A model for spatio-temporal injury surveillance: implications for the evolution of a trauma system

Background Geographical variations in case volume have important implications for trauma system configuration, and have been recognised for some time. However, temporal trends in these distributions have received relatively little attention. The aim of this study was to propose a model to facilitate the spatio-temporal surveillance of injuries, using Scotland as a case study. Methods Retrospective analysis of five years’ (2009-2013) of trauma incident location data. We analysed the study population as a whole, as well as predefined subgroups, such as those with abnormal physiological signs. In order to leverage sufficient statistical power to detect temporal trends in rare events over short time periods and small spatial units, we used a geographically weighted regression model. Results There were 509,725 incidents. There were increases in case volume in Glasgow, the central Southern part of the country, the Northern parts of the Highlands, the North-East, and the Orkney and Shetland Islands. Statistically significant changes were mostly restricted to major cities. Decreases in the number of incidents were seen in the Hebrides, Western Scotland, Fife and Lothian, and the Borders. Statistically significant changes were seen mostly in Fife and Lothian, the West, some areas of the Borders, and in the Peterhead area. Subgroup analyses showed markedly different spatio-temporal patterns. Conclusions This project has demonstrated the feasibility of population-based spatio-temporal injury surveillance. Even over a relatively short period, the geographical distribution of where injuries occur may change, and different injuries present different spatio-temporal patterns. These findings have implications for health policy and service delivery. Level of evidence Level V Study type Epidemiological study Correspondence to: Jan Jansen, Center for Injury Sciences, 1922 7th Avenue South, Birmingham, Alabama 35294, USA. Email: jjansen@uabmc.edu, Phone:+1 (205) 975 3030, Fax:+1 (205) 975 3040 Conflicts of interest: The authors declare no conflicts of interest. Funding: The study was funded by NHS Grampian endowments. Presentations: An abstract of this work was presented at the Academic Surgical Congress 2018. © 2018 Lippincott Williams & Wilkins, Inc.

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