Group

Home Acute Care Hospital Intermediate Care Facility Other Rehabilitation


5. Appendices

List of appendices

Appendix 1: Adult Major Trauma Service summaries

Appendix 2: Paediatric Major Trauma Service summaries

Appendix 3: Regional Trauma Service summaries

Appendix 4: Calculation of the Injury Severity Score

Appendix 5: Calculation of adjusted mortality rate

Appendix 6: Map of NSW showing ASGS Remoteness Areas

Note: Trauma data profiles presented at Appendices 1-3 include the use an adjusted mortality rate

(age). For further information on the method used for calculating these items, please see Appendix

5.

Caution should be used when referring to the case fatality rate (all ISS) in the following facility

trauma data profiles as patients with an ISS <13 are included only if they had an ICU admission or

died. Other survivors in this group are not collected, therefore the case fatality rate for this group

cannot be accurately calculated and may be misleading. It is contained in this report only to

facilitate comparison to reports from previous years. It is recommended that you only refer to the

case fatality rate (ISS >12).


Appendix 1: Adult Major Trauma Service Summaries

Table 27: Trauma data profile, John Hunter Hospital

Facility Peer

Total admissions 344 233.7

Mean monthly admissions 28.7 19.5

Case fatality rate (all ISS) 9.6% 9.8%

Case fatality rate (ISS >12) 9.8% 8.4%

Age Adjusted Mortality Rate 11% 10%

Gender

Female / Male 77 / 267 58.1 / 175.6

Age ranges

Mean age 49.5 52.7

0-4 0 (0.0%) 1 (0.4%)

5-9 0 (0.0%) 0.4 (0.2%)

10-14 0 (0.0%) 0.7 (0.3%)

15-19 22 (6.4%) 12.4 (5.3%)

20-24 29 (8.4%) 17.1 (7.3%)

25-29 30 (8.7%) 19 (8.1%)

30-34 28 (8.1%) 15 (6.4%)

35-39 25 (7.3%) 14.3 (6.1%)

40-44 21 (6.1%) 13.1 (5.6%)

45-49 21 (6.1%) 15 (6.4%)

50-54 28 (8.1%) 17.4 (7.5%)

55-59 25 (7.3%) 13.6 (5.8%)

60-64 16 (4.7%) 13.4 (5.7%)

65-69 22 (6.4%) 13.4 (5.7%)

70-74 23 (6.7%) 13.3 (5.7%)

75-79 14 (4.1%) 14.6 (6.2%)

80-84 17 (4.9%) 13.6 (5.8%)

85 and over 23 (6.7%) 26.1 (11.2%)

Injury Severity Score (ISS) ranges

Mean ISS 20.0 19.3

ISS <13 18 (5.2%) 24.4 (10.5%)

ISS 13-15 81 (23.5%) 55.3 (23.7%)

ISS 16-24 147 (42.7%) 94.4 (40.4%)

ISS 25-40 85 (24.7%) 51.9 (22.2%)

ISS 41-75 13 (3.8%) 7.7 (3.3%)

Mechanisms of injury

Assault 19 (5.5%) 14.7 (6.3%)

Falls 115 (33.4%) 101.9 (43.6%)

Falls (≥65 years) 74 (21.5%) 62 (26.5%)

Road trauma 125 (36.3%) 73.6 (31.5%)

Other transport incident 42 (12.2%) 17.6 (7.5%)

All other injuries 43 (12.5%) 26 (11.1%)


Types of injury

Blunt 325 (94.5%) 219.1 (93.8%)

Penetrating 13 (3.8%) 9.3 (4.0%)

Other and Unknown 6 (1.7%) 5.3 (2.3%)

Admission type

Direct admission 241 (70.1%) 181.4 (11.1%)

Transfer in 103 (29.9%) 51 (3.1%)

Unknown 0 (0.0%) 1 (0.1%)

Arrival modes

Ambulance 233 (67.7%) 179.9 (11.0%)

Helicopter 62 (18.0%) 25.7 (1.6%)

Other (Private Vehicle, Fixed Wing, Unknown) 49 (14.2%) 28.1 (1.7%)


Mean - Overall 7.01 7.01

ISS < 13 6.17 6.38

ISS 13-15 7.73 7.66

ISS 16-24 7.39 7.33

ISS 25-40 6.32 6.40

ISS 41-75 3.85 4.10

Hospital length of stay

Total bed days 3916 3026.7


ISS < 13 14.0 10.4

ISS 13-15 8.7 8.9

ISS 16-24 10.6 13.1

ISS 25-40 12.1 15.2

ISS 41-75 28.6 32.9

ICU length of stay

ICU total bed days (admissions) 535 (103) 536.1 (91.7)


ISS < 13 4.50 2.77

ISS 13-15 1.88 3.85

ISS 16-24 3.66 5.61

ISS 25-40 5.97 7.44

ISS 41-75 12.63 13.67

Hospital ventilation days

Total ventilation bed days (number of cases) 370 (83) 359.3 (68.1)


ISS < 13 1.8 2.7

ISS 13-15 2.4 4.4

ISS 16-24 3.6 5.3

ISS 25-40 5.2 5.9

ISS 41-75 8.4 9.4


Table 28: Trauma data profile, Liverpool Hospital

Facility Peer






Gender

Female / Male 47 / 160 58.1 / 175.6

Age ranges

Mean age 51.4 52.7

0-4 1 (0.5%) 1 (0.4%)

5-9 1 (0.5%) 0.4 (0.2%)

10-14 3 (1.4%) 0.7 (0.3%)

15-19 13 (6.3%) 12.4 (5.3%)

20-24 13 (6.3%) 17.1 (7.3%)

25-29 19 (9.2%) 19 (8.1%)

30-34 16 (7.7%) 15 (6.4%)

35-39 13 (6.3%) 14.3 (6.1%)

40-44 10 (4.8%) 13.1 (5.6%)

45-49 12 (5.8%) 15 (6.4%)

50-54 12 (5.8%) 17.4 (7.5%)

55-59 10 (4.8%) 13.6 (5.8%)

60-64 11 (5.3%) 13.4 (5.7%)

65-69 14 (6.8%) 13.4 (5.7%)

70-74 13 (6.3%) 13.3 (5.7%)

75-79 12 (5.8%) 14.6 (6.2%)

80-84 12 (5.8%) 13.6 (5.8%)

85 and over 22 (10.6%) 26.1 (11.2%)


Mean ISS 19.6 19.3

ISS <13 19 (9.2%) 24.4 (10.5%)

ISS 13-15 53 (25.6%) 55.3 (23.7%)

ISS 16-24 84 (40.6%) 94.4 (40.4%)

ISS 25-40 43 (20.8%) 51.9 (22.2%)

ISS 41-75 8 (3.9%) 7.7 (3.3%)


Assault 22 (10.6%) 14.7 (6.3%)

Falls 84 (40.6%) 101.9 (43.6%)

Falls (≥65 years) 56 (27.1%) 62 (26.5%)

Road trauma 61 (29.5%) 73.6 (31.5%)




Types of injury

Blunt 192 (92.8%) 219.1 (93.8%)

Penetrating 15 (7.2%) 9.3 (4.0%)


Admission type


Transfer in 37 (17.9%) 51 (3.1%)

Unknown 0 (0.0%) 1 (0.1%)

Arrival modes

Ambulance 160 (77.3%) 179.9 (11.0%)

Helicopter 15 (7.2%) 25.7 (1.6%)




ISS < 13 5.58 6.38

ISS 13-15 7.55 7.66

ISS 16-24 7.46 7.33

ISS 25-40 6.29 6.40

ISS 41-75 4.34 4.10




ISS < 13 8.1 10.4

ISS 13-15 9.9 8.9

ISS 16-24 9.1 13.1

ISS 25-40 16.3 15.2

ISS 41-75 38.8 32.9

ICU length of stay



ISS < 13 1.78 2.77

ISS 13-15 7.33 3.85

ISS 16-24 4.57 5.61

ISS 25-40 12.50 7.44

ISS 41-75 11.57 13.67




ISS < 13 2.4 2.7

ISS 13-15 7.2 4.4

ISS 16-24 4.7 5.3

ISS 25-40 7.3 5.9

ISS 41-75 7.3 9.4


Table 29: Trauma data profile, Royal North Shore Hospital

Facility Peer






Gender

Female / Male 90 / 238 58.1 / 175.6

Age ranges

Mean age 55.4 52.7

0-4 2 (0.6%) 1 (0.4%)

5-9 2 (0.6%) 0.4 (0.2%)

10-14 1 (0.3%) 0.7 (0.3%)

15-19 16 (4.9%) 12.4 (5.3%)

20-24 21 (6.4%) 17.1 (7.3%)

25-29 21 (6.4%) 19 (8.1%)

30-34 20 (6.1%) 15 (6.4%)

35-39 15 (4.6%) 14.3 (6.1%)

40-44 18 (5.5%) 13.1 (5.6%)

45-49 20 (6.1%) 15 (6.4%)

50-54 21 (6.4%) 17.4 (7.5%)

55-59 13 (4.0%) 13.6 (5.8%)

60-64 22 (6.7%) 13.4 (5.7%)

65-69 19 (5.8%) 13.4 (5.7%)

70-74 23 (7.0%) 13.3 (5.7%)

75-79 28 (8.5%) 14.6 (6.2%)

80-84 21 (6.4%) 13.6 (5.8%)

85 and over 45 (13.7%) 26.1 (11.2%)


Mean ISS 19.1 19.3

ISS <13 50 (15.2%) 24.4 (10.5%)

ISS 13-15 68 (20.7%) 55.3 (23.7%)

ISS 16-24 127 (38.7%) 94.4 (40.4%)

ISS 25-40 74 (22.6%) 51.9 (22.2%)

ISS 41-75 9 (2.7%) 7.7 (3.3%)


Assault 4 (1.2%) 14.7 (6.3%)

Falls 168 (51.2%) 101.9 (43.6%)

Falls (≥65 years) 104 (31.7%) 62 (26.5%)

Road trauma 102 (31.1%) 73.6 (31.5%)




Types of injury

Blunt 301 (91.8%) 219.1 (93.8%)

Penetrating 4 (1.2%) 9.3 (4.0%)


Admission type 35


Transfer in 90 (27.4%) 51 (3.1%)

Unknown 0 (0.0%) 1 (0.1%)

Arrival modes

Ambulance 248 (75.6%) 179.9 (11.0%)

Helicopter 44 (13.4%) 25.7 (1.6%)




ISS < 13 7.18 6.38

ISS 13-15 7.68 7.66

ISS 16-24 7.29 7.33

ISS 25-40 6.31 6.40

ISS 41-75 4.57 4.10




ISS < 13 7.4 10.4

ISS 13-15 11.3 8.9

ISS 16-24 16.6 13.1

ISS 25-40 19.2 15.2

ISS 41-75 41.2 32.9

ICU length of stay



ISS < 13 1.76 2.77

ISS 13-15 2.78 3.85

ISS 16-24 5.25 5.61

ISS 25-40 7.05 7.44

ISS 41-75 13.88 13.67




ISS < 13 1.9 2.7

ISS 13-15 3.7 4.4

ISS 16-24 6.5 5.3

ISS 25-40 5.4 5.9

ISS 41-75 9.3 9.4

35 2 records excluded Admissions from within same facility


Table 30: Trauma data profile, Royal Prince Alfred Hospital

Facility Peer






Gender

Female / Male 39 / 114 58.1 / 175.6

Age ranges

Mean age 53.1 52.7

0-4 2 (1.3%) 1 (0.4%)

5-9 0 (0.0%) 0.4 (0.2%)

10-14 0 (0.0%) 0.7 (0.3%)

15-19 2 (1.3%) 12.4 (5.3%)

20-24 9 (5.9%) 17.1 (7.3%)

25-29 18 (11.8%) 19 (8.1%)

30-34 9 (5.9%) 15 (6.4%)

35-39 5 (3.3%) 14.3 (6.1%)

40-44 11 (7.2%) 13.1 (5.6%)

45-49 11 (7.2%) 15 (6.4%)

50-54 19 (12.4%) 17.4 (7.5%)

55-59 10 (6.5%) 13.6 (5.8%)

60-64 6 (3.9%) 13.4 (5.7%)

65-69 12 (7.8%) 13.4 (5.7%)

70-74 6 (3.9%) 13.3 (5.7%)

75-79 7 (4.6%) 14.6 (6.2%)

80-84 9 (5.9%) 13.6 (5.8%)

85 and over 17 (11.1%) 26.1 (11.2%)


Mean ISS 18.7 19.3

ISS <13 12 (7.8%) 24.4 (10.5%)

ISS 13-15 30 (19.6%) 55.3 (23.7%)

ISS 16-24 80 (52.3%) 94.4 (40.4%)

ISS 25-40 28 (18.3%) 51.9 (22.2%)

ISS 41-75 3 (2.0%) 7.7 (3.3%)


Assault 15 (9.8%) 14.7 (6.3%)

Falls 80 (52.3%) 101.9 (43.6%)

Falls (≥65 years) 42 (27.5%) 62 (26.5%)

Road trauma 35 (22.9%) 73.6 (31.5%)




Types of injury

Blunt 140 (91.5%) 219.1 (93.8%)

Penetrating 12 (7.8%) 9.3 (4.0%)


Admission type


Transfer in 23 (15.0%) 51 (3.1%)

Unknown 0 (0.0%) 1 (0.1%)

Arrival modes

Ambulance 134 (87.6%) 179.9 (11.0%)

Helicopter 0 (0.0%) 25.7 (1.6%)




ISS < 13 6.78 6.38

ISS 13-15 7.83 7.66

ISS 16-24 7.50 7.33

ISS 25-40 6.89 6.40

ISS 41-75 5.31 4.10




ISS < 13 13.5 10.4

ISS 13-15 6.7 8.9

ISS 16-24 12.9 13.1

ISS 25-40 13.2 15.2

ISS 41-75 5.7 32.9

ICU length of stay



ISS < 13 1.83 2.77

ISS 13-15 0 3.85

ISS 16-24 5.23 5.61

ISS 25-40 4.69 7.44

ISS 41-75 7.50 13.67




ISS < 13 1.9 2.7

ISS 13-15 0 4.4

ISS 16-24 4.1 5.3

ISS 25-40 3.2 5.9

ISS 41-75 8.0 9.4


Table 31: Trauma data profile, St George Hospital

Facility Peer






Gender

Female / Male 40 / 129 58.1 / 175.6

Age ranges

Mean age 53.7 52.7

0-4 1 (0.6%) 1 (0.4%)

5-9 0 (0.0%) 0.4 (0.2%)

10-14 1 (0.6%) 0.7 (0.3%)

15-19 9 (5.3%) 12.4 (5.3%)

20-24 16 (9.5%) 17.1 (7.3%)

25-29 9 (5.3%) 19 (8.1%)

30-34 7 (4.1%) 15 (6.4%)

35-39 14 (8.3%) 14.3 (6.1%)

40-44 8 (4.7%) 13.1 (5.6%)

45-49 11 (6.5%) 15 (6.4%)

50-54 9 (5.3%) 17.4 (7.5%)

55-59 14 (8.3%) 13.6 (5.8%)

60-64 11 (6.5%) 13.4 (5.7%)

65-69 5 (3.0%) 13.4 (5.7%)

70-74 9 (5.3%) 13.3 (5.7%)

75-79 9 (5.3%) 14.6 (6.2%)

80-84 18 (10.7%) 13.6 (5.8%)

85 and over 18 (10.7%) 26.1 (11.2%)


Mean ISS 20.5 19.3

ISS <13 16 (9.5%) 24.4 (10.5%)

ISS 13-15 38 (22.5%) 55.3 (23.7%)

ISS 16-24 66 (39.1%) 94.4 (40.4%)

ISS 25-40 37 (21.9%) 51.9 (22.2%)

ISS 41-75 12 (7.1%) 7.7 (3.3%)


Assault 8 (4.7%) 14.7 (6.3%)

Falls 78 (46.2%) 101.9 (43.6%)

Falls (≥65 years) 44 (26.0%) 62 (26.5%)

Road trauma 58 (34.3%) 73.6 (31.5%)




Types of injury

Blunt 159 (94.1%) 219.1 (93.8%)

Penetrating 7 (4.1%) 9.3 (4.0%)


Admission type


Transfer in 49 (29.0%) 51 (3.1%)

Unknown 0 (0.0%) 1 (0.1%)

Arrival modes

Ambulance 136 (80.5%) 179.9 (11.0%)

Helicopter 16 (9.5%) 25.7 (1.6%)




ISS < 13 5.48 6.38

ISS 13-15 7.77 7.66

ISS 16-24 6.78 7.33

ISS 25-40 5.96 6.40

ISS 41-75 3.03 4.10




ISS < 13 14.0 10.4

ISS 13-15 9.2 8.9

ISS 16-24 14.1 13.1

ISS 25-40 18.8 15.2

ISS 41-75 35.7 32.9

ICU length of stay



ISS < 13 4.13 2.77

ISS 13-15 7.67 3.85

ISS 16-24 6.46 5.61

ISS 25-40 8.95 7.44

ISS 41-75 13.70 13.67




ISS < 13 4.1 2.7

ISS 13-15 7.5 4.4

ISS 16-24 6.1 5.3

ISS 25-40 7.5 5.9

ISS 41-75 11.7 9.4


Table 32: Trauma data profile, St Vincent’s Hospital

Facility Peer






Gender

Female / Male 23 / 83 58.1 / 175.6

Age ranges36

Mean age 49.9 52.7

0-4 1 (0.9%) 1 (0.4%)

5-9 0 (0.0%) 0.4 (0.2%)

10-14 0 (0.0%) 0.7 (0.3%)

15-19 7 (6.6%) 12.4 (5.3%)

20-24 8 (7.5%) 17.1 (7.3%)

25-29 12 (11.3%) 19 (8.1%)

30-34 7 (6.6%) 15 (6.4%)

35-39 4 (3.8%) 14.3 (6.1%)

40-44 4 (3.8%) 13.1 (5.6%)

45-49 10 (9.4%) 15 (6.4%)

50-54 9 (8.5%) 17.4 (7.5%)

55-59 9 (8.5%) 13.6 (5.8%)

60-64 7 (6.6%) 13.4 (5.7%)

65-69 6 (5.7%) 13.4 (5.7%)

70-74 0 (0.0%) 13.3 (5.7%)

75-79 5 (4.7%) 14.6 (6.2%)

80-84 3 (2.8%) 13.6 (5.8%)

85 and over 14 (13.2%) 26.1 (11.2%)


Mean ISS 19.6 19.3

ISS <13 14 (13.2%) 24.4 (10.5%)

ISS 13-15 21 (19.8%) 55.3 (23.7%)

ISS 16-24 40 (37.7%) 94.4 (40.4%)

ISS 25-40 28 (26.4%) 51.9 (22.2%)

ISS 41-75 3 (2.8%) 7.7 (3.3%)


Assault 9 (8.5%) 14.7 (6.3%)

Falls 51 (48.1%) 101.9 (43.6%)

Falls (≥65 years) 24 (22.6%) 62 (26.5%)

Road trauma 18 (17.0%) 73.6 (31.5%)



36

2 records without age recorded


Types of injury

Blunt 102 (96.2%) 219.1 (93.8%)

Penetrating 0 (0.0%) 9.3 (4.0%)


Admission type


Transfer in 1 (0.9%) 51 (3.1%)

Unknown 0 (0.0%) 1 (0.1%)

Arrival modes

Ambulance 92 (86.8%) 179.9 (11.0%)

Helicopter 0 (0.0%) 25.7 (1.6%)




ISS < 13 6.56 6.38

ISS 13-15 7.78 7.66

ISS 16-24 7.79 7.33

ISS 25-40 7.00 6.40

ISS 41-75 4.40 4.10




ISS < 13 7.6 10.4

ISS 13-15 5.9 8.9

ISS 16-24 7.2 13.1

ISS 25-40 14.1 15.2

ISS 41-75 51.3 32.9

ICU length of stay



ISS < 13 2.00 2.77

ISS 13-15 5.75 3.85

ISS 16-24 1.63 5.61

ISS 25-40 4.82 7.44

ISS 41-75 29.33 13.67




ISS < 13 1.7 2.7

ISS 13-15 7.3 4.4

ISS 16-24 2.5 5.3

ISS 25-40 6.5 5.9

ISS 41-75 19.7 9.4


Table 33: Trauma data profile, Westmead Hospital

Facility Peer






Gender

Female / Male 91 / 238 58.1 / 175.6

Age ranges37

Mean age 54.4 52.7

0-4 0 (0.0%) 1 (0.4%)

5-9 0 (0.0%) 0.4 (0.2%)

10-14 0 (0.0%) 0.7 (0.3%)

15-19 18 (5.5%) 12.4 (5.3%)

20-24 24 (7.3%) 17.1 (7.3%)

25-29 24 (7.3%) 19 (8.1%)

30-34 18 (5.5%) 15 (6.4%)

35-39 24 (7.3%) 14.3 (6.1%)

40-44 20 (6.1%) 13.1 (5.6%)

45-49 20 (6.1%) 15 (6.4%)

50-54 24 (7.3%) 17.4 (7.5%)

55-59 14 (4.3%) 13.6 (5.8%)

60-64 21 (6.4%) 13.4 (5.7%)

65-69 16 (4.9%) 13.4 (5.7%)

70-74 19 (5.8%) 13.3 (5.7%)

75-79 27 (8.2%) 14.6 (6.2%)

80-84 15 (4.6%) 13.6 (5.8%)

85 and over 44 (13.4%) 26.1 (11.2%)


Mean ISS 18.1 19.3

ISS <13 42 (12.8%) 24.4 (10.5%)

ISS 13-15 96 (29.2%) 55.3 (23.7%)

ISS 16-24 117 (35.6%) 94.4 (40.4%)

ISS 25-40 68 (20.7%) 51.9 (22.2%)

ISS 41-75 6 (1.8%) 7.7 (3.3%)


Assault 26 (7.9%) 14.7 (6.3%)

Falls 137 (41.6%) 101.9 (43.6%)

Falls (≥65 years) 90 (27.4%) 62 (26.5%)

Road trauma 116 (35.3%) 73.6 (31.5%)



37 1 record excluded due to missing age


Types of injury

Blunt 315 (95.7%) 219.1 (93.8%)

Penetrating 14 (4.3%) 9.3 (4.0%)


Admission type


Transfer in 54 (16.4%) 51 (3.1%)

Unknown 7 (2.1%) 1 (0.1%)

Arrival modes

Ambulance 256 (77.8%) 179.9 (11.0%)

Helicopter 43 (13.1%) 25.7 (1.6%)




ISS < 13 5.78 6.38

ISS 13-15 7.56 7.66

ISS 16-24 7.03 7.33

ISS 25-40 6.29 6.40

ISS 41-75 3.47 4.10




ISS < 13 12.2 10.4

ISS 13-15 8.0 8.9

ISS 16-24 17.1 13.1

ISS 25-40 13.2 15.2

ISS 41-75 21.0 32.9

ICU length of stay



ISS < 13 4.00 2.77

ISS 13-15 4.27 3.85

ISS 16-24 9.58 5.61

ISS 25-40 8.45 7.44

ISS 41-75 10.25 13.67




ISS < 13 3.8 2.7

ISS 13-15 2.8 4.4

ISS 16-24 6.2 5.3

ISS 25-40 5.9 5.9

ISS 41-75 3.8 9.4


Appendix 2: Paediatric Major Trauma Service summaries

Table 34: Trauma data profile, John Hunter Children’s Hospital

Facility Peer

Total admissions 23 35





Gender

Female / Male 7 / 16 8.7 / 26.3

Age ranges

Mean age 8.6 7.4

0-4 7 (30.4%) 13.3 (38.1%)

5-9 6 (26.1%) 7.7 (21.9%)

10-14 6 (26.1%) 11.3 (32.4%)

15-19 4 (17.4%) 2.7 (7.6%)


Mean ISS 18.3 19.6

ISS <13 5 (21.7%) 7.3 (21.0%)

ISS 13-15 4 (17.4%) 5.7 (16.2%)

ISS 16-24 7 (30.4%) 11 (31.4%)

ISS 25-40 7 (30.4%) 9.7 (27.6%)

ISS 41-75 0 (0.0%) 1.3 (3.8%)


Assault 2 (8.7%) 2.7 (7.8%)

Falls 4 (17.4%) 10.7 (31.1%)

Road trauma 8 (34.8%) 8.3 (24.3%)


All other injuries 4 (17.4%) 6.7 (19.4%)

Types of injury

Blunt 19 (82.6%) 31.7 (90.5%)

Penetrating 0 (0.0%) 0.3 (1.0%)

Other and Unknown 4 (17.4%) 3 (8.6%)

Admission type


Transfer in 7 (30.4%) 18.7 (17.8%)

Arrival modes

Ambulance 15 (65.2%) 19.3 (18.4%)

Helicopter 4 (17.4%) 5.7 (5.4%)

Other (Private Vehicle, Fixed Wing, Unknown) 4 (17.4%) 10 (9.5%)




ISS < 13 6.23 5.59

ISS 13-15 6.90 7.45

ISS 16-24 6.50 6.52

ISS 25-40 5.96 5.71

ISS 41-75 0 3.98




ISS < 13 3.8 8.2

ISS 13-15 7.0 4.5

ISS 16-24 5.7 13.0

ISS 25-40 44.0 26.3

ISS 41-75 0 58.0

ICU length of stay



ISS < 13 1.40 1.50

ISS 13-15 2.00 1.50

ISS 16-24 2.00 5.63

ISS 25-40 10.25 5.47

ISS 41-75 0 16.50




ISS < 13 2.7 2.2

ISS 13-15 3.0 3.0

ISS 16-24 2.5 5.8

ISS 25-40 11.0 5.4

ISS 41-75 0 6.0


Table 35: Trauma data profile, Sydney Children’s Hospital

Facility Peer






Gender

Female / Male 9 / 28 8.7 / 26.3

Age ranges

Mean age 6.8 7.4

0-4 16 (43.2%) 13.3 (38.1%)

5-9 6 (16.2%) 7.7 (21.9%)

10-14 14 (37.8%) 11.3 (32.4%)

15-19 1 (2.7%) 2.7 (7.6%)


Mean ISS 18.7 19.6

ISS <13 7 (18.9%) 7.3 (21.0%)

ISS 13-15 7 (18.9%) 5.7 (16.2%)

ISS 16-24 11 (29.7%) 11 (31.4%)

ISS 25-40 11 (29.7%) 9.7 (27.6%)

ISS 41-75 1 (2.7%) 1.3 (3.8%)


Assault 6 (16.2%) 2.7 (7.8%)

Falls 17 (45.9%) 10.7 (31.1%)

Road trauma 5 (13.5%) 8.3 (24.3%)



Types of injury

Blunt 37 (100.0%) 31.7 (90.5%)

Penetrating 0 (0.0%) 0.3 (1.0%)


Admission type


Transfer in 28 (75.7%) 18.7 (17.8%)

Arrival modes

Ambulance 20 (54.1%) 19.3 (18.4%)

Helicopter 3 (8.1%) 5.7 (5.4%)





ISS < 13 5.48 5.59

ISS 13-15 7.65 7.45

ISS 16-24 5.86 6.52

ISS 25-40 5.61 5.71

ISS 41-75 4.09 3.98




ISS < 13 8.9 8.2

ISS 13-15 3.0 4.5

ISS 16-24 19.8 13.0

ISS 25-40 8.4 26.3

ISS 41-75 12.0 58.0

ICU length of stay



ISS < 13 1.14 1.50

ISS 13-15 0 1.50

ISS 16-24 7.00 5.63

ISS 25-40 2.50 5.47

ISS 41-75 11.00 16.50




ISS < 13 1.3 2.2

ISS 13-15 0 3.0

ISS 16-24 5.8 5.8

ISS 25-40 2.7 5.4

ISS 41-75 12.0 6.0


Table 36: Trauma data profile, The Children’s Hospital at Westmead

Facility Peer






Gender

Female / Male 10 / 35 8.7 / 26.3

Age ranges

Mean age 7.2 7.4

0-4 17 (37.8%) 13.3 (38.1%)

5-9 11 (24.4%) 7.7 (21.9%)

10-14 14 (31.1%) 11.3 (32.4%)

15-19 3 (6.7%) 2.7 (7.6%)


Mean ISS 20.9 19.6

ISS <13 10 (22.2%) 7.3 (21.0%)

ISS 13-15 6 (13.3%) 5.7 (16.2%)

ISS 16-24 15 (33.3%) 11 (31.4%)

ISS 25-40 11 (24.4%) 9.7 (27.6%)

ISS 41-75 3 (6.7%) 1.3 (3.8%)


Assault 0 (0.0%) 2.7 (7.8%)

Falls 11 (25.6%) 10.7 (31.1%)

Road trauma 12 (27.9%) 8.3 (24.3%)



Types of injury

Blunt 39 (86.7%) 31.7 (90.5%)

Penetrating 1 (2.2%) 0.3 (1.0%)


Admission type


Transfer in 21 (46.7%) 18.7 (17.8%)

Arrival modes

Ambulance 23 (51.1%) 19.3 (18.4%)

Helicopter 10 (22.2%) 5.7 (5.4%)





ISS < 13 5.20 5.59

ISS 13-15 7.56 7.45

ISS 16-24 7.14 6.52

ISS 25-40 5.65 5.71

ISS 41-75 3.92 3.98




ISS < 13 10.0 8.2

ISS 13-15 4.7 4.5

ISS 16-24 11.3 13.0

ISS 25-40 32.9 26.3

ISS 41-75 73.3 58.0

ICU length of stay



ISS < 13 1.80 1.50

ISS 13-15 1.00 1.50

ISS 16-24 5.83 5.63

ISS 25-40 6.14 5.47

ISS 41-75 22.00 16.50




ISS < 13 2.3 2.2

ISS 13-15 0 3.0

ISS 16-24 7.5 5.8

ISS 25-40 5.4 5.4

ISS 41-75 4.0 6.0


Appendix 3: Regional Trauma Service summaries

Table 37: Trauma data profile, Coffs Harbour Health Campus

Facility Peer






Gender

Female / Male 7 / 27 9.2 / 28.4

Age ranges

Mean age 48.2 52.5

0-4 1 (2.9%) 0.5 (1.3%)

5-9 1 (2.9%) 0.5 (1.3%)

10-14 0 (0.0%) 0.8 (2.1%)

15-19 3 (8.8%) 2.3 (6.1%)

20-24 3 (8.8%) 2.5 (6.6%)

25-29 1 (2.9%) 1.7 (4.5%)

30-34 4 (11.8%) 2 (5.3%)

35-39 0 (0.0%) 1.4 (3.7%)

40-44 2 (5.9%) 2.2 (5.9%)

45-49 1 (2.9%) 2.7 (7.2%)

50-54 3 (8.8%) 2.3 (6.1%)

55-59 3 (8.8%) 2.4 (6.4%)

60-64 3 (8.8%) 2.7 (7.2%)

65-69 2 (5.9%) 2.7 (7.2%)

70-74 0 (0.0%) 2.8 (7.4%)

75-79 2 (5.9%) 2 (5.3%)

80-84 2 (5.9%) 2.7 (7.2%)

85 and over 3 (8.8%) 3.4 (9.0%)


Mean ISS 24.0 17.9

ISS <13 2 (5.9%) 7 (18.6%)

ISS 13-15 4 (11.8%) 8.9 (23.7%)

ISS 16-24 15 (44.1%) 13.5 (35.9%)

ISS 25-40 8 (23.5%) 7.1 (18.9%)

ISS 41-75 5 (14.7%) 1.1 (2.9%)


Assault 0 (0.0%) 1.8 (4.8%)

Falls 11 (32.4%) 14.1 (37.5%)

Falls (≥65 years) 7 (20.6%) 8.9 (23.7%)

Road trauma 16 (47.1%) 12.1 (32.2%)




Types of injury

Blunt 27 (79.4%) 35.2 (93.6%)

Penetrating 2 (5.9%) 1.6 (4.3%)


Admission type


Transfer in 3 (8.8%) 7.5 (2.0%)

Unknown 0 (0.0%) 0.3 (0.1%)

Arrival modes

Ambulance 29 (85.3%) 29.8 (7.9%)

Helicopter 2 (5.9%) 2 (0.5%)




ISS < 13 7.84 7.41

ISS 13-15 7.08 7.73

ISS 16-24 7.22 7.47

ISS 25-40 5.57 6.43

ISS 41-75 6.77 5.42




ISS < 13 3.0 8.2

ISS 13-15 2.8 11.3

ISS 16-24 10.3 9.3

ISS 25-40 1.8 4.8

ISS 41-75 1.0 5.6

ICU length of stay



ISS < 13 2.00 2.20

ISS 13-15 1.00 4.06

ISS 16-24 3.18 3.80

ISS 25-40 2.00 2.91

ISS 41-75 1.00 3.00




ISS < 13 0 1.8

ISS 13-15 1.0 1.2

ISS 16-24 3.5 3.2

ISS 25-40 1.0 2.0

ISS 41-75 1.0 1.0


Table 38: Trauma data profile, Gosford Hospital

Facility Peer






Gender

Female / Male 9 / 28 9.2 / 28.4

Age ranges

Mean age 58.9 52.5

0-4 1 (2.7%) 0.5 (1.3%)

5-9 1 (2.7%) 0.5 (1.3%)

10-14 0 (0.0%) 0.8 (2.1%)

15-19 5 (13.5%) 2.3 (6.1%)

20-24 2 (5.4%) 2.5 (6.6%)

25-29 0 (0.0%) 1.7 (4.5%)

30-34 0 (0.0%) 2 (5.3%)

35-39 0 (0.0%) 1.4 (3.7%)

40-44 1 (2.7%) 2.2 (5.9%)

45-49 2 (5.4%) 2.7 (7.2%)

50-54 2 (5.4%) 2.3 (6.1%)

55-59 1 (2.7%) 2.4 (6.4%)

60-64 2 (5.4%) 2.7 (7.2%)

65-69 2 (5.4%) 2.7 (7.2%)

70-74 4 (10.8%) 2.8 (7.4%)

75-79 5 (13.5%) 2 (5.3%)

80-84 0 (0.0%) 2.7 (7.2%)

85 and over 9 (24.3%) 3.4 (9.0%)


Mean ISS 18.0 17.9

ISS <13 6 (16.2%) 7 (18.6%)

ISS 13-15 12 (32.4%) 8.9 (23.7%)

ISS 16-24 11 (29.7%) 13.5 (35.9%)

ISS 25-40 7 (18.9%) 7.1 (18.9%)

ISS 41-75 1 (2.7%) 1.1 (2.9%)


Assault 1 (2.7%) 1.8 (4.8%)

Falls 15 (40.5%) 14.1 (37.5%)

Falls (≥65 years) 12 (32.4%) 8.9 (23.7%)

Road trauma 12 (32.4%) 12.1 (32.2%)




Types of injury

Blunt 36 (97.3%) 35.2 (93.6%)

Penetrating 1 (2.7%) 1.6 (4.3%)


Admission type


Transfer in 0 (0.0%) 7.5 (2.0%)

Unknown 0 (0.0%) 0.3 (0.1%)

Arrival modes

Ambulance 35 (94.6%) 29.8 (7.9%)

Helicopter 0 (0.0%) 2 (0.5%)




ISS < 13 6.53 7.41

ISS 13-15 7.84 7.73

ISS 16-24 7.62 7.47

ISS 25-40 5.74 6.43

ISS 41-75 7.55 5.42




ISS < 13 5.2 8.2

ISS 13-15 4.8 11.3

ISS 16-24 3.0 9.3

ISS 25-40 1.7 4.8

ISS 41-75 41.0 5.6

ICU length of stay



ISS < 13 1.00 2.20

ISS 13-15 0 4.06

ISS 16-24 0 3.80

ISS 25-40 1.00 2.91

ISS 41-75 0 3.00



Mean - Overall 0 2.2

ISS < 13 0 1.8

ISS 13-15 0 1.2

ISS 16-24 0 3.2

ISS 25-40 0 2.0

ISS 41-75 0 1.0


Table 39: Trauma data profile, Lismore Base Hospital

Facility Peer






Gender

Female / Male 8 / 17 9.2 / 28.4

Age ranges

Mean age 48.4 52.5

0-4 1 (4.0%) 0.5 (1.3%)

5-9 1 (4.0%) 0.5 (1.3%)

10-14 1 (4.0%) 0.8 (2.1%)

15-19 0 (0.0%) 2.3 (6.1%)

20-24 1 (4.0%) 2.5 (6.6%)

25-29 3 (12.0%) 1.7 (4.5%)

30-34 2 (8.0%) 2 (5.3%)

35-39 1 (4.0%) 1.4 (3.7%)

40-44 3 (12.0%) 2.2 (5.9%)

45-49 2 (8.0%) 2.7 (7.2%)

50-54 0 (0.0%) 2.3 (6.1%)

55-59 1 (4.0%) 2.4 (6.4%)

60-64 1 (4.0%) 2.7 (7.2%)

65-69 1 (4.0%) 2.7 (7.2%)

70-74 1 (4.0%) 2.8 (7.4%)

75-79 1 (4.0%) 2 (5.3%)

80-84 2 (8.0%) 2.7 (7.2%)

85 and over 3 (12.0%) 3.4 (9.0%)


Mean ISS 20.4 17.9

ISS <13 2 (8.0%) 7 (18.6%)

ISS 13-15 3 (12.0%) 8.9 (23.7%)

ISS 16-24 11 (44.0%) 13.5 (35.9%)

ISS 25-40 8 (32.0%) 7.1 (18.9%)

ISS 41-75 1 (4.0%) 1.1 (2.9%)


Assault 1 (4.0%) 1.8 (4.8%)

Falls 9 (36.0%) 14.1 (37.5%)

Falls (≥65 years) 5 (20.0%) 8.9 (23.7%)

Road trauma 9 (36.0%) 12.1 (32.2%)




Types of injury

Blunt 24 (96.0%) 35.2 (93.6%)

Penetrating 0 (0.0%) 1.6 (4.3%)


Admission type


Transfer in 6 (24.0%) 7.5 (2.0%)

Unknown 0 (0.0%) 0.3 (0.1%)

Arrival modes

Ambulance 20 (80.0%) 29.8 (7.9%)

Helicopter 1 (4.0%) 2 (0.5%)




ISS < 13 5.97 7.41

ISS 13-15 7.84 7.73

ISS 16-24 7.21 7.47

ISS 25-40 6.32 6.43

ISS 41-75 7.84 5.42




ISS < 13 7.5 8.2

ISS 13-15 5.7 11.3

ISS 16-24 5.5 9.3

ISS 25-40 1.0 4.8

ISS 41-75 1.0 5.6

ICU length of stay



ISS < 13 2.00 2.20

ISS 13-15 1.00 4.06

ISS 16-24 4.00 3.80

ISS 25-40 1.50 2.91

ISS 41-75 0 3.00




ISS < 13 3.0 1.8

ISS 13-15 0 1.2

ISS 16-24 3.5 3.2

ISS 25-40 1.0 2.0

ISS 41-75 0 1.0


Table 40: Trauma data profile, Nepean Hospital

Facility Peer






Gender

Female / Male 13 / 45 9.2 / 28.4

Age ranges

Mean age 55.8 52.5

0-4 1 (1.7%) 0.5 (1.3%)

5-9 0 (0.0%) 0.5 (1.3%)

10-14 1 (1.7%) 0.8 (2.1%)

15-19 1 (1.7%) 2.3 (6.1%)

20-24 4 (6.9%) 2.5 (6.6%)

25-29 3 (5.2%) 1.7 (4.5%)

30-34 3 (5.2%) 2 (5.3%)

35-39 1 (1.7%) 1.4 (3.7%)

40-44 5 (8.6%) 2.2 (5.9%)

45-49 4 (6.9%) 2.7 (7.2%)

50-54 3 (5.2%) 2.3 (6.1%)

55-59 4 (6.9%) 2.4 (6.4%)

60-64 5 (8.6%) 2.7 (7.2%)

65-69 4 (6.9%) 2.7 (7.2%)

70-74 6 (10.3%) 2.8 (7.4%)

75-79 2 (3.4%) 2 (5.3%)

80-84 7 (12.1%) 2.7 (7.2%)

85 and over 4 (6.9%) 3.4 (9.0%)


Mean ISS 13.7 17.9

ISS <13 21 (36.2%) 7 (18.6%)

ISS 13-15 12 (20.7%) 8.9 (23.7%)

ISS 16-24 19 (32.8%) 13.5 (35.9%)

ISS 25-40 6 (10.3%) 7.1 (18.9%)

ISS 41-75 0 (0.0%) 1.1 (2.9%)


Assault 4 (6.9%) 1.8 (4.8%)

Falls 33 (56.9%) 14.1 (37.5%)

Falls (≥65 years) 19 (32.8%) 8.9 (23.7%)

Road trauma 6 (10.3%) 12.1 (32.2%)




Types of injury

Blunt 53 (91.4%) 35.2 (93.6%)

Penetrating 5 (8.6%) 1.6 (4.3%)


Admission type


Transfer in 17 (29.3%) 7.5 (2.0%)

Unknown 0 (0.0%) 0.3 (0.1%)

Arrival modes

Ambulance 45 (77.6%) 29.8 (7.9%)

Helicopter 0 (0.0%) 2 (0.5%)




ISS < 13 7.53 7.41

ISS 13-15 7.84 7.73

ISS 16-24 7.43 7.47

ISS 25-40 5.62 6.43

ISS 41-75 0 5.42




ISS < 13 14.7 8.2

ISS 13-15 11.2 11.3

ISS 16-24 23.8 9.3

ISS 25-40 3.5 4.8

ISS 41-75 0 5.6

ICU length of stay



ISS < 13 2.50 2.20

ISS 13-15 2.75 4.06

ISS 16-24 6.00 3.80

ISS 25-40 1.33 2.91

ISS 41-75 0 3.00



Mean - Overall 0 2.2

ISS < 13 0 1.8

ISS 13-15 0 1.2

ISS 16-24 0 3.2

ISS 25-40 0 2.0

ISS 41-75 0 1.0


Table 41: Trauma data profile, Orange Health Service

Facility Peer






Gender

Female / Male 14 / 40 9.2 / 28.4

Age ranges

Mean age 48.6 52.5

0-4 0 (0.0%) 0.5 (1.3%)

5-9 1 (1.9%) 0.5 (1.3%)

10-14 2 (3.7%) 0.8 (2.1%)

15-19 5 (9.3%) 2.3 (6.1%)

20-24 7 (13.0%) 2.5 (6.6%)

25-29 3 (5.6%) 1.7 (4.5%)

30-34 1 (1.9%) 2 (5.3%)

35-39 2 (3.7%) 1.4 (3.7%)

40-44 4 (7.4%) 2.2 (5.9%)

45-49 4 (7.4%) 2.7 (7.2%)

50-54 4 (7.4%) 2.3 (6.1%)

55-59 1 (1.9%) 2.4 (6.4%)

60-64 3 (5.6%) 2.7 (7.2%)

65-69 1 (1.9%) 2.7 (7.2%)

70-74 5 (9.3%) 2.8 (7.4%)

75-79 2 (3.7%) 2 (5.3%)

80-84 4 (7.4%) 2.7 (7.2%)

85 and over 5 (9.3%) 3.4 (9.0%)


Mean ISS 14.6 17.9

ISS <13 20 (37.0%) 7 (18.6%)

ISS 13-15 12 (22.2%) 8.9 (23.7%)

ISS 16-24 16 (29.6%) 13.5 (35.9%)

ISS 25-40 5 (9.3%) 7.1 (18.9%)

ISS 41-75 1 (1.9%) 1.1 (2.9%)


Assault 2 (3.7%) 1.8 (4.8%)

Falls 17 (31.5%) 14.1 (37.5%)

Falls (≥65 years) 11 (20.4%) 8.9 (23.7%)

Road trauma 20 (37.0%) 12.1 (32.2%)




Types of injury

Blunt 53 (98.1%) 35.2 (93.6%)

Penetrating 1 (1.9%) 1.6 (4.3%)


Admission type


Transfer in 15 (27.8%) 7.5 (2.0%)

Unknown 1 (1.9%) 0.3 (0.1%)

Arrival modes

Ambulance 36 (66.7%) 29.8 (7.9%)

Helicopter 8 (14.8%) 2 (0.5%)




ISS < 13 7.79 7.41

ISS 13-15 7.84 7.73

ISS 16-24 7.19 7.47

ISS 25-40 7.65 6.43

ISS 41-75 4.09 5.42




ISS < 13 7.1 8.2

ISS 13-15 11.3 11.3

ISS 16-24 4.7 9.3

ISS 25-40 6.8 4.8

ISS 41-75 12.0 5.6

ICU length of stay



ISS < 13 1.90 2.20

ISS 13-15 6.14 4.06

ISS 16-24 2.17 3.80

ISS 25-40 3.00 2.91

ISS 41-75 11.00 3.00




ISS < 13 0 1.8

ISS 13-15 1.0 1.2

ISS 16-24 1.7 3.2

ISS 25-40 1.0 2.0

ISS 41-75 0 1.0


Table 42: Trauma data profile, Port Macquarie Base Hospital

Facility Peer






Gender

Female / Male 4 / 19 9.2 / 28.4

Age ranges

Mean age 44.3 52.5

0-4 0 (0.0%) 0.5 (1.3%)

5-9 1 (4.3%) 0.5 (1.3%)

10-14 0 (0.0%) 0.8 (2.1%)

15-19 1 (4.3%) 2.3 (6.1%)

20-24 0 (0.0%) 2.5 (6.6%)

25-29 2 (8.7%) 1.7 (4.5%)

30-34 7 (30.4%) 2 (5.3%)

35-39 0 (0.0%) 1.4 (3.7%)

40-44 2 (8.7%) 2.2 (5.9%)

45-49 2 (8.7%) 2.7 (7.2%)

50-54 0 (0.0%) 2.3 (6.1%)

55-59 2 (8.7%) 2.4 (6.4%)

60-64 2 (8.7%) 2.7 (7.2%)

65-69 0 (0.0%) 2.7 (7.2%)

70-74 3 (13.0%) 2.8 (7.4%)

75-79 0 (0.0%) 2 (5.3%)

80-84 0 (0.0%) 2.7 (7.2%)

85 and over 1 (4.3%) 3.4 (9.0%)


Mean ISS 21.7 17.9

ISS <13 7 (30.4%) 7 (18.6%)

ISS 13-15 1 (4.3%) 8.9 (23.7%)

ISS 16-24 8 (34.8%) 13.5 (35.9%)

ISS 25-40 5 (21.7%) 7.1 (18.9%)

ISS 41-75 2 (8.7%) 1.1 (2.9%)


Assault 1 (4.3%) 1.8 (4.8%)

Falls 1 (4.3%) 14.1 (37.5%)

Falls (≥65 years) 1 (4.3%) 8.9 (23.7%)

Road trauma 16 (69.6%) 12.1 (32.2%)




Types of injury

Blunt 21 (91.3%) 35.2 (93.6%)

Penetrating 1 (4.3%) 1.6 (4.3%)


Admission type


Transfer in 0 (0.0%) 7.5 (2.0%)

Unknown 0 (0.0%) 0.3 (0.1%)

Arrival modes

Ambulance 21 (91.3%) 29.8 (7.9%)

Helicopter 1 (4.3%) 2 (0.5%)




ISS < 13 7.50 7.41

ISS 13-15 7.84 7.73

ISS 16-24 7.84 7.47

ISS 25-40 6.42 6.43

ISS 41-75 1.10 5.42




ISS < 13 4.4 8.2

ISS 13-15 6.0 11.3

ISS 16-24 5.0 9.3

ISS 25-40 2.4 4.8

ISS 41-75 1.0 5.6

ICU length of stay



ISS < 13 2.86 2.20

ISS 13-15 5.00 4.06

ISS 16-24 2.33 3.80

ISS 25-40 2.33 2.91

ISS 41-75 1.00 3.00




ISS < 13 0 1.8

ISS 13-15 2.0 1.2

ISS 16-24 1.0 3.2

ISS 25-40 1.0 2.0

ISS 41-75 1.0 1.0


Table 43: Trauma data profile, Tamworth Rural Referral Hospital

Facility Peer






Gender

Female / Male 13 / 22 9.2 / 28.4

Age ranges38

Mean age 51.6 52.5

0-4 0 (0.0%) 0.5 (1.3%)

5-9 0 (0.0%) 0.5 (1.3%)

10-14 2 (5.7%) 0.8 (2.1%)

15-19 1 (2.9%) 2.3 (6.1%)

20-24 2 (5.7%) 2.5 (6.6%)

25-29 0 (0.0%) 1.7 (4.5%)

30-34 1 (2.9%) 2 (5.3%)

35-39 5 (14.3%) 1.4 (3.7%)

40-44 1 (2.9%) 2.2 (5.9%)

45-49 7 (20.0%) 2.7 (7.2%)

50-54 1 (2.9%) 2.3 (6.1%)

55-59 2 (5.7%) 2.4 (6.4%)

60-64 1 (2.9%) 2.7 (7.2%)

65-69 4 (11.4%) 2.7 (7.2%)

70-74 1 (2.9%) 2.8 (7.4%)

75-79 2 (5.7%) 2 (5.3%)

80-84 3 (8.6%) 2.7 (7.2%)

85 and over 2 (5.7%) 3.4 (9.0%)


Mean ISS 20.3 17.9

ISS <13 3 (8.6%) 7 (18.6%)

ISS 13-15 3 (8.6%) 8.9 (23.7%)

ISS 16-24 19 (54.3%) 13.5 (35.9%)

ISS 25-40 9 (25.7%) 7.1 (18.9%)

ISS 41-75 1 (2.9%) 1.1 (2.9%)


Assault 3 (8.6%) 1.8 (4.8%)

Falls 8 (22.9%) 14.1 (37.5%)

Falls (≥65 years) 6 (17.1%) 8.9 (23.7%)

Road trauma 9 (25.7%) 12.1 (32.2%)



38

1 record without age recorded


Types of injury

Blunt 32 (91.4%) 35.2 (93.6%)

Penetrating 3 (8.6%) 1.6 (4.3%)


Admission type


Transfer in 11 (31.4%) 7.5 (2.0%)

Unknown 1 (2.9%) 0.3 (0.1%)

Arrival modes

Ambulance 21 (60.0%) 29.8 (7.9%)

Helicopter 7 (20.0%) 2 (0.5%)




ISS < 13 7.22 7.41

ISS 13-15 7.84 7.73

ISS 16-24 7.55 7.47

ISS 25-40 7.80 6.43

ISS 41-75 4.09 5.42




ISS < 13 3.3 8.2

ISS 13-15 5.3 11.3

ISS 16-24 12.8 9.3

ISS 25-40 8.4 4.8

ISS 41-75 1.0 5.6

ICU length of stay



ISS < 13 1.67 2.20

ISS 13-15 6.00 4.06

ISS 16-24 3.43 3.80

ISS 25-40 3.57 2.91

ISS 41-75 0 3.00




ISS < 13 2.0 1.8

ISS 13-15 0 1.2

ISS 16-24 3.5 3.2

ISS 25-40 2.7 2.0

ISS 41-75 0 1.0


Table 44: Trauma data profile, The Tweed Hospital

Facility Peer






Gender

Female / Male 3 / 23 9.2 / 28.4

Age ranges

Mean age 51.8 52.5

0-4 1 (3.8%) 0.5 (1.3%)

5-9 0 (0.0%) 0.5 (1.3%)

10-14 0 (0.0%) 0.8 (2.1%)

15-19 2 (7.7%) 2.3 (6.1%)

20-24 1 (3.8%) 2.5 (6.6%)

25-29 1 (3.8%) 1.7 (4.5%)

30-34 0 (0.0%) 2 (5.3%)

35-39 2 (7.7%) 1.4 (3.7%)

40-44 0 (0.0%) 2.2 (5.9%)

45-49 2 (7.7%) 2.7 (7.2%)

50-54 5 (19.2%) 2.3 (6.1%)

55-59 2 (7.7%) 2.4 (6.4%)

60-64 2 (7.7%) 2.7 (7.2%)

65-69 4 (15.4%) 2.7 (7.2%)

70-74 1 (3.8%) 2.8 (7.4%)

75-79 0 (0.0%) 2 (5.3%)

80-84 1 (3.8%) 2.7 (7.2%)

85 and over 2 (7.7%) 3.4 (9.0%)


Mean ISS 19.7 17.9

ISS <13 0 (0.0%) 7 (18.6%)

ISS 13-15 8 (30.8%) 8.9 (23.7%)

ISS 16-24 10 (38.5%) 13.5 (35.9%)

ISS 25-40 8 (30.8%) 7.1 (18.9%)

ISS 41-75 0 (0.0%) 1.1 (2.9%)


Assault 2 (7.7%) 1.8 (4.8%)

Falls 15 (57.7%) 14.1 (37.5%)

Falls (≥65 years) 5 (19.2%) 8.9 (23.7%)

Road trauma 6 (23.1%) 12.1 (32.2%)




Types of injury

Blunt 25 (96.2%) 35.2 (93.6%)

Penetrating 0 (0.0%) 1.6 (4.3%)


Admission type


Transfer in 5 (19.2%) 7.5 (2.0%)

Unknown 0 (0.0%) 0.3 (0.1%)

Arrival modes

Ambulance 22 (84.6%) 29.8 (7.9%)

Helicopter 0 (0.0%) 2 (0.5%)




ISS < 13 0 7.41

ISS 13-15 7.33 7.73

ISS 16-24 7.32 7.47

ISS 25-40 6.95 6.43

ISS 41-75 0 5.42




ISS < 13 0 8.2

ISS 13-15 48.3 11.3

ISS 16-24 4.0 9.3

ISS 25-40 8.8 4.8

ISS 41-75 0 5.6

ICU length of stay



ISS < 13 0 2.20

ISS 13-15 0 4.06

ISS 16-24 4.50 3.80

ISS 25-40 9.00 2.91

ISS 41-75 0 3.00




ISS < 13 0 1.8

ISS 13-15 0 1.2

ISS 16-24 5.0 3.2

ISS 25-40 4.5 2.0

ISS 41-75 0 1.0


Table 45: Trauma data profile, Wagga Wagga Rural Referral Hospital

Facility Peer






Gender

Female / Male 6 / 22 9.2 / 28.4

Age ranges

Mean age 50.4 52.5

0-4 0 (0.0%) 0.5 (1.3%)

5-9 0 (0.0%) 0.5 (1.3%)

10-14 0 (0.0%) 0.8 (2.1%)

15-19 4 (14.3%) 2.3 (6.1%)

20-24 3 (10.7%) 2.5 (6.6%)

25-29 2 (7.1%) 1.7 (4.5%)

30-34 0 (0.0%) 2 (5.3%)

35-39 1 (3.6%) 1.4 (3.7%)

40-44 1 (3.6%) 2.2 (5.9%)

45-49 0 (0.0%) 2.7 (7.2%)

50-54 2 (7.1%) 2.3 (6.1%)

55-59 2 (7.1%) 2.4 (6.4%)

60-64 4 (14.3%) 2.7 (7.2%)

65-69 2 (7.1%) 2.7 (7.2%)

70-74 4 (14.3%) 2.8 (7.4%)

75-79 1 (3.6%) 2 (5.3%)

80-84 1 (3.6%) 2.7 (7.2%)

85 and over 1 (3.6%) 3.4 (9.0%)


Mean ISS 13.1 17.9

ISS <13 9 (32.1%) 7 (18.6%)

ISS 13-15 13 (46.4%) 8.9 (23.7%)

ISS 16-24 3 (10.7%) 13.5 (35.9%)

ISS 25-40 3 (10.7%) 7.1 (18.9%)

ISS 41-75 0 (0.0%) 1.1 (2.9%)


Assault 2 (7.1%) 1.8 (4.8%)

Falls 5 (17.9%) 14.1 (37.5%)

Falls (≥65 years) 5 (17.9%) 8.9 (23.7%)

Road trauma 10 (35.7%) 12.1 (32.2%)




Types of injury

Blunt 26 (92.9%) 35.2 (93.6%)

Penetrating 2 (7.1%) 1.6 (4.3%)


Admission type


Transfer in 11 (39.3%) 7.5 (2.0%)

Unknown 0 (0.0%) 0.3 (0.1%)

Arrival modes

Ambulance 20 (71.4%) 29.8 (7.9%)

Helicopter 1 (3.6%) 2 (0.5%)




ISS < 13 6.90 7.41

ISS 13-15 7.84 7.73

ISS 16-24 7.84 7.47

ISS 25-40 7.84 6.43

ISS 41-75 0 5.42




ISS < 13 3.4 8.2

ISS 13-15 2.4 11.3

ISS 16-24 4.7 9.3

ISS 25-40 2.7 4.8

ISS 41-75 0 5.6

ICU length of stay



ISS < 13 2.11 2.20

ISS 13-15 2.00 4.06

ISS 16-24 3.00 3.80

ISS 25-40 0 2.91

ISS 41-75 0 3.00




ISS < 13 1.0 1.8

ISS 13-15 1.0 1.2

ISS 16-24 0 3.2

ISS 25-40 0 2.0

ISS 41-75 0 1.0


Table 46: Trauma data profile, Wollongong Hospital

Facility Peer






Female / Male 15 / 41 9.2 / 28.4

Age ranges

Mean age 58.4 52.5

0-4 0 (0.0%) 0.5 (1.3%)

5-9 0 (0.0%) 0.5 (1.3%)

10-14 2 (3.6%) 0.8 (2.1%)

15-19 1 (1.8%) 2.3 (6.1%)

20-24 2 (3.6%) 2.5 (6.6%)

25-29 2 (3.6%) 1.7 (4.5%)

30-34 2 (3.6%) 2 (5.3%)

35-39 2 (3.6%) 1.4 (3.7%)

40-44 3 (5.4%) 2.2 (5.9%)

45-49 3 (5.4%) 2.7 (7.2%)

50-54 3 (5.4%) 2.3 (6.1%)

55-59 6 (10.7%) 2.4 (6.4%)

60-64 4 (7.1%) 2.7 (7.2%)

65-69 7 (12.5%) 2.7 (7.2%)

70-74 3 (5.4%) 2.8 (7.4%)

75-79 5 (8.9%) 2 (5.3%)

80-84 7 (12.5%) 2.7 (7.2%)

85 and over 4 (7.1%) 3.4 (9.0%)


Mean ISS 18.7 17.9

ISS <13 0 (0.0%) 7 (18.6%)

ISS 13-15 21 (37.5%) 8.9 (23.7%)

ISS 16-24 23 (41.1%) 13.5 (35.9%)

ISS 25-40 12 (21.4%) 7.1 (18.9%)

ISS 41-75 0 (0.0%) 1.1 (2.9%)


Assault 2 (3.6%) 1.8 (4.8%)

Falls 27 (48.2%) 14.1 (37.5%)

Falls (≥65 years) 18 (32.1%) 8.9 (23.7%)

Road trauma 17 (30.4%) 12.1 (32.2%)




Types of injury

Blunt 55 (98.2%) 35.2 (93.6%)

Penetrating 1 (1.8%) 1.6 (4.3%)


Admission type


Transfer in 7 (12.5%) 7.5 (2.0%)

Unknown 1 (1.8%) 0.3 (0.1%)

Arrival modes

Ambulance 49 (87.5%) 29.8 (7.9%)

Helicopter 0 (0.0%) 2 (0.5%)




ISS < 13 0 7.41

ISS 13-15 7.79 7.73

ISS 16-24 7.74 7.47

ISS 25-40 5.92 6.43

ISS 41-75 0 5.42




ISS < 13 0 8.2

ISS 13-15 10.0 11.3

ISS 16-24 6.1 9.3

ISS 25-40 7.2 4.8

ISS 41-75 0 5.6

ICU length of stay



ISS < 13 0 2.20

ISS 13-15 0 4.06

ISS 16-24 0 3.80

ISS 25-40 5.00 2.91

ISS 41-75 0 3.00




ISS < 13 0 1.8

ISS 13-15 1.0 1.2

ISS 16-24 0 3.2

ISS 25-40 1.7 2.0

ISS 41-75 0 1.0


Appendix 4: Calculation of the Injury Severity Score

An injury severity score (ISS) is calculated for each patient based on the AIS injury severity

classification of their specific injuries. The ISS value ranges from 1-75 and is calculated as:

ISS = A2 + B2 + C2

Where A, B, and C are the highest AIS severity codes in each of the (up to) three most severely

injured ISS body regions.

The six ISS body regions are:

Head or neck

Face

Chest



External

The following example shows how an ISS is calculated from a set of injuries.

Table 47: ISS calculation example

ISS Body region Injury AIS Severity Code Include in ISS

calculation?

Head or Neck Small subdural

haematoma AIS-4 Yes

Chest Bilateral lung contusion AIS-4 No

Chest Bilateral flail chest AIS-5 Yes


Superficial spleen laceration

AIS-2 Yes


Left phalange (little toe) fracture

AIS-1 No

On the basis of the above injuries, the ISS is calculated as:

ISS = 42 + 52 + 22

ISS = 45 (critical injury)


Appendix 5: Calculation of adjusted mortality rate

Adjusted mortality rate refers to the mortality rate that would have existed if each trauma service

had the same age or ISS distribution as the “standard” population. In this report, the total NSW

trauma patients were considered as the standard population. Adjusted mortality rates were

calculated based on indirect standardization method.

The following steps were undertaken independently to calculate adjusted mortality rates based on

ISS. Similar calculation was done for age.

1. Calculating the total number of observed deaths in each trauma service (ISS>12).

2. Calculating ISS specific mortality rates in the standard population (the total NSW trauma

patients). This was done by adding the population of each ISS group together and adding all

the death rate for each ISS group together and then calculating ISS specific mortality rate for

each ISS group of the standard population, i.e. the total NSW population.

3. Calculating expected deaths for each ISS group of the trauma service: Multiplying the number

of people in each ISS group of the trauma service by the ISS specific mortality rate of the

standard population (the total NSW trauma patients).

4. Calculating the sum of the expected death rates.

5. Calculating standardised mortality ratio (SMR) by dividing the total number of observed deaths

by the sum of expected deaths.

6. Calculating adjusted mortality rate by multiplying SMR by the crude death rate of the standard

population.

The example on the next page illustrates the calculations.


Table 48: Calculation of adjusted mortality rate

NSW Trauma Population (standard population)

ISS Group A) Number of patients in

each ISS group B) Total deaths in each

ISS Group

C) ISS specific mortality rate for each ISS group of the standard population

(C= B / A)

ISS 13-15 480 9 0.019

ISS 16-24 801 32 0.040

ISS 25-40 440 106 0.241

ISS 41-75 63 28 0.444

Total ∑A= 1784 ∑B= 175 0.10

Crude mortality rate of standard population (percentage) = ∑B / ∑A*100 = 356/3525 = 10.1%


Appendix 6: Australian Statistical Geography Standard Remoteness Areas

The Australian Statistical Geography Standard (ASGS) Remoteness Areas (RA) is based on the

Accessibility and Remoteness Index of Australia (ARIA+) which defines locations in terms of

remoteness, i.e. the physical distance of a location from the nearest urban centre (access to goods

and services) based on population size.

Figure 26: Map of NSW showing ASGS-RA39

For further information on ASGS-RA please see the Australian Bureau of Statistics website:

http://www.abs.gov.au/websitedbs/d3310114.nsf/home/remoteness+structure

39

Source: ABS, 1270.0.55.005 - Australian Statistical Geography Standard (ASGS): Volume 5 - Remoteness Structure, July 2011

http://www.abs.gov.au/websitedbs/d3310114.nsf/home/remoteness+structure

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