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

To the Editor: It is pleasing to see Curtis and colleagues report injury trends and mortality across New South Wales,1 but the data are old and precede major changes to the NSW trauma system. We are concerned that the conclusions of this study will be misapplied by policymakers, leading to unnecessary out-of-area transport of injured patients.

The authors concluded that there is a survival benefit when definitive care occurs at a “level 1” major trauma centre (MTC) rather than at a regional trauma centre (RTC).1 Unfortunately, the definitions they used for trauma centre designation are not those used by NSW Health for service planning.2 According to the NSW Health definition, there were nine MTCs and two RTCs during the study period, in contrast to eight level 1 and three level 3 hospitals defined in the study. Adding to the ambiguity, NSW Health designated two hospitals as RTCs in 20013 and three in 2004,4 with no documented dates for any of these changes. Further, the authors did not mention that Wollongong Hospital did not enter data into the NSW Trauma Registry until 2004.5