Health – Report finds inequities for Māori following major trauma

The Perioperative Mortality Review Committee (POMRC) is calling for district health boards (DHBs) to conduct an in-depth review into all cases of major trauma resulting in hospitalisation in Māori aged 15-18 years.

The recommendation comes from the POMRC’s ninth report, published today, which found that Māori youth aged between 15 and 18 years were three times more likely to die in the 30 days following major trauma than non-Māori in the same age group.

The POMRC reviews deaths related to surgery and anaesthesia that take place within the 30 days following an operation. It advises the Health Quality & Safety Commission on how to reduce these deaths and makes recommendations to make surgery safer for patients.

The ninth report focuses on comparing what happened (‘outcomes’) to Māori and non-Māori patients who were hospitalised following major trauma[1].

The report found that Māori were 37 percent more likely than non-Māori not to get an initial CT scan and 56 percent more likely to die in the first 30 days following major trauma that did not involve serious traumatic brain injury.

POMRC member Dr Dick Ongley says the report’s recommendations aim to help improve understanding of the factors that contribute to inequities in outcomes in the New Zealand health system.

‘We hope to help identify where the health sector can deliver better outcomes for Māori following major trauma.’

The report recommends Te Hononga Whētuki ā-Motu, the National Trauma Network, develops a national consensus guideline on prioritising CT scans for trauma cases to ensure unconscious bias and institutional racism do not result in inequitable health outcomes for Māori.

It also recommends DHBs review all cases of people with serious traumatic brain injury treated at non-neurological centres. The report recommends the reviews focus how appropriate and effective decisions about whether to transfer patients were.

The report also recommends all cases of trauma in Māori aged 15-18 also be reviewed to ensure key points of intervention were optimal and timely.

‘The reviews should consider the role implicit bias and institutional racism play in producing the inequities found and detailed in the report,’ says Dr Ongley.

‘There is a wide and established body of evidence about how unconscious bias and institutional racism in our health care system impacts Māori. Our report hopes to help those involved in the sector examine their own systems to improve trauma outcomes for Māori. Addressing this means linking trauma care to wider equity efforts in the sector, including educating providers and recognising how crucial equity is to providing good-quality health care,’ says Dr Ongley.

The report recommends the Accident Compensation Corporation (ACC) provides extra resources to enable the New Zealand Major Trauma Registry to collect data on people who die from major trauma at the site of injury or on the way to hospital.

The report says robust and up to date information about outcomes for those who die from major trauma before reaching hospital is required to allow for more comprehensive reporting and support the development of robust public health policies.

[1]For a definition of major trauma we use the Major Trauma Network definition: “Trauma to patients suffering physical injury as a result of energy transfer (such as from a car crash) and not internal pathologic processes (such as a disease), with an Injury Severity Score (ISS) of 13 or more”. The Injury Severity Score (ISS) is used internationally to give a numerical grading for the severity of injury that occurs in different body areas. The ISS can be directly correlated with a threat to life and, to a lesser degree, with complications, length of stay, cost and outcome.