Trauma in northern Quebec, 2005–2014: epidemiologic features, transfers and patient outcomes

Abstract

Background:The Inuit people residing in Nunavik, Quebec, are vulnerable to major trauma owing to environmental and social factors; however, there is no systematic data collection for trauma in Nunavik, and, apart from data regarding patients who are transferred to tertiary care centres, no data enter the Quebec trauma registry directly from Nunavik. We performed a study to characterize the epidemiologic fea tures of trauma in Nunavik, and describe indications for transfer and outcomes of patients referred to the tertiary trauma centre. Methods:We collected data retrospectively for all patients with trauma admitted to the Centre de santé Tulattavik de l'Ungava in Kuujjuaq from 2005 to 2014. Socio demographic, injury and health services data were extracted. The data were analyzed in conjunction with coroners' reports on death from trauma in Nunavik.Results: A total of 797 trauma cases were identified. The most common causes of injury were motor vehicle collisions (258 cases [32.4%]), falls (137 [17.2%]) and blunt assault (95 [11.9%]). Onethird of patients (262 [32.9%]) were transferred to the ter tiary care centre in Montréal. The incidence rate of major trauma (Injury Severity Score > 12) was 18.1 and 21.7 per 10 000 personyears in the Kuujjuaq region and the Puvirnituq region, respectively, which translates to a relative risk (RR) of 4 compared to the Quebec population. The disparity observed in trauma mortality rate was even greater, with an RR of 47.6 compared to the Quebec population. Conclusion:The study showed major disparity in trauma incidence and mortality rate between Nunavik and the province of Quebec. Our findings allow for a better understanding of the burden of injury and regional trauma mortality in Nunavik, and recommendations for optimization of the trauma system in this unique setting. Contexte :Le peuple Inuit du Nunavik, au Québec, est sujet à des traumatismes majeurs en raison de facteurs environnementaux et sociaux; or, on ne dispose d'aucun système de collecte des données concernant les traumatismes au Nunavik, et outre les données relatives aux patients transférés dans des établissements de soins tertiaires, aucun renseignement n'est consigné au Registre des traumatismes du Québec directe ment en provenance du Nunavik. Nous avons procédé à une étude pour cerner les caractéristiques épidémiologiques des traumatismes au Nunavik et décrire les indica tions de transfert et l'issue des traumatismes subis par les patients adressés vers des centres tertiaires de traumatologie.Méthodes : Nous avons recueilli les données de manière rétrospective pour tous les patients victimes de traumatismes admis au Centre de santé Tulattavik de l'Ungava, à Kuujjuaq, de 2005 à 2014. Nous avons extrait les données sociodémographiques, ainsi que les données sur les blessures et les services de santé utilisés. Nous avons analysé les données en parallèle avec les rapports des coroners sur les décès des suites de trau matismes au Nunavik.Résultats : En tout, 797 cas de traumatisme ont été recensés. Les causes les plus ...

Predictors of clinical deterioration and intensive care unit admission in trauma patients transferred from northern Quebec to a level 1 trauma centre: a retrospective cohort study

“…The median age was 33 (IQR 23-47) years, and the most com mon age range was 20-29 years (n = 235, 33.4%). There were more male than female patients (n = 444, 63.1%), and the median ISS was 10 (IQR [5][6][7][8][9][10][11][12][13][14][15][16][17]. The most com mon mechanisms of injury were motor vehicle collision (n = 244, 34.7%), followed by blunt assault (n = 155, 22.0%) and fall (n = 148, 21.0%).…”

“…Résultats : En tout, 704 cas ont été transférés du Nunavik et admis à l'HGM durant la période de l'étude. L'âge moyen était de 33 (écart interquartile [ÉI] 23-47) ans et l'indice de gravité des blessures (IGB) médian était de 10 (ÉI [5][6][7][8][9][10][11][12][13][14][15][16][17]. À l'analyse de régression multiple, le temps de transport entre le lieu où la blessure est survenue et l'arrivée à l'HGM (rapport des cotes [RC] 1,04, intervalle de confiance [IC] de 95 % 1,01-1,06), les blessures thoraciques (RC 1,75, 95 % IC 1,03-2,99), et les blessures à la tête et au cou (RC 3,76, IC de 95 % 2,10-6,76) ont été des prédicteurs de la détério ration de l'état clinique durant le transfert.…”

“…6,7 A recent retrospective study from our research group demonstrated that incidence rates of major traumatic injuries in Kuujjuaq and Puvirnituq were approximately 4fold higher than those for the Quebec general population, with an even greater disparity in trauma mortality rate. 8 In Nunavik, 2 regional hospitals, 1 in Kuujjuaq and another in Puvirnituq, provide secondary and limited ter tiary care to the resident populations of those villages and surrounding smaller communities (Figure 1). The Mont real General Hospital (MGH) is the level 1 trauma centre designated to receive all trauma transfers from the region.…”

Trauma systems in Canada: striving for quality across an expansive landmass

“…In fact, in the most recent year that ranked cause of death was published in Canada (2015), unintentional injury was the number 1 cause of death in 1-to 34-year-olds and the sixth leading cause of death for all age groups, with significantly higher morbidity and mortality in rural populations. [3,4] For reference to the reader, Canada is divided into 13 provinces/ territories. Health care is publicly funded as per the Canada Health Act, and each province or territory manages its own health care system using a budget allocated by the federal government.…”

“…In fact, in the most recent year that ranked cause of death was published in Canada (2015), unintentional injury was the number 1 cause of death in 1- to 34-year-olds and the sixth leading cause of death for all age groups, with significantly higher morbidity and mortality in rural populations. [3,4]…”