Major trauma in Western Australia and the effects of distance, time and remoteness on mortality

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Rural and remote major trauma is a serious problem in Western Australia (WA), where the issues of distance, time and remoteness are crucial. However, quantifying their effect on mortality has not been previously addressed. This thesis examined 9 years of linked major trauma data from the Royal Flying Doctor Service (RFDS), Trauma Registry, Death Registry and the Australian Bureau of Statistics. The standardised age-specific death rate per 100000 person years demonstrates an increased risk of death in Very Remote WA (RR 4.28, 95%CI 3.93-4.68). Rural major trauma patients transferred to Perth by the RFDS are more severely injured than their metropolitan counterparts (median ISS 25 vs 24, p = 0.001). There is an increased risk of death in rural major trauma patients (OR 2.60, 95%CI 1.05-6.53), but if a major trauma patient survives to be retrieved to Perth, the mortality outcomes are equivalent to the metropolitan area (OR 1.10, 95%CI 0.66-1.84). Risk increases by 87% for each 1000 km (OR 1.87, 95%CI 1.007-3.48, p = 0.05) flown by the RFDS; whereas total pre-tertiary hospital time decreases the risk of death (OR 0.92, 95%CI 0.86-0.99, p =0.03) reflecting the ‘self-selection’ that occurs. There was no mortality benefit associated with time to definitive care in Perth. Potentially preventable deaths in Perth’s secondary hospitals were low. The most noteworthy were the elderly after falls, and trauma system efforts should be focused on this group. These results underscore the importance of injury prevention to improve survival from trauma. For rural trauma the best measure of rurality is not distance or time, but remoteness.
Original languageEnglish
QualificationDoctor of Philosophy
StateUnpublished - 2012


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