Alvorlig skadede overført til universitetssykehus

Dehli, Trond; Bågenholm, Anna; Johnsen, Liv-Hege; Osbakk, Svein Are; Fredriksen, Knut; Bartnes, Kristian

doi:10.4045/tidsskr.09.0796

Cited by 9 publications

(8 citation statements)

References 10 publications

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“…Local hospitals in Finnmark have improved in-house trauma care by the regular multiprofessional trauma team training that seems to even out differences between urban and rural care [20]. Still, studies from Northern Norway have shown areas of potential improvement in local hospital trauma management concerning transfer routines, damage-control surgery, and use of diagnostic imaging [21,22]. These conditions are not exclusive to Finnmark, indicating that distance in itself probably plays a part in the disadvantages of the most rural trauma victims.…”

Section: Discussionmentioning

confidence: 99%

Fatal injury as a function of rurality-a tale of two Norwegian counties

Bakke

Hansen

Bendixen

et al. 2013

Scand J Trauma Resusc Emerg Med

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BackgroundMany studies indicate rural location as a separate risk for dying from injuries. For decades, Finnmark, the northernmost and most rural county in Norway, has topped the injury mortality statistics in Norway. The present study is an exploration of the impact of rurality, using a point-by-point comparison to another Norwegian county.MethodsWe identified all fatalities following injury occurring in Finnmark between 2000 and 2004, and in Hordaland, a mixed rural/urban county in western Norway between 2003 and 2004 using data from the Norwegian Cause of Death Registry. Intoxications and low-energy trauma in patients aged over 64 years were excluded. To assess the effect of a rural locale, Hordaland was divided into a rural and an urban group for comparison. In addition, data from Statistics Norway were analysed.ResultsFinnmark reported 207 deaths and Hordaland 217 deaths. Finnmark had an injury death rate of 33.1 per 100,000 inhabitants. Urban Hordaland had 18.8 deaths per 100,000 and rural Hordaland 23.7 deaths per 100,000. In Finnmark, more victims were male and were younger than in the other areas. Finnmark and rural Hordaland both had more fatal traffic accidents than urban Hordaland, but fewer non-fatal traffic accidents.ConclusionsThis study illustrates the disadvantages of the most rural trauma victims and suggests an urban-rural continuum. Rural victims seem to be younger, die mainly at the site of injury, and from road traffic accident injuries. In addition to injury prevention, the extent and possible impact of lay people’s first aid response should be explored.

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Section: Discussionmentioning

confidence: 99%

Fatal injury as a function of rurality-a tale of two Norwegian counties

Bakke

Hansen

Bendixen

et al. 2013

Scand J Trauma Resusc Emerg Med

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“…Thus, transferred patients are included in our analysis. We have previously shown that many trauma patients transferred in the acute phase are not adequately diagnosed and stabilized [18]. Minimization of undertriage requires decision-makers to strictly comply with our TTA protocol in all trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a university hospital trauma team activation protocol

Dehli

Fredriksen

Osbakk

et al. 2011

Scand J Trauma Resusc Emerg Med

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BackgroundAdmission with a multidisciplinary trauma team may be vital for the severely injured patient, as this facilitates rapid diagnosis and treatment. On the other hand, patients with minor injuries do not need the trauma team for adequate care. Correct triage is important for optimal resource utilization. The aim of the study was to evaluate our criteria for activating the trauma team, and identify suboptimal criteria that might be changed in the interest of precision.MethodsThe study is an observational, retrospective cohort-study. All patients admitted with the trauma team (n = 382), all severely injured (Injury Severity Score (ISS) >15) (n = 161), and all undergoing an emergency procedure aimed at counteracting compromised airways, respiration or circulation at our hospital (n = 142) during 2006-2007 were included. Data were recorded from the admission records and the electronic patient records. The trauma team activation protocol was evaluated against the occurrence of severe injury and the occurrence of emergency procedures.ResultsA total of 441 patients were included. The overtriage was 71% and undertriage 32% when evaluating against ISS >15 as the standard of reference. When occurrence of emergency procedures was held as the standard of standard of reference, the over- and undertriage was 71% and 21%, respectively. Mechanism of injury-criteria for trauma team activation contributed the most to overtriage. The emergency procedures performed were mostly endotracheal intubation and external fixation of fractures. Less than 3% needed haemostatic laparotomy or thoracotomy. Approximately 2/3 of the overtriage represented isolated head or cervical spine injuries, and/or interhospital transfers.ConclusionsThe over- and undertriage of our protocol are both too high. To decrease overtriage we suggest omissions and modifications of some of the criteria. To decrease undertriage, transferred patients and patients with head injuries should be more thoroughly assessed against the trauma team activation criteria.

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“…In some Scandinavian regions, the distance between the injury location and the nearest regional trauma centre may be great, and prehospital transport is often influenced by weather and topographical considerations [15,16]. This increases the role of local hospitals in resuscitating, stabilising and promptly transferring severely injured patients to higher levels of care [11]. The optimal time range for direct trauma centre admission vs. initial stabilisation at local hospitals is, however, yet to be determined.…”

Section: Introductionmentioning

confidence: 99%

Patients Referred to a Norwegian Trauma Centre: effect of transfer distance on injury patterns, use of resources and outcomes

Kristiansen

Lossius

Søreide

et al. 2011

J Trauma Manage Outcomes

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BackgroundTriage and interhospital transfer are central to trauma systems. Few studies have addressed transferred trauma patients. This study investigated transfers of variable distances to OUH (Oslo University Hospital, Ullevål), one of the largest trauma centres in Europe.MethodsPatients included in the OUH trauma registry from 2001 to 2008 were included in the study. Demographic, injury, management and outcome data were abstracted. Patients were grouped according to transfer distance: ≤20 km, 21-100 km and > 100 km.ResultsOf the 7.353 included patients, 5.803 were admitted directly, and 1.550 were transferred. The number of transfers per year increased, and there was no reduction in injury severity during the study period. Seventy-six per cent of the transferred patients were severely injured. With greater transfer distances, injury severity increased, and there were larger proportions of traffic injuries, polytrauma and hypotensive patients. With shorter distances, patients were older, and head injuries and injuries after falls were more common. The shorter transfers less often activated the trauma team: ≤20 km -34%; 21-100 km -51%; > 100 km -61%, compared to 92% of all directly admitted patients. The mortality for all transferred patients was 11%, but was unequally distributed according to transfer distance.ConclusionThis study shows heterogeneous characteristics and high injury severity among interhospital transfers. The rate of trauma team assessment was low and should be further examined. The mortality differences should be interpreted with caution as patients were in different phases of management. The descriptive characteristics outlined may be employed in the development of triage protocols and transfer guidelines.

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Alvorlig skadede overført til universitetssykehus

Abstract: Trauma care at local hospitals may be improved by more systematic imaging, a lower threshold for emergency surgery, and early communication with the university hospital.

Cited by 9 publications

References 10 publications

Fatal injury as a function of rurality-a tale of two Norwegian counties

Fatal injury as a function of rurality-a tale of two Norwegian counties

Evaluation of a university hospital trauma team activation protocol

Patients Referred to a Norwegian Trauma Centre: effect of transfer distance on injury patterns, use of resources and outcomes

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