Grant Christey - Academia.edu (original) (raw)

Papers by Grant Christey

Anz Journal of Surgery, Mar 6, 2013

Journal of Surgical Case Reports

Acute appendicitis is one of the most common causes of acute abdominal pain globally. The pathoph... more Acute appendicitis is one of the most common causes of acute abdominal pain globally. The pathophysiology of acute appendicitis is due to occlusion of the appendiceal lumen commonly from a faecolith. Obstruction of the appendiceal lumen by ingested foreign bodies is possible albeit rare. Here, we present an extremely rare case of acute appendicitis caused by impaction of the patients tooth within the lumen of the appendix. There have been only seven reported cases of impacted teeth causing appendicitis in the literature. There are no evidence-based guidelines for the management of appendicitis caused by tooth impaction. The authors suggest operative management with appendicectomy should be considered in the first instance.

Surgery in Practice and Science

Trauma Care

Background: The literature has suggested that acceptable outcomes in elective general surgery can... more Background: The literature has suggested that acceptable outcomes in elective general surgery can be achieved with registrars operating but is less clear with trauma surgery. Methods: This was a retrospective study of all laparotomies performed for adult trauma between 2012 and 2020 at a Level 1 Trauma Centre in New Zealand to identify potential differences in clinical outcomes between primary operators. The primary operator of each operation was identified, along with the presence or absence of a consultant and the clinical outcome. Results: During the 9-year study period, a total of 204 trauma laparotomies were performed at Waikato Hospital. The groups of the primary operators were: a registrar with a consultant present (27%), a registrar without a consultant present (22%), a registrar assisting a consultant (48%), and a consultant who operated without a registrar (3%). Direct comparison was made between the three groups where registrars were involved in the laparotomy. There was ...

The New Zealand medical journal, 2019

AIM Current policy direction seeks to promote participation in both recreational and active trans... more AIM Current policy direction seeks to promote participation in both recreational and active transport cycling. We evaluate cycling-related injuries resulting in hospital admission across the Midland Region of New Zealand to establish injury trends. METHOD A retrospective review of anonymised prospectively-collected trauma registry data from 1 June 2012 to 31 July 2016 in the Midland Region. Cases include patients hospitalised with cycling-related injuries. RESULTS Nine hundred and ninety-eight cyclists were admitted to hospital (2012-2016). Admission volumes increased approximately 16.8% per year, major trauma by 11.9% and non-major trauma by 17.8%. Overall, 66.7% of admissions were for people aged over 20 years and 73.4% were for males. The participation-adjusted annual injury rate was 78.4 per 100,000. This masked considerable variation by gender, age group and injury severity. CONCLUSION Hospital admission volumes and rates are rising with underlying variation in patient demograp...

The New Zealand medical journal, 2018

BACKGROUND Māori are disproportionately impacted by injury in New Zealand, therefore reliable eth... more BACKGROUND Māori are disproportionately impacted by injury in New Zealand, therefore reliable ethnicity data are essential for measuring and addressing inequities in trauma incidence, care and outcomes. AIM To audit the quality of ethnicity data captured by the Waikato Hospital Trauma Registry and Waikato Hospital patient management system against self-identified ethnicity. METHOD Self-identified ethnicity using the New Zealand Census ethnicity question was gathered from 100 consecutive trauma patients and compared with ethnicity recorded in their Trauma Registry record and in the hospital's patient management database. RESULTS Twenty-nine (29%) participants self-identified as Māori, of whom six were classified as New Zealand European (NZE) only in the Trauma Registry and five as NZE on the hospital patient management database. Over half of Māori (n=18/29) reported more than one ethnicity compared with 4% (n=3/71) of non-Māori. Self-identified ethnicity matched Trauma Registry e...

The New Zealand medical journal, 2021

AIM To assess the effects of the community lockdown phases on trauma-related admissions to Midlan... more AIM To assess the effects of the community lockdown phases on trauma-related admissions to Midland region hospitals over the period 15 February to 10 July 2020, and to compare volume variation with the same period in the previous three years. METHODS A retrospective, descriptive study of prospectively collected data from the Midland Trauma Registry in New Zealand. RESULTS There was a 36.7% (p<.00001) reduction in injury admissions during Alert Level 4 ('Lockdown') compared with the same period in 2017, 2018 and 2019. This was in the context of volume increases during the pre-lockdown period (17.8%, p<.00001) and a 'rebound' as restrictions eased. There was an increase in injuries occurring at home (28.3%, p<.00001) and on footpaths (37.9%, p=0.00076), while there was a decline in events on roads (33.0%, p=0.017), at schools (75.0%, p<.00001) and in sports areas (79.7%, p<.00001). Falls remained the dominant mechanism of injury in 2020, contributing 39....

The New Zealand medical journal, 2020

AIM The aims of this study were to describe the variation in volumes and types of injuries admitt... more AIM The aims of this study were to describe the variation in volumes and types of injuries admitted to a level one trauma centre in New Zealand over two 14-day periods before and during the national level 4 lockdown for COVID-19; and highlight communities at risk of preventable injury that may impact negatively on hospital resources. METHOD A retrospective, descriptive study of prospectively collected data in the Midland Trauma Registry in New Zealand. RESULTS Overall there was a reduction of 43% in all injury-related admissions with significant reductions seen in major injury (50% reduction), males (50% reduction) and children aged 0-14 years (48% reduction). Results for ethnicity and persons aged over 14 years were within 3% deviation of this overall 43% reduction. Injuries at home, particularly falls, predominate. CONCLUSION Despite the significant reduction in admissions during level 4 lockdown, hospitals should continue to provide full services until resource limitations are un...

The New Zealand medical journal, 2018

AIM Pre-hospital triage strategies aim to identify the type and extent of patient injuries and en... more AIM Pre-hospital triage strategies aim to identify the type and extent of patient injuries and ensure that they are transferred to the most appropriate trauma centres. Despite the importance of appropriate pre-hospital transport, there is little evidence base to assist medical staff on optimal destination policy for emergent pre-hospital transport. This paper explores the spatial relationship of patient transfers prior to the implementation of the Midland Pre-Hospital Trauma Destination Matrix in New Zealand, and is a retrospective view of practice against a destination policy that was applied after the study period. METHODS We use data obtained from the Midland Trauma Registry merged with Global Positioning System (GPS) data from St John and Land Information New Zealand Data Service on major trauma occurring in 2014 and 2015. Using ArcGIS, data were analysed for spatial relationships between factors associated with major trauma events and pre-hospital transportation. RESULTS In the...

The New Zealand medical journal, 2019

AIM To describe quad bike injury-related hospitalisations in the Midland region over a six-year p... more AIM To describe quad bike injury-related hospitalisations in the Midland region over a six-year period. METHOD A retrospective review of anonymised, prospectively-collected trauma registry data from 1 July 2012 to 30 June 2018 was undertaken. Cases include patients hospitalised with quad bike-related injuries. Non-major injuries are included to provide a clearer picture of the trauma burden. RESULTS Three hundred and forty-six injuries resulted in hospitalisation with 70.2% of events occurring on a farm. Males outnumbered females 3.7:1. Forty-six children (<16 years) were hospitalised, of which 23 were injured on-farm and seven on a road. Over six years there was an annual average increase of 7.3% for all events occurring on a farm, 2.6% for injuries occurring during a farming activity and 4.7% for off-farm recreational injuries. CONCLUSION Despite continued public debate and education on the safe use of quad bikes, injuries severe enough to require hospitalisation continue to oc...

Injury, 2020

Introduction: The availability and implementation of evidence-based care is essential to achievin... more Introduction: The availability and implementation of evidence-based care is essential to achieving safe, quality trauma patient outcomes. Little is documented, however, about the challenges trauma clinicians face in their day-to day practice, or their views on the availability of evidence. This paper presents the most significant clinical practice challenges reported by multidisciplinary trauma care professionals in Australia and New Zealand, in particular those that may be resolved with focussed research or enhanced implementation activity. Methods: An exploratory survey of trauma professionals from relevant Australia and New Zealand professional organisations was conducted between September 2018 and February 2019 using the Snowballing Method. Participants were recruited via a nonrandom sampling technique to complete an online survey. Thematic analyses were conducted. Results: There were nine significant clinical practice challenge themes in trauma care, arising from 287 individual clinical practice challenges reported. The most reported being clinical management (bleeding, spinal, older patients) and operationalisation of the trauma system. There was no consensus as to the availability of evidence to guide each theme. Conclusion: Future research should seek to address the clinical practice challenge of Australian and New Zealand trauma community to enable safe, quality trauma patient outcomes.

Journal of Primary Health Care, 2019

INTRODUCTIONOccupational health on farms is important because farms are not only workplaces where... more INTRODUCTIONOccupational health on farms is important because farms are not only workplaces where agriculture workers are vulnerable to high injury and fatality rates, they are also homes where families and visitors undertake a variety of activities that can result in injury. AIMTo profile and describe injuries requiring hospital admission that occurred on farms, both for injuries related to farming activities and injuries unrelated to farm work in the Midland region of New Zealand. METHODSA review of anonymised prospectively collected Midland trauma registry data from 1 July 2012 to 30 June 2018 was undertaken. Cases include unintentional injuries occurring on a farm. Non-major injuries are included to better quantify the trauma burden. RESULTSIn total, 2303 hospital admissions met the study criteria. Non-major injury accounted for 93.1% of events and 45.0% of injuries occurred during farming activities. Five people died in hospital; all injured while undertaking farm work. Males m...

Injury, 2019

Background: Trauma registries are known to drive improvements and optimise trauma systems worldwi... more Background: Trauma registries are known to drive improvements and optimise trauma systems worldwide. This is the first reported comparison of the epidemiology and outcomes at major centres across Australia. Methods: The Australian Trauma Registry was a collaboration of 26 major trauma centres across Australia at the time of this study and currently collects information on patients admitted to these centres who

Injury, 2019

Introduction: The Australia New Zealand Trauma Registry enables the collection and analysis of st... more Introduction: The Australia New Zealand Trauma Registry enables the collection and analysis of standardised data about trauma patients and their care for quality improvement, injury prevention and benchmarking. Little is known, however, about the needs of providers and clinicians in relation to these data, or their views on trauma quality improvement priorities. As clinical experts, trauma clinicians should have input to these as ultimately their practice may be influenced by report findings. This paper presents the perspectives of multidisciplinary trauma care professionals in Australia and New Zealand about the use of the Australia New Zealand Trauma Registry data and trauma quality improvement priorities. Methods: An exploratory survey of trauma professionals from relevant Australia and New Zealand professional organisations was conducted using the Snowballing Method between September 2018 and February 2019. Participants were recruited via a non-random sampling technique to complete an online survey. Descriptive statistical and content analyses were conducted. Results: The data use priorities identified by 102 trauma professionals from a range of locations participated were clinical improvement and system/process improvement (86.3%). Participants reported that access to trauma data should primarily be for clinicians (93.1%) and researchers (87.3%). Having a standardised approach to review trauma cases across hospitals was a priority in trauma quality improvement. Conclusion: Trauma registry data are under-utilised and their use to drive clinical improvement and system/process improvement is fundamental to trauma quality improvement in Australia and New Zealand.

International Journal of Integrated Care, 2019

A trauma system is an organised, coordinated effort in a defi ned geographic area, which delivers... more A trauma system is an organised, coordinated effort in a defi ned geographic area, which delivers the full range of care to all injured patients, and is integrated with the local public health system with a focus on prevention. 1 Injured patients have the best chance of making a good recovery if the trauma system performs well and is effectively integrated into wider health and social care systems, leading to lower mortality rates, reduced lifelong disability and improved quality of life, with demonstrated cost savings to the health system.

Injury, 2017

To describe the epidemiological characteristics of patients with work-related injuries (WRI) admi... more To describe the epidemiological characteristics of patients with work-related injuries (WRI) admitted to hospitals in New Zealand's Midland Trauma System (MTS) during a four year period. Methods: A retrospective review was conducted of trauma registry records for adults (! 15 years) admitted to four hospitals in the MTS as a result of WRI between 1 January 2012 and 31 December 2015. We describe the patterns of injury incidence by demographic characteristics, employment industry, mechanism of injury, body regions injured, injury severity score (ISS), month, day and time of injury, duration of hospital stay, domicile District Health Board (DHB), and discharge destination. Results: The 2169 WRI trauma admissions, corresponded to an annualised rate of 205.8 per 100,000 workers or 234.3 per 100,000 full time employment employees (FTE). Injury rates were highest among males (238.0 per 100,000 workers) and those aged 15-24 years (227.1 per 100,000 workers), and lowest among Asians (83 per 100,000 workers). The highest injury rates occurred among the 'agriculture/ forestry/fishing', 'manufacturing', and 'transport/postal/warehousing' industries. 'Contact with machinery' was the most common mechanism of injury, and the 'extremities or pelvic girdle' the most common body region injured. The in-hospital case fatality rate was <0.5%. Conclusion: The predominance of WRI in the 'agriculture/forestry/fishing' industries in the Midland region is consistent with national estimates. The high rate of injuries amongst males, young adults, and Maori requires further exploration.

Archives of physical medicine and rehabilitation, Aug 7, 2017

To explore employment status, work limitations and productivity loss following mild traumatic bra... more To explore employment status, work limitations and productivity loss following mild traumatic brain injury (TBI). Inception cohort study over four years. General community. 245 Adults (>16 years at the time of injury), who experienced a mild TBI and who were employed prior to their injury. Not applicable MAIN OUTCOME MEASURES: Details of the injury, demographic information and pre-injury employment status were collected from medical records and self-report. Symptoms and mood were assessed one-month post-injury using the Rivermead Post-Concussion Symptom Questionnaire and the Hospital Anxiety and Depression Scale. Post-injury employment status and work productivity were assessed four-years post-injury using the Work Limitations Questionnaire. Four-years following mild TBI, 17.3% of participants had exited the workforce (other than for reasons of retirement or to study) or had reduced their working hours compared to pre-injury. A further 15.5% reported experiencing limitations at w...

Injury Prevention, 2016

Background The duration from emergency department (ED) to operative room (OR) is an important fac... more Background The duration from emergency department (ED) to operative room (OR) is an important factor to predict the outcome in severe trauma patients. Trauma Fast Track (TFT) policy was established in Khon Kaen Hospital for 5 years. According to this policy, shorter duration from ED to OR (ED time) might be more safe life of the patients. Methods Cross-sectional analytic study, the patients with penetrating torso and haemodynamic instability who admitted to Khon Kaen Hospital from October 2011 to September 2014 were included. The Fisher exact test were used for data analysis. Results A total of 82 patients were included. Of these, penetrating injury to abdomen and chest were 78% and 22%, respectively. The mortality rate was 25.6%. The mean ED time were 43 minutes and Injury Severity Score (ISS) were 18.8. The ED time more than 30 minute [odds ratio (OR), 4.1; 95% confidence interval (CI): 1.2-13.6; P = 0.021], and ISS more than 15 [OR, 9.5; 95%, CI: 1.1-78.7; P = 0.021] were associated with increase mortality rate. Conclusions The mortality rate of penetrating injury at torso with haemodynamic instability is significantly associated with duration from ED to OR and ISS. According to this result, unnecessary procedure or intervention at ER should be avoided.

The New Zealand medical journal, Jan 24, 2015

Anz Journal of Surgery, Mar 6, 2013

Journal of Surgical Case Reports

Acute appendicitis is one of the most common causes of acute abdominal pain globally. The pathoph... more Acute appendicitis is one of the most common causes of acute abdominal pain globally. The pathophysiology of acute appendicitis is due to occlusion of the appendiceal lumen commonly from a faecolith. Obstruction of the appendiceal lumen by ingested foreign bodies is possible albeit rare. Here, we present an extremely rare case of acute appendicitis caused by impaction of the patients tooth within the lumen of the appendix. There have been only seven reported cases of impacted teeth causing appendicitis in the literature. There are no evidence-based guidelines for the management of appendicitis caused by tooth impaction. The authors suggest operative management with appendicectomy should be considered in the first instance.

Surgery in Practice and Science

Trauma Care

Background: The literature has suggested that acceptable outcomes in elective general surgery can... more Background: The literature has suggested that acceptable outcomes in elective general surgery can be achieved with registrars operating but is less clear with trauma surgery. Methods: This was a retrospective study of all laparotomies performed for adult trauma between 2012 and 2020 at a Level 1 Trauma Centre in New Zealand to identify potential differences in clinical outcomes between primary operators. The primary operator of each operation was identified, along with the presence or absence of a consultant and the clinical outcome. Results: During the 9-year study period, a total of 204 trauma laparotomies were performed at Waikato Hospital. The groups of the primary operators were: a registrar with a consultant present (27%), a registrar without a consultant present (22%), a registrar assisting a consultant (48%), and a consultant who operated without a registrar (3%). Direct comparison was made between the three groups where registrars were involved in the laparotomy. There was ...

The New Zealand medical journal, 2019

AIM Current policy direction seeks to promote participation in both recreational and active trans... more AIM Current policy direction seeks to promote participation in both recreational and active transport cycling. We evaluate cycling-related injuries resulting in hospital admission across the Midland Region of New Zealand to establish injury trends. METHOD A retrospective review of anonymised prospectively-collected trauma registry data from 1 June 2012 to 31 July 2016 in the Midland Region. Cases include patients hospitalised with cycling-related injuries. RESULTS Nine hundred and ninety-eight cyclists were admitted to hospital (2012-2016). Admission volumes increased approximately 16.8% per year, major trauma by 11.9% and non-major trauma by 17.8%. Overall, 66.7% of admissions were for people aged over 20 years and 73.4% were for males. The participation-adjusted annual injury rate was 78.4 per 100,000. This masked considerable variation by gender, age group and injury severity. CONCLUSION Hospital admission volumes and rates are rising with underlying variation in patient demograp...

The New Zealand medical journal, 2018

BACKGROUND Māori are disproportionately impacted by injury in New Zealand, therefore reliable eth... more BACKGROUND Māori are disproportionately impacted by injury in New Zealand, therefore reliable ethnicity data are essential for measuring and addressing inequities in trauma incidence, care and outcomes. AIM To audit the quality of ethnicity data captured by the Waikato Hospital Trauma Registry and Waikato Hospital patient management system against self-identified ethnicity. METHOD Self-identified ethnicity using the New Zealand Census ethnicity question was gathered from 100 consecutive trauma patients and compared with ethnicity recorded in their Trauma Registry record and in the hospital's patient management database. RESULTS Twenty-nine (29%) participants self-identified as Māori, of whom six were classified as New Zealand European (NZE) only in the Trauma Registry and five as NZE on the hospital patient management database. Over half of Māori (n=18/29) reported more than one ethnicity compared with 4% (n=3/71) of non-Māori. Self-identified ethnicity matched Trauma Registry e...

The New Zealand medical journal, 2021

AIM To assess the effects of the community lockdown phases on trauma-related admissions to Midlan... more AIM To assess the effects of the community lockdown phases on trauma-related admissions to Midland region hospitals over the period 15 February to 10 July 2020, and to compare volume variation with the same period in the previous three years. METHODS A retrospective, descriptive study of prospectively collected data from the Midland Trauma Registry in New Zealand. RESULTS There was a 36.7% (p<.00001) reduction in injury admissions during Alert Level 4 ('Lockdown') compared with the same period in 2017, 2018 and 2019. This was in the context of volume increases during the pre-lockdown period (17.8%, p<.00001) and a 'rebound' as restrictions eased. There was an increase in injuries occurring at home (28.3%, p<.00001) and on footpaths (37.9%, p=0.00076), while there was a decline in events on roads (33.0%, p=0.017), at schools (75.0%, p<.00001) and in sports areas (79.7%, p<.00001). Falls remained the dominant mechanism of injury in 2020, contributing 39....

The New Zealand medical journal, 2020

AIM The aims of this study were to describe the variation in volumes and types of injuries admitt... more AIM The aims of this study were to describe the variation in volumes and types of injuries admitted to a level one trauma centre in New Zealand over two 14-day periods before and during the national level 4 lockdown for COVID-19; and highlight communities at risk of preventable injury that may impact negatively on hospital resources. METHOD A retrospective, descriptive study of prospectively collected data in the Midland Trauma Registry in New Zealand. RESULTS Overall there was a reduction of 43% in all injury-related admissions with significant reductions seen in major injury (50% reduction), males (50% reduction) and children aged 0-14 years (48% reduction). Results for ethnicity and persons aged over 14 years were within 3% deviation of this overall 43% reduction. Injuries at home, particularly falls, predominate. CONCLUSION Despite the significant reduction in admissions during level 4 lockdown, hospitals should continue to provide full services until resource limitations are un...

The New Zealand medical journal, 2018

AIM Pre-hospital triage strategies aim to identify the type and extent of patient injuries and en... more AIM Pre-hospital triage strategies aim to identify the type and extent of patient injuries and ensure that they are transferred to the most appropriate trauma centres. Despite the importance of appropriate pre-hospital transport, there is little evidence base to assist medical staff on optimal destination policy for emergent pre-hospital transport. This paper explores the spatial relationship of patient transfers prior to the implementation of the Midland Pre-Hospital Trauma Destination Matrix in New Zealand, and is a retrospective view of practice against a destination policy that was applied after the study period. METHODS We use data obtained from the Midland Trauma Registry merged with Global Positioning System (GPS) data from St John and Land Information New Zealand Data Service on major trauma occurring in 2014 and 2015. Using ArcGIS, data were analysed for spatial relationships between factors associated with major trauma events and pre-hospital transportation. RESULTS In the...

The New Zealand medical journal, 2019

AIM To describe quad bike injury-related hospitalisations in the Midland region over a six-year p... more AIM To describe quad bike injury-related hospitalisations in the Midland region over a six-year period. METHOD A retrospective review of anonymised, prospectively-collected trauma registry data from 1 July 2012 to 30 June 2018 was undertaken. Cases include patients hospitalised with quad bike-related injuries. Non-major injuries are included to provide a clearer picture of the trauma burden. RESULTS Three hundred and forty-six injuries resulted in hospitalisation with 70.2% of events occurring on a farm. Males outnumbered females 3.7:1. Forty-six children (<16 years) were hospitalised, of which 23 were injured on-farm and seven on a road. Over six years there was an annual average increase of 7.3% for all events occurring on a farm, 2.6% for injuries occurring during a farming activity and 4.7% for off-farm recreational injuries. CONCLUSION Despite continued public debate and education on the safe use of quad bikes, injuries severe enough to require hospitalisation continue to oc...

Injury, 2020

Introduction: The availability and implementation of evidence-based care is essential to achievin... more Introduction: The availability and implementation of evidence-based care is essential to achieving safe, quality trauma patient outcomes. Little is documented, however, about the challenges trauma clinicians face in their day-to day practice, or their views on the availability of evidence. This paper presents the most significant clinical practice challenges reported by multidisciplinary trauma care professionals in Australia and New Zealand, in particular those that may be resolved with focussed research or enhanced implementation activity. Methods: An exploratory survey of trauma professionals from relevant Australia and New Zealand professional organisations was conducted between September 2018 and February 2019 using the Snowballing Method. Participants were recruited via a nonrandom sampling technique to complete an online survey. Thematic analyses were conducted. Results: There were nine significant clinical practice challenge themes in trauma care, arising from 287 individual clinical practice challenges reported. The most reported being clinical management (bleeding, spinal, older patients) and operationalisation of the trauma system. There was no consensus as to the availability of evidence to guide each theme. Conclusion: Future research should seek to address the clinical practice challenge of Australian and New Zealand trauma community to enable safe, quality trauma patient outcomes.

Journal of Primary Health Care, 2019

INTRODUCTIONOccupational health on farms is important because farms are not only workplaces where... more INTRODUCTIONOccupational health on farms is important because farms are not only workplaces where agriculture workers are vulnerable to high injury and fatality rates, they are also homes where families and visitors undertake a variety of activities that can result in injury. AIMTo profile and describe injuries requiring hospital admission that occurred on farms, both for injuries related to farming activities and injuries unrelated to farm work in the Midland region of New Zealand. METHODSA review of anonymised prospectively collected Midland trauma registry data from 1 July 2012 to 30 June 2018 was undertaken. Cases include unintentional injuries occurring on a farm. Non-major injuries are included to better quantify the trauma burden. RESULTSIn total, 2303 hospital admissions met the study criteria. Non-major injury accounted for 93.1% of events and 45.0% of injuries occurred during farming activities. Five people died in hospital; all injured while undertaking farm work. Males m...

Injury, 2019

Background: Trauma registries are known to drive improvements and optimise trauma systems worldwi... more Background: Trauma registries are known to drive improvements and optimise trauma systems worldwide. This is the first reported comparison of the epidemiology and outcomes at major centres across Australia. Methods: The Australian Trauma Registry was a collaboration of 26 major trauma centres across Australia at the time of this study and currently collects information on patients admitted to these centres who

Injury, 2019

Introduction: The Australia New Zealand Trauma Registry enables the collection and analysis of st... more Introduction: The Australia New Zealand Trauma Registry enables the collection and analysis of standardised data about trauma patients and their care for quality improvement, injury prevention and benchmarking. Little is known, however, about the needs of providers and clinicians in relation to these data, or their views on trauma quality improvement priorities. As clinical experts, trauma clinicians should have input to these as ultimately their practice may be influenced by report findings. This paper presents the perspectives of multidisciplinary trauma care professionals in Australia and New Zealand about the use of the Australia New Zealand Trauma Registry data and trauma quality improvement priorities. Methods: An exploratory survey of trauma professionals from relevant Australia and New Zealand professional organisations was conducted using the Snowballing Method between September 2018 and February 2019. Participants were recruited via a non-random sampling technique to complete an online survey. Descriptive statistical and content analyses were conducted. Results: The data use priorities identified by 102 trauma professionals from a range of locations participated were clinical improvement and system/process improvement (86.3%). Participants reported that access to trauma data should primarily be for clinicians (93.1%) and researchers (87.3%). Having a standardised approach to review trauma cases across hospitals was a priority in trauma quality improvement. Conclusion: Trauma registry data are under-utilised and their use to drive clinical improvement and system/process improvement is fundamental to trauma quality improvement in Australia and New Zealand.

International Journal of Integrated Care, 2019

A trauma system is an organised, coordinated effort in a defi ned geographic area, which delivers... more A trauma system is an organised, coordinated effort in a defi ned geographic area, which delivers the full range of care to all injured patients, and is integrated with the local public health system with a focus on prevention. 1 Injured patients have the best chance of making a good recovery if the trauma system performs well and is effectively integrated into wider health and social care systems, leading to lower mortality rates, reduced lifelong disability and improved quality of life, with demonstrated cost savings to the health system.

Injury, 2017

To describe the epidemiological characteristics of patients with work-related injuries (WRI) admi... more To describe the epidemiological characteristics of patients with work-related injuries (WRI) admitted to hospitals in New Zealand's Midland Trauma System (MTS) during a four year period. Methods: A retrospective review was conducted of trauma registry records for adults (! 15 years) admitted to four hospitals in the MTS as a result of WRI between 1 January 2012 and 31 December 2015. We describe the patterns of injury incidence by demographic characteristics, employment industry, mechanism of injury, body regions injured, injury severity score (ISS), month, day and time of injury, duration of hospital stay, domicile District Health Board (DHB), and discharge destination. Results: The 2169 WRI trauma admissions, corresponded to an annualised rate of 205.8 per 100,000 workers or 234.3 per 100,000 full time employment employees (FTE). Injury rates were highest among males (238.0 per 100,000 workers) and those aged 15-24 years (227.1 per 100,000 workers), and lowest among Asians (83 per 100,000 workers). The highest injury rates occurred among the 'agriculture/ forestry/fishing', 'manufacturing', and 'transport/postal/warehousing' industries. 'Contact with machinery' was the most common mechanism of injury, and the 'extremities or pelvic girdle' the most common body region injured. The in-hospital case fatality rate was <0.5%. Conclusion: The predominance of WRI in the 'agriculture/forestry/fishing' industries in the Midland region is consistent with national estimates. The high rate of injuries amongst males, young adults, and Maori requires further exploration.

Archives of physical medicine and rehabilitation, Aug 7, 2017

To explore employment status, work limitations and productivity loss following mild traumatic bra... more To explore employment status, work limitations and productivity loss following mild traumatic brain injury (TBI). Inception cohort study over four years. General community. 245 Adults (>16 years at the time of injury), who experienced a mild TBI and who were employed prior to their injury. Not applicable MAIN OUTCOME MEASURES: Details of the injury, demographic information and pre-injury employment status were collected from medical records and self-report. Symptoms and mood were assessed one-month post-injury using the Rivermead Post-Concussion Symptom Questionnaire and the Hospital Anxiety and Depression Scale. Post-injury employment status and work productivity were assessed four-years post-injury using the Work Limitations Questionnaire. Four-years following mild TBI, 17.3% of participants had exited the workforce (other than for reasons of retirement or to study) or had reduced their working hours compared to pre-injury. A further 15.5% reported experiencing limitations at w...

Injury Prevention, 2016

Background The duration from emergency department (ED) to operative room (OR) is an important fac... more Background The duration from emergency department (ED) to operative room (OR) is an important factor to predict the outcome in severe trauma patients. Trauma Fast Track (TFT) policy was established in Khon Kaen Hospital for 5 years. According to this policy, shorter duration from ED to OR (ED time) might be more safe life of the patients. Methods Cross-sectional analytic study, the patients with penetrating torso and haemodynamic instability who admitted to Khon Kaen Hospital from October 2011 to September 2014 were included. The Fisher exact test were used for data analysis. Results A total of 82 patients were included. Of these, penetrating injury to abdomen and chest were 78% and 22%, respectively. The mortality rate was 25.6%. The mean ED time were 43 minutes and Injury Severity Score (ISS) were 18.8. The ED time more than 30 minute [odds ratio (OR), 4.1; 95% confidence interval (CI): 1.2-13.6; P = 0.021], and ISS more than 15 [OR, 9.5; 95%, CI: 1.1-78.7; P = 0.021] were associated with increase mortality rate. Conclusions The mortality rate of penetrating injury at torso with haemodynamic instability is significantly associated with duration from ED to OR and ISS. According to this result, unnecessary procedure or intervention at ER should be avoided.

The New Zealand medical journal, Jan 24, 2015