Outcomes at non-trauma centres within a trauma referral network: A five-year retrospective cohort study from Australia

Abstract

ObjectiveDescribe major trauma activity and mortality within non-trauma centres within a single trauma referral network in New South Wales, Australia over a five-year period. DesignMulti-centre retrospective cohort study. MethodsThis was a retrospective cohort study of trauma patients presenting to non-trauma centres within a metropolitan major trauma referral network between January 2011 and June 2016. The outcome of interest examined was in-hospital mortality for major trauma (Injury Severity Score ISS>12), consistent with current state-wide trauma reporting guidelines. ResultsA total of 4827 trauma patients were identified from non-major trauma centres of which 352 (7.3%) had an ISS>12. The most common mechanisms were road trauma (54.6%) and falls (37.4%). The mortality with those ISS>12 was 9.3%. During the same period, the overall trauma mortality (ISS>12) at the Major Trauma Centre was similar at 10.2% (p=0.10). After adjusting for age and ISS differences between Major Trauma Centre and other facilities within the network, the odds of in-hospital mortality after major trauma (ISS>12) was higher in the Major Trauma Centre compared to other facilities within the same network (adjusted odds ratio 2.7; 95% CI 1.6, 4.7; p=0.0004). ConclusionAcross a single trauma referral network coordinated by a major trauma service, non-trauma centres account for around a quarter of total major trauma volume and adjusted mortality was lower in these centres compared to patients treated at major trauma centres.