6th October 2017, Volume 130 Number 1463

Siobhan Isles, Grant Christey, Ian Civil, Peter Hicks

Abbreviations AIS Abbreviated Injury Score CT Computerised Tomography DHB District Health Board GCS Glasgow Coma Scale ICD International Classification of Disease ISS Injury Severity Score INR International Normalised Ratio…

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Summary

The establishment of the New Zealand Trauma Registry means that for the first time we have the capability to understand the patterns of trauma and the impact this has on individuals, their family/whanau, and the cost to society. The NZ-MTR is an important tool to support a data-driven approach to trauma. This paper explores how the NZ-MTR was established and its potential to bring us in line with formal systems internationally.

Abstract

Aim

To describe the development of the New Zealand Major Trauma Registry (NZ-MTR) and the initial experiences of its use.

Method

The background to the development of the NZ-MTR was reviewed and the processes undertaken to implement a single-instance of a web-based national registry described. A national minimum dataset was defined and utilised. Key structures to support the Registry such as a data governance group were established.

Results

The NZ-MTR was successfully implemented and is the foundation for a new, data-driven model of quality improvement. In its first year of operation over 1,300 patients were entered into the Registry although coverage is not yet universal. Overall incidence is 40.8 major trauma cases/100,000 population. The incidence in the Māori population was 69/100,000 compared with 31/100,000 in the non-Māori population. Case fatality rate was 9%. Three age peaks were observed at 20–24 years, 50–59 years and above 85 years. Road traffic crashes accounted for 50% of all caseload. A significant proportion of major trauma patients (21%) were transferred to one or more hospitals before reaching a definitive care facility.

Conclusion

Despite the challenges working across multiple jurisdictions, initiation of a single-instance web-based registry has been achieved. The NZ-MTR enables New Zealand to have a national view of trauma treatment and outcomes for the first time. It will inform quality improvement and injury prevention initiatives and potentially decrease the burden of injury on all New Zealanders.

Author Information

Siobhan Isles, Major Trauma National Clinical Network, Auckland; Grant Christey, Clinical Director, Midland Trauma System, Hamilton; Ian Civil, National Clinical Lead, Major Trauma National Clinical Network; Peter Hicks, Intensive Care, Capital & Coast District Health Board, Wellington.

Acknowledgements

The authors wish to acknowledge the support of trauma data collectors across New Zealand, the registry support staff at the Midland Trauma System, the ambulance sector and hospital trauma teams which contribute to the trauma system.

Correspondence

Siobhan Isles, Major Trauma National Clinical Network, Level 2, 650 Great South Rd, Auckland 1051.

Correspondence Email

siobhan.isles@nra.health.nz

Competing Interests

Dr Christey reports grants from district health boards, grants from Accident Compensation Corporation outside the submitted work.

References

  1. Rowling JK. Harry Potter and the Half-Blood Prince. Bloomsbury. London. 2015.
  2. Maxson T, Mabry CD, Sutherland MJ, Robertson RD, Booker JO, Collins T, et al. Does the Institution of a Statewide Trauma System Reduce Preventable Mortality and Yield a Positive Return on Investment for Taxpayers? J Am Coll Surg. 2017; 224(4):489–99.
  3. Gabbe BJ, Simpson PM, Sutherland AM, Wolfe R, Fitzgerald MC, Judson R, et al. Improved functional outcomes for major trauma patients in a regionalized, inclusive trauma system. Ann Surg. 2012; 255(6):1009–15.
  4. Gabbe BJ, Lyons RA, Fitzgerald MC, Judson R, Richardson J, Cameron PA. Reduced population burden of road transport-related major trauma after introduction of an inclusive trauma system. Ann Surg. 2015; 261(3):565–72.
  5. Cameron PA, Gabbe BJ, McNeil JJ, Finch CF, Smith KL, Cooper DJ, et al. The trauma registry as a statewide quality improvement tool. J Trauma. 2005; 59(6):1469–76.
  6. Moore L, Clark DE. The value of trauma registries. Injury. 2008; 39(6):686–95.
  7. Civil I. Trauma system coordination in New Zealand: a year of progress. N Z Med J. 1995; 108(996):93–4.
  8. Civil I. Trauma: still a problem in New Zealand. N Z Med J. 2004; 117(1201):U1042.
  9. Civil I. A national trauma network: now or never for New Zealand. N Z Med J. 2010; 123(1316):9–10.
  10. Royal Australasian College of Surgeons, NZ Trauma Committee. Guidelines for a structured approach to the provision of optimal trauma care. RACS. 2012
  11. Ministry of Health and Accident Compensation Corporation. Injury-related Health Loss: A report from the New Zealand Burden of Diseases, Injuries and Risk Factors Study 2006–2016. Wellington: Ministry of Health. 2013. ISBN 978-0-478-40296-4.
  12. Major Trauma National Clinical Network. National Minimum Dataset for Major Trauma. 2015. http://www.majortrauma.nz/resources
  13. Australian Trauma Quality Improvement Program. Bi-National Trauma Minimum Dataset (BNTMDS) for Australia and New Zealand. 2013.
  14. Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974; 14(3):187–96.
  15. AAAM’s Abbreviated Injury Scale. Association for the Advancement of Automotive Medicine. Retrieved 2014-03-27. http://www.aaam.org/abbreviated-injury-scale-ais/
  16. Ministry of Health. HISO 10037.1:2010 Connected Health Architectural Framework. Wellington: Ministry of Health. 2010.
  17. Long WB, Sacco WJ, Copes WS, Lawnick MM, Proctor SM, Sacco JB. An evaluation of expert human and automated Abbreviated Injury Scale and ICD-9-CM injury coding. J Trauma. 1994; 36(4):499–503. 
  18. Major Trauma National Clinical Network. Privacy Framework for the NZ-MTR. 2016. http://www.majortrauma.nz/resources
  19. Major Trauma National Clinical Network. Annual report for 2015-16. 2016. http://www.majortrauma.nz/resources
  20. MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006; 354(4):366–78.
  21. Roberts DJ, Ouellet JF, McBeth PB, Kirkpatrick AW, Dixon E, Ball CG. The “weekend warrior”: fact or fiction for major trauma? Can J Surg. 2014; 57(3):E62
  22. MacKenzie EJ. Review of evidence regarding trauma system effectiveness resulting from panel studies. J Trauma. 1999; 47(3 Suppl):S34–41. 
  23. Cameron PA, Finch CF, Gabbe BJ, Collins LJ, Smith KL, McNeil JJ. Developing Australia’s first statewide trauma registry: what are the lessons? ANZ J Surg. 2004; 74(6):424–8. 
  24. The Trauma Audit and Research Network. The first decade: 1990–2000. http://www.tarn.ac.uk/content/downloads/36/FirstDecade.pdf
  25. Cameron PA, Gabbe BJ, Cooper DJ, Walker T, Judson R, McNeil J. A statewide system of trauma care in Victoria: effect on patient survival. Med J Aust. 2008; 189(10):546–50.

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