Publications

Grant Christey, Janet Amey, Neerja Singh, Bronwyn Denize, Alaina Campbell

NZMJ Vol 134 No 1532: 26 March 2021

Abstract

AIM:

To assess the effects of the community lockdown phases on trauma-related admissions to Midland region hospitals over the period 15 February to 10 July 2020, and to compare volume variation with the same period in the previous three years.

METHODS:

A retrospective, descriptive study of prospectively collected data from the Midland Trauma Registry in New Zealand.

RESULTS:

There was a 36.7% (p<.00001) reduction in injury admissions during Alert Level 4 (‘Lockdown’) compared with the same period in 2017, 2018 and 2019. This was in the context of volume increases during the pre-lockdown period (17.8%, p<.00001) and a ‘rebound’ as restrictions
eased. There was an increase in injuries occurring at home (28.3%, p<.00001) and on footpaths(37.9%, p=0.00076), while there was a decline in events on roads (33.0%,p=0.017), at schools
(75.0%, p<.00001) and in sports areas (79.7%,p<.00001). Falls remained the dominant mechanism of injury in 2020, contributing 39.9% of all hospitalisations.

CONCLUSIONS:

The reduction in hospital admissions during alert levels 4 and 3 was short lived, with a
rebound evident when restrictions eased. Hospital resources have been strained because this rebound coincided with a planned ‘catch up’ on healthcare that was delayed during the higher community restriction levels.

Cite

Christey G, Amey J, Singh N, Denize B, Campbell A. Admission to hospital for injury during COVID-19 alert level restrictions. N Z Med J. 2021 Mar 26;134(1531):50-58. PMID: 33767476.

Kate Curtis, Belinda Gabbe, Kirsten Vallmuur, Katherine Martin, Shizar Nahidi, Ramon Z. Shaban, Cliff Pollard, Grant Christey

Injury 51 (2020) 1183–1188, January 06, 2020

Abstract

Alastair Smith, John Garvitch, Kaye Clark and Grant Christey 

Journal of Road Safety – Volume 31, Issue 2, 2020

Key Findings

• A total of 689 casualties, resulting from on-road motorcycle crashes in the Midland Region of New Zealand, were
  admitted to hospital as trauma patients during 2012-2016.
• Approximately 56% of trauma admission records could be linked with police records, while an additional 303 patient
  records could not be linked to any police records.
• Linkage rates were significantly associated with crash severity, patient injury severity, rurality of crash location, age,
  and self-presentation to hospital.
• Younger motorcycle crash patients, aged under 45 years, were significantly less likely to be linked across datasets, and
  appear to be under represented among police records.
• This may partly be explained by significantly higher rates of self-presentation to hospital by younger motorcycle
  casualties.
• A greater understanding of this behaviour may help guide prevention strategies aimed towards younger riders.

Abstract
Police records, held in the Crash Analysis System (CAS) by the New Zealand Transport Agency (NZTA), and hospital
admission data held in the Midland Trauma System (MTS) trauma registry, were linked using probabilistic methods. A total
of 1,331 casualties resulting from motorcycle crashes on roads in the Midland Region during 2012-2016 were recorded by
police. During the same period, and occurring within the same geographical area, a total of 689 on-road motorcycle related
crash casualties were admitted to hospital as trauma patients. Linkage of these two datasets revealed substantial under
reporting to police of motorcycle crash casualties resulting in hospitalisation. Approximately 56% (386) of hospital trauma
admission records could be linked with police CAS records with an additional 303 (44%) patient admission records which
could not be linked to any police records. Linkage rates were significantly associated with crash severity as recorded by
police, patient injury severity recorded in the trauma registry, patient age, rurality of crash location, and self-presentation to
hospital. In particular, younger motorcyclists aged under 45 years were significantly more likely to self-present to hospital
with the odds of linkage for self-presenters seventeen times lower than those who did not self-present. The merging of these
two datasets has highlighted several sources of bias underlying reporting of motorcycle crashes to police. An understanding
of these biases may help to inform policymakers when planning wider preventive strategies designed to reduce the burden
of motorcycle crashes in New Zealand.

Keywords
Motorcycle, casualty, trauma, linkage

Cite

Smith A, Garvitch J, Clark K, Christey G. Police motorcycle crash casualty reports and their linkage with hospital trauma admissions in the Midland Region of New Zealand, 2012-2016. Journal of road safety. 2020;31(2):13.

Grant Christey, Janet Amey, Alaina Campbell, Alastair Smith

The New Zealand Medical Journal Vol 133 No 1513: 24 April 2020

AIM: The aims of this study were to describe the variation in volumes and types of injuries admitted to a
level one trauma centre in New Zealand over two 14-day periods before and during the national level 4
lockdown for COVID-19; and highlight communities at risk of preventable injury that may impact negatively
on hospital resources.

METHOD: A retrospective, descriptive study of prospectively collected data in the Midland Trauma Registry
in New Zealand.

RESULTS: Overall there was a reduction of 43% in all injury-related admissions with significant reductions
seen in major injury (50% reduction), males (50% reduction) and children aged 0–14 years (48% reduction).
Results for ethnicity and persons aged over 14 years were within 3% deviation of this overall 43% reduction.
Injuries at home, particularly falls, predominate.

CONCLUSION: Despite the significant reduction in admissions during level 4 lockdown, hospitals should
continue to provide full services until resource limitations are unavoidable. Immediate messaging is
recommended to reduce rates of injury on the farm and at home, specifically falls prevention. Ongoing
attention of road users to road safety is essential to reduce the incidence of preventable major injury. These
immediate measures can potentially reduce unnecessary pressure on hospital beds and resources during
the pandemic.

Cite

 Christey G, Amey J, Campbell A, Smith A.  Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 in New Zealand. New Zealand Medical Journal, 24 April 2020, 133(1513):81-88. 

Kate Curtis a, Belinda Gabbe, Ramon Z. Shaban, Shizar Nahidi, CliffPollard AM, Kirsten Vallmuur, Katherine Martin, Grant Christey

Injury 51 (2020) 84–90

https://doi.org/10.1016/j.injury.2019.09.033

Introduction: The Australia New Zealand Trauma Registry enables the collection and analysis of standard- ised data about trauma patients and their care for quality improvement, injury prevention and bench- marking. Little is known, however, about the needs of providers and clinicians in relation to these data, or their views on trauma quality improvement priorities. As clinical experts, trauma clinicians should have input to these as ultimately their practice may be influenced by report findings. This paper presents the perspectives of multidisciplinary trauma care professionals in Australia and New Zealand about the use of the Australia New Zealand Trauma Registry data and trauma quality improvement priorities.

Methods: An exploratory survey of trauma professionals from relevant Australia and New Zealand professional organisations was conducted using the Snowballing Method between September 2018 and February 2019. Participants were recruited via a non-random sampling technique to complete an online survey. Descriptive statistical and content analyses were conducted.

Results: The data use priorities identified by 102 trauma professionals from a range of locations participated were clinical improvement and system/process improvement (86.3%). Participants reported that access to trauma data should primarily be for clinicians (93.1%) and researchers (87.3%). Having a standardised approach to review trauma cases across hospitals was a priority in trauma quality improvement. Conclusion: Trauma registry data are under-utilised and their use to drive clinical improvement and system/process improvement is fundamental to trauma quality improvement in Australia and New Zealand.

Cite

Curtis K, Gabbe B, Shaban RZ, Nahidi S, AM CP, Vallmuur K, Martin K, Christey G. Priorities for trauma quality improvement and registry use in Australia and New Zealand. Injury. 2020 Jan 1;51(1):84-90.

Janet Amey PhD; Grant Christey BSc(Hons), MBChB, FRACS, FACS

J PRIM HEALTH CARE 2019;11(4):342–350.
doi:10.1071/HC19049

Introduction: Occupational health on farms is important because farms are not only workplaces where agriculture workers are vulnerable to high injury and fatality rates, they are also homes where families and visitors undertake a variety of activities that can result in injury.

Aim: To profile and describe injuries requiring hospital admission that occurred on farms, both for injuries related to farming activities and injuries unrelated to farm work in the Midland region of New Zealand.

Conclusion: In total, 2303 hospital admissions met the study criteria. Non-major injury accounted for 93.1% of events and 45.0% of injuries occurred during farming activities. Five people died in hospital; all injured while undertaking farm work. Males made up 84.8% of farm work and 70.9% of non-farm work injuries. Horse riding had the highest number of injuries, with off-road motorcycles, livestock, falls and quad bike injuries comprising the most common injury activities and
mechanisms. Farming-related major injuries commonly involved quad bikes, non-traffic vehicles and motorcycles. Farmers in the Districts of Waitomo, Rotorua, Waipa and Taupo _ had the highest standardised hospitalisation rates.

Cite

Amey J, Christey G. Farm injury resulting in hospital admission: a review of farm work and non-farm work-related injury. Journal of Primary Health Care. 2019 Dec 1;11(4):342-50.

P.A. Cameron , M.C. Fitzgerald, K. Curtis, E. McKie, B. Gabbe, A. Earnest, G. Christey, C. Clarke, J. Crozier, M. Dinh, D.Y. Ellis, T. Howard, A.P. Joseph, K. McDermott, J. Matthew, R. Ogilvie, C. Pollard, S. Rao, M. Reade, N. Rushworth, S. Zalstein, On behalf of the Australian Trauma Quality Improvement Program (AusTQIP) collaboration.

Injury, available online 3 October 2019.

Background: Trauma registries are known to drive improvements and optimise trauma systems world- wide. This is the first reported comparison of the epidemiology and outcomes at major centres across Australia.

Conclusion: Australia has the capability to identify national injury trends to target prevention and reduce the burden of injury. Quality of care following injury can now be benchmarked across Australia and with the planned enhancements to data collection and reporting, this will enable improved management of trauma victims. 

Cite

Cameron PA, Fitzgerald MC, Curtis K, McKie E, Gabbe B, Earnest A, Christey G, Clarke C, Crozier J, Dinh M, Ellis DY. Over view of major traumatic injury in Australia––Implications for trauma system design. Injury. 2020 Jan 1;51(1):114-21.

Amey. J., Christey. G (2019) The New Zealand Medical Journal, Vol 132, No. 1501 / 7976.

Aim: To describe quad bike injury-related hospitalisations in the Midland region over a six-yer period.  Conclusion: Despite continued public debate and education on the safe use of quad bikes, injuries severe enough to require hospitalisation continue to occur. Children continue to be injured, both as riders and passengers. Ageing farmers are a developing area for concern. While workplace safety garners most of the safety attention, two other areas also deserve injury prevention consideration; injuries that occur on-farm but not during farming activities and those occurring off-farm to recreational riders.

Cite

 Amey J, Christey G. A six-year review of patients admitted to hospital with injuries related to quad bike use. The New Zealand Medical Journal (Online). 2019 Aug 30;132(1501):33-40.

Singh, N., Joe, N., Amey, J., Smith, A., Christey, G. (2019) The New Zealand Medical Journal, Vol 132, No. 1494 / 7868.

Aim: Current policy direction seeks to promote participation in both recreational and active transport cycling. We evaluate cycling-related injuries resulting in hospital admission across the Midland Region of New Zealand to establish injury trends. Conclusion: Hospital admission volumes and rates are rising with underlying variation in patient demography, place and severity of injury. Current policy direction to grow cycling participation based on the health, environmental and economic benefits is ahead of the implementation of safer cycling infrastructure, creating a timing lag. From a regional hospital-based trauma service perspective, this timing lag needs due consideration if the full benefits of increasing participation are to be realised.

Cite

Singh N, Joe N, Amey J, Smith A, Christey G. Cycling-related injuries and cycling promotion: a trauma service perspective. The New Zealand Medical Journal (Online). 2019 May 3;132(1494):41-8.

Beaton, A., O'Leary, K., Thorburn, J., Campbell, A., Christey, G. (2019) The New Zealand Medical Journal, Vol 132, No. 1494 / 7866.

Aim: To explore injured patients’ experiences of care to identify areas for improvement in routine service delivery from surgical teams in the transition from inpatient to community-based care.

Conclusion: This study highlights perceived issues in the patient care pathway in the transition from inpatient to community-based care, especially communication and discharge information provided by surgical clinical teams and Accident Compensation Corporation (ACC). Comprehensive inpatient care and clinical handover to primary care (rather than discharge planning processes) by dedicated clinical trauma services may provide more holistic models for surgical services to improve their influence on the transition of trauma patients into the community, assisted by organisation changes and support to enable effective service delivery. Specifically, trauma patients and their carers perceived the need for better screening and treatment for psychological trauma in the inpatient and outpatient setting; better information exchange prior to the transition from inpatient to primary care; more convenient and accessible follow-up services including a single point of contact for coordination of post-discharge care; and acknowledgement and practical support to relieve the significant and pervasive carer burden identified in this study. These findings provide the opportunity to implement focused system changes to provide more equitable and effective support in the transition to community care and beyond. The end result will be better experiences for patients and whānau, and improved health and vocational outcomes following serious injury.

Cite

 Beaton A, O'Leary K, Thorburn J, Campbell A, Christey G. Improving patient experience and outcomes following serious injury. New Zealand Medical Journal. 2019, 132(1494):15-25.

Kool, B.; Ameratunga, S., Scott, N., Lawrenson, R., Christey, G. (2017). Injury, Vol. 48, p2478-2484.

Aim: To describe the epidemiological characteristics of patients with work-related injuries (WRI) admitted to hospitals in New Zealand's Midland Trauma System (MTS) durina a four year period.

Conclusion: Work-related injuries are a preventable cause of harm and health inequities in New Zealand, and targeted by the Government for a reduction of 25% by 2020.  Characteristics of WRI in the Midland Region of New Zealand identified in this study may assist in identifying areas for intervention.

Cite

 Kool B, Ameratunga S, Scott N, Lawrenson R, Christey G. The epidemiology of work-related injury admissions to hospitals in the Midland region of New Zealand. Injury, 2017, 48(11):2478–2484.

O’Leary, K., Kool, B., Christey, G. (2017). New Zealand Medical Journal, Vol. 130, No. 1463, p45-53.

Aim: To describe the epidemiology of injuries sustained by older adult trauma patients admitted t hospitals in the Midland Region (population 886,000) of New Zealand.

Conclusion: These findings illustrate the growing volumes and changing epidemiology of both major and minor trauma affecting older persons hospitalised following trauma in one of the four health regions of New Zealand.  There is a need to prepare for an increase in demand for trauma services to meet the needs of an ageing population in New Zealand.

Cite

 O’Leary K, Kool B, Christey G. Characteristics of older adults hospitalised following trauma in the Midland region of New Zealand. New Zealand Medical Journal, 2017, 130(1463):45-53

Alamri, Y., Moon, D., Ah Yen, D., Wakeman, C., Eglinton, T., Frizelle, F. (2017). New Zealand Medical Journal, Vol. 130, No. 1463, p11-18.

Aim: The aim of this study was to describe the demographics, mechanisms of injury, management and outcomes in patients who suffered splenic trauma in Christchurch, New Zealand.

Conclusion: Splenic injuries have shown a steady increase in the last decade.  Spenectomy rates have decreased in favour of non-operative techniques.  Radiological intervention with splenic artery embolisation was successful in all selected patient with high-grade injuries.

Cite

Alamri Y, Moon D, Yen DA, Wakeman C, Eglinton T, Frizelle F, Isles S, Christey G, Civil I, Hicks P, Robinson T. Ten-year experience of splenic trauma in New Zealand: the rise of non-operative management. Slavery in New Zealand. 2017 Oct 6;130(1463).

Whitehead, J., Roskruge, M., Tan, C., Smith, A., Christey, G. (2018). New Zealand Medical Journal, Vol. 131 No. 1470, p71-78.

Aim: Pre-hospital triage strategies aim to identify the type and extent of patient injuries and ensure that they are transferred to the most appropriate trauma centres.  Despite the importance of appropriate pre-hospital transport, there is little evidence base to assist medical staff on optimal destination policy for emergent pre-hospital transport.  This paper explores the spatial relationship of patient transfers prior to the implementation of the Midland Pre-Hospital Trauma Destination Matrix in New Zealand, and is a retrospective view of practice against a destination policy that was applied after the study period.

Conclusion: Approximately one-third of patients were not directly transported to the preferred definitive care hospital subsequently defined in the Midland Pre-Hospital Trauma Destination Matrix.  Ongoing monitoring of the pre-hospital transportation system and the implementation of a formal pre-hospital transport policy may improve the efficiency of the Midland Trauma System.  Future studies should examine the possible reasons for variations in triage decisions across the Midland Region.

Cite

 Whitehead, J., Roskruge, M., Tan, C., Smith, A., Christey G. Monitoring prehospital transport of severely injured patients in the Midland Region of New Zealand. New Zealand Medical Journal, 2018,131(1470):71-78.

Jones, A. R., Smith, A., & Christey, G. (2018). The New Zealand Medical Journal, Vol. 131 No. 1483, pg50-58.

Aim: To examine the pattern and outcomes of equine-related injuries for hospitalised patients in the Midland Region of New Zealand over a five-year period.

Conclusion:The study has identified the demography, injury types, risk factors and outcomes for equine-related injuries in the Midland Region of New Zealand.  Indications are that the severity of such injuries may be less than previously reported.  However, the volumes and costs of injury represent a significant burden on the health system, individuals and communities. More detailed understanding of causative factors will allow targeting of prevention strategies to address high-risk activities and demographic groups.

Cite

Jones AR, Smith A, Christey G. Equine-related injuries requiring hospitalisation in the Midland Region of New Zealand: a continuous five-year review. The New Zealand Medical Journal, 2018, 131(1483):50-58.

Tosswill, M., Roskruge, M., Smith, A., & Christey, G. (2018). The New Zealand Medical Journal, Vol. 131No. 1483, pg13-20.

Aim: To assess the incidence and patterns of injury resulting from force transferred from large livestock in the Midland Region of New Zealand, and to identify foci for prevention.

Conclusion: This study has identified high-risk animals, activities, age intervals and times during which large livestock-related injuries may occur, and revealed the significant impact on hospitals and communities that these injuries result in.

Cite

Tosswill M, Roskruge M, Smith A, Christey G. Livestock-related injuries in the Midland region of New Zealand. New Zealand Medical Journal, 2018,131(1483):13-20.

Scott, N., Clark, H., Kool, B., Ameratunga, S., Christey, G., & Cormack, D. (2018). The New Zealand medical journal, Vol. 131, No. 1483, p21-29.

Aim: To audit the quality of ethnicity data captured by the Waikato Hospital Trauma Registry and Waikato Hospital patient management system against self-identified enthnicity.

Conclusion: The degree of misclassification of Maori ethnicity data among patients in the Waikato Trauma Registry and the Waikato Hospital patient management system highlights a need for improvements to how ethnicity data is captured within these databases and potentially many other similiar entities collecting enthnicity data in New Zealand.  The release of revised standardised protocols for the collection of ethnicity data is timely given the recent establishment of a national trauma registry.  Without quality data, the opportunity to investigate and address ethnic inequities in trauma incidence and management is greatly compromised.

Cite

Scott N, Clark H, Kool B, Ameratunga S, Christey G, Cormack D. Audit of ethnicity data in the Waikato Hospital Patient Management System and Trauma Registry: pilot of the Hospital Ethnicity Data Audit Toolkit. The New Zealand Medical Journal, 2018, 131(1483):21-29.

Isles, S., Christey, G., Civil, I., Hicks, Hicks, P. (2017). The New Zealand Medical Journal, Vol. 130, No.1463, p19-27.

Aim: to describe the development of the New Zealand Major Trauma Registry (NZ-MTR) and the initial experiences of its use.

Conclusion: Despite the challenges working across multiple jurisdictions, initiation of a single-instance web-based registry has been achieved.  The NZ-MTR enables New Zealand to have a national view of trauma treatment and outcomes for the first time.  It will inform quality improvement and injury prevention initiatives and potentially decrease the burden of injury on all New Zealanders.

Cite

 Isles S, Christey G, Civil I, Hicks P. The New Zealand Major Trauma Registry: the foundation for a data-driven approach in a contemporary trauma system. New Zealand Medical Journal, 2017, 130(1463):19-27.

Spijker, EE., Jones, K., Duijff, JW., Smith, A., Christey, G. (2018). Royal New Zealand College of General Practitioners, Vol.10, No.4, p292-302.

Aim: To determine the extent to which adults' experience impaired health-related quality of life (QoL), symptoms of post-traumatic stress disorder, depression, chronic pain and harmful alcohol use during the year following major trauma, and to identify factors associated with outcomes.  Conclusion: A significant proportion of adults experience adverse psychosocial outcomes in the first year following major trauma.  Screening and management of potentially comorbid psychosocial needs could improve care and outcomes for survivors.

Cite

Spijker EE, Jones K, Duijff JW, Smith A, Christey GR. Psychiatric comorbidities in adult survivors of major trauma: findings from the Midland Trauma Registry.Journal of Primary Health Care, 2018, 10(4):292-302.

Wood, A., Duijiff, JW., Christey, G. (2013) ANZ Journal of Surgery, Royal Australasian College of Surgeons, Vol 83, p206-210.

Aim: The aim of this study was to assess the burden of all-terrain vehicle (ATV) injuries within the Waikato region of New Zealand.

Conclusion: Quad bike injuries are an increasing burden on Waikato health care.  The best strategy to tackle this epidemic needs to be further debated.

Cite

 Wood A, Duijff J.W, Christey G.R. Quad bike injuries in Waikato, New Zealand: an institutional review from 2007–2011. Australian and New Zealand Journal of Surgery, 2013, 83(4); 206-210.