Collective intelligence informs mechanisms, protocol and toolkit to merge National Ambulance Service data and the Major Trauma Audit to inform the national trauma system

Introduction:The trauma care system in Ireland is being re-configured to have major trauma centers for severe injuries and other sites for less severe injuries. This is to ensure patients are brought quickly to the most appropriate hospital to manage their injuries. The National Ambulance Service (NAS) electronic Patient Care Record (ePCR) records what happens to patients before they reach the hospital and the Major Trauma Audit (MTA) captures data on patients’ hospital treatment. These datasets are currently separate and if they could be joined, they would inform important decisions on which hospitals to take patients. This study aims to investigate joining these datasets to create a seamless database of the patient journey from roadside to recovery.Method:Proof of Concept–The ePCR and MTA datasets will be linked on a once-off basis. The combined anonymized dataset will then be analyzed to identify pre-hospital characteristics that determine the need to bypass smaller hospitals and bring patients to a larger major trauma center or trauma unit.Stakeholder input for ongoing dataset combination and utilization–A stakeholder consultation process will explore the best way to make a GDPR-compliant combination of datasets on an on-going basis, including geo-location data and the inclusion of patient reported outcome measures. This will incorporate the requirements of the Data Protection Commissioner, National Office of Clinical Audit, patients, clinicians, NAS, HSE and other stakeholders.Geospatial implications of major trauma services–Once ongoing data combination is approved, we will determine geospatial implications of the trauma network for prehospital care configuration and the patient journey.Results:Study results will inform prehospital service configuration to ensure safe and equitable patient management.Conclusion:The data arising from this study will capture the full trauma patient journey. This data is essential to inform policy and practice for trauma care in Ireland.

IntroductionEach year, the National Ambulance Service (NAS) attends many patients who receive a working diagnosis of trauma but do not meet the full inclusion criteria for the Major Trauma Audit...

Implementing Major Trauma Audit in Ireland.

Prehospital trauma scoring systems have traditionally used mortality as the primary outcome, but trauma is complex condition with diverse presentations and outcomes, each of which are moderated by age. We assess the predictive performance of six prehospital trauma scoring systems across multiple outcomes, and explore the inclusion of simple age categorisations on predictive validity. This retrospective observational study used nationwide, linked prehospital data from the National Ambulance Service (NAS) and in-hospital data from the Irish Major Trauma Audit (MTA) where the inclusion criteria are based on Injury Severity Score (ISS), length of stay and injury details. 101,114 adult trauma patients were included. Six trauma scoring systems were applied to the data and predictive performance was compared for three outcomes: major trauma (ISS > 15), MTA inclusion, and in-hospital mortality. For tools not originally including age, prior validated age categories were added and predictive performance re-assessed. All trauma scores performed suboptimally in predicting ISS > 15 (C-statistics 0.61-0.71). For MTA inclusion, no model performed acceptably (≤ 0.64). Mortality prediction was acceptable/good (0.71-0.87). Including simple age categorisations into existing tools reduced each tool's predictive accuracy for ISS > 15, yielded modest improvements for MTA inclusion, and improved mortality prediction. Trauma scoring systems were most effective at predicting mortality, especially when age was included. However, they were less effective for identifying major trauma (ISS > 15) or MTA inclusion, even with age different age inclusions. The New Trauma Score, which includes oxygen saturation, showed the best overall performance for major trauma.

Objectives & BackgroundThe provision of both Paediatric and Trauma care in Ireland is undergoing reconfiguration with the formation of a National Children's Hospital (NCH) and Major Trauma Centres and Networks....

Cycling related major trauma in Ireland

Major trauma audit: Metrics for improving care

Effect of age on major trauma profile and characterisation: Analysis from the national major trauma audit in Ireland.

French regional trauma network: the Rhone-Alpes example

BackgroundTime-sensitive emergencies in areas of low population density have statistically poorer outcomes. This includes incidents of major trauma. This study assesses the effect that population density at a receiving hospital of a major trauma patient has on survival. MethodsPatients meeting Trauma Audit Research Network criteria for major trauma from 2016 to 2020 in Ireland were included in this retrospective observational study. Incident data were retrieved from the Major Trauma Audit, while data on population density were calculated from Irish state sources. The primary outcome measure of survival to discharge was compared to population density using logistic regression, adjusted for demographic and incident variables. Records were divided into population density tertiles to assess for between-group differences in potential predictor variables. ResultsPopulation density at a receiving hospital had no impact on mortality in Irish major trauma patients from our logistic regression model (OR = 1.01, 95% CI 0.98–1.05, p = 0.53). Factors that did have an impact were age, Charlson Comorbidity Index, Injury Severity Score, and the presence of an Orthopaedic Surgery service at the receiving hospital (all p < 0.001). Age and Charlson Comorbidity Index differed slightly by population density tertile; both were higher in areas of high population density (all p < 0.001). ConclusionsSurvival to discharge in Irish major trauma patients does not differ substantially based on population density. This is an important finding as Ireland moves to a new trauma system, with features based on population distribution. An Orthopaedic Surgery service is an important feature of a major trauma receiving hospital and its presence improves outcomes.

A Fine Excision: ATLS Manual No Longer Defines Trauma as a Surgical Disease

Facial injuries in major trauma patients in Ireland.

IntroductionTraumatic brain injury (TBI) is the most significant cause of death and disability resulting from major trauma. The aim of this study is to describe the demographics of TBI patients, the current pathways of care and outcomes in the Republic of Ireland from 2014 to 2019. MethodsWe performed a retrospective review of all TBI patients meeting inclusion criteria in Ireland's Major Trauma Audit (MTA) from 2014 to 2019. Severe TBI was defined as an abbreviated injury scale (AIS) ≥3 and GCS ≤8. ResultsDuring the study period, 30,891 patients sustained major trauma meeting inclusion criteria for MTA, of which 7,393 (23.9%) patients met the inclusion criteria for TBI; 1,025 (13.9%) were classified as severe. The median age was 60.6 years (IQR 36.9–78.0), 54.3 years (32.8–73.4) for males and 71.7 years (50.0–83.0) for females (p<0.001). Of patients with severe TBI, 185 (18.0%) were brought direct to a neurosurgical centre, 389 (37.9%) were transferred to a neurosurgical centre and 321 (31.3%) had a neurosurgical intervention performed. In patients sustaining severe TBI, older patients (Adjusted OR, 0.96,95% CI 0.95–0.97) and patients requiring another surgery (OR 0.31, 95%CI 0.18–0.53) were less likely to be secondarily transferred to a neurosurgical centre. There were 47 (4.6%) patients with severe TBI discharged to rehabilitation. The 30-day mortality in Ireland was 11.6% in all TBI patients and 45.5% in severe TBI patients. Older patients and patients with higher ISS had a higher chance of death. Male patients, patients treated in neurosurgical centre, patients who had neurosurgery or non-neurosurgical surgery had a higher chance of survival. ConclusionThis population-based study bench marks the ‘as is’ for patients with TBI in Ireland. We found that presently in Ireland, the mortality rate from severe TBI appears to be higher than that reported in international literature, and only a minority of severe TBI patients are brought directly from the incident to a neurosurgical centre. The new major trauma system should focus on providing effective and efficient access to neurosurgical, neuro-critical and neuro-rehabilitative care for patients who sustain TBI.

BackgroundFalls from a low height i.e. standing height or less are the leading cause of trauma in Ireland. Each year almost 4000 patients fracture their hip and 3000 major trauma patients suffer life threatening or life changing injuries due to a fall.MethodsThe National Office of Clinical Audit manages two national trauma based clinical audits, the Irish Hip Fracture Database since 2012 and the Major Trauma Audit. Combined they have data on over 50,000 patients who have suffered serious injury from a fall. Both audts are web-based and clinically led and contain data on patient demographics, care standards, injury profile and outcomes. This data is reported back to the healthsystem on a continuous basis to facilitate care planning and quality improvment.Results95% of hip fractures are attributable to a low fall in the home or nurisng home and 62% of major trauma is from low falls 50% of which was in the home. As age increased so too does the proportion of patients presenting with a fall. Data from the audits shows that older patients are less likely to be suspected of serious injuries due to the inocuous nature of the mechanism of injury and therefore recognition of the serious nature of their injuries is delayed and often patients are not seen as promptly as they should by senior clinicans and outcomes are much worse then those who did not present by a ‘low mechanism injury’. Both audits have demonstrated this is increasing, in line with our ageing population and the protracted time patients spent in their homes during the pandemic has led to a further increase in patients presenting with falls and frailty.ConclusionTo date education materials have been developed on how to keep safe in the home, falls prevention and home activity advice for healthcare workers, public health and patients. This has generated some coverage in the media but more needs to be done to keep our population fit and active and aware of the importance of bone health to support not just an active life but also safe lifestyle.

Introduction Motorcyclists are over-represented in collision statistics in Ireland. There is a lack of descriptive studies assessing the impact and injury pattern of this trauma cohort. This study examines this trauma subset using data collected by the Major Trauma Audit (MTA) by the National Office of Clinical Audit (NOCA) to identify patient demographics, injury mechanism and type, treatments received, and outcomes. Methods All motorcycle-related trauma cases recorded on the MTA, NOCA in Ireland for the period 2014 to 2019 were gathered and analysed. Results There were 704 cases identified; 94% of cases were male. The median (interquartile range (IQR)) age was 38.2 (26.7–49.7). There were 6.4% ( n = 45) aged 0–18 years, 88.2% ( n = 621) aged 18–64 and 5.4% ( n = 38) greater than 65 years. The median injury severity score (ISS) overall of this trauma cohort was 13 (IQR 9–24) but 306 patients (43.5%) had an ISS &gt; 15. The most severe injury body region with 35.4% ( n = 249) was the limbs. Most patients arrived during the summer months with Sunday the highest day of attendance ( n = 181, 25.7%). May to August were the months with the most attendance ( n = 366, 52%). Most patients were discharged home ( n = 372, 52.8%) and 43.8% ( n = 308) required transfer to at least one other hospital for definitive care. There were 19 patients (2.7%) who died after arrival to hospital. Conclusion Motorcycle trauma predominantly affects a young male population with moderate severity injury characteristics. A significant proportion of patients present at weekends during the summer months, likely the result of recreational riding. A large cohort of patients requires transfer for definitive care, which has significant implications for trauma care pathways. National policies to enforce safety measures and public awareness for recreational motorcycle use may improve traffic safety and ultimately population health.