Waikato Hospital, Hamilton 3204, New Zealand

Abstract

Large parts of the Midland region, as well as New Zealand as a whole, are very rural and sparsely populated. However, the incidence of trauma resulting in hospitalisation in relation to rurality of patient domicile has not been described for any representative population in New Zealand. Furthermore, studies in the UK, Europe, and North America suggest that trauma in rural areas has significant effects on health outcomes compared with urban trauma (Health, 2007; Lipsky et al., 2014; Litchfield, 2002; Singh & Siahpush, 2014). In this study, trauma registry data collected by the Midland Trauma System (MTS) for patients admitted to hospitals in the Midland region has been used to describe trauma patient demographics, causes of injury, and outcomes. These variables have been analysed in relation to patient domicile according to three principle rurality groups: urban, semirural, and rural, to identify similarities and variations between the groups.

Background

One in four New Zealanders live rurally or in small rural towns (Ministry of Health, 2018). For those who live in rural areas, the timeliness of treatment may be impeded by the long distances emergency services must travel to reach them and then convey them to trauma care facilities (Smith, Humphreys, & Wilson, 2008). Several studies in Australia, Europe, and North America have also demonstrated variations in the risk and causes of injury or death in urban and rural areas (Bakke et al., 2013; Harland, Greenan, & Ramirez, 2014; Jørgensen, 2013; Kristiansen, Rehn, Gravseth, Lossius, & Kristensen, 2012; Mitchell & Chong, 2010; Ryb, Dischinger, McGwin Jr, & Griffin, 2012; Singh & Siahpush, 2014).

One study that looked at location of crash and location of residence for victims found that rurality was an increased risk for both drivers who live in rural areas and to others who travel there (Jørgensen, 2013). A New South Wales, Australia, study examined differences in injury rates of child motor vehicle passengers using usual residence rather than crash location (Du, Finch, Hayen, & Hatfield, 2007). Children residing in rural areas also had significantly higher injury rates (Relative Risk = 2.1) than urban children across all injured body regions and specific injuries. This study citing literature that used crash location, stated that rural areas had three times the rate of injury than urban areas; with the authors suggesting the difference between this and their study may be attributed to locating people by their use of usual residence rather than the crash location. As yet there is sparse knowledge of the incidence and distribution of trauma requiring admission to hospital in New Zealand as it relates to the rurality of domicile of the patient.

The Midland Region (usually resident population count ~880,000, Census 2013) has a demographic and socio-economic profile that is broadly representative of New Zealand’s total population (Census 2013) therefore providing a useful population model to study. The Midland Trauma System was established in 2010 to enable standardisation of trauma care consistent with international best practice (Christey, 2013). The Midland DHBs (Bay of Plenty, Lakes, Taranaki, Tairāwhiti and Waikato) contribute trauma data to a customised regional trauma registry that includes data from point of injury to discharge from acute care.

This study aims to determine the detailed nature and volume of injury associated with urban, semirural, and rural communities. The risk profiles of these populations will be identified and compared to guide further analysis. Care processes and outcomes will also be assessed according to rurality of patient residence. Remediable anomalies will be reported directly to regional care providers and injury prevention bodies, and the effects of evidence-based change measured in the MTS trauma registry.