Pathways and factors that influence time to definitive trauma care for injured children in New South Wales, Australia.
- Publisher:
- ELSEVIER SCI LTD
- Publication Type:
- Journal Article
- Citation:
- Injury, 2022, 53, (1), pp. 61-68
- Issue Date:
- 2022-01
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Full metadata record
Field | Value | Language |
---|---|---|
dc.contributor.author | Curtis, K | |
dc.contributor.author | Kennedy, B | |
dc.contributor.author | Lam, MK | |
dc.contributor.author | Mitchell, RJ | |
dc.contributor.author | Black, D | |
dc.contributor.author | Burns, B | |
dc.contributor.author | Dinh, M | |
dc.contributor.author | Holland, AJ | |
dc.date.accessioned | 2022-11-22T02:36:57Z | |
dc.date.available | 2021-02-12 | |
dc.date.available | 2022-11-22T02:36:57Z | |
dc.date.issued | 2022-01 | |
dc.identifier.citation | Injury, 2022, 53, (1), pp. 61-68 | |
dc.identifier.issn | 0020-1383 | |
dc.identifier.issn | 1879-0267 | |
dc.identifier.uri | http://hdl.handle.net/10453/163643 | |
dc.description.abstract | BACKGROUND: Timely definitive paediatric trauma care influences patient and parental physical and emotional outcomes. New South Wales (NSW) covers a large geographical area with all three NSW paediatric trauma centres (PTC) located in two approximated major cities, meaning it is inevitable that some injured children receive initial treatment locally and then require transfer. Little is known about the factors that then impact timely arrival of injured children to definitive care. METHODS: This included children admitted between July 2015 and September 2016, <16 years with an injury severity (ISS) ≥9; or requiring intensive care admission; or deceased following injury. Children were identified through the three PTCs, NSW Trauma Registry and NSW Medical Retrieval Registry. RESULTS: There were 593 children admitted following injury and 46% required transfer to a PTC. There was no significant difference in age, ISS, ICU admission or head injury (AIS >2) between transferred and directly transported cohorts. There were significant differences in mechanism of injury between the two groups (χ2(9) = 45.9, p < 0.001). The median (IQR) time to book a transfer from arrival at the referring facility, was 146.5 (86-238) minutes. Time from injury to arrival at the PTC more than doubled for children transferred, with significant and unwarranted variability between transporting agencies resulting in unwarranted delays to surgical intervention. For example, time spent at the referring facility by Aeromedical Retrieval Service was less than half that of the Newborn & paediatric Emergency Transport Service [53 (IQR:47-61) vs 115 (84-155) minutes (p <0.001)]. CONCLUSION: Clinicians caring for paediatric trauma patients in facilities outside trauma centres require the capability and opportunity to identify and notify early those requiring transfer for ongoing management. The provision of a streamlined referral and transfer process for all paediatric trauma patients requiring treatment in NSW PTCs would reduce the burden on the referring facility, reduce variation amongst transport providers and improve time to definitive care. | |
dc.format | Print-Electronic | |
dc.language | eng | |
dc.publisher | ELSEVIER SCI LTD | |
dc.relation.ispartof | Injury | |
dc.relation.isbasedon | 10.1016/j.injury.2021.02.036 | |
dc.rights | info:eu-repo/semantics/openAccess | |
dc.subject | 1103 Clinical Sciences, 1110 Nursing, 1117 Public Health and Health Services | |
dc.subject.classification | Orthopedics | |
dc.subject.mesh | Australia | |
dc.subject.mesh | Child | |
dc.subject.mesh | Emergency Medical Services | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Infant, Newborn | |
dc.subject.mesh | Injury Severity Score | |
dc.subject.mesh | New South Wales | |
dc.subject.mesh | Retrospective Studies | |
dc.subject.mesh | Trauma Centers | |
dc.subject.mesh | Wounds and Injuries | |
dc.subject.mesh | Australia | |
dc.subject.mesh | Child | |
dc.subject.mesh | Emergency Medical Services | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Infant, Newborn | |
dc.subject.mesh | Injury Severity Score | |
dc.subject.mesh | New South Wales | |
dc.subject.mesh | Retrospective Studies | |
dc.subject.mesh | Trauma Centers | |
dc.subject.mesh | Wounds and Injuries | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Wounds and Injuries | |
dc.subject.mesh | Injury Severity Score | |
dc.subject.mesh | Retrospective Studies | |
dc.subject.mesh | Child | |
dc.subject.mesh | Infant, Newborn | |
dc.subject.mesh | Trauma Centers | |
dc.subject.mesh | Emergency Medical Services | |
dc.subject.mesh | Australia | |
dc.subject.mesh | New South Wales | |
dc.title | Pathways and factors that influence time to definitive trauma care for injured children in New South Wales, Australia. | |
dc.type | Journal Article | |
utslib.citation.volume | 53 | |
utslib.location.activity | Netherlands | |
utslib.for | 1103 Clinical Sciences | |
utslib.for | 1110 Nursing | |
utslib.for | 1117 Public Health and Health Services | |
pubs.organisational-group | /University of Technology Sydney | |
pubs.organisational-group | /University of Technology Sydney/Faculty of Health | |
pubs.organisational-group | /University of Technology Sydney/Faculty of Health/Public Health | |
utslib.copyright.status | open_access | * |
pubs.consider-herdc | false | |
dc.date.updated | 2022-11-22T02:36:56Z | |
pubs.issue | 1 | |
pubs.publication-status | Published | |
pubs.volume | 53 | |
utslib.citation.issue | 1 |
Abstract:
BACKGROUND: Timely definitive paediatric trauma care influences patient and parental physical and emotional outcomes. New South Wales (NSW) covers a large geographical area with all three NSW paediatric trauma centres (PTC) located in two approximated major cities, meaning it is inevitable that some injured children receive initial treatment locally and then require transfer. Little is known about the factors that then impact timely arrival of injured children to definitive care. METHODS: This included children admitted between July 2015 and September 2016, <16 years with an injury severity (ISS) ≥9; or requiring intensive care admission; or deceased following injury. Children were identified through the three PTCs, NSW Trauma Registry and NSW Medical Retrieval Registry. RESULTS: There were 593 children admitted following injury and 46% required transfer to a PTC. There was no significant difference in age, ISS, ICU admission or head injury (AIS >2) between transferred and directly transported cohorts. There were significant differences in mechanism of injury between the two groups (χ2(9) = 45.9, p < 0.001). The median (IQR) time to book a transfer from arrival at the referring facility, was 146.5 (86-238) minutes. Time from injury to arrival at the PTC more than doubled for children transferred, with significant and unwarranted variability between transporting agencies resulting in unwarranted delays to surgical intervention. For example, time spent at the referring facility by Aeromedical Retrieval Service was less than half that of the Newborn & paediatric Emergency Transport Service [53 (IQR:47-61) vs 115 (84-155) minutes (p <0.001)]. CONCLUSION: Clinicians caring for paediatric trauma patients in facilities outside trauma centres require the capability and opportunity to identify and notify early those requiring transfer for ongoing management. The provision of a streamlined referral and transfer process for all paediatric trauma patients requiring treatment in NSW PTCs would reduce the burden on the referring facility, reduce variation amongst transport providers and improve time to definitive care.
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