Does injury pattern among major road trauma patients influence prehospital transport decisions regardless of the distance to the nearest trauma centre? – a retrospective study

Abstract

Background Prehospital undertriage occurs when the required level of care for a major trauma patient is underestimated and the patient is transported to a lower-level emergency care facility. One possible reason is that the pattern of injuries exceeding a certain severity threshold is not easily recognizable in the field. The present study aims to examine whether the injury patterns of major road trauma patients are associated with trauma centre transport decisions in Sweden, controlling for the distance from the crash to the nearest trauma centre and other patient characteristics. Methods The Swedish Traffic Accident Data Acquisition (STRADA) database was queried from April 2011 to March 2017. Teaching hospitals with neurosurgery capabilities were classified as trauma centres (TC), all other hospitals were classified as other emergency departments (ED). Injury Severity Score ≥ 13 was used as the threshold for major trauma. Ten common injury patterns were derived from the STRADA data; six patterns included serious neuro trauma to the head or spine. The remaining four patterns were: other severe injuries, moderate to serious abdomen injuries, serious thorax injuries and all other remaining injury patterns. Logistic regression was used to analyse the effect of injury patterns, age, sex and distance from crash to nearest TC on transport decision (TC or ED). Results Of the 2542 patients, 38.0% were transported to a TC, equating to a prehospital undertriage of 62%. Over half (59.4%) of the patients had four or more Abbreviated Injury Scale (AIS) 2+ injuries. After controlling for age, sex and distance to nearest TC, only patients sustaining serious head injuries together with other severe injuries had significantly higher odds of being transported to a TC (OR = 4.18, 95% CI: 2.03, 8.73). The odds of being transported to a TC decreased by 5% with every kilometre further away the crash location was to the nearest TC. Conclusion These results highlight that there is considerable prehospital undertriage in Sweden and suggest that distance to nearest TC is more influential in transport decisions than injury pattern. These results can be used to further develop prehospital transportation guidelines and designation of trauma centres.

Mortality of trauma patients treated at trauma centers compared to non-trauma centers in Sweden: a retrospective study

“…From the study by Fagerlind et al [ 13 ], it is known that the distance to trauma center has a strong influence on the transport decision in the Swedish prehospital care setting. A difference in transportation times between patients managed at trauma centers compared to non-trauma centers was, therefore, anticipated, and confirmed by statistical analysis (Table 1 ).…”

“…Some studies suggest that the potentially preventable death rate is around 20–40% [ 2 , 3 , 24 ]. In Sweden, a high proportion of major trauma patients and the majority of patients sustaining severe injury in motor vehicle crashes are transported to non-trauma centers, indicating a high rate of undertriage [ 12 , 13 ]. The predominant reason may be that most regional guidelines do not support bypassing the closest care facility in favor of a more distant regional trauma center [ 12 ].…”

“…In Scandinavia, due to sparse population density and long duration of transportation, trauma care relies more on organized inter-hospital transfer [ 25 ]. In fact, distance to the nearest trauma center has the strongest influence on the transport destination decision, whereby the odds of being transported to a trauma center decreases with 5% for every kilometer [ 13 ]. No national study has previously evaluated if the high rate of undertriage leads to a difference in mortality rate between Sweden’s regional trauma centers, the University Hospitals, and non-trauma centers.…”

Serum Copeptin levels in the emergency department predict major clinical outcomes in adult trauma patients

“…Severely injured trauma patients, especially those with altered vital signs, do not pose a particular prognostic challenge during early triage and are usually correctly referred to the appropriate facility [2]. This process is not so obvious for trauma patients who initially appear in good and stable conditions, but whose conditions deteriorate rapidly later on.…”

Impact of hospital type on risk-adjusted, traffic-related 30-day mortality: a population-based registry study

“…Further, there is a trend towards the centralization of specialized trauma care in Sweden [ 12 , 13 ] and international studies support such organization [ 14 , 15 ]. It is therefore important to look further into the matter using Swedish national data to recognize what should be recommended from a national perspective.…”