Introduction
The RCH Trauma Registry was commenced in 1999 as part
of the measures introduced in response to the Victorian State
Government's 1999 Review of Trauma and Emergency Services (RoTES)
report. Since July 2000 the registry has aimed to capture
all trauma admissions meeting database criteria - presently
at a rate of approximately 2000 admissions per year, of which
between 100 and 150 patients meet major trauma criteria (see
below).
A summary of the RCH Trauma Registry, including a note on injury
scoring, may be found here:
Information collected
Inclusion criteria for the registry are:
- Blunt, penetrating or burn trauma
- Drowning, hanging or electrocution trauma
- Accidental ingestion or inhalation of medication, toxic
substance or physical obstruction
- Envenomation
Data fields collected on trauma admissions include:
- Demographics, such as date of birth
- Comorbidities, including current medications
- Injury information, including a description of events and
Department of Human Services' VEMD Injury Surveillance codes
- Transport and pre-hospital information, including types of
transport, times of ambulance activity and scene observations
- Where applicable, referring hospital information, including
times of arrival and discharge
- RCH arrival information, including hospital entry point,
initial observations and procedures, and 'trauma call'
documentation
- Operations performed under general anaesthesia, including
times of operations
- Outcome information including Abbreviated Injury Scale (AIS)
coding and Injury Severity Score (ISS)
Major trauma and the Abbreviated Injury Scale
Blunt, penetrating and burn trauma admissions are classified as
major or non-major according to whether a patient meets one or more
RoTES criteria for major trauma:
- ISS of greater than 12 (see comment below)
- Intensive Care stay greater than 24 hours, with the need for
mechanical ventilation
- 'Urgent' (within 48 hours) surgery for intracranial,
intraabdominal or intrathoracic injury, or for fixation of pelvic
or spinal fractures
- Death after injury
It is estimated that the RCH sees more than 80% of the pediatric
major trauma load in the state of Victoria, either by direct
admission or transfer from another hospital.
The ISS threshold used to delineate between major and non-major
trauma changed in July 2010, due to the adoption of the (Update)
2008 version of the AIS across Victoria. Prior to 2010, the
Victorian State Trauma System used an ISS of greater than 15 to
define major trauma, as calculated using the 1998 version of the
AIS. Changes to the classification of injury made between the 1998
and 2008 AIS versions have resulted in the adoption of the ISS
greater than 12 threshold.
Although further work is needed to evaluate the effects of
adopting the 2008 AIS, it is believed that adoption of the ISS
>12 threshold using the 2008 AIS will identify a similar number
of major trauma patients to the number identified using ISS >15
and the 1998 AIS. A brief note prepared by the RCH Trauma Service
about this issue may be found here:
The 2008 Update of the AIS has been described by the AAAM (the
developers of the AIS) as a minor revision of the 2005 AIS. Work
performed by the RCH Trauma Service (together with colleagues in
Norway) has identified inconsistencies between AIS 2005
dictionaries, while cataloguing all of the changes implemented
between these revisions. It is therefore strongly recommended that
registries using the 2005 AIS adopt the more standardised 2008
AIS.
The complete list of changes made between the 2005 and 2008
Update versions of the AIS may be found here:
Trauma registry Minimum Dataset work
The RCH Trauma Service has for several years been at the forefront of efforts to standardise trauma data collection across Australia and New Zealand. The documents contained here describe the bi-national minimum dataset (BMDS) developed for Australasian trauma registries, and provide some information on the processes by which it was developed.
Further information
For more information on RCH Trauma Service data collection,
research and the RCH trauma registry, please contact:
Cameron Palmer,
B.Orth (Hons), DOBA, Grad Dip (Clin Epi)
RCH Trauma Service Data Manager
Ph: +61 3 9345 4806
cameron.palmer@rch.org.au