An urgent DHB-wide review is being called for to understand why rangatahi Māori are far more likely to die after significant trauma than non-Māori.
In a first of its kind, the Health Quality and Safety Commission has examined whether Māori who were hospitalised for a life-threatening trauma – such as a car accident or fall – received equitable care and had the same survival rates as non-Māori.
The review, conducted by the commission’s Perioperative Mortality Review Committee found “inequity was clear” for Māori youth aged 15 to 18 years.
They were over three times more likely to die in the 30 days following major trauma than non-Māori in the same age group.
Overall, it found Māori were 56 percent more likely than non-Māori to die in the first month after a major trauma, excluding serious brain injury.
Perioperative Mortality Review Committee member Dr Dick Ongley – who undertook the review – said it was not clear what was driving the disparity.
“Even if we control lots of other factors, for example, distance from time to hospital, socioeconomic factors, we still see this example of inequity – which is consistent with other reports.
“We want DHBs to look into that.”
Another major finding was that Māori were 37 percent more likely to not receive a CT scan, which is used to assess and understand the severity of the trauma and has an impact on mortality outcomes,
“One of our recommendations was to ask the DHBs and in fact the National Trauma Network about what should trigger a CT scan … so we have a set protocol,” Ongley said.
The disparity could be driven by Māori being likely to have burns or penetrating trauma, meaning they are too unstable to receive a CT scan, Ongley said, but further research was needed.
Asked whether unconscious bias was behind the inequity, he said it was not clear yet, but if this was a driving factor, standardising CT scans would “remove unconscious bias”.
“I think every clinician would like to think it doesn’t have a role to play but there’s a chance to examine not only your own hospital but also yourself and have a think about those questions.”
The report recommends a review by each DHB into all cases of trauma in Māori aged 15 to 18 to identify whether treatment was timely, and what processes need to be improved to ensure equitable care.
It calls for an audit of CT scans for Māori patients including examining the role of institutional racism, and for all DHBs to prioritise CT scans for trauma patients.
It has also recommended a review by each DHB, to be conducted by a trauma nurse specialist or kaupapa Māori navigation trauma team, to find out if all aspects of care are addressing inequity.