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Objective: To measure the prevalence of alcohol and/or other drug (AOD) detections in suspected major trauma patients with non‐transport injuries who presented to an adult major trauma centre. Methods: This registry‐based cohort study examined the prevalence of AOD detections in patients aged ≥18 years who: (i) sustained non‐transport injuries; and (ii) met predefined trauma call‐out criteria and were therefore managed by an interdisciplinary trauma team between 1 July 2021 and 31 December 2022. Prevalence was measured using routine in‐hospital blood alcohol and urine drug screens. Results: A total of 1469 cases met the inclusion criteria. Of cases with a valid blood test (n = 1248, 85.0%), alcohol was detected in 313 (25.1%) patients. Of the 733 (49.9%) cases with urine drug screen results, cannabinoids were most commonly detected (n = 103, 14.1%), followed by benzodiazepines (n = 98, 13.4%), amphetamine‐type substances (n = 80, 10.9%), opioids (n = 28, 3.8%) and cocaine (n = 17, 2.3%). Alcohol and/or at least one other drug was detected in 37.4% (n = 472) of cases with either a blood alcohol or urine drug test completed (n = 1263, 86.0%). Multiple substances were detected in 16.6% (n = 119) of cases with both blood alcohol and urine drug screens (n = 718, 48.9%). Detections were prevalent in cases of interpersonal violence (n = 123/179, 68.7%) and intentional self‐harm (n = 50/106, 47.2%), and in those occurring on Friday and Saturday nights (n = 118/191, 61.8%). Conclusion: AOD detections were common in trauma patients with non‐transport injury causes. Population‐level surveillance is needed to inform prevention strategies that address AOD use as a significant risk factor for serious injury. [ABSTRACT FROM AUTHOR]

Background: The Injury Severity Score (ISS) is the most ubiquitous summary score derived from Abbreviated Injury Scale (AIS) data. It is frequently used to classify patients as 'major trauma' using a threshold of ISS >15. However, it is not known whether this is still appropriate, given the changes which have been made to the AIS codeset since this threshold was first used. This study aimed to identify appropriate ISS and New Injury Severity Score (NISS) thresholds for use with the 2008 AIS (AIS08) which predict mortality and in-hospital resource use comparably to ISS >15 using AIS98.Methods: Data from 37,760 patients in a state trauma registry were retrieved and reviewed. AIS data coded using the 1998 AIS (AIS98) were mapped to AIS08. ISS and NISS were calculated, and their effects on patient classification compared. The ability of selected ISS and NISS thresholds to predict mortality or high-level in-hospital resource use (the need for ICU or urgent surgery) was assessed.Results: An ISS >12 using AIS08 was similar to an ISS >15 using AIS98 in terms of both the number of patients classified major trauma, and overall major trauma mortality. A 10% mortality level was only seen for ISS 25 or greater. A NISS >15 performed similarly to both of these ISS thresholds. However, the AIS08-based ISS >12 threshold correctly classified significantly more patients than a NISS >15 threshold for all three severity measures assessed.Conclusions: When coding injuries using AIS08, an ISS >12 appears to function similarly to an ISS >15 in AIS98 for the purposes of identifying a population with an elevated risk of death after injury. Where mortality is a primary outcome of trauma monitoring, an ISS >12 threshold could be adopted to identify major trauma patients.Level Of Evidence: Level II evidence--diagnostic tests and criteria. [ABSTRACT FROM AUTHOR]

Background There is limited evidence describing the long-term outcomes of severe pelvic ring fractures. The aim of this study was to describe the longer term independent living and return to work outcomes following severe pelvic ring fracture. Methods Adult survivors to discharge from two major trauma centres with AO/ Tile type B and C fractures were followed up at 6, 12 and 24-months post-injury to capture functional ( Glasgow Outcome Scale- Extended [ GOS- E]) and return to work data. Multivariable, mixed effects models were used to identify predictors of outcome. Results A total of 111 of 114 (97%) cases were followed up. The mean ( SD) age of participants was 41.9 (18.9) years, 77% were male, 81% were transport-related and 90% were multi-trauma patients. Further, 11% were managed conservatively, 10% with external fixation and 79% with open reduction and internal fixation. At 24 months, 77% were living independently ( GOS- E > 4) and 59% had returned to work. Higher Injury Severity Scores ( ISS) were associated with lower risk-adjusted odds of return to work ( P = 0.04) and independent living ( P = 0.06). Post-operative infection was associated with living independently ( P = 0.02). Conclusion Despite the severity of the injuries sustained, 77% of severe pelvic ring fracture patients were living independently and 59% had returned to work, 2-years post-injury. Fracture type and management were not key predictors of outcome. Large-scale multi-centre studies are needed to fully understand the burden of severe pelvic ring fractures and to guide clinical management. [ABSTRACT FROM AUTHOR]

Background: Understanding the factors that impact on disability is necessary to inform trauma care and enable adequate risk adjustment for benchmarking and monitoring. A key consideration is how to adjust for pre-existing conditions when assessing injury outcomes, and whether the inclusion of comorbidity is needed in addition to adjustment for age. This study compared different approaches to modelling the impact of comorbidity, collected as part of the routine hospital episode data, on disability outcomes following orthopaedic injury. Methods: 12-month Glasgow Outcome Scale - Extended (GOS-E) outcomes for 13,519 survivors to discharge were drawn from the Victorian Orthopaedic Trauma Outcomes Registry, a prospective cohort study of admitted orthopaedic injury patients. ICD-10-AM comorbidity codes were mapped to four comorbidity indices. Cases with a GOS-E score of 7-8 were considered "recovered". A split dataset approach was used with cases randomly assigned to development or test datasets. Logistic regression models were fitted with "recovery" as the outcome and the performance of the models based on each comorbidity index (adjusted for injury and age) measured using calibration (Hosmer-Lemshow (H-L) statistics and calibration curves) and discrimination (Area under the Receiver Operating Characteristic (AUC)) statistics. Results: All comorbidity indices improved model fit over models with age and injuries sustained alone. None of the models demonstrated acceptable model calibration (H-L statistic p < 0.05 for all models). There was little difference between the discrimination of the indices for predicting recovery: Charlson Comorbidity Index (AUC 0.70, 95% CI: 0.68, 0.71); number of ICD-10 chapters represented (AUC 0.70, 95% CI: 0.69, 0.72); number of six frequent chronic conditions represented (AUC 0.70, 95% CI: 0.69, 0.71); and the Functional Comorbidity Index (AUC 0.69, 95% CI: 0.68, 0.71). Conclusions: The presence of ICD-10 recorded comorbid conditions is an important predictor of long term functional outcome following orthopaedic injury and adjustment for comorbidity is indicated when assessing risk-adjusted functional outcomes over time or across jurisdictions. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: To evaluate the validity of the 12-item Short Form Health Survey (SF-12), Sickness Impact Profile (SIP) and the Short Musculoskeletal Functional Assessment Questionnaire (SMFA) for use in an orthopaedic trauma population. Materials and methods: A prospective validation trial was completed at a Level 1 adult trauma centre in Melbourne, Australia. One hundred and fifty four patients with orthopaedic trauma managed or followed-up by an orthopaedic unit were prospectively recruited. Patients with pathological fractures related to metastatic disease and/or an isolated orthopaedic injury, a documented history of mental illness or dementia or those for whom follow-up was likely to be difficult were excluded. The SF-12, SIP and SMFA were administered by a trained interviewer at one and six months. Each questionnaire was scored for the physical and mental components and then compared for content and construct validity at each time point. Results: Complete data were collected for 134 patients at one and six months. The one and six month component scores correlated strongly between the SF-12 physical, SIP physical (r =0.513–0.669) and SMFA dysfunction (r =0.529–0.778); the SF-12 mental, SIP mental (r =0.643–0.719) and SMFA bother (r =0.564–0.602) components. The strength of association was greater for the six month time point compared to the one month measure. The SF-12 demonstrated no ceiling or floor effects, and provided a lower time burden on participants and researchers when compared to the SIP and SMFA. Conclusions: For large population-based surveillance research into orthopaedic injury the SF-12 provides a valid and versatile tool. [Copyright &y& Elsevier]

Background: Severe burns represent a challenging and complex clinical presentation, requiring highly specialized burns centres that are staffed and equipped appropriately. The integration of burns care into trauma systems has been recommended. This study describes the profile, transfer and outcomes of severe burns within an inclusive, regionalized trauma system. Methods: A retrospective analysis of prospectively collected data from the Victorian State Trauma Registry for the period July 2001-June 2009 was performed. Major trauma cases with any burn injury were analysed. A severe burns case was defined as a total body surface area (TBSA) burned ≥20%. Descriptive statistics were used to define the profile of severe burns cases, their management and in-hospital outcomes. Results: For the 315 cases, the mean (standard deviation) age was 39 (22) years, and 73% were male. Fire/flames was the predominant cause (72%), and 39% sustained an inhalation injury. All paediatric ( n= 37) and 98% of adult cases with a %TBSA ≥20 were managed at the state's burn services. Half of the cases experienced an inter-hospital transfer. Sixty-seven percent of cases were admitted to the intensive care unit, 22% died in-hospital and the median length of stay was 31 days. Conclusions: An inclusive trauma system with burns services co-located at the major trauma services resulted in almost complete referral of severe burns cases to burns services for management. Half of the cases arrived at the burns services directly from the scene of injury, highlighting the importance of ongoing clinical education about the initial management of severe burns at non-burns service hospitals. [ABSTRACT FROM AUTHOR]

The article presents a study on the twelve-month outcomes of a serious orthopaedic injuries due to sport and active recreation to patients that are admitted to Level 1 Trauma Centers in Melbourne, Victoria. It states that a total of 366 adults admitted to two Level 1 trauma centers for an orthopaedic sport and active recreation injury have participated to the study and they were captured by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). It reveals that almost one quarter of the patients were still experiencing moderate to severe physical disability, and the increasing age and patterns of injury were the main predictors of a poor physical outcome at 12 months. It also emphasizes the importance of further investigation into sports and recreation injury.

Summary: Precise prehospital trauma triage criteria are critical for ensuring patients with severe injuries are transported to trauma centres. Most prehospital trauma triage criteria adopt a combination of physiological, anatomic and mechanism of injury components, but this approach still fails to identify a number of patients with severe injuries and often burdens trauma centres with patients suffering minor injuries. Paramedic judgement has been identified as an alternative method for the triage of trauma patients. This study critically reviewed the literature regarding the ability of paramedics to predict injury severity, and found there is no clear evidence supporting paramedic judgement as an accurate triage method. However, the studies were limited due to significant data losses, variable definitions of major trauma, differences across EMS and trauma care systems, variable paramedic experience levels and incomparable methods of data collection. The role of paramedic judgement in identifying patients with severe blunt anatomic injuries requires further investigation. [Copyright &y& Elsevier]

The revised trauma score (RTS) has been embraced by the trauma community worldwide. Although originally developed as a triage tool, the use of the RTS has since been expanded to include the prediction of outcome following traumatic injury. Through a critical review of the literature, evidence for use of the RTS is discussed along with the limitations of this commonly used tool. In summary, the RTS is a well-established predictor of mortality in trauma populations, but there is a lack of definitive evidence supporting its use as a primary triage tool and as a predictor of outcomes other than mortality. Difficulty in collecting the components of the RTS creates issues for data validity and the use of the RTS as a research tool. Although the weighted RTS has been developed to improve the prediction capacity of the RTS, studies reporting its use are few and there is debate regarding the applicability of the published coefficients for broad use. Overall, further studies are warranted to clearly establish the usefulness of the RTS as a triage tool in the field, to further evaluate the weighted version of the RTS, and to determine the ability of the RTS to predict functional outcome and quality of life. In particular, future research is needed to address these issues in Australian trauma populations. [ABSTRACT FROM AUTHOR]

Objective: To i) quantify the agreement between comorbidities documented within medical records and an orthopaedic trauma dataset; and ii) compare agreement between these sources before and after the introduction of new comorbidity coding rules in Australian hospitals.Study Design and Setting: A random sample of adult (≥ 16 years) orthopaedic trauma patients (n = 400) were extracted from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Diagnoses of obesity, arthritis, diabetes and cardiac conditions documented within patients' medical records were compared to ICD-10-AM comorbidity codes (provided by hospitals) for the same admission. Agreement was calculated (Cohen's kappa) before and after the introduction of new coding rules.Results: All comorbidities had the same or higher prevalence in medical record data compared to coded data. Kappa values ranged from <0.001 (poor agreement) for coronary artery disease to 0.94 (excellent agreement) for type 2 diabetes. There was improvement in agreement between sources for most conditions following the introduction of new coding rules.Conclusion: There has been improvement in the coding of certain comorbidities since the introduction of new coding rules, suggesting that, since 2015, administrative data has improved capacity to capture patients' comorbidity profiles. Consideration must be taken when using the ICD-10-AM data due to its limitations. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess changes in patient activities and interactions observed in response to a new trauma ward at a level 1 trauma centre, and subsequently, a new allied health staffing model. Design: Explorative case study using behavioural mapping. Setting: Level 1 trauma centre in Melbourne, Australia. Participants: Hospitalised trauma patients. Main measures: Behavioural mapping of patients' activities and interactions was conducted by two observers over three 4-day observation phases: (i) at baseline, (ii) on the new ward and (iii) with the new staffing model. Changes in activities and interactions were assessed via negative binomial regression models and reported as incident rate ratios. Results: In total, 1264 patient observations were recorded over an 18-month period. After moving to the new ward, patients were observed performing activities of daily living at a 2.1-fold higher rate than at baseline (95% confidence interval: 1.18, 3.81) but walking/standing/climbing stairs 54% less (95% confidence interval: 0.22, 0.94). Subsequent to the new staffing model, patients were observed in the gym at a 4.1-fold higher rate (95% confidence interval: 1.60, 10.32) and interacting with allied health professionals at a 9.1-fold higher rate (95% confidence interval: 4.88, 16.98), than at baseline. After COVID-19 restrictions were introduced, patients were observed lying down 22% more (95% confidence interval: 1.04, 1.43), with 73% fewer visitor interactions (95% confidence interval: 0.17, 0.43). Conclusions: Greater engagement in physical and social activities was observed following the implementation of the new allied health staffing model at a level 1 trauma centre. Whether these changes translate to improved trauma outcomes is important to investigate. [ABSTRACT FROM AUTHOR]

Background: Although orthopaedic trauma results in significant disability and substantial financial cost, there is a paucity of large cohort studies that collectively describe the functional outcomes of a variety of these injuries. The current study aimed to investigate the outcomes of patients admitted with a range of orthopaedic injuries to adult Level 1 trauma centres. Methods: Patients were recruited from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), which included all patients with orthopaedic trauma admitted to the two adult Level 1 trauma centres in Victoria (Australia). Patients were categorised into three groups; isolated orthopaedic injuries, multiple orthopaedic injuries and orthopaedic and other injuries. Demographic and injury data were collected from the medical record and hospital/trauma databases, and functional outcome instruments were given at 6 months post-injury. Results: Of the 1303 patients recruited for VOTOR over a 12-month period, 1181 patients were eligible for the study and a response rate of 75.6% was obtained at 6 months post-injury. Patients reported ongoing pain (moderate-severe: 37.2%), disability (79.5%) and inability to return to work (35.2%). Poorer outcomes were evident in patients with orthopaedic and other injuries than those with single or multiple orthopaedic injuries alone. Conclusion: A large percentage of patients have ongoing pain and disability and a reduced capacity to return to work 6 months after orthopaedic trauma. Further research into the long-term outcomes of patients with orthopaedic injuries is required to identify patient subgroups and specific injuries and procedures that result in high morbidity. [ABSTRACT FROM AUTHOR]

Trauma registries, like disease registries, provide an important analysis tool to assess the management of patient care. Trauma registries are well established and relatively common in the USA and have been used to change legislation, promote trauma prevention and to evaluate trauma system effectiveness. In Australia, the first truly statewide trauma registry was established in Victoria in 2001 with an estimated capture of 1700 major trauma cases annually. The Victorian State Trauma Registry, managed by the Victorian State Trauma Outcomes Registry and Monitoring (VSTORM) group, was established in response to a ministerial review of trauma and emergency services undertaken in 1997 to advise the Victorian Government on a best practice model of trauma service provision that was responsive to the particular needs of critically ill trauma patients. This taskforce recommended the establishment of a new system of care for major trauma patients in Victoria and a statewide trauma registry to monitor this new system. The development of the Victorian state trauma registry has shown that there are certain issues that must be resolved for successful implementation of any system-wide registry. This paper describes the issues faced by VSTORM in developing, implementing and maintaining a statewide trauma registry. [ABSTRACT FROM AUTHOR]

Objectives: To develop a hospital indicator of resource use for injury admissions.Methods: We focused on resource use for acute injury care and therefore adopted a hospital perspective. We included patients ≥16 years old with an Injury Severity Score >9 admitted to any of the 57 trauma centers of an inclusive Canadian trauma system from 2014 to 2018. We extracted data from the trauma registry and hospital financial reports and estimated resource use with activity-based costing. We developed risk-adjustment models by trauma center designation level (I/II and III/IV) for the whole sample, traumatic brain injuries, thoraco-abdominal injuries, orthopedic injuries, and patients ≥65 years old. Candidate variables were selected using bootstrap resampling. We performed benchmarking by comparing the adjusted mean cost in each center, obtained using shrinkage estimates, to the provincial mean.Results: We included 38 713 patients. The models explained between 12% and 36% (optimism-corrected r2) of the variation in resource use. In the whole sample and in all subgroups, we identified centers with higher- or lower-than-expected resource use across level I/II and III/IV centers.Conclusions: We propose an algorithm to produce the indicator using data routinely collected in trauma registries to prompt targeted exploration of potential areas for improvement in resource use for injury admissions. The r2 of our models suggest that between 64% and 88% of the variation in resource use for injury care is dictated by factors other than patient baseline risk. [ABSTRACT FROM AUTHOR]

Introduction: It is well recognised that organised trauma systems reduce trauma patient mortality. As established systems mature, there is an increasing need to better understand the patient recovery trajectory. Mobility and physical function are key aspects of recovery, but the optimal instruments for measurement in the acute hospital setting remain unclear. Methods: A systematic review was undertaken to identify and describe mobility and physical function instruments scored by direct patient assessment, in adult trauma patients in an acute hospital setting. Databases were searched with no date restrictions. Instruments that were specific to subgroups or related to individual conditions, diseases or joints were excluded. The consensus-based standards for the selection of health measurement instruments checklist was used to assess risk of bias where relevant. Clinimetric properties were reported where possible, including reliability, validity and responsiveness. Results: Fourteen thousand one hundred and fourteen articles were identified with 37 eligible for final review, including six instruments. None had been specifically designed for use in a heterogeneous range of trauma patients. The Functional Independence Measure was the most commonly cited (n = 10 studies), with evidence of construct validity, responsiveness and minimal floor/ceiling effects (<3%). The Acute Care Index of Function (n = 1 study) was found to be valid and responsive whilst the modified Iowa Level of Assistance (n = 2 studies) was reliable and responsive, but ceiling effects ranged from 26% to 37%. Little clinimetric data were available for other measures. Conclusion: Evidence from a few studies show promise for the use of the Functional Independence Measure, Acute Care Index of Function and modified Iowa Level of Assistance to measure mobility and physical function in trauma patients, however comprehensive clinimetric data are lacking. Future research should test these scores in specifically designed clinimetric property studies in defined trauma patient populations. This would enable the identification of a gold standard measure for evaluating treatment effectiveness, enabling benchmarking between centres, allow prediction of recovery pathways and optimise trauma patient outcomes. [ABSTRACT FROM AUTHOR]

Background Injuries represent one of the leading causes of preventable morbidity and mortality. For countries with ageing populations, admissions of injured older patients are increasing exponentially. Yet, we know little about hospital resource use for injured older patients. Our primary objective was to evaluate inter-hospital variation in the risk-adjusted resource use for injured older patients. Secondary objectives were to identify the determinants of resource use and evaluate its association with clinical outcomes. Methods We conducted a multicenter retrospective cohort study of injured older patients (≥65 years) admitted to any trauma centres in the province of Quebec (2013–2016, N  = 33,184). Resource use was estimated using activity-based costing and modelled with multilevel linear models. We conducted separate subgroup analyses for patients with trauma and fragility fractures. Results Risk-adjusted resource use varied significantly across trauma centres, more for older patients with fragility fractures (intra-class correlation coefficients [ICC] = 0.093, 95% CI [0.079, 0.102]) than with trauma (ICC = 0.047, 95% CI = 0.035–0.051). Risk-adjusted resource use increased with age, and the number of comorbidities, and varied with discharge destination (P  < 0.001). Higher hospital resource use was associated with higher incidence of complications for trauma (Pearson correlation coefficient r  = 0.5, 95% CI = 0.3–0.7) and fragility fractures (r  = 0.5, 95% CI = 0.3–0.7) and with higher mortality for fragility fractures (r  = 0.4, 95% CI = 0.2–0.6). Conclusions We observed significant inter-hospital variations in resource use for injured older patients. Hospitals with higher resource use did not have better clinical outcomes. Hospital resource use may not always positively impact patient care and outcomes. Future studies should evaluate mechanisms, by which hospital resource use impacts care. [ABSTRACT FROM AUTHOR]

Background: The incidence of older adult traumatic brain injury (TBI) is increasing in both high and middle to low-income countries. It is unknown whether older adults with isolated, serious TBI can be safely managed outside of major trauma centres. This registry based cohort study aimed to compare mortality and functional outcomes of older adults with isolated, serious TBI who were managed at specialised Major Trauma Services (MTS) and Metropolitan Neurosurgical Services (MNS).Method: Older adults (65 years and over) who sustained an isolated, serious TBI following a low fall (from standing or ≤ 1 m) were extracted from the Victorian State Trauma Registry from 2007 to 2016. Multivariable models were fitted to assess the association between hospital designation (MTS vs. MNS) and the two outcomes of interest: in-hospital mortality and functional outcome, adjusting for potential confounders. Functional outcomes were measured using the Glasgow Outcome Scale Extended at six months post-injury.Results: From 2007-2016, there were 1904 older adults who sustained an isolated, serious TBI from a low fall who received definitive care at an MTS (n = 1124) or an MNS (n = 780). After adjusting for confounders, there was no mortality benefit for patients managed at an MTS over an MNS (OR = 0.84; 95% CI: 0.65, 1.08; P = 0.17) or improvement in functional outcome six months post-injury (OR = 1.13; 95% CI: 0.94, 1.36; P = 0.21).Conclusion: For older adults with isolated, serious TBI following a low fall, there was no difference in mortality or functional outcome based on definitive management at an MTS or an MNS. This confirms that MNS without the added designation of a major trauma centre are a suitable destination for the management of isolated, serious TBI in older adults. [ABSTRACT FROM AUTHOR]

Before the COVID-19 pandemic, few injury compensation schemes supported access to service-delivery via telehealth. The aim of this qualitative study was to explore the perspectives of people recovering from serious transport injury, health care providers, and senior staff of a transport injury compensation scheme, in relation to the uptake and implementation of telehealth during the COVID-19 pandemic, and its ongoing use. Semi-structured interviews were undertaken with 35 participants, including 15 seriously injured patients, 16 health care providers and 4 compensation scheme staff. A thematic analysis was performed using a framework approach. Themes identified included the need to provide continuity of care via telehealth during the pandemic for patients recovering from injury, and the associated organisational and technical support needs. It was noted that some types of services worked well via telehealth, including psychology, while others did not, including physical assessments. The convenience of telehealth was highlighted, in relation to reduced travel. However, there were often safety fears relating to falls, and communication issues with injured people. This research found that the majority of injured patients and health care providers had benefitted from the introduction of service delivery via telehealth during the pandemic for some types of services. Participants saw opportunities for continued benefit post-pandemic, particularly for improving equity of access to health care for people with barriers to mobility and travel. [ABSTRACT FROM AUTHOR]

Background: Variations in adjusted costs have been observed among trauma centres in the United States but patient outcomes were not better in centres with higher costs. Attempts to improve injury care efficiency are hampered by insufficient patient-level information on resource use and on the drivers of resource use intensity.Objectives: To estimate patient-level resource use for injury admissions, identify determinants of resource use intensity, and evaluate inter-hospital variations in resource use.Methods: We conducted a retrospective cohort study including ≥16-year-olds admitted to adult trauma centres in a mature, inclusive Canadian trauma system between 2014 and 2016. We extracted data from the trauma registry and hospital financial reports. We estimated resource use with activity-based costs, identified determinants of resource use intensity using a multilevel linear model and assessed the relative importance of each determinant with Cohen's f2. We evaluated inter-provider variations with intraclass correlation coefficients (ICC) and 95% confidence intervals.Results: We included 32,411 patients. Median costs per admission were $4857 (Quartiles 1 and 3 2961-8448). The most important contributors to total resource use were the medical ward (57%), followed by the operating room (OR; 23%) and the intensive care unit (13%). The strongest determinant of resource use intensity was discharge destination (Cohen's f2 = 7%). The most resource intense patient group was spinal cord injuries with $11,193 (7115-17,606) per admission. While resource use increased with increasing age for the medical ward, it decreased with increasing age for the OR. Resource use was 18% higher in level I centres compared to level IV centres and we observed significant variations in resource use across centres (ICC = 5% [4-6]), particularly for the OR (28% [20-40]).Conclusions: Resource use for acute injury care in Quebec is not solely due to the clinical status of patients. We identified determinants of resource use that can be used to establish evidence-based resource allocations and improve injury care efficiency. The method we developed for estimating patient-level, in-hospital resource use for injury admissions and identifying related determinants could be reproduced using local trauma registry data and our unit costs or unit costs specific to each setting. [ABSTRACT FROM AUTHOR]

Background: Self-harm and intentional injuries represent a significant public health concern. People who survive serious injury from self-harm can experience poor outcomes that negatively impact on their daily life. The aim of this study was to investigate a cohort of major trauma patients hospitalised for self-harm in Victoria, and to identify risk factors for longer term mortality, functional recovery and return to work.Method: 482 adult major trauma patients who were injured due to self-harm and survived to hospital discharge, and were captured by the population-based Victorian State Trauma Registry (VSTR), were included. For those with a date of injury from January 1, 2007 to December 31, 2013, demographics and injury event data, Glasgow Outcome Scale Extended (GOS-E) and return to work (RTW) outcomes at 6, 12 and 24 months post-injury were extracted from the registry. Post-discharge mortality was identified through the Victorian Registry of Births, Deaths and Marriages (BDM). Multivariable logistic regression was used to determine predictors of the GOS-E and RTW and survival analysis was used to identify predictors of mortality.Results: A total of 37 (7.7%) deaths occurred post-discharge. There were no clear predictors of all-cause mortality. Overall, 36% of patients reported making a good recovery at 24 months. Older age (p=0.01), transport-related methods of self-harm (p=0.02), higher Injury Severity Score (p<0.001) and having a Charlson Comorbidity Index weighting of one or more (p=0.02) were predictive of poorer functional recovery. Of patients who were working or studying prior to injury, 54% reported returning to work by 24 months post-injury. Higher Injury Severity Score was an important predictor of not returning to work (p=0.002).Conclusion: The vast majority of major trauma patients who self-harmed and survived to hospital discharge were alive at two years post-injury, yet only half of this cohort returned to work and just over a third of patients experienced a good recovery. [ABSTRACT FROM AUTHOR]

Introduction: Trampoline-related injuries in adults are uncommon. Participation in trampolining is increasing following its admission as a sport in the Olympics and the opening of local recreational trampoline centres. The aim of this study was to assess the number and outcomes of adult trampoline-related orthopaedic injuries presenting to four trauma hospitals in Victoria.Methods: A cohort study was performed for the period 2007-2013. Adult patients registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) who had sustained a trampolining related injury were included in this study. Descriptive analyses were used to describe the patient population, the injuries sustained and their in-hospital and 6-month outcomes.Results: There was an increase in trampolining injuries from 2007 (n=3) to 2012 (n=14) and 2013 (n=18). Overall, fifty patients with a median age of 25 (range 16-66) were identified. Thirty-five patients (70%) had lower limb injuries, 20 patients (40%) had spinal injuries and one patient had an upper limb injury. Thirty-nine patients (78%) required surgery. Fractures of the tibia (n=13), ankle fractures (n=12) and cervical spine injuries (n=7) were the most common injuries; all of which required surgery. Complications included death, spinal cord injuries, compartment syndrome and open fractures. At 6 months post injury, more than half (52%) of the patients had not achieved a good recovery, 32% had some form of persistent disability, 14% did not get back to work and overall physical health for the cohort was well below population norms for the SF-12.Conclusion: Adult trampoline-related injuries have increased in the last few years in this cohort identified through VOTOR. Lower limb and spinal injuries are most prevalent. Public awareness and education are important to reduce the risk for people participating in this activity. [ABSTRACT FROM AUTHOR]

Abstract: Background and Objectives: To develop prediction models for outcomes following trauma that met prespecified performance criteria. To compare three methods of developing prediction models: logistic regression, classification trees, and artificial neural networks. Methods: Models were developed using a 1996–2001 dataset from a major trauma center in Victoria, Australia. Developed models were subjected to external validation using the first year of data collection, 2001–2002, from a state-wide trauma registry for Victoria. Different authors developed models for each method. All authors were blinded to the validation dataset when developing models. Results: Prediction models were developed for an intensive care unit stay following trauma (prevalence 23%) using information collected at the scene of the injury. None of the three methods gave a model that satisfied the performance criteria of sensitivity >80%, positive predictive value >50% in the validation dataset. Prediction models were also developed for death (prevalence 2.9%) using hospital-collected information. The performance criteria of sensitivity >95%, specificity >20% in the validation dataset were not satisfied by any model. Conclusion: No statistical method of model development was optimal. Prespecified performance criteria provide useful guides to interpreting the performance of developed models. [Copyright &y& Elsevier]