Major Trauma in NSW, 2015...NSW ITIM Major Trauma in NSW, 2015 ii AGENCY FOR CLINICAL INNOVATION Level 4, Sage Building 67 Albert Avenue Chatswood NSW 2067 PO Box 699 Chatswood NSW

NSW ITIM Major Trauma in NSW, 2014 i

NSW Institute of Trauma and Injury Management

Major Trauma in NSW, 2015 A Report from the NSW Trauma Registry

NSW ITIM Major Trauma in NSW, 2015 ii

AGENCY FOR CLINICAL INNOVATION

Level 4, Sage Building

67 Albert Avenue

Chatswood NSW 2067

PO Box 699 Chatswood NSW 2057

T +61 2 9464 4666 | F +61 2 9464 4728

E [email protected] | www.aci.health.nsw.gov.au

SHPN: (ACI) 160502 ISBN: 978-1-76000- 559-7(print); 978-1-76000- 560-3 (online)

Authors:

Hardeep Singh, Data Officer, NSW Institute of Trauma and Injury Management, ACI

Elvis Maio, Data Officer, NSW Institute of Trauma and Injury Management, ACI

Glenn Sisson, Project Officer, NSW Institute of Trauma and Injury Management, ACI

Benjamin Hall, Project Officer, NSW Institute of Trauma and Injury Management, ACI

Pooria Sarrami, Research Officer, NSW Institute of Trauma and Injury Management, ACI

Further copies of this publication can be obtained from

the Agency for Clinical Innovation website at www.aci.health.nsw.gov.au/networks/itim

Suggested citation: NSW Institute of Trauma and Injury Management. Major Trauma in NSW 2015. Sydney: NSW

Agency for Clinical Innovation, 2016.

Disclaimer: Content within this publication was accurate at the time of publication. This work is copyright. It may be

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requires written permission from the Agency for Clinical Innovation.

Version: 1.1 Trim: ACI/D16/7662

© Agency for Clinical Innovation 2016

The Agency for Clinical Innovation (ACI) works with clinicians, consumers and managers to design and promote better

healthcare for NSW. It does this by:

service redesign and evaluation – applying redesign methodology to assist healthcare providers and consumers to

review and improve the quality, effectiveness and efficiency

of services

specialist advice on healthcare innovation – advising on the development, evaluation and adoption of healthcare

innovations from optimal use through to disinvestment

initiatives including guidelines and models of care – developing a range of evidence-based healthcare improvement

initiatives to benefit the NSW health system

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healthcare innovations into practice across metropolitan and rural NSW

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sharing on healthcare innovation and improvement

continuous capability building – working with healthcare providers to build capability

in redesign, project management and change management through the Centre for Healthcare Redesign.

ACI Clinical Networks, Taskforces and Institutes provide a unique forum for people to collaborate across clinical specialties

and regional and service boundaries to develop successful healthcare innovations.

A priority for the ACI is identifying unwarranted variation in clinical practice and working in partnership with healthcare

providers to develop mechanisms to improve clinical practice

and patient care.

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NSW ITIM Major Trauma in NSW, 2015 iii

Acknowledgements

The NSW Institute of Trauma and Injury Management wishes to acknowledge the NSW Trauma Services for their contribution of data to the NSW Trauma Registry.

NSW ITIM Major Trauma in NSW, 2015 iv

Glossary

Abbreviated Injury Scale (AIS) is an anatomically-based, consensus-derived, global severity

scoring system that classifies each injury by body region according to its relative importance on a 6

point ordinal scale. The AIS is the basis for the Injury Severity Score (ISS) calculation of the

multiply injured patient. See Section 2 – Methodology for more information.

Adjusted mortality rate refers to the mortality rate that would have existed if each trauma service

had the same age distribution as the “standard” population. In this report, the total NSW trauma

patients (Injury Severity Score >12) were considered as the standard population. Adjusted

mortality rates were calculated based on the indirect standardisation method. See Appendix 5 for

more information.

Case fatality rate is the proportion of deaths for a designated population expressed as a

percentage.

Definitive care is defined as the hospital providing the highest level of care to meet all the clinical

needs of the patient. Many patients receive definitive care at Regional Trauma Services, but a

small number of patients are transferred to a Major Trauma Service (higher level) for specialised

care.

Geriatric population is defined as those aged 65 years or older.

Location of injury is defined as either metropolitan or rural based on the recorded postcode of

injury. The process used to define the two categories is outlined in Part 2 - Methodology.

Injury Severity Score (ISS) assesses the combined effects of the multiply injured patient and is

based on an anatomical injury severity classification, the Abbreviated Injury Scale (AIS). The ISS is

an internationally recognised scoring system which correlates with mortality, morbidity and other

measures of severity. The ISS is calculated as the sum of the squares of the highest AIS code in

each of the three most severely injured ISS body regions. See Section 2 – Methodology for more

information.

ISS body regions consists of 6 anatomical regions as defined in the AIS dictionary:

Head or neck

Face

Chest

Abdominal or pelvic contents

Extremities or pelvic girdle

External

Isolated fractured neck of femur is defined as the AIS codes 853161.3 and 853162.3 and where

no other injury is recorded.

NSW ITIM Major Trauma in NSW, 2015 v

Major trauma is defined as all patients of any age, who were admitted to a designated NSW

Trauma Service within 14 days of sustaining an injury, and:

Had an Injury Severity Score (ISS) > 12 (moderate to critically injured); or

Admitted to an Intensive Care Unit (irrespective of ISS) following injury; or

Died in hospital (irrespective of ISS) following injury, except those with an isolated fractured

neck of femur injury sustained from a fall from a standing height (<1 metre) and those aged 65

years or older who die with minor soft tissue injury only.

Major trauma services (MTS) can provide the full spectrum of care for major and moderately

injured patients, from initial resuscitation through to rehabilitation and discharge. There are

currently 7 adult and 3 paediatric designated MTS in NSW.

Mechanism of injury refers to the mechanisms whereby energy is transferred from the

environment to the person.

Minor soft tissue injury is defined as a superficial injury including abrasions, contusions, and

lacerations (AIS codes: 910000.1; 910200.1; 910400.1; 910600.1, 810099.1, 810202.1, 810402.1,

810600.1, 810602.1, 710099.1, 710202.1, 710402.1, 710600.1, 710602.1, 510099.1, 510202.1,

510402.1, 510600.1, 510602.1, 410099.1, 410202.1, 410402.1, 410600.1, 410602.1, 310099.1,

310202.1, 310402.1, 310600.1, 310602.1, 210099.1, 210202.1, 210402.1, 210600.1, 210602.1).

Polytrauma is defined as serious injury (AIS severity >2) in two or more ISS body regions.

Regional trauma services (RTS) can provide all aspects of care to patients with minor to

moderate trauma, and definitive care to a limited number of major trauma patients in collaboration

with the MTS. An RTS provides initial assessment, stabilisation, definitive care and initiates

transfer to an MTS when a patient requires services not available at the RTS. There are currently

10 designated RTS in NSW.

Revised Trauma Score is a physiological scoring system used for predicting death. It consists of

the first set of vital signs data obtained on the patient after arrival at hospital including Glasgow

Coma Scale, Systolic Blood Pressure and Respiratory Rate. Values for the Revised Trauma Score

are in the range 0 to 7.8408. The lower the score, the higher the likelihood of death. See Section 2

– Methodology for more information.

Standardised Mortality Ratio (SMR) is a ratio between the observed number of deaths in a study

population and the number of deaths that would be expected, based on the age or Injury Severity

Score (ISS) specific rates in a standard population and the age or ISS distribution of the study

population.

NSW ITIM Major Trauma in NSW, 2015 vi

Executive summary

Each year more than 3,900 people are admitted to a NSW Trauma Service for injuries defined as

major trauma. How the NSW trauma system responds to these patients is critical for their long term

outcome and quality of life and for reducing the overall financial and social cost of trauma to

individuals and the community as a whole.

A key priority for the NSW Institute of Trauma and Injury Management (ITIM) is to monitor the

effectiveness of the NSW trauma system response to these major trauma patients. This group of

patients places the greatest demand on the trauma system and on other agencies and services –

not simply for health care, but for a wide range of needs.

This report describes how the NSW trauma system responded to these patients, from the time of

injury and provision of pre-hospital services, through to in-hospital services provided at a NSW

Trauma Service. The report investigates the data to determine whether the NSW trauma system is

functioning effectively, to ensure that the right patient arrived at the right hospital in a timely matter.

The report helps us understand the nature of the injuries sustained and how they occurred. The

findings are used by various agencies concerned with minimising the likelihood and effects of

traumatic injury and contributing to safety and injury prevention efforts. Data from the NSW Trauma

Registry is used by ITIM to provide advice and feedback to clinicians and other stakeholders and

enables research into patterns of service demand and staffing. This data also supports

benchmarking and performance improvement activities.

It is important to note that this report does not represent all injuries in NSW, nor does it represent

the full work or caseload of trauma services in hospitals or the full set of data recorded in hospital

trauma registries.

2015 report highlights:

3,970 major trauma patients.

4,103 major trauma admissions.

Average age was 51.7 years old.

Males were 2.4 times more likely to be injured.

Case fatality rate (ISS >12) was 10.1% (was 11.2% in 2014).

Females had higher case fatality rate (12.2%) compared to males (9.2%).

Falls accounted for 43.2% of all major trauma, exceeding road trauma (36.5%).

"Three or more fractured ribs without flail" was the most common serious injury (26%).

28.9% of major trauma was sustained in a rural area.

Pedestrian trauma had a slightly higher case fatality rate (11.3%) than motor bike

collisions and significantly above other forms of road trauma.

62.2% of major trauma patients sustained injuries to the head or neck body region, with

the chest region injured in 48.4% of patients.

NSW ITIM Major Trauma in NSW, 2014 vii

Contents

Acknowledgements ......................................................................................................................................... iii

Glossary ........................................................................................................................................................... iv

Executive summary ......................................................................................................................................... vi

Contents .......................................................................................................................................................... vii

List of tables ..................................................................................................................................................... ix

List of figures ................................................................................................................................................... xi

Monitoring the NSW Trauma System ............................................................................................................. 1

NSW Trauma System ........................................................................................................................................ 1

Mandate for trauma data ................................................................................................................................... 1

NSW Trauma Registry ....................................................................................................................................... 1

NSW Trauma Services ...................................................................................................................................... 2

Methodology ..................................................................................................................................................... 3

Inclusion criteria ................................................................................................................................................. 3

Exclusion criteria ................................................................................................................................................ 3

Data quality ........................................................................................................................................................ 4

The Injury Severity Score and Abbreviated Injury Score ................................................................................... 4

Revised Trauma Score ...................................................................................................................................... 5

Metropolitan and rural categorisation ................................................................................................................ 5

Major trauma patients ...................................................................................................................................... 6

Introduction ........................................................................................................................................................ 6

Summary profile ................................................................................................................................................. 6

Age and gender ................................................................................................................................................. 7

Mechanism of injury ......................................................................................................................................... 10

Time and day of injury...................................................................................................................................... 15

Injuries ............................................................................................................................................................. 16

Injury Severity Score ........................................................................................................................................ 18

Pre-hospital time .............................................................................................................................................. 19

Mode of transport ............................................................................................................................................. 20

NSW ITIM Major Trauma in NSW, 2015 viii

Major trauma admissions .............................................................................................................................. 22

Introduction ...................................................................................................................................................... 22

Facility overview ............................................................................................................................................... 22

Admission type ................................................................................................................................................. 24

Revised Trauma Score .................................................................................................................................... 25

Trauma team activation ................................................................................................................................... 26

Vital signs on arrival to the Emergency Department ....................................................................................... 28

Intensive Care Unit admissions ....................................................................................................................... 29

Length of stay .................................................................................................................................................. 30

Surgical procedures ......................................................................................................................................... 32

Discharge destination of survivors ................................................................................................................... 33

Appendices ..................................................................................................................................................... 34

Appendix 1: Adult Major Trauma Service Summaries ..................................................................................... 35

Appendix 2: Paediatric Major Trauma Service summaries.............................................................................. 49

Appendix 3: Regional Trauma Service summaries ......................................................................................... 55

Appendix 4: Calculation of the Injury Severity Score ....................................................................................... 75

Appendix 5: Calculation of adjusted mortality rate .......................................................................................... 76

Appendix 6: Australian Statistical Geography Standard Remoteness Areas .................................................. 78

NSW ITIM Major Trauma in NSW, 2015 ix

List of tables

Table 1: Revised Trauma Score points system ................................................................................................. 5

Table 2: Summary statistics for major trauma and mortality ............................................................................. 6

Table 3: Major trauma patients, injury and death rate by age group ................................................................. 7

Table 4: Type of injury ..................................................................................................................................... 10

Table 5: Mechanism of injury by age ............................................................................................................... 11

Table 6: Mechanism of injury by place of injury .............................................................................................. 13

Table 7: Falls in detail ...................................................................................................................................... 14

Table 8: Road trauma in detail ........................................................................................................................ 14

Table 9: Assaults in detail ................................................................................................................................ 14

Table 10: Top 5 injuries with an AIS severity >2 ............................................................................................. 16

Table 11: Number of ISS body regions injured with an AIS severity >2 ......................................................... 17

Table 12: Single body region versus polytrauma with an AIS severity >2 ...................................................... 17

Table 13: Major trauma patients by ISS group ................................................................................................ 18

Table 14: Time of injury to arrival at a designated trauma service .................................................................. 19

Table 15: Time of injury to arrival at definitive care if transferred from another trauma service ..................... 20

Table 16: Mode of transport to definitive care ................................................................................................. 20

Table 17: Overview of trauma service admissions .......................................................................................... 22

Table 18: Number of admissions by type ........................................................................................................ 24

Table 19: Overview of ICU and hospital length of stay ................................................................................... 30

Table 20: ICU and hospital length of stay by ISS ............................................................................................ 30

Table 21: ICU and hospital length of stay by age ............................................................................................ 31

Table 22: Surgical procedures performed by type in total admissions ............................................................ 32

Table 23: Trauma data profile, John Hunter Hospital ...................................................................................... 35

Table 24: Trauma data profile, Liverpool Hospital ........................................................................................... 37

Table 25: Trauma data profile, Royal North Shore Hospital............................................................................ 39

Table 26: Trauma data profile, Royal Prince Alfred Hospital .......................................................................... 41

Table 27: Trauma data profile, St George Hospital ......................................................................................... 43

Table 28: Trauma data profile, St Vincent’s Hospital ...................................................................................... 45

Table 29: Trauma data profile, Westmead Hospital ........................................................................................ 47

Table 30: Trauma data profile, John Hunter Children’s Hospital .................................................................... 49

NSW ITIM Major Trauma in NSW, 2015 x

Table 31: Trauma data profile, Sydney Children’s Hospital ............................................................................ 51

Table 32: Trauma data profile, The Children’s Hospital at Westmead ............................................................ 53

Table 33: Trauma data profile, Coffs Harbour Health Campus ....................................................................... 55

Table 34: Trauma data profile, Gosford Hospital ............................................................................................ 57

Table 35: Trauma data profile, Lismore Base Hospital ................................................................................... 59

Table 36: Trauma data profile, Nepean Hospital ............................................................................................. 61

Table 37: Trauma data profile, Orange Health Service ................................................................................... 63

Table 38: Trauma data profile, Port Macquarie Base Hospital........................................................................ 65

Table 39: Trauma data profile, Tamworth Rural Referral Hospital .................................................................. 67

Table 40: Trauma data profile, The Tweed Hospital ....................................................................................... 69

Table 41: Trauma data profile, Wagga Wagga Rural Referral Hospital .......................................................... 71

Table 42: Trauma data profile, Wollongong Hospital ...................................................................................... 73

Table 43: ISS calculation example .................................................................................................................. 75

Table 44: Calculation of adjusted mortality rate .............................................................................................. 77

NSW ITIM Major Trauma in NSW, 2015 xi

List of figures

Figure 1: Number of major trauma patients by age, gender and mortality ........................................................ 8

Figure 2: Age-specific injury rate by age and gender ........................................................................................ 8

Figure 3: Case fatality rate by age and gender (ISS>12) .................................................................................. 9

Figure 4: Age-specific mortality rate by age and gender ................................................................................... 9

Figure 5: Mechanism of injury ......................................................................................................................... 10

Figure 6: Mechanism of injury by age .............................................................................................................. 12

Figure 7: Mechanism of injury as a percentage by age ................................................................................... 12

Figure 8: Age-specific rates of mechanism of injury ........................................................................................ 13

Figure 9: Number of patients by time of injury ................................................................................................. 15

Figure 10: Number of patients by day of injury ................................................................................................ 15

Figure 11: All injuries by ISS body region ........................................................................................................ 16

Figure 12: Number of major trauma patients by ISS group and gender ......................................................... 18

Figure 13: Case fatality rate by ISS and gender (ISS >12) ............................................................................. 19

Figure 14: Mode of transport to definitive care when transported direct from the scene of injury, by injury

location............................................................................................................................................................. 21

Figure 15: Mode of transport to definitive care when transferred from another acute care facility, by injury

location............................................................................................................................................................. 21

Figure 16: Adult Major Trauma Services - SMR for ISS and age (ISS >12) ................................................... 23

Figure 17: Paediatric Major Trauma Services - SMR for ISS and age (ISS >12) ........................................... 23

Figure 18: Regional Trauma Services - SMR for ISS and age (ISS >12) ....................................................... 24

Figure 19: Average Revised Trauma Score by ISS group .............................................................................. 25

Figure 20: Trauma team activation by admission type .................................................................................... 26

Figure 21: Trauma team activation by ISS group ............................................................................................ 27

Figure 22: Initial systolic blood pressure on arrival to the ED and mortality .................................................... 28

Figure 23: Initial Glasgow Coma Scale (GCS) on arrival to the ED and mortality .......................................... 28

Figure 24: Initial temperature on arrival to ED and mortality ........................................................................... 29

Figure 25: ICU admission by ISS group .......................................................................................................... 29

Figure 26: Surgical procedures performed by ISS group ................................................................................ 32

Figure 27: Discharge destination of survivors ................................................................................................. 33

Figure 28: Discharge destination of survivors by ISS group ........................................................................... 33

Figure 29: Map of NSW showing ASGS-RA.................................................................................................... 78

NSW ITIM Major Trauma in NSW, 2015 1

1. Monitoring the NSW Trauma System

NSW Trauma System

The primary function of the NSW Trauma System is to facilitate and coordinate an organised

multidisciplinary system response with the aim of reducing the burden of injury. The system

encompasses a continuum of care that provides traumatically injured patients with the greatest

likelihood of returning to their pre-injury level of function within the community.

This continuum of care includes injury prevention, pre-hospital coordination and care, appropriate

triage and transport, emergency department trauma care, trauma service team activation, surgical

intervention, intensive/critical and general in-hospital care, rehabilitation services, allied health and

medical care follow up.

The overall goal of the NSW Trauma System is to decrease the incidence and severity of injury

and to ensure optimal, accessible and equitable care to improve health outcomes for those who

are injured. The main objective of the trauma system is to get the ‘right patient to the right hospital

in the right time receiving the right care.’ To meet this objective, designated trauma services need

to have appropriate resources to meet the complex needs of the injured patient.

Mandate for trauma data

The NSW Trauma Services Plan (2009) outlines the role of the NSW ITIM, including monitoring

and reporting on the performance of individual Trauma Services to ensure that performance is

consistent with the standard of care and to manage a state-wide clinical injury data collection

process.

The plan also positions NSW ITIM to develop partnerships with injury stakeholders, such as the

Local Health Districts, NSW Ambulance, State Insurance Regulatory Authority (SIRA), State

Coroner, Clinical Excellence Commission (CEC) and universities, in order to build an improved

critical mass for research and education across the spectrum of trauma prevention care and

rehabilitation. The collection of trauma data is an important aspect of these activities.

NSW Trauma Registry

NSW ITIM is responsible for managing the collection of data about moderate to critically injured

people admitted to trauma services in NSW. Data collected is held securely in the NSW Trauma

Registry. Data in the registry is submitted from each of the designated NSW Trauma Services.

The NSW Trauma Registry contains de-identified patient records but does not hold data for every

injured person admitted to hospital in NSW. Data is only included for patients with the greatest

needs – the most seriously injured – who are treated at a NSW Trauma Service, a designated

hospital in NSW which contributes to the NSW Trauma Registry. This data is known as the NSW

Trauma Minimum Data Set and forms the basis of data analysis and reporting activities at NSW

ITIM. As the scope of the current data collection is restricted to these designated hospitals, there

may be some data for trauma admissions to other hospitals that are not included in the NSW

Trauma Registry.


NSW Trauma Services

The NSW Trauma System consists of 7 adult Major Trauma Services, 3 Paediatric Major Trauma

Services and 10 Regional Trauma Services. All of the services contributed data to the NSW

Trauma Registry used in this report.

The NSW Trauma Services are listed below:

Adult Major Trauma Services:

John Hunter Hospital

Liverpool Hospital

Royal North Shore Hospital

Royal Prince Alfred Hospital

St George Hospital

St Vincent's Hospital

Westmead Hospital

Paediatric Major Trauma Services:

John Hunter Children's Hospital

Sydney Children's Hospital

The Children's Hospital at Westmead

Regional Trauma Services:

Coffs Harbour Base Hospital

Gosford Hospital

Lismore Base Hospital

Nepean Hospital

Orange Health Service

Port Macquarie Base Hospital

Tamworth Rural Referral Hospital

The Tweed Hospital

Wagga Wagga Rural Referral Hospital

Wollongong Hospital


2. Methodology

This report is compiled from data submitted by reporting facilities to the NSW Trauma Registry in

accordance with the inclusion and exclusion criteria detailed below. Data for this report was

extracted from the NSW Trauma Registry on 26th October 2016.

Inclusion criteria

All major trauma patient records from the NSW Trauma Registry, where the date of injury occurred

in the calendar year of 2015, are included in this report.

Major trauma is defined as all patients of any age, who were admitted to a NSW Trauma Service

within 14 days of sustaining an injury, and who:

Had an Injury Severity Score (ISS) > 12 (moderate to critically injured); or

Admitted to an Intensive Care Unit (irrespective of ISS) following injury; or

Died in hospital (irrespective of ISS) following injury.

As a result of these criteria, patient records submitted for inclusion in this report do not represent

all injuries in NSW, nor do they represent the full work or caseload of trauma services in hospitals,

nor the full set of data recorded in hospital trauma registries.

Exclusion criteria

The criteria for excluding a patient record from this report are:

Patients not admitted to a designated NSW Trauma Service

Patients admitted to a designated NSW Trauma Service greater than 14 days after sustaining

an injury

Patients who die with an isolated fractured neck of femur injury sustained from a fall from a

standing height (<1 metre)1

Patients aged 65 years or older who die with minor soft tissue injury only2

Records have also been excluded from this report if the following key data elements have missing

or invalid data recorded in the registry:

Injury Severity Score

Date of injury

Date of admission

A total of 38 records were excluded from this report.

1 See Glossary for definition of an isolated fractured neck of femur injury.

2 See Glossary for definition of a minor soft tissue injury.


Data quality

Data submitted to the NSW Trauma Registry is subject to rigorous checking and validation by ITIM

and the reporting facilities, while missing or invalid data is flagged and returned to individual

trauma services for completion and validation.

The Injury Severity Score and Abbreviated Injury Score

One of the key criteria for inclusion in this report is an Injury Severity Score (ISS) > 12. The ISS is

an internationally recognised scoring system which correlates with mortality, morbidity and other

measures of severity. The ISS is calculated based on an anatomical injury severity classification,

the Abbreviated Injury Scale (AIS). The AIS classifies individual injuries by body region on a 6 point

severity scale from minor (1) to maximum (6 - currently untreatable injury). The NSW Trauma

Registry uses the AIS 2005 (Update 2008) dictionary.

The AIS is used by accredited staff at each hospital trauma registry to score individual patient

injuries and their severity, and provides a common tool for comparing and selecting patient records

for inclusion in the NSW Trauma Registry. Scoring is undertaken retrospectively but usually within

24-48 hours after admission to allow for identification of all injuries. On initial evaluation, these

patients typically have abnormal vital signs or a significant anatomical injury.

Injuries are individually allocated to one of six body regions and the severities of the top three

injuries in different body regions are used to calculate the ISS. The ISS along with the body regions

and injury and severity codes used in this calculation are recorded in the NSW Trauma Registry

(see Appendix 4 for further detail).

The calculated ISS value ranges from 1-75. Serious to critically injured trauma patients are defined

as those patients with an ISS > 15, which is an internationally recognised indicator of serious injury.

In this report the ISS is reported in ranges:

13-15 (moderate injury)

16-24 (serious injury)

25-40 (severe injury)

41-75 (critical injury)


Revised Trauma Score

The Revised Trauma Score is a physiological scoring system used as a predictor of mortality in

trauma populations. It consists of data from the first set of vital signs obtained on arrival at hospital,

including the Glasgow Coma Scale, systolic blood pressure and respiratory rate. Each element is

scored with a weighting as outlined in Table 1.3 Values for the Revised Trauma Score are in the

range 0 to 7.8408. The lower the score, the higher the likelihood of death.

Table 1: Revised Trauma Score points system

Glasgow Coma Scale (GCS)

Systolic blood pressure (SBP)

Respiratory rate (RR) Points

15-13 >89 10-29 4

12-9 76-89 >29 3

8-6 50-75 6-9 2

5-4 1-49 1-5 1

3 0 0 0

Revised Trauma Score = 0.9368 GCS + 0.7326 SBP + 0.2908 RR

Metropolitan and rural categorisation

Various data elements within the report are categorised as either ‘Metropolitan’ or ‘Rural.’ These

categories are derived using the postcode of injury and the Australian Statistical Geography

Standard (ASGS) Remoteness Areas (RA). The ASGS-RA is based on the Accessibility and

Remoteness Index of Australia (ARIA+) which defines locations in terms of remoteness, i.e. the

physical distance of a location from the nearest urban centre (access to goods and services) based

on population size.

The ASGS-RA consists of 5 categories:

Major cities

Inner regional

Outer regional

Remote

Very remote

For the purpose of this report, all locations with the ASGS-RA classification of ‘Major cities’ are

listed as ‘Metropolitan’. All other ASGS-RA classified locations are combined and listed as ‘Rural’.

For further information and an overview map of the ASGS-RA categorisation of NSW, please see

Appendix 6.

3 Champion HR et al, "A Revision of the Trauma Score", J Trauma, 1989; 29:623-629.


3. Major trauma patients

Introduction

The information in this section of the report is based on the number of major trauma patients who

received care in a NSW Trauma Service (n=3,970), not the number of trauma admissions

(n=4,103), as some patients were treated in more than one NSW reporting facility. Trauma

admission data (hospital activity) is discussed in detail in Section 4.

Summary profile

During the 2015 calendar year, there were 3,970 major trauma patients treated at NSW Trauma

Services, of which 71.1% (n=2,671)4 were injured in a metropolitan location and 431 died (overall

case fatality rate of 10.9%).5 The age-standardised injury rate was 48.8 per 100,000 persons and

the age-standardised death rate was 4.8 per 100,000 persons.6 The Standardised Mortality Ratio

(SMR)7 was 4.3, indicating that the proportion of deaths in major trauma patients in 2015 was more

than four times greater than that of the general Australian population (Table 2).

Table 2: Summary statistics for major trauma and mortality

Summary statistics Count

Total number injured overall 3,970

Total number injured with ISS >12 3,525

Injury rate per 100,000 persons (age-standardised) 48.8

Location of injury (metropolitan / rural)4 2,671 (71.1%) / 1,087 (28.9%)

Total number of deaths overall (case fatality rate)5 431 (10.9%)

Total number of deaths with ISS >12 (case fatality rate)5 356 (10.1%)

Death rate per 100,000 persons (age-standardised) 4.8 (95% CI 4.5 – 5.1)

Standardised Mortality Ratio (SMR) 4.3 (95% CI 3.9 – 4.7)

Average age 51.7

Average Injury Severity Score (ISS) 19.1

4 212 records were excluded due to being recorded as overseas, not applicable or not recorded.

5 Case fatality rate is the proportion of deaths for a designated population expressed as a percentage. Caution should be used when

referring to the case fatality rate (all ISS) as patients with an ISS <13 are included only if they had an ICU admission or died. Other

survivors in this group are not collected, therefore the case fatality rate for this group cannot be accurately calculated and may be

misleading. It is contained in this report only to facilitate comparison to reports from previous years. It is recommended that you only

refer to the case fatality rate (ISS >12).

6 Rate given as per 100,000 persons, standardised to the Australian population at 30 June 2001. Source: Australian Bureau of Statistics.

Australian Demographic Statistics, Jun 2013. Catalogue No. 3101. Canberra: ABS, Dec 2013.

7 See Glossary for definition of the Standardised Mortality Ratio (SMR). Standardised to the Australian population at 30 June 2001.

Source: Australian Bureau of Statistics. Australian Demographic Statistics, Jun 2013. Catalogue No. 3101. Canberra: ABS, Dec 2013.


Age and gender

The average age of a major trauma patient in NSW in 2015 was 51.7 years old. Table 3 outlines

the age distribution which demonstrates a sharp rise in the incidence of major trauma in the

geriatric population,8 especially those aged 75 years and older, as it has in previous years. The 75

years and older age group also has a significantly higher case fatality rate for ISS >12 (21.3%,

n=837) versus the less than 75 years age group (6.6%, n= 2,685).

Table 3: Major trauma patients, injury and death rate by age group (n=3,967)9

Age group (years)

Number of injured

(% of total)

Cumulative number of

injured (% of total)

Age-specific

injury rate per

100,00010

Age-specific

death rate per

100,00010

Case fatality

rate (All ISS)

Case fatality

rate (ISS >12)

0-4 86 (2.2%) 86 (2.2%) 17.5 1.2 7.0% 7.1%

5-9 46 (1.2%) 132 (3.3%) 9.5 1.4 15.2% 18.9%

10-14 93 (2.3%) 225 (5.7%) 20.6 1.8 8.6% 10.7%

15-19 209 (5.3%) 434 (10.9%) 44.6 2.3 5.3% 5.9%

20-24 255 (6.4%) 689 (17.4%) 49.0 1.3 2.7% 2.8%

25-29 246 (6.2%) 935 (23.6%) 45.0 3.7 8.1% 9.3%

30-34 222 (5.6%) 1,157 (29.2%) 40.1 1.8 4.5% 5.2%

35-39 221 (5.6%) 1,378 (34.7%) 43.9 1.4 3.2% 3.6%

40-44 220 (5.5%) 1,598 (40.3%) 41.9 2.7 6.4% 5.6%

45-49 232 (5.8%) 1,830 (46.1%) 47.6 3.1 6.5% 7.4%

50-54 279 (7.0%) 2,109 (53.2%) 55.8 3.8 6.8% 6.5%

55-59 242 (6.1%) 2,351 (59.3%) 51.4 2.6 5.0% 5.4%

60-64 217 (5.5%) 2,568 (64.7%) 51.9 4.1 7.8% 8.1%

65-69 228 (5.7%) 2,796 (70.5%) 60.4 4.2 7.0% 7.0%

70-74 238 (6.0%) 3,034 (76.5%) 83.3 8.7 10.5% 8.9%

75-79 250 (6.3%) 3,284 (82.8%) 116.9 23.4 20.0% 17.6%

80-84 272 (6.9%) 3,556 (89.6%) 176.1 45.3 25.7% 21.2%

85 and over 411 (10.4%) 3,967 (100%) 250.5 71.3 28.5% 23.6%

8 Geriatric defined as aged 65 years and older.

9 3 records excluded due to age not recorded

10 Rate given as per 100,000 persons, based on the NSW population at 30 June 2015. Source: Australian Bureau of Statistics.

Australian Demographic Statistics, Catalogue No. 3235. Canberra: ABS, Aug 2016.


Males have a significantly higher number of major trauma injuries (n=2,805) compared to females (n=1,162), except in the 80 years old and over age groups (Figure 1). Overall, males are 2.4 times more likely to be injured than females.

Figure 1: Number of major trauma patients by age, gender and mortality (n=3,967)11

The age-specific injury rate for males ranged from 10.5 to 315.5 per 100,000 persons and in

females ranged 8.5 to 213.4 per 100,000 persons (Figure 2).

Figure 2: Age-specific injury rate by age and gender (n=3,967)11

11

3 records excluded due to age not recorded

0

20

40

60

80

100

120

140

160

180

200

220

Num

ber

of patie

nts

Age group

Died - Male

Died - Female

Survived - Male

Survived - Female

0

50

100

150

200

250

300

350

Age-s

pecific

inju

ry r

ate

per

100,0

00

Age group

Males

Females


The case fatality rate (the proportion of deaths of a designated population) where the ISS was

greater than 12 (n=3,525) was higher for females (12.2%, n=125) than for males (9.2%, n=231)

with the overall case fatality rate in this group of 10.1% (Figure 3).

Figure 3: Case fatality rate by age and gender (ISS>12) (n=3,522)12

Whilst females have a higher case fatality rate, males have a higher age-specific mortality rate per

100,000 persons (Figure 4).

Figure 4: Age-specific mortality rate by age and gender (n=3,967)12

12


0%

5%

10%

15%

20%

25%

30%

Case fata

lity r

ate

Age group

Males

Females

0

20

40

60

80

100

Age-s

pecific

mort

alit

y r

ate

per

100,0

00

Age group

Males

Females


Mechanism of injury

The vast majority of major trauma in NSW in 2015 was caused by blunt injuries (95.8%), such as

falls and motor vehicle collisions (Table 4).

Table 4: Type of injury (n=3,876)13

Type of injury Number of patients

(% of total) Case fatality rate

(overall) Case fatality rate

(ISS >12)

Blunt 3,714 (95.8%) 10.8% 9.9%

Penetrating 162 (4.2%) 9.9% 9.4%

The top three mechanisms of major trauma were falls (43.2%, n=1,717), road trauma (36.5%,

n=1,451) and assault (5.9%, n=234). All other mechanisms combined accounted for 14.3%

(n=568) (Figure 5). The distribution of these mechanisms of injury by age group is demonstrated in

Table 5.

Figure 5: Mechanism of injury (n=3,970)

13

Only blunt and penetrating injury types are reported. Other injury types (n=94) are recorded as ‘N/A’ or ‘Unknown'.

5.9%

43.2%

36.5%

14.3%

Assault

Fall

Road Trauma

All other Mechanisms


Table 5: Mechanism of injury by age (n=3,967)14

Age group

Number of patients (age-specific rate per 100,000)

Falls Road Trauma Assaults All other

mechanisms

0-4 39 (7.9) 8 (1.6) 11 (2.2) 28 (5.7)

5-9 9 (1.9) 20 (4.1) 0 (0) 17 (3.5)

10-14 27 (6) 38 (7.7) 0 (0) 28 (5.7)

15-19 36 (7.7) 113 (23) 18 (3.7) 42 (8.5)

20-24 46 (8.8) 143 (29.1) 28 (5.7) 38 (7.7)

25-29 50 (9.2) 117 (23.8) 31 (6.3) 48 (9.8)

30-34 38 (6.9) 106 (21.6) 31 (6.3) 47 (9.6)

35-39 50 (9.9) 98 (19.9) 32 (6.5) 41 (8.3)

40-44 64 (12.2) 92 (18.7) 23 (4.7) 41 (8.3)

45-49 63 (12.9) 107 (21.8) 20 (4.1) 42 (8.5)

50-54 82 (16.4) 138 (28.1) 20 (4.1) 39 (7.9)

55-59 87 (18.5) 108 (22) 10 (2) 37 (7.5)

60-64 104 (24.9) 73 (14.8) 4 (0.8) 36 (7.3)

65-69 121 (32.1) 77 (15.7) 1 (0.2) 29 (5.9)

70-74 144 (50.4) 72 (14.6) 0 (0) 22 (4.5)

75-79 182 (85.1) 50 (10.2) 2 (0.4) 16 (3.3)

80-84 223 (144.4) 41 (8.3) 1 (0.2) 7 (1.4)

85 and over 350 (213.3) 49 (10) 2 (0.4) 10 (2)

Total 1715 1450 234 568

14



Falls accounts for 72.9% (n=1,020) of major trauma patients aged 65 years and older (Figures 6-8).

Figure 6: Mechanism of injury by age (n=3,967)15

Figure 7: Mechanism of injury as a percentage by age (n=3,967)15

15


0

50

100

150

200

250

300

350

400

Num

ber

of patie

nts

Age group

Fall

Road Trauma

Assault

All Other Mechanisms

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Perc

enta

ge o

f in

jury

/ a

ge g

roup

Age group

Fall

Road Trauma

Assault



Figure 8: Age-specific rates of mechanism of injury (n=3,967)16

Falls were responsible for 49.3% of the injuries in the metropolitan area, compared to 29.9% in

rural areas. Road trauma was higher in rural areas (45.6%) than in metropolitan areas (32.1%),

and assaults were higher in the metropolitan area. The ‘all other mechanisms’ group is

proportionally higher in the rural area at 20.4% versus 12.1% in the metropolitan area (Table 6).

Table 6: Mechanism of injury by place of injury (n=3,758)17

Mechanism of Injury Metropolitan

(% of metropolitan) Rural

(% of rural)

Assault 174 (6.5%) 44 (4.0%)

Fall 1,316 (49.3%) 325 (29.9%)

Road Trauma 857 (32.1%) 496 (45.6%)

All other mechanisms 323 (12.1%) 222 (20.4%)

Total 2,671 1,087

The top three mechanisms of injury are outlined in more detail in Tables 7-9. Falls from a standing

height (<1m) accounted for 58.7% of all falls, 28.1% of all trauma mechanisms, 48.3% of all trauma

deaths and an ISS >12 case fatality rate of 15.6% (Table 7). Pedestrian trauma had a slightly

higher case fatality rate (11.3%) than motor bike collisions and well above other forms of road

trauma (Table 8). There were only 3 recorded cases of shooting (0.1%) compared to 71 stabbings

16

3 records were excluded due to age not recorded

17 212 were excluded due to being recorded as overseas, not applicable or not recorded

0

50

100

150

200

250

Age-s

pecific

rate

per

100,0

00

Age group

Fall

Road Trauma

Assault



(1.8%), with blunt assault accounting for 158 patients (4.0%), remaining the most common

mechanism of injury (68.1%) in the assault group (Table 9).

Table 7: Falls in detail

Mechanism Number injured

(% of all mechanisms)

Number of deaths, all ISS

Percentage of all trauma deaths

Number of deaths, ISS >12

(case fatality rate)

Low (<1m) 1,116 (28.1%) 208 48.3% 154 (15.6%)

Medium (1-5m) 572 (14.4%) 36 8.4% 34 (6.5%)

High (>5m) 119 (3%) 11 2.6% 11 (9.9%)

Unspecified 93 (2.3%) 12 2.8% 8 (10.5%)

Total 1,900 (47.9%) 267 61.9% 207 (12.2%)

Table 8: Road trauma in detail







Motor Vehicle Collision

637 (16%) 57 13.2% 45 (7.9%)

Motor Bike Collision

18

509 (12.8%) 59 13.7% 50 (11.2%)

Pedestrian 225 (5.7%) 28 6.5% 22 (11.3%)

Pedal Cyclist 79 (2%) 8 1.9% 5 (7.5%)

Total 1,450 (36.5%) 152 35.3% 122 (9.6%)

Table 9: Assaults in detail







Blunt assault 158 (4%) 24 5.6% 20 (13.9%)

Shooting 3 (0.1%) 0 0.0% 0 (0%)

Stabbing 71 (1.8%) 13 3.0% 11 (17.5%)

Total 232 (5.8%) 37 8.6% 31 (14.8%)

18

Includes 3 wheeler and quad bikes (all-terrain vehicles).


Time and day of injury

It is notable that 56.4% of patients (n=1,964) were injured between 10am and 7pm resulting in

peak activity in the hospitals during the afternoon and evening (Figure 9).

Figure 9: Number of patients by time of injury (n=3,482)19

The mean daily number of persons injured on a weekday was 10.0. The number of persons injured

on weekends was higher at a mean of 13.1 per day (Figure 10).20

Figure 10: Number of patients by day of injury (n=3,970)

19

498 records were excluded due to the time of injury not being recorded or unknown.

20 In 2015 there were 261 week days and 104 weekend days.

0

50

100

150

200

250

300

00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Num

ber

of patie

nts

Time of day

547

491 500 524

544

723

641

0

100

200

300

400

500

600

700

800

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Num

ber

of patie

nts

Day of the week


Injuries

Three or more fractured ribs without a flail segment21 continues to be the most common single

injury sustained (26%, n=1034) where the AIS severity was greater than 2 (Table 10). Thoracic

injuries occupy three out of the top five injuries, with cerebral haematomas having two out of the

top five.

Table 10: Top 5 injuries with an AIS severity >2 (n=3,970)

Injury description AIS severity Number of patients

(% of total)

Fractured ≥3 ribs without flail 3 1,034 (26.0%)

Cerebrum haematoma - subdural - small; moderate 4 482 (12.1%)

Cerebrum haematoma - subdural - large; massive; extensive 5 283 (7.1%)

Thoracic fracture without cord involvement – vertebral body - major 3 239 (6.0%)

Haemopneumothorax - not further specified 3 203 (5.1%)

In addition, 62.2% of major trauma patients sustained injuries to the head or neck body region, with

the chest region injured in 48.4% of major trauma patients (Figure 11).

Figure 11: All injuries by ISS body region (n=3,970)

21

Flail is defined as three or more ribs fractured in more than one location and/or resulting in paradoxical chest movement. Ref:

Abbreviated Injury Scale 2005 (Update 2008) Dictionary. Association of the Advancement of Automotive Medicine (AAAM). Barrington,

IL, 2008.

62.2%

15.3%

48.4%

24.1%

41.9%

63.5%

0%

10%

20%

30%

40%

50%

60%

70%

Head or neck Face Chest Abdominal or pelviccontents

Extremities orpelvic girdle

External

Perc

enta

ge o

f to

tal patie

nts

ISS body region


The majority of major trauma patients (75.8%) sustained serious injury (AIS severity >2) to only

one ISS body region (Table 11).

Table 11: Number of ISS body regions injured with an AIS severity >2 (n=3,970)

Number of ISS body regions injured

Number of patients (% of total) (All ISS)

Number of patients (% of total) (ISS >12)

0 246 (6.2%) 0

1 3,008 (75.8%) 2,809 (79.7%)

2 596 (15.0%) 596 (16.9%)

3 107 (2.7%) 107 (3.0%)

4 11 (0.3%) 11 (0.3%)

5 2 (0.1%) 2 (0.1%)

Moreover, 19.2% of major trauma patients sustained polytrauma, defined as serious injury (AIS

severity >2) in two or more ISS body regions.22 Polytrauma had a higher case fatality rate at 14.7%

versus that of single body region injury at 8.9% (Table 12).

Table 12: Single body region versus polytrauma with an AIS severity >2 (n=3,970)

Number of patients – All ISS (% of total)

Case fatality rate (All ISS)

Case fatality rate (ISS >12)

Single body region 3,008 (80.8%) 9.8% 8.9%

Polytrauma 714 (19.2%) 14.7% 14.7%

22

Butcher, N.E. and Balogh, Z.J. AIS > 2 in at least two body regions: A potential new anatomical definition of polytrauma. Injury. 2012;

43(2): 196-199.


Injury Severity Score

An Injury Severity Score (ISS) of greater than 12 is a key identifier of a major trauma patient. The

ISS correlates with mortality - the higher the ISS, the higher the mortality rate (Table 13). It is

important to note that ISS is only calculated on injuries sustained and does not include other

potential contributors to mortality and morbidity such as patient’s age and comorbidities. The

average ISS for all major trauma patients was 19.1. This increased to 20.6 when excluding those

with an ISS less than 13.

Table 13: Major trauma patients by ISS group (n=3,970)

ISS group Number of patients

(% of total) Number of deaths (case fatality rate)

ISS <13 445 (11.2%) 75 (N/A)23

ISS 13-15 924 (23.3%) 15 (1.6%)

ISS 16-24 1,590 (40.1%) 67 (4.2%)

ISS 25-40 897 (22.6%) 224 (25%)

ISS 41-75 114 (2.9%) 50 (43.9%)

The serious injury category (ISS 16-24) contained the highest number of injured at 1,590 (40.1%),

followed by the moderate injury category (ISS 13-15) which had 924 (23.3%) injured and the

severe injury category (ISS 25-40) had 897 (22.6%) (Figure 12).

Figure 12: Number of major trauma patients by ISS group and gender (n=3,970)

23

Patients with an ISS <13 are included only if they had an ICU admission or died. Other survivors in this group are not collected,

therefore the case fatality rate for this group cannot be accurately calculated and may be misleading.

305

669

1122

622

89 140

255

468

275

25

0

200

400

600

800

1000

1200

ISS < 13 ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75

Num

ber

of patie

nts

ISS Group

Male

Female


Females had a higher case fatality rate than males in all ISS groups except the ISS 41-75 group

(Figure 13). This was reflected in the overall case fatality rate which was higher in females than

males (12.2% versus 9.2%).

Figure 13: Case fatality rate by ISS and gender (ISS >12) (n=3,525)

Pre-hospital time

The time from injury to arrival at a designated trauma service can have a significant impact on

morbidity and mortality in the major trauma patient cohort. The regional population and geography

of NSW is vastly spread and this impacts on the variation in the time of arrival to a designated

trauma service. Patients who were injured in a metropolitan region arrived at a designated trauma

service faster (80 mins) than those injured in a rural location (190 mins) (Table 14).

Table 14: Time of injury to arrival at a designated trauma service (n=3,338)24

Location of injury Median time of injury to arrival at a

designated trauma service

Metropolitan 80 mins (n=2,409)

Rural 190 mins (n=929)

NSW overall 96 mins (n=3,338)

See the methodology section on pg.5 of this report for more information regarding the definitions of

metropolitan and rural.

24

522 records excluded due to data being incomplete relating time of injury or admission, was injured overseas, or location of injury

unknown.

1.2%

3.7%

22.5%

46.1%

2.7%

5.3%

30.5%

36.0%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75

Case fata

lity r

ate

ISS group

Male

Female


A number of major trauma patients (n=249) who arrived at a designated trauma service needed to

be transferred to a higher level of care for specialised treatment. Whilst vital, this transfer prolongs

the time before the required (definitive) care can be provided, such as specialised surgery,

interventional radiology or paediatric services. The overall median time to definitive care was 660

minutes. An injury in a rural area took 270 minutes longer to reach definitive care compared to a

metropolitan area, if transferred from a designated trauma service (Table 15).

Table 15: Time of injury to arrival at definitive care if transferred from another trauma

service (n=249)25

Location of injury Median time of injury to arrival at definitive care

if transferred from another trauma service

Metropolitan 563 mins (n=143)

Rural 833 mins (n=106)

NSW overall 660 mins (n=249)

Mode of transport

Major trauma patients are transported to a designated trauma service from either the scene of the

injury or from another hospital. Road ambulance was by far the most common mode of transport

(74.8%), with helicopter, fixed wing and private transport also used (Table 16, Figure 14 and 15).

Table 16: Mode of transport to definitive care (n=3,931)26

Transport mode Direct from scene of

injury Transfer from another

acute care facility Total

Road Ambulance 2,381 (79%) 559 (60.9%) 2,940 (74.8%)

Helicopter 434 (14.4%) 172 (18.7%) 606 (15.4%)

Private Vehicle 175 (5.8%) 3 (0.3%) 178 (4.5%)

Fixed Wing 6 (0.2%) 140 (15.3%) 146 (3.7%)

Other 3 (0.1%) 6 (0.7%) 9 (0.2%)

Unknown 14 (0.5%) 38 (4.1%) 52 (1.3%)

Total 3,013 918 3,931

25

9 records were excluded due to data being incomplete relating to time of injury or admission or location of injury.

26 39 records were excluded where location of injury was recorded as overseas, same facility, or transport mode missing.


Figure 14: Mode of transport to definitive care when transported direct from the scene of

injury, by injury location (n=2,879)

Figure 15: Mode of transport to definitive care when transferred from another acute care

facility, by injury location (n=848)

87.3%

7.5% 4.7%

0.5%

53.8%

39.1%

6.6%

0.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ambulance Helicopter Private Vehicle Other and Unknown

Perc

enta

ge o

f to

tal

Mode of transport

Metro

Rural

83.7%

10.5%

0.7% 4.9%

37.8%

27.5% 30.0%

4.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ambulance Helicopter Fixed Wing Other and Unknown

Perc

enta

ge o

f to

tal

Mode of transport

Metro

Rural


4. Major trauma admissions

Introduction

The information in this section of the report is based on the number of major trauma admissions to

NSW Trauma Services (n=4,103), not the number of major trauma patients (n=3,970), as some

patients were treated in more than one NSW reporting facility. Trauma patient data is discussed in

detail in Section 3.

Facility overview

The table below provides an overview of the major trauma admissions for each designated trauma

service together with averages from the three trauma service types (Table 17).

Table 17: Overview of trauma service admissions (n=3,566)

Facility Number of admissions

Average age

Average ISS

Case fatality rate (All ISS)

27

Case fatality rate (ISS >12)

Adult Major Trauma Services 3115 53.7 19.5 10.7% 10.0%

John Hunter Hospital 665 53.8 19.3 9.5% 9.7%

Liverpool Hospital 472 53.2 20.0 11.7% 9.8%

Royal North Shore Hospital 603 56.5 20.5 10.4% 10.8%

Royal Prince Alfred Hospital 289 56.9 19.4 13.8% 11.6%

St George Hospital 353 52.3 20.1 9.1% 8.4%

St Vincent's Hospital 227 49.9 18.6 8.4% 8.6%

Westmead Hospital 506 51.5 18.3 11.9% 10.3%

Paediatric Major Trauma Services 194 7.7 18.4 21.1% 11.1%

John Hunter Children’s Hospital 41 8.8 19.6 9.8% 11.8%

Sydney Children's Hospital 63 6.7 18.4 6.3% 8.0%

The Children's Hospital at Westmead 90 7.9 20.8 11.1% 14.1%

Regional Trauma Services 794 53.7 18.0 10.2% 8.4%

Coffs Harbour Base Hospital 78 49.8 21.5 11.5% 11.9%

Gosford Hospital 71 54.8 18.4 21.1% 11.1%

Lismore Base Hospital 57 46.9 17.5 5.3% 5.4%

Nepean Hospital 95 57.1 13.7 11.6% 6.3%

Orange Health Service 101 51.6 16.5 5.9% 6.8%

Port Macquarie Base Hospital 57 53.2 19.2 7.0% 3.8%

Tamworth Rural Referral Hospital 97 55.2 17.5 7.2% 7.0%

The Tweed Hospital 45 52.8 20.0 4.4% 4.7%

Wagga Wagga Base Hospital 69 51.8 16.8 2.9% 3.2%

Wollongong Hospital 124 58.3 20.1 17.7% 15.7%

27

Patients with an ISS <13 are included only if they had an ICU admission or died. Other survivors in this group are not collected,

therefore the case fatality rate for this group cannot be accurately calculated and may be misleading.


The Standardised Mortality Ratio (SMR)28 for the Adult Major Trauma Services shows a relatively

small range between peer facilities (age: 0.86 – 1.11; ISS: 0.75 – 1.16) compared with the

Regional Trauma Services SMR which are quite disperse (age: 0.38 – 1.81; ISS: 0.42 – 1.56). The

SMR range on the on the graphs has been fixed the same for all three figures to enable a visual

comparison (Figures 16-18).

Figure 16: Adult Major Trauma Services - Standardised Mortality Ratio (SMR) for ISS and

age (ISS >12) (n=2,808)

Figure 17: Paediatric Major Trauma Services - Standardised Mortality Ratio (SMR) for ISS

and age (ISS >12) (n=155)

28 See Glossary for definition of the Standardised Mortality Ratio (SMR). Standardised to the NSW Major Trauma Population (ISS >12).

0.3

0.5

0.7

0.9

1.1

1.3

1.5

1.7

1.9

Royal PrinceAlfred

Westmead Liverpool Royal NorthShore

John Hunter St Vincents St George

SM

R

Facilties

Age SMR

ISS SMR

Age SMR Peer

ISS SMR Peer

0.3

0.5

0.7

0.9

1.1

1.3

1.5

1.7

1.9

John Hunter Children Children's Hospital Westmead Sydney Children's Hospital

SM

R

Facilities

Age SMR

ISS SMR

Age SMR Peer

ISS SMR Peer


Figure 18: Regional Trauma Services - Standardised Mortality Ratio (SMR) for ISS and age

(ISS >12) (n=688)

Admission type

The majority of major trauma patients (76.3%, n=3,129) were admitted to a trauma service direct from the scene of injury, however there were significant differences in the admission type between adult and paediatric patient groups (Table 18).

Table 18: Number of admissions by type (n=4,103)

Admission type Number of admissions

(paediatric / adult)

Percentage of admissions

(paediatric / adult)

Direct from scene 96 / 3,033 49.5% / 77.6%

Transfer from another acute care facility

98 / 835 50.5% / 21.4%

Unknown and other 0 / 41 0 / 1.0%

0.3

0.5

0.7

0.9

1.1

1.3

1.5

1.7

1.9

CoffsHarbour

Gosford Wollongong Orange Tamworth Lismore Nepean PortMacquarie

TweedHeads

WaggaWagga

SM

R

Facilities

Age SMR

ISS SMR

Age SMR Peer

ISS SMR Peer



The Revised Trauma Score29 is an early (<24 hours) indicator of trauma outcomes. The lower the

score, the higher is the likelihood of death. There was a negative correlation between the Revised

Trauma Score and ISS, showing that the higher the ISS, the lower the Revised Trauma Score. The

average Revised Trauma Score was 7.1 (Figure 19).

Figure 19: Average Revised Trauma Score by ISS group (n=3,563)30

29

See the Glossary for a definition of the Revised Trauma Score.

30 540 records excluded as no Revised Trauma Score recorded.

6.7

7.6 7.4

6.6

5.1

0

1

2

3

4

5

6

7

8


Avera

ge R

evis

ed T

raum

a S

core

ISS group


Trauma team activation

Major trauma patients require rapid, thorough and systematic assessment and resuscitation. This

is conducted on arrival by a multidisciplinary team known as a trauma team. The activation of the

trauma team is based on a locally derived set of criteria including mechanism of injury and

physiological parameters. 55% of patients who arrived at a trauma service direct from scene

received a full trauma team activation compared to 22.7% of those who were transferred from

another acute care facility (Figure 20).

Figure 20: Trauma team activation by admission type (n=4,087)31

31

16 records excluded due to type of admission being 'transfer within facility' or 'unknown' or trauma team activation not recorded

47.3%

55.0%

22.7%

16.6%

14.4%

24.1%

5.9%

5.9%

6.1%

22.3%

18.4%

35.3%

3.5% 2.5%

7.0%

4.4% 3.9% 4.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All Admissions (n=4,087) Direct from scene (n=3,118) Transfer from another acute carefacility (n=928)

Perc

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Full Trauma Team Activation Modified Trauma Team Activation

Trauma Consult Trauma Team not activated and not required

Trauma Team not activated and required Unknown and other


The activation of the trauma team increased with severity of injury as expected with 42.9% (n=405) of the ISS 13-15 group receiving a full trauma team activation compared to 90.8% (n=109) of the ISS 4-75 group (Figure 21).

Figure 21: Trauma team activation by ISS group (n=4,099)32

32

4 records were excluded due to trauma team activation not recorded.

52.7%

42.9% 41.8%

52.4%

90.8%

14.4%

23.2%

17.7%

10.5%

4.2%

4.2%

6.3%

7.8%

3.6%

20.6%

18.3%

24.6%

25.4%

3.3%

2.4%

3.4%

3.7%

4.2%

13.5%

28.5% 38.3%

19.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Perc

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f IS

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roup

ISS group

Full Trauma Team Activation Modified Trauma Team Activation

Trauma Consult Trauma Team not activated and not required

Trauma Team not activated and required Unknown and other


Vital signs on arrival to the Emergency Department

The initial vital signs on arrival to the Emergency Department (ED) are useful indicators of injury

severity and predictors of death. Major trauma patients who presented with hypotension (systolic

blood pressure <100mmHg), a Glasgow Coma Scale (GCS) <13 or hypothermia (temperature

<35°C) represented a higher proportion of those who died compared to all patients (Figures 22-24).

Figure 22: Initial systolic blood pressure on arrival to the ED and mortality (n=3,792) 33

Figure 23: Initial Glasgow Coma Scale (GCS) on arrival to the ED and mortality (n=3,773)34

33

311 records excluded due to SBP not being recorded.

34 330 records excluded due to GCS not being recorded.

91.4% 92.4%

82.0%

8.6% 7.6%

18.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All patients n=3,792 Survived n=3,414 Died n=378

Perc

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<100mmHg

>=100mmHg and over

57.4% 61.6%

21.6%

18.8%

19.4%

14.0%

5.3%

4.8%

9.6%

18.4% 14.2%

54.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Perc

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f adm

issio

ns

3-8

9-12

13-14

15


Figure 24: Initial temperature on arrival to ED and mortality (n=3,180)35

Intensive Care Unit admissions

Overall 39.5% (n=1,621) of major trauma patients received an Intensive Care Unit (ICU) admission,

with the percentage increasing with the level of injury severity (Figure 25). Whilst the number of

ICU admissions may be explained by the level of severity of injury, the complexity of injury and

other factors such as comorbidities may also influence the requirement for an ICU admission.

Figure 25: ICU admission by ISS group (n=4,103)

35

923 records excluded due to initial temperature not recorded.

87.6% 88.7%

76.5%

7.0% 5.7%

20.4%

5.4% 5.6% 3.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Perc

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>37.5°C

< 35°C

35-37°C

39.5%

16.4%

28.4%

53.7%

77.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

All ISS ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75

Perc

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roup

ISS group


Length of stay

The length of stay (LOS) in hospital, and in particular the LOS in an Intensive Care Unit (ICU), is

an indicator of the severity and complexity of the injury. The average hospital LOS for major

trauma patients was 13.2 days (Table 19).

Table 19: Overview of ICU and hospital length of stay (n=4,098)36

Number of patients Average days Median days

ICU LOS 1,621 5.5 2.0

Total Hospital LOS 4,098 12.8 6.0

The average ICU length of stay increased with severity with ISS 13-15 group being 3 days and ISS

41-75 group being 11.7 days. A similar increasing pattern was also shown in the hospital length of

stay as expected (Table 20).

Table 20: ICU and hospital length of stay by ISS (n=4,098)34

ISS group Average ICU LOS

Median ICU LOS

Average hospital LOS

Median hospital LOS

ISS <13 2.7 1 10.6 5

ISS 13-15 3.0 2 9.1 5

ISS 16-24 5.2 2 12.4 7

ISS 25-40 7.6 4 16.5 8

ISS 41-75 11.7 5 28.3 12

36

5 records excluded due to unknown hospital length of stay


No considerable change was observed in the median values of ICU LOS and hospital LOS across

different age groups (Table 21).

Table 21: ICU and hospital length of stay by age (n=4,100)37

Age group Average ICU LOS

Median ICU LOS

Average hospital LOS

Median hospital LOS

0-4 5.7 2 12.8 5.0

5-9 5.0 1 17.8 5.0

10-14 4.9 1 14.8 5.0

15-19 4.3 2 10.1 6.0

20-24 6.7 2 13.5 6.0

25-29 5.3 1 11.0 6.0

30-34 5.5 2 12.5 6.0

35-39 4.8 2 13.5 6.0

40-44 5.1 2.5 12.3 6.0

45-49 5.6 2 13.5 7.0

50-54 6.3 3 11.9 6.0

55-59 6.2 3 14.7 8.0

60-64 7.4 4 14.8 7.0

65-69 8.2 4 14.2 8.0

70-74 4.2 2 12.4 6.0

75-79 4.5 2 12.5 6.5

80-84 5.2 3 13.2 8.0

85 and over 3.7 2 11.6 7.0

37

3 records excluded due to missing age


Surgical procedures

Despite the serious nature of the injuries sustained by major trauma patients, the number of

surgical procedures performed was very low with 765 procedures performed on 702 patients

(17.1% of all admissions) with highest percentage of procedures performed in the ISS 41-75 group

(Table 22). A sharp rise in the proportion of craniotomy procedures performed is noted from the

ISS 16-24 group to the ISS 25-40 group (Figure 26).

Table 22: Surgical procedures performed by type in total admissions (n=4,103)

Procedure Number of procedures Percentage of total admissions

Laparotomy 156 3.9%

Open Reduction Internal Fixation (ORIF)

403 10.2%

Thoracotomy 25 0.6%

Craniotomy 181 4.6%

Total 765 17.1%38

Figure 26: Surgical procedures performed by ISS group (n=4,103)

38

The total percentage of surgical procedures performed is based on the number of admissions where one or more procedures were

performed (n=702), not the total number of procedures performed (n=765).

0%

5%

10%

15%

20%

25%

30%


Perc

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roup

ISS group

Craniotomy

Laparotomy

ORIF

Thoracatomy


Discharge destination of survivors

Survivors of major trauma (n=3,672) were discharged to various locations, with home being the

most common (66.8%). In addition, 8.5% of patients were discharged to an acute care hospital for

a higher level of care and over 15.3% of patients were discharged to rehabilitation. ‘Other’

incorporates locations such as board and care, burns centre, foster care, residential institution,

missing and unknown (Figure 27).

Figure 27: Discharge destination of survivors (n=3,672)

The rate of discharge home decreased as the injury severity increased, coinciding with an increase

in the rate of discharge to rehabilitation services (Figure 28).

Figure 28: Discharge destination of survivors by ISS group (n=3,672)

66.8%

8.5% 5.6%

15.3%

3.9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Home Acute Intermediate Care Rehabilitation Other

Perc

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Discharge destination

75.6% 77.4%

67.5%

50.5%

31.4%

7.4% 6.1%

8.0%

12.7%

12.9%

4.8% 3.6%

5.0%

9.7%

10.0%

7.2% 9.5% 15.8%

22.8%

44.3%

5.0% 3.4% 3.8% 4.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Perc

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ISS group

Home Acute Care Hospital Intermediate Care Facility Rehabilitation Other


5. Appendices

List of appendices

Appendix 1: Adult Major Trauma Service summaries

Appendix 2: Paediatric Major Trauma Service summaries

Appendix 3: Regional Trauma Service summaries

Appendix 4: Calculation of the Injury Severity Score

Appendix 5: Calculation of adjusted mortality rate

Appendix 6: Map of NSW showing ASGS Remoteness Areas

Note: Trauma data profiles presented at Appendices 1-3 include the use standardised mortality

ratios (age and ISS) and an adjusted mortality rate (age). For further information on the method

used for calculating these items, please see Appendix 5.

Caution should be used when referring to the case fatality rate (all ISS) in the following facility

trauma data profiles as patients with an ISS <13 are included only if they had an ICU admission or

died. Other survivors in this group are not collected, therefore the case fatality rate for this group

cannot be accurately calculated and may be misleading. It is contained in this report only to

facilitate comparison to reports from previous years. It is recommended that you only refer to the

case fatality rate (ISS >12).


Appendix 1: Adult Major Trauma Service Summaries

Table 23: Trauma data profile, John Hunter Hospital

Facility Peer

Total admissions 665 445

Mean monthly admissions 55.4 37.1

Case fatality rate (all ISS) 9.5% 10.7%

Case fatality rate (ISS >12) 9.7% 9.0%

Standardised Mortality Ratio (SMR) Age 0.99 1.01

Age Adjusted Mortality Rate 10.0% 10.2%

Standardised Mortality Ratio (SMR) ISS 1.16 0.97

Gender

Female / Male 208 / 457 131.3 / 313.7

Age ranges

Mean age 53.8 53.7

0-4 0 0.6 (0.1%)

5-9 0 0.3 (0.1%)

10-14 0 1 (0.2%)

15-19 31 (4.7%) 23.4 (5.3%)

20-24 44 (6.6%) 32.4 (7.3%)

25-29 55 (8.3%) 30.1 (6.8%)

30-34 30 (4.5%) 27.6 (6.2%)

35-39 50 (7.5%) 28.1 (6.3%)

40-44 41 (6.2%) 26.4 (5.9%)

45-49 47 (7.1%) 28.6 (6.4%)

50-54 50 (7.5%) 31 (7.0%)

55-59 34 (5.1%) 27.4 (6.2%)

60-64 42 (6.3%) 26.6 (6.0%)

65-69 44 (6.6%) 25.7 (5.8%)

70-74 36 (5.4%) 27.1 (6.1%)

75-79 51 (7.7%) 29.6 (6.6%)

80-84 42 (6.3%) 32.3 (7.3%)

85 and over 68 (10.2%) 46.4 (10.4%)

Injury Severity Score (ISS) ranges

Mean ISS 19.3 19.5

ISS <13 27 (4.1%) 43.9 (9.9%)

ISS 13-15 162 (24.4%) 100.1 (22.5%)

ISS 16-24 332 (49.9%) 182.3 (41.0%)

ISS 25-40 131 (19.7%) 104.9 (23.6%)

ISS 41-75 13 (2.0%) 13.9 (3.1%)

Mechanisms of injury

Assault 30 (4.5%) 28.3 (6.4%)

Falls 265 (39.8%) 197 (44.3%)

Falls (≥65 years) 178 (26.8%) 119 (26.7%)

Road trauma 267 (40.2%) 163.4 (36.7%)

All other injuries 103 (15.5%) 56.3 (12.6%)


Types of injury

Blunt 640 (96.2%) 418.1 (94.0%)

Penetrating 22 (3.3%) 18.9 (4.2%)

Other and Unknown 3 (0.5%) 8 (1.8%)

Admission type

Direct admission 494 (74.3%) 341.6 (11.0%)

Transfer in 170 (25.6%) 100.3 (3.2%)

Unknown 1 (0.2%) 3.1 (0.1%)

Arrival modes

Ambulance 467 (70.2%) 338.9 (10.9%)

Helicopter 112 (16.8%) 55.1 (1.8%)

Other (Private Vehicle, Fixed Wing, Unknown) 86 (12.9%) 51 (1.6%)


Mean - Overall 7.2 7.0

ISS < 13 5.9 6.5

ISS 13-15 7.7 7.6

ISS 16-24 7.4 7.4

ISS 25-40 6.5 6.5

ISS 41-75 4.9 4.7

Hospital length of stay

Total bed days 7582 6140.6


ISS < 13 7.5 10.0

ISS 13-15 9.8 9.8

ISS 16-24 11.6 13.4

ISS 25-40 13.6 17.7

ISS 41-75 14.2 31.5

ICU length of stay

ICU total bed days (admissions) 838 (160) 1049.4 (174.7)


ISS < 13 2.6 2.5

ISS 13-15 2.5 3.3

ISS 16-24 5.7 5.6

ISS 25-40 6.4 8.0

ISS 41-75 3.8 12.4

Hospital ventilation days

Total ventilation bed days (number of cases) 648 (131) 813.1 (133.1)


ISS < 13 2.8 2.3

ISS 13-15 2.8 4.3

ISS 16-24 5.5 5.6

ISS 25-40 5.7 7.0

ISS 41-75 4.3 13.6


Table 24: Trauma data profile, Liverpool Hospital

Facility Peer








Gender

Female / Male 134 / 338 131.3 / 313.7

Age ranges

Mean age 53.2 53.7

0-4 2 (0.4%) 0.6 (0.1%)

5-9 1 (0.2%) 0.3 (0.1%)

10-14 1 (0.2%) 1 (0.2%)

15-19 25 (5.3%) 23.4 (5.3%)

20-24 31 (6.6%) 32.4 (7.3%)

25-29 29 (6.1%) 30.1 (6.8%)

30-34 32 (6.8%) 27.6 (6.2%)

35-39 33 (7.0%) 28.1 (6.3%)

40-44 28 (5.9%) 26.4 (5.9%)

45-49 30 (6.4%) 28.6 (6.4%)

50-54 32 (6.8%) 31 (7.0%)

55-59 41 (8.7%) 27.4 (6.2%)

60-64 24 (5.1%) 26.6 (6.0%)

65-69 24 (5.1%) 25.7 (5.8%)

70-74 28 (5.9%) 27.1 (6.1%)

75-79 30 (6.4%) 29.6 (6.6%)

80-84 36 (7.6%) 32.3 (7.3%)

85 and over 45 (9.5%) 46.4 (10.4%)


Mean ISS 20.0 19.5

ISS <13 32 (6.8%) 43.9 (9.9%)

ISS 13-15 120 (25.4%) 100.1 (22.5%)

ISS 16-24 199 (42.2%) 182.3 (41.0%)

ISS 25-40 100 (21.2%) 104.9 (23.6%)

ISS 41-75 21 (4.4%) 13.9 (3.1%)


Assault 39 (8.3%) 28.3 (6.4%)

Falls 169 (35.8%) 197 (44.3%)

Falls (≥65 years) 115 (24.4%) 119 (26.7%)

Road trauma 206 (43.6%) 163.4 (36.7%)



Types of injury

Blunt 446 (94.5%) 418.1 (94.0%)

Penetrating 26 (5.5%) 18.9 (4.2%)

Other and Unknown 0 8 (1.8%)

Admission type


Transfer in 65 (13.8%) 100.3 (3.2%)

Unknown 0 3.1 (0.1%)

Arrival modes

Ambulance 352 (74.6%) 338.9 (10.9%)

Helicopter 69 (14.6%) 55.1 (1.8%)




ISS < 13 6.3 6.5

ISS 13-15 7.6 7.6

ISS 16-24 7.3 7.4

ISS 25-40 6.4 6.5

ISS 41-75 4.5 4.7




ISS < 13 9.0 10.0

ISS 13-15 9.8 9.8

ISS 16-24 13.7 13.4

ISS 25-40 17.4 17.7

ISS 41-75 25.7 31.5

ICU length of stay



ISS < 13 2.0 2.5

ISS 13-15 2.5 3.3

ISS 16-24 8.3 5.6

ISS 25-40 11.2 8.0

ISS 41-75 13.6 12.4




ISS < 13 2.6 2.3

ISS 13-15 3.1 4.3

ISS 16-24 5.8 5.6

ISS 25-40 8.0 7.0

ISS 41-75 10.5 13.6


Table 25: Trauma data profile, Royal North Shore Hospital

Facility Peer








Gender

Female / Male 181 / 422 131.3 / 313.7

Age ranges

Mean age 56.5 53.7

0-4 1 (0.2%) 0.6 (0.1%)

5-9 0 0.3 (0.1%)

10-14 3 (0.5%) 1 (0.2%)

15-19 25 (4.1%) 23.4 (5.3%)

20-24 34 (5.6%) 32.4 (7.3%)

25-29 31 (5.1%) 30.1 (6.8%)

30-34 37 (6.1%) 27.6 (6.2%)

35-39 28 (4.6%) 28.1 (6.3%)

40-44 38 (6.3%) 26.4 (5.9%)

45-49 40 (6.6%) 28.6 (6.4%)

50-54 41 (6.8%) 31 (7.0%)

55-59 44 (7.3%) 27.4 (6.2%)

60-64 35 (5.8%) 26.6 (6.0%)

65-69 33 (5.5%) 25.7 (5.8%)

70-74 43 (7.1%) 27.1 (6.1%)

75-79 44 (7.3%) 29.6 (6.6%)

80-84 61 (10.1%) 32.3 (7.3%)

85 and over 65 (10.8%) 46.4 (10.4%)


Mean ISS 20.5 19.5

ISS <13 76 (12.6%) 43.9 (9.9%)

ISS 13-15 111 (18.4%) 100.1 (22.5%)

ISS 16-24 207 (34.3%) 182.3 (41.0%)

ISS 25-40 187 (31.0%) 104.9 (23.6%)

ISS 41-75 22 (3.6%) 13.9 (3.1%)


Assault 23 (3.8%) 28.3 (6.4%)

Falls 310 (51.4%) 197 (44.3%)

Falls (≥65 years) 189 (31.3%) 119 (26.7%)

Road trauma 197 (32.7%) 163.4 (36.7%)



Types of injury

Blunt 554 (91.9%) 418.1 (94.0%)

Penetrating 11 (1.8%) 18.9 (4.2%)


Admission type


Transfer in 228 (37.8%) 100.3 (3.2%)

Unknown 0 3.1 (0.1%)

Arrival modes

Ambulance 448 (74.3%) 338.9 (10.9%)

Helicopter 86 (14.3%) 55.1 (1.8%)




ISS < 13 7.1 6.5

ISS 13-15 7.3 7.6

ISS 16-24 7.4 7.4

ISS 25-40 6.6 6.5

ISS 41-75 5.2 4.7




ISS < 13 12.9 10.0

ISS 13-15 9.5 9.8

ISS 16-24 17.2 13.4

ISS 25-40 23.5 17.7

ISS 41-75 49.9 31.5

ICU length of stay



ISS < 13 3.0 2.5

ISS 13-15 2.8 3.3

ISS 16-24 3.7 5.6

ISS 25-40 7.6 8.0

ISS 41-75 17.0 12.4




ISS < 13 3.7 2.3

ISS 13-15 3.4 4.3

ISS 16-24 4.6 5.6

ISS 25-40 7.8 7.0

ISS 41-75 29.6 13.6


Table 26: Trauma data profile, Royal Prince Alfred Hospital

Facility Peer








Gender

Female / Male 85 / 204 131.3 / 313.7

Age ranges

Mean age 56.9 53.7

0-4 0 0.6 (0.1%)

5-9 0 0.3 (0.1%)

10-14 1 (0.3%) 1 (0.2%)

15-19 10 (3.5%) 23.4 (5.3%)

20-24 15 (5.2%) 32.4 (7.3%)

25-29 16 (5.5%) 30.1 (6.8%)

30-34 22 (7.6%) 27.6 (6.2%)

35-39 18 (6.2%) 28.1 (6.3%)

40-44 18 (6.2%) 26.4 (5.9%)

45-49 17 (5.9%) 28.6 (6.4%)

50-54 15 (5.2%) 31 (7.0%)

55-59 15 (5.2%) 27.4 (6.2%)

60-64 21 (7.3%) 26.6 (6.0%)

65-69 17 (5.9%) 25.7 (5.8%)

70-74 24 (8.3%) 27.1 (6.1%)

75-79 14 (4.8%) 29.6 (6.6%)

80-84 24 (8.3%) 32.3 (7.3%)

85 and over 42 (14.5%) 46.4 (10.4%)


Mean ISS 19.4 19.5

ISS <13 30 (10.4%) 43.9 (9.9%)

ISS 13-15 39 (13.5%) 100.1 (22.5%)

ISS 16-24 136 (47.1%) 182.3 (41.0%)

ISS 25-40 79 (27.3%) 104.9 (23.6%)

ISS 41-75 5 (1.7%) 13.9 (3.1%)


Assault 30 (10.4%) 28.3 (6.4%)

Falls 147 (50.9%) 197 (44.3%)

Falls (≥65 years) 91 (31.5%) 119 (26.7%)

Road trauma 67 (23.2%) 163.4 (36.7%)



Types of injury

Blunt 257 (88.9%) 418.1 (94.0%)

Penetrating 28 (9.7%) 18.9 (4.2%)


Admission type


Transfer in 41 (14.2%) 100.3 (3.2%)

Unknown 0 3.1 (0.1%)

Arrival modes

Ambulance 248 (85.8%) 338.9 (10.9%)

Helicopter 1 (0.3%) 55.1 (1.8%)




ISS < 13 6.9 6.5

ISS 13-15 7.7 7.6

ISS 16-24 7.4 7.4

ISS 25-40 6.6 6.5

ISS 41-75 4.6 4.7




ISS < 13 10.8 10.0

ISS 13-15 8.5 9.8

ISS 16-24 13.3 13.4

ISS 25-40 14.5 17.7

ISS 41-75 36.8 31.5

ICU length of stay



ISS < 13 2.0 2.5

ISS 13-15 3.5 3.3

ISS 16-24 4.6 5.6

ISS 25-40 5.8 8.0

ISS 41-75 8.0 12.4




ISS < 13 1.6 2.3

ISS 13-15 1.0 4.3

ISS 16-24 4.4 5.6

ISS 25-40 6.2 7.0

ISS 41-75 6.3 13.6


Table 27: Trauma data profile, St George Hospital

Facility Peer








Gender

Female / Male 98 / 255 131.3 / 313.7

Age ranges

Mean age 52.3 53.7

0-4 1 (0.3%) 0.6 (0.1%)

5-9 1 (0.3%) 0.3 (0.1%)

10-14 2 (0.6%) 1 (0.2%)

15-19 24 (6.8%) 23.4 (5.3%)

20-24 28 (7.9%) 32.4 (7.3%)

25-29 20 (5.7%) 30.1 (6.8%)

30-34 28 (7.9%) 27.6 (6.2%)

35-39 21 (5.9%) 28.1 (6.3%)

40-44 10 (2.8%) 26.4 (5.9%)

45-49 16 (4.5%) 28.6 (6.4%)

50-54 34 (9.6%) 31 (7.0%)

55-59 27 (7.6%) 27.4 (6.2%)

60-64 24 (6.8%) 26.6 (6.0%)

65-69 20 (5.7%) 25.7 (5.8%)

70-74 16 (4.5%) 27.1 (6.1%)

75-79 27 (7.6%) 29.6 (6.6%)

80-84 21 (5.9%) 32.3 (7.3%)

85 and over 33 (9.3%) 46.4 (10.4%)


Mean ISS 20.1 19.5

ISS <13 42 (11.9%) 43.9 (9.9%)

ISS 13-15 78 (22.1%) 100.1 (22.5%)

ISS 16-24 137 (38.8%) 182.3 (41.0%)

ISS 25-40 76 (21.5%) 104.9 (23.6%)

ISS 41-75 20 (5.7%) 13.9 (3.1%)


Assault 19 (5.4%) 28.3 (6.4%)

Falls 151 (42.8%) 197 (44.3%)

Falls (≥65 years) 78 (22.1%) 119 (26.7%)

Road trauma 146 (41.4%) 163.4 (36.7%)



Types of injury

Blunt 335 (94.9%) 418.1 (94.0%)

Penetrating 14 (4.0%) 18.9 (4.2%)


Admission type


Transfer in 101 (28.6%) 100.3 (3.2%)

Unknown 0 3.1 (0.1%)

Arrival modes

Ambulance 278 (78.8%) 338.9 (10.9%)

Helicopter 47 (13.3%) 55.1 (1.8%)




ISS < 13 5.9 6.5

ISS 13-15 7.6 7.6

ISS 16-24 7.2 7.4

ISS 25-40 6.3 6.5

ISS 41-75 4.2 4.7




ISS < 13 11.8 10.0

ISS 13-15 9.8 9.8

ISS 16-24 13.6 13.4

ISS 25-40 17.6 17.7

ISS 41-75 37.2 31.5

ICU length of stay



ISS < 13 2.4 2.5

ISS 13-15 1.3 3.3

ISS 16-24 6.1 5.6

ISS 25-40 9.0 8.0

ISS 41-75 15.3 12.4




ISS < 13 2.2 2.3

ISS 13-15 1.6 4.3

ISS 16-24 5.6 5.6

ISS 25-40 9.5 7.0

ISS 41-75 11.2 13.6


Table 28: Trauma data profile, St Vincent’s Hospital

Facility Peer








Gender

Female / Male 69 / 158 131.3 / 313.7

Age ranges39

Mean age 49.9 53.7

0-4 0 0.6 (0.1%)

5-9 0 0.3 (0.1%)

10-14 0 1 (0.2%)

15-19 9 (4.0%) 23.4 (5.3%)

20-24 26 (11.5%) 32.4 (7.3%)

25-29 30 (13.2%) 30.1 (6.8%)

30-34 15 (6.6%) 27.6 (6.2%)

35-39 16 (7.0%) 28.1 (6.3%)

40-44 17 (7.5%) 26.4 (5.9%)

45-49 8 (3.5%) 28.6 (6.4%)

50-54 10 (4.4%) 31 (7.0%)

55-59 7 (3.1%) 27.4 (6.2%)

60-64 16 (7.0%) 26.6 (6.0%)

65-69 14 (6.2%) 25.7 (5.8%)

70-74 13 (5.7%) 27.1 (6.1%)

75-79 8 (3.5%) 29.6 (6.6%)

80-84 12 (5.3%) 32.3 (7.3%)

85 and over 24 (10.6%) 46.4 (10.4%)


Mean ISS 18.6 19.5

ISS <13 30 (13.2%) 43.9 (9.9%)

ISS 13-15 59 (26.0%) 100.1 (22.5%)

ISS 16-24 85 (37.4%) 182.3 (41.0%)

ISS 25-40 46 (20.3%) 104.9 (23.6%)

ISS 41-75 7 (3.1%) 13.9 (3.1%)


Assault 20 (8.8%) 28.3 (6.4%)

Falls 119 (52.4%) 197 (44.3%)

Falls (≥65 years) 60 (26.4%) 119 (26.7%)

Road trauma 58 (25.6%) 163.4 (36.7%)


39

2 records without age recorded


Types of injury

Blunt 217 (95.6%) 418.1 (94.0%)

Penetrating 5 (2.2%) 18.9 (4.2%)


Admission type


Transfer in 4 (1.8%) 100.3 (3.2%)

Unknown 0 3.1 (0.1%)

Arrival modes

Ambulance 210 (92.5%) 338.9 (10.9%)

Helicopter 1 (0.4%) 55.1 (1.8%)




ISS < 13 6.8 6.5

ISS 13-15 7.7 7.6

ISS 16-24 7.6 7.4

ISS 25-40 6.4 6.5

ISS 41-75 5.1 4.7




ISS < 13 6.1 10.0

ISS 13-15 12.4 9.8

ISS 16-24 9.9 13.4

ISS 25-40 13.5 17.7

ISS 41-75 13.4 31.5

ICU length of stay



ISS < 13 1.3 2.5

ISS 13-15 2.6 3.3

ISS 16-24 3.7 5.6

ISS 25-40 7.8 8.0

ISS 41-75 3.4 12.4




ISS < 13 1.3 2.3

ISS 13-15 3.3 4.3

ISS 16-24 5.4 5.6

ISS 25-40 6.2 7.0

ISS 41-75 3.8 13.6


Table 29: Trauma data profile, Westmead Hospital

Facility Peer








Gender

Female / Male 144 / 362 131.3 / 313.7

Age ranges

Mean age 51.5 53.7

0-4 0 0.6 (0.1%)

5-9 0 0.3 (0.1%)

10-14 0 1 (0.2%)

15-19 40 (7.9%) 23.4 (5.3%)

20-24 49 (9.7%) 32.4 (7.3%)

25-29 30 (5.9%) 30.1 (6.8%)

30-34 29 (5.7%) 27.6 (6.2%)

35-39 31 (6.1%) 28.1 (6.3%)

40-44 33 (6.5%) 26.4 (5.9%)

45-49 42 (8.3%) 28.6 (6.4%)

50-54 35 (6.9%) 31 (7.0%)

55-59 24 (4.7%) 27.4 (6.2%)

60-64 24 (4.7%) 26.6 (6.0%)

65-69 28 (5.5%) 25.7 (5.8%)

70-74 30 (5.9%) 27.1 (6.1%)

75-79 33 (6.5%) 29.6 (6.6%)

80-84 30 (5.9%) 32.3 (7.3%)

85 and over 48 (9.5%) 46.4 (10.4%)


Mean ISS 18.3 19.5

ISS <13 70 (13.8%) 43.9 (9.9%)

ISS 13-15 132 (26.1%) 100.1 (22.5%)

ISS 16-24 180 (35.6%) 182.3 (41.0%)

ISS 25-40 115 (22.7%) 104.9 (23.6%)

ISS 41-75 9 (1.8%) 13.9 (3.1%)


Assault 37 (7.3%) 28.3 (6.4%)

Falls 218 (43.1%) 197 (44.3%)

Falls (≥65 years) 122 (24.1%) 119 (26.7%)

Road trauma 203 (40.1%) 163.4 (36.7%)



Types of injury

Blunt 478 (94.5%) 418.1 (94.0%)

Penetrating 26 (5.1%) 18.9 (4.2%)


Admission type


Transfer in 93 (18.4%) 100.3 (3.2%)

Unknown 21 (4.2%) 3.1 (0.1%)

Arrival modes

Ambulance 369 (72.9%) 338.9 (10.9%)

Helicopter 70 (13.8%) 55.1 (1.8%)




ISS < 13 6.0 6.5

ISS 13-15 7.6 7.6

ISS 16-24 7.2 7.4

ISS 25-40 6.5 6.5

ISS 41-75 4.8 4.7




ISS < 13 8.4 10.0

ISS 13-15 9.2 9.8

ISS 16-24 13.3 13.4

ISS 25-40 17.3 17.7

ISS 41-75 23.4 31.5

ICU length of stay



ISS < 13 3.0 2.5

ISS 13-15 6.1 3.3

ISS 16-24 9.6 5.6

ISS 25-40 9.3 8.0

ISS 41-75 12.2 12.4




ISS < 13 2.0 2.3

ISS 13-15 7.4 4.3

ISS 16-24 7.7 5.6

ISS 25-40 5.9 7.0

ISS 41-75 6.9 13.6


Appendix 2: Paediatric Major Trauma Service summaries

Table 30: Trauma data profile, John Hunter Children’s Hospital

Facility Peer

Total admissions 41 64.7







Gender

Female / Male 11 / 30 22.7 / 42

Age ranges

Mean age 8.8 7.7

0-4 11 (26.8%) 22 (34.0%)

5-9 6 (14.6%) 14.3 (22.2%)

10-14 21 (51.2%) 22.7 (35.0%)

15-19 3 (7.3%) 5.7 (8.8%)


Mean ISS 19.6 19.8

ISS <13 7 (17.1%) 13 (20.1%)

ISS 13-15 13 (31.7%) 10 (15.5%)

ISS 16-24 7 (17.1%) 20.3 (31.4%)

ISS 25-40 12 (29.3%) 18 (27.8%)

ISS 41-75 2 (4.9%) 3.3 (5.2%)


Assault 2 (4.9%) 3 (4.6%)

Falls 11 (26.8%) 20.3 (31.4%)

Road trauma 16 (39.0%) 19.3 (29.9%)

All other injuries 12 (29.3%) 22 (34.0%)

Types of injury

Blunt 37 (90.2%) 53.3 (82.5%)

Penetrating 1 (2.4%) 1.7 (2.6%)

Other and Unknown 3 (7.3%) 9.7 (14.9%)

Admission type

Direct admission 25 (61.0%) 32 (16.5%)

Transfer in 16 (39.0%) 32.7 (16.8%)

Arrival modes

Ambulance 28 (68.3%) 36.3 (18.7%)

Helicopter 4 (9.8%) 8.7 (4.5%)

Other (Private Vehicle, Fixed Wing, Unknown) 9 (22.0%) 19.7 (10.1%)




ISS < 13 5.9 6.4

ISS 13-15 7.5 7.3

ISS 16-24 7.8 7.4

ISS 25-40 6.1 5.7

ISS 41-75 4.1 3.9


Total bed days 335 1154


ISS < 13 3.4 10.3

ISS 13-15 10.7 7.8

ISS 16-24 5.3 13.2

ISS 25-40 11.1 31.8

ISS 41-75 1.0 30.4

ICU length of stay

ICU total bed days (admissions) 61 (17) 210 (39.3)


ISS < 13 1.4 2.0

ISS 13-15 1.0 1.7

ISS 16-24 0 5.7

ISS 25-40 6.9 8.1

ISS 41-75 1.0 10.3




ISS < 13 1.8 2.3

ISS 13-15 1.0 1.5

ISS 16-24 0 6.4

ISS 25-40 4.0 8.6

ISS 41-75 0 20.1


Table 31: Trauma data profile, Sydney Children’s Hospital

Facility Peer








Gender

Female / Male 28 / 35 22.7 / 42

Age ranges

Mean age 6.7 7.7

0-4 29 (46.0%) 22 (34.0%)

5-9 10 (15.9%) 14.3 (22.2%)

10-14 17 (27.0%) 22.7 (35.0%)

15-19 7 (11.1%) 5.7 (8.8%)


Mean ISS 18.4 19.8

ISS <13 13 (20.6%) 13 (20.1%)

ISS 13-15 10 (15.9%) 10 (15.5%)

ISS 16-24 23 (36.5%) 20.3 (31.4%)

ISS 25-40 15 (23.8%) 18 (27.8%)

ISS 41-75 2 (3.2%) 3.3 (5.2%)


Assault 6 (9.5%) 3 (4.6%)

Falls 29 (46.0%) 20.3 (31.4%)

Road trauma 15 (23.8%) 19.3 (29.9%)


Types of injury

Blunt 62 (98.4%) 53.3 (82.5%)

Penetrating 1 (1.6%) 1.7 (2.6%)

Other and Unknown 0 9.7 (14.9%)

Admission type


Transfer in 42 (66.7%) 32.7 (16.8%)

Arrival modes

Ambulance 34 (54.0%) 36.3 (18.7%)

Helicopter 5 (7.9%) 8.7 (4.5%)




ISS < 13 6.7 6.4

ISS 13-15 5.7 7.3

ISS 16-24 7.4 7.4

ISS 25-40 6.0 5.7

ISS 41-75 0 3.9





ISS < 13 10.7 10.3

ISS 13-15 3.9 7.8

ISS 16-24 10.6 13.2

ISS 25-40 26.1 31.8

ISS 41-75 1.5 30.4

ICU length of stay



ISS < 13 2.6 2.0

ISS 13-15 2.0 1.7

ISS 16-24 3.0 5.7

ISS 25-40 4.4 8.1

ISS 41-75 1.0 10.3




ISS < 13 2.6 2.3

ISS 13-15 0 1.5

ISS 16-24 4.7 6.4

ISS 25-40 4.4 8.6

ISS 41-75 1.0 20.1


Table 32: Trauma data profile, The Children’s Hospital at Westmead

Facility Peer








Gender

Female / Male 29 / 61 22.7 / 42

Age ranges

Mean age 7.9 7.7

0-4 26 (28.9%) 22 (34.0%)

5-9 27 (30.0%) 14.3 (22.2%)

10-14 30 (33.3%) 22.7 (35.0%)

15-19 7 (7.8%) 5.7 (8.8%)


Mean ISS 20.8 19.8

ISS <13 19 (21.1%) 13 (20.1%)

ISS 13-15 7 (7.8%) 10 (15.5%)

ISS 16-24 31 (34.4%) 20.3 (31.4%)

ISS 25-40 27 (30.0%) 18 (27.8%)

ISS 41-75 6 (6.7%) 3.3 (5.2%)


Assault 1 (1.1%) 3 (4.6%)

Falls 21 (23.3%) 20.3 (31.4%)

Road trauma 27 (30.0%) 19.3 (29.9%)


Types of injury

Blunt 61 (67.8%) 53.3 (82.5%)

Penetrating 3 (3.3%) 1.7 (2.6%)


Admission type


Transfer in 40 (44.4%) 32.7 (16.8%)

Arrival modes

Ambulance 47 (52.2%) 36.3 (18.7%)

Helicopter 17 (18.9%) 8.7 (4.5%)




ISS < 13 6.6 6.4

ISS 13-15 7.7 7.3

ISS 16-24 7.3 7.4

ISS 25-40 5.4 5.7

ISS 41-75 3.9 3.9





ISS < 13 12.6 10.3

ISS 13-15 8.1 7.8

ISS 16-24 16.8 13.2

ISS 25-40 44.2 31.8

ISS 41-75 49.8 30.4

ICU length of stay



ISS < 13 1.8 2.0

ISS 13-15 2.0 1.7

ISS 16-24 7.3 5.7

ISS 25-40 10.8 8.1

ISS 41-75 14.0 10.3




ISS < 13 2.3 2.3

ISS 13-15 2.0 1.5

ISS 16-24 7.0 6.4

ISS 25-40 11.0 8.6

ISS 41-75 23.3 20.1


Appendix 3: Regional Trauma Service summaries

Table 33: Trauma data profile, Coffs Harbour Health Campus

Facility Peer








Gender

Female / Male 17 / 61 20.9 / 58.5

Age ranges

Mean age 49.8 53.7

0-4 1 (1.3%) 1.8 (2.3%)

5-9 1 (1.3%) 0.4 (0.5%)

10-14 2 (2.6%) 2.5 (3.1%)

15-19 2 (2.6%) 3.6 (4.5%)

20-24 6 (7.7%) 3.8 (4.8%)

25-29 6 (7.7%) 4.3 (5.4%)

30-34 3 (3.8%) 3.7 (4.7%)

35-39 6 (7.7%) 3.2 (4.0%)

40-44 3 (3.8%) 4.3 (5.4%)

45-49 5 (6.4%) 4.1 (5.2%)

50-54 6 (7.7%) 7.2 (9.1%)

55-59 9 (11.5%) 5.5 (6.9%)

60-64 6 (7.7%) 4 (5.0%)

65-69 9 (11.5%) 6.3 (7.9%)

70-74 3 (3.8%) 5.6 (7.1%)

75-79 5 (6.4%) 5.1 (6.4%)

80-84 1 (1.3%) 5.2 (6.5%)

85 and over 4 (5.1%) 8.7 (11.0%)


Mean ISS 21.5 18.0

ISS <13 11 (14.1%) 10.6 (13.4%)

ISS 13-15 15 (19.2%) 21.3 (26.8%)

ISS 16-24 25 (32.1%) 30.3 (38.2%)

ISS 25-40 22 (28.2%) 15.9 (20.0%)

ISS 41-75 5 (6.4%) 1.3 (1.6%)


Assault 6 (7.7%) 3.6 (4.5%)

Falls 20 (25.6%) 30.8 (38.8%)

Falls (≥65 years) 8 (10.3%) 20.8 (26.2%)

Road trauma 39 (50.0%) 31 (39.0%)



Types of injury

Blunt 72 (92.3%) 75.3 (94.8%)

Penetrating 2 (2.6%) 2.8 (3.5%)


Admission type


Transfer in 7 (9.0%) 13.9 (1.8%)

Unknown 1 (1.3%) 1.3 (0.2%)

Arrival modes

Ambulance 68 (87.2%) 59.7 (7.5%)

Helicopter 3 (3.8%) 7.4 (0.9%)




ISS < 13 7.5 7.5

ISS 13-15 7.8 7.7

ISS 16-24 7.7 7.5

ISS 25-40 6.6 6.7

ISS 41-75 6.5 5.4




ISS < 13 6.5 12.5

ISS 13-15 5.8 7.0

ISS 16-24 9.9 8.1

ISS 25-40 3.2 5.7

ISS 41-75 1.2 2.9

ICU length of stay

ICU total bed days (admissions) 110 (32) 91.1 (28)


ISS < 13 3.9 3.3

ISS 13-15 3.0 2.7

ISS 16-24 2.4 3.4

ISS 25-40 4.8 3.7

ISS 41-75 1.0 2.0




ISS < 13 3.5 3.7

ISS 13-15 0 2.2

ISS 16-24 2.0 4.2

ISS 25-40 1.0 2.3

ISS 41-75 1.5 1.6


Table 34: Trauma data profile, Gosford Hospital

Facility Peer








Gender

Female / Male 23 / 48 20.9 / 58.5

Age ranges

Mean age 54.8 53.7

0-4 2 (2.8%) 1.8 (2.3%)

5-9 0 0.4 (0.5%)

10-14 2 (2.8%) 2.5 (3.1%)

15-19 6 (8.5%) 3.6 (4.5%)

20-24 5 (7.0%) 3.8 (4.8%)

25-29 4 (5.6%) 4.3 (5.4%)

30-34 1 (1.4%) 3.7 (4.7%)

35-39 2 (2.8%) 3.2 (4.0%)

40-44 5 (7.0%) 4.3 (5.4%)

45-49 0 4.1 (5.2%)

50-54 9 (12.7%) 7.2 (9.1%)

55-59 1 (1.4%) 5.5 (6.9%)

60-64 2 (2.8%) 4 (5.0%)

65-69 6 (8.5%) 6.3 (7.9%)

70-74 4 (5.6%) 5.6 (7.1%)

75-79 4 (5.6%) 5.1 (6.4%)

80-84 8 (11.3%) 5.2 (6.5%)

85 and over 10 (14.1%) 8.7 (11.0%)


Mean ISS 18.4 18.0

ISS <13 8 (11.3%) 10.6 (13.4%)

ISS 13-15 16 (22.5%) 21.3 (26.8%)

ISS 16-24 27 (38.0%) 30.3 (38.2%)

ISS 25-40 19 (26.8%) 15.9 (20.0%)

ISS 41-75 1 (1.4%) 1.3 (1.6%)


Assault 2 (2.8%) 3.6 (4.5%)

Falls 38 (53.5%) 30.8 (38.8%)

Falls (≥65 years) 29 (40.8%) 20.8 (26.2%)

Road trauma 21 (29.6%) 31 (39.0%)



Types of injury

Blunt 69 (97.2%) 75.3 (94.8%)

Penetrating 2 (2.8%) 2.8 (3.5%)


Admission type


Transfer in 0 13.9 (1.8%)

Unknown 0 1.3 (0.2%)

Arrival modes

Ambulance 58 (81.7%) 59.7 (7.5%)

Helicopter 0 7.4 (0.9%)




ISS < 13 6.3 7.5

ISS 13-15 7.8 7.7

ISS 16-24 7.7 7.5

ISS 25-40 6.9 6.7

ISS 41-75 0.0 5.4




ISS < 13 14.4 12.5

ISS 13-15 3.8 7.0

ISS 16-24 3.9 8.1

ISS 25-40 3.8 5.7

ISS 41-75 1.0 2.9

ICU length of stay



ISS < 13 4.0 3.3

ISS 13-15 0 2.7

ISS 16-24 0 3.4

ISS 25-40 0 3.7

ISS 41-75 0 2.0


Total ventilation bed days (number of cases) 0 30.7 (9.7)

Mean - Overall 0 3.2

ISS < 13 0 3.7

ISS 13-15 0 2.2

ISS 16-24 0 4.2

ISS 25-40 0 2.3

ISS 41-75 0 1.6


Table 35: Trauma data profile, Lismore Base Hospital

Facility Peer








Gender

Female / Male 11 / 46 20.9 / 58.5

Age ranges

Mean age 46.9 53.7

0-4 1 (1.8%) 1.8 (2.3%)

5-9 2 (3.5%) 0.4 (0.5%)

10-14 4 (7.0%) 2.5 (3.1%)

15-19 3 (5.3%) 3.6 (4.5%)

20-24 5 (8.8%) 3.8 (4.8%)

25-29 3 (5.3%) 4.3 (5.4%)

30-34 1 (1.8%) 3.7 (4.7%)

35-39 2 (3.5%) 3.2 (4.0%)

40-44 3 (5.3%) 4.3 (5.4%)

45-49 1 (1.8%) 4.1 (5.2%)

50-54 7 (12.3%) 7.2 (9.1%)

55-59 6 (10.5%) 5.5 (6.9%)

60-64 3 (5.3%) 4 (5.0%)

65-69 4 (7.0%) 6.3 (7.9%)

70-74 4 (7.0%) 5.6 (7.1%)

75-79 4 (7.0%) 5.1 (6.4%)

80-84 1 (1.8%) 5.2 (6.5%)

85 and over 3 (5.3%) 8.7 (11.0%)


Mean ISS 17.5 18.0

ISS <13 1 (1.8%) 10.6 (13.4%)

ISS 13-15 18 (31.6%) 21.3 (26.8%)

ISS 16-24 32 (56.1%) 30.3 (38.2%)

ISS 25-40 6 (10.5%) 15.9 (20.0%)

ISS 41-75 0 1.3 (1.6%)


Assault 2 (3.5%) 3.6 (4.5%)

Falls 21 (36.8%) 30.8 (38.8%)

Falls (≥65 years) 10 (17.5%) 20.8 (26.2%)

Road trauma 20 (35.1%) 31 (39.0%)



Types of injury

Blunt 52 (91.2%) 75.3 (94.8%)

Penetrating 3 (5.3%) 2.8 (3.5%)


Admission type


Transfer in 3 (5.3%) 13.9 (1.8%)

Unknown 0 1.3 (0.2%)

Arrival modes

Ambulance 40 (70.2%) 59.7 (7.5%)

Helicopter 12 (21.1%) 7.4 (0.9%)




ISS < 13 7.8 7.5

ISS 13-15 7.7 7.7

ISS 16-24 7.0 7.5

ISS 25-40 5.8 6.7

ISS 41-75 0 5.4




ISS < 13 2.0 12.5

ISS 13-15 6.4 7.0

ISS 16-24 6.3 8.1

ISS 25-40 2.3 5.7

ISS 41-75 0.0 2.9

ICU length of stay



ISS < 13 1.0 3.3

ISS 13-15 2.8 2.7

ISS 16-24 3.9 3.4

ISS 25-40 1.0 3.7

ISS 41-75 0 2.0




ISS < 13 2.0 3.7

ISS 13-15 8.0 2.2

ISS 16-24 5.3 4.2

ISS 25-40 1.3 2.3

ISS 41-75 0 1.6


Table 36: Trauma data profile, Nepean Hospital

Facility Peer








Gender

Female / Male 29 / 66 20.9 / 58.5

Age ranges

Mean age 57.1 53.7

0-4 5 (5.3%) 1.8 (2.3%)

5-9 0 0.4 (0.5%)

10-14 1 (1.1%) 2.5 (3.1%)

15-19 3 (3.2%) 3.6 (4.5%)

20-24 2 (2.1%) 3.8 (4.8%)

25-29 3 (3.2%) 4.3 (5.4%)

30-34 9 (9.5%) 3.7 (4.7%)

35-39 0 3.2 (4.0%)

40-44 6 (6.3%) 4.3 (5.4%)

45-49 4 (4.2%) 4.1 (5.2%)

50-54 10 (10.5%) 7.2 (9.1%)

55-59 5 (5.3%) 5.5 (6.9%)

60-64 2 (2.1%) 4 (5.0%)

65-69 5 (5.3%) 6.3 (7.9%)

70-74 11 (11.6%) 5.6 (7.1%)

75-79 6 (6.3%) 5.1 (6.4%)

80-84 9 (9.5%) 5.2 (6.5%)

85 and over 14 (14.7%) 8.7 (11.0%)


Mean ISS 13.7 18.0

ISS <13 32 (33.7%) 10.6 (13.4%)

ISS 13-15 31 (32.6%) 21.3 (26.8%)

ISS 16-24 27 (28.4%) 30.3 (38.2%)

ISS 25-40 5 (5.3%) 15.9 (20.0%)

ISS 41-75 0 1.3 (1.6%)


Assault 5 (5.3%) 3.6 (4.5%)

Falls 56 (58.9%) 30.8 (38.8%)

Falls (≥65 years) 40 (42.1%) 20.8 (26.2%)

Road trauma 21 (22.1%) 31 (39.0%)



Types of injury

Blunt 88 (92.6%) 75.3 (94.8%)

Penetrating 7 (7.4%) 2.8 (3.5%)


Admission type


Transfer in 26 (27.4%) 13.9 (1.8%)

Unknown 0 1.3 (0.2%)

Arrival modes

Ambulance 69 (72.6%) 59.7 (7.5%)





ISS < 13 7.3 7.5

ISS 13-15 7.7 7.7

ISS 16-24 7.6 7.5

ISS 25-40 6.6 6.7

ISS 41-75 0 5.4




ISS < 13 24.7 12.5

ISS 13-15 10.7 7.0

ISS 16-24 20.9 8.1

ISS 25-40 14.4 5.7

ISS 41-75 0.0 2.9

ICU length of stay



ISS < 13 5.0 3.3

ISS 13-15 3.3 2.7

ISS 16-24 2.1 3.4

ISS 25-40 3.3 3.7

ISS 41-75 0 2.0



Mean - Overall 0 3.2

ISS < 13 0 3.7

ISS 13-15 0 2.2

ISS 16-24 0 4.2

ISS 25-40 0 2.3

ISS 41-75 0 1.6


Table 37: Trauma data profile, Orange Health Service

Facility Peer

Total admissions 101.0 79.4


Case fatality rate (all ISS) 6% 10%

Case fatality rate (ISS >12) 7% 7%




Gender

Female / Male 23 / 78 20.9 / 58.5

Age ranges

Mean age 51.6 53.7

0-4 0 1.8 (2.3%)

5-9 0 0.4 (0.5%)

10-14 1 (1.0%) 2.5 (3.1%)

15-19 5 (5.0%) 3.6 (4.5%)

20-24 4 (4.0%) 3.8 (4.8%)

25-29 13 (12.9%) 4.3 (5.4%)

30-34 5 (5.0%) 3.7 (4.7%)

35-39 4 (4.0%) 3.2 (4.0%)

40-44 11 (10.9%) 4.3 (5.4%)

45-49 8 (7.9%) 4.1 (5.2%)

50-54 7 (6.9%) 7.2 (9.1%)

55-59 6 (5.9%) 5.5 (6.9%)

60-64 3 (3.0%) 4 (5.0%)

65-69 6 (5.9%) 6.3 (7.9%)

70-74 9 (8.9%) 5.6 (7.1%)

75-79 6 (5.9%) 5.1 (6.4%)

80-84 5 (5.0%) 5.2 (6.5%)

85 and over 8 (7.9%) 8.7 (11.0%)


Mean ISS 16.5 18.0

ISS <13 28 (27.7%) 10.6 (13.4%)

ISS 13-15 17 (16.8%) 21.3 (26.8%)

ISS 16-24 38 (37.6%) 30.3 (38.2%)

ISS 25-40 15 (14.9%) 15.9 (20.0%)

ISS 41-75 3 (3.0%) 1.3 (1.6%)


Assault 4 (4.0%) 3.6 (4.5%)

Falls 24 (23.8%) 30.8 (38.8%)

Falls (≥65 years) 17 (16.8%) 20.8 (26.2%)

Road trauma 45 (44.6%) 31 (39.0%)



Types of injury

Blunt 98 (97.0%) 75.3 (94.8%)

Penetrating 3 (3.0%) 2.8 (3.5%)


Admission type


Transfer in 21 (20.8%) 13.9 (1.8%)

Unknown 1 (1.0%) 1.3 (0.2%)

Arrival modes

Ambulance 52 (51.5%) 59.7 (7.5%)

Helicopter 33 (32.7%) 7.4 (0.9%)




ISS < 13 7.8 7.5

ISS 13-15 7.8 7.7

ISS 16-24 7.6 7.5

ISS 25-40 7.1 6.7

ISS 41-75 5.4 5.4




ISS < 13 4.1 12.5

ISS 13-15 7.2 7.0

ISS 16-24 5.2 8.1

ISS 25-40 3.1 5.7

ISS 41-75 1.0 2.9

ICU length of stay



ISS < 13 1.9 3.3

ISS 13-15 2.2 2.7

ISS 16-24 2.5 3.4

ISS 25-40 2.0 3.7

ISS 41-75 1.0 2.0




ISS < 13 0 3.7

ISS 13-15 2.0 2.2

ISS 16-24 4.3 4.2

ISS 25-40 1.3 2.3

ISS 41-75 1.0 1.6


Table 38: Trauma data profile, Port Macquarie Base Hospital

Facility Peer








Gender

Female / Male 14 / 43 20.9 / 58.5

Age ranges

Mean age 53.2 53.7

0-4 1 (1.8%) 1.8 (2.3%)

5-9 0 0.4 (0.5%)

10-14 3 (5.3%) 2.5 (3.1%)

15-19 1 (1.8%) 3.6 (4.5%)

20-24 0 3.8 (4.8%)

25-29 4 (7.0%) 4.3 (5.4%)

30-34 4 (7.0%) 3.7 (4.7%)

35-39 4 (7.0%) 3.2 (4.0%)

40-44 2 (3.5%) 4.3 (5.4%)

45-49 3 (5.3%) 4.1 (5.2%)

50-54 6 (10.5%) 7.2 (9.1%)

55-59 2 (3.5%) 5.5 (6.9%)

60-64 9 (15.8%) 4 (5.0%)

65-69 5 (8.8%) 6.3 (7.9%)

70-74 2 (3.5%) 5.6 (7.1%)

75-79 0 5.1 (6.4%)

80-84 5 (8.8%) 5.2 (6.5%)

85 and over 6 (10.5%) 8.7 (11.0%)


Mean ISS 19.2 18.0

ISS <13 4 (7.0%) 10.6 (13.4%)

ISS 13-15 16 (28.1%) 21.3 (26.8%)

ISS 16-24 22 (38.6%) 30.3 (38.2%)

ISS 25-40 14 (24.6%) 15.9 (20.0%)

ISS 41-75 1 (1.8%) 1.3 (1.6%)


Assault 2 (3.5%) 3.6 (4.5%)

Falls 16 (28.1%) 30.8 (38.8%)

Falls (≥65 years) 10 (17.5%) 20.8 (26.2%)

Road trauma 26 (45.6%) 31 (39.0%)



Types of injury

Blunt 52 (91.2%) 75.3 (94.8%)

Penetrating 3 (5.3%) 2.8 (3.5%)


Admission type


Transfer in 7 (12.3%) 13.9 (1.8%)

Unknown 0 (0.0%) 1.3 (0.2%)

Arrival modes

Ambulance 49 (86.0%) 59.7 (7.5%)

Helicopter 2 (3.5%) 7.4 (0.9%)




ISS < 13 7.8 7.5

ISS 13-15 7.7 7.7

ISS 16-24 7.6 7.5

ISS 25-40 7.3 6.7

ISS 41-75 5.0 5.4




ISS < 13 3.5 12.5

ISS 13-15 5.1 7.0

ISS 16-24 5.8 8.1

ISS 25-40 5.9 5.7

ISS 41-75 1.0 2.9

ICU length of stay



ISS < 13 2.3 3.3

ISS 13-15 3.7 2.7

ISS 16-24 3.3 3.4

ISS 25-40 10.3 3.7

ISS 41-75 0 2.0




ISS < 13 0 3.7

ISS 13-15 1.0 2.2

ISS 16-24 1.0 4.2

ISS 25-40 0 2.3

ISS 41-75 0 1.6


Table 39: Trauma data profile, Tamworth Rural Referral Hospital

Facility Peer








Gender

Female / Male 24 / 73 20.9 / 58.5

Age ranges40

Mean age 55.2 53.7

0-4 3 (3.1%) 1.8 (2.3%)

5-9 1 (1.0%) 0.4 (0.5%)

10-14 3 (3.1%) 2.5 (3.1%)

15-19 3 (3.1%) 3.6 (4.5%)

20-24 8 (8.2%) 3.8 (4.8%)

25-29 2 (2.1%) 4.3 (5.4%)

30-34 1 (1.0%) 3.7 (4.7%)

35-39 5 (5.2%) 3.2 (4.0%)

40-44 4 (4.1%) 4.3 (5.4%)

45-49 5 (5.2%) 4.1 (5.2%)

50-54 6 (6.2%) 7.2 (9.1%)

55-59 6 (6.2%) 5.5 (6.9%)

60-64 7 (7.2%) 4 (5.0%)

65-69 8 (8.2%) 6.3 (7.9%)

70-74 10 (10.3%) 5.6 (7.1%)

75-79 9 (9.3%) 5.1 (6.4%)

80-84 4 (4.1%) 5.2 (6.5%)

85 and over 11 (11.3%) 8.7 (11.0%)


Mean ISS 17.5 18.0

ISS <13 11 (11.3%) 10.6 (13.4%)

ISS 13-15 30 (30.9%) 21.3 (26.8%)

ISS 16-24 42 (43.3%) 30.3 (38.2%)

ISS 25-40 12 (12.4%) 15.9 (20.0%)

ISS 41-75 2 (2.1%) 1.3 (1.6%)


Assault 5 (5.2%) 3.6 (4.5%)

Falls 27 (27.8%) 30.8 (38.8%)

Falls (≥65 years) 21 (21.6%) 20.8 (26.2%)

Road trauma 46 (47.4%) 31 (39.0%)


40

1 record without age recorded


Types of injury

Blunt 91 (93.8%) 75.3 (94.8%)

Penetrating 3 (3.1%) 2.8 (3.5%)


Admission type


Transfer in 28 (28.9%) 13.9 (1.8%)

Unknown 3 (3.1%) 1.3 (0.2%)

Arrival modes

Ambulance 59 (60.8%) 59.7 (7.5%)

Helicopter 22 (22.7%) 7.4 (0.9%)




ISS < 13 7.7 7.5

ISS 13-15 7.7 7.7

ISS 16-24 7.5 7.5

ISS 25-40 6.6 6.7

ISS 41-75 4.1 5.4




ISS < 13 5.5 12.5

ISS 13-15 9.1 7.0

ISS 16-24 8.4 8.1

ISS 25-40 4.6 5.7

ISS 41-75 7.5 2.9

ICU length of stay



ISS < 13 2.0 3.3

ISS 13-15 1.6 2.7

ISS 16-24 3.1 3.4

ISS 25-40 2.7 3.7

ISS 41-75 4.0 2.0




ISS < 13 2.8 3.7

ISS 13-15 0 2.2

ISS 16-24 4.3 4.2

ISS 25-40 1.8 2.3

ISS 41-75 3.0 1.6


Table 40: Trauma data profile, The Tweed Hospital

Facility Peer








Gender

Female / Male 11 / 34 20.9 / 58.5

Age ranges

Mean age 52.8 53.7

0-4 2 (4.4%) 1.8 (2.3%)

5-9 0 0.4 (0.5%)

10-14 0 2.5 (3.1%)

15-19 2 (4.4%) 3.6 (4.5%)

20-24 2 (4.4%) 3.8 (4.8%)

25-29 3 (6.7%) 4.3 (5.4%)

30-34 3 (6.7%) 3.7 (4.7%)

35-39 0 3.2 (4.0%)

40-44 1 (2.2%) 4.3 (5.4%)

45-49 3 (6.7%) 4.1 (5.2%)

50-54 9 (20.0%) 7.2 (9.1%)

55-59 3 (6.7%) 5.5 (6.9%)

60-64 1 (2.2%) 4 (5.0%)

65-69 4 (8.9%) 6.3 (7.9%)

70-74 4 (8.9%) 5.6 (7.1%)

75-79 2 (4.4%) 5.1 (6.4%)

80-84 2 (4.4%) 5.2 (6.5%)

85 and over 4 (8.9%) 8.7 (11.0%)


Mean ISS 20.0 18.0

ISS <13 2 (4.4%) 10.6 (13.4%)

ISS 13-15 7 (15.6%) 21.3 (26.8%)

ISS 16-24 21 (46.7%) 30.3 (38.2%)

ISS 25-40 15 (33.3%) 15.9 (20.0%)

ISS 41-75 0 1.3 (1.6%)


Assault 2 (4.4%) 3.6 (4.5%)

Falls 18 (40.0%) 30.8 (38.8%)

Falls (≥65 years) 12 (26.7%) 20.8 (26.2%)

Road trauma 18 (40.0%) 31 (39.0%)



Types of injury

Blunt 42 (93.3%) 75.3 (94.8%)

Penetrating 2 (4.4%) 2.8 (3.5%)


Admission type


Transfer in 4 (8.9%) 13.9 (1.8%)

Unknown 0 1.3 (0.2%)

Arrival modes

Ambulance 41 (91.1%) 59.7 (7.5%)

Helicopter 1 (2.2%) 7.4 (0.9%)




ISS < 13 4.1 7.5

ISS 13-15 7.5 7.7

ISS 16-24 7.4 7.5

ISS 25-40 6.3 6.7

ISS 41-75 0 5.4


Total bed days 305.0 619.7


ISS < 13 4.5 12.5

ISS 13-15 14.9 7.0

ISS 16-24 6.6 8.1

ISS 25-40 3.6 5.7

ISS 41-75 0 2.9

ICU length of stay



ISS < 13 1.0 3.3

ISS 13-15 1.5 2.7

ISS 16-24 4.1 3.4

ISS 25-40 4.5 3.7

ISS 41-75 0 2.0




ISS < 13 2.5 3.7

ISS 13-15 2.0 2.2

ISS 16-24 4.3 4.2

ISS 25-40 5.0 2.3

ISS 41-75 0 1.6


Table 41: Trauma data profile, Wagga Wagga Rural Referral Hospital

Facility Peer








Gender

Female / Male 14 / 55 20.9 / 58.5

Age ranges

Mean age 51.8 53.7

0-4 0 1.8 (2.3%)

5-9 0 0.4 (0.5%)

10-14 5 (7.2%) 2.5 (3.1%)

15-19 4 (5.8%) 3.6 (4.5%)

20-24 4 (5.8%) 3.8 (4.8%)

25-29 2 (2.9%) 4.3 (5.4%)

30-34 3 (4.3%) 3.7 (4.7%)

35-39 4 (5.8%) 3.2 (4.0%)

40-44 2 (2.9%) 4.3 (5.4%)

45-49 8 (11.6%) 4.1 (5.2%)

50-54 3 (4.3%) 7.2 (9.1%)

55-59 7 (10.1%) 5.5 (6.9%)

60-64 3 (4.3%) 4 (5.0%)

65-69 5 (7.2%) 6.3 (7.9%)

70-74 5 (7.2%) 5.6 (7.1%)

75-79 5 (7.2%) 5.1 (6.4%)

80-84 3 (4.3%) 5.2 (6.5%)

85 and over 6 (8.7%) 8.7 (11.0%)


Mean ISS 16.8 18.0

ISS <13 6 (8.7%) 10.6 (13.4%)

ISS 13-15 31 (44.9%) 21.3 (26.8%)

ISS 16-24 24 (34.8%) 30.3 (38.2%)

ISS 25-40 8 (11.6%) 15.9 (20.0%)

ISS 41-75 0 1.3 (1.6%)


Assault 1 (1.4%) 3.6 (4.5%)

Falls 19 (27.5%) 30.8 (38.8%)

Falls (≥65 years) 16 (23.2%) 20.8 (26.2%)

Road trauma 34 (49.3%) 31 (39.0%)



Types of injury

Blunt 66 (95.7%) 75.3 (94.8%)

Penetrating 2 (2.9%) 2.8 (3.5%)


Admission type


Transfer in 16 (23.2%) 13.9 (1.8%)

Unknown 0 1.3 (0.2%)

Arrival modes

Ambulance 53 (76.8%) 59.7 (7.5%)





ISS < 13 7.7 7.5

ISS 13-15 7.7 7.7

ISS 16-24 7.7 7.5

ISS 25-40 7.0 6.7

ISS 41-75 0 5.4




ISS < 13 10.3 12.5

ISS 13-15 4.3 7.0

ISS 16-24 2.5 8.1

ISS 25-40 3.1 5.7

ISS 41-75 0.0 2.9

ICU length of stay



ISS < 13 1.7 3.3

ISS 13-15 3.4 2.7

ISS 16-24 1.3 3.4

ISS 25-40 1.0 3.7

ISS 41-75 0 2.0




ISS < 13 0 3.7

ISS 13-15 1.0 2.2

ISS 16-24 1.0 4.2

ISS 25-40 1.0 2.3

ISS 41-75 0 1.6


Table 42: Trauma data profile, Wollongong Hospital

Facility Peer








Gender

Female / Male 43 / 81 20.9 / 58.5

Age ranges

Mean age 58.3 53.7

0-4 3 (2.4%) 1.8 (2.3%)

5-9 0 (0.0%) 0.4 (0.5%)

10-14 4 (3.2%) 2.5 (3.1%)

15-19 7 (5.6%) 3.6 (4.5%)

20-24 2 (1.6%) 3.8 (4.8%)

25-29 3 (2.4%) 4.3 (5.4%)

30-34 7 (5.6%) 3.7 (4.7%)

35-39 5 (4.0%) 3.2 (4.0%)

40-44 6 (4.8%) 4.3 (5.4%)

45-49 4 (3.2%) 4.1 (5.2%)

50-54 9 (7.3%) 7.2 (9.1%)

55-59 10 (8.1%) 5.5 (6.9%)

60-64 4 (3.2%) 4 (5.0%)

65-69 11 (8.9%) 6.3 (7.9%)

70-74 4 (3.2%) 5.6 (7.1%)

75-79 10 (8.1%) 5.1 (6.4%)

80-84 14 (11.3%) 5.2 (6.5%)

85 and over 21 (16.9%) 8.7 (11.0%)


Mean ISS 20.1 18.0

ISS <13 3 (2.4%) 10.6 (13.4%)

ISS 13-15 32 (25.8%) 21.3 (26.8%)

ISS 16-24 45 (36.3%) 30.3 (38.2%)

ISS 25-40 43 (34.7%) 15.9 (20.0%)

ISS 41-75 1 (0.8%) 1.3 (1.6%)


Assault 7 (5.6%) 3.6 (4.5%)

Falls 69 (55.6%) 30.8 (38.8%)

Falls (≥65 years) 45 (36.3%) 20.8 (26.2%)

Road trauma 40 (32.3%) 31 (39.0%)



Types of injury

Blunt 123 (99.2%) 75.3 (94.8%)

Penetrating 1 (0.8%) 2.8 (3.5%)


Admission type


Transfer in 27 (21.8%) 13.9 (1.8%)

Unknown 8 (6.5%) 1.3 (0.2%)

Arrival modes

Ambulance 108 (87.1%) 59.7 (7.5%)

Helicopter 1 (0.8%) 7.4 (0.9%)




ISS < 13 7.8 7.5

ISS 13-15 7.7 7.7

ISS 16-24 7.2 7.5

ISS 25-40 6.7 6.7

ISS 41-75 7.8 5.4




ISS < 13 25.7 12.5

ISS 13-15 5.9 7.0

ISS 16-24 10.2 8.1

ISS 25-40 9.5 5.7

ISS 41-75 12.0 2.9

ICU length of stay



ISS < 13 16.0 3.3

ISS 13-15 1.0 2.7

ISS 16-24 8.1 3.4

ISS 25-40 3.2 3.7

ISS 41-75 3.0 2.0




ISS < 13 12.0 3.7

ISS 13-15 1.5 2.2

ISS 16-24 6.4 4.2

ISS 25-40 3.2 2.3

ISS 41-75 0 1.6


Appendix 4: Calculation of the Injury Severity Score

An injury severity score (ISS) is calculated for each patient based on the AIS injury severity

classification of their specific injuries. The ISS value ranges from 1-75 and is calculated as:

ISS = A2 + B2 + C2

Where A, B, and C are the highest AIS severity codes in each of the (up to) three most severely

injured ISS body regions.

The six ISS body regions are:

Head or neck

Face

Chest



External

The following example shows how an ISS is calculated from a set of injuries.

Table 43: ISS calculation example

ISS Body region Injury AIS Severity Code Include in ISS

calculation?

Head or Neck Small subdural

haematoma AIS-4 Yes

Chest Bilateral lung contusion AIS-4 No

Chest Bilateral flail chest AIS-5 Yes


Superficial spleen laceration

AIS-2 Yes


Left phalange (little toe) fracture

AIS-1 No

On the basis of the above injuries, the ISS is calculated as:

ISS = 42 + 52 + 22

ISS = 45 (critical injury)


Appendix 5: Calculation of adjusted mortality rate

Adjusted mortality rate refers to the mortality rate that would have existed if each trauma service

had the same age or ISS distribution as the “standard” population. In this report, the total NSW

trauma patients were considered as the standard population. Adjusted mortality rates were

calculated based on indirect standardization method.

The following steps were undertaken independently to calculate adjusted mortality rates based on

ISS. Similar calculation was done for age.

1. Calculating the total number of observed deaths in each trauma service (ISS>12).

2. Calculating ISS specific mortality rates in the standard population (the total NSW trauma

patients). This was done by adding the population of each ISS group together and adding all

the death rate for each ISS group together and then calculating ISS specific mortality rate for

each ISS group of the standard population, i.e. the total NSW population.

3. Calculating expected deaths for each ISS group of the trauma service: Multiplying the number

of people in each ISS group of the trauma service by the ISS specific mortality rate of the

standard population (the total NSW trauma patients).

4. Calculating the sum of the expected death rates.

5. Calculating standardised mortality ratio (SMR) by dividing the total number of observed deaths

by the sum of expected deaths.

6. Calculating adjusted mortality rate by multiply SMR by the crude death rate of the standard

population.

The example on the next page illustrates the calculations.


Table 44: Calculation of adjusted mortality rate

NSW Trauma Population (standard population)

ISS Group A)

Number of patients in each ISS group

B)

Total deaths in each ISS Group

C)

ISS specific mortality rate for each ISS group of the standard population (C= B / A)

ISS 13-15 924 15 0.016

ISS 16-24 1590 67 0.042

ISS 25-40 897 224 0.249

ISS 41-75 114 50 0.438

Total ∑A= 3525 ∑B= 356 0.10

Crude mortality rate of standard population (percentage) = ∑B / ∑A*100 = 356/3525 = 10.1%

An exemplary trauma service

ISS Group D)

Number of patients in the ISS group

E)

Total observed deaths in each ISS Group

F)

Expected death rates for each ISS group (F = D * C)

ISS 13-15 39 4 0.63

ISS 16-24 135 5 5.69

ISS 25-40 79 20 19.73

ISS 41-75 5 1 2.19

Total 258 ∑E = 30 ∑F= 28.24

SMR= ∑E / ∑F = 30/28.24 = 1.06 Adjusted mortality rate = SMR * Crude mortality rate of standard population Adjusted mortality rate = 1.06 * 10.1 = 10.7%


Appendix 6: Australian Statistical Geography Standard Remoteness Areas

The Australian Statistical Geography Standard (ASGS) Remoteness Areas (RA) is based on the

Accessibility and Remoteness Index of Australia (ARIA+) which defines locations in terms of

remoteness, i.e. the physical distance of a location from the nearest urban centre (access to goods

and services) based on population size.

Figure 29: Map of NSW showing ASGS-RA41

For further information on ASGS-RA please see the Australian Bureau of Statistics website:

http://www.abs.gov.au/websitedbs/d3310114.nsf/home/remoteness+structure

41

Source: ABS, 1270.0.55.005 - Australian Statistical Geography Standard (ASGS): Volume 5 - Remoteness Structure, July 2011

http://www.abs.gov.au/websitedbs/d3310114.nsf/home/remoteness+structure

Major Trauma in NSW, 2015...NSW ITIM Major Trauma in NSW, 2015 ii AGENCY FOR CLINICAL INNOVATION Level 4, Sage Building 67 Albert Avenue Chatswood NSW 2067 PO Box 699 Chatswood NSW

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