How trauma incident data can be used to prevent future injuries

by Donna Chisholm / 16 January, 2018
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Grant Christey: a road crash costs on average $15,000 in hospital treatment alone.

The minutest details of a trauma incident yield data that can avert future injury.

On the computer screen in surgeon Grant Christey’s office is a map of the Midland district his trauma system covers. It takes in major centres, including New Plymouth, Hamilton, Rotorua, Tauranga and Gisborne, and comprises five district health boards: Tairāwhiti, Taranaki, Lakes, Bay of Plenty and Waikato.

On this map are hundreds of brightly coloured dots, each colour signifying a type of incident: red for assault; cyan for motorbike crashes, for example – that have resulted in one or more patients being taken to hospital. Each of the dots has a story to tell through a mind-boggling depth of data.

Christey clicks on a cluster of motorbike crashes in Ngatea in the past five years. “There’s your demographic,” he says. “Exactly what we would expect.” You might think he’s referring to 15-25-year-old “road warriors”, a traditional black-spot group for crash statistics. He’s not. These victims are predominantly aged 55-59, the “accountants on Harleys”.

“The new motorbike injury patient is the older rider, because they’ve got the money to buy the big bikes and they’ve got leisure time.”

The data could help save lives. The Midland Trauma Research Centre has teamed up with the NZ Transport Agency to investigate motorbike crashes in the Waikato, so rider groups, roads and conditions at higher risk can be identified. In the Waikato DHB, more than 1000 crashes in the past five years have cost at least $2 million in hospital treatment alone.

“We can look at the cost of a piece of road for the past five years and say, ‘Maybe they should put up a few road signs there’. It’s a pretty cost-effective way of preventing road crashes that cost an average of $15,000 each. We are putting a dollar value on prevention now.”

Here’s another cluster – assaults in two parts of Hamilton, Glenview and Fairview Downs. “We can identify the actual streets, so we could go to police and council and say, ‘We’ve identified a potential problem here’.”

And in South Waikato, Christey points to a “massive peak” in farm quad-bike accidents in 50-65-year-olds. The average cost of hospital treatment is $22,000 – and the total cost to society many times that. “These are older farmers who don’t get a broken arm or ankle and jump off – they can’t get off the bikes and the bikes roll and they get a crushed chest.”

It costs $350,000 a year to treat the injuries in that age group alone. The data has prompted the trauma system to commission a qualitative study to interview farmers and try to understand why the accidents are happening. That information could then be used to target prevention campaigns.

A few weeks ago, Christey even identified schools in the region that had an unexpectedly high rate of children breaking limbs on monkey bars.

Although other districts collect some trauma data, Midland’s registry is the most detailed in the country, collating 200 pieces of information on each major-trauma patient, and 120 on those with minor trauma. For major trauma, that includes the GPS co-ordinates of where the incident occurred, the time of day, day of the week, what happened, the weather conditions and outcomes. Although unique identifiers are removed for privacy reasons, each patient’s injuries and treatment are also documented.

The Midland Trauma System has also introduced a “pre-hospital matrix” chart for paramedics, to help them determine which hospital they should head to first with patients with complex, severe injuries. “If you have a patient with a brain injury, you aren’t doing them a favour by taking them to a hospital where they can’t do a craniotomy. It’s better to drive an extra 20-30 minutes to a hospital where they can do one. The fastest route is not always the best if it’s the wrong destination.”

It will be another year before statistics show whether that change is further improving outcomes.

This article was first published in the December 9, 2018 issue of the New Zealand Listener.

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