A population-based epidemiological and health economic analysis of fracture-related infection.

Aims: The aim of this study was to perform the first population-based description of the epidemiological and health economic burden of fracture-related infection (FRI). Methods: This is a retrospective cohort study of operatively managed orthopaedic trauma patients from 1 January 2007 to 31 December 2016, performed in Queensland, Australia. Record linkage was used to develop a person-centric, population-based dataset incorporating routinely collected administrative, clinical, and health economic information. The FRI group consisted of patients with International Classification of Disease 10th Revision diagnosis codes for deep infection associated with an implanted device within two years following surgery, while all others were deemed not infected. Demographic and clinical variables, as well as healthcare utilization costs, were compared. Results: There were 111,402 patients operatively managed for orthopaedic trauma, with 2,775 of these (2.5%) complicated by FRI. The development of FRI had a statistically significant association with older age, male sex, residing in rural/remote areas, Aboriginal or Torres Strait Islander background, lower socioeconomic status, road traffic accident, work-related injuries, open fractures, anatomical region (lower limb, spine, pelvis), high injury severity, requiring soft-tissue coverage, and medical comorbidities (univariate analysis). Patients with FRI had an eight-times longer median inpatient length of stay (24 days vs 3 days), and a 2.8-times higher mean estimated inpatient hospitalization cost (AU$56,565 vs AU$19,773) compared with uninfected patients. The total estimated inpatient cost of the FRI cohort to the healthcare system was AU$156.9 million over the ten-year period. Conclusion: The results of this study advocate for improvements in trauma care and infection management, address social determinants of health, and highlight the upside potential to improve prevention and treatment strategies.

Navigating child product safety: Perspectives from experts on international challenges and priorities in regulation and research.

OBJECTIVE: To elicit and summarise collective expert opinion on contemporary child product safety risks, challenges and priorities. METHODS: An online survey targeted international experts from a cross-section of product safety fields. RESULTS: Fifty-five experts participated, representing 1,137 years of product safety experience, from a broad range of fields including industry risk management, product assessment and testing, policy and regulation, research, paediatric medicine, advocacy and product liability. Participants identified the leading product safety hazards across all age brackets as falls, drowning and chemical hazards, with variance in specific age brackets, particularly the threat to breathing hazards for infants. The leading products of concern to experts were electrical connection/distribution products, primarily button batteries and lithium-ion batteries, infant furnishing products and household furniture. Product safety priorities and challenges were identified under five themes: regulatory, surveillance, industry, consumer and product-specific. CONCLUSIONS: The gains in knowledge, insight and understanding from experts on contemporary child product safety risks and issues should inform policy and future research. IMPLICATIONS FOR PUBLIC HEALTH: There are significant consequences of unsafe consumer products on population health, and the results are timely as we face new product safety issues emerging from e-commerce, the digital transition and innovative product technologies.

Factors associated with higher alcohol concentrations in emergency department presentations: PACE study.

INTRODUCTION: The health impact from alcohol is of recognised concern, from acute intoxication as well as increased risk of chronic health issues over time. Identifying factors associated with higher alcohol consumption when presenting to the emergency department (ED) will inform public health policy and enable more targeted health care and appropriate referrals. METHODS: Secondary testing of blood samples collected during routine clinical care of 1160 ED patients presenting to the Royal Brisbane and Women's Hospital in Queensland, Australia, for 10 days between 22 January and 1 February 2021. Alcohol was measured by blood ethanol (intake in recent hours) and phosphatidylethanol (PEth; intake over 2-4 weeks). Zero-inflated negative binomial regression was used to identify demographic and clinical factors associated with higher alcohol concentrations. RESULTS: Males were found to have 83% higher blood ethanol and 32% higher PEth concentrations than females (adjusted rate ratio [ARR] 1.83, 95% confidence interval [CI] 1.37-2.45 and ARR 1.32, 95% CI 1.04-1.68, respectively). Blood ethanol concentrations were 3.4 times higher for those 18-44 years, compared to those aged 65+ (ARR 3.40, 95% CI 2.40-4.82) whereas PEth concentrations were found to be the highest in those aged 45-64 years, being 70% higher than those aged 65+ (ARR 1.70, 95% CI 1.19-2.44). Patients brought in involuntarily had eight-times higher blood ethanol concentrations than those who self-attended. DISCUSSION AND CONCLUSIONS: This study used two alcohol markers to identify factors associated with higher alcohol concentrations in emergency presentations. The findings demonstrate how these biomarkers can provide informative data for public health responses and monitoring of alcohol use trends.

Identifying foci for safety messages targeting child injury from driving quad bikes: A critical beliefs analysis of parental beliefs in Australia.

INTRODUCTION: In Australia, between 2017-2021, 16% of quad bike fatalities involved children. Trauma statistics highlight that public awareness of the risks associated with children driving quads is required. Consistent with the Step approach to Message Design and Testing (SatMDT) and, in particular, Steps 1 and 2, this study sought to identify critical beliefs influencing parental intentions to allow their children to drive a quad bike and develop message content. The critical beliefs analysis was based on eliciting the Theory of Planned Behavior's (TPB) behavioral, normative, and control beliefs. METHODS: An online survey was distributed via parenting blogs, social media posts, and snowballing of the researchers' network list. Parents who participated (N = 71; 53F, 18 M), were aged between 25-57 years (M = 40.96, SD = 6.98), had at least one child aged between 3 to 16 years, and currently resided in Australia. RESULTS: The critical beliefs analysis identified four critical beliefs that significantly predicted parental intentions to allow their child to drive a quad bike. These beliefs included a behavioral belief (the perceived advantage that allowing their child to drive a quad bike would enable tasks to be completed), two normative beliefs (the perception that one's parents and partner would likely approve of allowing their child to drive a quad bike), and one control belief (a perceived barrier to allowing one's child to drive a quad that was associated with being aware of an increasing cultural concern around the safety of quad bikes). CONCLUSIONS: Findings contribute to insights regarding parental beliefs underpinning their intention to allow their child to drive a quad bike, an area previously lacking in research evidence. PRACTICAL APPLICATIONS: With child-use posing a high-risk activity for children, this study provides an important contribution that may help to inform future safety messaging targeting children's use of quad bikes.

External causes of emergency department presentations: A missing piece to understanding unintentional childhood injury in Australia.

OBJECTIVE: To identify external causes of unintentional childhood injury presenting to Australian EDs. METHODS: Six major paediatric hospitals in four Australian states supplied de-identified ED data for 2011-2017 on age, sex, attendance time/date, presenting problem, injury diagnosis, triage category and mode of separation. Three hospitals supplied data on external cause and intent of injury. A machine classifier tool was used to supplement the missing external cause coding in the remaining hospitals to enable the compilation of a standardised dataset for childhood injury causes analysis. RESULTS: A total of 486 762 ED presentations for unintentional injury in children aged 0-14 years were analysed. The leading specified cause of ED presentations was low fall (35.0%) followed by struck/collision with an object (13.8%) with little sex difference observed. Males aged 10-14 years had higher rates of motorcycle, pedal cycle and fire/flame-related injury and lower rates of horse-related injury and drug/medicinal substance poisoning compared with females. The leading specified external cause resulting in hospitalisation was low fall (32.2%) followed by struck/collision with an object (11.1%). The injuries with the highest proportion of children being hospitalised were drownings (64.4%), pedestrian (53.4%), motorcycle (52.7%) and horse-related injuries (50.0%). CONCLUSIONS: This is the first large-scale study since the 1980s to explore external causes of unintentional childhood injury presenting to Australian paediatric EDs. It demonstrates a hybrid human-machine learning approach to create a standardised database to overcome data deficiencies. The results supplement existing knowledge of hospitalised paediatric injury to better understand the causes of childhood injury by age and sex, which require health service utilisation.

The epidemiology of sports and leisure-related injury hospitalisations in Queensland: A five-year review.

OBJECTIVE: To describe the epidemiology of sports and leisure-related injury hospitalisations in Queensland DESIGN, SETTING, AND PATIENTS: Retrospective analysis of routinely collected hospital admissions data from all Queensland hospitals (public and private) between 2012 and 2016 for injury-related admissions where the activity engaged in when injured was coded as sports or leisure activity. MAIN OUTCOME MEASURES: Number of hospitalisations; rate of hospitalisation per 100,000 population and demographic, injury, treatment, and outcome details of hospitalised injury patients. RESULTS: Between 01 January 2012 and 31 December 2016, 76,982 people were hospitalised for a sports or leisure-related injury in Queensland. More people were hospitalised in public hospitals than private. Rates were highest for those under 14 years (601.5/100,000 population) and were higher in males (130.6/100,000 population) than females (28.9/100,000 population). A total of 18,734 injuries (24.3%; 79.5/100,000 population) were sustained while playing team ball sports, with rugby codes (rugby union, rugby league and rugby unspecified) representing the single largest source of injuries with 6,592. The extremities were the most likely body location of injury (46,644; 198/100,000 population), and the most common injury type was a fracture (35,018; 148.6/100,000 population). CONCLUSIONS: The findings highlight the significant burden of sport and leisure-related injury hospitalisations in Queensland. This information is important for injury prevention and trauma system planning.

Development of a standardized minimum dataset for including low-severity trauma patients in trauma registry collections in Australia and Aotearoa New Zealand.

BACKGROUND: Trauma continues to place a burden on individuals, communities and health care systems around the world. To help reduce this burden and improve care, trauma registries in Australia and Aotearoa New Zealand collect standardized data on patients admitted with Injury Severity Scores greater than 12. There is currently no agreed minimum data set for trauma patients with Injury Severity Score less than 13, representing an opportunity to provide more data for quality improvement and injury prevention. METHODS: A binational, expert, advisory group assessed the value of potential fields for a minimum dataset for low severity trauma. Existing trauma registries in Australia and Aotearoa New Zealand were assessed to ensure compatibility. RESULTS: Thirty-five data fields met criteria for inclusion in the low-severity minimum dataset. The fields comprised a subset of the Australia New Zealand Major Trauma Registry and were included in existing low-severity registries. CONCLUSION: A minimum data set for low severity has been defined for use in Australia and Aotearoa New Zealand. In addition to high severity trauma data this will provide a standard for data collection that will contribute to quality improvement and injury prevention.

Understanding compensable and non-compensable patient profiles, pathways and physical outcomes for transport and work-related injuries in Queensland, Australia through data linkage.

INTRODUCTION: In many jurisdictions, people experiencing an injury often pursue compensation to support their treatment and recovery expenses. Healthcare costs form a significant portion of payments made by compensation schemes. Compensation scheme regulators need accurate and comprehensive data on injury severity, treatment pathways and outcomes to enable scheme modelling, monitoring and forecasting. Regulators routinely rely on data provided by insurers which have limited healthcare information. Health data provide richer information and linking health data with compensation data enables the comparison of profiles, patterns, trends and outcomes of injured patients who claim and injured parties who are eligible but do not claim. METHODS AND ANALYSIS: This is a retrospective population-level epidemiological data linkage study of people who have sought ambulatory, emergency or hospital treatment and/or made a compensation claim in Queensland after suffering a transport or work-related injury, over the period 1 January 2011 to 31 December 2021. It will use person-linked data from nine statewide data sources: (1) Queensland Ambulance Service, (2) Emergency Department, (3) Queensland Hospital Admitted Patients, (4) Retrieval Services, (5) Hospital Costs, (6) Workers' Compensation, (7) Compulsory Third Party Compensation, (8) National Injury Insurance Scheme and (9) Queensland Deaths Registry. Descriptive, parametric and non-parametric statistical methods and geospatial analysis techniques will be used to answer the core research questions regarding the patient's health service use profile, costs, treatment pathways and outcomes within 2 years postincident as well as to examine the concordance and accuracy of information across health and compensation databases. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Royal Brisbane and Women's Hospital Human Research Ethics Committee, and governance approval was obtained via the Public Health Act 2005, Queensland. The findings of this study will be used to inform key stakeholders across the clinical, research and compensation regulation area, and results will be disseminated through peer-reviewed journals, conference presentations and reports/seminars with key stakeholders.

Bandaids are not the fix: Examining the patterns of injury-related emergency department presentations in Australian children.

OBJECTIVE: To provide an epidemiological understanding of the types of injuries treated in ED in Australian children, describe the impact of these injuries in volume and severity, and assess the patterns by demographic and temporal factors. METHODS: ED data from six major paediatric hospitals in four Australian states over the period 2011-2017 were analysed to identify childhood injury patterns by nature of injury and body region, as well as sex, age group and temporal factors. RESULTS: A total of 486 762 ED presentations for injury in children aged 0-14 years were analysed. The most common injuries for all age groups were fractures of the upper extremities. Leading injury diagnosis groups varied by age groups and sex. Overall, children aged 1-2 years had the highest number of ED presentations for injury, and from birth more males than females presented to ED with injuries with the highest absolute sex difference observed for 10- to 14-year-olds. Seventeen percent of children who presented to ED were admitted to hospital with the leading type of hospitalised injury being fractures. Little monthly variation in ED presentations was observed, except for higher presentations for drowning in summer months, and for most injury types, ED presentations were higher during weekends and daytime. CONCLUSIONS: This is the first large-scale quantification of paediatric injury-related ED presentation patterns in Australia since the conclusion of the National Injury Surveillance and Prevention Program about 30 years ago. It provides valuable information to inform paediatric ED resourcing decisions as well as important evidence for injury prevention practitioners.

Prevalence of alcohol consumption in emergency presentations: Novel approach using two biomarkers, ethanol and phosphatidylethanol.

INTRODUCTION: The aim was to determine the prevalence of alcohol-related presentations to an emergency department (ED) in a major Australian hospital, through a novel surveillance approach using two biomarkers, blood ethanol and phosphatidylethanol (PEth). METHODS: Observational study using secondary testing of blood samples collected during routine clinical care of ED patients presenting to the Royal Brisbane and Women's Hospital in Queensland, Australia, between 22 January and 2 February 2021. Data were collected from 1160 patients during the 10-day study period. The main outcomes were the prevalence of acute alcohol intake, as determined by blood ethanol, and recent use over 2-4 weeks, as determined by PEth concentrations, for all ED presentations and different diagnostic groups. RESULTS: The overall prevalence for blood ethanol was 9.3% (95% confidence interval [CI] 7.8%, 11.1%), 5.3% for general medical presentations, increasing four-fold to 22.2% for injury presentations. The overall prevalence of PEth positive samples was 32.5% (95% CI 29.9%, 35.3%) and 41.4% for injury presentations. There were 263 (25.3%) cases that tested negative for acute blood ethanol but positive for PEth concentrations indicative of significant to heavy medium-term alcohol consumption. DISCUSSION AND CONCLUSIONS: This novel surveillance approach demonstrates that using blood ethanol tests in isolation significantly underestimates the prevalence of medium-term alcohol consumption in ED presentations. Prevalence of alcohol use was higher for key diagnostic groups such as injury presentations. Performing periodic measurement of both acute and medium-term alcohol consumption accurately and objectively in ED presentations, would be valuable for informing targeted public health prevention and control strategies.

Application of a Machine Learning-Based Decision Support Tool to Improve an Injury Surveillance System Workflow.

BACKGROUND: Emergency department (ED)-based injury surveillance systems across many countries face resourcing challenges related to manual validation and coding of data. OBJECTIVE: This study describes the evaluation of a machine learning (ML)-based decision support tool (DST) to assist injury surveillance departments in the validation, coding, and use of their data, comparing outcomes in coding time, and accuracy pre- and postimplementations. METHODS: Manually coded injury surveillance data have been used to develop, train, and iteratively refine a ML-based classifier to enable semiautomated coding of injury narrative data. This paper describes a trial implementation of the ML-based DST in the Queensland Injury Surveillance Unit (QISU) workflow using a major pediatric hospital's ED data comparing outcomes in coding time and pre- and postimplementation accuracies. RESULTS: The study found a 10% reduction in manual coding time after the DST was introduced. The Kappa statistics analysis in both DST-assisted and -unassisted data shows increase in accuracy across three data fields, that is, injury intent (85.4% unassisted vs. 94.5% assisted), external cause (88.8% unassisted vs. 91.8% assisted), and injury factor (89.3% unassisted vs. 92.9% assisted). The classifier was also used to produce a timely report monitoring injury patterns during the novel coronavirus disease 2019 (COVID-19) pandemic. Hence, it has the potential for near real-time surveillance of emerging hazards to inform public health responses. CONCLUSION: The integration of the DST into the injury surveillance workflow shows benefits as it facilitates timely reporting and acts as a DST in the manual coding process.

DINED (Delivery-related INjuries in the Emergency Department) part 2: A chart review of risk factors and injuries affecting food delivery riders.

OBJECTIVE: This study aimed to examine patterns of injury, the impact of these injuries on patients and identification of potentially modifiable contributing factors through industry regulation reforms and education. METHODS: Food delivery rider (FDR)-related presentations to the Royal Brisbane and Women's Hospital Emergency and Trauma Centre for a year from September 2020 were identified. Data collected included patient and incident demographics: time, type and location of injuries, investigations and care required, length of stay, admission requirements and follow up. RESULTS: The cohort included 81.8% male with a mean age of 25.2 years. Most injuries occurred on the road from a collision with a vehicle. The most common injury was fractures. Incidence increased on weekends and during the evening. More than half the cohort were admitted to hospital. Only 22.7% of patients were eligible for workers compensation and less than half were covered by Medicare. The majority (72.7%) of cases involved non-resident riders from other countries. CONCLUSION: The majority of FDRs presenting with injuries are not Australian citizens and less than half were Medicare eligible potentially contributing to inadequate access to care especially fracture follow up. There were spikes in injuries occurring at night, weekends and during periods of pandemic associated lockdowns demonstrating an increased usage of delivery services during these times. Results highlight injury patterns experienced by delivery riders and potentially modifiable risk factors for this rapidly growing area of employment within the gig economy.

Community Opioid Dispensing After Injury (CODI): Protocol for a Population-Based Data Linkage Study.

BACKGROUND: There is an urgent need to reduce preventable deaths and hospitalizations from prescription opioid harms and minimize the negative effect opioid misuse can have on injured individuals, families, and the wider community. Data linkage between administrative hospitalization records for injured patients and community opioid dispensing can improve our understanding of the health and surgical trajectories of injured persons and generate insights into corresponding opioid dispensing patterns. OBJECTIVE: The Community Opioid Dispensing after Injury (CODI) study aims to link inpatient hospitalization data with opioid dispensing data to examine the distribution and predictive factors associated with high or prolonged community opioid dispensing among adults, for 2 years following an injury-related hospital admission. METHODS: This is a retrospective population-based cohort study of adults aged 18 years or older hospitalized with an injury in Queensland, Australia. The study involves the linkage of statewide hospital admissions, opioid prescription dispensing, and mortality data collections. All adults hospitalized for an injury between January 1, 2014, and December 31, 2015, will be included in the cohort. Demographics and injury factors are recorded at the time of the injury admission. Opioid dispensing data will be linked and extracted for 3 months prior to the injury admission date to 2 years after the injury separation date (last date December 31, 2017). Deaths data will be extracted for the 2-year follow-up period. The primary outcome measure will be opioid dispensing (frequency and quantity) in the 2 years following the injury admission. Patterns and factors associated with community opioid dispensing will be examined for different injury types, mechanisms, and population subgroups. Appropriate descriptive statistics will be used to describe the cohort. Regression models will be used to examine factors predictive of levels and duration of opioid use. Nonparametric methods will be applied when the data are not normally distributed. RESULTS: The project is funded by the Royal Brisbane and Women's Hospital Foundation. As of November 2021, all ethics and data custodian approvals have been granted. Data extraction and linkage has been completed. Data management and analysis is underway with results relating to an analysis for blunt chest trauma patients expected to be published in 2022. CONCLUSIONS: Little is currently known of the true prevalence or patterns of opioid dispensing following injury across Queensland. This study will provide new insights about factors associated with high and long-term opioid dispensing at a population level. This information is essential to inform targeted public policy and interventions to reduce the risk of prolonged opioid use and dependence for those injured. The novel work undertaken for this project will be vital to planning, delivering, monitoring, and evaluating health care services for those injured. The findings of this study will be used to inform key stakeholders as well as clinicians and pain management services. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/36357.

Applying a public health approach to identify priorities for regulating child product safety.

OBJECTIVE: To identify leading injury risk factors and jurisdictional differences in Australian and US child-related product safety regulatory responses to inform the development of Australian policy and reform priorities. METHODS: The study established and evaluated a knowledge base of child-related product safety regulatory responses (recalls, bans, standards and warnings) made in Australia and the US over the period 2011-17 to identify risk factors and potential regulatory gaps. RESULTS: The research identified 1,540 Australian and US child-related product safety regulatory responses with the most common response type being product safety recall, and the leading product hazards in responses being choking, fire, fall, strangulation and chemical hazards. Jurisdictional differences identified potential regulatory gaps in Australia related to chemical hazards and high-risk durable infant and toddler products, and some data deficiencies in Australian responses. CONCLUSIONS: Priorities include the need to improve the prevention orientation of the Australian product safety framework, to create an intelligence platform to assess injury risks more precisely and to address regulatory gaps related to the use of toxic chemicals in children's products and high-risk durable infant and toddler products. IMPLICATIONS FOR PUBLIC HEALTH: The study demonstrates the identification of policy and reform priorities for child product safety using a public health lens.

Prevalence of Alcohol Consumption in Emergency department presentations (PACE) in Queensland, Australia, using alcohol biomarkers ethanol and phosphatidylethanol: an observational study protocol.

INTRODUCTION: Alcohol use in patients presenting to the emergency department (ED) is a significant problem in many countries. There is a need for valid and reliable surveillance of the prevalence of alcohol use in patients presenting to the ED, to provide a more complete picture of the risk factors and inform targeted public health interventions. This PACE study will use two biomarkers, blood ethanol and phosphatidylethanol (PEth), to determine the patterns, presence and level of alcohol use in patients presenting to an Australian ED. METHODS AND ANALYSIS: This is an observational prevalence study involving the secondary use of routinely collected blood samples from patients presenting to the Royal Brisbane and Women's Hospital (RBWH) Emergency and Trauma Centre (ETC). Samples will be tested for acute and medium-term alcohol intake using the two biomarkers blood ethanol and PEth respectively, over one collection period of 10-12 days. Descriptive statistics such as frequencies, percentages, means, SD, medians and IQRs, will be used to describe the prevalence, pattern and distribution of acute and medium-term alcohol intake in the study sample. The correlation between acute and medium-term alcohol intake levels will also be examined. ETHICS AND DISSEMINATION: This study has been approved by the RBWH Human Research Ethics Committee (reference, LNR/2019/QRBW/56859). Findings will be disseminated to key stakeholders such as RBWH ETC, Australasian College for Emergency Medicine, Royal Australasian College of Surgeons, Statewide Clinical Networks, and used to inform clinicians and hospital services. Findings will be submitted for publication in peer-reviewed journals and presentation at appropriate conferences.

Trauma by-pass guideline: A data-driven conformance analysis for road trauma cases in Queensland.

OBJECTIVE: Study objectives were to (i) develop and test a whole-of-system method for identifying patients who meet a major trauma by-pass guideline definition; (ii) apply this method to assess conformance to the current 2006 guideline for a road trauma cohort; and (iii) leverage relevant findings to propose improvements to the guideline. METHODS: Retrospective analysis of existing, routinely collected data relating to Queensland road trauma patients July 2015 to June 2017. Data from ambulance, aero-medical retrievals, ED, hospital and death registers were linked and used for analysis. Processes of care measured included: frequency of pre-hospital triage criteria, distribution of destination (trauma service level), compliance with guideline (recommended vs actual destination), trauma service level by threat to life (injury severity) (all modes of transport and aero-medical in particular), proportion of patients requiring only ED, transport pathway (direct vs inter-hospital transfer). RESULTS: 3847 cases were identified from data as meeting criteria for major trauma by-pass. The top five most frequently used criteria for qualifying patients as meeting the major trauma by-pass guideline were pulse rate, vehicle rollover, possible spinal cord injury, respiration rate and entrapment. The study demonstrates a 65% conformance to the clinical guideline. Overtriaged patients (transported to higher trauma service than recommended) generally reveal International Classification of Disease Injury Severity Score representing a high threat to life. CONCLUSION: Overall, the present study found good conformance, with overtriage rate as expected by clinicians. It is recommended to include data values to capture paramedics assessment of trauma level to enable more accurate assessment of conformance to guideline and future revision of the thresholds.

Comparing the accuracy of ICD-based severity estimates to trauma registry-based injury severity estimates for predicting mortality outcomes.

INTRODUCTION: Trauma registries have been used internationally for several decades to measure the quality of trauma care between hospitals. Given the significant costs involved in establishing and maintaining trauma registries, and increasing availability of routinely collected, linked health data describing a patient's journey (and inherent cost savings in data re-use), there is significant interest in development of integrated, comprehensive trauma data repositories. However, approaches to estimating injury severity using routinely collected data would need to be developed if routinely collected hospital data were to be used as an alternative/supplement to registries. OBJECTIVES: This study aimed to compare the accuracy of registry-based injury severity estimates with ICD-based injury severity estimates in predicting mortality outcomes in a cohort of minor and major trauma patients in Queensland, using retrospectively linked trauma registry and hospital admissions data. METHODS: Queensland Trauma Registry (QTR) data with an admission date between 1 January 2005 and 31 December 2011 was linked with all acute care patients included in the Queensland Hospital Admitted Patient Data Collection (QHAPDC) with a Principal Diagnosis coded with an ICD-10-AM code within Chapter 19 (S00-T98). Abbreviated Injury Scale coding was undertaken manually by QTR trauma data nurses for the registry data. ICD-based injury severity scores (ICISS) were calculated automatically using all injury-related diagnoses captured in the QHAPDC data using the ICISS multiplicative and worst injury method. RESULTS: There were 92,140 QTR patients admitted between January 2005 and December 2011 with a valid ISS with a matching QHAPDC record (98.4% survived, 1.6% died). ICISS (multiplicative and worst injury approach) showed marginally better predictive accuracy than ISS when predicting mortality across minor and major injury and ICISS showed marginally better predictive accuracy to ISS when restricted to major trauma/high threat to life cases. Both ICISS and ISS restricted to major trauma/high threat to life showed poorer accuracy compared to the predictive performance when both minor and major cases were included. CONCLUSION: ICD-based predictions were as accurate as ISS-based predictions for this cohort and this study provides evidence to support the potential for using routinely coded hospital data for risk adjustment within State-based trauma data repositories.

Three Es of linked injury data: Episodes, Encounters and Events.

BACKGROUND: Treatment and recovery times following injury can be lengthy, comprising multiple interactions with the hospital system for initial acute care, subsequent rehabilitation and possible re-presentation due to complications. AIMS: This article aims to promote the use of consistent terminology in injury data linkage studies, suggest important factors to consider when managing linked injury data, and encourage thorough documentation and a robust discourse around different approaches to data management to ensure reproducibility, consistency and comparability of analyses arising from linked injury data. APPROACH: This paper is presented in sections describing: (1) considerations for identifying injury cohorts, (2) considerations for grouping Episodes into Encounters and (3) considerations for grouping Encounters into Events. Summary tools are provided to aid researchers in the management of linked injury data. DISCUSSION: Careful consideration of decisions made when identifying injury cohorts and grouping data into units of analysis (Episodes/Encounters/Events) is essential when using linked injury data. Choices made have the potential to significantly impact the epidemiological and clinical findings derived from linked injury data studies, which ultimately affect the quality of injury prevention initiatives and injury management policy and practice. It is intended that this paper will act as a call to action for injury linkage methodologists, and those using linked data, to critique approaches, share tools and engage in a robust discourse to further advance the use of linked injury data, and ultimately enhance the value of linked injury data for clinicians and health and social policymakers.

Identifying the priority challenges in trauma care delivery for Australian and New Zealand trauma clinicians.

INTRODUCTION: Injury is a leading cause of death and disability world-wide. Little is known about the day-to-day challenges the trauma clinicians face in their practice that they feel could be improved through an increased evidence base. This study explored and ranked the trauma clinical practice research priorities of trauma care professionals across Australia and New Zealand. METHODS: A modified-Delphi study was conducted between September 2019 and January 2020. The study employed two rounds of online survey of trauma professionals from relevant Australia and New Zealand professional organisations using snowballing method. Participants were asked to rank the importance of 29 recommendations, each corresponding to a key challenge in trauma care delivery. Decisions on the priorities of the challenges were determined by a consensus of >70% of respondents ranking the challenge as important or very important. RESULTS: One hundred and fifty-five participants completed Round One, and 106 participants completed Round Two. A total of 15 recommendations reached >70% in Round One. Nine recommendations also reached >70% consensus in Round Two. Recommendations ranked highest were 'Caring for elderly trauma patients', 'Identifying and validating key performance indicators for trauma system benchmarking and improvement', and 'Management of traumatic brain injury'. CONCLUSION: This study identified the priority areas for trauma research as determined by clinician ranking of the most important for informing and improving their practice. Addressing these areas generates potential to improve the quality and safety of trauma care in Australian and New Zealand.