Cliff Pollard

Epidemiology of Traumatic Epidural Hematoma in Young Age

BACKGROUND Epidural hematoma (EDH) is a major traumatic brain injury and a potentially life-threatening condition, with the mortality rate in the young age group varying across studies. The aim of this analysis was to investigate the magnitude of traumatic EDH in young patients aged 0 year to 24 years in Queensland, Australia. METHODS Study patients presented to the emergency department of 14 public hospitals participating in the Queensland Trauma Registry during 2005 to 2007 and were diagnosed and admitted for treatment of EDH. Age group comparisons were performed for demographic, injury, treatment, operation details, and outcome-related variables. RESULTS We identified 224 young patients with traumatic EDH. The most frequent cause of injury was a fall in the 0 year to 9 years age groups and road traffic crash in those aged 10 years to 24 years. Almost 81% of the EDH cases were due to accidental injury, 17% due to assault, with the remainder due to self-harm and undetermined intent. Skull fracture was present in 75% of the study patients. Neurosurgical operations were performed on 40%. The overall Injury Severity Score adjusted in-hospital mortality rate was 4.8%. The odds of in-hospital mortality was 2.5 (95% confidence interval, 0.8-8.2) compared with older patients (25-64 years). CONCLUSIONS The results indicate that the Injury Severity Score adjusted in-hospital mortality rates for young patients with EDH were 4.8%. Given the limited information on morbidity resulting from EDH, further analysis to examine modifiable factors for better management and to evaluate survivors long-term health outcomes via a longitudinal follow-up study is warranted.

Characteristics and outcomes of injury patients in an Aboriginal and Torres Strait Islander population--Queensland Trauma Registry, Australia.

INTRODUCTION There are few published data for the magnitude of injury-related health problems in indigenous people such as Aboriginal and Torres Strait Islanders. The objective of our study was to compare the characteristics and outcomes of injury in the indigenous population to the non-indigenous population, who are living in Queensland, Australia. METHODS Participants were injured patients who presented to the emergency department for treatment and admitted to 15 public hospitals participating in the Queensland Trauma Registry (QTR) during 2003-2005. RESULTS Amongst 38,036 injured patients, 1847 patients were identified as indigenous and 35,530 as non-indigenous. Compared to the non-indigenous group, the indigenous group was significantly younger with no difference by gender. The injury severity score (ISS) and percentage of major injury (ISS > or = 16) were lower in the indigenous group. Indigenous patients had a significantly higher percentage of penetrating type injuries compared to non-indigenous (19.5% vs. 12.5%). The age- and injury severity-adjusted mortality rate was also significantly higher in indigenous. In age-stratified logistic regression analysis, the injury severity-adjusted odds for mortality was 3.0 times higher [95% confidence interval (95% CI): 1.6-5.5] in the indigenous, compared to the non-indigenous group, in 40-64-year olds, whilst increased odds in other age groups were not statistically significant. CONCLUSION Our results indicate that middle-aged indigenous patients are more likely to die due to injury compared to non-indigenous patients. This suggests that strategies are required to improve outcomes particularly in the most affected injury patient group.

Inclusion of ‘minor’ trauma cases provides a better estimate of the total burden of injury: Queensland Trauma Registry provides a unique perspective

INTRODUCTION Injury is recognised as a frequent cause of preventable mortality and morbidity; however, incidence estimates focusing only on the extent of mortality and major trauma may seriously underestimate the magnitude of the total injury burden. There currently exists a paucity of information regarding minor trauma, and the aim of this study was to increase awareness of the contribution of minor trauma cases to the total burden of injury. METHODS The demographics, injury details, acute care factors and outcomes of both minor trauma cases and major trauma cases were evaluated using data from the state-wide trauma registry in Queensland, Australia, from 2005 to 2010. The impact of changes in Abbreviated Injury Scale (AIS) versions on the classification of minor and major injury cases was also assessed. RESULTS Over the 6-year period, minor cases [Injury Severity Score (ISS) ≤ 12] accounted for almost 90% of all trauma included on the Queensland Trauma Registry (QTR). These cases utilised more than half a million acute care bed days, underwent more than 66,500 operations, and accounted for more than 48,000 patient transport episodes via road ambulance, fixed wing aircraft, or helicopter. Furthermore, more than 5800 minor trauma cases utilised in-hospital rehabilitation services; almost 3000 were admitted to an ICU; and more than 20,000 were admitted to hospital for greater than one week. When using the contemporary criteria for classifying trauma (AIS 08), the proportion of cases classified as minor trauma (87.7%) and major trauma (12.3%) were similar to the proportion using the traditional criteria for AIS90 (87.9% and 12.1%, respectively). CONCLUSIONS This evaluation of minor trauma cases admitted to public hospitals in Queensland detected high levels of demand placed on trauma system resources in terms of acute care bed days, operations, ICU admissions, in-hospital rehabilitation services and patient transportation, and which are all associated with high cost. These data convincingly demonstrate the significant burden of injury imposed by minor trauma cases serious enough to be admitted to hospital.

Standardising trauma monitoring: the development of a minimum dataset for trauma registries in Australia and New Zealand

INTRODUCTION Trauma registries are central to the implementation of effective trauma systems. However, differences between trauma registry datasets make comparisons between trauma systems difficult. In 2005, the collaborative Australian and New Zealand National Trauma Registry Consortium began a process to develop a bi-national minimum dataset (BMDS) for use in Australasian trauma registries. This study aims to describe the steps taken in the development and preliminary evaluation of the BMDS. METHODS A working party comprising sixteen representatives from across Australasia identified and discussed the collectability and utility of potential BMDS fields. This included evaluating existing national and international trauma registry datasets, as well as reviewing all quality indicators and audit filters in use in Australasian trauma centres. After the working party activities concluded, this process was continued by a number of interested individuals, with broader feedback sought from the Australasian trauma community on a number of occasions. Once the BMDS had reached a suitable stage of development, an email survey was conducted across Australasian trauma centres to assess whether BMDS fields met an ideal minimum standard of field collectability. The BMDS was also compared with three prominent international datasets to assess the extent of dataset overlap. Following this, the BMDS was encapsulated in a data dictionary, which was introduced in late 2010. RESULTS The finalised BMDS contained 67 data fields. Forty-seven of these fields met a previously published criterion of 80% collectability across respondent trauma institutions; the majority of the remaining fields either could be collected without any change in resources, or could be calculated from other data fields in the BMDS. However, comparability with international registry datasets was poor. Only nine BMDS fields had corresponding, directly comparable fields in all the national and international-level registry datasets evaluated. CONCLUSION A draft BMDS has been developed for use in trauma registries across Australia and New Zealand. The email survey provided strong indications of the utility of the fields contained in the BMDS. The BMDS has been adopted as the dataset to be used by an ongoing Australian Trauma Quality Improvement Program.

The epidemiology of horse-related injuries for different horse exposures, activities, and age groups in Queensland, Australia.

BACKGROUND The dangers associated with horse riding, a popular activity throughout Australia, are well documented; yet, few studies have comprehensively described injuries caused by horses to nonriders. This study aimed to facilitate targeted injury prevention strategies and appropriate trauma management by describing all horse-related injuries, for both riders and nonriders, in Queensland, and identifying those at greatest risk. METHODS Horse-related injury data from 2005 to 2009 were extracted from the Queensland Trauma Registry. Descriptive comparisons were undertaken for demographic, injury, and acute care characteristics between riders and nonriders, between pediatric and adult cases, and between sports/leisure and work injuries. The relative risk of surgery by sex and between riders and nonriders was assessed. RESULTS More than 25% of injuries occurred in people not riding a horse. Nonriders sustained a significantly higher proportion of internal organ injuries, open wounds, as well as facial and pelvic/abdominal injuries. Females accounted for more than 80% of children who were injured while riding a horse. For adults, 25% were injured while working, and more than 66% of injured workers were male. Injuries most commonly occurred in regional areas. Surgery was most common among children, nonriders, and those with Injury Severity Score (ISS) of 1 to 8. The likelihood of surgery was 25% higher for nonriders (95% confidence interval, 1.14–1.38%). CONCLUSION Horse-related injuries are most prevalent in identifiable populations, particularly young female riders and adult males injured while working. Injuries inflicted by horses to nonriders contribute more than 27% of all horse-related injuries; however, most previous research has been limited to injured riders. Compared with riders, nonriders more frequently sustain internal, facial, and pelvic injuries; are male; and undergo surgery. The results of this study may be used to tailor prevention strategies and inform trauma management specific to the type of horse exposure, patient age, and activity engaged in when injured. LEVEL OF EVIDENCE Epidemiologic study, level III.