Introduction: Transfer to major trauma centres has a survival benefit for all trauma patients. Time from injury to arrival is the most important factor in their morbidity and mortality. North Queensland provides a unique challenge geographically and logistically due to its size and distribution of services.
Methods: A retrospective cohort study using the Townsville Trauma Registry was performed to identify all adults with major trauma treated at the Townsville University Hospital (TUH) from March 2021 – March 2023. Inclusion criteria were adults of 18 years or above, with Injury Severity Score (ISS) >/= 12. Only transfers from non-regional hospitals were included. Registry details were supplemented with chart review. Outcomes included time to first Computed Tomography (CT), overall survival, discharge destination and delay to discharge.
Results: 637 patients identified. 225 were transferred more than 70km with a maximum distance of 984km. Median ISS tended to increase with increasing distance, and initial GCS tended to reduce, with corresponding increase in craniotomy rates. In multivariable analysis, the only significant predictors of delay to arrival were increasing distance (0.01 h/km, 95% CI 0.003 – 0.02, P=0.01) and age (0.07 h/year, 95% CI 0.01 – 0.13, P=0.02). The only significant predictor of discharge delay was a need for rehabilitation (OR 180, 95% CI 94.1 – 265.8, P<0.01).
Conclusion: Distance contributes to delay to patient retrieval and intervention for major trauma in North Queensland, however not in a linear fashion. Remoteness does not appear to be a significant barrier to discharge.