Helsinki Trauma Outcome Study 2005: Audit on Outcome in Trauma Management in Adult Patients in Southern Part of Finland (original) (raw)
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World Journal of Surgery, 2013
Background Trauma centers are associated with improved survival rates and outcomes in trauma patients. In 2000 our hospital officially became a level I trauma center. The implementation of the trauma center model showed a significant reduction in mortality and hospital length of stay in our hospital and throughout the trauma region. The aim of the present prospective database study was to present the outcomes of patients treated during the course of further maturation of a level I trauma center. Methods We performed the prospective database study and included and analyzed outcome data for all adult trauma patients admitted to our trauma center during the years 2003 through 2006 (period 1) and 2007 through 2010 (period 2). Results A total of 5,299 patients were included; 2,419 in period 1 and 2,880 in period 2. Mean Injury Severity Score (ISS) increased from 12.6 to 13.8 (p \ 0.001). Mean Revised Trauma Score decreased from 7.4 to 7.2 (p \ 0.001). Penetrating injuries increased from 111 (4.6 %) to 192 (6.7 %) (p \ 0.001). More head injuries (?7.2 %) and spine injuries (?3.1 %), and fewer injuries to extremities (-6.5 %) were seen in the second period. Mortality, adjusted for age and ISS, was lower in period 2 (odds ratio [OR]: 0.736, p = 0.010). Adjusted for age, ISS, and survival, both the hospital stay and the intensive care unit stay were shortened (OR: 1.068, p \ 0.018; OR:
Risk-adjusted mortality in severely injured adult trauma patients in Sweden
BJS open, 2022
Background: Risk-adjusted mortality (RAM) analysis and comparisons of clinically relevant subsets of trauma patients allow hospitals to assess performance in different processes of care. The aim of the study was to develop a RAM model and compare RAM ratio (RAMR) in subsets of severely injured adult patients treated in university hospitals (UHs) and emergency hospitals (EHs) in Sweden. Methods: This was a retrospective study of the Swedish trauma registry data (2013 to 2017) comparing RAMR in patients (aged 15 years or older and New Injury Severity Score (NISS) of more than 15) in the total population (TP) and in multisystem blunt (MB), truncal penetrating (PEN), and severe traumatic brain injury (STBI) subsets treated in UHs and EHs. The RAM model included the variables age, NISS, ASA Physical Status Classification System Score, and physiology on arrival. Results: In total, 6690 patients were included in the study (4485 from UHs and 2205 from EHs). The logistic regression model showed a good fit. RAMR was 4.0, 3.8, 7.4, and 8.5 percentage points lower in UH versus EH for TP (P , 0.001), MB (P , 0.001), PEN (P = 0.096), and STBI (P = 0.005), respectively. The TP and MB subsets were subgrouped in with (+) and without (−) traumatic brain injury (TBI). RAMR was 7.5 and 7.0, respectively, percentage points lower in UHs than in EHs in TP + TBI and MB + TBI (both P , 0.001). In the TP-TBI (P = 0.027) and MB-TBI (P = 0.107) subsets the RAMR was 1.6 and 1.8 percentage points lower, respectively. Conclusion: The lower RAMR in UHs versus EH were due to differences in TBI-related mortality. No evidence supported that Swedish EHs provide inferior quality of care for trauma patients without TBI or for patients with penetrating injuries.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2014
Background: Approximately 10% of the Norwegian population is injured every year, with injuries ranging from minor injuries treated by general practitioners to major and complex injuries requiring specialist in-hospital care. There is a lack of knowledge concerning the caseload of potentially severely injured patients in Norwegian hospitals. Aim of the study was to describe the current status of the Norwegian trauma system by identifying the number and the distribution of contributing hospitals and the caseload of potentially severely injured trauma patients within these hospitals. Methods: A cross-sectional survey with a structured questionnaire was sent in the summer of 2012 to all Norwegian hospitals that receive trauma patients. These were defined by number of trauma team activations in the included hospitals. A literature review was performed to assess over time the development of hospitals receiving trauma patients. Results: Forty-one hospitals responded and were included in the study. In 2011, four trauma centres and 37 acute care hospitals received a total of 6,570 trauma patients. Trauma centres received 2,175 (33%) patients and other hospitals received 4,395 (67%) patients. There were significant regional differences between health care regions in the distribution of trauma patients between trauma centres and acute care hospitals. More than half (52.5%) of the hospitals received fewer than 100 patients annually. The national rate of hospital admission via trauma teams was 13 per 10,000 inhabitants. There was a 37% (from 65 to 41) reduction in the number of hospitals receiving trauma patients between 1988 and 2011.
Comparison of risk-adjusted survival in two Scandinavian Level-I trauma centres
Scandinavian journal of trauma, resuscitation and emergency medicine, 2016
Assessment of trauma-system performance is important for improving the care of injured patients. The aim of the study was to compare risk-adjusted survival in two Scandinavian Level-I trauma centres. This was an observational, retrospective study of prospectively-collected trauma registry data for patients >14 years from Karolinska University Hospital - Solna (KUH), Sweden, and Oslo University Hospital - Ullevål (OUH), Norway, from 2009-2011. Probability of survival (Ps) was calculated according to the Trauma and Injury Severity Score (TRISS) method. Risk-adjusted survival per patient was calculated by assigning every patient a value corresponding to gained or lost fractional life: Each survivor contributed a reward of 1-Ps and each death a penalty of -Ps. The sum of penalties and rewards, corresponding to the difference between expected and actual mortality, was compared between the centres. We present the data as excess survivors per 100 trauma patients. There were 4485 admissi...
Swiss Medical Weekly, 2014
QUESTIONS UNDER STUDY: Patient characteristics and risk factors for death of Swiss trauma patients in the Trauma Audit and Research Network (TARN). METHODS: Descriptive analysis of trauma patients (≥16 years) admitted to a level I trauma centre in Switzerland (September 1, 2009 to August 31, 2010) and entered into TARN. Multivariable logistic regression analysis was used to identify predictors of 30-day mortality. RESULTS: Of 458 patients 71% were male. The median age was 50.5 years (inter-quartile range [IQR] 32.2-67.7), median Injury Severity Score (ISS) was 14 (IQR 9-20) and median Glasgow Coma Score (GCS) was 15 (IQR 14-15). The ISS was >15 for 47%, and 14% had an ISS >25. A total of 17 patients (3.7%) died within 30 days of trauma. All deaths were in patients with ISS >15. Most injuries were due to falls <2 m (35%) or road traffic accidents (29%). Injuries to the head (39%) were followed by injuries to the lower limbs (33%), spine (28%) and chest (27%). The time of admission peaked between 12:00 and 22:00, with a second peak between 00:00 and 02:00. A total of 64% of patients were admitted directly to our trauma centre. The median time to CT was 30 min (IQR 18-54 min). Using multivariable regression analysis, the predictors of mortality were older age, higher ISS and lower GCS. CONCLUSIONS: Characteristics of Swiss trauma patients derived from TARN were described for the first time, providing a detailed overview of the institutional trauma population. Based on these results, patient management and hospital resources (e.g. triage of patients, time to CT, staffing during night shifts) could be evaluated as a further step.
Analysis of Hospital Mortality and Epidemiology in Trauma Patients: A Multi-Center Study
Journal of Current Surgery, 2011
Background: This study evaluated the clinical characteristics of trauma patients in the southeastern coastal area of Turkey and investigated the factors influencing mortality. Methods: Patients admitted with trauma to the emergency departments of Harran and Gaziantep Medical Schools and to the emergency services of hospitals in Sanlıurfa between June 2008 and December 2008 were enrolled retrospectively in this study. All medical records and follow-up data were reviewed for each patient. Results: The study evaluated 15,120 trauma patients. The causes of trauma were motor vehicle accidents (38.7%), falls from heights (36.8%), burns (7.8%), knife wounds and gun shots (8.1%), homicides (6.5%), and workplace-related accidents (2.1%). The overall patient mortality rate was 3.8%. The mean patient ages were 47.8 ± 0.9 and 29.7 ± 0.4 among those who died and among those who survived, respectively (P < 0.01). The median times to arrival were 130 minutes and 42 minutes among those who died and among those who survived, respectively (P < 0.01). Whereas 79.9% of patients were discharged after treatment in the emergency departments, 16.3% were referred to various departments for hospitalization, and 3.8% were admitted to the intensive care unit (ICU). The mean score on the Glasgow Coma Scale was 7.5 ± 0.3 among who died and 12.8 ± 0.6 among those who survived (P < 0.05), and the mean Revised Trauma Scores were 8.7 ± 0.5 among those who died and 11.5 ± 0.7 among those who survived (P < 0.05). Intubation or cardiopulmonary resuscitation was initiated in 88% of those who died and 43.5% of those who survived (P < 0.05). Of those who died, 84% had cranial injuries and 43.5% had thoracic injuries. Conclusions: Frequent causes of trauma in our region are motor vehicle accidents and falls from heights. Type of trauma, rapid arrival at the hospital, hospital procedures and interventions, age, sex, and trauma scores were predictors of mortality in trauma patients.
Trends in trauma care in England and Wales 1989–97
The Lancet, 2000
In 1988, the Royal College of Surgeons reported major deficiencies in trauma care in UK hospitals. We investigated whether and how that care has changed in the last decade by use of data collected by the UK Trauma Audit and Research Network. We analysed injury-severity, process, and outcome variables from 91602 patients' records on the database at the end of 1997, collected from 97 (49% of trauma-receiving) hospitals in England, Wales, and two in Ireland. We did longitudinal analyses of odds of death, process variables, and individual hospitals' performance. We took account of potential selection bias from missing data and recruitment of new hospitals. The severity-adjusted odds of death after trauma declined gradually from 1989 (odds ratio 1997/1989 0.63 [95% CI [0.49-0.82]). In 1997, the reduction in odds of death was significant even after adjustment for missing data (ratio 1997/1989 0.72 [0.55-0.92]) and recruitment of new hospitals (0.64 [0.44-0.93]). There was significant variability in the proportion of survivors (adjusted for severity of injury and age) between the highest and lowest 10% of UK hospitals. The time between the call to the emergency services and arrival at hospital increased from 32 min in 1989 to 45 min in 1997, irrespective of injury severity. The proportion of severely injured patients seen first by senior doctors increased from 32% to 60%. Hospital care has made a valuable but variable contribution to reductions in case fatality after injury in the UK in the past 10 years, though further improvement is possible.