TS1: DEVELOPMENT OF A COMPREHENSIVE TRAUMA SYSTEM IN QUEENSLAND – BENCHMARKING TRAUMA CARE PERFORMANCE IN A TERTIARY HOSPITAL IN QUEENSLAND TO EUROPEAN TRAUMA CENTRES.

Abstract

Queensland is in the phase to develop a comprehensive, integrated state wide Trauma System with support from the Queensland Health and Emergency Services. A strategic step in this circumstance is benchmarking the current trauma system with other established trauma systems, to compare performance and indicators of trauma care. Queensland’s first recognized Adult Major Trauma Service, the Princess Alexandra Hospital (PAH) in Brisbane, was compared with the results of the established Trauma Registry of the German Trauma Society (DGU). This study analysed the whole range of trauma care, from the scene of the accident to discharge from the hospital.

Methodology: The study populations were retrospectively identified and extracted from the Queensland Trauma Registry and the DGU Trauma Registry. Both databases contain all primary and secondary admitted trauma patients of all ages, with an Injury Severity Score (ISS) > 15, for the year 2005. The collected patient data included demographics, mechanism of injury, details on pre-hospital phase, injury, treatment, complications and outcome.

Results: At the PAH 309 patients with an ISS > 15 were treated, compared to 2537 in the DGU Registry. The demographics (age and gender) and trauma mechanisms (blunt vs penetrating injuries) were comparable, even the average ISS scores were higher in the DGU registry (29) than at PAH (25). The primary referrals from the accident scene to the PA Hospital were significantly lower (52%) than to the German Trauma centres (82%). The secondary referrals arrived at PA Hospital on average 13.5 hrs post accident compared to 3.4 hrs in the DGU registry. PAH patients less often needed surgery (61% versus 78%), ICU-admission (49% versus 88%) and mechanical ventilation (44% versus 72%). The average time of the patients in ED was significantly higher with almost 4 hrs compared to 1 hrs in the German trauma centres. Nevertheless the overall mortality was lower at PA Hospital: 10% versus 18%, with an equal time to death, age and injury severity of deaths.

Conclusions: Queensland’s enormous size entails significant implications for trauma care. The results of the benchmarking study may reflect an suboptimal care in the first crucial hours after the accident leading to a higher secondary referral rate and a lower ISS score of the arriving patients to PA Hospital. The relatively low number of in-hospital deaths was presumably due to a higher number of prehospital deaths, although we are unable to quantify this at present. The in hospital clinical course was elongated in the ED at PA Hospital, and several reasons can be discussed for this.

This benchmarking study helps to reflect the current trauma care coming to PA Hospital, even many issues remain unanswered in a retrospective study.

This presentation will review the integrated approach of Queensland to streamline the trauma care and highlights the first steps taken to improve the efficiency of the system.