Identifying Homogeneous Patterns of Injury in Paediatric Trauma Patients to Improve Risk-Adjusted Models of Mortality and Functional Outcomes

Disadvantaged by More Than Distance: A Systematic Literature Review of Injury in Rural Australia

Rural populations experience injury-related mortality and morbidity rates 1.5 times greater than metropolitan residents. Motivated by a call for stronger epidemiological evidence around rural injuries to inform prevention, a systematic review of peer-reviewed literature published between January 2010 and March 2021 was undertaken to explore the epidemiology of rural injury and associated risk factors in Australia. A subsequent aim was to explore definitions of rurality used in injury prevention studies. There were 151 papers included in the review, utilizing 23 unique definitions to describe rurality. People living in rural areas were more likely to be injured, for injuries to be more severe, and for injuries to have greater resulting morbidity than people in metropolitan areas. The increase in severity reflects the mechanism of rural injury, with rural injury events more likely to involve a higher energy exchange. Risk-taking behavior and alcohol consumption were significant risk factors for rural injury, along with rural cluster demographics such as age, sex, high socio-economic disadvantage, and health-related comorbidities. As injury in rural populations is multifactorial and nonhomogeneous, a wide variety of evidence-based strategies are needed. This requires funding, political leadership for policy formation and development, and implementation of evidence-based prevention interventions.

Injury profiles and clinical management of older patients with major trauma

OBJECTIVES

This study aimed to characterise the most common injury profiles and interventions in older major trauma patients, and how they change with age.

METHODS

This is a retrospective review of interventions, injury profiles and outcomes of major trauma patients aged 65 years and older from 2007 to 2018, using data from the Victorian State Trauma Registry. A latent class analysis (LCA) was used to identify homogenous injury groups.

RESULTS

The LCA identified five injury profiles: isolated head injury; chest/upper limb injuries; multi-trauma; isolated spine; and head/chest/upper limb. Among 10,001 patients, 50% had an isolated head injury, and 83% of patients received definitive treatment at a major trauma centre. 50% of patients received a surgical or non-surgical intervention, and 36% underwent surgery. These proportions declined with increasing age.

CONCLUSIONS

Older patients with major trauma are a heterogeneous group, whose mechanisms and patterns of injury, and clinical management change with increasing age.

A 5-year Profile of Trauma Admissions to the Surgical Intensive Care Unit of a Tertiary Hospital in Singapore

Introduction: This retrospective pilot study provides information on trauma admissions to the Surgical Intensive Care Unit (SICU) of a tertiary hospital in Singapore. The aim was to use the data collected to generate awareness and interest in this area. The authors also wish to use the information to advocate subsequent in-depth collection and analysis of data and the development of a Trauma Registry. As this was a pilot study, the data collected were by no means exhaustive and only descriptive analysis was applied. Materials and Methods: Trauma admissions to the SICU for the period between January 2001 and December 2005 were identified from the admissions logbook maintained in the unit. The physical case-notes or electronic-records for the identified cases were retrieved and the relevant data and parameters were entered into the data collection sheet. Descriptive analysis was applied to the data collected. Results: A total of 503 cases over the 5-year period fulfilled our criteria. Motor vehicle accidents were the greatest contributor of trauma admissions to the SICU (53%). The length of stay (LOS) in the unit ranged from 1 to 59 days. The anatomical area most frequently injured was the head (68%). Out of the 132 mortalities, male patients accounted for 84%. Two-thirds (67%) of injury-related mortality occurred in young patients aged less than 45 years. Motor vehicle accidents accounted for nearly half (47%) of injury-related mortality. Motorcyclists accounted for almost half (46%) of motor vehicle accident deaths. Conclusion: The preponderance of young people involved in motor vehicle accidents with head injuries has a large impact on society and on the hospital workload. The authors hope that this pilot study will generate awareness and interest in the area of trauma injuries. They recommend that a nationwide trauma registry be established to look closer into this “disease”, as other developed countries have done. Key words: Critical care, Data, Registry