Using emergency trauma team activations to measure trauma activity and injury severity: 10 years of experience using an Australian major trauma centre registry

  • M. M. Dinh
  • S. Roncal
  • K. Curtis
  • R. Ivers
Original Article



To describe the outcomes of Emergency Department trauma team activations over a 10-year period with respect to injury severity and hospital length of stay.


This was a retrospective study using trauma registry data at a single Major Trauma Centre in Australia. All trauma team activations and arrivals on pre-hospital major trauma (T1) protocol recorded in the trauma registry between June 2006 and July 2016 were included. The outcome of interest was major trauma, defined as an Injury Severity Score (ISS) >12 or length of stay >3 days or requiring urgent operative intervention or admission to the Intensive Care Unit following trauma.


A total of 9876 hospital trauma activations were analysed from January 2006 to June 2016. Of these 53.3% were admitted as an in-patient and 16.6% were classified as having an ISS >15. Major trauma occurred in 38% of cases. With respect to hospital utilisation, patients with an ISS <16 accounted for around half of total cumulative in-patient bed-days.


Analysis of data from trauma team activations in ED has allowed a description of trauma activity and hospital bed day utilisation as a function of injury severity. The results confirm that those with minor trauma accounted for the vast majority of cases and around half of all hospital in-patient bed-days.


Trauma Emergency department Triage 


Author contributions

MMD contributed to study design, data analysis and manuscript preparation; SR contributed to data analysis; RI, KC and BG contributed to study design and manuscript preparation.

Compliance with ethical standards


The study was not funded.

Ethical approval

Approval for the study was obtained from the Sydney Local Health District Research Ethics Committee.

Research involving human participants/animals

The study did not involve human or animal subjects.

Conflict of interest

Michael M Dinh, Susan Roncal, Rebecca Ivers and Kate Curtis declare that they have no conflicts of interest with respect to this study.


  1. 1.
    World Health Organisation. Guidelines for trauma quality improvement programs. WHO Press, Geneva. (2009). Accessed Dec 2016 (ISBN 978 92 4 159774 6)
  2. 2.
    Paffrath T, Lefering R, Flohé S. How to define severely injured patients? An injury severity score (ISS) based approach alone is not sufficient. Injury. 2014;45(Suppl 3):S64-9.PubMedGoogle Scholar
  3. 3.
    O’Reilly GM, Gabbe B, Cameron PA. Trauma registry methodology: a survey of trauma registry custodians to determine current approaches. Injury. 2015;46(2):201–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Baker SP, O’Neill B, Haddon W Jr, 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.CrossRefPubMedGoogle Scholar
  5. 5.
    Palmer C. Major trauma and the injury severity score—where should we set the bar? Annu Proc Assoc Adv Automot Med. 2007;51:13–29.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Lang J, Dallow N, Lang A, Tetsworth K et al. Inclusion of “minor” trauma cases provides a better estimate of the total burden of injury: Queensland trauma registry provides a unique perspective. Injury. 2014;45(8):1236–41.CrossRefPubMedGoogle Scholar
  7. 7.
    Gruen RL, Jurkovich GJ, McIntyre LK, et al. Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. Ann Surg. 2006;244(3):371 – 80.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Dinh MM, Oliver M, Bein KJ, et al. Performance of the New South Wales Ambulance Service major trauma transport protocol (T1) at an inner city trauma centre. Emerg Med Aust. 2012;24(4):401–7.CrossRefGoogle Scholar
  9. 9.
    Dinh MM, Bein KJ, Gabbe BJ, et al. A trauma quality improvement programme associated with improved patient outcomes: 21 years of experience at an Australian Major Trauma Centre. Injury. 2014;45(5):830–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Dinh MM, Cornwall K, Bein KJ, et al. Health status and return to work in trauma patients at 3 and 6 months post-discharge: an Australian major trauma centre study. Eur J Trauma Emerg Surg.2015 Aug 11. [Epub ahead of print].Google Scholar
  11. 11.
    NSW Department of Health. Selected Specialty and Statewide Services Plan Number six. (2009). (ISBN 978-1-74187-392-4).
  12. 12.
    Nwomeh BC, Lowell W, Kable R, et al. History and development of trauma registry: lessons from developed to developing countries. World J Emerg Surg. 2006;1:32.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Cole E, Lecky F, West A, Smith N. ELoTS Study Collaborators. The impact of a pan-regional inclusive trauma system on quality of care. Ann Surg. 2016;264(1):188–94.CrossRefPubMedGoogle Scholar
  14. 14.
    Lidal IB, Holte HH, Vist GE. Triage systems for pre-hospital emergency medical services—a systematic review. Scand J Trauma Resusc Emerg Med. 2013;21:28.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hammer PM, Storey AC, Bell T, Bayt D, et al. Improving geriatric trauma outcomes: a small step toward a big problem. J Trauma. 2016;81(1):162–7. doi: 10.1097/TA.0000000000001063.CrossRefGoogle Scholar
  16. 16.
    Palmer CS, Davey TM, Mok MT, et al. Standardising trauma monitoring: the development of a minimum dataset for trauma registries in Australia and New Zealand. Injury. 2013;44(6):834–41.CrossRefPubMedGoogle Scholar
  17. 17.
    Curtis K, Zou Y, Morris R, Black D. Trauma case management: improving patient outcomes. Injury. 2006;37(7):626–32.CrossRefPubMedGoogle Scholar
  18. 18.
    Santana MJ, Stelfox HT, Trauma Quality Indicator Consensus Panel. Development and evaluation of evidence-informed quality indicators for adult injury care. Ann Surg. 2014; 259(1):186–92.CrossRefPubMedGoogle Scholar
  19. 19.
    Curtis K, Lam M, Mitchell R, Dickson C, McDonnell K. Major trauma: the unseen financial burden to trauma centres, a descriptive multicentre analysis. Aust Health Rev. 2014;38(1):30–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Chalkley D, Cheung G, Walsh M, Tai N. Deaths from trauma in London—a single centre experience. Emerg Med J. 2011;28(4):305–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Sears JM, Bowman SM, Hogg-Johnson S, Shorter ZA. Occupational injury trends derived from trauma registry and hospital discharge records: lessons for surveillance and research. J Occup Environ Med. 2014;56(10):1067–73.CrossRefPubMedGoogle Scholar
  22. 22.
    Cadilhac DA, Kim J, Lannin NA, Levi CR, et al. Australian Stroke Clinical Registry Consortium. Better outcomes for hospitalized patients with TIA when in stroke units: an observational study. Neurology. 2016; 86(22):2042–8.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Emergency Department, Royal Prince Alfred Hospital, Sydney Medical SchoolThe University of Sydney, The George Institute for Global HealthCamperdownAustralia
  2. 2.Sydney Nursing SchoolThe University of SydneySydneyAustralia

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