23rd February 2018,
Jesse Whitehead, Matt Roskruge, Colin Tan, Alistair Smith, Grant Christey
In 2013, injuries accounted for 8% of New Zealand’s morbidity and mortality (disability-adjusted life years) and were the second greatest cause of morbidity and mortality among children (10%) and youth…
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This study evaluates the geospatial movement of major trauma patients from pre-hospital locations to hospitals in the Midland region and compares the actual destination to the optimal destination defined for patients meeting clinical criteria defined in the national major trauma triage policy. This study has been conducted prior to implementation of the Midland Pre-Hospital Major Trauma Destination Matrix and will be repeated in 2019 to evaluate change in processes resulting from the “Midland Matrix”.
Pre-hospital triage strategies aim to identify the type and extent of patient injuries and ensure that they are transferred to the most appropriate trauma centres. Despite the importance of appropriate pre-hospital transport, there is little evidence base to assist medical staff on optimal destination policy for emergent pre-hospital transport. This paper explores the spatial relationship of patient transfers prior to the implementation of the Midland Pre-Hospital Trauma Destination Matrix in New Zealand, and is a retrospective view of practice against a destination policy that was applied after the study period.
We use data obtained from the Midland Trauma Registry merged with Global Positioning System (GPS) data from St John and Land Information New Zealand Data Service on major trauma occurring in 2014 and 2015. Using ArcGIS, data were analysed for spatial relationships between factors associated with major trauma events and pre-hospital transportation.
In the retrospective analysis of 162 major trauma patients, 107 (66%) were transported to a hospital that matched the destination specified in the Matrix, and 55 (34%) were transported to a non-Matrix designated hospital.
Approximately one-third of patients were not directly transported to the preferred definitive care hospital subsequently defined in the Midland Pre-Hospital Trauma Destination Matrix. Ongoing monitoring of the pre-hospital transportation system and the implementation of a formal pre-hospital transport policy may improve the efficiency of the Midland Trauma System. Future studies should examine the possible reasons for variations in triage decisions across the Midland Region.
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