The burden of trauma in Eeyou Istchee (Cree territories, James Bay): epidemiology, transfers, and patient outcomes

Background: In this study, we sought to characterize the epidemiologic features of trauma in Eeyou Istchee and describe outcomes for patients referred to our institution. Our primary objectives were to better define the regional burden of injury, identify potentially hidden trauma mortality, and explore opportunities for injury prevention and trauma system optimization in this unique setting in northern Quebec. Methods: We conducted a retrospective review of our institutional trauma registry, identifying all trauma patients transferred to the Montreal General Hospital from Eeyou Istchee between 2012 and 2022. We extracted and analyzed patient demographics, mechanisms of injury, and outcomes. We also reviewed the coroner’s reports for all trauma-related deaths in Eeyou Istchee over the same period. We used descriptive statistics for analysis. Results: A total of 587 patients (aged 18 to 91 yr) were transferred, including 353 males (60.1%) and 234 females (39.9%). The highest number of transfers (n=84, 14.3%) occurred in 2022. The most common mechanisms of injury were blunt trauma (n=228, 38.8%) and falls (n=163, 27.8%). We also observed motor vehicle collisions (n=103, 17.5%) and penetrating trauma (n=50, 8.5%), while 17 cases (2.9%) involved other mechanisms, and 26 (4.4%) were of unknown origin. Assault was reported by 211 (35.9%) patients. Of all patients, 146 (24.9%) were admitted, and 441 (75.1%) were discharged from the emergency department. Computed tomography was performed for 376 patients (85.3%), among whom 222 (59.0%) patients had no injuries identified. Coroner data identified 82 trauma-related deaths, including 61 males (74.4%) and 21 females (25.6%). Motor vehicle collisions were the most common cause of death (n=23, 28.0%). The trauma-related mortality rate in Eeyou Istchee was 47.8 per 10000 population, compared with 27.8 per 10000 in the rest of Quebec, yielding a relative risk of 1.72. Conclusion: There is a marked disparity in trauma-related mortality between Eeyou Istchee and the rest of Quebec, with motor vehicle collisions representing the leading cause of trauma death. Strengthening partnerships with local communities in Eeyou Istchee is essential to enhance awareness, promote injury prevention, and improve trauma system effectiveness in the region.