Bridget Kool

University of Auckland · Section of Epidemiology and Biostatistics

aim: To evaluate adherence to the New Zealand Major Trauma Destination Policy (MTDP). This audit assessed if, based on their injuries, Emergency Medical Services (EMS) attended major trauma cases were taken to the MTDP determined appropriate hospital. Findings will guide and further improve pre-hospital trauma care and associated patient outcomes....

Background An optimally structured prehospital trauma care system can reduce the serious consequences of many injuries. Whether all major trauma patients should be directed to a trauma centre (TC), bypassing closer lower-level hospitals, is a contentious issue. In particular, it is unclear if direct transport reduces risk of death. Objective To ex...

Background Time is an important determinant of outcomes for individuals following trauma. Optimising prehospital trauma systems and care, such as (where appropriate) reducing prehospital times, and ensuring patients get to the appropriate receiving facility are necessary in order to reduce serious injury-related mortality and morbidity. Objective...

Background Major trauma is a significant contributor to morbidity and mortality. The provision of optimal prehospital Emergency Medical Services (EMS) care and timely transfer to advanced-level hospital care are vital to increase the likelihood of survival of following major trauma. Objective To identify factors that predict 24-hour mortality in p...

Background There are many long-standing challenges in delivering equitable health care in Aotearoa-New Zealand’s healthcare system. Little is known about inequities in EMS delivered care and transport pathways to hospital-level care, and any overlapping disparities by location of injury incident and ethnicity. Objective This study examines the int...

Introduction The out-of-hospital emergency medical service (EMS) care responses and the transport pathways to hospital play a vital role in patient survival following injury and are the first component of a well-functioning, optimised system of trauma care. Despite longstanding challenges in delivering equitable healthcare services in the health sy...

Background Māori (the Indigenous people of Aotearoa New Zealand (NZ)) are more likely to experience injury than non-Māori, but less likely to have effective access to publicly funded injury care services. It is unknown if this pattern extends into older age. This retrospective study analysed Accident Compensation Corporation (ACC; national no-fault...

aim: To describe the demographic and injury profile of major trauma among 20–65-year-old New Zealanders. methods: A retrospective analysis of routinely collected data from the New Zealand Major Trauma Registry for the period 1 July 2017 to 30 June 2020 was conducted. Sex, age and ethnicity-based rates were then calculated using census-based populat...

Objectives To characterise unintentional injury‐related hospitalisation and mortality amongst older adults (aged 50+ years) in the Lakes and Bay of Plenty District Health Boards of Aotearoa New Zealand and to examine whether hospitalisation patterns differed by ethnicity. Methods This observational study analysed unintentional injury‐related hospi...

Aim Approaches to understanding child injury tend to focus on short-term proximal influences. Previous analyses have found higher rates of injury among Māori and Pacific children in Aotearoa New Zealand (NZ). This study aimed to investigate how combinations of situations and multiple events act across the life-course to either protect preschool chi...

Objective To identify antenatal and early childhood exposures of unintentional injury among infants in New Zealand (NZ). Method The theoretical life-course framework of child injury prevention domains was utilised to analyse data from a prospective longitudinal NZ birth cohort (Growing Up in NZ). Risk and protective factors for injury were identif...

Aim: To describe the incidence, characteristics, and ethnic variation of hospitalisations for treatment injury and complications of medical or surgical care in older adults in two regions of Aotearoa New Zealand. Methods: This observational study analysed treatment-related hospital admissions (<24 hours; index injury from primary or secondary ca...

Background: Linking self-reported data collected from longitudinal studies with administrative health records is timely and cost-effective, provides the opportunity to augment information contained in each and can offset some of the limitations of both data sources. The aim of this study was to compare maternal-reported child injury data with admi...

Objectives (1) To explore the relationship between regionally implemented dog control strategies and dog bite injuries (DBIs) and (2) to evaluate current implementation of dog control strategies. Methods Observational study using a nationwide online survey of territorial authorities (TAs). Domains of interest included complaints for attacks on peo...

Background The Inclusive Trauma System has a multidisciplinary team of trauma patients such as PT and rehabilitation teams to help reduce complications from injuries. Khon Kaen Hospital (Level A) is a center hospital linked to hospitals at level M1, M2, F1 and F2 in 26 districts, but there are limitations in linking the rehabilitation system in tra...

Background Most injury-related deaths occur in the first 24 hours following the event. Some of these patients could survive if identified and managed promptly and effectively. Aims To assess the survivability of prehospital injury deaths in New Zealand. Methods A cross-sectional review of prehospital injury death post-mortems (PM) during 2009–201...

Background The prevention of dog bites is an increasingly important public health topic, as the incidence of serious injury continues to rise. Objectives To evaluate the effectiveness of interventions to prevent dog bites and aggression. Methods Online databases were searched (PubMed, Cochrane Library, Embase, and Google Scholar), using the searc...

Background Major trauma is a significant contributor to morbidity and mortality. The provision of optimal prehospital Emergency Medical Services (EMS) care and timely transfer to advanced-level hospital care are vital to increase the likelihood of survival of following major trauma. The aim of this study was to identify the factors that predict pre...

Background Although reducing the time from injury to definitive care has been shown to achieve better outcomes for patients, the relationship between injury incident location and access to specialist care has been largely unexplored. Aims To determine the number and distribution of prehospital trauma deaths in New Zealand (NZ) without timely acces...

Background In New Zealand (NZ), unintentional injuries pose a major public health threat to children and are one of the leading causes of hospitalisation and death among children. This study aims to explore the longitudinal relationship between a wide range of child, family and environmental factors and the risk of injury among preschool-aged child...

Introduction Occiput-posterior (OP) or occiput-transverse (OT) fetal malposition has a prevalence of 33–58% in the first-stage of labour with 12–22% persisting until delivery. Malposition is associated with significant maternal and neonatal morbidity. Most previous studies report the incidence and adverse maternal and fetal outcomes of persistent f...

Background: Fetal malposition (occipito-posterior and persistent occipito-transverse) in labour is associated with adverse maternal and infant outcomes. Whether use of maternal postures can improve these outcomes is unclear. This Cochrane Review of maternal posture in labour is one of two new reviews replacing a 2007 review of maternal postures in...

Introduction: Evidence of safe and effective maternal interventions to improve fetal malposition in labor is inconclusive. A contemporary, randomized controlled trial of maternal posture would expand this evidence, however, collaboration with midwives will be critical. The aim of this study is to assess midwives' views on the acceptability of a tr...

Objective: To describe the characteristics of the New Zealand child injury prevention workforce and the organisations they represent. Methods: Representatives of organisations on the Safekids Aotearoa database were invited to complete an online survey. The standardised questionnaire asked for information about injury prevention focus and experti...

Background: Understanding the epidemiology of injury caused by dogs is crucial for targeting injury prevention efforts and monitoring their effectiveness. There are no contemporary published New Zealand studies describing the epidemiology of dog-related injuries (DRIs). This study aims to address this gap. Aim: To describe the epidemiology of DRI...

Background The prevention of dog bites is an increasingly important public health topic, as the incidence of serious injury continues to rise. Objectives To evaluate the effectiveness of interventions to prevent dog bites and aggression. Methods Online databases were searched (PubMed, Cochrane Library, Embase and Google Scholar), using the search...

Aim: To describe the incidence and characteristics of major trauma in New Zealand. Methods: A systematic review based on a MEDLINE search strategy was performed using the databases PubMed, EMBASE, CINAHL and Scopus. Search terms included: "Wounds and Injuries," "Fatal Injuries," "Injury Severity Score," "Major Trauma," "Severe Trauma," "Injury S...

Introduction: Fetal malposition in labor results in adverse maternal and infant health. Whilst evidence for effective interventions is inconclusive, based on the hypothesis that gravity corrects malposition, the feasibility and design of a randomized controlled trial (RCT) to improve maternal and infant health outcomes should be considered. The ai...

Background Injury is one of the leading causes of mortality and morbidity worldwide and yet preventable and predictable. In New Zealand (NZ), unintentional injury is the leading cause of emergency department visits, hospitalisations and death among children, making it a significant public health concern. Objective To identify the factors that plac...

Studies estimate that 84% of the USA and New Zealand’s (NZ) resident populations have timely access (within 60 min) to advanced-level hospital care. Our aim was to assess whether usual residence (ie, home address) is a suitable proxy for location of injury incidence. In this observational study, injury fatalities registered in NZ’s Mortality Collec...

Introduction: Tertiary surveys aim to detect injuries missed in the initial assessment of trauma. We introduced a process by which the trauma nurse specialist performed a number of the tertiary surveys (NTSs) at our paediatric trauma centre. Methods: Data from the first six months following introduction of the NTS were compared to retrospective...

Helicopter Emergency Medical Services (HEMS) in New Zealand (NZ) are located at hospitals or airports near the communities they serve. This may result in suboptimal response times. Timely access to advanced hospital care improves critically injured patients’ chances of survival. This study optimised the location of HEMS bases in NZ and compared cur...

Objective: To identify contemporary studies investigating multifaceted and inter-linked contributory frameworks for unintentional injuries among children in New Zealand. Methods: A literature review was performed in seven databases. Studies published in English up to February 2020 reporting risk factors for child injury in New Zealand were included...

Background Traumatic injuries are one of the major causes of disability and death worldwide and have an immense impact on the health of the population. In New Zealand, an estimated 8% of total health loss from all causes was attributed to injuries in 2016. The aim of this research is to describe the incidence and characteristics of major trauma in...

Background : Of the five million injury deaths that occur globally each year, an estimated 70% occur before the injured person reaches hospital. Although reducing the time from injury to definitive care has been shown to achieve better outcomes for patients, the relationship between injury incident location and access to specialist care has been la...

Objective: There is interest in opportunities that lie in the prehospital setting to reduce the substantial burden of fatal injury. This study examines the epidemiology of prehospital and in‐hospital fatal injury in New Zealand. Methods: All deaths registered in 2008–2012 with an underlying cause of death external cause‐code V01‐Y36 (ICD‐10‐AM) wer...

Background Injury is a leading cause of death and health loss in New Zealand and internationally. The potentially fatal or severe consequences of many injuries can be reduced through an optimally structured prehospital trauma care system that can provide timely and appropriate care. Objective To investigate the relationship between emergency medic...

Research honours degrees provide potential pathways into Masters and Doctorate degrees. Essential to their success is that they provide a sound grounding for novice researchers without taxing supervisors unduly. Our case study is a Bachelor Health Science (BHSc) (Hons) degree at the University of Auckland, New Zealand, a postgraduate degree aimed a...

Introduction: With escalating incidence of road traffic crashes (RTCs), related injuries and deaths in Sri Lanka, understanding its burden on vulnerable road users such as older people and people with disability have important implications for traffic injury prevention and transport policy planning. Objectives: To determine crash characteristics an...

Background: Birth-related third- and fourth-degree perineal trauma is common and associated with short- and long-term complications. Aim: To conduct a review of clinical audits investigating management of women with perineal trauma. Materials and methods: We identified all audits undertaken in eight New Zealand public hospitals between 2005 an...

Introduction Transport, a well-recognised determinant of health, is particularly salient to well-being and equitable health outcomes amongst older people and people living with disabilities living in low-and middle-income countries. This study explored the facilitators and barriers for safe and accessible transportation from the perspectives of old...

Introduction Acknowledging a notable gap in available evidence, this study aimed to assess the survivability of prehospital injury deaths in New Zealand. Methods A cross-sectional review of prehospital injury death postmortems (PM) undertaken during 2009–2012. Deaths without physical injuries (eg, drownings, suffocations, poisonings), where there...

Introduction: A barrier to local investigator-led research in low income settings, is the limited availability of personnel with appropriate research skills or qualifications to conduct the type of research required for evidence-informed policy making to improve access and quality of health care. In response to this, Fiji National University’s Coll...

Introduction: While teaching patient safety and quality improvement (QI) skills to medical students is endorsed as being important, best practice for achieving learner outcomes in QI is particularly unclear. We systematically reviewed QI curricula for medical students to identify approaches to QI training that are associated with positive learner...

An understanding of students' career interests at entry and exit from undergraduate nursing programmes could inform decisions regarding curricula and clinical placements. Since 2006, the University of Auckland has surveyed healthcare students at entry to and exit from their respective programmes, collecting information on a range of demographic, an...

This qualitative study examines how health professionals working in paediatrics understand and practice spiritual care. Semi-structured interviews were held with six paediatric health professionals. Domains of interest were understanding spiritual care, training in spiritual care and culture in spiritual care. An Interpretive Phenomenological Analy...

Objective Mobile Health approaches show promise as a delivery mode for alcohol screening and brief intervention. The ‘YourCall’ trial evaluated the effect of a low-intensity mobile phone text message brief intervention compared with usual care on hazardous drinking and alcohol-related harms among injured adults. This paper extends our previously pu...

Aims: This cross-sectional observational study presents a focused analysis of alcohol-related presentations (ARPs) to a major New Zealand emergency department (ED) with the aim of describing and comparing the profile and outcomes of these presentations. Methods: A secondary analysis of 12 months (November 2017 to October 2018) of electronic pati...

This report provides findings from Medical Schools Outcome Database (MSOD) questionnaires administered between 2016 and 2018 to doctors in their fifth postgraduate year who had graduated from a New Zealand medical school between 2011 and 2013.

Objective Rapid access to advanced emergency medical and trauma care has been shown to significantly reduce mortality and disability. This study aims to systematically examine geographical access to prehospital care provided by emergency medical services (EMS) and advanced-level hospital care, for the smallest geographical units used in New Zealand...

The Medical Schools Outcomes Database and Longitudinal Tracking Project (MSOD) is an on-going collaborative longitudinal study that is conducted under the auspices of Medical Deans Australia and New Zealand (MDANZ). The project has been operating since 2005. This report presents summary data from the 2015-2019 Commencing Medical Student Questionnai...

For over a decade, the Medical Schools Outcomes Database and Longitudinal Tracking Project (MSOD) has collected data from medical students in Australia and New Zealand. This project aims to explore how individual student background or attributes might interact with curriculum or early postgraduate training to affect eventual career choice and locat...

Introduction: Health-related quality of life (HRQoL) is an important aspect to consider when assessing the non-fatal impact of injuries. The aim of this review was to critically appraise the range of generic instruments employed in the assessment of HRQoL following injury in low-and middle-income countries (LMICs). As a prelude to subsequent resear...

Diabetes Mellitus (DM) is the leading cause of morbidity and mortality in the Republic of the Marshall Islands (RMI), a small Pacific nation located in Micronesia (population 53,184). Although generally preventable, diabetic foot disease is among the most frequently reported complication of DM globally and in the RMI. Over 25% of people with DM glo...

BACKGROUND Alcohol use is a major public health concern associated with an increased risk of morbidity and mortality. Health professionals in primary care commonly see patients with a range of alcohol-related risks and problems providing an ideal opportunity for screening and brief intervention. OBJECTIVE The aim of this study was to develop a pro...

Background: Alcohol use is a major public health concern associated with an increased risk of morbidity and mortality. Health professionals in primary care commonly see patients with a range of alcohol-related risks and problems, providing an ideal opportunity for screening and brief intervention (BI). Objective: This study aimed to develop a pr...

Background Timely advanced hospital level care gives the injured patient the best chance of survival from time critical injury. Little is known about the coverage and accessibility of emergency ambulance services in New Zealand despite the fact that New Zealand’s long travel distances and dispersed population present many challenges to the delivery...

Background Trauma-related injuries are a common cause of mortality globally. There has been little examination of prehospital fatalities (deaths occurring either at the scene of the injury event or en route to hospital) and the identification of primary and secondary prevention opportunities in the prehospital setting to prevent trauma-related fata...

Background: Māori are disproportionately impacted by injury in New Zealand, therefore reliable ethnicity data are essential for measuring and addressing inequities in trauma incidence, care and outcomes. Aim: To audit the quality of ethnicity data captured by the Waikato Hospital Trauma Registry and Waikato Hospital patient management system aga...

Background and Aims Societal‐level volume and pattern of drinking and alcohol control policy have received little attention in the alcohol and injury literature. The aim of this study was to estimate the association between alcohol‐related injury, individual‐level drinking variables, country‐level detrimental drinking pattern and alcohol policy. D...

Screening and brief intervention for hazardous alcohol use in trauma care settings is known to reduce alcohol intake and injury recidivism, but is often not implemented due to resource constraints. Brief interventions delivered by mobile phone could overcome this challenge. This study aimed to evaluate the effect of a mobile phone text message inte...

Objective To determine the amount and nature of health professional education related to fall prevention for older adults in Australian and New Zealand universities. Methods Universities offering medicine, nursing and allied health courses were invited to complete an online survey enquiring about fall prevention course‐related information: topics;...

In many countries, beaches are a high-risk location for drowning. In New Zealand, youth and young adults are particularly at risk of drowning at beaches, accounting for 17.4% of drowning deaths and 18.4% of rescues at surf beaches between 2008 and 2013, over 90% of fatalities were male. This study explored New Zealand youth risk perceptions of drow...

Introduction: We present a study that provides a contemporary view of alcohol-related injury prevalence amongst patients presenting to a New Zealand (NZ) emergency department (ED). Methods: Adult injury patients presenting to Auckland City Hospital ED within 6 h of injury were invited to participate during three recruitment periods (2015-2016)....

Aim: To describe how we incorporate experiential quality improvement (QI) learning at the University of Auckland by integrating a clinical audit project into the Year 6 obstetrics and gynaecology clinical attachment. Methods: Students gain insight into the relevance of QI while engaged in day-to-day clinical work. Students work with a clinical s...

New Zealand youth are over-represented in drowning statistics yet little is known about their understanding of water safety, especially in surf beach context. This study aimed to ascertain current youth surf safety knowledge, specifically rip current awareness, explore self-reported competencies and confidence when surf swimming, and examine youth...

Aim: To describe the epidemiology of injuries sustained by older adult trauma patients admitted to hospitals in the Midland region (population 886,000) of New Zealand. Methods: A review of older adult (≥65 years) trauma cases from the Midland Trauma Registry for the three-year period January 2012 to December 2014 was conducted. Demographics, mec...

Aim: Globally, rates of paediatric food-induced anaphylaxis (FIA) are increasing. Little data is available regarding the epidemiology of FIA among New Zealand (NZ) children. This study investigated the incidence of paediatric (0-14 years) FIA hospital presentations in NZ over a 10-year period. Methods: Ministry of Health public hospital discharg...

Objective: To describe the epidemiological characteristics of patients with work-related injuries (WRI) admitted to hospitals in New Zealand's Midland Trauma System (MTS) during a four year period. Methods: A retrospective review was conducted of trauma registry records for adults (≥15years) admitted to four hospitals in the MTS as a result of W...

Aim: To review media accounts of fatal child unintentional injury events reported in leading New Zealand newspapers for their completeness and potential to deliver evidence-based injury prevention messages. Method: Media accounts of fatal unintentional child (0-14 years) injury events in New Zealand's four largest newspapers between 2011 and 201...

Objectives: To determine whether specific demographic characteristics are associated with the presence or absence of household safety strategies. Methods: This study was conducted within Growing Up in New Zealand, a contemporary longitudinal study of New Zealand (NZ) children. Multivariable analyses were used to examine the maternal (self-priori...

Background Teaching clinical audit skills to nascent health professionals is one strategy to improve frontline care. The undergraduate medical curriculum at the University of Auckland provides improvement science theory and skills in Year 5 teaching, and the opportunity to put this into practice during an Obstetrics and Gynaecology (O&G) clinical a...

Aim: Timely access to computerised tomography (CT) for acute traumatic brain injuries (TBIs) facilitates rapid diagnosis and surgical intervention. In 2009, New Zealand introduced a mandatory target for emergency department (ED) stay such that 95% of patients should leave ED within 6 h of arrival. This study investigated whether this target influe...

Background: Traumatic injury is a leading cause of premature death and health loss in New Zealand. Outcomes following injury are very time sensitive, and timely access of critically injured patients to advanced hospital trauma care services can improve injury survival. Objective: This cross-sectional study will investigate the epidemiology and g...

Background Behavioural brief interventions (BI) can support people to reduce harmful drinking but multiple barriers impede the delivery and equitable access to these. To address this challenge, we developed YourCall™, a novel short message service (SMS) text message intervention incorporating BI principles. This protocol describes a trial evaluatin...

Background Despite known benefits, brief interventions (BIs) for problem drinking are often not implemented in trauma care wards due to resource constraints. We evaluated a mobile phone text message intervention (YourCall) designed to overcome this challenge. Methods Of 1564 potentially eligible injured patients aged 16–69 years recruited from the...

Background The effectiveness of trauma systems in reducing injury mortality is well established. This study aimed to explore clinicians’ perceptions of the quality of clinical trauma care delivered in New Zealand’s only regional trauma system. Methods An anonymous online survey of clinicians providing trauma care in five hospitals in the Midland r...

Background Risky driving and unsafe vehicles are two areas receiving increased global attention as priorities for road traffic injury prevention. However, the attendant risks have not been quantified in low- and middle-income Pacific nations using controlled epidemiological studies. Methods A population-based case-control study was designed to inc...

Background Food allergy including anaphylaxis is an increasing clinical problem in many countries. Little information is available regarding prevalence, causative foods and time trends in the New Zealand adult population. Objective This cross-sectional study investigated the incidence of hospital presentation with food-induced anaphylaxis in New Ze...

Objective: To investigate the association between kava use and the risk of four-wheeled motor vehicle crashes in Fiji. Kava is a traditional beverage commonly consumed in many Pacific Island Countries. Herbal anxiolytics containing smaller doses of kava are more widely available. Methods: Data for this population-based case-control study were co...

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No abstract is available for this article.

Objective: To develop a more concise, user-friendly edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM advisory board is probably already hard at work on the DSM-6, so this study is focused on the DSM-(00)7 edition. Design: We conducted an observational study, using a mixed methods approach to analyse the 50th ed...

No abstract is available for this article.

Background: Screening for alcohol misuse and brief interventions (BIs) for harm in trauma care settings are known to reduce alcohol intake and injury recidivism, but are rarely implemented. We created the content for a mobile phone text message BI service to reduce harmful drinking among patients admitted to hospital following an injury who screen...

Kava is marketed as a herbal anxiolytic in several countries and is consumed recreationally in high doses in many indigenous Pacific and Australian Aboriginal communities. We reviewed the published literature examining the association (if any) between kava use and motor vehicle crashes (MVCs), MVC-related injuries or driving performance. Search of...

Head injury is a leading cause of mortality and acquired neurological impairment in children. Head-injured children may have neurobehavioural deficits that persist for years following injury. Head injury can result in significant and persistent caregiver burden, including mental health issues, family stress and disorganisation, and unmet social and...

The aim of this study was to describe the attitudes and perceptions of primary health care doctors in Fiji regarding the importance of eye care in diabetes mellitus (DM) management, to explore current eye care practice, and to investigate awareness and use of relevant clinical practice guidelines. The study builds on earlier research conducted in F...

This study investigated whether hospitalised fall-related injuries among young and middle-aged adults were associated with short term effects of alcohol intake, marijuana use and sleep deprivation. A case-crossover design was used to study 690 adults (aged 20 to 64 years) admitted to public hospitals within 48 hours of a fall-related injury, occurr...