Kate Curtis

Injury trends and mortality in adult patients with major trauma in New South Wales.

Objective: To examine trends in mechanism and outcome of major traumatic injury in adults since the implementation of the New South Wales trauma monitoring program, and to identify factors associated with mortality.

Comparison of radiation exposure of trauma patients from diagnostic radiology procedures before and after the introduction of a panscan protocol.

Objectives: To compare the proportion of patients exposed to a radiation dose in excess of 20 mSv, and to document missed injuries before and after the introduction of a panscan protocol for blunt trauma.

The cost-effectiveness of physician staffed Helicopter Emergency Medical Service (HEMS) transport to a major trauma centre in NSW, Australia

BACKGROUND AND CONTEXT Helicopter Emergency Medical Services (HEMS) are highly resource-intensive facilities that are well established as part of trauma systems in many high-income countries. We evaluated the cost-effectiveness of a physician-staffed HEMS intervention in combination with treatment at a major trauma centre versus ground ambulance or indirect transport (via a referral hospital) in New South Wales (NSW), Australia. METHODS Cost and effectiveness estimates were derived from a cohort of trauma patients arriving at St George Hospital in NSW, Australia during an 11-year period. Adjusted estimates of in-hospital mortality were derived using logistic regression and adjusted hospital costs were estimated through a general linear model incorporating a gamma distribution and log link. These estimates along with other assumptions were incorporated into a Markov model with an annual cycle length to estimate a cost per life saved and a cost per life-year saved at one year and over a patients lifetime respectively in three patient groups (all patients; patients with serious injury [Injury Severity Score>12]; patients with traumatic brain injury [TBI]). RESULTS Results showed HEMS to be more costly but more effective at reducing in-hospital mortality leading to a cost per life saved of

Improved trauma patient outcomes after implementation of a dedicated trauma admitting service

1,566,379,

Mental health following traumatic physical injury: An integrative literature review

533,781 and

How to talk to doctors – a guide for effective communication

519,787 in all patients, patients with serious injury and patients with TBI respectively. When modelled over a patients lifetime, the improved mortality associated with HEMS led to a cost per life year saved of

Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery

96,524,

Comparative analysis of trends in paediatric trauma outcomes in New South Wales, Australia

50,035 and

The variation of acute treatment costs of trauma in high-income countries

49,159 in the three patient groups respectively. Sensitivity analyses revealed a higher probability of HEMS being cost-effective in patients with serious injury and TBI. CONCLUSION Our investigation confirms a HEMS intervention is associated with improved mortality in trauma patients, especially in patients with serious injury and TBI. The improved benefit of HEMS in patients with serious injury and TBI leads to improved estimated cost-effectiveness.

What is the impact of multidisciplinary team simulation training on team performance and efficiency of patient care? An integrative review

BACKGROUND Regionalised trauma systems have been shown to improve the outcome of seriously injured patients. However, it is not clear which components of these systems have the most impact on patient outcomes. The study evaluates the association between implementation of a single, dedicated trauma admitting service at an urban trauma centre and subsequent patient outcomes. METHODS This was a retrospective review of prospectively collected trauma registry data at the St George Public Hospital, a level I urban trauma centre in Sydney, Australia. Two concurrent 18-month periods, before and after implementation of a full-time trauma service, were compared for differences in patient mortality, complication rates, and ED, ICU and hospital lengths of stay. RESULTS There were 962 patients admitted to the hospital in the 18 months immediately preceding the implementation of the trauma service (the PRE group) and 990 patients in the subsequent 18 months (the POST group). There were no significant differences between groups with respect to patient demographics or mechanism of injury, although a higher proportion of patients in the POST group had injury severity scores (ISS) above 15 (30.6% versus 24.8%, p=0.02). There was an 8% reduction in death rate among the most severely injured patients (ISS>15), in the POST group as compared to the PRE group (12.2% and 20.2% respectively, p=0.007). CONCLUSIONS The implementation of a full-time trauma service in this hospital was associated with a reduction in death rate among the most severely injured patients, and a decrease in LOS in patients with an ISS<15.