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

Candefjord, Stefan; Asker, Linn; Caragounis, Eva Corina

doi:10.1007/s00068-020-01446-6

Cited by 32 publications

(42 citation statements)

References 44 publications

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“…Despite the fact that none of the university hospitals in Sweden is considered to be a complete level I trauma centre, the results showed a lower mortality rate when the trauma care was provided in university hospitals. These findings are in line with a previous Swedish study including both paediatric and adult trauma patients, and argue for continued efforts at regionalization 17 .…”

Section: Discussionsupporting

confidence: 91%

“…A number of studies have thereafter presented results supporting the golden hour 8–12 , while others report inconclusive or contradictory results in both paediatric and adult trauma patients 13–16 . A recent Swedish trauma study including patients of all ages found no association between longer transport time and adverse outcome, although it did not specifically investigate the paediatric population 17 . Despite extensive previous research investigating a suggested correlation between prehospital time and adverse outcome after trauma, the results remain inconclusive and the definite impact of transport time on paediatric trauma patients is still unclear 18 .…”

Section: Introductionmentioning

confidence: 97%

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Association of transport time with adverse outcome in paediatric trauma

2021

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Background It is unclear how the length of prehospital transport time affects outcome in paediatric trauma. This study evaluated the association of transport time from alarm to arrival at hospital with adverse outcome in paediatric trauma patients in Sweden. Methods This was a retrospective study based on prospectively collected data from the Swedish trauma registry between 2012 and 2019 of children less than 18 years with major trauma (New Injury Severity Score (NISS) greater than 15). The primary outcome was 30-day mortality, and secondary outcomes were emergency interventions (e.g., chest tube or laparotomy) and low functional outcome (Glasgow Outcome Scale 2–3). Primary exposure was transport time from alarm to arrival at hospital. Co-variables in multivariable regressions were gender, age, ASA score before injury, injury intention, dominant injury type, NISS, Glasgow Coma Scale score, prehospital competence and hospital level. Results Among 597 patients, 30-day mortality was 9.8 per cent, emergency interventions were performed in 34.7 per cent and low functional outcome was registered in 15.9 per cent. Median transport time was 51 (i.q.r. 37–68) minutes. After adjustment for patient, injury and hospital characteristics, no association between longer transport time and 30-day mortality, frequency of emergency interventions or lower functional outcome could be found. Treatment at a university hospital was associated with a lower risk for 30-day mortality (odds ratio 0.23 (95 per cent c.i. 0.08 to 0.68), P = 0.008). Conclusion Longer transport time after major paediatric trauma was not associated with adverse outcome. Hence, it seems that longer transport distances should not be an obstacle against centralization of paediatric trauma care. Further studies should focus on the role of prehospital competence and other transport-associated parameters and their association with adverse outcome.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 97%

Association of transport time with adverse outcome in paediatric trauma

2021

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“…The effective triage of injured patients is the first step towards providing high-quality care and reducing mortality rates [20]. A recent piece of evidence from Sweden showed that treatment at TCs was associated with a 41% lower adjusted 30-day mortality (Odds Ratio [OR] 0.59, 95% Confidence Interval [CI] 0.50-0.70, P < 0.0001) compared to non-TCs for all trauma patients (i.e., ISS ≥ 1) [21]. Evidence from the United States of America (USA) also showed that TC treatment, compared to non-TC treatment, was associated with a significantly lower in-hospital mortality rate (7.6% vs. 9.5%, Relative Risk [RR] 0.80, 95% CI 0.66-0.98) and one-year mortality rate (10.4% vs. 13.8%, RR 0.75, 95% CI 0.60-0.95) [22].…”

Section: Introductionmentioning

confidence: 99%

Under-triage of older trauma patients in prehospital care: a systematic review

2021

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Background It is argued that many older trauma patients are under-triaged in prehospital care which may adversely affect their outcomes. This systematic review aimed to assess prehospital under-triage rates for older trauma patients, the accuracy of the triage criteria, and the impact of prehospital triage decisions on outcomes. Methods A computerised literature search using MEDLINE, Scopus, and CINHAL databases was conducted for studies published between 1966 and 2021 using a list of predetermined index terms and their associated alternatives. Studies which met the inclusion criteria were included and critiqued using the Critical Appraisal Skills Programme tool. Due to the heterogeneity of the included studies, narrative synthesis was used in this systematic review. Results Of the 280 identified studies, 23 met the inclusion criteria. Current trauma triage guidelines have poor sensitivity to identify major trauma and the need for TC care for older adults. Although modified triage tools for this population have improved sensitivity, they showed significantly decreased specificity or were not applied to all older people. The issue of low rates of TC transport for positively triaged older patients is not well understood. Furthermore, the benefits of TC treatment for older patients remain uncertain. Conclusions This systematic review showed that under-triage is an ongoing issue for older trauma patients in prehospital care and its impact on their outcomes is still uncertain. Further high-quality prospective research is needed to assess the accuracy of prehospital triage criteria, the factors other than the triage criteria that affect transport decisions, and the impact of under-triage on outcomes.

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“…Traumatic braininjured patients represent a group that benefits from early specialized care for better outcomes [5,6]. This emphasizes the importance of early patient allocation to specialized care, preferably from the trauma site [7][8][9]. Determining patient allocation for TBI care is heavily influenced by the injury severity and the geographical proximity to the nearest hospital [10].…”

Section: Introductionmentioning

confidence: 99%

“…Treating trauma-specific injuries at dedicated regional trauma centers in Sweden has been associated with reduced mortality by up to 32% [7][8][9]. However, little is known about the potential differences in mortality among trauma patients suffering from a severe traumatic brain injury between regional trauma centers (university hospitals), all of which have neurosurgical services, and nontrauma centers (non-university hospitals) in Sweden.…”

Section: Introductionmentioning

confidence: 99%

The significance of direct transportation to a trauma center on survival for severe traumatic brain injury

Cao

Bass

Forssten

et al. 2022

Eur J Trauma Emerg Surg

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Introduction While timely specialized care can contribute to improved outcomes following traumatic brain injury (TBI), this condition remains the most common cause of post-injury death worldwide. The purpose of this study was to investigate the difference in mortality between regional trauma centers in Sweden (which provide neurosurgical services round the clock) and non-trauma centers, hypothesizing that 1-day and 30-day mortality will be lower at regional trauma centers. Patients and methods This retrospective cohort study used data extracted from the Swedish national trauma registry and included adults admitted with severe TBI between January 2014 and December 2018. The cohort was divided into two subgroups based on whether they were treated at a trauma center or non-trauma center. Severe TBI was defined as a head injury with an AIS score of 3 or higher. Poisson regression analyses with both univariate and multivariate models were performed to determine the difference in mortality risk [Incidence Rate Ratio (IRR)] between the subgroups. As a sensitivity analysis, the inverse probability of treatment weighting (IPTW) method was used to adjust for the effects of confounding. Results A total of 3039 patients were included. Patients admitted to a trauma center had a lower crude 30-day mortality rate (21.7 vs. 26.4% days, p = 0.006). After adjusting for confounding variables, patients treated at regional trauma center had a 28% [adj. IRR (95% CI): 0.72 (0.55–0.94), p = 0.015] decreased risk of 1-day mortality and an 18% [adj. IRR (95% CI): 0.82 (0.69–0.98)] reduction in 30-day mortality, compared to patients treated at a non-trauma center. After adjusting for covariates in the Poisson regression analysis performed after IPTW, admission and treatment at a trauma center were associated with a 27% and 17% reduction in 1-day and 30-day mortality, respectively. Conclusion For patients suffering a severe TBI, treatment at a regional trauma center confers a statistically significant 1-day and 30-day survival advantage over treatment at a non-trauma center.

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

Cited by 32 publications

References 44 publications

Association of transport time with adverse outcome in paediatric trauma

Association of transport time with adverse outcome in paediatric trauma

Under-triage of older trauma patients in prehospital care: a systematic review

The significance of direct transportation to a trauma center on survival for severe traumatic brain injury

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