Major trauma mortality in rural and metropolitan NSW, 2009-2014: a retrospective analysis of trauma registry data.
OBJECTIVE
To determine trends in crude and risk-adjusted mortality for major trauma patients injured in rural or metropolitan New South Wales, 2009-2014.


METHODS
A retrospective analysis of NSW statewide trauma registry data.


METHODS
Adult patients (aged 16 years or more) who presented with major trauma (Injury Severity Scores greater than 15) to a NSW hospital during 2009-2014.


METHODS
The main covariate of interest was geographic location of injury (metropolitan v rural/regional areas). Inpatient mortality was analysed by multivariable logistic regression.


RESULTS
Data for 11 423 eligible patients were analysed. Inpatient mortality for those injured in metropolitan locations was 14.7% in 2009 and 16.1% in 2014 (P = 0.45). In rural locations, there was a statistically significant decline in in-hospital mortality over the study period, from 12.1% in 2009 to 8.7% in 2014 (P = 0.004). Risk-adjusted mortality for those injured in a rural location was lower in 2013 than during 2009, but remained stable for those injured in metropolitan locations.


CONCLUSIONS
Crude and risk-adjusted mortality after major trauma have remained stable in those injured in metropolitan areas of NSW between 2009 and 2014. The apparent downward trend in mortality associated with severe trauma in rural/regional locations requires further analysis.
Sydney Medical School, University of Sydney, Sydney, NSW dinh.mm@gmail.com.
Michael M
MM
Dinh
Sydney Nursing School, University of Sydney, Sydney, NSW.
Kate
K
Curtis
Australian Institute of Health Innovation, Macquarie University, Sydney, NSW.
Rebecca J
RJ
Mitchell
Royal Prince Alfred Hospital, Sydney, NSW.
Kendall J
KJ
Bein
John Hunter Hospital, Newcastle, NSW.
Zsolt J
ZJ
Balogh
Nepean Hospital, Penrith, NSW.
Ian
I
Seppelt
Ambulance Service of New South Wales, Sydney, NSW.
Colin
C
Deans
The George Institute for Global Health, Sydney, NSW.
Rebecca
R
Ivers
Royal Prince Alfred Hospital, Sydney, NSW.
Saartje
S
Berendsen Russell
Institute of Trauma and Injury Management, New South Wales Agency for Clinical Innovation, Sydney, NSW.
Oran
O
Rigby
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014193:Trauma Centers / Q000592:standards; D014754:Violence / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D055815:Young Adult