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NSW ITIM Major Trauma in NSW: 2016 - 2017 i
Major Trauma in NSW: 2016-17 A Report from the NSW Trauma Registry
NSW Institute of Trauma and Injury Management
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 i
AGENCY FOR CLINICAL INNOVATION
Level 4, 67 Albert Avenue
Chatswood NSW 2067
PO Box 699 Chatswood NSW 2057
T +61 2 9464 4666 | F +61 2 9464 4728
E [email protected] | www.aci.health.nsw.gov.au
SHPN (ACI) 180677, ISBN 978-1-76000-990-8.
Produced by: NSW Institute of Trauma and Injury Management
Further copies of this publication can be obtained from
the Agency for Clinical Innovation website at www.aci.health.nsw.gov.au
Suggested citation: NSW Agency for Clinical Innovation. Major Trauma in NSW: 2016-17. Sydney: ACI; 2018.
Disclaimer: Content within this publication was accurate at the time of publication. This work is copyright. It may be
reproduced in whole or part for study or training purposes subject to the inclusion of an acknowledgment of the source.
It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above,
requires written permission from the Agency for Clinical Innovation.
Version: 1 Trim: ACI/D18/4085
© Agency for Clinical Innovation 2018
The Agency for Clinical Innovation (ACI) works with clinicians, consumers and managers to design and
promote better healthcare for NSW. It does this by:
service redesign and evaluation – applying redesign methodology to assist healthcare providers and
consumers to review and improve the quality, effectiveness and efficiency
of services
specialist advice on healthcare innovation – advising on the development, evaluation and adoption of
healthcare innovations from optimal use through to disinvestment
initiatives including guidelines and models of care – developing a range of evidence-based healthcare
improvement initiatives to benefit the NSW health system
implementation support – working with ACI Networks, consumers and healthcare providers to assist
delivery of healthcare innovations into practice across metropolitan and rural NSW
knowledge sharing – partnering with healthcare providers to support collaboration, learning capability
and knowledge sharing on healthcare innovation and improvement
continuous capability building – working with healthcare providers to build capability
in redesign, project management and change management through the Centre for Healthcare
Redesign.
ACI Clinical Networks, Taskforces and Institutes provide a unique forum for people to collaborate across
clinical specialties and regional and service boundaries to develop successful healthcare innovations.
A priority for the ACI is identifying unwarranted variation in clinical practice and working in partnership
with healthcare providers to develop mechanisms to improve clinical practice
and patient care.
www.aci.health.nsw.gov.au
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 ii
Acknowledgements
The NSW Institute of Trauma and Injury Management wishes to acknowledge the NSW Trauma Services for their contribution of data to the NSW Trauma Registry.
ACI team
Hardeep Singh, Data Officer, NSW Institute of Trauma and Injury Management
Glenn Sisson, Project Officer, NSW Institute of Trauma and Injury Management
Pooria Sarrami, Research Officer, NSW Institute of Trauma and Injury Management
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 iii
Glossary
Abbreviated Injury Scale (AIS) is an anatomically-based, consensus-derived, global severity
scoring system that classifies each injury by body region, according to its relative importance on a
six point ordinal scale. The AIS is the basis for the Injury Severity Score (ISS) calculation of the
multiply injured patient.
Case fatality rate is the proportion of deaths for a designated population expressed as a
percentage. The NSW Trauma Minimum Data Set does not include all survivors with an ISS of less
than or equal to 12. The case fatality rate in this report is only calculated on patients with an ISS of
greater than 12, and will be expressed as ‘case fatality rate for ISS >12’.
Definitive care is defined as the hospital providing the highest level of care to meet all the clinical
needs of the patient. Many patients receive definitive care at regional trauma services, but a small
number of patients are transferred to a major trauma service (higher level) for specialised care.
Geriatric population is defined as those aged 65 years or older.
Location of injury is defined as either metropolitan or rural based on the recorded postcode of
injury. The process used to define the two categories is outlined in Section 2 - Methodology.
Injury Severity Score (ISS) assesses the combined effects of the multiply injured patient and is
based on an anatomical injury severity classification, the AIS. The ISS is an internationally
recognised scoring system which correlates with mortality, morbidity and other measures of
severity. The ISS is calculated as the sum of the squares of the highest AIS code in each of the
three most severely injured ISS body regions.
ISS body regions consists of six anatomical regions as defined in the AIS dictionary:
head or neck
face
chest
abdominal or pelvic contents
extremities or pelvic girdle
external.
Isolated fractured neck of femur is defined as the AIS codes 853161.3 and 853162.3 and where
no other injury is recorded.
Major trauma is defined as all patients of any age, who were admitted to a designated NSW
trauma service within seven days of sustaining an injury, and:
had an ISS>12 (moderate to critically injured), or
were admitted to an intensive care unit (irrespective of ISS) following injury, or
died in hospital (irrespective of ISS) following injury, except those with an isolated fractured
neck of femur injury sustained from a fall from a standing height (<1 metre) and those aged
65 years or older who die with minor soft tissue injury only.
Major trauma services can provide the full spectrum of care for major and moderately injured
patients, from initial resuscitation through to rehabilitation and discharge. There are currently seven
adult and three paediatric designated major trauma services in NSW.
Mechanism of injury refers to the mechanisms whereby energy is transferred from the
environment to the person.
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 iv
Minor soft tissue injury is defined as a superficial injury including abrasions, contusions, and
lacerations (AIS codes: 910000.1; 910200.1; 910400.1; 910600.1, 810099.1, 810202.1, 810402.1,
810600.1, 810602.1, 710099.1, 710202.1, 710402.1, 710600.1, 710602.1, 510099.1, 510202.1,
510402.1, 510600.1, 510602.1, 410099.1, 410202.1, 410402.1, 410600.1, 410602.1, 310099.1,
310202.1, 310402.1, 310600.1, 310602.1, 210099.1, 210202.1, 210402.1, 210600.1, 210602.1).
Other transport incident is defined as a patient involved in an accident involving a device
designed primarily for, or being used at the time primarily for, conveying persons or goods from
one place to another (ICD 10 codes: V00 – V99 inclusive) that did not meet place of occurrence
road trauma criteria.
Polytrauma is defined as serious injury (AIS severity >2) in two or more ISS body regions.
Regional trauma services can provide all aspects of care to patients with minor to moderate
trauma, and definitive care to a limited number of major trauma patients in collaboration with the
major trauma service. A regional trauma service provides initial assessment, stabilisation, definitive
care and initiates transfer to a major trauma service when a patient requires services not available
at the regional trauma service. There are currently ten designated regional trauma services in
NSW.
Road trauma is defined as a patient involved in an accident involving a device designed primarily
for, or being used at the time primarily for, conveying persons or goods from one place to another
(ICD 10 codes: V00 – V89 inclusive) AND had a street, highway and other paved roadways as the
place of occurrence of the external cause (ICD 10 codes: Y92.4 inclusive).
Revised Trauma Score is a physiological scoring system used for predicting death. It consists of
the first set of vital signs data obtained on the patient after arrival at hospital including Glasgow
Coma Scale, systolic blood pressure and respiratory rate. Values for the Revised Trauma Score
are in the range 0 to 7.8408. The lower the score, the higher the likelihood of death.
Standardised Mortality Ratio is a ratio between the observed number of deaths in a study
population and the number of deaths that would be expected, based on the age or ISS specific
rates in a standard population and the age or ISS distribution of the study population.
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 v
Abbreviations
ASGS-RA Australian Statistical Geography Standard Remoteness Areas
AIS Abbreviated Injury Scale
ARIA+ Accessibility and Remoteness Index of Australia
ED Emergency department
ICD International Classification of Diseases
ICU Intensive care unit
ISS Injury Severity Score
ITIM NSW Institute of Trauma and Injury Management
LOS Length of stay
MTS Major trauma service
ORIF Open reduction internal fixation
PTS Paediatric trauma service
RTS Regional trauma service
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 vi
Executive summary
Each year approximately 4,000 people are admitted to a NSW trauma service for injuries defined
as major trauma. How the NSW trauma system responds to these patients is critical for their
long-term outcome and quality of life and for reducing the overall financial and social cost of
trauma to individuals and the community as a whole.
A key priority for the NSW Institute of Trauma and Injury Management (ITIM), within the Agency for
Clinical Innovation, is to monitor the effectiveness of the NSW trauma system response to these
major trauma patients. This group of patients places the greatest demand on the trauma system
and on other agencies and services, not simply for health care, but for a wide range of needs.
This report describes how the NSW trauma system responded to major trauma patients, from the
time of injury and provision of pre-hospital services, through to in-hospital services provided at a
NSW trauma service. The report investigates the data to determine whether the NSW trauma
system is functioning effectively, to ensure that the right patient arrived at the right hospital in a
timely matter.
The report helps us understand the nature of the injuries sustained and how they occurred. The
findings are used by various agencies concerned with minimising the likelihood and effects of
traumatic injury and contributing to safety and injury prevention efforts. Data from the NSW Trauma
Registry is used by ITIM to provide advice and feedback to clinicians and other stakeholders and
enables research into patterns of service demand and staffing. This data also supports
benchmarking and performance improvement activities.
It is important to note that this report does not represent all injuries in NSW, nor does it represent
the full work or caseload of trauma services in hospitals or the full set of data recorded in hospital
trauma registries.
2016-17 report highlights for major trauma in NSW
3845 major trauma patients resulted in 3961 major trauma admissions.
Average age was 52 years old.
Males were 2.5 times more likely to be injured than females.
Case fatality rate for ISS>12 was 10.2%.
Females had a higher case fatality rate (13.2%) compared to males (9.0%).
Falls accounted for 44.2% of all major traumas, exceeding transport incidents (37.6%).
‘Three or more fractured ribs without flail’ was the most common serious injury (15.7%).
25.5% of major traumas were sustained in a rural area.
The greatest proportion of traumatic injuries was falls in the metro setting (50.2%), and
transport incidents in the rural setting (52.2%).
Pedestrian traumas had a significantly higher case fatality rate (17.0%) than all other
forms of road trauma.
61.0% of major trauma patients sustained injuries to the head or neck body region, and
49.2% the chest region.
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 vii
Contents
Acknowledgements ...................................................................................................................... ii
Glossary ....................................................................................................................................... iii
Abbreviations ................................................................................................................................ v
Executive summary ..................................................................................................................... vi
Contents ...................................................................................................................................... vii
List of tables ......................................................................................................................... ix
List of figures ......................................................................................................................... x
Monitoring the NSW trauma system ............................................................................................ 1
NSW trauma system .............................................................................................................. 1
Mandate for trauma data ........................................................................................................ 1
NSW Trauma Registry ........................................................................................................... 1
NSW trauma services ............................................................................................................ 2
Methodology ................................................................................................................................. 3
Inclusion criteria ..................................................................................................................... 3
Exclusion criteria .................................................................................................................... 3
Data quality ............................................................................................................................ 3
The Injury Severity Score and Abbreviated Injury Score ........................................................ 4
Revised Trauma Score .......................................................................................................... 5
Metropolitan and rural categorisation ..................................................................................... 5
Major trauma patients ................................................................................................................... 6
Introduction ............................................................................................................................ 6
Summary profile ..................................................................................................................... 6
Age and gender ..................................................................................................................... 8
Mechanism of injury ............................................................................................................. 11
Transport incidents by place of occurrence .......................................................................... 19
Time and day of injury .......................................................................................................... 21
Injuries ................................................................................................................................. 22
Injury Severity Score ............................................................................................................ 24
Pre-hospital time .................................................................................................................. 25
Mode of transport ................................................................................................................. 26
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 viii
Major trauma admissions ........................................................................................................... 28
Introduction .......................................................................................................................... 28
Facility overview .................................................................................................................. 28
Admission type .................................................................................................................... 29
Revised Trauma Score ........................................................................................................ 29
Trauma team activation ....................................................................................................... 30
Vital signs on arrival to the emergency department .............................................................. 32
Intensive care unit admissions ............................................................................................. 33
Length of stay ...................................................................................................................... 34
Procedures .......................................................................................................................... 36
Discharge destination of survivors ....................................................................................... 37
Appendices ................................................................................................................................. 39
Appendix 1: Data completeness........................................................................................... 40
Appendix 2: Adult major trauma service summaries............................................................. 43
Appendix 3: Paediatric major trauma service summaries ..................................................... 57
Appendix 4: Regional trauma service summaries ................................................................ 63
Appendix 5: Calculation of the Injury Severity Score ............................................................ 83
Appendix 6: Australian Statistical Geography Standard Remoteness Areas ........................ 84
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 ix
List of tables
Table 1: Record of data exclusions ................................................................................................................... 4
Table 2: Revised Trauma Score points system ................................................................................................. 5
Table 3: Summary statistics for major trauma and mortality ............................................................................. 6
Table 4: Major trauma patients, injury and mortality by age group ................................................................... 8
Table 5: Type of injury ..................................................................................................................................... 11
Table 6: Mechanism of injury by age ............................................................................................................... 13
Table 7: Mechanism of injury by location ........................................................................................................ 16
Table 8: Falls in detail ...................................................................................................................................... 17
Table 9: Transport incidents in detail ............................................................................................................... 17
Table 10: Assaults in detail .............................................................................................................................. 18
Table 11: All other mechanisms in detail ......................................................................................................... 18
Table 12: Transport incidents by location of injury .......................................................................................... 19
Table 13: Road trauma in detail ...................................................................................................................... 19
Table 14: Other transport incidents in detail .................................................................................................... 20
Table 15: Top 5 injuries with an AIS severity >2 ............................................................................................. 22
Table 16: Number of ISS body regions injured with an AIS severity >2 ......................................................... 23
Table 17: Single body region versus polytrauma with an AIS severity >2 ...................................................... 23
Table 18: Major trauma patients by ISS group ................................................................................................ 24
Table 19: Median time of injury to arrival at a designated trauma service ...................................................... 25
Table 20: Median time of injury to arrival at definitive care ............................................................................. 26
Table 21: Mode of transport to definitive care ................................................................................................. 26
Table 22: Overview of trauma service admissions .......................................................................................... 28
Table 23: Number of admissions by type ........................................................................................................ 29
Table 24: Overview of ICU and hospital length of stay ................................................................................... 34
Table 25: ICU and hospital length of stay by ISS ............................................................................................ 34
Table 26: ICU and hospital length of stay by age ............................................................................................ 35
Table 27: Procedures performed by type ........................................................................................................ 36
Table 28: Detailed data completeness by facility ............................................................................................ 41
Table 29: Trauma data profile, John Hunter Hospital ...................................................................................... 43
Table 30: Trauma data profile, Liverpool Hospital ........................................................................................... 45
Table 31: Trauma data profile, Royal North Shore Hospital............................................................................ 47
Table 32: Trauma data profile, Royal Prince Alfred Hospital .......................................................................... 49
Table 33: Trauma data profile, St George Hospital ......................................................................................... 51
Table 34: Trauma data profile, St Vincent’s Hospital ...................................................................................... 53
Table 35: Trauma data profile, Westmead Hospital ........................................................................................ 55
Table 36: Trauma data profile, John Hunter Children’s Hospital .................................................................... 57
Table 37: Trauma data profile, Sydney Children’s Hospital ............................................................................ 59
Table 38: Trauma data profile, The Children’s Hospital at Westmead ............................................................ 61
Table 39: Trauma data profile, Coffs Harbour Health Campus ....................................................................... 63
Table 40: Trauma data profile, Gosford Hospital ............................................................................................ 65
Table 41: Trauma data profile, Lismore Base Hospital ................................................................................... 67
Table 42: Trauma data profile, Nepean Hospital ............................................................................................. 69
Table 43: Trauma data profile, Orange Health Service ................................................................................... 71
Table 44: Trauma data profile, Port Macquarie Base Hospital........................................................................ 73
Table 45: Trauma data profile, Tamworth Rural Referral Hospital .................................................................. 75
Table 46: Trauma data profile, The Tweed Hospital ....................................................................................... 77
Table 47: Trauma data profile, Wagga Wagga Rural Referral Hospital .......................................................... 79
Table 48: Trauma data profile, Wollongong Hospital ...................................................................................... 81
Table 49: ISS calculation example .................................................................................................................. 83
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 x
List of figures
Figure 1: Five year trend in the number of major trauma patients .................................................................... 7
Figure 2: Five year trend in the number of major trauma patients by facility type............................................. 7
Figure 3: Number of major trauma patients by age, gender and mortality ........................................................ 9
Figure 4: Age-specific injury rate by age and gender ........................................................................................ 9
Figure 5: Case fatality rate by age and gender (ISS>12) ................................................................................ 10
Figure 6: Age-specific mortality rate by age and gender ................................................................................. 10
Figure 7: Five year trend of mortality rate by facility type (ISS>12) ................................................................ 11
Figure 8: Mechanism of injury ......................................................................................................................... 12
Figure 9: Five year trend in the number of falls and transport incidents ......................................................... 14
Figure 10: Mechanism of injury by age ............................................................................................................ 14
Figure 11: Mechanism of injury as a percentage by age ................................................................................. 15
Figure 12: Age-specific injury rate by mechanism of injury ............................................................................. 15
Figure 13: Mechanism of injury by location ..................................................................................................... 16
Figure 14: Mechanism of injury as a percentage by location .......................................................................... 16
Figure 15: Number of patients by time of injury ............................................................................................... 21
Figure 16: Number of patients by day of injury ................................................................................................ 21
Figure 17: All injuries by ISS body region ........................................................................................................ 22
Figure 18: Number of major trauma patients by ISS group and gender ......................................................... 24
Figure 19: Case fatality rate by ISS and gender ............................................................................................. 25
Figure 20: Mode of transport to definitive care when transported direct from the scene of injury, by injury
location............................................................................................................................................................. 27
Figure 21: Mode of transport to definitive care when transferred from another acute care facility, by injury
location............................................................................................................................................................. 27
Figure 22: Average Revised Trauma Score by ISS group .............................................................................. 29
Figure 23: Trauma team activation by admission type .................................................................................... 30
Figure 24: Trauma team activation by ISS group ............................................................................................ 31
Figure 25: Initial systolic blood pressure on arrival to the ED and mortality .................................................... 32
Figure 26: Initial Glasgow Coma Scale on arrival to the ED and mortality ...................................................... 32
Figure 27: Initial temperature on arrival to ED and mortality ........................................................................... 33
Figure 28: ICU admission by ISS group .......................................................................................................... 33
Figure 29: Procedures performed by ISS group .............................................................................................. 36
Figure 30: Five year trend of procedures performed ....................................................................................... 37
Figure 31: Discharge destination of survivors ................................................................................................. 37
Figure 32: Discharge destination of survivors by ISS group ........................................................................... 38
Figure 33: Overall data completeness by facility ............................................................................................. 40
Figure 33: Map of 2016 Remoteness areas for Australia ................................................................................ 84
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 1
Monitoring the NSW trauma system
NSW trauma system
The primary function of the NSW trauma system is to facilitate and coordinate an organised
multidisciplinary system response with the aim of reducing the burden of injury. The system
encompasses a continuum of care that provides traumatically injured patients with the greatest
likelihood of returning to their pre-injury level of function within the community.
This continuum of care includes injury prevention, pre-hospital coordination and care, appropriate
triage and transport, emergency department trauma care, trauma service team activation, surgical
intervention, intensive or critical and general in-hospital care, rehabilitation services, allied health
and medical care follow up.
The overall goal of the NSW trauma system is to decrease the incidence and severity of injury and
to ensure optimal, accessible and equitable care to improve health outcomes for those who are
injured. The main objective of the trauma system is to get the ‘right patient to the right hospital in
the right time, receiving the right care.’ To meet this objective, designated trauma services need to
have appropriate resources to meet the complex needs of the injured patient.
Mandate for trauma data
The NSW Trauma Services Plan (2009) outlines the role of the NSW Institute of Trauma and Injury
Management (ITIM), including monitoring and reporting on the performance of individual trauma
services to ensure that performance is consistent with the standard of care and to manage a
statewide clinical injury data collection process.
The plan also positions ITIM to develop partnerships with injury stakeholders, such as the local
health districts, NSW Ambulance, State Insurance Regulatory Authority, State Coroner, Clinical
Excellence Commission and universities. These partnerships aim to build an improved critical
mass for research and education across the spectrum of trauma prevention care and rehabilitation.
The collection of trauma data is an important aspect of these activities.
NSW Trauma Registry
ITIM is responsible for managing the collection of data about moderate to critically injured people
admitted to trauma services in NSW. Data collected is held securely in the NSW Trauma Registry.
Data in the registry is submitted from each of the designated NSW trauma services.
The NSW Trauma Registry contains de-identified patient records, but does not hold data for every
injured person admitted to hospital in NSW. Data is only included for patients with the greatest
needs, the most seriously injured, who are treated at a designated NSW trauma service. This data
is known as the NSW Trauma Minimum Data Set and forms the basis of data analysis and
reporting activities at ITIM. As the scope of the current data collection is restricted to these
designated hospitals, there may be some data for trauma admissions to other hospitals that are not
included in the NSW Trauma Registry.
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 2
NSW trauma services
The NSW trauma system consists of seven adult major trauma services, three paediatric major
trauma services and ten regional trauma services. All of the services contributed data to the NSW
Trauma Registry used in this report.
Adult major trauma services
John Hunter Hospital
Liverpool Hospital
Royal North Shore Hospital
Royal Prince Alfred Hospital
St George Hospital
St Vincent's Hospital
Westmead Hospital
Paediatric major trauma services
John Hunter Children's Hospital
Sydney Children's Hospital
The Children's Hospital at Westmead
Regional trauma services
Coffs Harbour Health Campus
Gosford Hospital
Lismore Base Hospital
Nepean Hospital
Orange Health Service
Port Macquarie Base Hospital
Tamworth Hospital
The Tweed Hospital
Wagga Wagga Rural Referral Hospital
Wollongong Hospital
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 3
Methodology
This report is compiled from data submitted by reporting facilities to the NSW Trauma Registry in
accordance with the inclusion and exclusion criteria detailed below. Data for this report was
extracted from the NSW Trauma Registry on 19 May 2018.
Inclusion criteria
All major trauma patient records from the NSW Trauma Registry, where the date of injury occurred
between 1 July 2016 and 30 June 2017, are included in this report.
Major trauma is defined as all patients of any age, who were admitted to a NSW trauma service
within seven days of sustaining an injury, and who:
had an Injury Severity Score (ISS)>12 (moderate to critically injured), or
were admitted to an intensive care unit (irrespective of ISS) following injury, or
died in hospital (irrespective of ISS) following injury.
As a result of these criteria, patient records submitted for inclusion in this report do not represent
all injuries in NSW, nor do they represent the full work or caseload of trauma services in hospitals,
nor the full set of data recorded in hospital trauma registries.
Exclusion criteria
The criteria for excluding a patient record from this report are as follows.
Patients not admitted to a designated NSW trauma service.
Patients admitted to a designated NSW trauma service greater than seven days after
sustaining an injury.
Patients who die with an isolated fractured neck of femur injury sustained from a fall from a
standing height (<1 metre)1
Patients aged 65 years or older who die with minor soft tissue injury only.2
Records have also been excluded from this report if the Outcome (survived or died) data element
is missing or invalid data recorded in the registry.
Based on the criteria outlined above, a total of 61 records were excluded as outlined in Table 1.
Data quality
Data submitted to the NSW Trauma Registry is subject to rigorous checking and validation by ITIM
and the reporting facilities while missing or invalid data is flagged and returned to individual trauma
services for completion and validation.
The average data completeness by the trauma facilities was 87.4%. A detailed breakdown of data
completeness by trauma facility is available in Appendix 1.
1 See Glossary for definition of an isolated fractured neck of femur injury.
2 See Glossary for definition of a minor soft tissue injury.
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 4
Table 1: Record of data exclusions
Data criteria Excluded Remaining records
Data extracted (19 May 2018) ISS>12, or had ICU admission, or died
N/A 4022
Exclusions
Date of admission >7 days from injury 48 3974
Isolated neck of femur injuries (with outcome = died) 11 3963
Over 65yrs old and died with minor soft tissue injury only 0 3963
Missing outcome 2 3961
Total remaining records 3961
The Injury Severity Score and Abbreviated Injury Score
One of the key criteria for inclusion in this report is an Injury Severity Score (ISS) >12. The ISS is
an internationally recognised scoring system which correlates with mortality, morbidity and other
measures of severity. The ISS is calculated based on an anatomical injury severity classification,
the Abbreviated Injury Scale (AIS). The AIS classifies individual injuries by body region on a six
point severity scale from minor (1) to maximum (6 - currently untreatable injury). The NSW Trauma
Registry uses the AIS 2005 (Update 2008) dictionary.
The AIS is used by accredited staff at each hospital to score individual patient injuries and their
severity. It provides a common tool for comparing and selecting patient records for inclusion in the
NSW Trauma Registry. Scoring is undertaken retrospectively but usually within 24-48 hours after
admission to allow for identification of all injuries. On initial evaluation, these patients typically have
abnormal vital signs or a significant anatomical injury.
Injuries are individually allocated to one of six body regions and the severities of the top three
injuries in different body regions are used to calculate the ISS. The ISS along with the body regions
and injury and severity codes used in this calculation are recorded in the NSW Trauma Registry
(see Appendix 5 for further detail).
The calculated ISS value ranges from 1-75. Serious to critically injured trauma patients are defined
as those patients with an ISS >15, which is an internationally recognised indicator of serious injury.
In this report the ISS is reported in ranges:
13-15 (moderate injury)
16-24 (serious injury)
25-40 (severe injury)
41-75 (critical injury).
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 5
Revised Trauma Score
The Revised Trauma Score is a physiological scoring system used as a predictor of mortality in
trauma populations. It consists of data from the first set of vital signs obtained on arrival at hospital,
including the Glasgow Coma Scale, systolic blood pressure and respiratory rate. Each element is
scored with a weighting as outlined in Table 2.3 Values for the Revised Trauma Score are in the
range 0 to 7.8408. The lower the score, the higher the likelihood of death.
Table 2: Revised Trauma Score points system
Glasgow Coma Scale
Systolic blood pressure
Respiratory rate Points
15-13 >89 10-29 4
12-9 76-89 >29 3
8-6 50-75 6-9 2
5-4 1-49 1-5 1
3 0 0 0
Revised Trauma Score = 0.9368 Glasgow Coma Scale + 0.7326 systolic blood pressure + 0.2908 respiratory rate
Metropolitan and rural categorisation
Various data elements within the report are categorised as either ‘Metropolitan’ or ‘Rural’. These
categories are derived using the postcode of injury and the Australian Statistical Geography
Standard (ASGS) Remoteness Areas (RA). The ASGS-RA is based on the Accessibility and
Remoteness Index of Australia which defines locations in terms of remoteness, i.e. the physical
distance of a location from the nearest urban centre (access to goods and services) based on
population size.
The ASGS-RA (2016) consists of five categories:
major cities
inner regional
outer regional
remote
very remote.
For the purpose of this report, all locations with the ASGS-RA classification of ‘Major cities’ are
listed as ‘Metropolitan’. All other ASGS-RA classified locations are combined and listed as ‘Rural’.
For further information and an overview map of the ASGS-RA categorisation of NSW, please see
Appendix 6.
3 Champion HR et al, "A Revision of the Trauma Score", J Trauma, 1989; 29:623-629.
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 6
Major trauma patients
Introduction
The information in this section of the report is based on the number of major trauma patients who
received care in a NSW trauma service (n=3845), not the number of trauma admissions (n=3961),
as some patients were treated in more than one NSW reporting facility. Trauma admission data
(hospital activity) is discussed in detail in the Major trauma admissions section.
Summary profile
During the period 1 July 2016 to 30 June 2017, there were 3845 major trauma patients treated at
NSW trauma services. Of these, 74.5% (n=2709)4 were injured in a metropolitan location and 428
died (case fatality rate for ISS >12 of 10.2%). The age-standardised injury rate was 47.8 per
100,000 persons5 and the age-standardised death rate was 4.4 per 100,000 persons.5 The
standardised mortality ratio6 was 4.1, indicating that the proportion of deaths in major trauma
patients during the reporting period was more than four times greater than that of the general
Australian population (Table 3).
Table 3: Summary statistics for major trauma and mortality
Summary statistics Value
Total number of patients injured overall 3845
Total number of patients injured with ISS >12 3363
Injury rate per 100,000 persons (age-standardised)5 48.9 (95% CI 47.8 - 50)
Location of injury (metropolitan / rural)4 2709 (74.5%) / 929 (25.5%)
Total number of deaths overall 428
Total number of deaths with ISS >12 (case fatality rate) 343 (10.2%)
Death rate per 100,000 persons (age-standardised)5 4.4 (95% CI 3.6 - 5.1)
Standardised mortality ratio 4.1 (95% CI 3.6 – 4.5)
Average age (years) 52
Average Injury Severity Score (ISS) 19.0
4 207 records were excluded due to location of injury being recorded as overseas, not applicable or not recorded. 5 Annualised rate given as per 100,000 persons, standardised to the Australian population at 30 June 2001. Source: Australian Bureau
of Statistics. Australian Demographic Statistics, Mar 2013. Catalogue No. 3101. Canberra: ABS, Dec 2013. 6 See Glossary for definition of the standardised mortality ratio. Standardised to the Australian population at 30 June 2001. Source:
Australian Bureau of Statistics. Australian Demographic Statistics, Jun 2013. Catalogue No. 3101. Canberra: ABS, Dec 2013.
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 7
Over the previous four years, there has been a steady increase in the number of major trauma
patients, but in the 2016-17 financial year there was a 4.9% decrease (Figure 1).
Figure 1: Five year trend in the number of major trauma patients (n=19,168)
The largest proportional decrease in 2016-17 was seen in the paediatric trauma services (-14.0%),
compared to adult major trauma services (-4.3%) and regional trauma services (-3.9%), as seen in
Figure 2.
Figure 2: Five year trend in the number of major trauma patients by facility type (n=19,168)
3611
3776
3893
4043
3845
3300
3400
3500
3600
3700
3800
3900
4000
4100
2012-13 2013-14 2014-15 2015-16 2016-17
Financial year
Num
ber
of
patients
0
500
1000
1500
2000
2500
3000
3500
2012-13 2013-14 2014-15 2015-16 2016-17
Num
ber
of
patients
Financial year
MTS
PTS
RTS
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 8
Age and gender
The average age of a major trauma patient in NSW during the reporting period was 52 years old.
Table 4 outlines the age distribution, which demonstrates a sharp rise in the incidence of major
trauma in the geriatric population,7 especially those aged 75 years and older, as it has in previous
years. The 75 years and older age group also had a higher case fatality rate for ISS >12 (17.7%,
n=779) compared with the under 75 years age group (7.9%, n= 2583).
Table 4: Major trauma patients, injury and mortality by age group (n=3844)8
Age group (years)
Number of injured
(% of total)
Cumulative number of
injured (% of total)
Age-specific injury rate
per 100,0009
Age-specific death rate
per 100,0009
Case fatality rate
(ISS >12)
0-4 90 (2.3%) 90 (2.3%) 18.2 1.8 12.5%
5-9 43 (1.1%) 133 (3.5%) 8.5 0.6 8.8%
10-14 56 (1.5%) 189 (4.9%) 12.0 0.4 4.3%
15-19 206 (5.4%) 395 (10.3%) 43.8 3.4 8.5%
20-24 269 (7%) 664 (17.3%) 49.8 3.1 6.8%
25-29 226 (5.9%) 890 (23.2%) 38.3 3.1 8.9%
30-34 210 (5.5%) 1100 (28.6%) 36.0 2.2 7.1%
35-39 206 (5.4%) 1306 (34%) 38.7 2.4 7.5%
40-44 214 (5.6%) 1520 (39.5%) 41.9 1.2 3.1%
45-49 235 (6.1%) 1755 (45.7%) 45.7 2.9 5.7%
50-54 246 (6.4%) 2001 (52.1%) 50.5 3.5 6.5%
55-59 284 (7.4%) 2285 (59.4%) 58.5 3.7 6.1%
60-64 221 (5.7%) 2506 (65.2%) 51.2 3.9 7.0%
65-69 220 (5.7%) 2726 (70.9%) 57.0 7.0 12.7%
70-74 220 (5.7%) 2946 (76.6%) 70.0 10.8 15.3%
75-79 231 (6%) 3177 (82.6%) 103.0 18.7 12.9%
80-84 247 (6.4%) 3424 (89.1%) 156.2 28.5 15.2%
85 and over 420 (10.9%) 3844 (100%) 247.2 68.3 22.0%
7 Geriatric defined as aged 65 years and older. 8 1 record excluded due to age not recorded. 9 Annualised rate given as per 100,000 persons, based on the estimated NSW population at 30 June 2017. Source: Australian Bureau
of Statistics. Australian Demographic Statistics, Catalogue No. 31010. Canberra: ABS, Sept 2017.
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 9
Males have a higher number of major trauma injuries (n=2741) compared to females (n=1103),
except in the 85 years old and over age groups (Figure 3). Overall, males are 2.5 times more likely
to be injured than females.
Figure 3: Number of major trauma patients by age, gender and mortality (n=3844)8
The age-specific injury rate for males ranged from 5.2 to 114.8 per 100,000 persons and in
females ranged 3.4 to 132.4 per 100,000 persons (Figure 4).9
Figure 4: Age-specific injury rate by age and gender (n=3844)8,9
0
20
40
60
80
100
120
140
160
180
200
220
Num
ber
of
patients
Age group
Died - Male
Died - Female
Survived - Male
Survived - Female
0
20
40
60
80
100
120
140
Age-s
pecific
rate
(in
jury
/100,0
00)
Age group
Males
Females
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 10
The case fatality rate for ISS >12 (n=3363) was higher for females (13.2%, n=127) than for males
(9.0%, n=216), with the overall case fatality rate being 10.2% (Figure 5).
Figure 5: Case fatality rate by age and gender (ISS>12) (n=3363)
While females have a higher case fatality rate for ISS >12, males have a higher age-specific
mortality rate per 100,000 persons (Figure 6).9
Figure 6: Age-specific mortality rate by age and gender (n=3844)8,9
0%
5%
10%
15%
20%
25%
30%
Case f
ata
lity
rate
Age group
Males
Females
0
20
40
60
80
100
120
Age-s
pecific
rate
(in
jury
/100,0
00)
Age group
Males
Females
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 11
Figure 7 shows the five year trend of mortality rates (ISS>12) for the three facility types. Overall,
the mortality rate has decreased from 10.7% to 10.2% during the last five years.
Figure 7: Five year trend of mortality rate by facility type (ISS>12) (n=16,764)
Mechanism of injury
The vast majority of major trauma in NSW in the reporting period was caused by blunt injuries
(95.8%), such as falls and motor vehicle collisions (Table 5).
Table 5: Type of injury (n=3728)10
Type of injury Number of patients
(% of total) Case fatality rate
(ISS >12)
Blunt 3570 (95.8%) 9.5%
Penetrating 158 (4.2%) 12.3%
The top three mechanisms of major trauma were:
falls (44.2%, n=1699)
transport incidents (37.6%, n=1447) out of which 1112 were road trauma incidents11
assaults (7.0%, n=268).
All other mechanisms combined accounted for 11.2% (n=431) (Figure 8). The distribution of these
mechanisms of injury by age group is demonstrated in Table 6.
10 Only blunt and penetrating injury types are reported. Other injury types (n=117) are recorded as ‘N/A’ or ‘Unknown'.
11 See Glossary for the definition of road trauma.
4%
5%
6%
7%
8%
9%
10%
11%
12%
2012-13 2013-14 2014-15 2015-16 2016-17
Mort
alit
y ra
te
Financial year
MTS
PTS
RTS
Overall
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 12
Figure 8: Mechanism of injury (n=3485)
1699
1447
268
431
0
200
400
600
800
1000
1200
1400
1600
1800
Falls Transport incident Assault All other mechanisms
Num
ber
of
patients
Mechanism of injury
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 13
Table 6: Mechanism of injury by age (n=3844)8
Age group
Number of patients (age-specific rate per 100,000)9
Falls Transport incident
Assault All other
mechanisms
0-4 38 (7.7) 14 (2.8) 6 (1.2) 32 (6.5)
5-9 14 (2.8) 18 (3.6) 0 (0) 11 (2.2)
10-14 23 (4.9) 24 (5.2) 0 (0) 9 (1.9)
15-19 31 (6.6) 102 (21.7) 24 (5.1) 49 (10.4)
20-24 59 (10.9) 135 (25) 38 (7) 37 (6.9)
25-29 42 (7.1) 110 (18.6) 31 (5.3) 43 (7.3)
30-34 47 (8.1) 108 (18.5) 27 (4.6) 28 (4.8)
35-39 54 (10.2) 93 (17.5) 30 (5.6) 29 (5.5)
40-44 56 (11) 106 (20.8) 25 (4.9) 27 (5.3)
45-49 73 (14.2) 106 (20.6) 29 (5.6) 27 (5.3)
50-54 77 (15.8) 121 (24.8) 20 (4.1) 28 (5.7)
55-59 93 (19.2) 137 (28.2) 22 (4.5) 32 (6.6)
60-64 99 (22.9) 93 (21.5) 6 (1.4) 23 (5.3)
65-69 133 (34.5) 65 (16.8) 4 (1) 18 (4.7)
70-74 130 (41.4) 74 (23.5) 2 (0.6) 14 (4.5)
75-79 174 (77.6) 49 (21.9) 3 (1.3) 5 (2.2)
80-84 202 (127.7) 32 (20.2) 1 (0.6) 12 (7.6)
85 and over 354 (208.4) 60 (35.3) 0 (0) 6 (3.5)
Total 1699 1447 268 430
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 14
Figure 9 shows the five year trend of the increasing percentage of falls and the decreasing
percentage of transport incidents resulting in major trauma.
Figure 9: Five year trend in the number of falls and transport incidents (n=16,124)
The greatest burden of major trauma for people aged 65 years and older is falls (74.2%, n=993),
whilst for those aged under 65 years it is transport incidents (46.6%, n=1167).
The highest incidence of assaults are in the 20-24 years age group (14%, n=38). See Table 6 and
Figures 10-12.
Figure 10: Mechanism of injury by age (n=3844)8
35%
36%
37%
38%
39%
40%
41%
42%
43%
44%
45%
2012-13 2013-14 2014-15 2015-16 2016-17
Perc
enta
ge b
y m
echanis
m
Financial year
Falls
Transportincident
0
50
100
150
200
250
300
350
400
Num
ber
of
patients
Age group
Falls
Transport incident
Assault
All other mechanisms
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 15
Figure 11: Mechanism of injury as a percentage by age (n=3844)8
Figure 12: Age-specific injury rate by mechanism of injury (n=2042)8,9
Falls were responsible for 50.2% of the injuries in the metropolitan area, compared to 29% in rural
areas.
Transport incidents accounted for a higher percentage of injuries in rural areas, 52.2%, than in
metropolitan areas, 32.1% (Table 7, Figures 13-14).
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Perc
enta
ge b
y age
Age group
Falls
Transport incident
Assault
All othermechanisms
0
20
40
60
80
100
120
140
160
180
200
220
Age-s
pecific
rate
(in
jury
/100,0
00)
Age group
Falls
Transport incident
Assault
All other mechanisms
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 16
Table 7: Mechanism of injury by location (n=3638)4
Mechanism of Injury Metropolitan
(% of metropolitan) Rural
(% of rural)
Falls 1360 (50.2%) 269 (29.0%)
Transport incident 870 (32.1%) 485 (52.2%)
Assault 197 (7.3%) 48 (5.2%)
All other mechanisms 282 (10.4%) 127 (13.7%)
Total 2709 (74.5%) 929 (25.5%)
Figure 13: Mechanism of injury by location (n=3638)4
Figure 14: Mechanism of injury as a percentage by location (n=3638)4
1360
870
197282269
485
48127
0
200
400
600
800
1000
1200
1400
1600
Falls Transport incident Assault All other mechanisms
Num
ber
of
patients
Mechanism of injury
Metro
Rural
50.2%
32.1%
7.3%10.4%
29.0%
52.2%
5.2%
13.7%
0%
10%
20%
30%
40%
50%
60%
Falls Transport incident Assault All other mechanisms
Perc
enta
ge b
y lo
cation
Mechanim of injury
Metro
Rural
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 17
The mechanisms of injury are outlined in more detail in Tables 7-10.
Falls from a standing height (lowest level, <1m) accounted for the greatest burden of all heights.
They accounted for 61.4% of all falls, 26.6% of all trauma mechanisms, 41.4% of all trauma
deaths, and had case fatality rate for ISS >12 of 13.7% (Table 8).
Table 8: Falls in detail (n=1669)
Mechanism Number injured
(% of all mechanisms)
Number of deaths, ISS >12
(case fatality rate)
Percentage of all trauma deaths
Low (<1m) 1024 (26.6%) 121 (13.7%) 41.4%
Medium (1-5m) 488 (12.7%) 37 (8.3%) 10.5%
High (>5m) 123 (3.2%) 12 (10.2%) 2.8%
Unspecified 34 (0.9%) 0 (0%) 0%
Total 1669 (43.4%) 170 (11.5%) 54.7%
Pedestrian trauma had the highest case fatality rate for ISS >12 (17%), well above other forms of
road trauma (Table 9).
Table 9: Transport incidents in detail (n=1447)
Mechanism Number injured
(% of all mechanisms)
Number of deaths, ISS >12
(case fatality rate)
Percentage of all trauma deaths
Car occupant 522 (13.6%) 38 (8.2%) 9.8%
Motorcycle rider 410 (10.7%) 13 (3.4%) 3%
Pedestrian 220 (5.7%) 35 (17%) 8.4%
Pedal cyclist 159 (4.1%) 1 (0.6%) 0.2%
All other transport 136 (3.5%) 3 (2.5%) 0.7%
Total 1447 (37.6%) 90 (6.7%) 22.2%
The most common mechanisms of injury in the assault group were assaults involving bodily force
(n=97, 2.5%), stabbing (n=43, 1.1%), and assault by blunt object (n=35, 0.9%). In comparison
there were only 13 recorded cases of shooting (0.3%), however these resulted in the highest case
fatality rate for ISS >12 in the assault group, at 23.1% (Table 10).
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 18
Table 10: Assaults in detail (n=225)
Mechanism Number injured
(% of all mechanisms)
Number of deaths, ISS >12
(case fatality rate)
Percentage of all trauma deaths
Bodily force 97 (2.5%) 3 (3.1%) 0.7%
Stabbing 43 (1.1%) 5 (11.6%) 1.2%
Blunt object 35 (0.9%) 2 (5.7%) 0.5%
Shooting 13 (0.3%) 3 (23.1%) 0.7%
All other assaults 37 (1%) 5 (13.5%) 1.4%
Total 225 (5.9%) 18 (8%) 4.4%
Of the other mechanisms of injury, self-harm was the most common (n=131, 3.4%). Drownings and
self-harm had the highest case fatality rate for ISS >12 in the ‘all other mechanisms’ group at 46.2%
and 33.3% respectively (Table 11).
Table 11: All other mechanisms in detail (n=431)
Mechanism Number injured
(% of all mechanisms)
Number of deaths, ISS >12
(case fatality rate)
Percentage of all trauma deaths
Self-harm 131 (3.4%) 31 (33.3%) 8.2%
Inanimate mechanical forces12
84 (2.2%) 4 (5.9%) 0.9%
Burns 76 (2%) 7 (18.4%) 2.3%
Animate mechanical forces13
61 (1.6%) (0%) 0%
Other 41 (1.1%) 6 (22.2%) 1.6%
Drownings 38 (1%) 12 (46.2%) 2.8%
Total 431 (11.2%) 60 (19.9%) 15.9%
12 Inanimate forces include contact with, struck by, striking against, thrown against, caught, crushed, jammed or pinched in or between
inanimate objects. 13 Animate forces include hit, struck, kicked, twisted, bitten or scratched by another person (accidental) or animal.
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 19
Transport incidents by place of occurrence
In order to provide a greater analysis of the burden road trauma has on the health system, a ‘place
of occurrence’ code qualifier was applied to all transport incidents resulting in two categories: road
trauma; and other transport incidents. For the purpose of this report, road trauma is defined as a
transport incident which occurred on a street, highway or other paved roadway.14
Road trauma accounts for 28.9% (n=1112) of all mechanisms of injury, the second highest behind falls
at 43.4% (n=1669). The rate of ‘road trauma’ and ‘other transport incidents’ were higher in rural areas,
36.3% and 13.1% respectively, than in metropolitan areas, 26.4% and 4.6% respectively (Table 12).
Table 12: Transport incidents by location of injury (n=1447)
Mechanism of Injury (place of occurrence)
Metropolitan (% of metropolitan)
Rural (% of rural)
Unknown location (% of unknown)
Road trauma 715 (26.4%) 337 (36.3%) 60 (29.0%)
Other transport incidents 124 (4.6%) 122 (13.1%) 12 (5.8%)
Unspecified place of occurrence
31 (1.1%) 26 (2.8%) 20 (9.7%)
Total 870 485 92
Injuries to car occupants remains the highest mechanism of injury in the road trauma group
(n=491, 12.8%) with pedestrian trauma having the highest case fatality rate for ISS >12 (16.5%),
well above other forms of road trauma (Table 13).
Table 13: Road trauma in detail14 (n=1112)
Mechanism Number injured
(% of all mechanisms)
Number of deaths, ISS >12
(case fatality rate)
Percentage of all trauma deaths
Car occupant 491 (12.8%) 37 (8.4%) 9.6%
Motorcycle rider (incl. passengers)
295 (7.7%) 12 (4.4%) 2.8%
Pedestrian 189 (4.9%) 29 (16.5%) 7.2%
Pedal cyclist 112 (2.9%) 1 (0.9%) 0.2%
All other road transport15
25 (0.7%) 2 (10%) 0.5%
Total 1112 (28.9%) 81 (7.9%) 19.6%
14 See Glossary for a detailed definition of ‘road trauma’ and ‘other transport incident’. 15 Includes other forms of land transport such as three-wheeler and quad bikes (all-terrain vehicles).
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 20
The most common mechanisms in the ‘other transport incidents’14 group were motorcycle collisions
(n=115), other land transport incidents (n=108), pedal cyclists (n=47), and pedestrians (n=31). Of
the ‘Other land transport’ group, animal-rider or animal-drawn vehicle were the most common
(n=61) followed by all-terrain vehicle incidents (n=34) (Table 14).
Table 14: Other transport incidents in detail14 (n=335)
Other transport incidents include incidents being reported as occurring NOT on a street, highway
or other paved roadway.
Mechanism Number injured
(% of all mechanisms)
Number of deaths, ISS >12
(case fatality rate)
Percentage of all trauma deaths
Motorcycle rider 115 (3%) 1 (0.9%) 0.2%
Other land transport 108 (2.8%) 2 (2.0%) 0.5%
Pedal cyclist 47 (1.2%) 0 (0%) 0%
Pedestrian 31 (0.8%) 5 (16.7%) 1.2%
Water transport 13 (0.3%) 0 (0%) 0%
Car occupant 11 (0.3%) 0 (0%) 0%
Air and space 8 (0.2%) 0 (0%) 0%
Occupant of heavy transport vehicle
1 (0%) 0 (0%) 0%
Occupant of pick-up truck or van
1 (0%) 0 (0%) 0%
Total 335 (8.7%) 8 (2.6%) 1.9%
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 21
Time and day of injury
Of note is that 56% of patients (n=1847) were injured between 11 am and 7 pm, which resulted in
peak activity in the hospitals during the afternoon and evening (Figure 15).
Figure 15: Number of patients by time of injury (n=3303)16
The mean daily number of persons injured on a weekday was 9.5. The number of persons injured
on weekends was higher, with a mean of 13.0 per day (Figure 16).17
Figure 16: Number of patients by day of injury (n=3845)17
16 542 records excluded due to no valid time of injury being recorded.
17 In the reporting period there were 261 week days and 104 weekend days.
0
50
100
150
200
250
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Num
ber
of
patients
Time of day
626
475456 473
522565
728
0
100
200
300
400
500
600
700
800
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Num
ber
of
patients
Day of the week
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 22
Injuries
Three or more fractured ribs without a flail segment18 continued to be the most common single
serious injury sustained (15.7%, n=603) where the AIS severity was greater than 2 (Table 15).
Cerebral haematomas occupied three of the top five injuries.
Table 15: Top 5 injuries with an AIS severity >2 (n=3845)
Injury description AIS
severity
Number of patients
(% of total)
Fractured ≥3 ribs without flail18 3 603 (15.7%)
Cerebrum hematoma - subdural - small; moderate 4 187 (4.9%)
Cerebrum hematoma - subdural - tiny 3 123 (3.2%)
Thoracic fracture without cord involvement - vertebral body - major 3 101 (2.6%)
Cerebrum hematoma - subdural - large; massive; extensive 5 65 (1.7%)
In addition, 61% of major trauma patients sustained injuries to the head or neck body region, with
the chest region injured in 49.2% of major trauma patients (Figure 17).
Figure 17: All injuries by ISS body region (n=3845)
18 Flail is defined as three or more ribs fractured in more than one location and/or resulting in paradoxical chest movement. Ref:
Abbreviated Injury Scale 2005 (Update 2008) Dictionary. Association of the Advancement of Automotive Medicine (AAAM). Barrington,
IL, 2008.
61.0%
17.9%
49.2%
24.9%
41.4%
57.1%
0%
10%
20%
30%
40%
50%
60%
70%
Head or neck Face Chest Abdominal or pelviccontents
Extremities orpelvic girdle
External
Perc
enta
ge o
f to
tal patients
ISS body region
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 23
The majority of major trauma patients (80.4%) sustained serious injury (AIS severity >2) to only
one ISS body region (Table 16).
Table 16: Number of ISS body regions injured with an AIS severity >2 (n=3845)
Number of ISS body regions injured with an
AIS severity >2
Number of patients (% of total)
(All ISS)
Number of patients (% of total) (ISS >12)
0 258 (7.2%) 1 (0.03%)
1 2884 (80.4%) 2659 (79.1%)
2 592 (16.5%) 592 (17.6%)
3 95 (2.6%) 95 (2.8%)
4 15 (0.4%) 15 (0.4%)
5 1 (0.03%) 1 (0.03%)
Moreover, 19.6% of major trauma patients sustained polytrauma, defined as sustaining serious injury
(AIS severity >2) in two or more ISS body regions19 (Table 17).
Table 17: Single body region versus polytrauma with an AIS severity >2 (n=3587)20
Number of patients – All ISS
(% of total) Case fatality rate
(ISS >12)
Single body region 2884 (80.4%) 8.6%
Polytrauma 703 (19.6%) 16.2%
19 Butcher, N.E. and Balogh, Z.J. AIS > 2 in at least two body regions: A potential new anatomical definition of polytrauma. Injury. 2012;
43(2): 196-199.
20 258 patients excluded due to sustaining no injuries with an AIS severity >2.
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 24
Injury Severity Score
An ISS of greater than 12 is a key identifier of a major trauma patient. The ISS correlates with
mortality – the higher the ISS, the higher the mortality rate (Table 18). It is important to note that
ISS is only calculated on injuries sustained and does not include other potential contributors to
mortality and morbidity such as patient’s age and comorbidities. The average ISS for all major
trauma patients was 19.0. This increased to 20.6 when excluding those with an ISS less than 13.
Table 18: Major trauma patients by ISS group (n=3840)21
ISS group Number of patients
(% of total) Number of deaths (case fatality rate)
ISS <13 477 (12.4%) 80 (16.8%)22
ISS 13-15 914 (23.8%) 14 (1.5%)
ISS 16-24 1497 (39%) 57 (3.8%)
ISS 25-40 842 (21.9%) 216 (25.7%)
ISS 41-75 110 (2.9%) 56 (50.9%)
The serious injury category (ISS 16-24) contained the highest number of injured at 1497 (39%),
followed by the moderate injury category (ISS 13-15) which had 914 (23.8%) injured and the
severe injury category (ISS 25-40) had 842 (21.9%) (Figure 18).
Figure 18: Number of major trauma patients by ISS group and gender (n=3840)24
21 5 records were excluded due to no ISS recorded. 22 Patients with an ISS <13 are included only if they had an ICU admission or died. Other survivors in this group are not collected,
therefore the case fatality rate for this group cannot be accurately calculated and may be misleading.
340
640
1109
569
81137
274
388
273
29
0
100
200
300
400
500
600
700
800
900
1000
1100
1200
ISS < 13 ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75
Num
ber
of
patients
ISS group
Male
Female
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 25
Females had a higher case fatality rate than males in all ISS groups (Figure 19). Overall the case
fatality rates were higher in females than males (13.2% versus 9.0%).
Figure 19: Case fatality rate by ISS and gender (n=3840)24
Pre-hospital time
The time from injury to arrival at a designated trauma service can have a significant impact on
morbidity and mortality in the major trauma patient cohort. The regional population and geography
of NSW is vastly spread and this impacts on the variation in the time of arrival to a designated
trauma service. Patients who were injured in a metropolitan region arrived at a designated trauma
service faster (74 mins) than those injured in a rural location (128 mins) (Table 19).
Table 19: Median time of injury to arrival at a designated trauma service (n=3638)23
Location of injury Direct from scene Transferred from another hospital
Overall
Metropolitan 74 mins (n=2358) 502 mins (n=351) 80 mins (n=2709)
Rural 128 mins (n=619) 538 mins (n=310) 181 mins (n=929)
NSW overall 80 mins (n=2977) 517 mins (n=661) 92 mins (n=3638)
See the methodology section of this report for more information regarding the definitions of
metropolitan and rural.
23 207 records excluded as location of injury (metro/rural) unknown.
1.1%3.3%
23.7%
45.7%
2.6%5.2%
29.7%
65.5%
0%
10%
20%
30%
40%
50%
60%
70%
ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75
Case F
ata
lity
Rate
ISS group
Male
Female
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 26
A number of major trauma patients (n=230), who arrived at a designated trauma service, needed to
be transferred to a higher level of care for specialised treatment. While vital, this transfer prolongs the
time before the required (definitive) care can be provided, such as specialised surgery, interventional
radiology or paediatric services. Overall, 835 major trauma patients were transferred from another
acute care facility with a median time of injury to definitive care of 548 minutes (Table 20).
Table 20: Median time of injury to arrival at definitive care (n=3638)23
Location of injury Direct from scene Transferred from another hospital
Overall
Metropolitan 74 mins (n=2255) 512 mins (n=439) 82 mins (n=2709)
Rural 130 mins (n=530) 605 mins (n=396) 229 mins (n=929)
NSW overall 80 mins (n=2785) 548 mins (n=835) 97 mins (n=3638)
Mode of transport
Major trauma patients are transported to a designated trauma service from either the scene of the
injury or from another hospital. Road ambulance was by far the most common mode of transport
(75.9%), with helicopter, fixed wing and private transport also used (Table 21, Figures 20-21).
Table 21: Mode of transport to definitive care24 (n=3814)25
Transport mode Direct from scene of
injury
Transfer from another
acute care facility Total
Road ambulance 2359 (81.1%) 606 (67.3%) 2965 (77.8%)
Fixed wing 1 (0%) 110 (12.2%) 111 (2.9%)
Helicopter 362 (12.4%) 162 (18%) 524 (13.8%)
Private vehicle 183 (6.3%) 2 (0.2%) 185 (4.9%)
Unknown 14 (0.5%) 0 (0%) 14 (0.4%)
Other 4 (0.1%) 11 (1.2%) 15 (0.4%)
Total 2923 891 3814
24 See Glossary for definition of definitive care 25 31 records were excluded where location of injury was recorded as overseas, same facility, or transport mode missing.
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 27
Figure 20: Mode of transport to definitive care when transported direct from the scene of
injury, by injury location (n=2785)
Figure 21: Mode of transport to definitive care when transferred from another acute care
facility, by injury location (n=827)
87.5%
0.0%
7.1%4.9%
0.4% 0.1%
59.1%
0.2%
34.7%
5.7%
0.2% 0.2%0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ambulance Fixed wing Helicopter Private vehicle Unknown Other
Perc
enta
ge o
f to
tal
Mode of transport
Metro
Rural
89.0%
1.1%
8.9%
0.2% 0.0% 0.7%
45.9%
24.6%27.2%
0.3% 0.0% 2.1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ambulance Fixed wing Helicopter Private vehicle Unknown Other
Perc
enta
ge o
f to
tal
Mode of transport
Metro
Rural
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 28
Major trauma admissions
Introduction
The information in this section of the report is based on the number of major trauma admissions to
NSW trauma services (n=3961), not the number of major trauma patients (n=3845), as some
patients were treated in more than one NSW reporting facility. Trauma patient data is discussed in
detail in the Major trauma patients section.
Facility overview
The table below provides an overview of the major trauma admissions for each designated trauma
service together with averages from the three trauma service types (Table 22).
Table 22: Overview of trauma service admissions (n=3961)
Facility Number of admissions
Average age
Average ISS
Case fatality rate (ISS >12)
Adult major trauma services 3004 54.0 19.4 9.7%
John Hunter Hospital 497 50.2 19.5 9.2%
Liverpool Hospital 449 51.8 19.8 9.0%
Royal North Shore Hospital 615 57.4 20.1 11.1%
Royal Prince Alfred Hospital 332 56.0 19.7 7.5%
St George Hospital 347 55.0 20.2 12.3%
St Vincent's Hospital 214 51.9 18.4 7.1%
Westmead Hospital 550 54.2 17.8 9.8%
Paediatric major trauma services 173 7.1 19.1 11.1%
John Hunter Children’s Hospital 25 8.3 14.8 5.9%
Sydney Children's Hospital 64 7.7 17.9 4.0%
The Children's Hospital at Westmead 84 6.3 21.3 17.6%
Regional trauma services 784 53.1 17.8 10.4%
Coffs Harbour Base Hospital 66 48.5 20.2 10.7%
Gosford Hospital 58 59.1 17.6 9.8%
Lismore Base Hospital 65 48.0 20.8 17.2%
Nepean Hospital 114 56.9 13.5 9.3%
Orange Health Service 104 52.3 17.1 8.1%
Port Macquarie Base Hospital 53 52.7 17.4 16.7%
Tamworth Rural Referral Hospital 79 49.9 17.7 3.0%
The Tweed Hospital 40 48.1 21.5 12.5%
Wagga Wagga Base Hospital 59 45.5 16.7 5.7%
Wollongong Hospital 146 59.1 19.0 12.4%
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 29
Admission type
The majority of major trauma patients (76.6%, n=3035) were admitted to a trauma service direct
from the scene of injury, however, there were differences in the admission type between adult and
paediatric patient groups (Table 23).
Table 23: Number of admissions by type (n=3961)
Admission type Number of admissions
(paediatric / adult)
Percentage of admissions
(paediatric / adult)
Direct from scene 139 / 2895 58.4% / 77.8%
Transfer from another acute care facility
99 / 805 41.6% / 21.6%
Unknown and other 0 / 22 0% / 0.6%
Revised Trauma Score
The Revised Trauma Score26 is an early (<24 hours) indicator of trauma outcomes. The lower the
score, the higher is the likelihood of death. There was a negative correlation between the Revised
Trauma Score and ISS, showing that the higher the ISS, the lower the Revised Trauma Score. The
average Revised Trauma Score was 7.1 (Figure 22).
Figure 22: Average Revised Trauma Score by ISS group (n=3689)27
26 See the Glossary for a definition of the Revised Trauma Score.
27 272 records excluded as no Revised Trauma Score was recorded.
7.1
7.77.4
6.3
4.7
0
1
2
3
4
5
6
7
8
All admissions ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75
Avera
ge R
evis
ed T
raum
a S
core
ISS group
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 30
Trauma team activation
Major trauma patients require rapid, thorough and systematic assessment and resuscitation. This
is conducted on arrival by a multidisciplinary team known as a trauma team. The activation of the
trauma team is based on a locally derived set of criteria including mechanism of injury and
physiological parameters. 48.7% of patients who arrived at a trauma service direct from scene
received a full trauma team activation compared to 21.0% of those who were transferred from
another acute care facility (Figure 23).
Figure 23: Trauma team activation by admission type (n=3961)
42.2%
48.7%
21.0%
15.5%
13.7%
21.7%
7.2%
7.3%
6.7%
23.6%20.0%
35.5%
4.7% 3.9%7.6%
6.9% 6.4% 7.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
All admissions (n=3961) Direct from scene (n=3035) Transfer from another acute carefacility (n=904)
Perc
enta
ge o
f adm
issio
ns
Unknown and other
Trauma Team not activated and required
Trauma Team not activated and not required
Trauma Consult
Modified Trauma Team Activation
Full Trauma Team Activation
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 31
The activation of the trauma team increased with severity of injury as expected with 34.0% (n=317)
of the ISS 13-15 group receiving a full trauma team activation compared to 89.6% (n=103) of the
ISS 41-75 group (Figure 24).
Figure 24: Trauma team activation by ISS group (n=3961)
42.2% 42.7%
34.0%
39.5%
48.9%
89.6%
15.5%
11.0%
22.1% 17.0%9.7%
5.2%
7.2%
5.4%
10.1%8.3%
3.8%
23.6% 29.2%
18.9%
23.8%27.9%
4.7%3.3%
3.9%
5.2%5.9%
6.9% 8.3% 11.0% 6.1% 3.8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
All admissions ISS < 13 ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75
Perc
enta
ge o
f adm
issio
ns
Unknown and Other
Trauma Team not activated and required
Trauma Team not activated and not required
Trauma Consult
Modified Trauma Team Activation (MTTA)
Full Trauma Team Activation (FTTA)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 32
Vital signs on arrival to the emergency department
The initial vital signs on arrival to the Emergency Department (ED) are useful indicators of injury
severity and predictors of death. Major trauma patients who presented with hypotension (systolic
blood pressure <100mmHg), a Glasgow Coma Scale <13 or hypothermia (temperature <35°C)
represented a higher proportion of those who died compared to all patients (Figures 25-27).
Figure 25: Initial systolic blood pressure on arrival to the ED and mortality (n=3827) 28
Figure 26: Initial Glasgow Coma Scale on arrival to the ED and mortality (n=3755)29
28 134 records excluded due to systolic blood pressure not being recorded.
29 206 records excluded due to Glasgow Coma Scale not being recorded.
90.7%92.7%
73.6%
9.3% 7.3% 26.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
All patients n=3827 Survived n=3430 Died n= 397
Perc
enta
ge o
f adm
issio
ns
Under 100mmHg
100mmHg and over
17.8%
13.0%
59.4%
5.4%5.2%
6.9%
20.8%
21.3%
16.8%
56.0% 60.6% 17.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
All patients n=3755 Survived n=3361 Died n= 394
Perc
enta
ge o
f adm
issio
ns
15
13-14
9-12
3-8
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 33
Figure 27: Initial temperature on arrival to ED and mortality (n=2747)30
Intensive care unit admissions
Overall 41.7% (n=1648) of major trauma patients received an intensive care unit (ICU) admission,
with the percentage increasing with the level of injury severity (Figure 28). Whilst the number of
ICU admissions may be explained by the level of severity of injury, the complexity of injury and
other factors such as comorbidities may also influence the requirement for an ICU admission.
It is important to note that the ISS <13 group is only included in the report if they have been
admitted to ICU or died, hence the high proportion of ICU admissions in this group.
Figure 28: ICU admission by ISS group (n=3956)31
30 1214 records excluded due to initial temperature not recorded. 31 5 records excluded due to no ISS recorded
88.1% 89.4%
76.3%
5.8% 4.3% 19.5%6.1% 6.3%
4.1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
All patients n=2747 Survived n=2481 Died n=266
Perc
enta
ge o
f adm
issio
ns
>37.5°C
< 35°C
35-37°C
2316
60
790
1037
392
38
1640 420 141 519 482 77
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
All ISS ISS < 13 ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75
ICU admissions
Non ICU admissions
ISS group
Perc
enta
ge
of IS
S g
roup
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 34
Length of stay
The length of stay (LOS) in hospital, and in particular the LOS in an ICU, is an indicator of the
severity and complexity of the injury. The average hospital LOS for major trauma patients was 12.2
days (Table 24).
Table 24: Overview of ICU and hospital length of stay (n=3959)32
Number of patients Average days Median days
ICU LOS 1640 5.4 2.0
Total hospital LOS 3959 12.2 7.0
The average ICU length of stay increased with severity, with ISS 13-15 group being 4.3 days and
ISS 41-75 group being 10.5 days. A similar increasing pattern was also shown in the hospital length
of stay as expected (Table 25).
Table 25: ICU and hospital length of stay by ISS (n=3956)31
ISS group Average ICU LOS
Median ICU LOS
Average hospital LOS
Median hospital LOS
ISS <13 2.61 1.0 9.74 6.0
ISS 13-15 4.30 2.0 8.94 5.0
ISS 16-24 5.02 3.0 11.82 7.0
ISS 25-40 7.81 4.0 16.97 9.0
ISS 41-75 10.53 6.0 17.62 6.0
32 2 records excluded due to missing hospital LOS
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 35
No considerable change was observed in the median values of ICU LOS and hospital LOS across
different age groups (Table 26).
Table 26: ICU and hospital length of stay by age (n=3960)8
Age group Average ICU LOS
Median ICU LOS
Average hospital LOS
Median hospital LOS
0-4 5.9 2.0 9.6 4
5-9 8.3 3.0 11.8 5
10-14 3.1 1.0 7.8 4
15-19 5.2 2.0 10.2 5
20-24 4.5 2.0 9.6 6
25-29 4.6 2.0 12.2 5
30-34 4.9 3.0 12.8 7
35-39 5.1 2.0 12.8 5
40-44 8.0 3.0 13.5 6
45-49 5.2 2.0 11.7 6
50-54 5.1 3.0 12.1 7
55-59 5.6 2.0 14.2 6
60-64 7.1 3.0 12.8 7
65-69 5.7 2.5 13.2 7
70-74 6.8 4.0 14.0 8
75-79 5.5 3.0 14.0 9
80-84 4.5 3.0 13.6 8
85 and over 3.6 2.0 10.1 7
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 36
Procedures
Despite the serious nature of the injuries sustained by major trauma patients, the number of
surgical or interventional radiology procedures performed was very low. 795 procedures were
performed on 714 patients (18% of all admissions). The highest percentage of procedures were
performed in the ISS 41-75 group (Table 27, Figure 29).
Table 27: Procedures performed by type (n=3961)
Procedure Number of procedures Percentage of total
admissions
Laparotomy 153 3.9%
Open reduction internal fixation 380 9.6%
Thoracotomy 47 1.2%
Craniotomy 147 3.7%
Embolisation 68 1.7%
Total 795 18.0%33
A sharp rise in the proportion of laparotomy and open reduction internal fixation and embolisation
procedures performed is noted in the ISS 41-75 group (Figure 29).
Figure 29: Procedures performed by ISS group (n=3956)31
33 The total percentage of admissions where a surgical procedure(s) was performed is based on the number of admissions where one
or more procedures were performed (n=714), not the total number of procedures performed (n=795).
0%
5%
10%
15%
20%
25%
All ISS ISS < 13 ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75
Laparotomy
ORIF
Thoracotomy
Craniotomy
Embolisation
ISS group
Perc
enta
ge
of IS
S g
roup
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 37
Over the last five years there has been an increased use of embolisation and open reduction
internal fixation procedures, along with a decrease in craniotomy procedures (Figure 30).
Figure 30: Five year trend of procedures performed
Discharge destination of survivors
Survivors of major trauma (n=3533) were discharged to various locations, with home being the
most common (65.8%) followed by rehabilitation at 14.3%. ‘Other’ incorporates locations such as
board and care, burns centre, foster care, residential institution, missing and unknown (Figure 31).
Figure 31: Discharge destination of survivors (n=3532)34
34 1 record excluded due to missing discharge destination
0
50
100
150
200
250
300
350
400
450
2012-13 2013-14 2014-15 2015-16 2016-17
Num
ber
of
pro
cedure
s
Financial years
Laparotomy
ORIF
Thoracotomy
Craniotomy
Embolisation
65.8%
8.1% 8.0%
3.9%
14.3%
0%
10%
20%
30%
40%
50%
60%
70%
Home Acute care facility Intermediate carefacility
Other Rehabilitation
Home
Acute care facility
Intermediate care facility
Other
Rehabilitation
Discharge destination
Perc
enta
ge
of to
tal
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 38
The rate of discharge home decreased as the injury severity increased, coinciding with an increase
in the rate of discharge to rehabilitation services (Figure 32).
Figure 32: Discharge destination of survivors by ISS group (n=3532)34
74.0%79.2%
66.9%
43.0%
27.1%
3.5%
4.1%
9.6%
12.2%
15.3%
8.5%
5.1%
7.5%
12.8%
10.2%
5.8% 3.1%
3.5%
4.4%
5.1%
8.3% 8.5%12.5%
27.7%
42.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ISS < 13 ISS 13-15 ISS 16-24 ISS 25-40 ISS 41-75
Rehabilitation
Other
Intermediate carefacility
Acute care facility
Home
ISS group
Perc
enta
ge o
f IS
S g
roup
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 39
Appendices
List of appendices
Appendix 1: Data completeness
Appendix 2: Adult major trauma service summaries
Appendix 3: Paediatric major trauma service summaries
Appendix 4: Regional trauma service summaries
Appendix 5: Calculation of the Injury Severity Score
Appendix 6: Australian Statistical Geography Standard Remoteness Areas
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 40
Appendix 1: Data completeness
High levels of data accuracy and entry completion, as entered by the trauma facilities, is crucial in
enabling accurate and thorough data analysis as part of a broader trauma quality assurance
program. The average overall data completion of mandatory data elements completed was 87.4%
with completion rates ranging from 81% to 93.5% (Figure 33).
Figure 33: Overall data completeness by facility
A detailed breakdown of data completion by facility, showing each mandatory data element can be
seen in Table 28.
89.2%
81.0%
84.1%
84.5%
85.2%
86.5%
84.5%
85.2%
89.3%
87.5%
93.5%
88.7%
91.2%
90.5%
89.5%
87.6%
84.0%
90.1%
88.9%
88.7%
70% 75% 80% 85% 90% 95%
Coffs Harbour Health Campus
Gosford Hospital
John Hunter Children's Hopsital
John Hunter Hospital
Lismore Base Hospital
Liverpool Hospital
Nepean Hospital
Orange Health Service
Port Macquarie Base Hospital
Royal North Shore Hospital
Royal Prince Alfred Hospital
St George Hospital
St Vincent's Hospital
Sydney Children's Hospital
Tamworth Hospital
Children's Hospital at Westmead
The Tweed Hospital
Wagga Wagga Rural Referral Hospital
Westmead Hospital
Wollongong Hospital
Overall datacompleteness
Average (87.4%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 41
Table 28: Detailed data completeness by facility
Legend: Percentage complete 100% 80-99% 60-79% Less than 60%
Data field
Coffs Harbour Health Campus
Gosford Hospital
John Hunter Children's Hopsital
John Hunter Hospital
Lismore Base Hospital
Liverpool Hospital
Nepean Hospital
Orange Health Service
Port Macquarie Base Hospital
Royal North Shore Hospital
Royal Prince Alfred Hospital
St George Hospital
St Vincent's Hospital
Sydney Children's Hospital
Tamw
orth Hospital
Children's Hospital at Westm
ead
The Tweed Hospital
Wagga W
agga Rural Referral Hospital
Westm
ead Hospital
Wollongong Hospital
Trauma ID
Age
Gender
Post code home
Post code injury
Injury date
Injury time
Primary cause of injury
Injury type
Injury place
Injury activity
Fall height
Scene agency
Scene mode
PH agency Run No.
PH agency call received date
PH agency call received time
PH agency arrive at patient date
PH agency arrive at patient time
Ph agency depart location date
PH agency depart location time
Admission date
Admission time
System access
ED arrival date
ED arrival time
ED depart date
ED depart time
Trauma response
Post ED disposition
Resp assisted
Resp assit type
Intubated
Intubation method
Paralytic agent
Sedation
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 42
Legend: Percentage complete 100% 80-99% 60-79% Less than 60%
Data field
Coffs Harbour Health Campus
Gosford Hospital
John Hunter Children's Hopsital
John Hunter Hospital
Lismore Base Hospital
Liverpool Hospital
Nepean Hospital
Orange Health Service
Port Macquarie Base Hospital
Royal North Shore Hospital
Royal Prince Alfred Hospital
St George Hospital
St Vincent's Hospital
Sydney Children's Hospital
Tamw
orth Hospital
Children's Hospital at Westm
ead
The Tweed Hospital
Wagga W
agga Rural Referral Hospital
Westm
ead Hospital
Wollongong Hospital
ED vitals - Heart rate
ED vitals - Resp rate
ED vitals - DBP
ED vitals - SBP
ED vitals - Temperature
ED vitals - SA02
ED vitals - GCS eye
ED vitals - GCS verbal
ED vitals - GCS motor
ED vitals - GCS total
ED vitals - RTS total
Ref hospital 1 arrival date
Ref hospital 1 arrival time
Ref hosp 1 trnfer rationale
Ref hosp 1 hospital procedures
Ref hospital 2 arrival date
Ref hospital 2 arrival time
Ref hosp 2 trnfer rationale
Ref hosp 2 procedures
Inter-facility 1 trnfer agency
Inter-facility 1 mode
Inter-facility 2 trnfer agency
Inter-facility 2 mode
Location tracking depts
Location tracking arrival dates
Location tracking arrival times
Procedure date/time
AIS codes
ISS
Outcome (discharge disposition)
Location of death
Discharge date
Discharge time
ICU length of stay
Hospital length of stay
Discharge to
Discharge facility
QA filter codes
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 43
Appendix 2: Adult major trauma service summaries
Table 29: Trauma data profile, John Hunter Hospital
Facility Peer
Total admissions 497 429
Mean monthly admissions 41.4 36
Case fatality rate (ISS >12) 9.2% 9.7%
Gender
Female / Male 129 / 368 124 / 305
Age ranges
Mean age 50.2 54.0
0-4 0 (0.0%) 1 (0.3%)
5-9 0 (0.0%) 0 (0.0%)
10-14 0 (0.0%) 0 (0.1%)
15-19 30 (6.0%) 21 (4.9%)
20-24 46 (9.3%) 33 (7.8%)
25-29 30 (6.0%) 28 (6.6%)
30-34 35 (7.0%) 26 (6.1%)
35-39 34 (6.8%) 24 (5.6%)
40-44 36 (7.2%) 25 (5.9%)
45-49 39 (7.8%) 28 (6.4%)
50-54 37 (7.4%) 29 (6.7%)
55-59 38 (7.6%) 32 (7.4%)
60-64 28 (5.6%) 26 (6.0%)
65-69 41 (8.2%) 27 (6.2%)
70-74 26 (5.2%) 25 (5.9%)
75-79 20 (4.0%) 27 (6.2%)
80-84 21 (4.2%) 28 (6.6%)
85 and over 36 (7.2%) 49 (11.4%)
Injury Severity Score ranges
Mean ISS 19.5 19.4
ISS <13 29 (5.8%) 46 (10.7%)
ISS 13-15 121 (24.3%) 102 (23.8%)
ISS 16-24 216 (43.5%) 170 (39.7%)
ISS 25-40 117 (23.5%) 97 (22.6%)
ISS 41-75 14 (2.8%) 14 (3.2%)
Mechanisms of injury
Assault 32 (6.4%) 31 (7.2%)
Falls 162 (32.6%) 194 (45.3%)
Falls (≥65 years) 98 (19.7%) 116 (27.0%)
Road trauma 162 (32.6%) 126 (29.5%)
Other transport incident 87 (17.5%) 33 (7.7%)
All other injuries 54 (10.9%) 44 (10.3%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 44
Facility Peer
Types of injury
Blunt 463 (93.2%) 401 (93.5%)
Penetrating 21 (4.2%) 17 (4.0%)
Other and unknown 13 (2.6%) 11 (2.5%)
Admission type
Direct admission 339 (68.2%) 329 (76.7%)
Transfer in 158 (31.8%) 98 (22.7%)
Unknown 0 (0.0%) 2 (0.5%)
Arrival modes
Ambulance 355 (71.4%) 335 (78.2%)
Helicopter 90 (18.1%) 47 (10.9%)
Other (private vehicle, fixed wing, unknown) 52 (10.5%) 47 (10.9%)
Revised Trauma Score
Mean - overall 7.1 7.1
ISS <13 6.8 6.8
ISS 13-15 7.7 7.6
ISS 16-24 7.5 7.4
ISS 25-40 6.3 6.4
ISS 41-75 4.7 4.7
Hospital length of stay
Total bed days 5723 5780
Mean - overall 11.5 13.5
ISS <13 10.5 10.4
ISS 13-15 8.3 9.5
ISS 16-24 10.3 12.8
ISS 25-40 16.3 19.6
ISS 41-75 19.1 18.0
ICU length of stay
ICU total bed days (number of ICU admissions) 921 (186) 1,055 (181)
Mean - overall 5.0 5.8
ISS <13 1.6 2.8
ISS 13-15 2.5 4.4
ISS 16-24 4.6 5.3
ISS 25-40 6.8 8.2
ISS 41-75 9.9 9.6
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 826 (108) 769 (123)
Mean - overall 7.6 6.3
ISS <13 2.1 2.9
ISS 13-15 3.2 4.6
ISS 16-24 5.2 5.8
ISS 25-40 11.1 8.5
ISS 41-75 9.7 7.1
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 45
Table 30: Trauma data profile, Liverpool Hospital
Facility Peer
Total admissions 449 429
Mean monthly admissions 37.4 36
Case fatality rate (ISS >12) 9.0% 9.7%
Gender
Female / Male 121 / 328 124 / 305
Age ranges
Mean age 51.8 54.0
0-4 0 (0.0%) 1 (0.3%)
5-9 0 (0.0%) 0 (0.0%)
10-14 1 (0.2%) 0 (0.1%)
15-19 29 (6.5%) 21 (4.9%)
20-24 45 (10.0%) 33 (7.8%)
25-29 32 (7.1%) 28 (6.6%)
30-34 27 (6.0%) 26 (6.1%)
35-39 25 (5.6%) 24 (5.6%)
40-44 30 (6.7%) 25 (5.9%)
45-49 25 (5.6%) 28 (6.4%)
50-54 24 (5.3%) 29 (6.7%)
55-59 31 (6.9%) 32 (7.4%)
60-64 26 (5.8%) 26 (6.0%)
65-69 32 (7.1%) 27 (6.2%)
70-74 21 (4.7%) 25 (5.9%)
75-79 34 (7.6%) 27 (6.2%)
80-84 27 (6.0%) 28 (6.6%)
85 and over 40 (8.9%) 49 (11.4%)
Injury Severity Score ranges
Mean ISS 19.8 19.4
ISS <13 34 (7.7%) 46 (10.7%)
ISS 13-15 112 (25.2%) 102 (23.8%)
ISS 16-24 190 (42.8%) 170 (39.7%)
ISS 25-40 89 (20.0%) 97 (22.6%)
ISS 41-75 19 (4.3%) 14 (3.2%)
Mechanisms of injury
Assault 43 (9.6%) 31 (7.2%)
Falls 189 (42.1%) 194 (45.3%)
Falls (≥65 years) 109 (24.3%) 116 (27.0%)
Road trauma 155 (34.5%) 126 (29.5%)
Other transport incident 23 (5.1%) 33 (7.7%)
All other injuries 39 (8.7%) 44 (10.3%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 46
Facility Peer
Types of injury
Blunt 426 (94.9%) 401 (93.5%)
Penetrating 22 (4.9%) 17 (4.0%)
Other and Unknown 1 (0.2%) 11 (2.5%)
Admission type
Direct admission 379 (84.4%) 329 (76.7%)
Transfer in 70 (15.6%) 98 (22.7%)
Unknown 0 (0.0%) 2 (0.5%)
Arrival modes
Ambulance 335 (74.6%) 335 (78.2%)
Helicopter 50 (11.1%) 47 (10.9%)
Other (private vehicle, fixed wing, unknown) 64 (14.3%) 47 (10.9%)
Revised Trauma Score
Mean - overall 7.0 7.1
ISS <13 6.5 6.8
ISS 13-15 7.7 7.6
ISS 16-24 7.3 7.4
ISS 25-40 6.2 6.4
ISS 41-75 5.4 4.7
Hospital length of stay
Total bed days 5694 5780
Mean - overall 12.7 13.5
ISS <13 12.7 10.4
ISS 13-15 8.3 9.5
ISS 16-24 13.6 12.8
ISS 25-40 16.4 19.6
ISS 41-75 14.7 18.0
ICU length of stay
ICU total bed days (number of ICU admissions) 908 (138) 1055 (181)
Mean - overall 6.6 5.8
ISS <13 3.6 2.8
ISS 13-15 6.9 4.4
ISS 16-24 7.1 5.3
ISS 25-40 7.6 8.2
ISS 41-75 8.2 9.6
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 669 (135) 769 (123)
Mean - overall 5.0 6.3
ISS <13 3.0 2.9
ISS 13-15 7.0 4.6
ISS 16-24 4.5 5.8
ISS 25-40 5.9 8.5
ISS 41-75 5.3 7.1
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 47
Table 31: Trauma data profile, Royal North Shore Hospital
Facility Peer
Total admissions 615 429
Mean monthly admissions 51.3 36
Case fatality rate (ISS >12) 11.1% 9.7%
Gender
Female / Male 184 / 431 124 / 305
Age ranges
Mean age 57.4 54.0
0-4 3 (0.5%) 1 (0.3%)
5-9 1 (0.2%) 0 (0.0%)
10-14 1 (0.2%) 0 (0.1%)
15-19 25 (4.1%) 21 (4.9%)
20-24 37 (6.0%) 33 (7.8%)
25-29 35 (5.7%) 28 (6.6%)
30-34 28 (4.6%) 26 (6.1%)
35-39 31 (5.0%) 24 (5.6%)
40-44 26 (4.2%) 25 (5.9%)
45-49 43 (7.0%) 28 (6.4%)
50-54 39 (6.3%) 29 (6.7%)
55-59 46 (7.5%) 32 (7.4%)
60-64 48 (7.8%) 26 (6.0%)
65-69 27 (4.4%) 27 (6.2%)
70-74 38 (6.2%) 25 (5.9%)
75-79 43 (7.0%) 27 (6.2%)
80-84 52 (8.5%) 28 (6.6%)
85 and over 92 (15.0%) 49 (11.4%)
Injury Severity Score ranges
Mean ISS 20.1 19.4
ISS <13 100 (16.3%) 46 (10.7%)
ISS 13-15 101 (16.4%) 102 (23.8%)
ISS 16-24 206 (33.5%) 170 (39.7%)
ISS 25-40 184 (29.9%) 97 (22.6%)
ISS 41-75 24 (3.9%) 14 (3.2%)
Mechanisms of injury
Assault 22 (3.6%) 31 (7.2%)
Falls 319 (51.9%) 194 (45.3%)
Falls (≥65 years) 198 (32.2%) 116 (27.0%)
Road trauma 154 (25.0%) 126 (29.5%)
Other transport incident 40 (6.5%) 33 (7.7%)
All other injuries 80 (13.0%) 44 (10.3%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 48
Facility Peer
Types of injury
Blunt 553 (89.9%) 401 (93.5%)
Penetrating 14 (2.3%) 17 (4.0%)
Other and unknown 48 (7.8%) 11 (2.5%)
Admission type
Direct admission 401 (65.2%) 329 (76.7%)
Transfer in 213 (34.6%) 98 (22.7%)
Unknown 0 (0.0%) 2 (0.5%)
Arrival modes
Ambulance 459 (74.6%) 335 (78.2%)
Helicopter 78 (12.7%) 47 (10.9%)
Other (private vehicle, fixed wing, unknown) 78 (12.7%) 47 (10.9%)
Revised Trauma Score
Mean - overall 7.1 7.1
ISS <13 7.3 6.8
ISS 13-15 7.6 7.6
ISS 16-24 7.4 7.4
ISS 25-40 6.8 6.4
ISS 41-75 4.4 4.7
Hospital length of stay
Total bed days 10,780 5,780
Mean - overall 17.5 13.5
ISS <13 11.2 10.4
ISS 13-15 9.7 9.5
ISS 16-24 15.4 12.8
ISS 25-40 26.9 19.6
ISS 41-75 23.8 18.0
ICU length of stay
ICU total bed days (number of ICU admissions) 2,262 (395) 1,055 (181)
Mean - overall 5.7 5.8
ISS <13 2.9 2.8
ISS 13-15 4.2 4.4
ISS 16-24 4.2 5.3
ISS 25-40 8.8 8.2
ISS 41-75 9.9 9.6
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 1,251 (177) 769 (123)
Mean - overall 7.1 6.3
ISS <13 3.9 2.9
ISS 13-15 6.2 4.6
ISS 16-24 5.3 5.8
ISS 25-40 9.2 8.5
ISS 41-75 7.3 7.1
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 49
Table 32: Trauma data profile, Royal Prince Alfred Hospital
Facility Peer
Total admissions 332 429
Mean monthly admissions 27.7 36
Case fatality rate (ISS >12) 7.5% 9.7%
Gender
Female / Male 112 / 220 124 / 305
Age ranges
Mean age 56.0 54.0
0-4 0 (0.0%) 1 (0.3%)
5-9 0 (0.0%) 0 (0.0%)
10-14 0 (0.0%) 0 (0.1%)
15-19 14 (4.2%) 21 (4.9%)
20-24 23 (6.9%) 33 (7.8%)
25-29 21 (6.3%) 28 (6.6%)
30-34 22 (6.6%) 26 (6.1%)
35-39 19 (5.7%) 24 (5.6%)
40-44 13 (3.9%) 25 (5.9%)
45-49 17 (5.1%) 28 (6.4%)
50-54 21 (6.3%) 29 (6.7%)
55-59 30 (9.0%) 32 (7.4%)
60-64 20 (6.0%) 26 (6.0%)
65-69 18 (5.4%) 27 (6.2%)
70-74 22 (6.6%) 25 (5.9%)
75-79 29 (8.7%) 27 (6.2%)
80-84 25 (7.5%) 28 (6.6%)
85 and over 38 (11.4%) 49 (11.4%)
Injury Severity Score ranges
Mean ISS 19.7 19.4
ISS <13 26 (7.8%) 46 (10.7%)
ISS 13-15 63 (19.0%) 102 (23.8%)
ISS 16-24 165 (49.7%) 170 (39.7%)
ISS 25-40 68 (20.5%) 97 (22.6%)
ISS 41-75 10 (3.0%) 14 (3.2%)
Mechanisms of injury
Assault 19 (5.7%) 31 (7.2%)
Falls 181 (54.5%) 194 (45.3%)
Falls (≥65 years) 110 (33.1%) 116 (27.0%)
Road trauma 84 (25.3%) 126 (29.5%)
Other transport incident 7 (2.1%) 33 (7.7%)
All other injuries 41 (12.3%) 44 (10.3%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 50
Facility Peer
Types of injury
Blunt 308 (92.8%) 401 (93.5%)
Penetrating 20 (6.0%) 17 (4.0%)
Other and Unknown 4 (1.2%) 11 (2.5%)
Admission type
Direct admission 296 (89.2%) 329 (76.7%)
Transfer in 36 (10.8%) 98 (22.7%)
Unknown 0 (0.0%) 2 (0.5%)
Arrival modes
Ambulance 298 (89.8%) 335 (78.2%)
Helicopter 1 (0.3%) 47 (10.9%)
Other (private vehicle, fixed wing, unknown) 33 (9.9%) 47 (10.9%)
Revised Trauma Score
Mean - overall 7.3 7.1
ISS < 13 7.0 6.8
ISS 13-15 7.7 7.6
ISS 16-24 7.6 7.4
ISS 25-40 6.7 6.4
ISS 41-75 3.9 4.7
Hospital length of stay
Total bed days 4,058 5,780
Mean - overall 12.2 13.5
ISS <13 7.5 10.4
ISS 13-15 11.4 9.5
ISS 16-24 10.8 12.8
ISS 25-40 17.5 19.6
ISS 41-75 17.1 18.0
ICU length of stay
ICU total bed days (number of ICU admissions) 665 (132) 1,055 (181)
Mean - overall 5.0 5.8
ISS <13 2.4 2.8
ISS 13-15 4.5 4.4
ISS 16-24 3.7 5.3
ISS 25-40 7.2 8.2
ISS 41-75 9.3 9.6
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 435 (75) 769 (123)
Mean - overall 5.8 6.3
ISS < 13 2.5 2.9
ISS 13-15 1.5 4.6
ISS 16-24 4.6 5.8
ISS 25-40 7.7 8.5
ISS 41-75 7.5 7.1
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 51
Table 33: Trauma data profile, St George Hospital
Facility Peer
Total admissions 347 429
Mean monthly admissions 28.9 36
Case fatality rate (ISS >12) 12.3% 9.7%
Gender
Female / Male 100 / 247 124 / 305
Age ranges
Mean age 55.0 54.0
0-4 2 (0.6%) 1 (0.3%)
5-9 0 (0.0%) 0 (0.0%)
10-14 1 (0.3%) 0 (0.1%)
15-19 16 (4.6%) 21 (4.9%)
20-24 26 (7.5%) 33 (7.8%)
25-29 21 (6.1%) 28 (6.6%)
30-34 25 (7.2%) 26 (6.1%)
35-39 12 (3.5%) 24 (5.6%)
40-44 16 (4.6%) 25 (5.9%)
45-49 23 (6.6%) 28 (6.4%)
50-54 27 (7.8%) 29 (6.7%)
55-59 27 (7.8%) 32 (7.4%)
60-64 15 (4.3%) 26 (6.0%)
65-69 24 (6.9%) 27 (6.2%)
70-74 24 (6.9%) 25 (5.9%)
75-79 19 (5.5%) 27 (6.2%)
80-84 21 (6.1%) 28 (6.6%)
85 and over 48 (13.8%) 49 (11.4%)
Injury Severity Score ranges
Mean ISS 20.2 19.4
ISS <13 31 (8.9%) 46 (10.7%)
ISS 13-15 84 (24.2%) 102 (23.8%)
ISS 16-24 137 (39.5%) 170 (39.7%)
ISS 25-40 82 (23.6%) 97 (22.6%)
ISS 41-75 13 (3.7%) 14 (3.2%)
Mechanisms of injury
Assault 17 (4.9%) 31 (7.2%)
Falls 172 (49.6%) 194 (45.3%)
Falls (≥65 years) 96 (27.7%) 116 (27.0%)
Road trauma 124 (35.7%) 126 (29.5%)
Other transport incident 18 (5.2%) 33 (7.7%)
All other injuries 16 (4.6%) 44 (10.3%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 52
Facility Peer
Types of injury
Blunt 330 (95.1%) 401 (93.5%)
Penetrating 12 (3.5%) 17 (4.0%)
Other and Unknown 5 (1.4%) 11 (2.5%)
Admission type
Direct admission 247 (71.2%) 329 (76.7%)
Transfer in 100 (28.8%) 98 (22.7%)
Unknown 0 (0.0%) 2 (0.5%)
Arrival modes
Ambulance 275 (79.3%) 335 (78.2%)
Helicopter 42 (12.1%) 47 (10.9%)
Other (private vehicle, fixed wing, unknown) 30 (8.6%) 47 (10.9%)
Revised Trauma Score
Mean - overall 6.7 7.1
ISS <13 6.0 6.8
ISS 13-15 7.8 7.6
ISS 16-24 7.1 7.4
ISS 25-40 5.4 6.4
ISS 41-75 3.4 4.7
Hospital length of stay
Total bed days 5281 5780
Mean - overall 15.2 13.5
ISS <13 9.7 10.4
ISS 13-15 13.5 9.5
ISS 16-24 15.6 12.8
ISS 25-40 19.2 19.6
ISS 41-75 10.3 18.0
ICU length of stay
ICU total bed days (number of ICU admissions) 909 (116) 1,055 (181)
Mean - overall 7.8 5.8
ISS <13 2.1 2.8
ISS 13-15 3.9 4.4
ISS 16-24 7.1 5.3
ISS 25-40 12.4 8.2
ISS 41-75 8.0 9.6
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 902 (116) 769 (123)
Mean - overall 7.8 6.3
ISS < 13 2.5 2.9
ISS 13-15 3.7 4.6
ISS 16-24 7.3 5.8
ISS 25-40 12.2 8.5
ISS 41-75 5.9 7.1
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 53
Table 34: Trauma data profile, St Vincent’s Hospital
Facility Peer
Total admissions 214 429
Mean monthly admissions 17.8 36
Case fatality rate (ISS >12) 7.1% 9.7%
Gender
Female / Male 54 / 160 124 / 305
Age ranges
Mean age 51.9 54.0
0-4 3 (1.4%) 1 (0.3%)
5-9 0 (0.0%) 0 (0.0%)
10-14 0 (0.0%) 0 (0.1%)
15-19 4 (1.9%) 21 (4.9%)
20-24 16 (7.5%) 33 (7.8%)
25-29 19 (8.9%) 28 (6.6%)
30-34 15 (7.0%) 26 (6.1%)
35-39 16 (7.5%) 24 (5.6%)
40-44 16 (7.5%) 25 (5.9%)
45-49 20 (9.3%) 28 (6.4%)
50-54 14 (6.5%) 29 (6.7%)
55-59 17 (7.9%) 32 (7.4%)
60-64 10 (4.7%) 26 (6.0%)
65-69 3 (1.4%) 27 (6.2%)
70-74 15 (7.0%) 25 (5.9%)
75-79 9 (4.2%) 27 (6.2%)
80-84 12 (5.6%) 28 (6.6%)
85 and over 25 (11.7%) 49 (11.4%)
Injury Severity Score ranges
Mean ISS 18.4 19.4
ISS <13 32 (15.0%) 46 (10.7%)
ISS 13-15 56 (26.2%) 102 (23.8%)
ISS 16-24 78 (36.4%) 170 (39.7%)
ISS 25-40 43 (20.1%) 97 (22.6%)
ISS 41-75 5 (2.3%) 14 (3.2%)
Mechanisms of injury
Assault 25 (11.7%) 31 (7.2%)
Falls 115 (53.7%) 194 (45.3%)
Falls (≥65 years) 50 (23.4%) 116 (27.0%)
Road trauma 44 (20.6%) 126 (29.5%)
Other transport incident 7 (3.3%) 33 (7.7%)
All other injuries 23 (10.7%) 44 (10.3%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 54
Facility Peer
Types of injury
Blunt 203 (94.9%) 401 (93.5%)
Penetrating 7 (3.3%) 17 (4.0%)
Other and unknown 4 (1.9%) 11 (2.5%)
Admission type
Direct admission 213 (99.5%) 329 (76.7%)
Transfer in 1 (0.5%) 98 (22.7%)
Unknown 0 (0.0%) 2 (0.5%)
Arrival modes
Ambulance 199 (93.0%) 335 (78.2%)
Helicopter 0 (0.0%) 47 (10.9%)
Other (private vehicle, fixed wing, unknown) 15 (7.0%) 47 (10.9%)
Revised Trauma Score
Mean - overall 7.2 7.1
ISS <13 6.7 6.8
ISS 13-15 7.7 7.6
ISS 16-24 7.6 7.4
ISS 25-40 6.3 6.4
ISS 41-75 6.4 4.7
Hospital length of stay
Total bed days 2255 5780
Mean - overall 10.6 13.5
ISS <13 8.2 10.4
ISS 13-15 6.9 9.5
ISS 16-24 12.1 12.8
ISS 25-40 14.0 19.6
ISS 41-75 17.4 18.0
ICU length of stay
ICU total bed days (number of ICU admissions) 440 (109) 1055 (181)
Mean - overall 4.0 5.8
ISS <13 1.9 2.8
ISS 13-15 4.3 4.4
ISS 16-24 3.8 5.3
ISS 25-40 5.3 8.2
ISS 41-75 15.3 9.6
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 306 (68) 769 (123)
Mean - overall 4.5 6.3
ISS <13 2.3 2.9
ISS 13-15 2.6 4.6
ISS 16-24 5.2 5.8
ISS 25-40 6.0 8.5
ISS 41-75 10.3 7.1
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 55
Table 35: Trauma data profile, Westmead Hospital
Facility Peer
Total admissions 550 429
Mean monthly admissions 45.8 36
Case fatality rate (ISS >12) 9.8% 9.7%
Gender
Female / Male 167 / 383 124 / 305
Age ranges
Mean age 54.2 54.0
0-4 1 (0.2%) 1 (0.3%)
5-9 0 (0.0%) 0 (0.0%)
10-14 0 (0.0%) 0 (0.1%)
15-19 30 (5.5%) 21 (4.9%)
20-24 41 (7.5%) 33 (7.8%)
25-29 41 (7.5%) 28 (6.6%)
30-34 31 (5.6%) 26 (6.1%)
35-39 30 (5.5%) 24 (5.6%)
40-44 39 (7.1%) 25 (5.9%)
45-49 26 (4.7%) 28 (6.4%)
50-54 40 (7.3%) 29 (6.7%)
55-59 33 (6.0%) 32 (7.4%)
60-64 32 (5.8%) 26 (6.0%)
65-69 41 (7.5%) 27 (6.2%)
70-74 30 (5.5%) 25 (5.9%)
75-79 33 (6.0%) 27 (6.2%)
80-84 39 (7.1%) 28 (6.6%)
85 and over 63 (11.5%) 49 (11.4%)
Injury Severity Score ranges
Mean ISS 17.8 19.4
ISS <13 70 (12.7%) 46 (10.7%)
ISS 13-15 176 (32.0%) 102 (23.8%)
ISS 16-24 198 (36.0%) 170 (39.7%)
ISS 25-40 96 (17.5%) 97 (22.6%)
ISS 41-75 10 (1.8%) 14 (3.2%)
Mechanisms of injury
Assault 58 (10.5%) 31 (7.2%)
Falls 223 (40.5%) 194 (45.3%)
Falls (≥65 years) 151 (27.5%) 116 (27.0%)
Road trauma 162 (29.5%) 126 (29.5%)
Other transport incident 49 (8.9%) 33 (7.7%)
All other injuries 58 (10.5%) 44 (10.3%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 56
Facility Peer
Types of injury
Blunt 525 (95.5%) 401 (93.5%)
Penetrating 25 (4.5%) 17 (4.0%)
Other and unknown 0 (0.0%) 11 (2.5%)
Admission type
Direct admission 429 (78.0%) 329 (76.7%)
Transfer in 105 (19.1%) 98 (22.7%)
Unknown 16 (2.9%) 2 (0.5%)
Arrival modes
Ambulance 427 (77.6%) 335 (78.2%)
Helicopter 66 (12.0%) 47 (10.9%)
Other (private vehicle, fixed wing, unknown) 57 (10.4%) 47 (10.9%)
Revised Trauma Score
Mean - overall 7.0 7.1
ISS <13 6.4 6.8
ISS 13-15 7.6 7.6
ISS 16-24 7.2 7.4
ISS 25-40 5.9 6.4
ISS 41-75 5.1 4.7
Hospital length of stay
Total bed days 6,666 5,780
Mean - overall 12.1 13.5
ISS <13 10.7 10.4
ISS 13-15 9.3 9.5
ISS 16-24 12.3 12.8
ISS 25-40 17.2 19.6
ISS 41-75 19.8 18.0
ICU length of stay
ICU total bed days (number of ICU admissions) 1,278 (190) 1,055 (181)
Mean - overall 6.7 5.8
ISS <13 3.7 2.8
ISS 13-15 5.8 4.4
ISS 16-24 8.1 5.3
ISS 25-40 7.9 8.2
ISS 41-75 9.9 9.6
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 995 (179) 769 (123)
Mean - overall 5.6 6.3
ISS < 13 3.1 2.9
ISS 13-15 4.2 4.6
ISS 16-24 7.1 5.8
ISS 25-40 6.3 8.5
ISS 41-75 6.5 7.1
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 57
Appendix 3: Paediatric major trauma service summaries
Table 36: Trauma data profile, John Hunter Children’s Hospital
Facility Peer
Total admissions 25 58
Mean monthly admissions 2.1 5
Case fatality rate (ISS >12) 5.9% 11.1%
Gender
Female / Male 7 / 18 22 / 35
Age ranges
Mean age 8.3 7.1
0-4 9 (36.0%) 24 (40.8%)
5-9 6 (24.0%) 13 (21.8%)
10-14 5 (20.0%) 14 (24.7%)
15-19 5 (20.0%) 7 (12.1%)
Injury Severity Score ranges
Mean ISS 14.8 19.1
ISS <13 8 (32.0%) 13 (22.0%)
ISS 13-15 3 (12.0%) 7 (12.7%)
ISS 16-24 12 (48.0%) 21 (35.8%)
ISS 25-40 1 (4.0%) 14 (24.9%)
ISS 41-75 1 (4.0%) 3 (4.6%)
Mechanisms of injury
Assault 2 (8.0%) 3 (4.6%)
Falls 8 (32.0%) 21 (36.8%)
Road trauma 6 (24.0%) 14 (23.6%)
Other transport incident 3 (12.0%) 4 (6.9%)
All other injuries 6 (24.0%) 16 (28.2%)
Types of injury
Blunt 18 (72.0%) 46 (79.3%)
Penetrating 2 (8.0%) 1 (2.3%)
Other and Unknown 5 (20.0%) 11 (18.4%)
Admission type
Direct admission 17 (68.0%) 29 (50.3%)
Transfer in 8 (32.0%) 29 (49.7%)
Unknown 0 (0.0%) 0 (0.0%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 58
Facility Peer
Arrival modes
Ambulance 16 (64.0%) 31 (53.4%)
Helicopter 3 (12.0%) 8 (13.2%)
Other (private vehicle, fixed wing, unknown) 6 (24.0%) 19 (33.3%)
Revised Trauma Score
Mean - overall 7.0 6.2
ISS <13 7.8 6.3
ISS 13-15 7.8 7.0
ISS 16-24 7.2 6.6
ISS 25-40 0.0 5.1
ISS 41-75 4.1 5.4
Hospital length of stay
Total bed days 119 674
Mean - overall 4.8 11.7
ISS <13 5.9 6.6
ISS 13-15 4.7 4.5
ISS 16-24 3.8 11.8
ISS 25-40 1.0 17.0
ISS 41-75 11.0 26.5
ICU length of stay
ICU total bed days (number of ICU admissions) 22 (12) 227 (38)
Mean - overall 1.8 6.0
ISS <13 1.5 2.6
ISS 13-15 0.0 1.2
ISS 16-24 2.3 4.5
ISS 25-40 0.0 8.8
ISS 41-75 3.0 21.4
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 18 (5) 196 (30)
Mean - overall 3.6 6.6
ISS <13 3.5 3.1
ISS 13-15 0.0 1.8
ISS 16-24 4.0 4.6
ISS 25-40 0.0 8.4
ISS 41-75 3.0 20.6
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Table 37: Trauma data profile, Sydney Children’s Hospital
Facility Peer
Total admissions 64 58
Mean monthly admissions 5.3 5
Case fatality rate (ISS >12) 4.0% 11.1%
Gender
Female / Male 20 / 44 22 / 35
Age ranges
Mean age 7.7 7.1
0-4 26 (40.6%) 24 (40.8%)
5-9 9 (14.1%) 13 (21.8%)
10-14 20 (31.3%) 14 (24.7%)
15-19 9 (14.1%) 7 (12.1%)
Injury Severity Score ranges
Mean ISS 17.9 19.1
ISS <13 14 (21.9%) 13 (22.0%)
ISS 13-15 12 (18.8%) 7 (12.7%)
ISS 16-24 19 (29.7%) 21 (35.8%)
ISS 25-40 19 (29.7%) 14 (24.9%)
ISS 41-75 0 (0.0%) 3 (4.6%)
Mechanisms of injury
Assault 3 (4.7%) 3 (4.6%)
Falls 28 (43.8%) 21 (36.8%)
Road trauma 16 (25.0%) 14 (23.6%)
Other transport incident 5 (7.8%) 4 (6.9%)
All other injuries 12 (18.8%) 16 (28.2%)
Types of injury
Blunt 64 (100.0%) 46 (79.3%)
Penetrating 0 (0.0%) 1 (2.3%)
Other and unknown 0 (0.0%) 11 (18.4%)
Admission type
Direct admission 22 (34.4%) 29 (50.3%)
Transfer in 42 (65.6%) 29 (49.7%)
Unknown 0 (0.0%) 0 (0.0%)
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Facility Peer
Arrival modes
Ambulance 30 (46.9%) 31 (53.4%)
Helicopter 7 (10.9%) 8 (13.2%)
Other (private vehicle, fixed wing, unknown) 27 (42.2%) 19 (33.3%)
Revised Trauma Score
Mean - overall 5.9 6.2
ISS <13 5.5 6.3
ISS 13-15 6.6 7.0
ISS 16-24 6.0 6.6
ISS 25-40 5.6 5.1
ISS 41-75 0.0 5.4
Hospital length of stay
Total bed days 725 674
Mean - overall 11.3 11.7
ISS <13 4.6 6.6
ISS 13-15 3.3 4.5
ISS 16-24 14.6 11.8
ISS 25-40 18.2 17.0
ISS 41-75 0.0 26.5
ICU length of stay
ICU total bed days (number of ICU admissions) 217 (45) 227 (38)
Mean - overall 4.8 6.0
ISS <13 2.1 2.6
ISS 13-15 1.3 1.2
ISS 16-24 5.1 4.5
ISS 25-40 8.0 8.8
ISS 41-75 0.0 21.4
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 146 (36) 196 (30)
Mean - overall 4.1 6.6
ISS < 13 2.0 3.1
ISS 13-15 2.0 1.8
ISS 16-24 5.9 4.6
ISS 25-40 5.3 8.4
ISS 41-75 0.0 20.6
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 61
Table 38: Trauma data profile, The Children’s Hospital at Westmead
Facility Peer
Total admissions 84 58
Mean monthly admissions 7.0 5
Case fatality rate (ISS >12) 17.6% 11.1%
Gender
Female / Male 40 / 44 22 / 35
Age ranges
Mean age 6.3 7.1
0-4 36 (42.9%) 24 (40.8%)
5-9 23 (27.4%) 13 (21.8%)
10-14 18 (21.4%) 14 (24.7%)
15-19 7 (8.3%) 7 (12.1%)
Injury Severity Score ranges
Mean ISS 21.3 19.1
ISS <13 16 (19.0%) 13 (22.0%)
ISS 13-15 7 (8.3%) 7 (12.7%)
ISS 16-24 31 (36.9%) 21 (35.8%)
ISS 25-40 23 (27.4%) 14 (24.9%)
ISS 41-75 7 (8.3%) 3 (4.6%)
Mechanisms of injury
Assault 3 (3.6%) 3 (4.6%)
Falls 28 (33.3%) 21 (36.8%)
Road trauma 19 (22.6%) 14 (23.6%)
Other transport incident 4 (4.8%) 4 (6.9%)
All other injuries 30 (35.7%) 16 (28.2%)
Types of injury
Blunt 56 (66.7%) 46 (79.3%)
Penetrating 2 (2.4%) 1 (2.3%)
Other and unknown 26 (31.0%) 11 (18.4%)
Admission type
Direct admission 48 (57.1%) 29 (50.3%)
Transfer in 36 (42.9%) 29 (49.7%)
Unknown 0 (0.0%) 0 (0.0%)
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Facility Peer
Arrival modes
Ambulance 47 (56.0%) 31 (53.4%)
Helicopter 13 (15.5%) 8 (13.2%)
Other (private vehicle, fixed wing, unknown) 24 (28.6%) 19 (33.3%)
Revised Trauma Score
Mean - overall 6.2 6.2
ISS <13 6.5 6.3
ISS 13-15 7.3 7.0
ISS 16-24 6.7 6.6
ISS 25-40 4.8 5.1
ISS 41-75 5.6 5.4
Hospital length of stay
Total bed days 1,179 674
Mean - overall 14.0 11.7
ISS <13 8.7 6.6
ISS 13-15 6.4 4.5
ISS 16-24 13.2 11.8
ISS 25-40 16.7 17.0
ISS 41-75 28.7 26.5
ICU length of stay
ICU total bed days (number of ICU admissions) 441 (56) 227 (38)
Mean - overall 7.9 6.0
ISS <13 3.6 2.6
ISS 13-15 1.0 1.2
ISS 16-24 4.3 4.5
ISS 25-40 9.4 8.8
ISS 41-75 24.5 21.4
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 424 (48) 196 (30)
Mean - overall 8.8 6.6
ISS <13 4.2 3.1
ISS 13-15 1.0 1.8
ISS 16-24 3.5 4.6
ISS 25-40 10.4 8.4
ISS 41-75 23.5 20.6
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Appendix 4: Regional trauma service summaries
Table 39: Trauma data profile, Coffs Harbour Health Campus
Facility Peer
Total admissions 66 78
Mean monthly admissions 5.5 7
Case fatality rate (ISS >12) 10.7% 10.4%
Gender
Female / Male 17 / 49 20 / 59
Age ranges
Mean age 48.5 53.1
0-4 2 (3.0%) 2 (1.9%)
5-9 0 (0.0%) 1 (0.8%)
10-14 2 (3.0%) 2 (1.9%)
15-19 2 (3.0%) 4 (5.5%)
20-24 4 (6.1%) 5 (5.8%)
25-29 5 (7.6%) 3 (4.2%)
30-34 5 (7.6%) 4 (4.5%)
35-39 4 (6.1%) 5 (5.9%)
40-44 4 (6.1%) 5 (5.9%)
45-49 4 (6.1%) 5 (6.7%)
50-54 5 (7.6%) 6 (7.1%)
55-59 8 (12.1%) 7 (9.0%)
60-64 6 (9.1%) 5 (6.4%)
65-69 5 (7.6%) 4 (5.4%)
70-74 2 (3.0%) 5 (6.2%)
75-79 2 (3.0%) 5 (6.0%)
80-84 2 (3.0%) 5 (6.9%)
85 and over 4 (6.1%) 8 (10.5%)
Injury Severity Score ranges
Mean ISS 20.2 17.8
ISS <13 10 (15.2%) 12 (15.3%)
ISS 13-15 13 (19.7%) 20 (25.0%)
ISS 16-24 23 (34.8%) 30 (38.8%)
ISS 25-40 17 (25.8%) 15 (19.4%)
ISS 41-75 3 (4.5%) 1 (1.5%)
Mechanisms of injury
Assault 3 (4.5%) 5 (6.4%)
Falls 19 (28.8%) 31 (39.2%)
Falls (≥65 years) 9 (13.6%) 19 (24.5%)
Road trauma 33 (50.0%) 24 (31.2%)
Other transport incident 7 (10.6%) 10 (13.1%)
All other injuries 4 (6.1%) 8 (10.1%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 64
Facility Peer
Types of injury
Blunt 59 (89.4%) 74 (94.4%)
Penetrating 3 (4.5%) 3 (4.2%)
Other and unknown 4 (6.1%) 1 (1.4%)
Admission type
Direct admission 65 (98.5%) 64 (82.1%)
Transfer in 1 (1.5%) 14 (17.2%)
Unknown 0 (0.0%) 1 (0.6%)
Arrival modes
Ambulance 60 (90.9%) 64 (81.8%)
Helicopter 3 (4.5%) 5 (5.8%)
Other (private vehicle, fixed wing, unknown) 3 (4.5%) 10 (12.4%)
Revised Trauma Score
Mean - overall 7.0 7.3
ISS <13 7.8 7.4
ISS 13-15 7.8 7.8
ISS 16-24 7.5 7.5
ISS 25-40 5.4 6.5
ISS 41-75 6.3 3.8
Hospital length of stay
Total bed days 314 575
Mean - overall 4.8 7.3
ISS <13 3.8 8.8
ISS 13-15 7.8 7.3
ISS 16-24 5.5 7.8
ISS 25-40 2.1 5.0
ISS 41-75 4.0 8.8
ICU length of stay
ICU total bed days (number of ICU admissions) 96 (25) 82 (26)
Mean - overall 3.8 3.2
ISS <13 1.4 2.2
ISS 13-15 9.0 4.3
ISS 16-24 4.6 3.9
ISS 25-40 2.8 3.0
ISS 41-75 7.0 4.5
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 51 (20) 38 (13)
Mean - overall 2.6 3.1
ISS <13 2.0 2.8
ISS 13-15 6.5 6.4
ISS 16-24 2.2 3.7
ISS 25-40 2.0 2.2
ISS 41-75 2.3 1.7
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 65
Table 40: Trauma data profile, Gosford Hospital
Facility Peer
Total admissions 58 78
Mean monthly admissions 4.8 7
Case fatality rate (ISS >12) 9.8% 10.4%
Gender
Female / Male 12 / 46 20 / 59
Age ranges
Mean age 59.1 53.1
0-4 0 (0.0%) 2 (1.9%)
5-9 2 (3.4%) 1 (0.8%)
10-14 2 (3.4%) 2 (1.9%)
15-19 4 (6.9%) 4 (5.5%)
20-24 1 (1.7%) 5 (5.8%)
25-29 0 (0.0%) 3 (4.2%)
30-34 1 (1.7%) 4 (4.5%)
35-39 1 (1.7%) 5 (5.9%)
40-44 4 (6.9%) 5 (5.9%)
45-49 2 (3.4%) 5 (6.7%)
50-54 6 (10.3%) 6 (7.1%)
55-59 4 (6.9%) 7 (9.0%)
60-64 6 (10.3%) 5 (6.4%)
65-69 2 (3.4%) 4 (5.4%)
70-74 2 (3.4%) 5 (6.2%)
75-79 4 (6.9%) 5 (6.0%)
80-84 4 (6.9%) 5 (6.9%)
85 and over 13 (22.4%) 8 (10.5%)
Injury Severity Score ranges
Mean ISS 17.6 17.8
ISS <13 7 (12.1%) 12 (15.3%)
ISS 13-15 14 (24.1%) 20 (25.0%)
ISS 16-24 24 (41.4%) 30 (38.8%)
ISS 25-40 13 (22.4%) 15 (19.4%)
ISS 41-75 0 (0.0%) 1 (1.5%)
Mechanisms of injury
Assault 5 (8.6%) 5 (6.4%)
Falls 29 (50.0%) 31 (39.2%)
Falls (≥65 years) 18 (31.0%) 19 (24.5%)
Road trauma 13 (22.4%) 24 (31.2%)
Other transport incident 6 (10.3%) 10 (13.1%)
All other injuries 5 (8.6%) 8 (10.1%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 66
Facility Peer
Types of injury
Blunt 56 (96.6%) 74 (94.4%)
Penetrating 2 (3.4%) 3 (4.2%)
Other and Unknown 0 (0.0%) 1 (1.4%)
Admission type
Direct admission 58 (100.0%) 64 (82.1%)
Transfer in 0 (0.0%) 14 (17.2%)
Unknown 0 (0.0%) 1 (0.6%)
Arrival modes
Ambulance 54 (93.1%) 64 (81.8%)
Helicopter 0 (0.0%) 5 (5.8%)
Other (private vehicle, fixed wing, unknown) 4 (6.9%) 10 (12.4%)
Revised Trauma Score
Mean - overall 7.5 7.3
ISS <13 7.8 7.4
ISS 13-15 7.8 7.8
ISS 16-24 7.5 7.5
ISS 25-40 6.9 6.5
ISS 41-75 0.0 3.8
Hospital length of stay
Total bed days 389 575
Mean - overall 6.7 7.3
ISS <13 10.4 8.8
ISS 13-15 4.1 7.3
ISS 16-24 7.2 7.8
ISS 25-40 6.5 5.0
ISS 41-75 0.0 8.8
ICU length of stay
ICU total bed days (number of ICU admissions) 17 (2) 82 (26)
Mean - overall 8.5 3.2
ISS <13 16.0 2.2
ISS 13-15 0.0 4.3
ISS 16-24 1.0 3.9
ISS 25-40 0.0 3.0
ISS 41-75 0.0 4.5
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 0 (0) 38 (13)
Mean - overall 0.0 3.1
ISS <13 0.0 2.8
ISS 13-15 0.0 6.4
ISS 16-24 0.0 3.7
ISS 25-40 0.0 2.2
ISS 41-75 0.0 1.7
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 67
Table 41: Trauma data profile, Lismore Base Hospital
Facility Peer
Total admissions 65 78
Mean monthly admissions 5.4 7
Case fatality rate (ISS >12) 17.2% 10.4%
Gender
Female / Male 14 / 51 20 / 59
Age ranges
Mean age 48.0 53.1
0-4 1 (1.5%) 2 (1.9%)
5-9 2 (3.1%) 1 (0.8%)
10-14 2 (3.1%) 2 (1.9%)
15-19 3 (4.6%) 4 (5.5%)
20-24 4 (6.2%) 5 (5.8%)
25-29 4 (6.2%) 3 (4.2%)
30-34 3 (4.6%) 4 (4.5%)
35-39 8 (12.3%) 5 (5.9%)
40-44 2 (3.1%) 5 (5.9%)
45-49 5 (7.7%) 5 (6.7%)
50-54 5 (7.7%) 6 (7.1%)
55-59 7 (10.8%) 7 (9.0%)
60-64 2 (3.1%) 5 (6.4%)
65-69 2 (3.1%) 4 (5.4%)
70-74 6 (9.2%) 5 (6.2%)
75-79 2 (3.1%) 5 (6.0%)
80-84 3 (4.6%) 5 (6.9%)
85 and over 4 (6.2%) 8 (10.5%)
Injury Severity Score ranges
Mean ISS 20.8 17.8
ISS <13 7 (10.8%) 12 (15.3%)
ISS 13-15 12 (18.5%) 20 (25.0%)
ISS 16-24 22 (33.8%) 30 (38.8%)
ISS 25-40 23 (35.4%) 15 (19.4%)
ISS 41-75 1 (1.5%) 1 (1.5%)
Mechanisms of injury
Assault 5 (7.7%) 5 (6.4%)
Falls 20 (30.8%) 31 (39.2%)
Falls (≥65 years) 12 (18.5%) 19 (24.5%)
Road trauma 23 (35.4%) 24 (31.2%)
Other transport incident 8 (12.3%) 10 (13.1%)
All other injuries 9 (13.8%) 8 (10.1%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 68
Facility Peer
Types of injury
Blunt 60 (92.3%) 74 (94.4%)
Penetrating 4 (6.2%) 3 (4.2%)
Other and unknown 1 (1.5%) 1 (1.4%)
Admission type
Direct admission 58 (89.2%) 64 (82.1%)
Transfer in 7 (10.8%) 14 (17.2%)
Unknown 0 (0.0%) 1 (0.6%)
Arrival modes
Ambulance 52 (80.0%) 64 (81.8%)
Helicopter 7 (10.8%) 5 (5.8%)
Other (private vehicle, fixed wing, unknown) 6 (9.2%) 10 (12.4%)
Revised Trauma Score
Mean - overall 6.8 7.3
ISS <13 6.8 7.4
ISS 13-15 7.8 7.8
ISS 16-24 7.5 7.5
ISS 25-40 5.7 6.5
ISS 41-75 1.5 3.8
Hospital length of stay
Total bed days 613 575
Mean - overall 9.4 7.3
ISS < 13 5.3 8.8
ISS 13-15 30.3 7.3
ISS 16-24 3.9 7.8
ISS 25-40 5.5 5.0
ISS 41-75 1.0 8.8
ICU length of stay
ICU total bed days (number of ICU admissions) 35 (20) 82 (26)
Mean - overall 1.8 3.2
ISS <13 1.3 2.2
ISS 13-15 3.0 4.3
ISS 16-24 1.7 3.9
ISS 25-40 1.3 3.0
ISS 41-75 0.0 4.5
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 31 (23) 38 (13)
Mean - overall 1.3 3.1
ISS < 13 1.6 2.8
ISS 13-15 0.0 6.4
ISS 16-24 1.4 3.7
ISS 25-40 1.3 2.2
ISS 41-75 1.0 1.7
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 69
Table 42: Trauma data profile, Nepean Hospital
Facility Peer
Total admissions 114 78
Mean monthly admissions 9.5 7
Case fatality rate (ISS >12) 9.3% 10.4%
Gender
Female / Male 31 / 83 20 / 59
Age ranges
Mean age 56.9 53.1
0-4 2 (1.8%) 2 (1.9%)
5-9 0 (0.0%) 1 (0.8%)
10-14 0 (0.0%) 2 (1.9%)
15-19 6 (5.3%) 4 (5.5%)
20-24 8 (7.0%) 5 (5.8%)
25-29 2 (1.8%) 3 (4.2%)
30-34 3 (2.6%) 4 (4.5%)
35-39 7 (6.1%) 5 (5.9%)
40-44 6 (5.3%) 5 (5.9%)
45-49 8 (7.0%) 5 (6.7%)
50-54 6 (5.3%) 6 (7.1%)
55-59 11 (9.6%) 7 (9.0%)
60-64 5 (4.4%) 5 (6.4%)
65-69 5 (4.4%) 4 (5.4%)
70-74 10 (8.8%) 5 (6.2%)
75-79 16 (14.0%) 5 (6.0%)
80-84 9 (7.9%) 5 (6.9%)
85 and over 10 (8.8%) 8 (10.5%)
Injury Severity Score ranges
Mean ISS 13.5 17.8
ISS <13 39 (34.2%) 12 (15.3%)
ISS 13-15 36 (31.6%) 20 (25.0%)
ISS 16-24 30 (26.3%) 30 (38.8%)
ISS 25-40 8 (7.0%) 15 (19.4%)
ISS 41-75 1 (0.9%) 1 (1.5%)
Mechanisms of injury
Assault 9 (7.9%) 5 (6.4%)
Falls 59 (51.8%) 31 (39.2%)
Falls (≥65 years) 38 (33.3%) 19 (24.5%)
Road trauma 17 (14.9%) 24 (31.2%)
Other transport incident 11 (9.6%) 10 (13.1%)
All other injuries 18 (15.8%) 8 (10.1%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 70
Facility Peer
Types of injury
Blunt 106 (93.0%) 74 (94.4%)
Penetrating 8 (7.0%) 3 (4.2%)
Other and Unknown 0 (0.0%) 1 (1.4%)
Admission type
Direct admission 93 (81.6%) 64 (82.1%)
Transfer in 21 (18.4%) 14 (17.2%)
Unknown 0 (0.0%) 1 (0.6%)
Arrival modes
Ambulance 91 (79.8%) 64 (81.8%)
Helicopter 1 (0.9%) 5 (5.8%)
Other (private vehicle, fixed wing, unknown) 22 (19.3%) 10 (12.4%)
Revised Trauma Score
Mean - overall 7.6 7.3
ISS <13 7.5 7.4
ISS 13-15 7.8 7.8
ISS 16-24 7.8 7.5
ISS 25-40 6.3 6.5
ISS 41-75 0.0 3.8
Hospital length of stay
Total bed days 1,367 575
Mean - overall 12.0 7.3
ISS < 13 14.4 8.8
ISS 13-15 8.9 7.3
ISS 16-24 14.5 7.8
ISS 25-40 5.8 5.0
ISS 41-75 3.0 8.8
ICU length of stay
ICU total bed days (number of ICU admissions) 145 (59) 82 (26)
Mean - overall 2.5 3.2
ISS < 13 2.6 2.2
ISS 13-15 1.2 4.3
ISS 16-24 2.8 3.9
ISS 25-40 2.2 3.0
ISS 41-75 2.0 4.5
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 2 (1) 38 (13)
Mean - overall 2.0 3.1
ISS < 13 2.0 2.8
ISS 13-15 0.0 6.4
ISS 16-24 0.0 3.7
ISS 25-40 0.0 2.2
ISS 41-75 0.0 1.7
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 71
Table 43: Trauma data profile, Orange Health Service
Facility Peer
Total admissions 104 78
Mean monthly admissions 8.7 7
Case fatality rate (ISS >12) 8.1% 10.4%
Gender
Female / Male 22 / 82 20 / 59
Age ranges
Mean age 52.3 53.1
0-4 1 (1.0%) 2 (1.9%)
5-9 0 (0.0%) 1 (0.8%)
10-14 3 (2.9%) 2 (1.9%)
15-19 4 (3.8%) 4 (5.5%)
20-24 7 (6.7%) 5 (5.8%)
25-29 5 (4.8%) 3 (4.2%)
30-34 5 (4.8%) 4 (4.5%)
35-39 5 (4.8%) 5 (5.9%)
40-44 9 (8.7%) 5 (5.9%)
45-49 9 (8.7%) 5 (6.7%)
50-54 5 (4.8%) 6 (7.1%)
55-59 10 (9.6%) 7 (9.0%)
60-64 7 (6.7%) 5 (6.4%)
65-69 9 (8.7%) 4 (5.4%)
70-74 7 (6.7%) 5 (6.2%)
75-79 4 (3.8%) 5 (6.0%)
80-84 9 (8.7%) 5 (6.9%)
85 and over 5 (4.8%) 8 (10.5%)
Injury Severity Score ranges
Mean ISS 17.1 17.8
ISS <13 18 (17.3%) 12 (15.3%)
ISS 13-15 30 (28.8%) 20 (25.0%)
ISS 16-24 36 (34.6%) 30 (38.8%)
ISS 25-40 18 (17.3%) 15 (19.4%)
ISS 41-75 2 (1.9%) 1 (1.5%)
Mechanisms of injury
Assault 5 (4.8%) 5 (6.4%)
Falls 30 (28.8%) 31 (39.2%)
Falls (≥65 years) 19 (18.3%) 19 (24.5%)
Road trauma 33 (31.7%) 24 (31.2%)
Other transport incident 24 (23.1%) 10 (13.1%)
All other injuries 12 (11.5%) 8 (10.1%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 72
Facility Peer
Types of injury
Blunt 101 (97.1%) 74 (94.4%)
Penetrating 3 (2.9%) 3 (4.2%)
Other and unknown 0 (0.0%) 1 (1.4%)
Admission type
Direct admission 75 (72.1%) 64 (82.1%)
Transfer in 26 (25.0%) 14 (17.2%)
Unknown 3 (2.9%) 1 (0.6%)
Arrival modes
Ambulance 74 (71.2%) 64 (81.8%)
Helicopter 17 (16.3%) 5 (5.8%)
Other (private vehicle, fixed wing, unknown) 13 (12.5%) 10 (12.4%)
Revised Trauma Score
Mean - overall 7.4 7.3
ISS <13 7.4 7.4
ISS 13-15 7.8 7.8
ISS 16-24 7.5 7.5
ISS 25-40 6.8 6.5
ISS 41-75 6.9 3.8
Hospital length of stay
Total bed days 656 575
Mean - overall 6.3 7.3
ISS <13 4.3 8.8
ISS 13-15 4.3 7.3
ISS 16-24 7.3 7.8
ISS 25-40 5.6 5.0
ISS 41-75 42.5 8.8
ICU length of stay
ICU total bed days (number of ICU admissions) 143 (35) 82 (26)
Mean - overall 4.1 3.2
ISS <13 1.8 2.2
ISS 13-15 4.0 4.3
ISS 16-24 6.3 3.9
ISS 25-40 7.3 3.0
ISS 41-75 0.0 4.5
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 61 (15) 38 (13)
Mean - overall 4.1 3.1
ISS <13 1.5 2.8
ISS 13-15 9.0 6.4
ISS 16-24 7.5 3.7
ISS 25-40 3.0 2.2
ISS 41-75 1.0 1.7
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 73
Table 44: Trauma data profile, Port Macquarie Base Hospital
Facility Peer
Total admissions 53 78
Mean monthly admissions 4.4 7
Case fatality rate (ISS >12) 16.7% 10.4%
Gender
Female / Male 11 / 42 20 / 59
Age ranges
Mean age 52.7 53.1
0-4 0 (0.0%) 2 (1.9%)
5-9 0 (0.0%) 1 (0.8%)
10-14 1 (1.9%) 2 (1.9%)
15-19 3 (5.7%) 4 (5.5%)
20-24 6 (11.3%) 5 (5.8%)
25-29 3 (5.7%) 3 (4.2%)
30-34 2 (3.8%) 4 (4.5%)
35-39 2 (3.8%) 5 (5.9%)
40-44 3 (5.7%) 5 (5.9%)
45-49 3 (5.7%) 5 (6.7%)
50-54 6 (11.3%) 6 (7.1%)
55-59 4 (7.5%) 7 (9.0%)
60-64 1 (1.9%) 5 (6.4%)
65-69 3 (5.7%) 4 (5.4%)
70-74 3 (5.7%) 5 (6.2%)
75-79 3 (5.7%) 5 (6.0%)
80-84 2 (3.8%) 5 (6.9%)
85 and over 8 (15.1%) 8 (10.5%)
Injury Severity Score ranges
Mean ISS 17.4 17.8
ISS <13 11 (20.8%) 12 (15.3%)
ISS 13-15 12 (22.6%) 20 (25.0%)
ISS 16-24 20 (37.7%) 30 (38.8%)
ISS 25-40 8 (15.1%) 15 (19.4%)
ISS 41-75 2 (3.8%) 1 (1.5%)
Mechanisms of injury
Assault 1 (1.9%) 5 (6.4%)
Falls 14 (26.4%) 31 (39.2%)
Falls (≥65 years) 8 (15.1%) 19 (24.5%)
Road trauma 19 (35.8%) 24 (31.2%)
Other transport incident 10 (18.9%) 10 (13.1%)
All other injuries 9 (17.0%) 8 (10.1%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 74
Facility Peer
Types of injury
Blunt 45 (84.9%) 74 (94.4%)
Penetrating 2 (3.8%) 3 (4.2%)
Other and Unknown 6 (11.3%) 1 (1.4%)
Admission type
Direct admission 50 (94.3%) 64 (82.1%)
Transfer in 3 (5.7%) 14 (17.2%)
Unknown 0 (0.0%) 1 (0.6%)
Arrival modes
Ambulance 43 (81.1%) 64 (81.8%)
Helicopter 1 (1.9%) 5 (5.8%)
Other (private vehicle, fixed wing, unknown) 9 (17.0%) 10 (12.4%)
Revised Trauma Score
Mean - overall 7.3 7.3
ISS <13 7.3 7.4
ISS 13-15 7.8 7.8
ISS 16-24 7.8 7.5
ISS 25-40 6.6 6.5
ISS 41-75 2.4 3.8
Hospital length of stay
Total bed days 239 575
Mean - overall 4.5 7.3
ISS <13 2.3 8.8
ISS 13-15 6.5 7.3
ISS 16-24 5.9 7.8
ISS 25-40 2.0 5.0
ISS 41-75 1.0 8.8
ICU length of stay
ICU total bed days (number of ICU admissions) 60 (27) 82 (26)
Mean - overall 2.2 3.2
ISS <13 1.5 2.2
ISS 13-15 1.8 4.3
ISS 16-24 3.2 3.9
ISS 25-40 2.0 3.0
ISS 41-75 0.0 4.5
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 15 (6) 38 (13)
Mean - overall 2.5 3.1
ISS <13 1.3 2.8
ISS 13-15 0.0 6.4
ISS 16-24 7.0 3.7
ISS 25-40 2.0 2.2
ISS 41-75 0.0 1.7
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 75
Table 45: Trauma data profile, Tamworth Rural Referral Hospital
Facility Peer
Total admissions 79 78
Mean monthly admissions 6.6 7
Case fatality rate (ISS >12) 3.0% 10.4%
Gender
Female / Male 18 / 61 20 / 59
Age ranges
Mean age 49.9 53.1
0-4 4 (5.1%) 2 (1.9%)
5-9 0 (0.0%) 1 (0.8%)
10-14 1 (1.3%) 2 (1.9%)
15-19 7 (8.9%) 4 (5.5%)
20-24 2 (2.5%) 5 (5.8%)
25-29 1 (1.3%) 3 (4.2%)
30-34 3 (3.8%) 4 (4.5%)
35-39 6 (7.6%) 5 (5.9%)
40-44 5 (6.3%) 5 (5.9%)
45-49 5 (6.3%) 5 (6.7%)
50-54 9 (11.4%) 6 (7.1%)
55-59 9 (11.4%) 7 (9.0%)
60-64 7 (8.9%) 5 (6.4%)
65-69 5 (6.3%) 4 (5.4%)
70-74 4 (5.1%) 5 (6.2%)
75-79 2 (2.5%) 5 (6.0%)
80-84 3 (3.8%) 5 (6.9%)
85 and over 6 (7.6%) 8 (10.5%)
Injury Severity Score ranges
Mean ISS 17.7 17.8
ISS <13 13 (16.5%) 12 (15.3%)
ISS 13-15 19 (24.1%) 20 (25.0%)
ISS 16-24 36 (45.6%) 30 (38.8%)
ISS 25-40 10 (12.7%) 15 (19.4%)
ISS 41-75 1 (1.3%) 1 (1.5%)
Mechanisms of injury
Assault 6 (7.6%) 5 (6.4%)
Falls 24 (30.4%) 31 (39.2%)
Falls (≥65 years) 14 (17.7%) 19 (24.5%)
Road trauma 25 (31.6%) 24 (31.2%)
Other transport incident 15 (19.0%) 10 (13.1%)
All other injuries 9 (11.4%) 8 (10.1%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 76
Facility Peer
Types of injury
Blunt 72 (91.1%) 74 (94.4%)
Penetrating 3 (3.8%) 3 (4.2%)
Other and unknown 4 (5.1%) 1 (1.4%)
Admission type
Direct admission 55 (69.6%) 64 (82.1%)
Transfer in 24 (30.4%) 14 (17.2%)
Unknown 0 (0.0%) 1 (0.6%)
Arrival modes
Ambulance 52 (65.8%) 64 (81.8%)
Helicopter 14 (17.7%) 5 (5.8%)
Other (private vehicle, fixed wing, unknown) 13 (16.5%) 10 (12.4%)
Revised trauma Score
Mean - overall 7.4 7.3
ISS <13 7.0 7.4
ISS 13-15 7.8 7.8
ISS 16-24 7.5 7.5
ISS 25-40 7.3 6.5
ISS 41-75 1.9 3.8
Hospital length of stay
Total bed days 668 575
Mean - overall 8.5 7.3
ISS <13 8.5 8.8
ISS 13-15 4.6 7.3
ISS 16-24 11.4 7.8
ISS 25-40 5.9 5.0
ISS 41-75 1.0 8.8
ICU length of stay
ICU total bed days (number of ICU admissions) 111 (37) 82 (26)
Mean - overall 3.0 3.2
ISS <13 1.6 2.2
ISS 13-15 6.0 4.3
ISS 16-24 3.4 3.9
ISS 25-40 2.4 3.0
ISS 41-75 0.0 4.5
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 44 (8) 38 (13)
Mean - overall 5.5 3.1
ISS <13 6.3 2.8
ISS 13-15 0.0 6.4
ISS 16-24 4.8 3.7
ISS 25-40 0.0 2.2
ISS 41-75 0.0 1.7
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 77
Table 46: Trauma data profile, The Tweed Hospital
Facility Peer
Total admissions 40 78
Mean monthly admissions 3.3 7
Case fatality rate (ISS >12) 12.5% 10.4%
Gender
Female / Male 10 / 30 20 / 59
Age ranges
Mean age 48.1 53.1
0-4 1 (2.5%) 2 (1.9%)
5-9 0 (0.0%) 1 (0.8%)
10-14 2 (5.0%) 2 (1.9%)
15-19 3 (7.5%) 4 (5.5%)
20-24 2 (5.0%) 5 (5.8%)
25-29 2 (5.0%) 3 (4.2%)
30-34 4 (10.0%) 4 (4.5%)
35-39 2 (5.0%) 5 (5.9%)
40-44 2 (5.0%) 5 (5.9%)
45-49 2 (5.0%) 5 (6.7%)
50-54 3 (7.5%) 6 (7.1%)
55-59 3 (7.5%) 7 (9.0%)
60-64 5 (12.5%) 5 (6.4%)
65-69 1 (2.5%) 4 (5.4%)
70-74 1 (2.5%) 5 (6.2%)
75-79 2 (5.0%) 5 (6.0%)
80-84 1 (2.5%) 5 (6.9%)
85 and over 4 (10.0%) 8 (10.5%)
Injury Severity Score ranges
Mean ISS 21.5 17.8
ISS <13 0 (0.0%) 12 (15.3%)
ISS 13-15 7 (17.5%) 20 (25.0%)
ISS 16-24 21 (52.5%) 30 (38.8%)
ISS 25-40 11 (27.5%) 15 (19.4%)
ISS 41-75 1 (2.5%) 1 (1.5%)
Mechanisms of injury
Assault 4 (10.0%) 5 (6.4%)
Falls 12 (30.0%) 31 (39.2%)
Falls (≥65 years) 7 (17.5%) 19 (24.5%)
Road trauma 21 (52.5%) 24 (31.2%)
Other transport incident 2 (5.0%) 10 (13.1%)
All other injuries 1 (2.5%) 8 (10.1%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 78
Facility Peer
Types of injury
Blunt 38 (95.0%) 74 (94.4%)
Penetrating 2 (5.0%) 3 (4.2%)
Other and unknown 0 (0.0%) 1 (1.4%)
Admission type
Direct admission 37 (92.5%) 64 (82.1%)
Transfer in 3 (7.5%) 14 (17.2%)
Unknown 0 (0.0%) 1 (0.6%)
Arrival modes
Ambulance 34 (85.0%) 64 (81.8%)
Helicopter 1 (2.5%) 5 (5.8%)
Other (private vehicle, fixed wing, unknown) 5 (12.5%) 10 (12.4%)
Revised Trauma Score
Mean – overall 7.2 7.3
ISS <13 0.0 7.4
ISS 13-15 7.8 7.8
ISS 16-24 7.5 7.5
ISS 25-40 6.8 6.5
ISS 41-75 0.0 3.8
Hospital length of stay
Total bed days 147 575
Mean - overall 3.7 7.3
ISS <13 0.0 8.8
ISS 13-15 3.3 7.3
ISS 16-24 3.4 7.8
ISS 25-40 4.7 5.0
ISS 41-75 1.0 8.8
ICU length of stay
ICU total bed days (number of ICU admissions) 28 (4) 82 (26)
Mean - overall 7.0 3.2
ISS <13 0.0 2.2
ISS 13-15 0.0 4.3
ISS 16-24 3.0 3.9
ISS 25-40 11.0 3.0
ISS 41-75 0.0 4.5
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 21 (3) 38 (13)
Mean - overall 7.0 3.1
ISS <13 0.0 2.8
ISS 13-15 0.0 6.4
ISS 16-24 0.0 3.7
ISS 25-40 10.0 2.2
ISS 41-75 1.0 1.7
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 79
Table 47: Trauma data profile, Wagga Wagga Rural Referral Hospital
Facility Peer
Total admissions 59 78
Mean monthly admissions 4.9 7
Case fatality rate (ISS >12) 5.7% 10.4%
Gender
Female / Male 19 / 40 20 / 59
Age ranges
Mean age 45.5 53.1
0-4 2 (3.4%) 2 (1.9%)
5-9 2 (3.4%) 1 (0.8%)
10-14 1 (1.7%) 2 (1.9%)
15-19 5 (8.5%) 4 (5.5%)
20-24 4 (6.8%) 5 (5.8%)
25-29 5 (8.5%) 3 (4.2%)
30-34 4 (6.8%) 4 (4.5%)
35-39 4 (6.8%) 5 (5.9%)
40-44 2 (3.4%) 5 (5.9%)
45-49 8 (13.6%) 5 (6.7%)
50-54 3 (5.1%) 6 (7.1%)
55-59 2 (3.4%) 7 (9.0%)
60-64 1 (1.7%) 5 (6.4%)
65-69 1 (1.7%) 4 (5.4%)
70-74 3 (5.1%) 5 (6.2%)
75-79 3 (5.1%) 5 (6.0%)
80-84 2 (3.4%) 5 (6.9%)
85 and over 7 (11.9%) 8 (10.5%)
Injury Severity Score ranges
Mean ISS 16.7 17.8
ISS <13 6 (10.2%) 12 (15.3%)
ISS 13-15 13 (22.0%) 20 (25.0%)
ISS 16-24 34 (57.6%) 30 (38.8%)
ISS 25-40 6 (10.2%) 15 (19.4%)
ISS 41-75 0 (0.0%) 1 (1.5%)
Mechanisms of injury
Assault 5 (8.5%) 5 (6.4%)
Falls 18 (30.5%) 31 (39.2%)
Falls (≥65 years) 10 (16.9%) 19 (24.5%)
Road trauma 20 (33.9%) 24 (31.2%)
Other transport incident 10 (16.9%) 10 (13.1%)
All other injuries 6 (10.2%) 8 (10.1%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 80
Facility Peer
Types of injury
Blunt 55 (93.2%) 74 (94.4%)
Penetrating 4 (6.8%) 3 (4.2%)
Other and unknown 0 (0.0%) 1 (1.4%)
Admission type
Direct admission 47 (79.7%) 64 (82.1%)
Transfer in 12 (20.3%) 14 (17.2%)
Unknown 0 (0.0%) 1 (0.6%)
Arrival modes
Ambulance 49 (83.1%) 64 (81.8%)
Helicopter 0 (0.0%) 5 (5.8%)
Other (private vehicle, fixed wing, unknown) 10 (16.9%) 10 (12.4%)
Revised Trauma Score
Mean - overall 7.7 7.3
ISS <13 7.8 7.4
ISS 13-15 7.2 7.8
ISS 16-24 7.8 7.5
ISS 25-40 7.8 6.5
ISS 41-75 0.0 3.8
Hospital length of stay
Total bed days 271 575
Mean - overall 4.6 7.3
ISS <13 7.7 8.8
ISS 13-15 3.5 7.3
ISS 16-24 5.1 7.8
ISS 25-40 1.0 5.0
ISS 41-75 0.0 8.8
ICU length of stay
ICU total bed days (number of ICU admissions) 55 (19) 82 (26)
Mean - overall 2.9 3.2
ISS <13 3.3 2.2
ISS 13-15 1.5 4.3
ISS 16-24 3.1 3.9
ISS 25-40 1.0 3.0
ISS 41-75 0.0 4.5
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 17 (16) 38 (13)
Mean - overall 1.1 3.1
ISS <13 2.0 2.8
ISS 13-15 1.0 6.4
ISS 16-24 1.0 3.7
ISS 25-40 1.0 2.2
ISS 41-75 0.0 1.7
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 81
Table 48: Trauma data profile, Wollongong Hospital
Facility Peer
Total admissions 146 78
Mean monthly admissions 12.2 7
Case fatality rate (ISS >12) 12.4% 10.4%
Gender
Female / Male 43 / 103 20 / 59
Age ranges
Mean age 59.1 53.1
0-4 2 (1.4%) 2 (1.9%)
5-9 0 (0.0%) 1 (0.8%)
10-14 1 (0.7%) 2 (1.9%)
15-19 6 (4.1%) 4 (5.5%)
20-24 7 (4.8%) 5 (5.8%)
25-29 6 (4.1%) 3 (4.2%)
30-34 5 (3.4%) 4 (4.5%)
35-39 7 (4.8%) 5 (5.9%)
40-44 9 (6.2%) 5 (5.9%)
45-49 6 (4.1%) 5 (6.7%)
50-54 7 (4.8%) 6 (7.1%)
55-59 12 (8.2%) 7 (9.0%)
60-64 10 (6.8%) 5 (6.4%)
65-69 9 (6.2%) 4 (5.4%)
70-74 10 (6.8%) 5 (6.2%)
75-79 9 (6.2%) 5 (6.0%)
80-84 19 (13.0%) 5 (6.9%)
85 and over 21 (14.4%) 8 (10.5%)
Injury Severity Score ranges
Mean ISS 19.0 17.8
ISS <13 9 (6.2%) 12 (15.3%)
ISS 13-15 40 (27.4%) 20 (25.0%)
ISS 16-24 58 (39.7%) 30 (38.8%)
ISS 25-40 38 (26.0%) 15 (19.4%)
ISS 41-75 1 (0.7%) 1 (1.5%)
Mechanisms of injury
Assault 7 (4.8%) 5 (6.4%)
Falls 81 (55.5%) 31 (39.2%)
Falls (≥65 years) 56 (38.4%) 19 (24.5%)
Road trauma 39 (26.7%) 24 (31.2%)
Other transport incident 9 (6.2%) 10 (13.1%)
All other injuries 10 (6.8%) 8 (10.1%)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 82
Facility Peer
Types of injury
Blunt 144 (98.6%) 74 (94.4%)
Penetrating 2 (1.4%) 3 (4.2%)
Other and unknown 0 (0.0%) 1 (1.4%)
Admission type
Direct admission 106 (72.6%) 64 (82.1%)
Transfer in 38 (26.0%) 14 (17.2%)
Unknown 2 (1.4%) 1 (0.6%)
Arrival modes
Ambulance 129 (88.4%) 64 (81.8%)
Helicopter 1 (0.7%) 5 (5.8%)
Other (private vehicle, fixed wing, unknown) 16 (11.0%) 10 (12.4%)
Revised Trauma Score
Mean - overall 7.4 7.3
ISS <13 7.8 7.4
ISS 13-15 7.8 7.8
ISS 16-24 7.4 7.5
ISS 25-40 6.9 6.5
ISS 41-75 0.0 3.8
Hospital length of stay
Total bed days 1086 575
Mean - overall 7.4 7.3
ISS <13 10.1 8.8
ISS 13-15 5.7 7.3
ISS 16-24 9.1 7.8
ISS 25-40 6.3 5.0
ISS 41-75 1.0 8.8
ICU length of stay
ICU total bed days (number of ICU admissions) 134 (33) 82 (26)
Mean - overall 4.1 3.2
ISS <13 2.5 2.2
ISS 13-15 10.0 4.3
ISS 16-24 6.9 3.9
ISS 25-40 1.7 3.0
ISS 41-75 0.0 4.5
Hospital ventilation days
Total ventilation bed days (number of ventilated cases) 140 (33) 38 (13)
Mean - overall 4.2 3.1
ISS <13 3.4 2.8
ISS 13-15 9.0 6.4
ISS 16-24 5.6 3.7
ISS 25-40 2.3 2.2
ISS 41-75 0.0 1.7
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 83
Appendix 5: Calculation of the Injury Severity Score
An ISS is calculated for each patient based on the AIS injury severity classification of their specific
injuries. The ISS value ranges from 1-75 and is calculated as:
ISS = A2 + B2 + C2
Where A, B, and C are the highest AIS severity codes in each of the (up to) three most severely
injured ISS body regions.
The six ISS body regions are:
head or neck
face
chest
abdominal or pelvic contents
extremities or pelvic girdle
external.
The following example shows how an ISS is calculated from a set of injuries.
Table 49: ISS calculation example
ISS body region Injury AIS severity
code
Include in
ISS
calculation?
Head or neck Small subdural haematoma AIS-4 Yes
Chest Bilateral lung contusion AIS-4 No
Chest Bilateral flail chest AIS-5 Yes
Abdominal or pelvic contents Superficial spleen laceration AIS-2 Yes
Extremities or pelvic girdle Left phalange (little toe) fracture AIS-1 No
On the basis of the above injuries, the ISS is calculated as:
ISS = 42 + 52 + 22
ISS = 45 (critical injury)
NSW Institute of Trauma and Injury Management Major Trauma in NSW: 2016-17 84
Appendix 6: Australian Statistical Geography Standard Remoteness Areas
The Australian Statistical Geography Standard (ASGS) Remoteness Areas (RA) is based on the
Accessibility and Remoteness Index of Australia (ARIA+) which defines locations in terms of
remoteness, i.e. the physical distance of a location from the nearest urban centre (access to goods
and services) based on population size.
Figure 33: Map of 2016 Remoteness areas for Australia
Source: ABS, http://www.abs.gov.au/websitedbs/d3310114.nsf/home/remoteness+structure
For further information on ASGS-RA please see The Australian Statistical Geography Standard
(ASGS) Remoteness Structure on the Australian Bureau of Statistics website.