Abstract
Introduction
Major trauma patients are often perceived as being young males injured by high energy transfer mechanisms. The aim of this study was to describe the demographics of major trauma patients who were transported to hospital by ambulance.
Methods
This is a retrospective cohort study of adult major trauma (injury severity score >15) patients transported to hospital by St John Western Australia emergency ambulance in metropolitan Perth, between 1 January 2013 and 31 December 2016. To describe the cohort, median and interquartile range (IQR) were used for continuous variables and counts and percentages for categorical variables. Differences between mechanism of injury groups were assessed using the Kruskal-Wallis test. Trauma deaths were defined as early (declared deceased within 24 hours) or late (declared deceased within 30 days).
Results
A total of 1625 patients were included. The median age was 51 years (IQR 30-75) and 1158 (71%) were male. Falls from standing were the most common mechanism of injury (n=460, 28%) followed by motor vehicle crashes (n=259, 16%). Falls from standing were responsible for the majority of early (n=45/175, 26%) and late deaths (n=69/158, 44%). A large number of early deaths also resulted from motorbike crashes (n=32/175, 18%) with a median age of 34 years (IQR 21-46, p<0.001).
Conclusion
Major trauma is not only a disease of the young. More than half of the cohort was more than 51 years of age and the most common cause was a fall from standing. Pre-hospital care must evolve to address the needs of a changing trauma patient demographic.
References
Haagsma JA, Graetz N, Bolliger I, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease Study 2013. Inj Prev 2016;22:3-18.
Kehoe A, Smith JE, Edwards A, Yates D, Lecky F. The changing face of major trauma in the UK. Emerg Med J 2015;32:911-5.
Fatovich DM, Jacobs IG, Langford SA, Phillips M. The effect of age, severity, and mechanism of injury on risk of death from major trauma in Western Australia. J Trauma Acute Care Surg 2013;74:647-51.
McCoy CE, Menchine M, Sampson S, Anderson C, Kahn C. Emergency medical services out-of-hospital scene and transport times and their association with mortality in trauma patients presenting to an urban level i trauma center. Ann Emerg Med 2013;61:167-74.
Beck B, Bray JE, Cameron P, et al. Predicting outcomes in traumatic out-of-hospital cardiac arrest: the relevance of Utstein factors. Emerg Med J 2017;34:786-92.
Australian Bureau of Statistics. Australian demographic statistics. 2016 Census. Available at: www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/CFE97018EC49EB38CA2580F2000BEBB4 [Accessed 25 August 2018].
St John Ambulance Western Australia Ltd. Clinical practice guidelines for ambulance care in Western Australia - paramedic industrial paramedic ambulance officer ambulance transport officer. Version 31. 2017.
Towler S. Trauma system and services - report of the Trauma Working Group. Western Australia: delivering a healthy WA, 2007. [Updated 25 July]. Available at: www.health.wa.gov.au/trauma_system_and_services/home/about.cfm [Accessed 25 August 2018].
Government of Western Australia East Metropolitan Health Service. Royal Perth Hospital. [Updated 22 March 2018]. Available at: https://rph.health.wa.gov.au/Our-services/Trauma-Service [Accessed 16 November 2018].
Government of Western Australia – Department of Health. Guiding principles for major trauma inter hospital transfer. [Updated 31 July 2013]. Available at: www.health.wa.gov.au/trauma_system_and_services/home/ [Accessed 25 August 2018].
Western Australian Department of Health. WA State Trauma Registry. Available at: www.health.wa.gov.au/Articles/U_Z/WA-State-Trauma-Registry [Accessed 25 August 2018].
Hemmila MR, Cain-Nielsen AH, Wahl WL, et al. Regional collaborative quality improvement for trauma reduces complications and costs. J Trauma Acute Care Surg 2015;78:78-87.
Dinh MM, Roncal S, Byrne CM, Petchell J. Growing trend in older patients with severe injuries: mortality and mechanisms of injury between 1991 and 2010 at an inner city major trauma centre. ANZ J Surg 2013;83:65-9.
Hashmi A, Ibrahim-Zada I, Rhee P, et al. Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg 2014;76:894-901.
Fatovich DM, Burrell M, Jacobs IG. Major trauma deaths at Perth secondary hospitals. Emerg Med Australas 2011;23:754-60.
Brown E, Tohira H, Bailey P, et al. Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth. ibid. 2019 [in press].
Fitzharris M, Stevenson M, Middleton P, Sinclair G. Adherence with the pre-hospital triage protocol in the transport of injured patients in an urban setting. Injury 2012;43:1368-76.
Doumouras AG, Haas B, Gomez D, et al. The impact of distance on triage to trauma center care in an urban trauma system. Prehosp Emerg Care 2012;16:456-62.
Staudenmayer KL, Hsia RY, Mann NC, Spain DA, Newgard CD. Triage of elderly trauma patients: a population-based perspective. J Am Coll Surg 2013;217:569-76.
Lukin W, Greenslade JH, Chu K, Lang J, Brown AF. Triaging older major trauma patients in the emergency department: an observational study. Emerg Med J 2015;32:281-6.
Trinder MW, Wellman SW, Nasim S, Weber DG. Evaluation of the trauma triage accuracy in a Level 1 Australian trauma centre. Emerg Med Australas 2018;30:699-704.
Beck B, Cameron P, Lowthian J, et al. Major trauma in older persons. BJS Open 2018;2:310-8.
Kehoe A, Smith JE, Bouamra O, et al. Older patients with traumatic brain injury present with a higher GCS score than younger patients for a given severity of injury. Emerg Med J 2016;33:381-5.
Cox S, Morrison C, Cameron P, Smith K. The epidemiology of elderly trauma in Victoria, Australia. Acad Emerg Med 2012;19:715.
Pracht EE, Langland-Orban B, Flint L. Survival advantage for elderly trauma patients treated in a designated trauma center. J Trauma Acute Care Surg 2011;71:69-77.
World Health Organisation. Falls 2018. Available at: room/fact-sheets/detail/falls [Accessed 14 January 2019].
Dinh MC, Mitchell K, Bein R, et al. Major trauma mortality in rural and metropolitan NSW, 2009-2014: a retrospective analysis of trauma registry data. Med J Aust 2016;205:403-7.
Curtis KM, Chong R, Balogh S, et al. Injury trends and mortality in adult patients with major trauma in New South Wales. ibid. 2012;197:233-7.
Fatovich DM, Jacobs IG. The relationship between remoteness and trauma deaths in Western Australia. J Trauma 2009;67:910-4.
Fatovich DM, Phillips M, Langford SA, Jacobs IG. A comparison of metropolitan vs rural major trauma in Western Australia. Resuscitation 2011;82:886-90.