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Civil I, Isles S, Campbell A, Moore J. The New Zealand National Trauma Registry: an essential tool for trauma quality improvement. Eur J Trauma Emerg Surg 2023; 49:1613-1617. [PMID: 37410132 PMCID: PMC10449937 DOI: 10.1007/s00068-023-02310-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Trauma registries are essential tools for trauma systems and underpin any quality improvement activities. This paper describes the history, function, challenges, and future goals of the New Zealand National Trauma Registry (NZTR). METHODS Using the available publications and knowledge of the authors, the development, governance, oversight, and usage of the registry is outlined. RESULTS The New Zealand Trauma Network has run a national trauma registry since 2015 and this now contains over fifteen thousand major trauma patient records. Annual reports and a range of research outputs have been published. Key quality improvement initiatives have been undertaken and are described. Vulnerabilities include lack of longterm funding and a small workforce. CONCLUSIONS The NZTR has proven to be a critical component of trauma quality improvement in New Zealand. A user-friendly portal and a simple minimum dataset have been keys to successes but maintenance of an effective structure in a constrained healthcare system is a challenge.
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Affiliation(s)
- Ian Civil
- Department of Surgery, University of Auckland and National Trauma Network, Wellington, New Zealand
| | | | | | - James Moore
- Intensive Care Unit and Department of Anaesthesia, Wellington Regional Hospital, Wellington, New Zealand
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Davie G, Lilley R, de Graaf B, Dicker B, Branas C, Ameratunga S, Civil I, Reid P, Kool B. Access to advanced-level hospital care: differences in prehospital times calculated using incident locations compared with patients' usual residence. Inj Prev 2021; 28:192-196. [PMID: 34933936 DOI: 10.1136/injuryprev-2021-044351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/26/2021] [Indexed: 11/04/2022]
Abstract
Studies estimate that 84% of the USA and New Zealand's (NZ) resident populations have timely access (within 60 min) to advanced-level hospital care. Our aim was to assess whether usual residence (ie, home address) is a suitable proxy for location of injury incidence. In this observational study, injury fatalities registered in NZ's Mortality Collection during 2008-2012 were linked to Coronial files. Estimated access times via emergency medical services were calculated using locations of incident and home. Using incident locations, 73% (n=4445/6104) had timely access to care compared with 77% when using home location. Access calculations using patients' home locations overestimated timely access, especially for those injured in industrial/construction areas (18%; 95% CI 6% to 29%) and from drowning (14%; 95% CI 7% to 22%). When considering timely access to definitive care, using the location of the injury as the origin provides important information for health system planning.
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Affiliation(s)
- Gabrielle Davie
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Rebbecca Lilley
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Brandon de Graaf
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Bridget Dicker
- St John New Zealand, Auckland, New Zealand.,Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand
| | - Charles Branas
- Department of Epidemiology, Columbia University in the City of New York, New York, New York, USA
| | - Shanthi Ameratunga
- School of Population Health, The University of Auckland, Auckland, New Zealand.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Ian Civil
- Trauma Services, Auckland District Health Board, Auckland, New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Maori, University of Auckland, Auckland, New Zealand
| | - Bridget Kool
- School of Population Health, The University of Auckland, Auckland, New Zealand
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Davie G, Lilley R, de Graaf B, Ameratunga S, Dicker B, Civil I, Reid P, Branas C, Kool B. Access to specialist hospital care and injury survivability: identifying opportunities through an observational study of prehospital trauma fatalities. Injury 2021; 52:2863-2870. [PMID: 33771346 DOI: 10.1016/j.injury.2021.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/14/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Of the five million injury deaths that occur globally each year, an estimated 70% occur before the injured person reaches hospital. Although reducing the time from injury to definitive care has been shown to achieve better outcomes for patients, the relationship between injury incident location and access to specialist care has been largely unexplored. OBJECTIVE To determine the number and distribution of prehospital (on-scene/en route) trauma deaths without timely access to a hospital with surgical and intensive care capabilities, overall and by estimated injury survivability. METHODS New Zealand's Mortality Collection and Hospital Discharge dataset were used to select prehospital injury deaths in 2009-2012. These records were linked to files held by Australasia's National Coronial Information Service (NCIS) to estimate, for the trauma subset, injury survivability. Using geographical locations of injury for the prehospital trauma fatalities, time from Emergency Medical System call-out to arrival at the closest specialist hospital was estimated. RESULTS Of 1,752 prehospital trauma fatalities, 14.7% (95%CI 13.0, 16.4) had potentially survivable injuries that occurred in locations without timely access (prehospital phase >60 minutes). More than half (132 of 257) of the potentially survivable prehospital trauma fatalities without timely access died as a result of a motor vehicle traffic crash. Only 10% (95%CI 5.7, 16.0) of prehospital trauma fatalities from falls were estimated to be potentially survivable and without timely access compared to 24.6% (95%CI 18.5, 31.5) of prehospital firearm fatalities. Through using geospatial techniques, "hot spot" locations of potentially survivable injuries without timely access to specialist major trauma hospitals were apparent. CONCLUSION Approximately 15% of prehospital trauma fatalities in New Zealand that are potentially survivable occur in locations without timely access to advanced level hospital care. Continued emphasis is required on both improving timely access to advanced trauma care, and on primary prevention of serious injuries. Decisions regarding trauma service delivery, a modifiable system-level factor, should consider the geographic distribution of locations of these injury events alongside the resident population distribution.
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Affiliation(s)
- Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Rebbecca Lilley
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Brandon de Graaf
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Shanthi Ameratunga
- Population Health Directorate, Counties Manukau Health, Auckland, New Zealand
| | - Bridget Dicker
- St John, Mt Wellington, Auckland, New Zealand; Department of Paramedicine, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Ian Civil
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
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de Graaf B, Lilley R, Davie G, Kool B. Optimising base locations for New Zealand's Helicopter Emergency Medical Services. Spat Spatiotemporal Epidemiol 2021; 38:100435. [PMID: 34353530 DOI: 10.1016/j.sste.2021.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/17/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
Helicopter Emergency Medical Services (HEMS) in New Zealand (NZ) are located at hospitals or airports near the communities they serve. This may result in suboptimal response times. Timely access to advanced hospital care improves critically injured patients' chances of survival. This study optimised the location of HEMS bases in NZ and compared current versus optimal placement on timely access for surrounding populations. Optimal placement of HEMS bases could result in 113,886 additional people (3% of the population) benefiting from access to advanced hospital care within one hour. Optimal placement would especially benefit indigenous Māori as well as deprived and rural communities.
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Affiliation(s)
- Brandon de Graaf
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
| | - Rebbecca Lilley
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Gabrielle Davie
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Bridget Kool
- School of Population Health, University of Auckland, Auckland, New Zealand
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Lilley R, Kool B, Davie G, de Graaf B, Dicker B. Opportunities to prevent fatalities due to injury: a cross-sectional comparison of prehospital and in-hospital fatal injury deaths in New Zealand. Aust N Z J Public Health 2021; 45:235-241. [PMID: 33522676 DOI: 10.1111/1753-6405.13068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/01/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE There is interest in opportunities that lie in the prehospital setting to reduce the substantial burden of fatal injury. This study examines the epidemiology of prehospital and in-hospital fatal injury in New Zealand. METHODS All deaths registered in 2008-2012 with an underlying cause of death external cause-code V01-Y36 (ICD-10-AM) were identified. The setting of death was determined following linkage to, and review of, hospital discharge data and Coronial records. RESULTS Of 7,522 injury deaths, 80% occurred in a prehospital setting, with the highest burden relating to males. Within those fatally injured, 25-54-year-olds had a higher risk of prehospital death than 55-84-year-olds (adjusted Relative Risk [aRR] 1.20, 95%CI 1.16, 1.20). Similarly, those injured due to drowning (aRR 1.39, CI 1.26, 1.53) and non-hanging suffocation (aRR 1.31, CI 1.18, 1.45) had a higher risk of prehospital death than those 'struck by/machinery'. CONCLUSION Prehospital deaths account for four out of five fatal injuries in New Zealand. Of the fatally injured population, the probability of prehospital death differed by age, sex, injury mechanism and intent. Implications for public health: This study highlights the importance of strengthening prevention efforts to reduce the substantive burden of prehospital fatalities in New Zealand.
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Affiliation(s)
- Rebbecca Lilley
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Otago School of Medicine, University of Otago, New Zealand
| | - Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
| | - Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Otago School of Medicine, University of Otago, New Zealand
| | - Brandon de Graaf
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Otago School of Medicine, University of Otago, New Zealand
| | - Bridget Dicker
- St Johns, Auckland, New Zealand.,Department of Paramedicine, Auckland University of Technology, New Zealand
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Kool B, Lilley R, Davie G, de Graaf B, Reid P, Branas C, Civil I, Dicker B, Ameratunga SN. Potential survivability of prehospital injury deaths in New Zealand: a cross-sectional study. Inj Prev 2020; 27:injuryprev-2019-043408. [PMID: 32447305 DOI: 10.1136/injuryprev-2019-043408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/20/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Acknowledging a notable gap in available evidence, this study aimed to assess the survivability of prehospital injury deaths in New Zealand. METHODS A cross-sectional review of prehospital injury death postmortems (PM) undertaken during 2009-2012. Deaths without physical injuries (eg, drownings, suffocations, poisonings), where there was an incomplete body, or insufficient information in the PM, were excluded. Documented injuries were scored using the AIS and an ISS derived. Cases were classified as survivable (ISS <25), potentially survivable (ISS 25-49) and non-survivable (ISS >49). RESULTS Of the 1796 cases able to be ISS scored, 11% (n=193) had injuries classified as survivable, 28% (n=501) potentially survivable and 61% (n=1102) non-survivable. There were significant differences in survivability by age (p=0.017) and intent (p<0.0001). No difference in survivability was observed by sex, ethnicity, day of week, seasonality or distance to advanced-level hospital care. 'Non-survivable' injuries occurred more commonly among those with multiple injuries, transport-related injuries and aged 15-29 year. The majority of 'survivable' cases were deceased when found. Among those alive when found, around half had received either emergency medical services (EMS) or bystander care. One in five survivable cases were classified as having delays in receiving care. DISCUSSION In New Zealand, the majority of injured people who die before reaching hospital do so from non-survivable injuries. More than one third have either survivable or potentially survivable injuries, suggesting an increased need for appropriate bystander first aid, timeliness of EMS care and access to advanced-level hospital care.
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Affiliation(s)
- Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rebbecca Lilley
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Brandon de Graaf
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Pararangi Reid
- Te Kupenga Hauora Maori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Ian Civil
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bridget Dicker
- Paramedicine Department, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Lilley R, de Graaf B, Kool B, Davie G, Reid P, Dicker B, Civil I, Ameratunga S, Branas C. Geographical and population disparities in timely access to prehospital and advanced level emergency care in New Zealand: a cross-sectional study. BMJ Open 2019; 9:e026026. [PMID: 31350239 PMCID: PMC6661642 DOI: 10.1136/bmjopen-2018-026026] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Rapid access to advanced emergency medical and trauma care has been shown to significantly reduce mortality and disability. This study aims to systematically examine geographical access to prehospital care provided by emergency medical services (EMS) and advanced-level hospital care, for the smallest geographical units used in New Zealand and explores national disparities in geographical access to these services. DESIGN Observational study involving geospatial analysis estimating population access to EMS and advanced-level hospital care. SETTING Population access to advanced-level hospital care via road and air EMS across New Zealand. PARTICIPANTS New Zealand population usually resident within geographical census meshblocks. PRIMARY AND SECONDARY OUTCOME MEASURES The proportion of the resident population with calculated EMS access to advanced-level hospital care within 60 min was examined by age, sex, ethnicity, level of deprivation and population density to identify disparities in geographical access. RESULTS An estimated 16% of the New Zealand population does not have timely EMS access to advanced-level hospital care via road or air. The 700 000 New Zealanders without timely access lived mostly in areas of low-moderate population density. Indigenous Māori, New Zealand European and older New Zealanders were less likely to have timely access. CONCLUSIONS These findings suggest that in New Zealand, geographically marginalised groups which tend to be rural and remote communities with disproportionately more indigenous Māori and older adults have poorer EMS access to advanced-level hospitals. Addressing these inequities in rapid access to medical care may lead to improvements in survival that have been documented for people who experience medical or surgical emergencies.
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Affiliation(s)
- Rebbecca Lilley
- Department of Preventive and Social Medicine, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Brandon de Graaf
- Department of Preventive and Social Medicine, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Bridget Kool
- Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Gabrielle Davie
- Department of Preventive and Social Medicine, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori, The University of Auckland, Auckland, New Zealand
| | - Bridget Dicker
- Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand
- St Johns, Auckland, New Zealand
| | - Ian Civil
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Trauma and Vascular Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Shanthi Ameratunga
- Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Charles Branas
- Department of Epidemiology, Columbia University, New York city, New York, USA
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Mills B, Hajat A, Rivara F, Nurius P, Matsueda R, Rowhani-Rahbar A. Firearm assault injuries by residence and injury occurrence location. Inj Prev 2019; 25:i12-i15. [PMID: 30928914 DOI: 10.1136/injuryprev-2018-043129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 11/04/2022]
Abstract
Research on spatial injury patterns is limited by a lack of precise injury occurrence location data. Using linked hospital and death records, we examined residence and injury locations for firearm assaults and homicides in or among residents of King County, Washington, USA from 1 January 2010 to 31 December 2014. In total, 670 injuries were identified, 586 with geocoded residence and injury locations. Three-quarters of injuries occurred outside the census tract where the victim resided. Median distance between locations was 3.9 miles, with victims 18-34 having the greatest distances between residence and injury location. 40 of 398 tracts had a ratio of injury incidents to injured residents of >1. Routine collection of injury location data and homelessness status could decrease misclassification and bias. Researchers should consider whether residential address is an appropriate proxy for injury location, based on data quality and their specific research question.
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Affiliation(s)
- Brianna Mills
- Department of Epidemiology, University of Washington, Seattle, Washington, USA .,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, USA
| | - Anjum Hajat
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, USA
| | - Frederick Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Paula Nurius
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, USA.,Department of Social Work, University of Washington, Seattle, Washington, USA
| | - Ross Matsueda
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, USA.,Department of Sociology, University of Washington, Seattle, Washington, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, USA
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