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Report Trauma Registry Report 2019

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Report Trauma Registry Report 2019 2019 Auckland City Hospital Trauma Registry Report Trauma Services Contents The Northern Region Trauma Network 2 Self-Harm 10 Executive Summary 3 Ethnicity 11 Auckland City Hospital Trauma Registry 4 Population distribution ADHB 2019 12 Entry criteria 4 Length of Stay 12 Data collection 4 DCCM bed utilisation 13 Major Trauma 4 Traumatic Brain Injury with AIS>2 admitted to ADHB over the last 5 years 13 Trauma Registry Report 2019 5 Discharge Destination 14 Total Trauma and Major Trauma admissions over the last 5 years 5 Patient outcomes: Major Trauma 14 Age and Gender Distribution for 2019 5 Trauma Deaths 15 Trauma Admissions 6 Mortality per ISS Grouping 16 Mode of Transport to Hospital 6 Major Trauma and ISS 16 Direct admissions and Transfers of Major Trauma 7 Rib fractures 16 Numbers of patients from each originating hospital 8 Summary 17 Cause of injury 9 Auckland City Hospital Trauma Service 17 Figures Tables Figure 1: Northern Region Catchment Area 5 Table 1: Population distribution Auckland District Health Board 2019 12 Figure 2: Total Trauma and Major Trauma admissions over the last 5 years 5 Table 2: Patient outcomes: Major Trauma 14 Figure 3: Age and Gender Distribution for 2019 5 Table 3: Mortality per ISS Grouping 16 Figure 4: Trauma admissions over 65 years 6 Figure 5 : Mode of Transport to Hospital for all trauma admissions 6 Figure 6 : Mode of Transport to Hospital for Major Trauma 6 Abbreviations Figure 7 : Major Trauma Transfers to ACH 7 ACH Auckland City Hospital Figure 8 : Percentage of Transfers from other hospitals 7 ADHB Auckland District Health Board Figure 9 : Originating hospital 8 AIS Abbreviated Injury Scale Figure 10 : Injury Cause - All Trauma 9 ALOS Average Length of Stay Figure 11 : Injury Cause - Major Trauma 9 CNS Central Nervous System Figure 12 : Admission as a result of physical self-harm 10 DCCM Department of Critical Care Medicine Figure 13 : Mechanism of injury for physical self-harm admissions 2019 10 ISS Injury Severity Score Figure 14 : Ethnicity - All Trauma 11 MMH Middlemore Hospital Figure 15 : Ethnicity - Major Trauma 11 MOF Multi-organ failure Figure 16 : Average length of stay per ISS grouping 12 TBI Traumatic Brain Injury Figure 17 : Median length of stay 12 Figure 18 : Total DCCM bed days used by Trauma patients/year 13 Figure 19 : TBI AIS>2 13 Figure 20 : Discharge destination - All Trauma 14 Figure 21 : Death type 2019 15 Figure 22 : Number of patient deaths 15 Figure 23 : Major Trauma and ISS 16 Trauma Figure 24 : Number of patients admitted with rib fractures by age 16 Services 1 The Northern Region Trauma Network Northland DHB Auckland District Health Board (ADHB) is part of the Northern Region Trauma Network. Auckland City Hospital (ACH) and Middlemore Auckland DHB Hospital (MMH) are tertiary major trauma hospitals. Whangarei, ACH, Starship and MMH are designated within the Northern Region to receive patients with Waitemata DHB major trauma whereas Waitemata is not. Within the Auckland metropolitan region patients defined status 1 and 2 (unstable) by St John Ambulance Manukau DHB within the Waitemata and Auckland DHB regions are transported to either Auckland or Starship Hospitals (under 15 year olds to Starship) whereas in the Counties Manukau DHB area status 1 and 2 patients are taken to MMH. ACH provides neurosurgical and cardiothoracic services for the entire region while MMH provides burns, plastic surgical, maxillofacial and spinal cord injury services. Figure 1: Northern Region Catchment Area 2 Auckland City Hospital | Trauma Registry Report 2019 Executive Summary The total number of trauma presentations has continued to increase in 2019. 2019 Major trauma patients represent an increased The total use of proportion of overall trauma load, saw minimal growth in overall trauma admissions increasing gradually from Critical Care beds but the 4.6% growth in major trauma admissions by trauma patients continuing a trend which has seen 17% in 2016 through to has increased annually. an increase of 40% 21.2% in 2019. in major trauma admissions This reflects the steady increase in the number of major trauma patients admitted. over the last 5 years. The ratio of Māori are overrepresented Overall mortality from major trauma patients is Direct admissions and in admission statistics 12.5%, transfers of major trauma in relation to DHB population down from 13.3% in 2018. patients has not changed for both all trauma and major trauma. Most deaths are a result of since 2018. serious traumatic brain injury. Reductions in haemorrhage deaths and multiple organ failure suggest improvements in early trauma care. Stabbing Admission of patients The “Code Crimson” protocol is the most common form of > 65 years old (www.trauma.co.nz/guidelines.html#part3) and effective use of the massive transfusion physical self-harm has doubled in the last 10 years. protocol are likely factors. requiring admission to hospital. 3 Auckland City Hospital Trauma Registry The Auckland City Hospital Trauma Registry was established in December 1994 and as of 31st December 2019 has 35,821 patients in the registry. Entry criteria Data collection Major Trauma Data is collected on all patients admitted to Auckland Data is extracted from patient charts during the daily Using AIS1990/98 major trauma is defined as those City Hospital (ACH) following injury with the following ward round and recorded on a data collection form patients with an ISS score of 16 or greater. This exceptions: which is regularly reviewed and updated while the means every patient with a single AIS 4 or 5 score patient is in hospital. qualifies as having suffered major trauma. In addition • Injuries that are the result of pathological the ISS≥16 criteria are met by a patient with two AIS3 conditions. Collector® is the software used for the registry. We scores or an AIS 3 score and 2 AIS 2 scores. use the Abbreviated Injury Scale (AIS) version 1990 • Late trauma transfers. Where a patient is updated 1998, this determines our Injury Severity transferred from another hospital where his/ Score (ISS). her initial treatment was expected to have been definitive. • AIS assigns a numerical value of between 1 and 6 according to the severity of injury (1 least, 6 • Admission for injuries that occurred one week most) for injuries in each region of the body. or more prior to the time of presentation to ISS takes the scores from the three regions with hospital. the highest AIS score, squares them and adds them together. ISS can range from 1 (least and • Hanging and drowning. not usually requiring admission to hospital) and • Elderly patients who sustain femoral neck 75 (most and usually fatal). ISS is not normally fractures for simple falls or other minor injuries distributed and is non-ordinal in that not every when admission is primarily related to an score between 1 and 75 is possible. associated co-morbidity. • The dataset is specifically configured to the • Patients under the age of 15 years. These requirements of ACH. Data is entered into the patients will attend Starship Hospital. registry from the collection form after the patient has been discharged from hospital. • The Trauma Registry assists in the study of trends in the region and injury prevention. 4 Auckland City Hospital | Trauma Registry Report 2019 Trauma Registry Report 2019 Total Trauma and Major Trauma admissions Age and Gender distribution for 2019 over the last 5 years Figure 3: Age and Gender Distribution for 2019 Figure 2: Total Trauma and Major Trauma admissions over the last 5 years 2000 400 1800 350 1600 300 1400 250 1200 1000 200 800 150 600 100 400 50 200 0 0 2015 2016 2017 2018 2019 15-24 25-34 35-44 45-54 55-64 65-74 75-84 >85 All trauma Major trauma Male Female The number of trauma patients admitted has increased each year over the past The age and gender distribution in 2019 are comparable to previous years’ five years. Between 2015 and 2019 there was a 6.6% increase. With regard to distributions, with males dominating in the younger decades of life. After the age of major trauma however the change from 2015 (273 patients) to 2019 (384 patients) 65 females predominate. This is despite the ACH Trauma Registry excluding femoral represents a 40% increase. A number of factors could explain this increase in neck fractures and other injuries related to co-morbidity. This age breakdown for major trauma relevant to all trauma admissions. It is unlikely that the proportion trauma incidence is common and largely related to longer female life expectancy of major trauma patients relevant to all trauma is increasing but much more likely rather that any particular behavioural predilection for women to sustain injury. that effective use of the St John prehospital destination policy has seen more major trauma patients preferrentially being transported to ACH. Changes in interhospital transfer numbers with ACH increasingly being referred patients for treatment of serious traumatic brain injury and complex thoracic injuries also a factor. 5 Trauma Admissions Mode of Transport to Hospital Figure 4: Trauma admissions over 65 years Most patients are transported by ambulance with the proportion being transported by road or air ambulance increasing from 63% to 86% when considering major 450 trauma as opposed to all trauma admissions 400 350 Figure 5 : Mode of transport to hospital for all trauma admissions 300 Ambulance 58% 250 200 Private car 35% 150 Helicopter 5% 100 50 POLICE Police car 1% 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Walk in 1% > 65 years old > 75 years old Other 1% The number of patients admitted over the age of 65 remains high in 2019. With aging of the population the number of patients in the older age groups is Not recorded 1% increasing and this is reflected in the age distribution of those suffering injury.
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