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:
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
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.
For more information on the RCH Trauma Service data collection, research and the RCH Trauma Registry, please contact:
B.Orth (Hons), DOBA, Grad Dip (Clin Epi)
RCH Trauma Service Data Manager
Ph: +61 3 9345 4806