Patient profile and outcomes of traumatic injury: The impact of mode of arrival to the emergency department

  • Julia Crilly
    Corresponding author at: Griffith University and Gold Coast Hospital and Health Service, Queensland, Australia
    School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia

    Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia

    Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
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  • David Bartlett
    Griffith Criminology Institute, Griffith University, Gold Coast, Queensland, Australia
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  • Ishtar Sladdin
    Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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  • Richard Pellatt
    Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
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  • Jesse T Young
    Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia

    Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia

    School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia

    National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
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  • Wietske Ham
    Institute of Nursing Studies, University of Applied Sciences, Utrecht, The Netherlands

    Emergency Department, University Medical Center Utrecht, Utrecht, The Netherlands
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  • Louise Porter
    Griffith Criminology Institute, Griffith University, Gold Coast, Queensland, Australia
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      Traumatic injuries are of global health concern and significant contributors to Emergency Department (ED) and hospital workload.


      To compare patterns of traumatic injuries among patient presentations to the ED across different modes of arrival (ambulance, police, or private transport) and to examine the predictors of an ED length of stay (LOS) exceeding 4 hours and hospital admission requirement.


      A retrospective observational study using 6 months of health data (8th October 2012–7th April 2013) of ED patient presentations made to one large, regional ED in Queensland, Australia, with a diagnosis code related to trauma.


      Over 6 months, 24.2% (n = 6,668) of adult patient presentations were trauma-related; most (60.9%) arrived via privately arranged transport (PAT); 38.7% were brought in by ambulance (BIBA) and 0.4% were brought in by police (BIBP). Demographics, clinical profile and patient outcomes differed based on mode of arrival. One in four patient presentations required hospital admission and 25% had an ED length of stay of >4 hours. Factors influencing hospital admission included older age, night shift, more emergent priority, and being BIBA. An ED length of stay of >4 hours was associated with older age, being BIBA, emergent nature of presentation, and hospital admission.


      The profile and outcomes of ED patient presentations with traumatic injury differs based on their mode of arrival to the ED. People BIBA were more likely to require hospital admission and have longer ED LOS, compared with those BIBP or PAT, even when controlling for covariates. Our findings may be used to inform nursing resource allocation when considering mode of arrival, especially for older people and people BIBA.


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        • Al-Thani H.
        • Mekkodathil A.
        • Hertelendy A.J.
        • Frazier T.
        • Cittone G.R.
        • El-Menyar A.
        Prehospital intervals and in-hospital trauma mortality: A retrospective study from a Level 1 trauma centre.
        Prehospital and Disaster Medicine. 2020; 35: 508-515
        • Aluisio A.R.
        • Gore R.
        • Decome I.
        • De Wulf A.
        • Bloem C.
        Prehospital characteristics in the north east department of Haiti: a cross-sectional study from a low-income setting without prehospital systems.
        Prehospital and Disaster Medicine. 2014; 29: 230-236
        • Australasian College for Emergency Medicine (ACEM)
        G24 - Guidelines on the implementation of the Australasian Triage Scale in emergency departments.
        2016 (Available from)
        • Australasian College for Emergency Medicine (ACEM)
        Position statement: Access block.
        ACEM. 2019; (March 2021)
        • Australian Institute of Health and Welfare
        Australian hospital statistics 2013–14: Emergency department care. Health services series no. 58. Cat. no. HSE 153.
        AIHW, Canberra2014
        • Australian Institute of Health and Welfare
        Emergency Department Care 2017–18: Australian Hospital Statistics. Health services series no. 89. Cat. no. HSE 216.
        AIHW, Canberra2018
      1. Australian Bureau of Statistics (ABS). (2013). Available from:[email protected]/Previousproducts/3218.0Main%20Features62012-13?opendocument&tabname=Summary&prodno=3218.0&issue=2012-13&num=&view= [Accessed 16 March 2022]

      2. Australian Psychological Society. (2021). Trauma. Available from: [Accessed 16 March 2022]

      3. Australian Bureau of Statistics (ABS). (2019). Australian Demographic Statistics June 2019(Cat. 3101.0). Available from:[email protected]/0/1CD2B1952AFC5E7ACA257298000F2E76 [Accessed 16 March 2022]

      4. American College of Surgeons. (2016). National Trauma Data Bank 2016: Annual Report. Available from: [Accessed 16 March 2022]

        • Australian Trauma Quality Improvement (AusTQIP) Collaboration
        Australia New Zealand Trauma Registry.
        Annual Report. Management of the Severely Injured, 1 July 2017 to 30 June 2018. Alfred Health, Melbourne, Victoria2019
        • Baker C.C.
        • Oppenheimer L.
        • Stephens B.
        • Lewis F.R.
        • Trunkey D.D.
        Epidemiology of trauma deaths.
        American Journal of Surgery. 1980; 140: 144-150
        • Barell V.
        • Aharonson-Daniel L.
        • Fingerhut L.A.
        • Mackenzie E.J.
        • Ziv A.
        • Boyko V.
        • et al.
        An introduction to the Barell body region by nature of injury diagnosis matrix.
        Injury Prevention. 2002; 8: 91-96
        • Beck B.
        • Cameron P.
        • Lowthian J.
        • Fitzgerald M.
        • Judson R.
        • Gabbe B.J.
        Major trauma in older persons.
        BJS Open. 2018; 2: 310-318
        • Becker A.
        • Segal G.
        • Berlin Y.
        • Hershko D.
        The emergency department length of stay: Is time running out?.
        Chinese Journal of Traumatology. 2019; 22: 125-128
        • Boyle J.
        • Jessup M.
        • Crilly J.
        • Green D.
        • Lind J.
        • Wallis M.
        • et al.
        Predicting emergency department admission.
        Emergency Medicine Journal. 2012; 29: 358-365
        • Cameron P.A.
        • Gabbe B.J.
        • Smith K.
        • Mitra B.
        Triaging the right patient to the right place in the shortest time.
        British Journal of Anaesthesia. 2014; 113: 226-233
        • Colnaric J.M.
        • Bachir R.H.
        • El Sayed M.J.
        Factors associated with survival in adult trauma patients transported to US trauma centres by police.
        Prehospital and Disaster Medicine. 2020; 00: 1-9
        • Considine J.
        • LeVasseur S.A.
        • Villanueva E.
        The Australasian Triage Scale: Examining emergency department nurses' performance using computer and paper scenarios.
        Annals of Emergency Medicine. 2004; 44: 516-523
      5. Council of Australian Governments (2011). The National Health Reform Agreement- National Partnership Agreement on Improving Public Hospital Services. Available from: [Accessed 20 March 2022]

        • Crawford K.
        • Morphet J.
        • Jones T.
        • Innes K.
        • Griffiths D.
        • Williams A.
        Initiatives to reduce overcrowding and access block in Australian emergency departments: A literature review.
        Collegian. 2014; 21: 359-366
        • Crilly J.
        • Keijzers G.
        • Tippett V.
        • O'Dwyer J.
        • Lind J.
        • Bost N.
        Improved outcomes for Emergency Department patients whose Ambulance off-stretcher time is not delayed.
        Emergency Medicine Australasia. 2015; 27: 216-224
        • Crilly J.
        • Polong-Brown J.
        • Lincoln C.
        • Timms J.
        • Becker K.
        • Scuffham P.
        • et al.
        A structure and process evaluation of a police Watch House Emergency Nurse (WHEN) model of care.
        International Emergency Nursing. 2019; 47100790
        • Crilly J.
        • Zhang P.
        • Lincoln C.
        • Scuffham P.
        • Timms J.
        • Becker K.
        • et al.
        Characteristics and outcomes of patient presentations made by police to an Australian emergency department.
        Emergency Medicine Australasia. 2019; 31: 1014-1023
        • Cubitt M.
        • Downie E.
        • Shakerian R.
        • Lange P.W.
        • Cole E.
        Timing and methods of frailty assessments in geriatric trauma patients: A systematic review.
        Injury. 2019; 50: 1795-1808
        • Curtis K.
        • Caldwell E.
        • Delprado A.
        • Munroe B.
        Traumatic injury in Australia and New Zealand.
        Australasian Emergency Nursing Journal. 2012; 15: 45-54
        • Dinh M.M.
        • Berendsen-Russell S.
        • Bein K.L.
        • Rogers K.
        • Muscatello D.
        • Paoloni R.
        • et al.
        The Sydney Triage to Admission Risk Tool (START) to predict emergency department disposition: A derivation and internal validation study using retrospective state-wide data from New South Wales, Australia.
        BMC Emergency Medicine. 2016; 16: 46
        • Dorney K.
        • Dodington J.M.
        • Rees C.A.
        • Farrell C.A.
        • Hanson H.R.
        • Lyons T.W.
        • et al.
        Preventing injuries must be a priority to prevent disease in the twenty-first century.
        Pediatric Research. 2020; 87: 282-292
        • Fingerhut LA
        • Warner M.
        The ICD-10 injury mortality diagnosis matrix.
        Injury Prevention. 2006; 12: 24-29
        • FitzGerald G.
        • Tippett V.
        • Schuetz M.
        • Clark M.
        • Tighe T.
        • Gillard N.
        • et al.
        Queensland Emergency Medical System: A structural and organizational model for the emergency medical system in Australia.
        Emergency Medicine Australasia. 2009; 21: 510-514
        • Forero R.
        • Nugus P.
        Australasian College for Emergency Medicine (ACEM) literature review on the Australasian Triage Scale (ATS).
        Citeseer. 2012; (2012)
        • Höke M.H.
        • Usul E.
        • Özkan S.
        Comparison of Trauma Severity Scores (ISS, NISS, RTS, BIG Score, and TRISS) in multiple trauma patients.
        Journal of Trauma Nursing. 2021; 28: 100-106
        • Institute of Medicine
        Crossing the Quality Chasm: A new health system for the 21st Century.
        National Academies Press (US), Washington DC2001
        • James S.L.
        • Luccheso R.L.
        • Bisignano C.
        • Castle C.D.
        • Dingles Z.V.
        • Fox J.T.
        • et al.
        Morbidity and mortality from road injuries: Results from the Global Burden of Disease Study 2017.
        Injury Prevention. 2020; 26: I46-i56
        • Kehoe A
        • Smith JE
        • Edwards A
        • Yates D
        • Lecky F.
        The changing face of major trauma in the UK.
        Emergency Medicine Journal. 2015; 32: 911-915
        • Keijzers G.B.
        • Campbell D.
        • Hooper J.
        • Bost N.
        • Crilly J.
        • Steele M.C.
        • et al.
        A prospective evaluation of missed injuries in trauma patients before and after formalising the trauma tertiary survey.
        World Journal of Surgery. 2014; 38: 222-232
        • Kim S.W.
        • Li J.Y.
        • Hakendorf P.
        • Teubner D.J.
        • Ben-Tovim D.I.
        • Thompson C.H.
        Predicting admission of patients by their presentation to the emergency department.
        Emergency Medicine Australasia. 2014; 26: 361-367
        • Kinney E.P.
        • Gursahani K.
        • Armbrecht E.
        • Dalawari P.
        Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?.
        Journal of Hospital Administration. 2015; 4: 1
        • Kristiansen T.
        • Lossius H.M.
        • Rehn M.
        • Kristensen P.
        • Gravseth H.M.
        • Røislien J.
        • et al.
        Epidemiology of trauma: A population-based study of geographical risk factors for injury deaths in the working-age population of Norway.
        Injury. 2014; 45: 23-30
        • Leeuwenburg T &
        • Hall J.
        Tyranny of distance and rural prehospital care: Is there potential for a national rural responder network?.
        Emergency Medicine Australasia. 2015; 27: 481-484
        • Li G.
        • Lau J.T.
        • McCarthy M.L.
        • Schull M.J.
        • Vermeulen M.
        • Kelen G.D.
        Emergency department utilization in the United States and Ontario, Canada.
        Academic Emergency Medicine. 2007; 14: 582-584
        • Lutz W
        • Sanderson W
        • Scherbov S.
        The coming acceleration of global population ageing.
        Nature. 2008; 451: 716-719
        • Markopoulou A.
        • Argyriou G.
        • Charalampidis E.
        • Koufopoulou A.
        • Nestor A.
        • Nanas S.
        • et al.
        Time-to-treatment for critically ill-polytrauma patients in Emergency Department.
        Health. Science Journal. 2013; 7: 81-89
        • McMurray A &
        • Cooper H.
        The nurse navigator: an evolving model of care.
        Collegian. 2017; 24: 205-212
        • Morley C.
        • Unwin M.
        • Peterson G.M.
        • Stankovich J.
        • Kingsman L.
        Emergency department crowding: a systematic review of causes, consequences and solutions.
        PLos One. 2018; 13E0203316
        • Mowery N.T.
        • Dougherty S.D.
        • Hildreth A.N.
        • Holmes J.H.
        • Chang M.C.
        • Martin R.S.
        • et al.
        Emergency department length of stay is an independent predictor of hospital mortality in trauma activation patients.
        Journal of Trauma: Injury, Infection and Critical Care. 2011; 70: 1317-1325
        • Oyeniyi BT
        • Fox EE
        • Scerbo M
        • Tomasek JS
        • Wade CE
        • Holcomb JB.
        Trends in 1029 trauma deaths at a level 1 trauma center: impact of a bleeding control bundle of care.
        Injury. 2017; 48: 5-12
        • Plath S.J.
        • Bratby J.A.
        • Poole L.
        • Forristal C.E.
        • Morel D.G.
        Nurse practitioners in the emergency department: establishing a successful service.
        Collegian. 2019; 26: 457-462
        • Richardson D.
        Increase in patient mortality at 10 days associated with emergency department overcrowding.
        Medical Journal of Australia. 2006; 184: 213-216
        • Ruger J.P.
        • Richter C.J.
        • Lewis L.M.
        Clinical and economic factors associated with ambulance use to the emergency department.
        Academic Emergency Medicine. 2006; 13: 879-885
        • Samaras N.
        • Chevalley T.
        • Samaras D.
        • Gold G.
        Older patients in the emergency department: A review.
        Annals of Emergency Medicine. 2010; 56: 261-269
        • Seow E.
        • Wong H.P.
        • Phe A.
        The pattern of ambulance arrivals in the emergency department of an acute care hospital in Singapore.
        Emergency Medicine Journal. 2001; 18: 297-299
        • Thompson A.
        • Gida S.
        • Nassif Y.
        • Hope C.
        • Brooks A.
        The impact of frailty on trauma outcomes using the clinical frailty scale.
        European Journal of Trauma and Emergency Surgery. 2021;
      6. United Nations. (2022). Ageing. Available from: [Accessed 16 March 2022]

      7. University of Florida Health. Traumatic Injury. Available from: (2022). [Accessed 16 March 2022]

        • Walter E &
        • Curtis K.
        The role and impact of the specialist trauma nurse: an integrative review.
        Journal of Trauma Nursing. 2015; 22: 153-169
        • Weyrich P.
        • Christ M.
        • Celebi N.
        • Riessen R.
        Triage systems in the emergency department.
        Medizinische Klinik - Intensivmedizin Notfallmedizin. 2012; 107: 67-78
      8. World Health Organization. (2017). Human rights and health.Available from: [Accessed 16 March 2022]

        • Young J.T.
        • Heffernan E.
        • Borschmann R.
        • Ogloff J.R.P.
        • Spittal M.J.
        • Kouyoumdjian F.G.
        • et al.
        Dual diagnosis and injury in adults recently released from prison: a prospective cohort study.
        Lancet Public Health. 2018; 3: E237-E248