Injury Treatment and Rehabilitation Accessibility Queensland Index (iTRAQI) Pilot for Moderate-to-Severe Traumatic Brain Injury: Technical report

Traumatic brain injuries (TBIs) are a major cause of disability and death in Australia. Timely access to vital neurosurgical treatment is the key determinant of survival and recovery. Queensland’s health care system is mainly centralized along the East Coast, with major trauma treatment hospitals located only in the South-East corner and Townsville.

Emergency retrieval services are State-based and to cover Queensland’s vast distances and dispersed population requires both road (Queensland Ambulance Service) and air (Retrieval Services Queensland) transport.

Rehabilitation also plays a vital role in regaining functional capacity and improving outcomes. Specialised in-patient rehabilitation is available at/near the major trauma centres, but as patients progress, can also be offered at less-specialised facilities.

The aim of developing the prototype injury Treatment and Rehabilitation Accessibility Queensland Index (iTRAQI) was to understand which areas had poor access to treatment and/or rehabilitation for moderate-to-severe TBI.

Appropriate patient transfers from 441 locations across Queensland (identified using Geoscape’s Administrative Boundaries for Queensland Town Points) to receive specialised neurosurgical acute care were determined by Retrieval Services Queensland and Queensland Ambulance Service. Aeromedical retrieval times used expert clinical advice, while ambulance road travel times used off-peak speed limits on road networks via ArcGIS Online.

Access to brain injury rehabilitation care considered only public in-patient rehabilitation, and appropriate facilities were identified through the Queensland Rehabilitation Service Directory using road travel times calculated using off-peak speed limits and road networks.

Estimated median travel times across Queensland to neurosurgical acute care ranged from less than five minutes to over 8.5 hours, with the poorest access seen in areas such as the Torres Strait region and South-West Queensland. Driving time to rehabilitation facilities ranged from approximately 10 minutes to over 20 hours, with the Torres Strait region having the poorest access.

The large disparities seen across Queensland, despite world-leading health, prehospital and retrieval services, highlight the importance of considering disease-specific accessibility indices. The travel times calculated for moderate-to-severe TBI are likely to be similar for other severe injury types requiring highly specialized care. Future work will compare the iTRAQI index against actual patient travel times to acute care, and consider where improvements can be made.