Abstract
BackgroundDespite evidence of a lower risk of death, major trauma patients are not always transported to Trauma Centres. This study examines the characteristics and outcomes of major trauma patients between transport destinations. MethodsA retrospective cohort study of major trauma patients (Injury Severity Score >15) transported by ambulance was undertaken. Cases were divided into transport destination groups: (1) Direct, those transported to the Trauma Centre directly from the scene; (2) Indirect, those transported to another hospital prior to Trauma Centre transfer and (3) Non-transfers, those transported to a non-Trauma Centre and never subsequently transferred. Median and interquartile range (IQR) were used to describe the groups and differences were assessed using the Kruskal–Wallis test for continuous variables and Pearson chi-square for categorical. ResultsA total of 1625 patients were included. The median age was oldest in the non-transfers cohort (72 years IQR 46–84). This group had the highest proportion of falls from standing and head injuries (n = 298/400, 75%, p < 0.001). The non-transfers had the highest proportion of 30-day mortality (n = 134/400, 34%). ConclusionsThere were significant differences between the groups with older adults, falls and head injuries over-represented in the non-transfer group. Considering the ageing population, trauma systems will need to adapt.
Highlights
Major trauma patients are reported to have a significantly lower risk of death if their care is provided in a Trauma Centre 1, 2
Cases were divided into three transport destination groups: (1) Direct, those who were transported to the Trauma Centre directly from the scene; (2) Indirect, those who were transported to another hospital prior to Trauma Centre transfer and (3) Non-transfers, those who were transported to a non-Trauma Centre and never subsequently transferred
From the State Trauma Registry, we identified 1,904 major trauma cases occurring in the metropolitan area of Perth between 1st January 2013 and 31st of December 2016 of which 1,664 met the study inclusion criteria
Summary
Major trauma patients are reported to have a significantly lower risk of death if their care is provided in a Trauma Centre 1, 2. In an optimal trauma system, prehospital triage ensures the transport of the right patient to the right hospital 3 This system of care involves trauma patients being transported to a small number of specialised Trauma Centres, staffed and equipped to provide multidisciplinary care to severely injured patients, as opposed to the closest hospital facility.[2, 4, 5] whether all major trauma patients should attend a Trauma Centre directly, bypassing closer lower level hospitals is a contentious issue and there is currently uncertainty as to whether direct transport reduces the risk of death 6-8. The St John-WA (SJ-WA) Clinical Practice Guidelines highlight certain situations in which major trauma should be considered and direct transport to the Level 1 Trauma Centre initiated 11 These include both mechanism of injury and anatomical criteria but exclude any physiological criteria. As the metropolitan area of Perth, WA spans more than 6000km[2] with the sole Level 1 Trauma Centre located in the centre of the city 13 major trauma patients are not always transported to the Trauma Centre directly, with initial resuscitation and stabilisation often provided at a closer hospital facility prior to secondary transfer 11, 12
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