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Development of a model to quantify the accessibility of a Canadian trauma system

  • Gavin Tansley (a1), Nadine Schuurman (a2), Mete Erdogan (a3), Matthew Bowes (a4), Robert Green (a5) (a6), Mark Asbridge (a7) and Natalie Yanchar (a1)...

Abstract

Objectives

Trauma systems have been widely implemented across Canada, but access to trauma care remains a challenge for much of the population. This study aims to develop and validate a model to quantify the accessibility of definitive care within one provincial trauma system and identify populations with poor access to trauma care.

Methods

A geographic information system (GIS) was used to generate models of pre-scene and post-scene intervals, respectively. Models were validated using a population-based trauma registry containing data on prehospital time intervals and injury locations for Nova Scotia (NS). Validated models were then applied to describe the population-level accessibility of trauma care for the NS population as well as a cohort of patients injured in motor vehicle collisions (MVCs).

Results

Predicted post-scene intervals were found to be highly correlated with documented post-scene intervals (β 1.05, p<0.001). Using the model, it was found that 88.1% and 42.7% of the population had access to Level III and Level I trauma care within 60 minutes of prehospital time from their residence, respectively. Access for victims of MVCs was lower, with 84.3% and 29.7% of the cohort having access to Level III and Level I trauma care within 60 minutes of the location of injury, respectively.

Conclusion

GIS models can be used to identify populations with poor access to care and inform service planning in Canada. Although only 43% of the provincial population has access to Level I care within 60 minutes, the majority of the population of NS has access to Level III trauma care.

Contexte

Différents systèmes de traumatologie ont été mis sur pied un peu partout au Canada, mais l’accès aux centres de traumatologie est difficile pour une grande partie de la population. L’étude décrite ici avait pour buts d’élaborer et de valider un modèle visant à quantifier l’accessibilité à des centres de soins pluridisciplinaires, rattachés à un seul système provincial de traumatologie, et de cerner les populations ayant difficilement accès aux centres de traumatologie.

Méthode

Les chercheurs ont eu recours à un système d’information géographique (SIG) pour générer des modèles d’intervalles d’intervention avant et après événement, respectivement. Les modèles ont été validés à l’aide d’un registre de traumatologie reposant sur la population et contenant des données sur les intervalles d’intervention en phase préhospitalière ainsi que sur les lieux d’accidents en Nouvelle-Écosse (N.-É.). Une fois validés, les modèles ont ensuite été appliqués pour établir le degré d’accessibilité aux centres de traumatologie pour l’ensemble de la population de la N.-É. ainsi que pour une cohorte de personnes ayant subi des blessures dans des accidents de véhicules automobiles (AVA).

Résultats

Une forte corrélation a été établie entre les intervalles d’intervention prévus après un événement et les intervalles d’intervention documentés après un événement (β=1,05; p<0,001). D’après le modèle, 88,1 % et 42,7 % de la population avaient accès, en phase préhospitalière, à un centre de traumatologie de niveau III ou de niveau I en l’espace de 60 minutes depuis leur lieu d’habitation, respectivement. Par contre, 84,3 % et 29,7 % des personnes blessées dans des AVA, soit des taux moins élevés que dans le groupe précédent, ont eu accès à un centre de traumatologie de niveau III ou de niveau I en l’espace de 60 minutes depuis le lieu de l’accident, respectivement.

Conclusions

Les modèles reposant sur les SIG peuvent servir à cerner les populations ayant difficilement accès aux centres de traumatologie, et à guider la planification des services au Canada. Bien que 43 % seulement de la population en N.-É. aient accès à un centre de traumatologie de niveau 1 en l’espace de 60 minutes, la grande partie de la population de la province a accès un centre de traumatologie de niveau III.

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Copyright

Corresponding author

Correspondence to: Dr. Gavin Tansley, Dalhousie University, 5850 University Ave., Halifax, NS B3K 6R8; Email: gtansley@dal.ca

References

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