Triaging older major trauma patients in the emergency department: an observational study.

BACKGROUND: The objective of this study was to compare the triage category assigned to older trauma patients with younger trauma patients upon arrival to the emergency department. The focus was to examine whether older major trauma patients were less likely to be assigned an emergency triage category on arrival to the emergency department after controlling for relevant demographics, injury characteristics and injury severity. METHODS: This was an observational study using data from the Queensland Trauma Registry. All trauma patients aged 15 years and older who presented to contributing hospitals between 1 January 2005 and 31 December 2009 with an Injury Severity Score (ISS)>15 were included. Logistic regression analysis examined the odds of assignment to emergency (Australasian Triage Scale (ATS) 1 or 2) versus urgent (ATS 3-5) treatment for patients across various age categories after adjustment for relevant demographics, injury characteristics and injury severity. RESULTS: The study used data on 6923 patients with a median (IQR) age of 43 (26-62) years and a mortality of 11.4% (95% CI 10.7% to 12.2%). Compared with individuals aged 15-34, the adjusted odds of being assigned an ATS category 1 or 2 were 30% lower (OR=0.68, 95% CI 0.57 to 0.81) for individuals aged 55-75 years and were 50% lower (OR=0.46, 95% CI 0.37 to 0.56) for individuals aged 75 years or older. CONCLUSIONS: Among patients with an ISS>15, older major trauma patients were less likely to be assigned an emergency triage category compared with younger patients. This suggests that the elderly may be undertriaged and provides a potential area of study for reducing mortality and morbidity in older trauma patients.

Inclusion of 'minor' trauma cases provides a better estimate of the total burden of injury: Queensland Trauma Registry provides a unique perspective.

INTRODUCTION: Injury is recognised as a frequent cause of preventable mortality and morbidity; however, incidence estimates focusing only on the extent of mortality and major trauma may seriously underestimate the magnitude of the total injury burden. There currently exists a paucity of information regarding minor trauma, and the aim of this study was to increase awareness of the contribution of minor trauma cases to the total burden of injury. METHODS: The demographics, injury details, acute care factors and outcomes of both minor trauma cases and major trauma cases were evaluated using data from the state-wide trauma registry in Queensland, Australia, from 2005 to 2010. The impact of changes in Abbreviated Injury Scale (AIS) versions on the classification of minor and major injury cases was also assessed. RESULTS: Over the 6-year period, minor cases [Injury Severity Score (ISS) ≤ 12] accounted for almost 90% of all trauma included on the Queensland Trauma Registry (QTR). These cases utilised more than half a million acute care bed days, underwent more than 66,500 operations, and accounted for more than 48,000 patient transport episodes via road ambulance, fixed wing aircraft, or helicopter. Furthermore, more than 5800 minor trauma cases utilised in-hospital rehabilitation services; almost 3000 were admitted to an ICU; and more than 20,000 were admitted to hospital for greater than one week. When using the contemporary criteria for classifying trauma (AIS 08), the proportion of cases classified as minor trauma (87.7%) and major trauma (12.3%) were similar to the proportion using the traditional criteria for AIS90 (87.9% and 12.1%, respectively). CONCLUSIONS: This evaluation of minor trauma cases admitted to public hospitals in Queensland detected high levels of demand placed on trauma system resources in terms of acute care bed days, operations, ICU admissions, in-hospital rehabilitation services and patient transportation, and which are all associated with high cost. These data convincingly demonstrate the significant burden of injury imposed by minor trauma cases serious enough to be admitted to hospital.

The epidemiology of horse-related injuries for different horse exposures, activities, and age groups in Queensland, Australia.

BACKGROUND: The dangers associated with horse riding, a popular activity throughout Australia, are well documented; yet, few studies have comprehensively described injuries caused by horses to nonriders. This study aimed to facilitate targeted injury prevention strategies and appropriate trauma management by describing all horse-related injuries, for both riders and nonriders, in Queensland, and identifying those at greatest risk. METHODS: Horse-related injury data from 2005 to 2009 were extracted from the Queensland Trauma Registry. Descriptive comparisons were undertaken for demographic, injury, and acute care characteristics between riders and nonriders, between pediatric and adult cases, and between sports/leisure and work injuries. The relative risk of surgery by sex and between riders and nonriders was assessed. RESULTS: More than 25% of injuries occurred in people not riding a horse. Nonriders sustained a significantly higher proportion of internal organ injuries, open wounds, as well as facial and pelvic/abdominal injuries. Females accounted for more than 80% of children who were injured while riding a horse. For adults, 25% were injured while working, and more than 66% of injured workers were male. Injuries most commonly occurred in regional areas. Surgery was most common among children, nonriders, and those with Injury Severity Score (ISS) of 1 to 8. The likelihood of surgery was 25% higher for nonriders (95% confidence interval, 1.14-1.38%). CONCLUSION: Horse-related injuries are most prevalent in identifiable populations, particularly young female riders and adult males injured while working. Injuries inflicted by horses to nonriders contribute more than 27% of all horse-related injuries; however, most previous research has been limited to injured riders. Compared with riders, nonriders more frequently sustain internal, facial, and pelvic injuries; are male; and undergo surgery. The results of this study may be used to tailor prevention strategies and inform trauma management specific to the type of horse exposure, patient age, and activity engaged in when injured. LEVEL OF EVIDENCE: Epidemiologic study, level III.

A comparison of injuries to moped/scooter and motorcycle riders in Queensland, Australia.

BACKGROUND: The popularity of moped and motor scooter riding in Australia is increasing. However, there is a paucity of information about their safety, especially in comparison to motorcycle riding where riders require specific licensing, education and training. Given it is widely established that motorcycle riders are overrepresented in road injury statistics, consideration of moped and scooter riders as a sub-group of all motorcyclists is required for accurate understanding of injury patterns and the acute care needs of this group. METHOD: A comparison of demographic, injury and acute care characteristics between seriously injured moped/scooter riders and motorcycle riders was undertaken using data from the state-wide trauma registry in Queensland, Australia, from 2006 to 2010. RESULTS: A total of 206 moped/scooter riders and 2667 motorcycle riders were identified. Motorcycle rider injury admissions significantly decreased over time (p<0.01), whereas no change was observed for injured moped/scooter riders. Moped/scooter riders sustained a greater percentage of head/neck (+8.6%), facial (+3.0%) and abdominal injuries (+2.3%), whereas motorcycle riders sustained a greater percentage of upper extremity (+4.0%), thoracic (+3.9%), spinal (+3.6%) and lower extremity injuries (+2.6%). There was no statistically significant difference in injury severity, length of acute hospital stay, admission to ICU or survival to discharge from acute care between injured moped/scooter riders and motorcycle riders. CONCLUSION: The results of this study suggest that riders of mopeds/scooters and motorcycles may have different injury patterns, but sustain similar overall injury severity. This analysis fills a gap in transport crash data, where there is limited information on the nature of injuries sustained. While moped-related injuries cannot be isolated in ICD-10 health coding, it is anticipated that ICD-11, due for release in 2015, may provide a moped-specific code; however, this will not address the issue of the apparent interchangeable use of the terms 'moped' and 'scooter' when reporting or documenting such injuries in health data systems including the medical record. Improved identification of moped-related cases in health data is required to increase potential for linkage across health and transport crash data, which may be used for further evaluation of injuries sustained by moped and scooter riders.

Mapping Abbreviated Injury Scale data from 1990 to 1998 versions: a stepping-stone in the contemporary evaluation of trauma.

INTRODUCTION: Many trauma registries have used the 1990 revision of the Abbreviated Injury Scale (AIS; AIS90) to code injuries sustained by trauma patients. Due to changes made to the AIS codeset since its release, AIS90-coded data lacks currency in the assessment of injury severity. The ability to map between the 1998 revision of AIS (AIS98) and the current (2008) AIS version (AIS08) already exists. The development of a map for transforming AIS90-coded data into AIS98 would therefore enable contemporary injury severity estimates to be derived from AIS90-coded data. METHODS: Differences between the AIS90 and AIS98 codesets were identified, and AIS98 maps were generated for AIS90 codes which changed or were not present in AIS98. The effectiveness of this map in describing the severity of trauma using AIS90 and AIS98 was evaluated using a large state registry dataset, which coded injury data using AIS90 over several years. Changes in Injury Severity Scores (ISS) calculated using AIS90 and mapped AIS98 codesets were assessed using three distinct methods. RESULTS: Forty-nine codes (out of 1312) from the AIS90 codeset changed or were not present in AIS98. Twenty-four codes required the assignment of maps to AIS98 equivalents. AIS90-coded data from 78,075 trauma cases were used to evaluate the map. Agreement in calculated ISS between coded AIS90 data and mapped AIS98 data was very high (kappa=0.971). The ISS changed in 1902 cases (2.4%), and the mean difference in ISS across all cases was 0.006 points. The number of cases classified as major trauma using AIS98 decreased by 0.8% compared with AIS90. A total of 3102 cases (4.0%) sustained at least one AIS90 injury which required mapping to AIS98. CONCLUSIONS: This study identified the differences between the AIS90 and AIS98 codesets, and generated maps for the conversion process. In practice, the differences between AIS90- and AIS98-coded data were very small. As a result, AIS90-coded data can be mapped to the current AIS version (AIS08) via AIS98, with little apparent impact on the functional accuracy of the mapped dataset produced.

Effects of gender, indigenous status and remoteness to health services on the occurrence of assault-related injuries in children and adolescents.

BACKGROUND: Assault-related injury is a devastating consequence of violence and is a prominent cause of morbidity and mortality in young age. However, reliable data sources are scarce and there has been a paucity of studies examining possible predisposing factors on the incidence of assault-related injury. METHOD: Logistic regression analyses were conducted to examine the effect of gender, indigenous status and remoteness to health services on sustaining assault-related injuries in patients aged 17 years and under by using data from the state-wide trauma registry in Queensland, Australia from 2005 to 2008. RESULTS: A total of 282 assault-related injury cases were identified. Indigenous females were at the highest risk of sustaining assault-related injuries (odds ratio (OR): 15.3, 95% confidence interval (CI): 8.17-28.6), followed by indigenous males (OR: 6.55, 95% CI: 3.60-11.9) and non-indigenous males (OR: 2.82, 95% CI: 1.78-4.47). Males were at a significantly higher risk than females in the group aged 13-17 years (OR: 2.11, 95% CI: 1.34-3.31). Living in a regional area was associated with a lower risk compared to major cities for non-indigenous people (OR: 0.59, 95% CI: 0.44-0.78). Indigenous people were at higher risk of sustaining an assault-related injury than non-indigenous people in regional areas (OR: 4.8, 95% CI: 3.14-7.42) and in remote areas (OR: 10.1, 95% CI: 2.64-38.69). CONCLUSIONS: The current study provides evidence of interaction effects among the predisposing factors. Identifying these factors is important to conduct effective preventive measures and trauma management plans focussing on high-risk groups of assault-related injuries in young age.

Characteristics and outcomes of injured older adults after hospital admission.

OBJECTIVES: To describe the seriously injured adult population aged 65 and older; compare the differences in injury characteristics and outcomes in three subgroups aged 65 to 74, 75 to 84, and 85 and older; and identify predictors of death, complications, and hospital discharge destination. DESIGN: Retrospective secondary analysis of data from the Queensland Trauma Registry (QTR) using all patients aged 65 and older admitted from 2003 through 2006. SETTING: Data from 15 regional and tertiary hospitals throughout Queensland, Australia. PARTICIPANTS: Six thousand sixty-nine patients: 2,291 (37.7%) aged 65 to 74, 2,265 (37.3%) aged 75 to 84, and 1,513 (24.9%) aged 85 and older. MEASUREMENTS: Outcome variables included mortality, complications, and discharge destination (usual residence, rehabilitation, nursing home, convalescence). Predictive factors incorporated demographic details, injury characteristics, and acute care factors. RESULTS: Hospital survival was 95.0%, with a median length of hospital stay of 8 days (interquartile range 5-15), and 33.8% of cases with a major injury developed a complication. Predictors of death included older age, male sex, admission to the intensive care unit (ICU), greater Injury Severity Score (ISS), injury caused by a fall, and two or more injuries; those who had surgery were less likely to die. Predictors of complications included ICU admission, older age, longer hospital stay, and two or more injuries. Predictors of discharge to a nursing home included older age, greater ISS, longer hospital stay, and injury caused by a fall, among others. CONCLUSION: Older adults with severe injuries are at risk of poor outcomes. These findings suggest opportunities for improving geriatric trauma care that could lead to better outcomes.