IJPDS International Journal of Population Data Science

New research from Aotearoa New Zealand is raising important questions about how best to transport seriously injured patients to hospital, suggesting that faster direct transfers to specialist trauma centres may not always improve survival outcomes.

This study, published in the International Journal of Population Data Science (IJPDS), examined whether people with injuries defined as ‘major trauma’ are more likely to survive if they are taken straight to a specialised trauma centre or first treated at a nearby hospital before being transferred.

By linking national data on more than 1,000 patients in New Zealand’s Trauma Registry with ambulance records, researchers compared 30-day survival outcomes between the two groups. All patients included in the analysis were injured in locations where both transport options were possible because a lower-level hospital was available closer to the scene.

The study found no evidence of a difference in short-term mortality between patients transported directly to a specialised trauma centre and those initially taken to a nearer hospital before transfer. However, the findings suggest that older patients aged 55 years and over who were first treated at a nearby hospital may have lower short-term mortality, although the reasons for this remain unclear.

The findings challenge assumptions that direct transport to a specialised trauma centre is always the best option for patients with major trauma. However, the authors note that direct transfer may still offer important benefits for people with specific injuries that require specialist services, such as neurosurgery, plastic surgery, or orthopaedics.

The study also highlights the importance of local context. Factors such as geography, population distribution, and the structure of health systems can influence which transport pathways work best. For example, in New Zealand, both advanced and mid-level hospitals are considered specialised trauma centres, creating a different healthcare landscape from that seen in other countries.

Internationally, many trauma systems promote direct transport to specialist trauma centres based on studies showing improved outcomes in some countries. However, during the time period of this study, one-in-five major trauma patients in New Zealand required transfer to a higher-level hospital, according to a National Trauma Network annual report.

The large multidisciplinary research team that included academics from five universities (three within New Zealand) and experts from emergency medical and trauma services caution that the study has limitations. The study included a relatively small number of patients, and the results were associated with wide margins of uncertainty.

“Our study findings have been described as ‘provocative’ as they challenge assumptions about transport pathways for seriously injured people”, said lead author Professor Gabrielle Davie. “Further research is thus needed to better understand how transport decisions affect different groups of patients, particularly older adults, who are a growing proportion of trauma cases around the world”.

Ultimately, the study suggests that while getting patients to the right place at the right time remains critical, the best route is not always straightforward, and a one-size-fits-all approach to trauma transport may not deliver the best outcomes for every patient.

 

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Professor Gabrielle Davie, University of Otago, New Zealand

The study was funded by the Health Research Council of New Zealand.

Davie, G., Dicker, B., Lilley, R., Campbell, N., Ameratunga, S., Civil, I., Branas, C., Reid, P., de Graaf, B., Montoya, L. and Kool, B. (2026) “The impact of indirect transport to a trauma centre on survival for major trauma patients: a national propensity-adjusted observational study”, International Journal of Population Data Science, 11(1). doi: 10.23889/ijpds.v11i1.3388.