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de Souza JC, Letson HL, Gibbs CR, Dobson GP. The burden of head trauma in rural and remote North Queensland, Australia. Injury 2024; 55:111181. [PMID: 37951809 DOI: 10.1016/j.injury.2023.111181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Head trauma is a leading cause of death and disability worldwide. Young males, Indigenous people, and rural/remote residents have been identified as high-risk populations for head trauma, however, Australian research is limited. Our aim was to define and describe the incidence, demographics, causes, prehospital interventions, and outcomes of head trauma patients transported by aeromedical services within North Queensland, Australia. We hypothesized that young, Indigenous males living remotely would be disproportionately affected by head trauma. METHODS We conducted a retrospective study of all head trauma patients transferred by air to or between Townsville, Cairns, Mount Isa and Mackay Hospitals between January 1, 2016 and December 31, 2018. Patients were identified from the Trauma Care in the Tropics data registry and followed for a median 30-months post-injury. Primary endpoints were patient and injury characteristics. Secondary outcome measures were hospital stay and mortality. RESULTS A total of 981 patients were included and 31.1 % were Indigenous. Sixty-seven percent of injuries occurred remotely and the median time from injury to hospital was 5.8-hours (range 67-3780 min). Eighty percent of severe head injuries occurred in males (p = 0.007). Indigenous and remote patients were more likely to sustain mild injuries. The most common mechanism of injury overall was vehicle accident (37.5 %), compared to assault in the Indigenous subgroup (46.6 %, p<0.001). The overall mortality rate was 4.9 %, with older age and lower initial Glasgow Coma Score significant predictors of in-hospital mortality. Prehospital intubation was associated with a 7-fold increased risk of mortality (p = 0.056), while patients that received tranexamic acid (TXA) were almost 5-times more likely to die. CONCLUSIONS In North Queensland, young Indigenous males are at highest risk of traumatic head injuries. Vehicle accidents are an important preventable cause of head injury in the region. TXA administration is an important consideration for remote head trauma retrievals, in which time to emergency care is prolonged. Appropriate treatment and risk stratification strategies considering time to definitive care, severity of injury, and other prehospital patient factors require further investigation.
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Affiliation(s)
- Julia Chequer de Souza
- College of Medicine & Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland 4811, Australia
| | - Hayley L Letson
- College of Medicine & Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland 4811, Australia.
| | - Clinton R Gibbs
- Retrieval Services Queensland, 100 Angus Smith Drive, Douglas, Queensland 4814, Australia; Emergency Department, Townsville University Hospital, Townsville Hospital and Health Service, 100 Angus Smith Drive, Douglas, Queensland 4814, Australia; College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Queensland 4811, Australia
| | - Geoffrey P Dobson
- College of Medicine & Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland 4811, Australia
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Hossain S, Moeller H, Sharpe P, Campbell M, Kimlin R, Porykali B, Shannon B, Gray J, Afzali H, Harrison JE, Ivers RQ, Ryder C. Characterising the Aboriginal and Torres Strait Islander patient journey after a serious road traffic injury and barriers to access to compensation: a protocol. Inj Prev 2024; 30:75-80. [PMID: 37923356 DOI: 10.1136/ip-2023-044997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Road safety has been a long-enduring policy concern in Australia, with significant financial burden of road trauma and evident socioeconomic disparities. Transport injuries disproportionately impact individuals in remote areas, those in lower socioeconomic situations, and Aboriginal and Torres Strait Islander populations. There is a lack of insight into transport injuries in Aboriginal and Torres Strait Islander communities, absence of Indigenous perspective in published research and limited utilisation of linked data assets to address the inequity. Aim 1 is to determine the breadth, cost and causal factors of serious injury from road traffic crashes in South Australia (SA) and New South Wales (NSW) with a focus on injury prevention. Aim 2 is to identify enablers and barriers to compensation schemes for Aboriginal and Torres Strait Islander patients in SA and NSW. METHODS AND ANALYSIS This study will be guided by an Aboriginal and Torres Strait Islander Governance Group, applying Knowledge Interface Methodology and Indigenous research principles to ensure Indigenous Data Sovereignty and incorporation of informed perspectives. A mixed-method approach will be undertaken to explore study aims including using big data assets and mapping patient journey. CONCLUSION The results of this study will provide valuable insights for the development of focused injury prevention strategies and policies tailored to Aboriginal and Torres Strait Islander communities. By addressing the specific needs and challenges faced by these communities, the study aims to enhance road safety outcomes and promote equitable access to healthcare and compensation for affected individuals and their families.
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Affiliation(s)
- Sadia Hossain
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Holger Moeller
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Patrick Sharpe
- Far West Community Partnerships, Far West Region, South Australia, Australia
| | - Marnie Campbell
- Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Rebecca Kimlin
- Barossa Hills Fleurieu Local Health Network, Mount Barker, South Australia, Australia
| | - Bobby Porykali
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Brett Shannon
- School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Jodi Gray
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Hossein Afzali
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - James E Harrison
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Rebecca Q Ivers
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Courtney Ryder
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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Smith S, McCreanor V, Watt K, Hope M, Warren J. Costs and 30-day readmission after lower limb fractures from motorcycle crashes in Queensland, Australia: A linked data analysis. Injury 2022; 53:3517-3524. [PMID: 35922339 DOI: 10.1016/j.injury.2022.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/20/2022] [Accepted: 07/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lower limb trauma is the most common injury sustained in motorcycle crashes. There are limited data describing this cohort in Australia and limited international data establishing costs due to lower limb trauma following motorcycle crashes. METHODS This retrospective cohort study utilised administrative hospitalisation data from Queensland, Australia from 2011-2017. Eligible participants included those admitted with a principal diagnosis coded as lower extremity or pelvic fracture following a motorcycle crash (defined as the index admission). Multiply injured motorcyclists where the lower limb injury was not coded as the primary diagnosis (i.e. principal diagnosis was rather coded as head injury, internal organ injures etc.) were not included in the study. Hospitalisation data were also linked to clinical costing data. Logistic regression was used to determine risk factors for 30-day readmission. Costing data were compared between those readmitted and those who weren't, using bootstrapped t-tests and ANVOA. RESULTS A total of 3342 patients met eligibility, with the most common lower limb fracture being tibia/fibula fractures (40.8%). 212 participants (6.3%) were readmitted within 30-days of discharge. The following were found to predict readmission: male sex (OR 1.84, 95% CI 1.01-1.94); chronic anaemia (OR 2.19, 95% CI 1.41-3.39); current/ex-smoker (OR 1.60, 95% CI 1.21-2.12); emergency admission (OR 2.77, 95% CI 1.35-5.70) and tibia/fibula fracture type (OR 1.46, 95% CI 1.10-1.94). The most common reasons for readmission were related to ongoing fracture care, infection or post-operative complications. The average hospitalisation cost for the index admission was AU$29,044 (95% CI $27,235-$30,853) with significant differences seen between fracture types. The total hospitalisation cost of readmissions was almost AU$2 million over the study period, with an average cost of $10,977 (95% CI $9,131- $13,059). CONCLUSIONS Unplanned readmissions occur in 6.3% of lower limb fractures sustained in motorcycle crashes. Independent predictors of readmission within 30 days of discharge included male sex, chronic anaemia, smoking status, fracture type and emergency admission. Index admission and readmission hospitalisation costs are substantial and should prompt health services to invest in ways to reduce readmission.
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Affiliation(s)
- Samuel Smith
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Australia; School of Medicine, University of Queensland, Brisbane, Australia; College of Public Health, Medical and Veterinary Science, James Cook University, Townsville, Australia; Jamieson Trauma Institute, Metro North Health, Herston, Australia.
| | - Victoria McCreanor
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia; Jamieson Trauma Institute, Metro North Health, Herston, Australia
| | - Kerrianne Watt
- College of Public Health, Medical and Veterinary Science, James Cook University, Townsville, Australia; Queensland Ambulance Service, Department of Health, Brisbane, Australia
| | - Matthew Hope
- School of Medicine, University of Queensland, Brisbane, Australia; Jamieson Trauma Institute, Metro North Health, Herston, Australia; Department of Orthopaedic Surgery, Princess Alexandria Hospital, Brisbane, Australia
| | - Jacelle Warren
- Jamieson Trauma Institute, Metro North Health, Herston, Australia; Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
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Disadvantaged by More Than Distance: A Systematic Literature Review of Injury in Rural Australia. SAFETY 2022. [DOI: 10.3390/safety8030066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Fitts MS, Burchill R, Wilson S, Palk GR, Clough AR, Conigrave KM, Slade T, Shakeshaft A, Lee KSK. Drink driving among Aboriginal and Torres Strait Islander Australians: What has been done and where to next? Drug Alcohol Rev 2021; 41:1412-1417. [PMID: 34927302 PMCID: PMC9544182 DOI: 10.1111/dar.13418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/09/2021] [Accepted: 11/13/2021] [Indexed: 11/26/2022]
Abstract
The Australian Government will set the direction for addressing road safety over the next decade with its 2021–2030 National Road Safety Strategy. This road map will detail objectives and goals agreed upon by all Australian states and territories. Similar to previous national strategies, Aboriginal and Torres Strait Islander (Indigenous) Australians are a high priority population. Indigenous Australians are over‐represented in serious injury and fatal road crashes, with alcohol a leading factor. Therapeutic and educational programs are a major strategy among the suite of measures designed to reduce and prevent drink driving in Australia. The release of this new strategy provides a timely opportunity to reflect on what is known about drink driving among Indigenous Australians and to consider the suitability of existing therapeutic and educational drink driving programs for Indigenous Australian contexts. Here, we summarise factors that contribute to drink driving in this population and identify outstanding knowledge gaps. Then, we present an overview of drink driving programs available for Indigenous Australians along with suggestions for why tailored programs are needed to suit local contexts. The response to address drink driving among Indigenous Australians has been fragmented Australia‐wide. A coordinated national response, with ongoing monitoring and evaluation, would improve policy effectiveness and inform more efficient allocation of resources. Together this information can help create suitable and effective drink driving programs for Indigenous drivers and communities Australia‐wide.
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Affiliation(s)
- Michelle S Fitts
- Institute for Culture and Society, Western Sydney University, Sydney, Australia.,Menzies School of Health Research, Charles Darwin University, Alice Springs, Australia.,James Cook University, Australian Institute of Tropical Health and Medicine, Cairns, Australia
| | | | - Scott Wilson
- Aboriginal Drug and Alcohol Council SA Aboriginal Corporation, Adelaide, Australia.,Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, Australia
| | - Gavan R Palk
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Alan R Clough
- James Cook University, Australian Institute of Tropical Health and Medicine, Cairns, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Tim Slade
- Faculty of Medicine and Health, The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - K S Kylie Lee
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, Australia.,Faculty of Health Sciences, National Drug Research Institute, Curtin University, Perth, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
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Pammer K, Freire M, Gauld C, Towney N. Keeping Safe on Australian Roads: Overview of Key Determinants of Risky Driving, Passenger Injury, and Fatalities for Indigenous Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052446. [PMID: 33801405 PMCID: PMC7967563 DOI: 10.3390/ijerph18052446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Social and cultural barriers associated with inequitable access to driver licensing and associated road safety education, as well as socioeconomic issues that preclude ongoing vehicle maintenance and registration, result in unsafe in-car behaviours such as passenger overcrowding. This in turn is associated with improper seatbelt usage, noncompliance with child restraint mandates, and driver distraction. For example, in Australia, where seatbelt use is mandatory, Indigenous road users are three times less likely to wear seatbelts than non-Indigenous road users. This is associated with a disproportionately high fatality rate for Indigenous drivers and passengers; 21% of Indigenous motor-vehicle occupants killed on Australian roads were not wearing a seatbelt at the time of impact. In addition, inequitable access to driver licensing instruction due to financial and cultural barriers results in Indigenous learner drivers having limited access to qualified mentors and instructors. A consequent lack of road safety instruction results in a normalising of risky driving behaviours, perpetuated through successive generations of drivers. Moreover, culturally biased driver instruction manuals, which are contextualised within an English written-language learning framework, fail to accommodate the learning needs of Indigenous peoples who may encounter difficulties with English literacy. This results in difficulty understanding the fundamental road rules, which in turn makes it difficult for young drivers to develop and sustain safe in-car behaviours. This paper considers the literature regarding road safety for Indigenous road users and critically evaluates strategies and policies that have been advanced to protect Indigenous drivers. Novel solutions to increasing road safety rule compliance are proposed, particularly in relation to passenger safety, which are uniquely embedded within Indigenous ways of knowing, being, and doing. Safe driving practices have crucial health and social implications for Indigenous communities by allowing more Indigenous people to participate in work and education opportunities, access healthcare, maintain cultural commitments, and engage with families and friends, qualities which are essential for ongoing health and wellbeing.
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Affiliation(s)
- Kristen Pammer
- The School of Psychology, Faculty of Science, The University of Newcastle, Callaghan, NSW 2308, Australia; (M.F.); (C.G.)
- Correspondence: ; Tel.: +61-1249-217-980
| | - Melissa Freire
- The School of Psychology, Faculty of Science, The University of Newcastle, Callaghan, NSW 2308, Australia; (M.F.); (C.G.)
| | - Cassandra Gauld
- The School of Psychology, Faculty of Science, The University of Newcastle, Callaghan, NSW 2308, Australia; (M.F.); (C.G.)
| | - Nathan Towney
- Vice-Chancellor’s Division, The University of Newcastle, Callaghan, NSW 2308, Australia;
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Golledge J, Drovandi A, Velu R, Quigley F, Moxon J. Survival following abdominal aortic aneurysm repair in North Queensland is not associated with remoteness of place of residence. PLoS One 2020; 15:e0241802. [PMID: 33186377 PMCID: PMC7665769 DOI: 10.1371/journal.pone.0241802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
Objective To assess whether survival and clinical events following elective abdominal aortic aneurysm (AAA) repair were associated with remoteness of residence in North Queensland, Australia. Methods This retrospective cohort study included participants undergoing elective AAA repair between February 2002 and April 2020 at two hospitals in Townsville, North Queensland, Australia. Outcomes were all-cause survival and AAA-related events, defined as requirement for repeat AAA repair or AAA-related mortality. Remoteness of participant’s place of residence was assessed by the Modified Monash Model classifications and estimated distance from the participants’ home to the tertiary vascular centre. Cox proportional hazard analysis examined the association of remoteness with outcome. Results The study included 526 participants undergoing elective repair by open (n = 204) or endovascular (n = 322) surgery. Fifty-four (10.2%) participants had a place of residence at a remote or very remote location. Participants' were followed for a median of 5.2 (inter-quartile range 2.5–8.3) years, during which time there were 252 (47.9%) deaths. Survival was not associated with either measure of remoteness. Fifty (9.5%) participants had at least one AAA-related event, including 30 (5.7%) that underwent at least one repeat AAA surgery and 23 (4.4%) that had AAA-related mortality. AAA-related events were more common in participants resident in the most remote areas (adjusted hazard ratio 2.83, 95% confidence intervals 1.40, 5.70) but not associated with distance from the participants’ residence to the tertiary vascular centre Conclusions The current study found that participants living in more remote locations were more likely to have AAA-related events but had no increased mortality following AAA surgery. The findings emphasize the need for careful follow-up after AAA surgery. Further studies are needed to examine the generalisability of the findings.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
- Australian Institute of Tropical Medicine, James Cook University, Townsville, Queensland, Australia
- * E-mail:
| | - Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Medicine, James Cook University, Townsville, Queensland, Australia
| | - Ramesh Velu
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Frank Quigley
- Mater Private Hospital, Townsville, Queensland, Australia
| | - Joseph Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Medicine, James Cook University, Townsville, Queensland, Australia
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