Injury trends and mortality in adult patients with major trauma in New South Wales

In reply: In our study,1 we allocated the numbers and type of trauma centres according to New South Wales Department of Health terminology and the Royal Australasian College of Surgeons Trauma Verification Committee model resource criteria. The latter reflected the resource availability of 24-hour, 7-day per week specialty services such as plastic surgery, cardiothoracic surgery and neurosurgery at those centres during the study period,2,3 as outlined in Box 1 of the original manuscript. Since publication of the article, we have found further NSW Health documentation that designates Nepean, Gosford and Wollongong Hospitals as regional trauma centres.4

Our results showed that trauma mortality decreased from 15% in 2003 to 12.9% in 2007. The adjusted relative odds of mortality decreased significantly from 2003 to 2007, except in 2005.1

We agree with Stapleton and colleagues that prehospital triage tools for major trauma are imperfect and are universally acknowledged to have varying undertriage and overtriage rates.5 However, we would argue that conclusions from recent single-centre Australian studies are limited by inadequate data.6 The T1 protocol was not considered as a confounder or used as an outcome measure in our study.

With regard to neurotrauma, injury to specific body regions including the head or neck was controlled for in our analysis. We acknowledged that the Trauma Registry data were limited to patients with an injury severity score > 15, and agree that examination of treatment and outcomes for all trauma patients is needed.