Skip to main content

Advertisement

SpringerLink
Log in

Trends in Procedures at Major Trauma Centres in New South Wales, Australia: An Analysis of State-Wide Trauma Data

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Objectives

To describe the trend in major trauma surgical procedures and interventional radiology in major trauma patients in Australia over the past 6 years.

Methods

This was a retrospective review of adult major trauma (Injury Severity Score greater than 15) patients using the New South Wales Statewide Trauma Registry between 2009 and 2014. Major trauma surgical procedures were classified into abdominal, neurosurgery, cardiothoracic and interventional radiology. The proportion of patients undergoing such procedures per year was the outcome of interest.

Results

There were around ten thousand cases analysed. The proportion of cases undergoing interventional radiology procedures increased from 1% in 2009 to around 6% in 2014. Other major trauma surgical procedures remained stable. Only around 100 laparotomies were performed in 2014. The predictors of having an IR procedure performed were increasing from 2009 (OR 1.5 95% CI 1.4, 1.6 p < 0.001), hypotension (OR 1.5 95% CI 1.1, 2.1 n = 0.01), severe abdominal injury (OR 4.2 95% CI 3.2, 5.3 p < 0.001) and lower limb (including pelvic) injury (OR 3.8 95% CI 3.0, 4.7 p < 0.001).

Conclusion

There has been a rapid increase in the use of interventional radiology over the past few years which will need to be addressed in future trauma service planning and models of care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Stassen NA, Bhullar I, Cheng JD et al (2012) Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 73(5 Suppl 4):S294–S300

    Article  PubMed  Google Scholar 

  2. Peitzman AB, Richardson JD (2010) Surgical treatment of injuries to the solid abdominal organs: a 50-year perspective from the journal of trauma. J Trauma 69(5):1011–1021

    Article  PubMed  Google Scholar 

  3. Como JJ, Bokhari F, Chiu WC et al (2010) Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma 68(3):721–733

    Article  PubMed  Google Scholar 

  4. Heetveld MJ, Harris I, Schlaphoff G, Sugrue M (2004) Guidelines for the management of haemodynamically unstable pelvic fracture patients. ANZ J Surg 74(7):520–529

    Article  PubMed  Google Scholar 

  5. Cullinane DC, Schiller HJ, Zielinski MD, Bilaniuk JW et al (2011) Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture—update and systematic review. J Trauma 71(6):1850–1868

    PubMed  Google Scholar 

  6. Bittner JG IV, Hawkins ML, Medeiros RS et al (2010) Nonoperative management of solid organ injury diminishes surgical resident operative experience: is it time for simulation training? J Surg Res 163(2):179–185

    Article  PubMed  Google Scholar 

  7. Bulinski P, Bachulis B, Naylor DF Jr, Kam D et al (2003) The changing face of trauma management and its impact on surgical resident training. J Trauma 54(1):161–163

    Article  PubMed  Google Scholar 

  8. Engelhardt S, Hoyt D, Coimbra R et al (2001) The 15-year evolution of an urban trauma center: what does the future hold for the trauma surgeon? J Trauma 51(4):633–637

    Article  CAS  PubMed  Google Scholar 

  9. Jennings GR, Poole GV, Yates NL et al (2001) Has nonoperative management of solid visceral injuries adversely affected resident operative experience? Am Surg 67(6):597–600

    CAS  PubMed  Google Scholar 

  10. Lukan JK, Carrillo EH, Franklin GA et al (2001) Impact of recent trends of noninvasive trauma evaluation and nonoperative management in surgical resident education. J Trauma 50(6):1015–1019

    Article  CAS  PubMed  Google Scholar 

  11. Malangoni MA, Biester TW, Jones AT et al (2013) Operative experience of surgery residents: trends and challenges. J Surg Educ 70(6):783–788

    Article  PubMed  Google Scholar 

  12. Model Resource Criteria for Level I,II, III, and IV Trauma Services in Australasia Royal Australasian Collage of Surgeons [Internet] (2014). https://www.surgeons.org/media/309212/doc_2014-09-mrc-v20-full-document.pdf

  13. Curtis KA, Mitchell RJ, Chong SS et al (2012) Injury trends and mortality in adult patients with major trauma in New South Wales. Med J Aust 197(4):233–237

    Article  PubMed  Google Scholar 

  14. Kirkpatrick AW, Vis C, Dube M et al (2014) The evolution of a purpose designed hybrid trauma operating room from the trauma service perspective: the RAPTOR (resuscitation with angiography percutaneous treatments and operative resuscitations). Injury 45(9):1413–1421

    Article  PubMed  Google Scholar 

  15. Association for the Advancement of Automotive Medicine (2008) The Abbreviated Injury Scale 2005—update 2008. Association for the Advancement of Automotive Medicine, Barrington

    Google Scholar 

  16. Dent D, Alsabrook G, Erickson BA et al (2004) Blunt splenic injuries: high nonoperative management rate can be achieved with selective embolization. J Trauma 56(5):1063–1067

    Article  PubMed  Google Scholar 

  17. Haan J, Ilahi ON, Kramer M et al (2003) Protocol-driven nonoperative management in patients with blunt splenic trauma and minimal associated injury decreases length of stay. J Trauma 55(2):317–321 (discussion 321-2)

    Article  PubMed  Google Scholar 

  18. Haan JM, Biffl W, Knudson MM et al (2004) Splenic embolization revisited: a multicenter review. J Trauma 56(3):542–547

    Article  PubMed  Google Scholar 

  19. Haan JM, Bochicchio GV, Kramer N, Scalea TM (2005) Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma 58(3):492–498

    Article  PubMed  Google Scholar 

  20. Liu PP, Lee WC, Cheng YF, Hsieh PM et al (2004) Use of splenic artery embolization as an adjunct to nonsurgical management of blunt splenic injury. J Trauma 56(4):768–772 (discussion 773)

    Article  PubMed  Google Scholar 

  21. van der Vlies CH, Hoekstra J, Ponsen KJ et al (2012) Impact of splenic artery embolization on the success rate of nonoperative management for blunt splenic injury. Cardiovasc Interv Radiol 35(1):76–81

    Article  Google Scholar 

  22. Grasberger RC, McMillian TN, Yeston NS et al (1986) Residents’ experience in the surgery of trauma. J Trauma 26(9):848–850

    Article  CAS  PubMed  Google Scholar 

  23. Bergeron E, Lavoie A, Razek T et al (2005) Penetrating thoracoabdominal injuries in Quebec: implications for surgical training and maintenance of competence. Can J Surg 48(4):284–288

    PubMed  PubMed Central  Google Scholar 

  24. Birkmeyer JD, Siewers AE, Finlayson EV et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137

    Article  PubMed  Google Scholar 

  25. Birkmeyer JD, Stukel TA, Siewers AE et al (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349(22):2117–2127

    Article  CAS  PubMed  Google Scholar 

  26. Demetriades D, Martin M, Salim A et al (2005) The effect of trauma center designation and trauma volume on outcome in specific severe injuries. Ann Surg 242(4):512–517 (discussion 517-9)

    PubMed  PubMed Central  Google Scholar 

  27. Nathens AB, Jurkovich GJ, Maier RV et al (2001) Relationship between trauma center volume and outcomes. JAMA 285(9):1164–1171

    Article  CAS  PubMed  Google Scholar 

  28. Livingston EH, Cao J (2010) Procedure volume as a predictor of surgical outcomes. JAMA 304(1):95–97

    Article  CAS  PubMed  Google Scholar 

  29. American College of Surgeons: Resources for optimal care of the injured patient 2014 (6th edn) [Internet]. https://www.facs.org/quality%20programs/trauma/vrc/resources

  30. Schwartz DA, Medina M, Cotton BA et al (2014) Are we delivering two standards of care for pelvic trauma? Availability of angioembolization after hours and on weekends increases time to therapeutic intervention. J Trauma Acute Care Surg 76(1):134–139

    Article  PubMed  Google Scholar 

  31. Howell GM, Peitzman AB, Nirula R et al (2010) Delay to therapeutic interventional radiology postinjury: time is of the essence. J Trauma 68:1296–1300

    Article  PubMed  Google Scholar 

  32. Tanizaki S, Maeda S, Matano H et al (2014) Time to pelvic embolization for hemodynamically unstable pelvic fractures may affect the survival for delays up to 60 min. Injury 45(4):738–741

    Article  PubMed  Google Scholar 

  33. RANZCR Radiology Workforce Report: Australia—Radiology Workforce Committee, The Royal Australian and New Zealand College of Radiologists. http://www.ranzcr.edu.au/documents-download/document-library-6/document-library-7?limit=15&sort=created_on&direction=asc. Accessed May 2016

  34. O’Brien J, Baerlocher MO, Asch MR et al (2007) Limitations influencing interventional radiology in Canada: results of a national survey by the Canadian Interventional Radiology Association (CIRA). Cardiovasc Interv Radiol 30(5):847–853

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma Services, Royal Prince Alfred Hospital, Sydney Medical School, The University of Sydney, Missenden Road, Sydney, 2050, Australia

    Matthew Oliver & Michael M. Dinh

  2. St George Hospital, Sydney Nursing School, The University of Sydney, Sydney, Australia

    Kate Curtis

  3. Radiology Department, Royal Prince Alfred Hospital, Sydney Medical School, The University of Sydney, Sydney, Australia

    Royce Paschkewitz

  4. Institute of Trauma and Injury Management, New South Wales Agency for Clinical Innovation, Sydney, Australia

    Oran Rigby

  5. Department of Traumatology, John Hunter Hospital, University of Newcastle, Sydney, Australia

    Zsolt J. Balogh

Authors
  1. Matthew Oliver
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael M. Dinh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kate Curtis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Royce Paschkewitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Oran Rigby
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zsolt J. Balogh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthew Oliver.

Ethics declarations

Conflicts of interest

There are no conflicts of interest or financial disclosures.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oliver, M., Dinh, M.M., Curtis, K. et al. Trends in Procedures at Major Trauma Centres in New South Wales, Australia: An Analysis of State-Wide Trauma Data. World J Surg 41, 2000–2005 (2017). https://doi.org/10.1007/s00268-017-3993-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-017-3993-8

Keywords

Search

Navigation