Equity in major trauma outcomes. Owen Ashwell

Background: Trauma is a considerable health burden globally: injuries have a substantial impact on health, both as a leading cause of premature death and because of disability following a trauma.
The POMRC chose to examine what factors impact on Māori and non-Māori mortality from major trauma, given this is an important health area that no one has comprehensively reviewed previously.
Methods: This analysis included data relating to all events of major trauma in the New Zealand Major Trauma Registry (NZ-MTR) from 1 July 2015 to 30 June 2019. We also analysed additional data from the National Health Index (NHI), including domicile codes, deprivation decile and ethnicity. Statistical methods included tabulating risk factors by ethnicity, calculating Māori to non-Māori mortality hazard ratios (HRs) using Cox regression, and using logistic regression to estimate odds ratios (ORs) for binary outcomes.
Results: The main determinants of 30-day mortality following major trauma were: older age, more comorbidities, more severe injury (based on Injury Severity Score [ISS], Glasgow Coma Scale [GCS] score and requiring intubation) and not receiving an index CT scan.

  • Inequity in mortality was clear for Māori youth aged 15–18 years, who were over three times more likely to die in the 30 days following major trauma than non-Māori in the same age group.
  • Māori were 37% more likely than non-Māori to not receive a CT scan.
  • Māori were 56% more likely than non-Māori to die in the first 30 days following major trauma that did not involve serious traumatic brain injury (sTBI).

Conclusion: The analysis in this report point to important areas in which improvements could lead to a reduction in inequities experienced by Māori following major trauma, as the report recommendations reflect. These recommendations will be discussed during the presentation.

 

Owen is a New Zealand registered nurse who has worked as a staff nurse, clinical nurse educator and charge nurse in the Post Anaesthetic Care Unit (PACU) at Wellington hospital, as well as varied nursing roles overseas, including the Scottish Liver Transplant Unit in Edinburgh, Scotland. Owen is currently the Senior Specialist Advisor for the Perioperative Mortality Review Committee, and works as a Specialist in the Adverse Events programme, part of the Health Quality & Safety Commission.

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