Chequer de Souza, Julia, Letson, Hayley L., Gibbs, Clinton R., and Dobson, Geoffrey P. (2023) The burden of head trauma in rural and remote North Queensland, Australia. Injury. 111181. (In Press)

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Abstract

Background: Head trauma is a leading cause of death and disability worldwide. Young males, Indigenous people, and rural/remote residents have been identified as high-risk populations for head trauma, however, Australian research is limited. Our aim was to define and describe the incidence, demographics, causes, prehospital interventions, and outcomes of head trauma patients transported by aeromedical services within North Queensland, Australia. We hypothesized that young, Indigenous males living remotely would be disproportionately affected by head trauma.

Methods: We conducted a retrospective study of all head trauma patients transferred by air to or between Townsville, Cairns, Mount Isa and Mackay Hospitals between January 1, 2016 and December 31, 2018. Patients were identified from the Trauma Care in the Tropics data registry and followed for a median 30-months postinjury. Primary endpoints were patient and injury characteristics. Secondary outcome measures were hospital stay and mortality.

Results: A total of 981 patients were included and 31.1 % were Indigenous. Sixty-seven percent of injuries occurred remotely and the median time from injury to hospital was 5.8-hours (range 67–3780 min). Eighty percent of severe head injuries occurred in males (p = 0.007). Indigenous and remote patients were more likely to sustain mild injuries. The most common mechanism of injury overall was vehicle accident (37.5 %), compared to assault in the Indigenous subgroup (46.6 %, p<0.001). The overall mortality rate was 4.9 %, with older age and lower initial Glasgow Coma Score significant predictors of in-hospital mortality. Prehospital intubation was associated with a 7-fold increased risk of mortality (p = 0.056), while patients that received tranexamic acid (TXA) were almost 5-times more likely to die.

Conclusions: In North Queensland, young Indigenous males are at highest risk of traumatic head injuries. Vehicle accidents are an important preventable cause of head injury in the region. TXA administration is an important consideration for remote head trauma retrievals, in which time to emergency care is prolonged. Appropriate treatment and risk stratification strategies considering time to definitive care, severity of injury, and other prehospital patient factors require further investigation.

Item ID:	81024
Item Type:	Article (Research - C1)
ISSN:	1879-0267
Keywords:	Trauma; Head; Injury; Rural; Remote; Epidemiology; Indigenous; Mortality; Australia
Copyright Information:	© 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Funders:	Emergency Medicine Foundation (EMF), Townsville Hospital and Health Service Study, Education and Research (SERTA)
Projects and Grants:	EMF Leading Edge Grant (EMLE-149R33–2020-GIBBS), SERTA Project Grant (2020_08)
Date Deposited:	14 Nov 2023 00:27
FoR Codes:	42 HEALTH SCIENCES > 4202 Epidemiology > 420299 Epidemiology not elsewhere classified @ 60% 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320207 Emergency medicine @ 40%
SEO Codes:	20 HEALTH > 2004 Public health (excl. specific population health) > 200408 Injury prevention and control @ 50% 21 INDIGENOUS > 2103 Aboriginal and Torres Strait Islander health > 210302 Aboriginal and Torres Strait Islander health status and outcomes @ 25% 20 HEALTH > 2001 Clinical health > 200199 Clinical health not elsewhere classified @ 25%
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