a report from the nsw trauma registry€¦ · a report from the nsw trauma registry ....

NSW Institute of Trauma and Injury Management

Major Trauma in NSW, 2013

A report from the NSW Trauma Registry

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.

Updated – 6 January 2015

1. Table 23 on page 34, updated Case Fatality Rate from 11.7% to 9.5% 2. Table 24 on page 36, updated Mean ISS from 21.0 to 21.7 and on page 37 all hospital content from second column

was updated 3. Table 25 on page 38, updated Mean ISS from 21.7 to 22.3

AGENCY FOR CLINICAL INNOVATION Level 4, Sage Building 67 Albert Avenue Chatswood NSW 2067 Agency for Clinical Innovation 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 Produced by: Elvis Maio, Data Officer, NSW Institute of Trauma and Injury Management Ph. +61 2 9464 4667 Email. [email protected] SHPN: (ACI) 140471 ISBN: 978-1-76000-120-9 Further copies of this publication can be obtained from: Agency for Clinical Innovation website at: www.aci.health.nsw.gov.au Disclaimer: Content within this publication was accurate at the time of publication. There is potential for minor revisions of data in this report. This work is copyright. It may be reproduced in whole or part for study or training purposes subject to the inclusion of an acknowledgment of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the Agency for Clinical Innovation. © Agency for Clinical Innovation 2014 Published December 2014, updated January 2015

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Table of Contents

1. EXECUTIVE SUMMARY 6

2. MONITORING THE NSW TRAUMA SYSTEM 7

2.1 NSW Trauma System 7

2.2 Mandate for trauma data 7

2.3 NSW Trauma Registry 7

2.4 NSW Trauma Services 8

3. METHODOLOGY 9

3.1 Data quality 9

3.2 The Injury Severity Score and Abbreviated Injury Score 9

3.3 Revised Trauma Score 9

3.4 Inclusion criteria 10

3.5 Exclusion criteria 10

4. MAJOR TRAUMA PATIENTS 11

4.1 Introduction 11

4.2 Summary profile 11

4.3 Age and gender 11

4.4 Mechanism of injury 15

4.5 Time and day of injury 20

4.6 Injuries 21

4.7 Injury Severity Score 23

4.8 Pre-hospital time 24

4.9 Mode of transport 25

5. MAJOR TRAUMA ADMISSIONS 27

5.1 Introduction 27

5.2 Facility overview 27

5.3 Admission type 28

5.4 Revised Trauma Score 28

5.5 Vital signs on arrival to the Emergency Department 29

5.6 Length of stay 30

5.7 Surgical procedures 32

5.8 Discharge destination of survivors 32

6. APPENDICES 33

6.1 Appendix 1: Adult Major Trauma Service summaries 34

6.2 Appendix 2: Paediatric Major Trauma Service summaries 48

6.3 Appendix 3: Regional Trauma Service summaries 54

6.4 Appendix 4: Calculation of the Injury Severity Score (ISS) 72

6.5 Appendix 5: Australian and NSW Postcode Ranges 73

7. GLOSSARY 74

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List of Tables

Table 1: Revised Trauma Score points system ..................................................................................................... 10

Table 2: Summary statistics for major trauma and mortality .................................................................................. 11

Table 3: Major trauma patients, injury and death rate by age group ...................................................................... 12

Table 4: Type of injury ........................................................................................................................................... 15

Table 5: Mechanism of injury by age ..................................................................................................................... 16

Table 6: Mechanism of injury by place of injury ..................................................................................................... 18

Table 7: Falls in detail ............................................................................................................................................ 19

Table 8: Road trauma in detail............................................................................................................................... 19

Table 9: Assaults in detail ...................................................................................................................................... 19

Table 10: Top 5 injuries with an AIS severity >2 .................................................................................................... 21

Table 11: Number of ISS body regions injured with an AIS severity >2 ................................................................ 22

Table 12: Single body region versus polytrauma with an AIS severity >2 ............................................................. 22

Table 13: Major trauma patients by ISS group ...................................................................................................... 23

Table 14: Time of injury to arrival at a designated trauma service) ....................................................................... 24

Table 15: Time of injury to arrival at definitive care if transferred from another trauma service ............................. 25

Table 16: Mode of transport to definitive care ....................................................................................................... 25

Table 17: Overview of trauma service admissions ................................................................................................ 27

Table 18: Number of admissions by type .............................................................................................................. 28

Table 19: Overview of ICU and hospital length of stay .......................................................................................... 30

Table 20: ICU and hospital length of stay by ISS .................................................................................................. 30

Table 21: ICU and hospital length of stay by age .................................................................................................. 31

Table 22: Number of surgical procedures performed by type in total admissions.................................................. 32

Table 23: Trauma data profile, John Hunter Hospital ............................................................................................ 34

Table 24: Trauma data profile, Liverpool Hospital ................................................................................................. 36

Table 25: Trauma data profile, Royal North Shore Hospital .................................................................................. 38

Table 26: Trauma data profile, Royal Prince Alfred Hospital ................................................................................. 40

Table 27: Trauma data profile, St George Hospital ............................................................................................... 42

Table 28: Trauma data profile, St Vincent’s Hospital ............................................................................................. 44

Table 29: Trauma data profile, Westmead Hospital ............................................................................................... 46

Table 30: Trauma data profile, John Hunter Children’s Hospital ........................................................................... 48

Table 31: Trauma data profile, Sydney Children’s Hospital ................................................................................... 50

Table 32: Trauma data profile, Westmead Children’s Hospital .............................................................................. 52

Table 33: Trauma data profile, Coffs Harbour Base Hospital ................................................................................ 54

Table 34: Trauma data profile, Gosford Hospital ................................................................................................... 56

Table 35: Trauma data profile, Lismore Base Hospital .......................................................................................... 58

Table 36: Trauma data profile, Nepean Hospital ................................................................................................... 60

Table 37: Trauma data profile, Orange Health Service ......................................................................................... 62

Table 38: Trauma data profile, Port Macquarie Base Hospital .............................................................................. 64

Table 39: Trauma data profile, Tamworth Rural Referral Hospital......................................................................... 66

Table 40: Trauma data profile, The Tweed Hospital .............................................................................................. 68

Table 41: Trauma data profile, Wagga Wagga Base Hospital ............................................................................... 70

Table 42: ISS calculation example ........................................................................................................................ 72

Table 43: Postcode ranges defining location of injury ........................................................................................... 73

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List of Figures

Figure 1: Number of major trauma patients by age, gender and mortality ................................................................... 13

Figure 2: Age-specific injury rate by age and gender .................................................................................................. 13

Figure 3: Case fatality rate by age and gender ............................................................................................................ 14

Figure 4: Age-specific mortality rate by age and gender ............................................................................................. 14

Figure 5: Mechanism of injury...................................................................................................................................... 15

Figure 6: Mechanism of injury by age .......................................................................................................................... 17

Figure 7: Mechanism of injury as a percentage by age ............................................................................................... 17

Figure 8: Age-specific rates of mechanism of injury .................................................................................................... 18

Figure 9: Number of patients by time of injury ............................................................................................................. 20

Figure 10: Number of patients by day of injury ............................................................................................................ 20

Figure 11: All injuries by ISS body region .................................................................................................................... 21

Figure 12: Number of major trauma patients by ISS group and gender ...................................................................... 23

Figure 13: Case fatality rate by ISS and gender .......................................................................................................... 24

Figure 14: Mode of transport to definitive care when transported direct from the scene of injury, by injury location ... 26

Figure 15: Mode of transport to definitive care when transfer from another acute care facility, by injury location ....... 26

Figure 16: Average Revised Trauma Score by ISS group ........................................................................................... 28

Figure 17: Initial systolic blood pressure on arrival to the ED and mortality ................................................................. 29

Figure 18: Initial Glasgow Coma Scale on arrival to the ED and mortality ................................................................... 29

Figure 19: Initial temperature on arrival to ED and mortality ........................................................................................ 30

Figure 20: Discharge destination of survivors by percentage ...................................................................................... 32

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1. Executive Summary Each year more than 3,100 people are moderately to critically injured in NSW and are

admitted to a NSW Trauma Service. 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 whole community.

A key priority for the NSW Institute of Trauma and Injury Management (ITIM) 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 these 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 worked and 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 able to contribute to safety and injury prevention efforts and assist other

agencies concerned with minimising the likelihood and effects of traumatic injury. Data from

the NSW Trauma Registry is used 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.

Report highlights:

3,186 major trauma patients.

3,411 major trauma admissions.

Average age was 51.9 years old.

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

Overall case fatality rate was 12.5%.

Females had a higher case fatality rate (14.3%) than males (11.8%).

Falls accounted for 44.5% of all major trauma, exceeding road trauma (37.8%).

Falls was the mechanism of injury for 75.0% of major trauma patients aged ≥65 years.

Rate of injury from falls markedly increased from 55 years of age.

Falls accounted for 55.8% of all major trauma deaths.

37.9% of major trauma was sustained in a rural area.

"Three or more fractured ribs" was the most common single injury sustained.

Subdural haemorrhage of varying severity occupied three of the top five injuries.

67.3% of major trauma patients sustained an injury to the head and neck region.

77.5% of major trauma patients sustained serious injury to only one body region.

25.0% of rural major trauma was transported from the scene of injury by helicopter.

4.7% of major trauma patients presented directly to hospital by private transport.

Average hospital length of stay was 13.5 days.

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2. Monitoring the NSW Trauma System

2.1 NSW Trauma System

The NSW Trauma System is an organised approach to facilitate and coordinate a

multidisciplinary system response to ultimately save the lives of traumatically injured patients.

The system encompasses a continuum of care that provides injured people 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.

2.2 Mandate for trauma data

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

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

individual Trauma Services to ensure that performance is consistent with the standard of

care and to manage a state-wide clinical injury data collection process.

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

the Ambulance Service of NSW, Motor Accidents Authority, State Coroner, Clinical

Excellence Commission 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.

2.3 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 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.

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2.4 NSW Trauma Services

The NSW Trauma System consists of 7 adult Major Trauma Services, 3 Paediatric Major

Trauma Services and 10 Regional Trauma Services. All of the services except Wollongong

Hospital 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 Base Hospital

Wollongong Hospital1

1 Wollongong Hospital did not contribute data to the NSW Trauma Registry in 2013.

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3. Methodology

3.1 Data quality

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

while missing or invalid data is flagged and returned to individual trauma services for

completion and validation.

3.2 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 6 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)

3.3 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 1.2 The lower the score, the

higher the likelihood of death.

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

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Table 1: Revised Trauma Score points system

Glasgow Coma Scale (GCS)

GCS points

(weight=0.9368)

Systolic blood pressure (SBP)

SBP points

(weight=0.7326)

Respiratory rate (RR)

RR points

(weight=0.2908)

15-13 4 >89 4 10-29 4

12-9 3 76-89 3 >29 3

8-6 2 50-75 2 6-9 2

5-4 1 1-49 1 1-5 1

3 0 0 0 0 0

3.4 Inclusion criteria

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

occurred in the calendar year of 2013, are included in this report.

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

Service within 14 days of sustaining an injury, and who:

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

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.

3.5 Exclusion criteria

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

Patients not admitted to a NSW Trauma Service

Patients admitted after 14 days of sustaining injury

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

from a standing height (<1 metre)

Patients aged 65 years or older who die with minor soft tissue injury only3

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

missing or invalid data recorded in the registry:

Injury Severity Score

Date of injury

Date of admission

A total of 7 records were excluded from this report due to missing or invalid data.

3 See Glossary for definition of minor soft tissue injury.

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4. Major trauma patients

4.1 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=3,186), not the number of trauma

admissions (n=3,411), as some patients were treated in more than one NSW reporting facility.

Trauma admission data (hospital activity) is discussed in detail in Section 5.

4.2 Summary profile

During the 2013 calendar year, there were 3,186 major trauma patients treated at NSW

Trauma Centres, of which 398 died (case fatality rate of 12.5%).4 The age-standardised

injury rate was 40.3 per 100,000 persons and the age-standardised death rate was 4.6 per

100,000 persons.5 The Standardised Mortality Ratio (SMR)6 was 4.8, indicating that the

proportion of deaths in major trauma patients in 2013 was nearly five times greater than that

of the general Australian population (Table 2).

Table 2: Summary statistics for major trauma and mortality

Summary statistics Count

Total number injured 3,186

Injury rate per 100,000 persons (age-standardised) 40.3

Total number of deaths (case fatality rate) 398 (12.5%)

Death rate per 100,000 persons (age-standardised) 4.6 (95% CI 4.3 – 4.9)

Standardised Mortality Ratio (SMR) 4.8

Average age 51.9 years

Average Injury Severity Score (ISS) 21.0

4.3 Age and gender

The average age of a major trauma patient in NSW in 2013 was 51.9 years old. Table 3

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

trauma in the geriatric population,7 especially those aged 75 years and older. The 75 years

and older age group also has a significantly higher case fatality rate (26.7%, n=767) versus

the less than 75 years age group (8.0%, n= 2,419).

4 Case fatality rate is the proportion of deaths for a designated population expressed as a percentage. 5 Rate given as per 100,000 persons, 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. 6 The Standardised Mortality Ratio (SMR) is a ratio between the observed number of deaths in an study population and the

number of deaths that would be expected, based on the age-specific and sex-specific rates in a standard population and the age and sex distribution of the study population. 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. 7 Geriatric defined as aged 65 years and older.

https://ibis.health.state.nm.us/resources/Glossary.html#R

https://ibis.health.state.nm.us/resources/Glossary.html#S


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

Age group (years)

Number of injured

(% of total)

Cumulative number of

injured (% of total)

Age-specific injury rate

per 100,0008

Case fatality rate

Age-specific death rate

per 100,0008

0-4 94 (3.0%) 94 (3.0%) 19.3 13.8% 2.7

5-9 37 (1.2%) 131 (4.1%) 8.0 8.1% 0.6

10-14 62 (1.9%) 193 (6.1%) 13.9 3.2% 0.4

15-19 163 (5.1%) 356 (11.2%) 35.1 9.2% 3.2

20-24 221 (6.9%) 577 (18.1%) 43.6 6.8% 3.0

25-29 170 (5.3%) 747 (23.4%) 32.0 8.2% 2.6

30-34 168 (5.3%) 915 (28.7%) 31.9 7.7% 2.5

35-39 178 (5.6%) 1,093 (34.3%) 35.9 4.5% 1.6

40-44 187 (5.9%) 1,280 (40.2%) 35.7 9.6% 3.4

45-49 184 (5.8%) 1,464 (46.0%) 38.2 5.4% 2.1

50-54 206 (6.5%) 1,576 (49.5%) 41.2 6.3% 2.6

55-59 176 (5.5%) 1,846 (57.9%) 38.9 6.3% 2.4

60-64 187 (5.9%) 2,033 (63.8%) 46.5 7.0% 3.2

65-69 192 (6.0%) 2,225 (69.8%) 53.8 7.8% 4.2

70-74 194 (6.1%) 2,419 (75.9%) 74.5 15.5% 11.5

75-79 214 (6.7%) 2,633 (82.6%) 106.8 20.1% 21.5

80-84 202 (6.3%) 2,835 (89.0%) 131.6 21.8% 28.7

85 and over 351 (11.0%) 3,186 (100%) 229.3 33.6% 77.1

8 Rate given as per 100,000 persons, based on the NSW population at 30 June 2013. Source: Australian Bureau of Statistics.

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

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Males have a significantly higher number of major trauma injuries with survival (88.2%, n=2,008) compared to females (85.7%, n=780), except in the 85 and over group (Figure 1). Overall, males are 2.5 times more likely to be injured than females. Figure 1: Number of major trauma patients by age, gender and mortality (n=3,186)

0

20

40

60

80

100

120

140

160

180

Num

ber

of patie

nts

Age group

Died - Male

Died - Female

Survived - Male

Survived - Female

The age-specific injury rate for males ranged from 10.9 to 310.5 per 100,000 persons and in females ranged 4.9 to 184.9 per 100,000 persons (Figure 2).

Figure 2: Age-specific injury rate by age and gender (n=3,186)

0

50

100

150

200

250

300

350

Age-s

pecific

rate

(in

jury

/ 1

00,0

00)

Age group

Males

Females

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The overall case fatality rate (the proportion of deaths of a designated population) was higher

for females (14.3%, n=130) than for males (11.8%, n=268). The difference was prominent in

the 20-34 and the 45-59 age groups (Figure 3). Of note, there were no recorded female

deaths in the 35-39 year age group.

Figure 3: Case fatality rate by age and gender (n=3,186)

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

rate per 100,000 persons in all age groups compared to that of females (Figure 4).

Figure 4: Age-specific mortality rate by age and gender (n=3,186)

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

Case fata

lity r

ate

Age group

Male

Female

0

20

40

60

80

100

120

140

Age-s

pecific

mort

alit

y r

ate

(d

eath

s / 1

00,0

00)

Age group

Male

Female

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4.4 Mechanism of injury

The vast majority of major trauma in NSW was caused by blunt injuries (96.0%), such as falls

and motor vehicle collisions (Table 4).

Table 4: Type of injury (n=3,158)9

Type of injury Number of patients (% of total) Case fatality rate

Blunt 3,031 (96.0%) 12.0%

Penetrating 127 (4.0%) 15.0%

The top three mechanisms of injury were falls (44.5%), road trauma (37.8%) and assault

(7.3%). All other mechanisms combined accounted for 10.5% (Figure 5). The distribution of

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

Figure 5: Mechanism of injury (n=3,186)

9 Only blunt and penetrating injury types are reported. Other injury types (n=28) are recorded as ‘N/A’ or ‘Unknown'.

7.3%

44.5% 37.8%

10.5%

Assault

Fall

Road Trauma

All other mechanisms

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Table 5: Mechanism of injury by age (n=3,186)

Age group

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

Falls Road Trauma Assaults All other

mechanisms

0-4 38 (7.8) 18 (3.7) 11 (2.3) 27 (5.5)

5-9 10 (2.2) 22 (4.7) 0 5 (1.1)

10-14 13 (2.9) 36 (8.1) 3 (0.7) 10 (2.2)

15-19 30 (6.5) 102 (21.9) 15 (3.2) 16 (3.4)

20-24 40 (7.9) 130 (25.7) 26 (5.1) 25 (4.9)

25-29 38 (7.1) 85 (16.0) 30 (5.6) 17 (3.2)

30-34 39 (7.4) 72 (13.7) 35 (6.6) 22 (4.2)

35-39 39 (7.9) 85 (17.1) 23 (4.6) 31 (6.3)

40-44 46 (8.8) 89 (17.0) 29 (5.5) 23 (4.4)

45-49 55 (11.4) 95 (19.7) 16 (3.3) 18 (3.7)

50-54 54 (10.8) 107 (21.4) 13 (2.6) 32 (6.4)

55-59 69 (15.2) 74 (16.3) 10 (2.2) 23 (5.1)

60-64 82 (20.4) 73 (18.1) 6 (1.5) 26 (6.5)

65-69 108 (30.3) 64 (17.9) 4 (1.1) 16 (4.5)

70-74 129 (49.5) 51 (19.6) 5 (1.9) 9 (3.5)

75-79 165 (82.3) 35 (17.5) 2 (1.0) 12 (6.0)

80-84 162 (105.6) 32 (20.9) 4 (2.6) 4 (2.6)

85 and over 301 (196.6) 33 (21.6) 0 17 (11.1)

Total 1418 1203 232 333

Falls in the elderly were a significant problem, accounting for 75.0% of major trauma patients

aged 65 years and older (Figures 6-7). The rate of injury from falls in the 85 and over age

group was 196.6 per 100,000 persons (Figure 8).

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Figure 6: Mechanism of injury by age (n=3,186)

Figure 7: Mechanism of injury as a percentage by age (n=3,186)

0

50

100

150

200

250

300

350

Num

ber

of patie

nts

Age group

Assault

Fall

Road Trauma


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perc

enta

ge o

f in

jury

/age g

roup

Age group

Assault

Fall

Road Trauma

All Other Mechanisms

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Figure 8: Age-specific rates of mechanism of injury (n=3,186)

Falls were responsible for 50.6% of the injuries in the metropolitan area, compared to 35.0%

in rural areas. Road trauma was higher in rural areas (44.6%) than in metro areas (32.8%),

and assaults were similar between the two injury locations (Table 6).

Table 6: Mechanism of injury by place of injury (n=3,117)10

Mechanism of Injury Metro (% of metro) Rural (% of rural)

Assault 137 (7.1%) 88 (7.4%)

Fall 980 (50.6%) 414 (35.0%)

Road Trauma 635 (32.8%) 527 (44.6%)

All other mechanisms 183 (9.5%) 153 (12.9%)

Total 1,935 (100%) 1,182 (100%)

The top three mechanisms of injury are outlined in more detail in Tables 7-9. Falls from a

standing height (<1m) accounted for 56.1% of all falls, 25.0% of all trauma mechanisms and

39.9% of all trauma deaths (Table 7). Pedestrian trauma had a significantly higher case

fatality rate (14.4%) compared to other road trauma mechanisms of injury (Table 8). There

were more than three times the number of stabbings compared to shootings which resulted

in major trauma, although blunt assault accounted for 4.8%, which remains the most

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

10 69 records excluded due to injury location unknown or injured overseas.

0

20

40

60

80

100

120

140

160

180

200

Age-s

pecific

rate

/100,0

00

Age group

Assault

Fall

Road Trauma


/ 75

Table 7: Falls in detail

Mechanism Number injured

(% of all mechanisms) Number of deaths (case fatality rate)

Percentage of all trauma deaths

Low (<1m) 795 (25.0%) 159 (20.0%) 39.9%

Medium (1-5m) 452 (14.2%) 38 (8.4%) 9.5%

High (>5m) 83 (2.6%) 10 (12.0%) 2.5%

Unspecified 88 (2.8%) 15 (17.0%) 3.8%

Total 1,418 (44.5%) 222 (15.7%) 55.8%

Table 8: Road trauma in detail




Motor Vehicle Collision

477 (15.0%) 27 (5.7%) 6.8%

Motor Bike Collision11

367 (11.5%) 16 (4.4%) 4.0%

Pedestrian 195 (6.1%) 28 (14.4%) 7.0%

Pedal Cyclist 164 (5.1%) 10 (6.1%) 2.5%

Total 1,203 (37.8%) 81 (6.7%) 20.4%

Table 9: Assaults in detail




Blunt assault 154 (4.8%) 14 (9.1%) 3.5%

Shooting 18 (0.6%) 4 (22.2%) 1.0%

Stabbing 60 (1.9%) 7 (11.7%) 1.8%

Total 232 (7.3%) 25 (10.8%) 6.3%

11 Includes 3 wheeler and quad bikes (all-terrain vehicles).

/ 75

4.5 Time and day of injury

54.2% of patients (n=1,500) were injured between 10am and 7pm resulting in peak activity in

the hospitals during the afternoon and evening (Figure 9).

Figure 9: Number of patients by time of injury (n=2,767)12

12 419 records were excluded due to the time of injury not being recorded or unknown.

13 In 2013 there were 261 week days and 104 weekend days.

0

20

40

60

80

100

120

140

160

180

200

00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Num

ber

of patie

ts

Time of day (24hrs)

The mean daily number of persons injured on a weekday was 8.1. The number of persons

injured on weekends was 20% higher at a mean of 10.2 per day (Figure 10).13

Figure 10: Number of patients by day of injury (n=3,186)

399 413 409 416

486

549

514

0

100

200

300

400

500

600

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Num

ber

of patie

nts

Day of the week

/ 75

4.6 Injuries

Three or more fractured ribs without a flail segment14 continues to be the most common

single injury sustained where the AIS severity was greater than 2 (Table 10). However,

subdural haemorrhage of varying severity occupied three out of the top five injuries,

accounting for 23.1% of all major trauma patients.

Table 10: Top 5 injuries with an AIS severity >2 (n=3,186)

Injury description AIS severity Number of patients

(% of total)

Fractured ≥3 ribs without flail 3 615 (19.3%)

Cerebrum haematoma - subdural - small; moderate 4 360 (11.3%)

Cerebrum haematoma - subdural - large; massive; extensive 5 227 (7.1%)

Cerebrum haematoma - subdural - tiny 3 148 (4.6%)

Base (basilar) skull fracture - not further specified 3 143 (4.5%)

67.3% of major trauma patients sustained injuries to the head or neck body region, with the

chest region injured in 48.1% of major trauma patients (Figure 11).

Figure 11: All injuries by ISS body region (n=3,186)

14 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.

67.3%

18.3%

48.1%

24.9%

42.5%

53.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Head Face Chest Abdominal orpelvic contents

Extremities orpelvic girdle

External

Perc

enta

ge o

f to

tal patie

nts

ISS body region

/ 75

The majority of major trauma patients (77.5%) sustained serious injury (AIS severity >2) to

only one ISS body region (Table 11).

Table 11: Number of ISS body regions injured with an AIS severity >2 (n=3,186)

Number of ISS body regions injured Number of patients (% of total)

1 2,467 (77.5%)

2 561 (17.6%)

3 106 (3.3%)

4 21 (0.7%)

5 1 (0.0%)

21.8% of major trauma patients sustained polytrauma, defined as serious injury (AIS severity

>2) in two or more ISS body regions.15 Polytrauma had a higher case fatality rate at 13.2%

versus that of single body region injury at 11.2% (Table 12).

Table 12: Single body region versus polytrauma with an AIS severity >2 (n=3,186)

Number of patients Case fatality rate

Single body region 2,467 (78.2%) 11.2%

Polytrauma 689 (21.8%) 13.2%

15 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.

/ 75

4.7 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 13).

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 major trauma patients was 21.

Table 13: Major trauma patients by ISS group (n=3,186)

ISS group Number of patients

(% of total) Number of deaths (case

fatality rate)

ISS <13 62 (1.9%) 62 (100%)16

ISS 13-15 728 (22.8%) 11 (1.5%)

ISS 16-24 1,392 (43.7%) 57 (4.1%)

ISS 25-40 869 (27.3%) 217 (25.0%)

ISS 41-75 135 (4.2%) 51 (37.8%)

The serious injury category (ISS 16-24) contained the highest number of injured at 1,393

(43.7%), the severe injury category (ISS 25-40) had 871 (27.3%) and the moderate injury

category (ISS 13-15) had 729 (22.9%) injured (Figure 12).

Figure 12: Number of major trauma patients by ISS group and gender (n=3,186)

16 Patients with an ISS<13 are included as major trauma only if the outcome was death, hence the case fatality rate of 100%.

36

545

973

627

98

26

184

420

244

37

0

100

200

300

400

500

600

700

800

900

1000

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

Num

ber

of patie

nts

ISS group

Male

Female

/ 75

Females had a higher case fatality rate than males in almost all ISS groups (Figure 13). This

was reflected in the overall case fatality rate which was higher in females than males (14.3%

vs 11.8%).

Figure 13: Case fatality rate by ISS and gender (n=3,186)

4.8 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 (75 mins) than those injured in a rural location (187 mins)

(Table 14).

Table 14: Time of injury to arrival at a designated trauma service (n=2,673)17

Location of injury Median time of injury to arrival at a

designated trauma service

Metropolitan 75 mins (n=1,754)

Rural 187 mins (n=919)

NSW overall 94 mins (n=2,673)

17 513 records excluded due to data being incomplete relating time of injury or admission, was injured overseas, or location of

injury unknown.

1.1%

4.1%

23.5%

39.8%

2.7% 4.1%

28.7%

32.4%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

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

Case F

ata

lity R

ate

ISS group

Male

Female

/ 75

A number of major trauma patients (n=233) 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 724 minutes. An injury in a rural area took 172 minutes longer to reach definitive

care compared to a metropolitan area, if transferred from a designated trauma service (Table

15).

Table 15: Time of injury to arrival at definitive care if transferred from another trauma

service (n=186)18

Location of injury If transferred median time of injury to

arrival at definitive care

Metropolitan 607 mins (n=50)

Rural 779 mins (n=136)

NSW overall 724 mins (n=186)

4.9 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 (77.3%), with helicopter, fixed wing and private transport also used (Table 16,

Figure 14 and Figure 15).

Table 16: Mode of transport to definitive care (n=2,991)19

Transport mode Direct from scene of

injury Transfer from another

acute care facility Total

Road Ambulance 1,896 (83.8%) 415 (58.0%) 2,311 (77.3%)

Helicopter 264 (11.6%) 162 (22.7%) 426 (14.2%)

Private Vehicle 108 (4.7%) 7 (1.0%) 115 (3.8%)

Fixed Wing 2 (0.1%) 117 (16.4%) 119 (4.0%)

Other 4 (0.2%) 6 (0.8%) 10 (0.3%)

Unknown 2 (0.1%) 8 (1.1%) 10 (0.3%)

Total 2,276 715 2,991

18 47 records were excluded due to data being incomplete relating to time of injury or admission.

19 195 records were excluded where location of injury was recorded as overseas, same facility, unknown or transport mode

missing.

/ 75

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

of injury, by injury location (n=2,276)

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

care facility, by injury location (n=715)

89.2%

6.0% 4.5% 0.2%

69.0%

25.0%

5.2% 0.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ambulance Helicopter Private Vehicle Other

Perc

enta

ge o

f to

tal

Mode of transport

Metropolitan (n=1,608)

Rural (n=668)

88.5%

8.6%

0.4% 2.5%

38.5%

26.6%

31.7%

3.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ambulance Helicopter Fixed Wing Other

Perc

enta

ge o

f to

tal

Mode of transport

Metropolitan (n=279)

Rural (n=436)

/ 75

5. Major trauma admissions

5.1 Introduction

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

admissions to NSW Trauma Services (n=3,411), not the number of major trauma patients

(n=3,186), as some patients were treated in more than one NSW reporting facility. Trauma

patient data is discussed in detail in Section 4.

5.2 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 17).

Table 17: Overview of trauma service admissions (n=3,411)

Facility Number of admissions

Average age

Average ISS

Case fatality rate

Adult Major Trauma Service 2,637 54.4 21.4 12.3%

John Hunter Hospital 486 50.9 21.0 9.5%

Liverpool Hospital 306 52.8 21.7 14.1%

Royal North Shore Hospital 476 59.1 22.3 18.1%

Royal Prince Alfred Hospital 310 58.5 20.9 10.3%

St George Hospital 422 54.1 22.3 11.8%

St Vincent's Hospital 189 52.1 21.5 8.5%

Westmead Hospital 448 53.0 20.2 11.6%

Paediatric Major Trauma Service 179 6.2 21.9 8.9%

John Hunter Children’s Hospital 40 7.5 19.1 7.5%

Sydney Children's Hospital 63 5.7 20.3 7.9%

The Children's Hospital at Westmead 76 6.0 24.8 10.5%

Regional Trauma Service 595 51.6 19.7 9.6%

Coffs Harbour Base Hospital 68 49.5 21.6 8.8%

Gosford Hospital 63 61.7 18.0 20.6%

Lismore Base Hospital 66 47.4 20.7 9.1%

Nepean Hospital 77 54.8 18.2 14.3%

Orange Health Service 91 50.7 20.7 6.6%

Port Macquarie Base Hospital 43 51.3 19.7 7.0%

Tamworth Rural Referral Hospital 60 45.8 17.9 1.7%

The Tweed Hospital 44 53.3 20.5 11.4%

Wagga Wagga Base Hospital 83 50.7 19.5 7.2%

/ 75

5.3 Admission type

The majority of major trauma patients (74.1%, n=2,528) were admitted to the trauma service direct from the scene of injury. However, 851 (24.9%) major trauma patients were admitted via inter-hospital transfer and less than 1% were either unable to be identified or already admitted in the hospital (Table 18). Table 18: Number of admissions by type (n=3,411)

Admission type Number of admissions Percentage of admissions

Direct from scene 2,528 74.1%

Transfer from another acute care facility

851 24.9%

Other and Unknown 32 0.9%

5.4 Revised Trauma Score

The Revised Trauma Score20 is an early (<24 hours) indicator of trauma outcomes. The

lower the score, the higher 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 RTS. The

average Revised Trauma Score was 7.1 (Figure 16).

Figure 16: Average Revised Trauma Score by ISS group (n=2,684)21

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

21 678 records were excluded as no Revised Trauma Score was recorded.

7.7 7.4

6.5

5.0

0

1

2

3

4

5

6

7

8

9

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

Avera

ge R

evis

ed T

raum

a S

core

ISS Group

/ 75

5.5 Vital signs on arrival to the Emergency Department

The initial vital signs on arrival to the ED are a useful indicator of injury severity and a

predictor 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

17-19).

Figure 17: Initial systolic blood pressure on arrival to the ED and mortality (n=2,911)

Figure 18: Initial Glasgow Coma Scale on arrival to the ED and mortality (n=2,892)

89.7%

74.5%

10.3%

25.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All patients n=2,911 Died n=341

Perc

enta

ge o

f patie

nts

<100mmHg

≥100mmHg

55.4%

19.8%

22.0%

18.7%

4.8%

9.1%

17.7%

52.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All patients n=2,892 Died n=353

Perc

enta

ge o

f patie

nts

3-8

9-12

13-14

15

/ 75

Figure 19: Initial temperature on arrival to ED and mortality (n=2,186)

5.6 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 13.5 days (Table 19).

Table 19: Overview of ICU and hospital length of stay

Number of patients Average days Median days

ICU LOS 1,189 6.4 3.0

Total Hospital LOS 3,411 13.5 7.0

There was a positive correlation between an increasing ISS with longer ICU LOS and with

overall hospital LOS (Table 20). It is important to note that all patients in the ISS <13 group

died during their hospital admission.

Table 20: ICU and hospital length of stay by ISS

ISS group Average ICU LOS

Median ICU LOS

Average hospital LOS

Median hospital LOS

ISS <13 3.9 3.0 9.0 6.0

ISS 13-15 4.6 2.5 10.0 6.0

ISS 16-24 4.8 2.0 12.2 7.0

ISS 25-40 6.8 3.0 15.9 9.0

ISS 41-75 12.6 6.0 30.4 12.5

88.0%

77.0%

6.2%

17.8%

5.8% 5.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All patients (n=2,186) Died (n=230)

Perc

enta

ge o

f patie

nts

>37.5°C

<35°C

35-37.5°C

/ 75

ICU LOS and hospital LOS were consistent across all age groups (Table 21).

Table 21: ICU and hospital length of stay by age

Age group Average ICU LOS

Median ICU LOS

Average hospital LOS

Median hospital LOS

0-4 5.4 2.0 15.4 3.0

5-9 5.1 3.0 10.8 4.0

10-14 6.5 1.0 22.6 6.0

15-19 6.2 2.0 12.5 6.0

20-24 5.2 3.0 11.5 6.0

25-29 6.9 4.0 13.7 6.5

30-34 7.9 4.0 14.6 6.0

35-39 8.7 4.0 13.0 7.0

40-44 5.9 3.0 12.7 6.0

45-49 6.0 3.0 11.5 6.0

50-54 7.0 3.0 16.7 7.5

55-59 7.7 3.0 15.5 8.0

60-64 7.8 4.0 17.8 9.0

65-69 7.3 4.0 13.2 7.0

70-74 6.0 2.5 13.1 8.0

75-79 4.6 3.0 12.1 7.0

80-84 4.3 2.0 13.8 8.0

85 and over 4.7 3.0 10.0 7.0

/ 75

5.7 Surgical procedures

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

surgical procedures performed was very low.

Table 22: Number of surgical procedures performed by type in total admissions (n=3,411)

Procedure Number of procedures Percentage of total

admissions

Laparotomy 132 3.9%

Open Reduction Internal Fixation (ORIF)

259 7.6%

Thoracotomy 25 0.7%

Craniotomy 169 5.0%

5.8 Discharge destination of survivors

Survivors of major trauma (n=3,013) were discharged to various locations, with home being

the most common (63.4%). 9.0% of patients were discharged to an acute care hospital for a

higher level of care and over 5% of patients were discharged to an intermediate care hospital,

such as the local referring hospital. ‘Other’ incorporates locations such as board and care,

burns centre, foster care, residential institution, missing and unknown (Figure 20).

Figure 20: Discharge destination of survivors by percentage (n=3,013)

63.4%

9.0% 5.4%

18.0%

4.2%

0%

10%

20%

30%

40%

50%

60%

70%

Home Acute Care Hospital Intermediate CareHospital

Rehabilitation Other

Perc

enta

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f patie

nts

Discharge location

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6. Appendices

List of appendices

6.1 Appendix 1: Adult Major Trauma Service summaries

6.2 Appendix 2: Paediatric Major Trauma Service summaries

6.3 Appendix 3: Regional Trauma Service summaries

6.4 Appendix 4: Calculation of the Injury Severity Score (ISS)

6.5 Appendix 5: Australian and NSW Postcode Ranges

/ 75

6.1 Appendix 1: Adult Major Trauma Service summaries

Table 23: Trauma data profile, John Hunter Hospital

Facility summary Peer average

Total admissions 486 377

Mean monthly admissions 40.5 31.4

Case fatality rate 9.5% 12.3%

Gender

Female / Male 120 / 366 106 / 270

Age ranges

Mean age 50.9 54.4

0-4 Nil 0.6 (0.2%)

5-9 Nil 0.3 (0.1%)

10-14 Nil 1.1 (0.3%)

15-19 35 (7.2%) 19.9 (5.3%)

20-24 36 (7.4%) 27.4 (7.3%)

25-29 41 (8.4%) 22.0 (5.8%)

30-34 32 (6.6%) 22.1 (5.9%)

35-39 31 (6.4%) 23.6 (6.3%)

40-44 34 (7.0%) 24.0 (6.4%)

45-49 31 (6.4%) 23.3 (6.2%)

50-54 34 (7.0%) 24.6 (6.5%)

55-59 28 (5.8%) 21.7 (5.8%)

60-64 31 (6.4%) 23.6 (6.3%)

65-69 34 (7.0%) 23.3 (6.2%)

70-74 21 (4.3%) 22.9 (6.1%)

75-79 29 (6.0%) 27.4 (7.3%)

80-84 29 (6.0%) 24.9 (6.6%)

85 and over 40 (8.2%) 44.1 (11.7%)

Injury Severity Score (ISS) ranges

Mean ISS 21.0 21.4

ISS <13 5 (1.0%) 7 (1.9%)

ISS 13-15 96 (19.8%) 82 (21.8%)

ISS 16-24 235 (48.4%) 163 (43.2%)

ISS 25-40 132 (27.2%) 106 (28.2%)

ISS 41-75 18 (3.7%) 18 (4.9%)

Mechanisms of injury

Assault 36 (7.4%) 28 (7.4%)

Falls 166 (34.2%) 174 (46.2%)

Road trauma 209 (43.0%) 136 (36.2%)

All other injuries 75 (15.4%) 38 (10.2%)

/ 75

Types of injury22

Blunt 457 (94.4%) 358 (95.8%)

Penetrating 27 (5.6%) 16 (4.2%)

Admission type and arrival modes23

Direct admission 327 (67.3%) 281 (74.5%)

Transfer in 158 (32.5%) 92 (24.5%)

Ambulance 387 (79.6%) 302 (80.2%)

Helicopter 57 (11.7%) 41 (10.8%)

Other (Private Vehicle, Fixed Wing, Unknown) 42 (8.6%) 34 (9.0%)

Revised Trauma Score

Mean - Overall 7.1 7.1

ISS < 13 7.4 7.0

ISS 13-15 7.8 7.7

ISS 16-24 7.5 7.4

ISS 25-40 6.5 6.5

ISS 41-75 4.8 4.9

Hospital length of stay

Total bed days 5,856 5415


ISS < 13 5.0 10.0

ISS 13-15 9.3 10.2

ISS 16-24 10.0 12.5

ISS 25-40 15.9 18.1

ISS 41-75 27.5 29.5

ICU length of stay

ICU Admissions 129 139


ISS < 13 1.0 4.1

ISS 13-15 2.3 5.2

ISS 16-24 3.5 5.2

ISS 25-40 5.6 7.4

ISS 41-75 13.3 12.0

Hospital ventilation days

Number of Cases 61 101


ISS < 13 Nil 2.8

ISS 13-15 4.5 4.9

ISS 16-24 5.2 5.1

ISS 25-40 6.5 6.7

ISS 41-75 4.9 8.9

22 2 patients without Type of Injury

23 1 Record with Unknown Admission Type

/ 75

Table 24: Trauma data profile, Liverpool Hospital





Gender

Female / Male 82 / 224 106 / 270

Age ranges

Mean age 52.8 54.4

0-4 <5 0.6 (0.2%)

5-9 <5 0.3 (0.1%)

10-14 <5 1.1 (0.3%)

15-19 20 (6.5%) 19.9 (5.3%)

20-24 26 (8.5%) 27.4 (7.3%)

25-29 16 (5.2%) 22.0 (5.8%)

30-34 16 (5.2%) 22.1 (5.9%)

35-39 17 (5.6%) 23.6 (6.3%)

40-44 19 (6.2%) 24.0 (6.4%)

45-49 22 (7.2%) 23.3 (6.2%)

50-54 17 (5.6%) 24.6 (6.5%)

55-59 22 (7.2%) 21.7 (5.8%)

60-64 18 (5.9%) 23.6 (6.3%)

65-69 20 (6.5%) 23.3 (6.2%)

70-74 18 (5.9%) 22.9 (6.1%)

75-79 16 (5.2%) 27.4 (7.3%)

80-84 20 (6.5%) 24.9 (6.6%)

85 and over 34 (11.1%) 44.1 (11.7%)


Mean ISS 21.7 21.4

ISS <13 <5 7 (1.9%)

ISS 13-15 87 (28.4%) 82 (21.8%)

ISS 16-24 115 (37.6%) 163 (43.2%)

ISS 25-40 78 (25.5%) 106 (28.2%)

ISS 41-75 22 (7.2%) 18 (4.9%)


Assault 32 (10.5%) 28 (7.4%)

Falls 117 (38.2%) 174 (46.2%)

Road trauma 123 (40.2%) 136 (36.2%)


/ 75

Types of injury

Blunt 293 (95.8%) 358 (95.8%)

Penetrating 13 (4.2%) 16 (4.2%)

Admission type and arrival modes


Transfer in 52 (17.0%) 92 (24.5%)

Ambulance 236 (77.1%) 302 (80.2%)

Helicopter 39 (12.7%) 41 (10.8%)




ISS < 13 7.4 7.0

ISS 13-15 7.6 7.7

ISS 16-24 7.2 7.4

ISS 25-40 6.2 6.5

ISS 41-75 4.4 4.9


Total bed days 3723 5415


ISS < 13 4.0 10.0

ISS 13-15 11.1 10.2

ISS 16-24 11.4 12.5

ISS 25-40 14.3 18.1

ISS 41-75 14.4 29.5

ICU length of stay



ISS < 13 3.5 4.1

ISS 13-15 9.4 5.2

ISS 16-24 5.4 5.2

ISS 25-40 7.5 7.4

ISS 41-75 9.3 12.0




ISS < 13 1.0 2.8

ISS 13-15 6.9 4.9

ISS 16-24 4.9 5.1

ISS 25-40 5.1 6.7

ISS 41-75 6.9 8.9

/ 75

Table 25: Trauma data profile, Royal North Shore Hospital





Gender

Female / Male 148 / 328 106 / 270

Age ranges

Mean age 59.1 54.4

0-4 <5 0.6 (0.2%)

5-9 Nil 0.3 (0.1%)

10-14 <5 1.1 (0.3%)

15-19 21 (4.4%) 19.9 (5.3%)

20-24 26 (5.5%) 27.4 (7.3%)

25-29 20 (4.2%) 22.0 (5.8%)

30-34 20 (4.2%) 22.1 (5.9%)

35-39 22 (4.6%) 23.6 (6.3%)

40-44 33 (6.9%) 24.0 (6.4%)

45-49 15 (3.2%) 23.3 (6.2%)

50-54 37 (7.8%) 24.6 (6.5%)

55-59 25 (5.3%) 21.7 (5.8%)

60-64 31 (6.5%) 23.6 (6.3%)

65-69 19 (4.0%) 23.3 (6.2%)

70-74 38 (8.0%) 22.9 (6.1%)

75-79 53 (11.1%) 27.4 (7.3%)

80-84 35 (7.4%) 24.9 (6.6%)

85 and over 77 (16.2%) 44.1 (11.7%)


Mean ISS 22.3 21.4

ISS <13 13 (2.7%) 7 (1.9%)

ISS 13-15 77 (16.2%) 82 (21.8%)

ISS 16-24 194 (40.8%) 163 (43.2%)

ISS 25-40 167 (35.1%) 106 (28.2%)

ISS 41-75 25 (5.3%) 18 (4.9%)


Assault 12 (2.5%) 28 (7.4%)

Falls 272 (57.1%) 174 (46.2%)

Road trauma 144 (30.3%) 136 (36.2%)


/ 75

Types of injury24

Blunt 463 (98.9%) 358 (95.8%)

Penetrating 5 (1.1%) 16 (4.2%)

Admission type25

and arrival modes


Transfer in 155 (32.6%) 92 (24.5%)

Ambulance 364 (76.5%) 302 (80.2%)

Helicopter 66 (13.9%) 41 (10.8%)




ISS < 13 7.2 7.0

ISS 13-15 7.5 7.7

ISS 16-24 7.5 7.4

ISS 25-40 6.8 6.5

ISS 41-75 5.3 4.9




ISS < 13 8.5 10.0

ISS 13-15 16.0 10.2

ISS 16-24 18.5 12.5

ISS 25-40 21.4 18.1

ISS 41-75 31.6 29.5

ICU length of stay



ISS < 13 4.0 4.1

ISS 13-15 4.2 5.2

ISS 16-24 5.3 5.2

ISS 25-40 8.0 7.4

ISS 41-75 14.5 12.0




ISS < 13 2.0 2.8

ISS 13-15 5.1 4.9

ISS 16-24 4.7 5.1

ISS 25-40 7.5 6.7

ISS 41-75 11.7 8.9


25 3 patients were transferred from within the hospital

/ 75

Table 26: Trauma data profile, Royal Prince Alfred Hospital





Gender

Female / Male 97 / 213 106 / 270

Age ranges

Mean age 58.5 54.4

0-4 Nil 0.6 (0.2%)

5-9 <5 0.3 (0.1%)

10-14 <5 1.1 (0.3%)

15-19 10 (3.2%) 19.9 (5.3%)

20-24 16 (5.2%) 27.4 (7.3%)

25-29 17 (5.5%) 22.0 (5.8%)

30-34 17 (5.5%) 22.1 (5.9%)

35-39 16 (5.2%) 23.6 (6.3%)

40-44 16 (5.2%) 24.0 (6.4%)

45-49 20 (6.5%) 23.3 (6.2%)

50-54 19 (6.1%) 24.6 (6.5%)

55-59 26 (8.4%) 21.7 (5.8%)

60-64 10 (3.2%) 23.6 (6.3%)

65-69 17 (5.5%) 23.3 (6.2%)

70-74 20 (6.5%) 22.9 (6.1%)

75-79 34 (11.0%) 27.4 (7.3%)

80-84 26 (8.4%) 24.9 (6.6%)

85 and over 44 (14.2%) 44.1 (11.7%)


Mean ISS 20.9 21.4

ISS <13 13 (4.2%) 7 (1.9%)

ISS 13-15 43 (13.9%) 82 (21.8%)

ISS 16-24 153 (49.4%) 163 (43.2%)

ISS 25-40 88 (28.4%) 106 (28.2%)

ISS 41-75 13 (4.2%) 18 (4.9%)


Assault 26 (8.4%) 28 (7.4%)

Falls 176 (56.8%) 174 (46.2%)

Road trauma 84 (27.1%) 136 (36.2%)


/ 75

Types of injury26

Blunt 293 (96.1%) 358 (95.8%)

Penetrating 12 (3.9%) 16 (4.2%)

Admission type27

and arrival modes


Transfer in 77 (24.8%) 92 (24.5%)

Ambulance 269 (86.8%) 302 (80.2%)

Helicopter 2 (0.6%) 41 (10.8%)




ISS < 13 7.6 7.0

ISS 13-15 7.8 7.7

ISS 16-24 7.5 7.4

ISS 25-40 6.8 6.5

ISS 41-75 5.9 4.9




ISS < 13 14.5 10.0

ISS 13-15 10.4 10.2

ISS 16-24 9.3 12.5

ISS 25-40 16.8 18.1

ISS 41-75 60.8 29.5

ICU length of stay



ISS < 13 2.0 4.1

ISS 13-15 2.8 5.2

ISS 16-24 4.5 5.2

ISS 25-40 6.4 7.4

ISS 41-75 9.5 12.0




ISS < 13 2.0 2.8

ISS 13-15 1.0 4.9

ISS 16-24 4.4 5.1

ISS 25-40 6.9 6.7

ISS 41-75 10.6 8.9


27 5 patients transferred from within the hospital

/ 75

Table 27: Trauma data profile, St George Hospital





Gender

Female / Male 133 / 289 106 / 270

Age ranges

Mean age 54.1 54.4

0-4 <5 0.6 (0.2%)

5-9 Nil 0.3 (0.1%)

10-14 <5 1.1 (0.3%)

15-19 22 (5.2%) 19.9 (5.3%)

20-24 34 (8.1%) 27.4 (7.3%)

25-29 25 (5.9%) 22.0 (5.8%)

30-34 28 (6.6%) 22.1 (5.9%)

35-39 33 (7.8%) 23.6 (6.3%)

40-44 23 (5.5%) 24.0 (6.4%)

45-49 24 (5.7%) 23.3 (6.2%)

50-54 23 (5.5%) 24.6 (6.5%)

55-59 18 (4.3%) 21.7 (5.8%)

60-64 27 (6.4%) 23.6 (6.3%)

65-69 30 (7.1%) 23.3 (6.2%)

70-74 27 (6.4%) 22.9 (6.1%)

75-79 23 (5.5%) 27.4 (7.3%)

80-84 29 (6.9%) 24.9 (6.6%)

85 and over 54 (12.8%) 44.1 (11.7%)


Mean ISS 22.3 21.4

ISS <13 <5 7 (1.9%)

ISS 13-15 96 (22.7%) 82 (21.8%)

ISS 16-24 180 (42.7%) 163 (43.2%)

ISS 25-40 113 (26.8%) 106 (28.2%)

ISS 41-75 29 (6.9%) 18 (4.9%)


Assault 22 (5.2%) 28 (7.4%)

Falls 174 (41.2%) 174 (46.2%)

Road trauma 188 (44.5%) 136 (36.2%)


/ 75

Types of injury28

Blunt 400 (96.2%) 358 (95.8%)

Penetrating 16 (3.8%) 16 (4.2%)



Transfer in 116 (27.5%) 92 (24.5%)

Ambulance 343 (81.2%) 302 (80.2%)

Helicopter 44 (10.5%) 41 (10.8%)




ISS < 13 6.7 7.0

ISS 13-15 7.7 7.7

ISS 16-24 7.2 7.4

ISS 25-40 6.4 6.5

ISS 41-75 4.4 4.9




ISS < 13 17.0 10.0

ISS 13-15 9.1 10.2

ISS 16-24 14.1 12.5

ISS 25-40 17.1 18.1

ISS 41-75 21.9 29.5

ICU length of stay



ISS < 13 6.5 4.1

ISS 13-15 4.4 5.2

ISS 16-24 5.9 5.2

ISS 25-40 7.4 7.4

ISS 41-75 8.6 12.0




ISS < 13 4.0 2.8

ISS 13-15 3.1 4.9

ISS 16-24 4.8 5.1

ISS 25-40 5.5 6.7

ISS 41-75 7.0 8.9


/ 75

Table 28: Trauma data profile, St Vincent’s Hospital





Gender

Female / Male 50 / 139 106 / 270

Age ranges

Mean age 52.1 54.4

0-4 Nil 0.6 (0.2%)

5-9 Nil 0.3 (0.1%)

10-14 <5 1.1 (0.3%)

15-19 5 (2.6%) 19.9 (5.3%)

20-24 15 (7.9%) 27.4 (7.3%)

25-29 17 (9.0%) 22.0 (5.8%)

30-34 15 (7.9%) 22.1 (5.9%)

35-39 17 (9.0%) 23.6 (6.3%)

40-44 11 (5.8%) 24.0 (6.4%)

45-49 16 (8.5%) 23.3 (6.2%)

50-54 8 (4.2%) 24.6 (6.5%)

55-59 10 (5.3%) 21.7 (5.8%)

60-64 13 (6.9%) 23.6 (6.3%)

65-69 16 (8.5%) 23.3 (6.2%)

70-74 7 (3.7%) 22.9 (6.1%)

75-79 9 (4.8%) 27.4 (7.3%)

80-84 9 (4.8%) 24.9 (6.6%)

85 and over 20 (10.6%) 44.1 (11.7%)


Mean ISS 21.5 21.4

ISS <13 Nil 7 (1.9%)

ISS 13-15 51 (27.0%) 82 (21.8%)

ISS 16-24 70 (37.0%) 163 (43.2%)

ISS 25-40 58 (30.7%) 106 (28.2%)

ISS 41-75 10 (5.3%) 18 (4.9%)


Assault 23 (12.2%) 28 (7.4%)

Falls 107 (56.6%) 174 (46.2%)

Road trauma 48 (25.4%) 136 (36.2%)


/ 75

Types of injury29

Blunt 181 (96.8%) 358 (95.8%)

Penetrating 6 (3.2%) 16 (4.2%)



Transfer in <5 92 (24.5%)

Ambulance 173 (91.5%) 302 (80.2%)

Helicopter Nil 41 (10.8%)




ISS < 13 Nil 7.0

ISS 13-15 7.7 7.7

ISS 16-24 7.5 7.4

ISS 25-40 6.4 6.5

ISS 41-75 5.4 4.9




ISS < 13 Nil 10.0

ISS 13-15 6.2 10.2

ISS 16-24 9.6 12.5

ISS 25-40 20.0 18.1

ISS 41-75 29.3 29.5

ICU length of stay



ISS < 13 Nil 4.1

ISS 13-15 1.0 5.2

ISS 16-24 4.3 5.2

ISS 25-40 7.1 7.4

ISS 41-75 14.8 12.0




ISS < 13 Nil 2.8

ISS 13-15 2.0 4.9

ISS 16-24 3.9 5.1

ISS 25-40 7.8 6.7

ISS 41-75 13.9 8.9


/ 75

Table 29: Trauma data profile, Westmead Hospital





Gender

Female / Male 115 / 333 106 / 270

Age ranges

Mean age 53.0 54.4

0-4 Nil 0.6 (0.2%)

5-9 Nil 0.3 (0.1%)

10-14 Nil 1.1 (0.3%)

15-19 26 (5.8%) 19.9 (5.3%)

20-24 39 (8.7%) 27.4 (7.3%)

25-29 18 (4.0%) 22.0 (5.8%)

30-34 27 (6.0%) 22.1 (5.9%)

35-39 29 (6.5%) 23.6 (6.3%)

40-44 32 (7.1%) 24.0 (6.4%)

45-49 35 (7.8%) 23.3 (6.2%)

50-54 34 (7.6%) 24.6 (6.5%)

55-59 23 (5.1%) 21.7 (5.8%)

60-64 35 (7.8%) 23.6 (6.3%)

65-69 27 (6.0%) 23.3 (6.2%)

70-74 29 (6.5%) 22.9 (6.1%)

75-79 28 (6.3%) 27.4 (7.3%)

80-84 26 (5.8%) 24.9 (6.6%)

85 and over 40 (8.9%) 44.1 (11.7%)


Mean ISS 20.2 21.4

ISS <13 11 (2.5%) 7 (1.9%)

ISS 13-15 126 (28.1%) 82 (21.8%)

ISS 16-24 192 (42.9%) 163 (43.2%)

ISS 25-40 108 (24.1%) 106 (28.2%)

ISS 41-75 11 (2.5%) 18 (4.9%)


Assault 43 (9.6%) 28 (7.4%)

Falls 207 (46.2%) 174 (46.2%)

Road trauma 160 (35.7%) 136 (36.2%)


/ 75

Types of injury

Blunt 417 (93.1%) 358 (95.8%)

Penetrating 31 (6.9%) 16 (4.2%)

Admission type30

and arrival modes


Transfer in 85 (19.0%) 92 (24.5%)

Ambulance 343 (76.6%) 302 (80.2%)

Helicopter 77 (17.2%) 41 (10.8%)




ISS < 13 5.9 7.0

ISS 13-15 7.6 7.7

ISS 16-24 7.2 7.4

ISS 25-40 6.3 6.5

ISS 41-75 4.9 4.9




ISS < 13 8.5 10.0

ISS 13-15 8.9 10.2

ISS 16-24 12.5 12.5

ISS 25-40 19.8 18.1

ISS 41-75 42.1 29.5

ICU length of stay



ISS < 13 5.5 4.1

ISS 13-15 8.1 5.2

ISS 16-24 7.1 5.2

ISS 25-40 9.2 7.4

ISS 41-75 19.8 12.0




ISS < 13 3.8 2.8

ISS 13-15 5.3 4.9

ISS 16-24 6.8 5.1

ISS 25-40 7.4 6.7

ISS 41-75 9.9 8.9

30 21 patients without Admission Type

/ 75

6.2 Appendix 2: Paediatric Major Trauma Service summaries

Table 30: Trauma data profile, John Hunter Children’s Hospital





Gender

Female / Male 5 / 35 19 / 41

Age ranges

Mean age 7.5 6.2

0-4 14 (35.0%) 29 (48.0%)

5-9 10 (25.0%) 12 (19.6%)

10-14 16 (40.0%) 17 (28.5%)

15-19 Nil 2 (3.9%)


Mean ISS 19.1 21.9

ISS <13 Nil 0.3 (0.6%)

ISS 13-15 6 (15.0%) 11.0 (18.4%)

ISS 16-24 22 (55.0%) 25.2 (42.5%)

ISS 25-40 12 (30.0%) 20.7 (34.6%)

ISS 41-75 Nil 2.3 (3.9%)


Assault <5 5 (7.8%)

Falls 11 (27.5%) 20 (33.5%)

Road trauma 17 (42.5%) 22 (36.3%)


Types of injury31

Blunt 39 (100.0%) 56.3 (98.8%)

Penetrating Nil 0.7 (1.2%)


Direct admission 21 (52.5%) 26.7 (44.7%)

Transfer in 19 (47.5%) 33.0 (55.3%)

Ambulance 22 (55.0%) 32.3 (54.2%)

Helicopter 5 (12.5%) 5.7 (9.5%)

Other (Private Vehicle, Fixed Wing, Unknown) 13 (32.5%) 21.7 (36.3%)

31 1 patient without Type of Injury

/ 75



ISS < 13 Nil Nil

ISS 13-15 7.8 7.2

ISS 16-24 7.5 7.3

ISS 25-40 5.4 5.6

ISS 41-75 Nil 4.1




ISS < 13 Nil 1.0

ISS 13-15 10.3 8.0

ISS 16-24 7.2 15.7

ISS 25-40 15.7 16.9

ISS 41-75 Nil 98.1

ICU length of stay



ISS < 13 Nil 1.0

ISS 13-15 1.0 1.7

ISS 16-24 1.3 4.3

ISS 25-40 2.1 4.8

ISS 41-75 Nil 27.7




ISS < 13 Nil 1.0

ISS 13-15 2.0 2.2

ISS 16-24 2.0 5.8

ISS 25-40 2.3 6.3

ISS 41-75 Nil 20.0

/ 75

Table 31: Trauma data profile, Sydney Children’s Hospital





Gender

Female / Male 20 / 43 19 / 41

Age ranges

Mean age 5.7 6.2

0-4 33 (52.4%) 29 (48.0%)

5-9 10 (15.9%) 12 (19.6%)

10-14 17 (27.0%) 17 (28.5%)

15-19 <5 2 (3.9%)


Mean ISS 20.3 21.9

ISS <13 <5 0.3 (0.6%)

ISS 13-15 18 (28.6%) 11.0 (18.4%)

ISS 16-24 23 (36.5%) 25.2 (42.5%)

ISS 25-40 20 (31.7%) 20.7 (34.6%)

ISS 41-75 <5 2.3 (3.9%)


Assault 8 (12.7%) 5 (7.8%)

Falls 26 (41.3%) 20 (33.5%)

Road trauma 17 (27.0%) 22 (36.3%)


Types of injury

Blunt 63 (100.0%) 56.3 (98.8%)




Transfer in 44 (69.8%) 33.0 (55.3%)

Ambulance 35 (55.6%) 32.3 (54.2%)

Helicopter <5 5.7 (9.5%)


/ 75



ISS < 13 Nil Nil

ISS 13-15 7.0 7.2

ISS 16-24 7.1 7.3

ISS 25-40 5.5 5.6

ISS 41-75 4.1 4.1




ISS < 13 1.0 1.0

ISS 13-15 4.4 8.0

ISS 16-24 14.0 15.7

ISS 25-40 11.3 16.9

ISS 41-75 31.0 98.1

ICU length of stay



ISS < 13 1.0 1.0

ISS 13-15 2.0 1.7

ISS 16-24 5.0 4.3

ISS 25-40 3.0 4.8

ISS 41-75 12.0 27.7




ISS < 13 1.0 1.0

ISS 13-15 2.0 2.2

ISS 16-24 6.8 5.8

ISS 25-40 8.4 6.3

ISS 41-75 2.0 20.0

/ 75

Table 32: Trauma data profile, Westmead Children’s Hospital





Gender

Female / Male 31 / 45 19 / 41

Age ranges

Mean age 6.0 6.2

0-4 39 (51.3%) 29 (48.0%)

5-9 15 (19.7%) 12 (19.6%)

10-14 18 (23.7%) 17 (28.5%)

15-19 <5 2 (3.9%)


Mean ISS 24.8 21.9

ISS <13 Nil 0.3 (0.6%)

ISS 13-15 9 (11.8%) 11.0 (18.4%)

ISS 16-24 31 (40.8%) 25.2 (42.5%)

ISS 25-40 30 (28.0%) 20.7 (34.6%)

ISS 41-75 6 (7.9%) 2.3 (3.9%)


Assault <5 5 (7.8%)

Falls 23 (30.3%) 20 (33.5%)

Road trauma 31 (40.8%) 22 (36.3%)


Types of injury32

Blunt 67 (97.1%) 56.3 (98.8%)

Penetrating <5 0.7 (1.2%)



Transfer in 36 (47.4%) 33.0 (55.3%)

Ambulance 40 (52.6%) 32.3 (54.2%)

Helicopter 10 (13.2%) 5.7 (9.5%)



/ 75



ISS < 13 Nil Nil

ISS 13-15 7.3 7.2

ISS 16-24 7.2 7.3

ISS 25-40 6.0 5.6

ISS 41-75 4.1 4.1




ISS < 13 Nil 1.0

ISS 13-15 13.7 8.0

ISS 16-24 23.0 15.7

ISS 25-40 21.1 16.9

ISS 41-75 109.3 98.1

ICU length of stay


Mean - Overall 9 5.8

ISS < 13 Nil 1.0

ISS 13-15 1.7 1.7

ISS 16-24 6.3 4.3

ISS 25-40 6.8 4.8

ISS 41-75 30.8 27.7




ISS < 13 Nil 1.0

ISS 13-15 2.5 2.2

ISS 16-24 6.8 5.8

ISS 25-40 6.0 6.3

ISS 41-75 23.0 20.0

/ 75

6.3 Appendix 3: Regional Trauma Service summaries

Table 33: Trauma data profile, Coffs Harbour Base Hospital





Gender

Female / Male 20 / 48 15 / 47

Age ranges

Mean age 49.5 51.6

0-14 5 (7.4%) 3.8 (5.7%)

15-24 5 (7.4%) 8.7 (13.1%)

25-44 18 (26.5%) 13.1 (19.8%)

45-64 19 (27.9%) 17.3 (26.2%)

65-74 11 (16.2%) 9.6 (14.5%)

75 and over 10 (14.7%) 13.7 (20.7%)


Mean ISS 21.6 19.7

ISS <13 Nil 1.2 (1.8%)

ISS 13-15 14 (20.6%) 16.3 (24.7%)

ISS 16-24 30 (44.1%) 31.1 (47.1%)

ISS 25-40 20 (29.4%) 16.0 (24.2%)

ISS 41-75 <5 1.4 (2.2%)


Assault 7 (10.3%) 4.8 (7.2%)

Falls 22 (32.4%) 24.9 (37.6%)

Road trauma 33 (48.5%) 25.7 (38.8%)

All other injuries 6 (8.8%) 10.8 (16.3%)

Types of injury33

Blunt 63 (94.0%) 62.8 (96.1%)


Admission type34

and arrival modes


Transfer in 8 (11.8%) 11.9 (18.1%)

Ambulance 56 (82.4%) 50.7 (76.6%)




34 1 patient without Admission type

/ 75



ISS < 13 Nil 7.8

ISS 13-15 7.8 7.8

ISS 16-24 7.8 7.6

ISS 25-40 6.6 6.7

ISS 41-75 5.5 6.2


Total bed days 343 539.2


ISS < 13 Nil 4.8

ISS 13-15 5.9 9.7

ISS 16-24 7.3 9.8

ISS 25-40 1.9 4.2

ISS 41-75 1.0 2.8

ICU length of stay

ICU Admissions 32 13.4

Mean - Overall 1.5 3

ISS < 13 Nil Nil

ISS 13-15 1.0 2.7

ISS 16-24 2.2 3.0

ISS 25-40 0.9 3.0

ISS 41-75 Nil 3.5


Number of Cases 19 11.0


ISS < 13 Nil Nil

ISS 13-15 1.0 1.0

ISS 16-24 2.3 2.0

ISS 25-40 1.3 1.7

ISS 41-75 1.0 1.8

/ 75

Table 34: Trauma data profile, Gosford Hospital





Gender

Female / Male 22 / 41 15 / 47

Age ranges

Mean age 61.7 51.6

0-14 <5 3.8 (5.7%)

15-24 <5 8.7 (13.1%)

25-44 9 (14.3%) 13.1 (19.8%)

45-64 13 (20.6%) 17.3 (26.2%)

65-74 7 (11.1%) 9.6 (14.5%)

75 and over 26 (41.3%) 13.7 (20.7%)


Mean ISS 18 19.7

ISS <13 <5 1.2 (1.8%)

ISS 13-15 16 (25.4%) 16.3 (24.7%)

ISS 16-24 29 (46.0%) 31.1 (47.1%)

ISS 25-40 15 (26.1%) 16.0 (24.2%)

ISS 41-75 Nil 1.4 (2.2%)


Assault <5 4.8 (7.2%)

Falls 40 (63.5%) 24.9 (37.6%)

Road trauma 13 (20.6%) 25.7 (38.8%)


Types of injury

Blunt 60 (95.2%) 62.8 (96.1%)




Transfer in Nil 11.9 (18.1%)

Ambulance 60 (95.2%) 50.7 (76.6%)

Helicopter Nil 3.4 (5.2%)

Other (Private Vehicle, Fixed Wing, Unknown) <5 12.0 (18.2%)

/ 75



ISS < 13 7.841 7.8

ISS 13-15 7.8 7.8

ISS 16-24 7.8 7.6

ISS 25-40 6.4 6.7

ISS 41-75 Nil 6.2




ISS < 13 4.3 4.8

ISS 13-15 6.8 9.7

ISS 16-24 7.8 9.8

ISS 25-40 2.7 4.2

ISS 41-75 Nil 2.8

ICU length of stay


Mean - Overall 2 3

ISS < 13 Nil Nil

ISS 13-15 1.0 2.7

ISS 16-24 3.0 3.0

ISS 25-40 Nil 3.0

ISS 41-75 Nil 3.5


Number of Cases N/R 11.0

Mean - Overall N/R 1.8

ISS < 13 N/R Nil

ISS 13-15 N/R 1.0

ISS 16-24 N/R 2.0

ISS 25-40 N/R 1.7

ISS 41-75 N/R 1.8

/ 75

Table 35: Trauma data profile, Lismore Base Hospital





Gender

Female / Male 16 / 50 15 / 47

Age ranges

Mean age 47.4 51.6

0-14 Nil 3.8 (5.7%)

15-24 13 (19.7%) 8.7 (13.1%)

25-44 21 (31.8%) 13.1 (19.8%)

45-64 15 (22.7%) 17.3 (26.2%)

65-74 9 (13.9%) 9.6 (14.5%)

75 and over 8 (12.1%) 13.7 (20.7%)


Mean ISS 20.7 19.7

ISS <13 Nil 1.2 (1.8%)

ISS 13-15 12 (18.2%) 16.3 (24.7%)

ISS 16-24 34 (51.5%) 31.1 (47.1%)

ISS 25-40 18 (27.3%) 16.0 (24.2%)

ISS 41-75 <5 1.4 (2.2%)


Assault 8 (12.1%) 4.8 (7.2%)

Falls 21 (31.8%) 24.9 (37.6%)

Road trauma 26 (39.4%) 25.7 (38.8%)


Types of injury35

Blunt 63 (96.9%) 62.8 (96.1%)




Transfer in <5 11.9 (18.1%)

Ambulance 51 (77.3%) 50.7 (76.6%)

Helicopter 11 (16.7%) 3.4 (5.2%)


35 1 patient without Injury Type

/ 75



ISS < 13 Nil 7.8

ISS 13-15 7.8 7.8

ISS 16-24 7.7 7.6

ISS 25-40 6.2 6.7

ISS 41-75 4.1 6.2




ISS < 13 Nil 4.8

ISS 13-15 5.3 9.7

ISS 16-24 5.4 9.8

ISS 25-40 4.5 4.2

ISS 41-75 1.0 2.8

ICU length of stay



ISS < 13 Nil Nil

ISS 13-15 Nil 2.7

ISS 16-24 1.4 3.0

ISS 25-40 1.3 3.0

ISS 41-75 Nil 3.5




ISS < 13 Nil Nil

ISS 13-15 Nil 1.0

ISS 16-24 1.3 2.0

ISS 25-40 2.1 1.7

ISS 41-75 1.0 1.8

/ 75

Table 36: Trauma data profile, Nepean Hospital





Gender

Female / Male 20 / 57 15 / 47

Age ranges

Mean age 54.8 51.6

0-14 <5 3.8 (5.7%)

15-24 8 (10.4%) 8.7 (13.1%)

25-44 11 (14.3%) 13.1 (19.8%)

45-64 32 (41.6%) 17.3 (26.2%)

65-74 12 (15.6%) 9.6 (14.5%)

75 and over 13 (16.9%) 13.7 (20.7%)


Mean ISS 18.2 19.7

ISS <13 <5 1.2 (1.8%)

ISS 13-15 25 (32.5%) 16.3 (24.7%)

ISS 16-24 35 (45.5%) 31.1 (47.1%)

ISS 25-40 11 (14.3%) 16.0 (24.2%)

ISS 41-75 <5 1.4 (2.2%)


Assault 6 (7.8%) 4.8 (7.2%)

Falls 31 (40.3%) 24.9 (37.6%)

Road trauma 27 (35.1%) 25.7 (38.8%)


Types of injury36

Blunt 74 (96.1%) 62.8 (96.1%)




Transfer in 31 (40.3%) 11.9 (18.1%)

Ambulance 57 (74.0%) 50.7 (76.6%)



36 1 Patient without Injury Type

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ISS < 13 7.8 7.8

ISS 13-15 7.8 7.8

ISS 16-24 7.6 7.6

ISS 25-40 6.6 6.7

ISS 41-75 7.8 6.2




ISS < 13 5.0 4.8

ISS 13-15 13.2 9.7

ISS 16-24 21.2 9.8

ISS 25-40 9.2 4.2

ISS 41-75 5.5 2.8

ICU length of stay



ISS < 13 Nil Nil

ISS 13-15 7.0 2.7

ISS 16-24 4.2 3.0

ISS 25-40 8.2 3.0

ISS 41-75 1.0 3.5


Number of Cases N/R 11.0

Mean - Overall N/R 1.8

ISS < 13 N/R Nil

ISS 13-15 N/R 1.0

ISS 16-24 N/R 2.0

ISS 25-40 N/R 1.7

ISS 41-75 N/R 1.8

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Table 37: Trauma data profile, Orange Health Service





Gender

Female / Male 27 / 64 15 / 47

Age ranges

Mean age 50.7 51.6

0-14 <5 3.8 (5.7%)

15-24 15 (16.5%) 8.7 (13.1%)

25-44 21 (23.1%) 13.1 (19.8%)

45-64 19 (20.9%) 17.3 (26.2%)

65-74 10 (11.0%) 9.6 (14.5%)

75 and over 22 (24.2%) 13.7 (20.7%)


Mean ISS 20.7 19.7

ISS <13 <5 1.2 (1.8%)

ISS 13-15 24 (26.4%) 16.3 (24.7%)

ISS 16-24 36 (39.6%) 31.1 (47.1%)

ISS 25-40 26 (28.6%) 16.0 (24.2%)

ISS 41-75 <5 1.4 (2.2%)


Assault 6 (6.6%) 4.8 (7.2%)

Falls 28 (30.8%) 24.9 (37.6%)

Road trauma 39 (42.9%) 25.7 (38.8%)


Types of injury

Blunt 91 (100.0%) 62.8 (96.1%)


Admission type37

and arrival modes


Transfer in 18 (19.8%) 11.9 (18.1%)

Ambulance 70 (76.9%) 50.7 (76.6%)

Helicopter 9 (9.9%) 3.4 (5.2%)


37 2 patients without Admission type

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ISS < 13 Nil 7.8

ISS 13-15 7.8 7.8

ISS 16-24 7.8 7.6

ISS 25-40 7.0 6.7

ISS 41-75 6.8 6.2




ISS < 13 4.0 4.8

ISS 13-15 5.6 9.7

ISS 16-24 5.3 9.8

ISS 25-40 7.3 4.2

ISS 41-75 1.0 2.8

ICU length of stay



ISS < 13 Nil Nil

ISS 13-15 1.0 2.7

ISS 16-24 1.7 3.0

ISS 25-40 3.6 3.0

ISS 41-75 N 3.5




ISS < 13 Nil Nil

ISS 13-15 Nil 1.0

ISS 16-24 1.7 2.0

ISS 25-40 1.8 1.7

ISS 41-75 1 1.8

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Table 38: Trauma data profile, Port Macquarie Base Hospital





Gender

Female / Male 13 / 30 15 / 47

Age ranges

Mean age 51.3 51.6

0-14 <5 3.8 (5.7%)

15-24 6 (14.0%) 8.7 (13.1%)

25-44 7 (16.3%) 13.1 (19.8%)

45-64 9 (20.9%) 17.3 (26.2%)

65-74 5 (11.6%) 9.6 (14.5%)

75 and over 12 (27.9%) 13.7 (20.7%)


Mean ISS 19.7 19.7

ISS <13 <5 1.2 (1.8%)

ISS 13-15 8 (18.6%) 16.3 (24.7%)

ISS 16-24 21 (48.8%) 31.1 (47.1%)

ISS 25-40 13 (30.2%) 16.0 (24.2%)

ISS 41-75 Nil 1.4 (2.2%)


Assault <5 4.8 (7.2%)

Falls 16 (37.2%) 24.9 (37.6%)

Road trauma 18 (41.9%) 25.7 (38.8%)


Types of injury

Blunt 39 (90.7%) 62.8 (96.1%)


Admission type and arrival modes38


Transfer in <5 11.9 (18.1%)

Ambulance 37 (86.0%) 50.7 (76.6%)



38 2 Patients without Admission Type

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ISS < 13 7.8 7.8

ISS 13-15 7.8 7.8

ISS 16-24 7.5 7.6

ISS 25-40 6.4 6.7

ISS 41-75 Nil 6.2




ISS < 13 7.0 4.8

ISS 13-15 5.3 9.7

ISS 16-24 6.1 9.8

ISS 25-40 1.7 4.2

ISS 41-75 Nil 2.8

ICU length of stay



ISS < 13 Nil Nil

ISS 13-15 0.0 2.7

ISS 16-24 3.6 3.0

ISS 25-40 1.0 3.0

ISS 41-75 Nil 3.5




ISS < 13 Nil Nil

ISS 13-15 Nil 1.0

ISS 16-24 1.0 2.0

ISS 25-40 1.2 1.7

ISS 41-75 Nil 1.8

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Table 39: Trauma data profile, Tamworth Rural Referral Hospital





Gender

Female / Male 11 / 49 15 / 47

Age ranges

Mean age 45.8 51.6

0-14 9 (15.0%) 3.8 (5.7%)

15-24 6 (10.0%) 8.7 (13.1%)

25-44 10 (16.7%) 13.1 (19.8%)

45-64 17 (28.3%) 17.3 (26.2%)

65-74 10 (16.7%) 9.6 (14.5%)

75 and over 8 (13.3%) 13.7 (20.7%)


Mean ISS 17.9 19.7

ISS <13 Nil 1.2 (1.8%)

ISS 13-15 25 (41.7%) 16.3 (24.7%)

ISS 16-24 28 (46.7%) 31.1 (47.1%)

ISS 25-40 6 (10.0%) 16.0 (24.2%)

ISS 41-75 <5 1.4 (2.2%)


Assault <5 4.8 (7.2%)

Falls 17 (28.3%) 24.9 (37.6%)

Road trauma 24 (40.0%) 25.7 (38.8%)


Types of injury39

Blunt 59 (100.0%) 62.8 (96.1%)


Admission type40

and arrival modes


Transfer in 22 (36.7%) 11.9 (18.1%)

Ambulance 24 (40.0%) 50.7 (76.6%)

Helicopter 6 (10.0%) 3.4 (5.2%)



40 1 patient without Admission type

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ISS < 13 Nil 7.8

ISS 13-15 7.8 7.8

ISS 16-24 7.4 7.6

ISS 25-40 6.3 6.7

ISS 41-75 7.8 6.2




ISS < 13 Nil 4.8

ISS 13-15 19.9 9.7

ISS 16-24 11.4 9.8

ISS 25-40 6.2 4.2

ISS 41-75 1.0 2.8

ICU length of stay



ISS < 13 Nil Nil

ISS 13-15 2.7 2.7

ISS 16-24 Nil 3.0

ISS 25-40 10.0 3.0

ISS 41-75 Nil 3.5




ISS < 13 Nil Nil

ISS 13-15 Nil 1.0

ISS 16-24 8.0 2.0

ISS 25-40 3 1.7

ISS 41-75 Nil 1.8

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Table 40: Trauma data profile, The Tweed Hospital





Gender

Female / Male 14 / 30 15 / 47

Age ranges

Mean age 53.3 51.6

0-14 <5 3.8 (5.7%)

15-24 8 (18.2%) 8.7 (13.1%)

25-44 8 (18.2%) 13.1 (19.8%)

45-64 5 (11.4%) 17.3 (26.2%)

65-74 8 (18.2%) 9.6 (14.5%)

75 and over 12 (27.3%) 13.7 (20.7%)


Mean ISS 20.5 19.7

ISS <13 Nil 1.2 (1.8%)

ISS 13-15 <5 16.3 (24.7%)

ISS 16-24 27 (61.4%) 31.1 (47.1%)

ISS 25-40 13 (29.5%) 16.0 (24.2%)

ISS 41-75 Nil 1.4 (2.2%)


Assault <5 4.8 (7.2%)

Falls 18 (40.9%) 24.9 (37.6%)

Road trauma 21 (47.7%) 25.7 (38.8%)

All other injuries <5 10.8 (16.3%)

Types of injury41

Blunt 43 (100.0%) 62.8 (96.1%)




Transfer in <5 11.9 (18.1%)

Ambulance 41 (93.2%) 50.7 (76.6%)




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ISS < 13 Nil 7.8

ISS 13-15 7.8 7.8

ISS 16-24 7.4 7.6

ISS 25-40 7.3 6.7

ISS 41-75 Nil 6.2




ISS < 13 Nil 4.8

ISS 13-15 10.8 9.7

ISS 16-24 20.5 9.8

ISS 25-40 1.8 4.2

ISS 41-75 Nil 2.8

ICU length of stay



ISS < 13 Nil Nil

ISS 13-15 1.0 2.7

ISS 16-24 2.7 3.0

ISS 25-40 Nil 3.0

ISS 41-75 Nil 3.5




ISS < 13 Nil Nil

ISS 13-15 Nil 1.0

ISS 16-24 1.0 2.0

ISS 25-40 1.3 1.7

ISS 41-75 Nil 1.8

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Table 41: Trauma data profile, Wagga Wagga Base Hospital





Gender

Female / Male 27 / 56 15 / 47

Age ranges

Mean age 50.7 51.6

0-14 <5 3.8 (5.7%)

15-24 13 (15.7%) 8.7 (13.1%)

25-44 13 (15.7%) 13.1 (19.8%)

45-64 27 (32.5%) 17.3 (26.2%)

65-74 14 (16.9%) 9.6 (14.5%)

75 and over 12 (14.5%) 13.7 (20.7%)


Mean ISS 19.5 19.7

ISS <13 <5 1.2 (1.8%)

ISS 13-15 19 (22.9%) 16.3 (24.7%)

ISS 16-24 40 (48.2%) 31.1 (47.1%)

ISS 25-40 22 (26.5%) 16.0 (24.2%)

ISS 41-75 <5 1.4 (2.2%)


Assault 6 (7.2%) 4.8 (7.2%)

Falls 31 (37.3%) 24.9 (37.6%)

Road trauma 30 (36.1%) 25.7 (38.8%)

All other injuries 16(19.3%) 10.8 (16.3%)

Types of injury42

Blunt 73 (91.3%) 62.8 (96.1%)

Penetrating 7 (8.8%) 2.6 (3.9%)



Transfer in 21 (25.3%) 11.9 (18.1%)

Ambulance 60 (72.3%) 50.7 (76.6%)




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ISS < 13 7.8 7.8

ISS 13-15 7.8 7.8

ISS 16-24 7.5 7.6

ISS 25-40 7.3 6.7

ISS 41-75 Nil 6.2




ISS < 13 5.0 4.8

ISS 13-15 6.5 9.7

ISS 16-24 4.4 9.8

ISS 25-40 3.1 4.2

ISS 41-75 16.0 2.8

ICU length of stay



ISS < 13 Nil Nil

ISS 13-15 5.5 2.7

ISS 16-24 2.5 3.0

ISS 25-40 2.7 3.0

ISS 41-75 6.0 3.5




ISS < 13 Nil Nil

ISS 13-15 Nil 1.0

ISS 16-24 2.5 2.0

ISS 25-40 1.9 1.7

ISS 41-75 6 1.8

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6.4 Appendix 4: Calculation of the Injury Severity Score (ISS)

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

Abdominal or pelvic contents

Extremities or pelvic girdle

External

The following example shows how an ISS is calculated from a set of injuries.

Table 42: ISS calculation example

ISS Body region Injury AIS Severity Code Include in ISS

calculation?

Head or Neck Small subdural

haematoma AIS-4 Yes

Chest Bilateral lung contusion AIS-4 No

Chest Bilateral flail chest AIS-5 Yes

Abdominal or pelvic

contents

Superficial spleen

laceration AIS-2 Yes

Extremities or pelvic

girdle

Left phalange (little toe)

fracture AIS-1 No

On the basis of the above injuries, the ISS is calculated as:

ISS = 42 + 52 + 22

ISS = 45 (critical injury)

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6.5 Appendix 5: Australian and NSW Postcode Ranges

The recorded postcode of injury is used to define the injury location as either metropolitan or

rural. The postcode ranges used are outlined in Table 43.

Table 43: Postcode ranges defining location of injury

Locality Postcode Range

Metropolitan 2000-2234




Rural Postcodes outside above ranges

Overseas 9990

Unknown 9999

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7. Glossary

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 patient. Many patients receive definitive 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 postcode ranges used to define the two categories are outlined in Appendix 5.

Injury Severity Score (ISS) assesses the combined effects of the multiply-injured patients

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.

ISS body regions consists of 6 anatomical regions as defined in the AIS dictionary:

1. Head or neck

2. Face

3. Chest

4. Abdominal or pelvic contents

5. Extremities or pelvic girdle

6. External

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

where no other injury is recorded.

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

Service within 14 days of sustaining an injury, and:

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

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 7 adult and 3 paediatric designated MTS in NSW.

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.

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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).

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. A RTS provides initial assessment, stabilisation, definitive care

and initiate transfer to an MTS when a patient requires services not available at the RTS.

There are currently 10 designated RTS in NSW.

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.

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

an study population and the number of deaths that would be expected, based on the age-

and sex-specific rates in a standard population and the age and sex distribution of the study

population.


https://ibis.health.state.nm.us/resources/Glossary.html#S


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