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Nilsbakken I, Wisborg T, Sollid S, Jeppesen E. Functional outcome and associations with prehospital time and urban-remote disparities in trauma: A Norwegian national population-based study. Injury 2024; 55:111459. [PMID: 38490851 DOI: 10.1016/j.injury.2024.111459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/03/2024] [Accepted: 02/25/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND There is a lack of knowledge regarding the functional outcomes of patients after trauma. Remote areas in Norway has been associated with an increased risk of trauma-related mortality. However, it is unknown how this might influence trauma-related morbidity. The aim of this study was to assess the functional outcomes of patients in the Norwegian trauma population and the relationship between prehospital time and urban-remote disparities on functional outcome. METHODS This registry-based study included 34,611 patients from the Norwegian Trauma Registry from 2015 - 2020. Differences in study population characteristics and functional outcomes as measured on the Glasgow Outcome Scale (GOS) at discharge were analysed. Three multinomial regression models were performed to assess the association between total prehospital time and urban-remote disparities and morbidity reported as GOS categories. RESULTS Ninety-four per cent of trauma patients had no disability or moderate disability at discharge. Among patients with severe disability or vegetative state, 81 % had NISS > 15. Patients with fall-related injuries had the highest proportion of severe disability or vegetative state. Among children and adults, every minute increase in total prehospital time was associated with higher odds of moderate disability. Urban areas were associated with higher odds of moderate disability in all age groups, whereas remote areas were associated with higher odds of severe disability or vegetative state in elderly patients. NISS was associated with a worse functional outcome. CONCLUSIONS The majority of trauma patients admitted to a trauma hospital in Norway were discharged with minimal change in functional outcome. Patients with severe injuries (NISS > 15) and patients with injuries from falls experienced the greatest decline in function. Every minute increase in total prehospital time was linked to an increased likelihood of moderate disability in children and adults. Furthermore, incurring injuries in urban areas was found to be associated with higher odds of moderate disability in all age groups, while remote areas were found to be associated with higher odds of severe disability or vegetative state in elderly patients.
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Affiliation(s)
- Imw Nilsbakken
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - T Wisborg
- Interprofessional rural research team - Finnmark, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway; Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway.
| | - S Sollid
- Prehospital Division, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - E Jeppesen
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; Faculty of Health Studies, VID Specialized University, Oslo, Norway.
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Lacey Q. Impact of the Social Determinants of Health on Adult Trauma Outcomes. Crit Care Nurs Clin North Am 2023; 35:223-233. [PMID: 37127378 DOI: 10.1016/j.cnc.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Social determinants of health (SDOHs) have been well studied within the literature in the United States but the effects of these determinants of health on patients with trauma have garnered less attention. The interaction between patients with SDOHs and patients with trauma requires clinicians caring for this population to view patients with trauma through a multifaceted lens. The purpose of this article will be to illuminate the drivers of trauma in the adult population and how the SDOHs and the health-care system come together to contribute to disparities in trauma outcomes.
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Andersen V, Gurigard VR, Holter JA, Wisborg T. Geographical risk of fatal and non-fatal injuries among adults in Norway. Injury 2021; 52:2855-2862. [PMID: 34425992 DOI: 10.1016/j.injury.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/05/2021] [Accepted: 08/05/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A rural gradient in trauma mortality disfavoring remote inhabitants is well known. Previous studies have shown higher risk of traumatic deaths in rural areas in Norway, combined with a paradoxically decreased prevalence of non-fatal injuries. We investigated the risk of fatal and severe non-fatal injuries among all adults in Norway during 2002-2016. METHODS All traumatic injuries and deaths among persons with a residential address in Norway from 2002-2016 were included. Data were collected from the Norwegian National Cause of Death Registry and the Norwegian Patient Registry. All cases were stratified into six groups of centrality based on Statistics Norway's classification system, from most urban (group one) to least urban/most rural (group six). Mortality and injury rates were calculated per 100,000 inhabitants per year. RESULTS The mortality rate differed significantly among the centrality groups (p<0.05). The rate was 64.2 per 100,000 inhabitants/year in the most urban group and 78.6 per 100,000 inhabitants/year in the most rural group. The lowest mortality rate was found in centrality group 2 (57.9 per 100,000 inhabitants/year). For centrality group 6 versus group 2, the risk of death was increased (relative risk, 1.36; 95%CI: 1.11-1.66; p<0.01). The most common causes of death were transport injury, self-harm, falls, and other external causes. The steepest urban-rural gradient was seen for transport injuries, with a relative risk of 3.32 (95%CI: 1.81-6.10; p<0.001) for group 6 compared with group 1. There was a significantly increasing risk for severe non-fatal injuries from urban to rural areas. Group 2 had the lowest risk for non-fatal injuries (1531 per 100,000 inhabitants/year) and group 6 the highest (1803 per 100,000 inhabitants/year). The risk for non-fatal injuries increased with increasing rurality, with a relative risk of 1.07 (95%CI: 1.02-1.11; p<0.01) for group 6 versus group 1. CONCLUSIONS Fatal and non-fatal injury risks increased in parallel with increasing rurality. The lowest risk was in the second most urban region, followed by the most urban (capital) region, yielding a J-shaped risk curve. Transport injuries had the steepest urban-rural gradient.
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Affiliation(s)
- Vegard Andersen
- Interprofessional Rural Research team, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, N-9600 Hammerfest, Norway
| | - Vilde Ravnsborg Gurigard
- Interprofessional Rural Research team, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, N-9600 Hammerfest, Norway
| | - June Alette Holter
- Interprofessional Rural Research team, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, N-9600 Hammerfest, Norway
| | - Torben Wisborg
- Interprofessional Rural Research team, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, N-9600 Hammerfest, Norway; Department of Anaesthesia and Intensive Care, Hammerfest Hospital, Finnmark Health Trust, N-9613 Hammerfest, Norway; Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, N-0424 Oslo, Norway.
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Reccord C, Power N, Hatfield K, Karaivanov Y, Mulay S, Wilson M, Pollock N. Rural-Urban Differences in Suicide Mortality: An Observational Study in Newfoundland and Labrador, Canada: Différences de la Mortalité Par Suicide en Milieu Rural-Urbain: Une Étude Observationnelle à Terre-Neuve et Labrador, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:918-928. [PMID: 33576277 PMCID: PMC8573702 DOI: 10.1177/0706743721990315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Suicide rates are higher in rural compared to urban areas. Although this pattern appears to be driven by higher rates among men, there is limited evidence about the characteristics of rural people who die by suicide in Canada. The objective of this study was to examine the demographics, manner of death, and social and clinical antecedents of people who died by suicide in rural areas compared to urban areas. METHODS We conducted an observational study of all suicide deaths that occurred among Newfoundland and Labrador residents between 1997 and 2016 using a linked data set derived from a comprehensive review of provincial medical examiner records. We used t tests and χ2 to assess associations between rural/urban status and variables related to demographics, circumstances, and manner of death, as well as social and medical history. Logistic regression was utilized to assess the independent contribution of any variable found to be significant in univariate analysis. RESULTS Rural people who died by suicide accounted for 54.8% of all deaths over a 20-year period. Overall, 81.6% of people who died were male. Compared to urban, rural people who died by suicide were younger, more likely to use firearms or hanging, and had a higher mean blood alcohol content at the time of death (27.69 vs. 22.95 mmol/L). Rural people were also less likely to have had a known history of a prior suicide attempt, psychiatric disorder, alcohol or substance abuse, or chronic pain. DISCUSSION The demographic and clinical differences between rural and urban people who died by suicide underscore the need for suicide prevention approaches that account for place-based differences. A key challenge for suicide prevention in rural communities is to ensure that interventions are developed and implemented in a manner that fits local contexts.
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Affiliation(s)
- Charlene Reccord
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nicole Power
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Keeley Hatfield
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada.,McMaster University, Hamilton, Ontario, Canada
| | - Yordan Karaivanov
- Medical Services, Labrador Health Centre, Labrador-Grenfell Health, Labrador, Newfoundland and Labrador, Canada.,Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Margo Wilson
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nathaniel Pollock
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,School of Public Health, University of Alberta, Edmonton, Canada.,School of Arctic and Subarctic Studies, Labrador Institute, Memorial University, Happy Valley-Goose Bay, NL
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Wilson T, Wisborg T, Vindenes V, Jamt RG, Furuhaugen H, Bogstrand ST. Psychoactive substances have major impact on injuries in rural arctic Norway - A prospective observational study. Acta Anaesthesiol Scand 2021; 65:824-833. [PMID: 33638866 DOI: 10.1111/aas.13807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rural areas have increased injury mortality with a high pre-hospital death rate. Knowledge concerning the impact of psychoactive substances on injury occurrence is lacking for rural arctic Norway. These substances are also known to increase pre-, per- and postoperative risk. The aim was by prospective observational design to investigate the prevalence and characteristics of psychoactive substance use among injured patients in Finnmark county. METHODS From January 2015 to August 2016, patients ≥18 years admitted to hospitals in Finnmark due to injury were approached when competent. Blood was analysed for ethanol, sedatives, opioids, hypnotics and illicit substances in consenting patients, who completed a questionnaire gathering demographic factors, self-reported use/behaviour and incident circumstances. RESULTS In 684 injured patients who consented to participation (81% consented), psychoactive substances were detected in 35.7%, alcohol being the most prevalent (23%). Patients in whom substances were detected were more often involved in violent incidents (odds ratio 8.92 95% confidence interval 3.24-24.61), indicated harmful use of alcohol (odds ratio 3.56, 95% confidence interval 2.34-5.43), reported the incident being a fall (odds ratio 2.21, 95% confidence interval 1.47-3.33) and presented with a reduced level of consciousness (odds ratio 3.91, 95% confidence interval 1.58-9.67). Subgroup analysis revealed significant associations between testing positive for a psychoactive substance and being diagnosed with a head injury or traumatic brain injury. CONCLUSION A significant proportion of injured patients had used psychoactive substances prior to admission. Use was associated with violence, falls, at-risk alcohol consumption, decreased level of consciousness on admittance and head injury.
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Affiliation(s)
- Thomas Wilson
- University of TromsøThe Arctic University of Norway Tromsø Norway
- Department of Forensic Sciences Section for Drug Abuse Research Oslo University Hospital Oslo Norway
- Department of Anaesthesia and Intensive Care Hammerfest HospitalFinnmark Hospital Trust Hammerfest Norway
| | - Torben Wisborg
- University of TromsøThe Arctic University of Norway Tromsø Norway
- Department of Anaesthesia and Intensive Care Hammerfest HospitalFinnmark Hospital Trust Hammerfest Norway
- Norwegian National Advisory Unit on Trauma Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
| | - Vigdis Vindenes
- Department of Forensic Sciences Section for Drug Abuse Research Oslo University Hospital Oslo Norway
| | - Ragnhild G. Jamt
- Department of Forensic Sciences Section for Drug Abuse Research Oslo University Hospital Oslo Norway
| | - Håvard Furuhaugen
- Department of Forensic Sciences Section for Drug Abuse Research Oslo University Hospital Oslo Norway
| | - Stig Tore Bogstrand
- Department of Forensic Sciences Section for Drug Abuse Research Oslo University Hospital Oslo Norway
- Institute of Health and Society Faculty of Medicine University of Oslo Oslo Norway
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Abstract
INTRODUCTION Pneumothorax remains an important cause of preventable trauma death. The aim of this systematic review is to synthesize the recent evidence on the efficacy, patient outcomes, and adverse events of different chest decompression approaches relevant to the out-of-hospital setting. METHODS A comprehensive literature search was performed using five databases (from January 1, 2014 through June 15, 2020). To be considered eligible, studies required to report original data on decompression of suspected or proven traumatic pneumothorax and be considered relevant to the prehospital context. They also required to be conducted mostly on an adult population (expected more than ≥80% of the population ≥16 years old) of patients. Needle chest decompression (NCD), finger thoracostomy (FT), and tube thoracostomy were considered. No meta-analysis was performed. Level of evidence was assigned using the Harbour and Miller system. RESULTS A total of 1,420 citations were obtained by the search strategy, of which 20 studies were included. Overall, the level of evidence was low. Eleven studies reported on the efficacy and patient outcomes following chest decompression. The most studied technique was NCD (n = 7), followed by FT (n = 5). Definitions of a successful chest decompression were heterogeneous. Subjective improvement following NCD ranged between 18% and 86% (n = 6). Successful FT was reported for between 9.7% and 32.0% of interventions following a traumatic cardiac arrest. Adverse events were infrequently reported. Nine studies presented only on anatomical measures with predicted failure and success. The mean anterior chest wall thickness (CWT) was larger than the lateral CWT in all studies except one. The predicted success rate of NCD ranged between 90% and 100% when using needle >7cm (n = 7) both for the lateral and anterior approaches. The reported risk of iatrogenic injuries was higher for the lateral approach, mostly on the left side because of the proximity with the heart. CONCLUSIONS Based on observational studies with a low level of evidence, prehospital NCD should be performed using a needle >7cm length with either a lateral or anterior approach. While FT is an interesting diagnostic and therapeutic approach, evidence on the success rates and complications is limited. High-quality studies are required to determine the optimal chest decompression approach applicable in the out-of-hospital setting.
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Lomia N, Berdzuli N, Sharashidze N, Sturua L, Pestvenidze E, Kereselidze M, Topuridze M, Stray-Pedersen B, Stray-Pedersen A. Socio-Demographic Determinants of Road Traffic Fatalities in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014). Int J Womens Health 2020; 12:527-537. [PMID: 32765119 PMCID: PMC7367745 DOI: 10.2147/ijwh.s244437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 06/09/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Globally and in the European region, the road traffic injuries (RTI) have emerged as a major public health and development problem, killing the most productive adult members of a population, including women. This study aimed to identify the key socio-demographic determinants of premature and avoidable RTI mortality in reproductive-aged women (15–49 years) in Georgia. Materials and Methods The study employed verbal autopsy data from the second national reproductive age mortality survey (RAMOS 2014). Univariate and multivariate logistic regression models were fitted using the Firth method to assess the crude and adjusted effects of each individual level socio-demographic factor on the odds of RTI-attributed death, with corresponding 95% confidence intervals (COR and AOR, 95% CI). Results Of 843 women aged 15–49 years, 78 (9.3%) were the victims of fatal traffic crashes. After multivariate adjustment, the odds of dying from RTI were significantly higher in women aged 15–29 years (AOR=7.73, 95% CI= 4.20 to 14.20), those being employed (AOR=2.11, 95% CI= 1.22 to 3.64) and the wealthiest (AOR=2.88, 95% CI= 1.44 to 5.77) compared, respectively, to their oldest (40–49 years), unemployed and poorest counterparts. Conversely, there were no statistically significant ethnic, marital, rural/urban, and educational disparities in women’s RTI fatalities. Overall, motorized four-wheeler occupants (78.2%), particularly passengers (71.8%), appeared to be the most common victims of fatal road injuries than pedestrians (20.5%). Alarmingly, the vast majority (85.9%) of any type of road users died instantly at the scene of collision, as compared to deaths en route to hospital (1.3%) or in hospital (11.5%). Conclusion Age, employment, and wealth status appeared to be the strong independent predictors of young women’s RTI mortality in Georgia. Future comprehensive research would be advantageous for further deciphering the differential impact of social determinants on traffic-induced fatalities, as a vital platform for evidence-based remedial actions on this predictable and preventable safety hazard.
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Affiliation(s)
- Nino Lomia
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nino Berdzuli
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nino Sharashidze
- Department of Clinical and Research Skills, Faculty of Medicine, Iv. Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Lela Sturua
- Department of Noncommunicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Ekaterine Pestvenidze
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maia Kereselidze
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Marina Topuridze
- Health Promotion Division, Department of Noncommunicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Babill Stray-Pedersen
- Department of Obstetrics and Gynecology, Rikshospitalet, Oslo University Hospital, and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arne Stray-Pedersen
- Department of Forensic Sciences, Oslo University Hospital, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Morgan JM, Calleja P. Emergency trauma care in rural and remote settings: Challenges and patient outcomes. Int Emerg Nurs 2020; 51:100880. [PMID: 32622226 DOI: 10.1016/j.ienj.2020.100880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 04/16/2020] [Accepted: 05/07/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Trauma is a global public health concern, with higher mortality rates acknowledged in rural and remote populations. Research to understand this phenomenon and to improve patient outcomes is therefore vital. Trauma systems have been developed to provide specialty care to patients in an attempt to improve mortality rates. However, not all trauma systems are created equally as distance and remoteness has a significant impact on the capabilities of the larger trauma systems that service vast geographical distances. The primary objective of this integrative literature review was to examine the challenges associated with providing emergency trauma care to rural and remote populations and the associated patient outcomes. The secondary objective was to explore strategies to improve trauma patient outcomes. METHODS An integrative review approach was used to inform the methods of this study. A systematic search of databases including CINAHL, Medline, EmBase, Proquest, Scopus, and Science Direct was undertaken. Other search methods included hand searching journal references. RESULTS 2157 articles were identified for screening and 87 additional papers were located by hand searching. Of these, 49 were included in this review. Current evidence reveals that rural and remote populations face unique challenges in the provision of emergency trauma care such as large distances, delays transferring patients to definitive care, limited resources in rural settings, specific contextual challenges, population specific risk factors, weather and seasonal factors and the availability and skill of trained trauma care providers. Consequently, rural and remote populations often experience higher mortality rates in comparison to urban populations although this may be different for specific mechanisms of injury or population subsets. While an increased risk of death was associated with an increase in remoteness, research also found it costs substantially less to provide care to rural patients in their rural environment than their urban counterparts. Other factors found to influence mortality rates were severity of injury and differences in characteristics between rural and urban populations. Trauma systems vary around the world and must address local issues that may be affected by distance, geography, seasonal population variations, specific population risk factors, trauma network operationalisation, referral and retrieval and involvement of hospitals and services which have no trauma designation. CONCLUSIONS The challenges acknowledged for rural and remote trauma patients may be lessened and mortality rates improved by implementing strategies such as telemedicine, trauma training and the expansion of trauma systems that are responsive to local needs and resources. Additional research to determine which of these challenges has the most significant impact on health outcomes for rural patients is required in an effort to reduce existing discrepancies. Emphasis on embracing and expanding inclusive planning for complex trauma systems, as well as strategies aimed at understanding the issues rural and remote clinicians face, will also assist to achieve this.
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Affiliation(s)
- Janita M Morgan
- School of Nursing and Midwifery, Griffith University, 170 Kessels Road, Nathan 4111, QLD, Australia; Gympie Hospital, Queensland Health, 12 Henry Street, Gympie 4570, QLD, Australia.
| | - Pauline Calleja
- School of Nursing and Midwifery, Griffith University, 170 Kessels Road, Nathan 4111, QLD, Australia; School of Nursing Midwifery & Social Sciences, CQUniversity, Level 3 Cairns Square, Corner Abbott and Shields Street, Cairns 4870, QLD, Australia; Retrieval Services Queensland, Department of Health, 125 Kedron Park Road, Kedron 4031, QLD, Australia.
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Holter JA, Wisborg T. Increased risk of fatal paediatric injuries in rural Northern Norway. Acta Anaesthesiol Scand 2019; 63:1089-1094. [PMID: 31074013 PMCID: PMC6767509 DOI: 10.1111/aas.13384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/18/2019] [Accepted: 04/02/2019] [Indexed: 01/18/2023]
Abstract
Background Finnmark, Northern Norway, had a mortality rate for paediatric injury in 1998‐2007 that was more than twice the national average. We investigated whether this rate had decreased in 2008‐2015 after improvements in emergency care. We also compared the mortality rate to rates of non‐fatal injury and trauma team activation both regionally and in Norway. Methods The study was based on 4 national registries. Mortality and injury rates were calculated per 100 000 persons per year. The study population was divided into age groups; 0‐5, 6‐10, 11‐15 and 16‐17 years. Results Between 1998‐2007 and 2008‐2015 there was an overall decrease in paediatric mortality rate due to external causes in Norway in total from 7.1 to 4.0. Despite this, in 2008‐2015, the mortality rate remained 2.5 times higher in Finnmark than in Norway (9.7, RR = 2.5 CI 1.4‐4.3, P = 0.001), similar to findings for 1998‐2007. Finnmark had half the rate of non‐fatal injuries in 1999‐2007 (5052, RR = 0.6, 95% CI 0.6‐0.7, P < 0.001) and in 2008‐2015 (3893, RR = 0.5, 95% CI 0.5‐0.6, P < 0.001) as in Norway. The rate of trauma team activation was similar in Finnmark and Norway. Conclusions The risk of injury‐related death remained significantly higher, while the overall risk of non‐fatal injury was significantly reduced for children in rural Northern Norway. Thus, injuries in this rural area seem to be less frequent but more severe. There is a need for detailed examination of each death to determine possible preventive measures.
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Affiliation(s)
- June A. Holter
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences University of Tromsø, The Arctic University of Norway Hammerfest Norway
| | - Torben Wisborg
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences University of Tromsø, The Arctic University of Norway Hammerfest Norway
- Department of Anaesthesia and Intensive Care Hammerfest Hospital, Finnmark Health Trust Hammerfest Norway
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
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10
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Root Causes of Preventable Prehospital Deaths in Road Traffic Injuries: A Systematic Review. Trauma Mon 2019. [DOI: 10.5812/traumamon.88412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Moore L, Champion H, Tardif PA, Kuimi BL, O'Reilly G, Leppaniemi A, Cameron P, Palmer CS, Abu-Zidan FM, Gabbe B, Gaarder C, Yanchar N, Stelfox HT, Coimbra R, Kortbeek J, Noonan VK, Gunning A, Gordon M, Khajanchi M, Porgo TV, Turgeon AF, Leenen L. Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis. World J Surg 2018; 42:1327-1339. [PMID: 29071424 DOI: 10.1007/s00268-017-4292-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes. METHODS We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. RESULTS We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65-0.80]) and helicopter transport (OR = 0.70 [0.55-0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4-7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44-1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [-0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68-0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. CONCLUSIONS This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.
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Affiliation(s)
- Lynne Moore
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, QC, Canada. .,Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center (Enfant-Jésus Hospital), Québec, QC, Canada.
| | - Howard Champion
- Department of Surgery, University of the Health Sciences, Annapolis, MD, USA
| | - Pier-Alexandre Tardif
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, QC, Canada.,Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center (Enfant-Jésus Hospital), Québec, QC, Canada
| | - Brice-Lionel Kuimi
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center (Enfant-Jésus Hospital), Québec, QC, Canada
| | - Gerard O'Reilly
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ari Leppaniemi
- Abdominal Center, Helsinki University hospital, Helsinki, Finland
| | - Peter Cameron
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christine Gaarder
- Department of Traumatology, Oslo University Hospital Ulleval, Oslo, Norway
| | - Natalie Yanchar
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Henry Thomas Stelfox
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Raul Coimbra
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California, San Diego Health System, San Diego, CA, USA
| | - John Kortbeek
- Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, AB, Canada
| | | | - Amy Gunning
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Malcolm Gordon
- Department of Emergency Medicine, University of Glasgow, Glasgow, UK
| | | | - Teegwendé V Porgo
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, QC, Canada.,Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center (Enfant-Jésus Hospital), Québec, QC, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, QC, Canada.,Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center (Enfant-Jésus Hospital), Québec, QC, Canada
| | - Luke Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Bäckström D, Larsen R, Steinvall I, Fredrikson M, Gedeborg R, Sjöberg F. Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing. Eur J Trauma Emerg Surg 2017; 44:589-596. [PMID: 28825159 PMCID: PMC6096611 DOI: 10.1007/s00068-017-0827-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/31/2017] [Indexed: 11/29/2022]
Abstract
Background Injury is an important cause of death in all age groups worldwide, and contributes to many losses of human and economic resources. Currently, we know a few data about mortality from injury, particularly among the working population. The aim of the present study was to examine death from injury over a period of 14 years (1999–2012) using the Swedish Cause of Death Registry (CDR) and the National Patient Registry, which have complete national coverage. Method CDR was used to identify injury-related deaths among adults (18 years or over) during the years 1999–2012. ICD-10 diagnoses from V01 to X39 were included. The significance of changes over time was analyzed by linear regression. Results The incidence of prehospital death decreased significantly (coefficient −0.22, r2 = 0.30; p = 0.041) during the study period, while that of deaths in hospital increased significantly (coefficient 0.20, r2 = 0.75; p < 0.001). Mortality/100,000 person-years in the working age group (18–64 years) decreased significantly (coefficient −0.40, r2 = 0.37; p = 0.020), mainly as a result of decrease in traffic-related deaths (coefficient −0.34, r2 = 0.85; p < 0.001). The incidence of deaths from injury among elderly (65 years and older) patients increased because of the increase in falls (coefficient 1.71, r2 = 0.84; p < 0.001) and poisoning (coefficient 0.13, r2 = 0.69; p < 0.001). Conclusion The epidemiology of injury in Sweden has changed during recent years in that mortality from injury has declined in the working age group and increased among those people 64 years old and over.
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Affiliation(s)
- D Bäckström
- Department of Anaesthesiology and Intensive Care, Vrinnevisjukhuset, Gamla Övägen 25, 603 79, Norrköping, Sweden. .,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - R Larsen
- Department of Anaesthesiology and Intensive Care, Universitetssjukhuset i Linköping, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - I Steinvall
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Hand Surgery, Plastic Surgery, and Burns, Linköping University, Linköping, Sweden
| | - M Fredrikson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - R Gedeborg
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - F Sjöberg
- Department of Anaesthesiology and Intensive Care, Universitetssjukhuset i Linköping, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Hand Surgery, Plastic Surgery, and Burns, Linköping University, Linköping, Sweden
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13
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Şaşmaz MI, Akça AH. Reliability of trauma management videos on YouTube and their compliance with ATLS ® (9th edition) guideline. Eur J Trauma Emerg Surg 2017; 44:753-757. [PMID: 28573427 DOI: 10.1007/s00068-017-0803-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In this study, the reliability of trauma management scenario videos (in English) on YouTube and their compliance with Advanced Trauma Life Support (ATLS®) guidelines were investigated. METHODS The search was conducted on February 15, 2016 by using the terms "assessment of trauma" and ''management of trauma''. All videos that were uploaded between January 2011 and June 2016 were viewed by two experienced emergency physicians. The data regarding the date of upload, the type of the uploader, duration of the video and view counts were recorded. The videos were categorized according to the video source and scores. RESULTS The search results yielded 880 videos. Eight hundred and thirteen videos were excluded by the researchers. The distribution of videos by years was found to be balanced. The scores of videos uploaded by an institution were determined to be higher compared to other groups (p = 0.003). CONCLUSION The findings of this study display that trauma management videos on YouTube in the majority of cases are not reliable/compliant with ATLS-guidelines and can therefore not be recommended for educational purposes. These data may only be used in public education after making necessary arrangements.
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Affiliation(s)
- M I Şaşmaz
- Denizli Servergazi State Hospital, Denizli, Turkey
| | - A H Akça
- Faculty of Medicine, Department of Emergency Medicine, Van Yüzüncü Yıl University, Van, Turkey.
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14
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Oliver GJ, Walter DP, Redmond AD. Are prehospital deaths from trauma and accidental injury preventable? A direct historical comparison to assess what has changed in two decades. Injury 2017; 48:978-984. [PMID: 28363752 DOI: 10.1016/j.injury.2017.01.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/26/2016] [Accepted: 01/20/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND & OBJECTIVES In 1994, Hussain and Redmond revealed that up to 39% of prehospital deaths from accidental injury might have been preventable had basic first aid care been given. Since then there have been significant advances in trauma systems and care. The exclusion of prehospital deaths from the analysis of trauma registries, giv en the high rate of those, is a major limitation in prehospital research on preventable death. We have repeated the 1994 study to identify any changes over the years and potential developments to improve patient outcomes. METHODS We examined the full Coroner's inquest files for prehospital deaths from trauma and accidental injury over a three-year period in Cheshire. Injuries were scored using the Abbreviated-Injury-Scale (AIS-1990) and Injury Severity Score (ISS), and probability of survival estimated using Bull's probits to match the original protocol. RESULTS One hundred and thirty-four deaths met our inclusion criteria; 79% were male, average age at death was 53.6 years. Sixty-two were found dead (FD), fifty-eight died at scene (DAS) and fourteen were dead on arrival at hospital (DOA). The predominant mechanism of injury was fall (39%). The median ISS was 29 with 58 deaths (43%) having probability of survival of >50%. Post-mortem evidence of head injury was present in 102 (76%) deaths. A bystander was on scene or present immediately after injury in 45% of cases and prior to the Emergency Medical Services (EMS) in 96%. In 93% of cases a bystander made the call for assistance, in those DAS or DOA, bystander intervention of any kind was 43%. CONCLUSIONS The number of potentially preventable prehospital deaths remains high and unchanged. First aid intervention of any kind is infrequent. There is a potentially missed window of opportunity for bystander intervention prior to the arrival of the ambulance service, with simple first-aid manoeuvres to open the airway, preventing hypoxic brain injury and cardiac arrest.
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Affiliation(s)
- G J Oliver
- Humanitarian and Conflict Response Institute, Ellen Wilkinson Building, Oxford Road, University of Manchester, Manchester, M15 6JA, UK.
| | - D P Walter
- Humanitarian and Conflict Response Institute, Ellen Wilkinson Building, Oxford Road, University of Manchester, Manchester, M15 6JA, UK
| | - A D Redmond
- Humanitarian and Conflict Response Institute, Ellen Wilkinson Building, Oxford Road, University of Manchester, Manchester, M15 6JA, UK
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15
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The trauma chain of survival - Each link is equally important (but some links are more equal than others). Injury 2017; 48:975-977. [PMID: 28427610 DOI: 10.1016/j.injury.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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16
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Forsell N, Holzmann M, Taki H, Eriksson A, Ruge T. Transport time from crash scene may influence survival. TRAUMA-ENGLAND 2017. [DOI: 10.1177/1460408616665407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- N Forsell
- Department of Surgery, Umeå University, Umeå, Sweden
| | - M Holzmann
- Department of Internal Medicine, Solna, Karolinska Institute, Stockholm, Sweden
- Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - H Taki
- Department of Surgery, Umeå University, Umeå, Sweden
| | - A Eriksson
- Department of Community Medicine and Rehabilitation, Section of Forensic Medicine, Umeå University, Umeå, Sweden
| | - T Ruge
- Department of Surgery, Umeå University, Umeå, Sweden
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17
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Raatiniemi L, Steinvik T, Liisanantti J, Ohtonen P, Martikainen M, Alahuhta S, Dehli T, Wisborg T, Bakke HK. Fatal injuries in rural and urban areas in northern Finland: a 5-year retrospective study. Acta Anaesthesiol Scand 2016; 60:668-76. [PMID: 26749577 PMCID: PMC4849198 DOI: 10.1111/aas.12682] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 11/28/2022]
Abstract
Background Finland has the fourth highest injury mortality rate in the European Union. To better understand the causes of the high injury rate, and prevent these fatal injuries, studies are needed. Therefore, we set out to complete an analysis of the epidemiology of fatal trauma, and any contributory role for alcohol, long suspected to promote fatal injuries. As a study area, we chose the four northernmost counties of Finland; their mix of remote rural areas and urban centres allowed us to correlate mortality rates with ‘rurality’. Methods The Causes of Death Register was consulted to identify deaths from external causes over a 5‐year time period. Data were retrieved from death certificates, autopsy reports and medical records. The municipalities studied were classified as either rural or urban. Results Of 2915 deaths categorized as occurring from external causes during our study period, 1959 were eligible for inclusion in our study. The annual crude mortality rate was 54 per 100,000 inhabitants; this rate was higher in rural vs. urban municipalities (65 vs. 45 per 100,000 inhabitants/year). Additionally, a greater number of pre‐hospital deaths from accidental high‐energy trauma occurred in rural areas (78 vs. 69%). 42% of all pre‐hospital deaths occurred under the influence of alcohol. Conclusion The crude mortality rate for fatal injuries was high overall as compared to other studies, and elevated in rural areas, where pre‐hospital deaths were more common. Almost half of pre‐hospital deaths occurred under the influence of alcohol.
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Affiliation(s)
- L. Raatiniemi
- Centre for Pre‐Hospital Emergency Care Oulu University Hospital Oulu Finland
- Department of Anesthesia and Intensive Care Lapland Central Hospital Rovaniemi Finland
- Department of Anesthesiology and Intensive Care Hammerfest Hospital Finnmark Health Trust Hammerfest Norway
| | - T. Steinvik
- Anesthesia and Critical Care Research Group University of Tromsø Tromsø Norway
| | - J. Liisanantti
- Division of Intensive Care Medicine Oulu University Hospital Oulu Finland
- Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - P. Ohtonen
- Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
- Division of Operative Care Oulu University Hospital Oulu Finland
| | - M. Martikainen
- Centre for Pre‐Hospital Emergency Care Oulu University Hospital Oulu Finland
| | - S. Alahuhta
- Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - T. Dehli
- Department of Gastroenterological Surgery University Hospital North Norway Tromsø Norway
| | - T. Wisborg
- Department of Anesthesiology and Intensive Care Hammerfest Hospital Finnmark Health Trust Hammerfest Norway
- Anesthesia and Critical Care Research Group University of Tromsø Tromsø Norway
- Norwegian National Advisory Unit on Trauma Oslo University Hospital Oslo Norway
| | - H. K. Bakke
- Anesthesia and Critical Care Research Group University of Tromsø Tromsø Norway
- Mo i Rana Hospital Helgeland Hospital Trust Mo i Rana Norway
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18
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Burden of injuries avertable by a basic surgical package in low- and middle-income regions: a systematic analysis from the Global Burden of Disease 2010 Study. World J Surg 2015; 39:1-9. [PMID: 25008243 PMCID: PMC4273085 DOI: 10.1007/s00268-014-2685-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Injuries accounted for 11 % of the global burden of disease in 2010. This study aimed to quantify the burden of injury in low- and middle-income countries (LMICs) that could be averted if basic surgical services were made available and accessible to the entire population. Methods We examined all causes of injury from the Global Burden of Disease 2010 Study. We split the disability-adjusted life years (DALYs) for these conditions between surgically “avertable” and “nonavertable” burdens. For estimating the avertable fatal burden, we applied the lowest fatality rates among the 21 epidemiologic regions to each LMIC region, assuming that the differences in death rates between each region and the lowest rates reflect the gap in surgical care. We adjusted for fatal cases that occur prior to reaching hospitals as they are not surgically avertable. Similarly, we applied the lowest nonfatal burden per case to each LMIC region. Results Overall, 21 % of the injury burden in LMICs was potentially avertable by basic surgical care (52.3 million DALYs). The avertable proportion was greater for deaths than for nonfatal burden (23 vs. 20 %), suggesting that surgical services for injuries more effectively save lives than ameliorate disability. Sub-Saharan Africa had the largest proportion of potentially avertable burden (25 %). South Asia had the highest total avertable DALYs (17.4 million). Road injury comprised the largest total avertable burden in LMICs (16.1 million DALYs). Conclusions Basic surgical care has the potential to play a major role in reducing the injury-related burden in LMICs. Electronic supplementary material The online version of this article (doi:10.1007/s00268-014-2685-x) contains supplementary material, which is available to authorized users.
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19
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BAKKE HK, DEHLI T, WISBORG T. Fatal injury caused by low-energy trauma - a 10-year rural cohort. Acta Anaesthesiol Scand 2014; 58:726-32. [PMID: 24773521 PMCID: PMC4171781 DOI: 10.1111/aas.12330] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 12/20/2022]
Abstract
Background Death after injury with low energy has gained increasing focus lately, and seems to constitute a significant amount of trauma-related death. The aim of this study was to describe the epidemiology of deaths from low-energy trauma in a rural Norwegian cohort. Methods All deaths from external causes in Finnmark County, Norway, from 1995 to 2004 were identified retrospectively through the Norwegian Cause of Death Registry. Deaths caused by hanging, drowning, suffocation, poisoning, and electrocution were excluded. Trauma was categorised as high energy or low energy based on mechanism of injury. All low-energy trauma deaths were then reviewed. Results There were 262 cases of trauma death during the period. Low-energy trauma counted for 43% of the trauma deaths, with an annual crude death rate of 13 per 100,000 inhabitants. Low falls accounted for 99% of the injuries. Fractures were sustained in 89% of cases and head injuries in 11%. Ninety per cent of patients had pre-existing medical conditions, and the median age was 82 years. Death was caused by a medical condition in 85% of cases. Fifty-two per cent of the patients died after discharge from the hospital. Conclusion In this cohort, low-energy trauma was a significant contributor to trauma related death, especially among elderly and patients with pre-existing medical conditions.
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Affiliation(s)
- H. K. BAKKE
- Anaesthesia and Critical Care Research Group Faculty of Health Sciences University of Tromsø Tromsø Norway
- Department of Surgery Mo i Rana Hospital Helgeland Hospital Trust Mo i Rana Norway
| | - T. DEHLI
- Department of Gastrointestinal Surgery University Hospital of North Norway Tromsø Tromsø Norway
| | - T. WISBORG
- Anaesthesia and Critical Care Research Group Faculty of Health Sciences University of Tromsø Tromsø Norway
- Department of Anaesthesiology and Intensive Care Finnmark Health Trust Hammerfest Hospital Hammerfest Norway
- Norwegian Trauma Competency Service Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
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Abstract
The introduction of trauma teams has improved patient outcome independently. The aim of establishing a trauma team is to ensure the early mobilization and involvement of more experienced medical staff and thereby to improve patient outcome. The team approach allows for distribution of the several tasks in assessment and resuscitation of the patient in a 'horizontal approach', which may lead to a reduction in time from injury to critical interventions and thus have a direct bearing on the patient's ultimate outcome. A trauma team leader or supervisor, who coordinates the resuscitation and ensures adherence to guidelines, should lead the trauma team. There is a major national and international variety in trauma team composition, however crucial are a surgeon, an Emergency Medicine physician or both and anaesthetist. Advanced Trauma Life Support training, simulation-based training, and video review have all improved patient outcome and trauma team performance. Developments in the radiology, such as the use of computed tomography scanning in the emergency room and the endovascular treatment of bleeding foci, have changed treatment algorithms in selected patients. These developments and new insights in shock management may have a future impact on patient management and trauma team composition.
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Affiliation(s)
- D Tiel Groenestege-Kreb
- Department of Trauma, University Medical Centre Utrecht (UMCU), HP G04·228, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - O van Maarseveen
- Department of Trauma, University Medical Centre Utrecht (UMCU), HP G04·228, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - L Leenen
- Department of Trauma, University Medical Centre Utrecht (UMCU), HP G04·228, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Kristiansen T, Lossius HM, Rehn M, Kristensen P, Gravseth HM, Røislien J, Søreide K. Epidemiology of trauma: a population-based study of geographical risk factors for injury deaths in the working-age population of Norway. Injury 2014; 45:23-30. [PMID: 23915491 DOI: 10.1016/j.injury.2013.07.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 06/23/2013] [Accepted: 07/06/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Trauma is a major global cause of morbidity and mortality. Population-based studies identifying high-risk populations and regions may facilitate primary prevention and the development of optimal trauma systems. This study describes the epidemiology of adult trauma deaths in Norway and identifies high-risk areas by assessing different geographical measures of rurality. METHODS All trauma-related deaths in Norway from 1998 to 2007 among individuals aged 16-66 years were identified by accessing national registries. Mortality data were analysed by linkage to population and geographical data at municipal, county and national levels. Three measures of rurality (centrality, population density and settlement density) were compared based on their association with trauma mortality rates. RESULTS The study included 8466 deaths, of which 78% were males. The national annual trauma mortality rate was 28.7 per 100,000. Population density was the best predictor of high-risk areas, and there was a consistent inverse relationship between mortality rates and population density. The most rural areas had 52% higher trauma mortality rates compared to the most urban areas. This difference was largely due to deaths following transport-related injury. Seventy-eight per cent of all deaths occurred in the prehospital phase. Rural areas and death following self-harm had higher proportion of prehospital deaths. CONCLUSION Rural areas, as defined by population density, are at a higher risk of deaths following traumatic injuries and have higher proportions of prehospital deaths and deaths following transport-related injuries. The heterogeneous characteristics of trauma populations with respect to geography and mode of injury should be recognised in the planning of preventive strategies and in the organisation of trauma care.
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Affiliation(s)
- Thomas Kristiansen
- Department of Research and Development, The Norwegian Air Ambulance Foundation, PO Box 94, N-1441 Drøbak, Norway; University of Oslo, Faculty Division Oslo University Hospital, Kirkeveien 166, N-0450 Oslo, Norway; Diakonhjemmet Hospital, Department of Anaesthesiology, PO Box 23 Vinderen, N-0319 Oslo, Norway.
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RAATINIEMI L, MIKKELSEN K, FREDRIKSEN K, WISBORG T. Do pre-hospital anaesthesiologists reliably predict mortality using the NACA severity score? A retrospective cohort study. Acta Anaesthesiol Scand 2013; 57:1253-9. [PMID: 24134443 PMCID: PMC4287201 DOI: 10.1111/aas.12208] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The National Advisory Committee on Aeronautics' (NACA) severity score is widely used in pre-hospital emergency medicine to grade the severity of illness or trauma in patient groups but is scarcely validated. The aim of this study was to assess the score's ability to predict mortality and need for advanced in-hospital interventions in a cohort from one anaesthesiologist-manned helicopter service in Northern Norway. METHODS All missions completed by one helicopter service during January 1999 to December 2009 were reviewed. One thousand eight hundred forty-one patients were assessed by the NACA score. Pre-hospital and in-hospital interventions were collected from patient records. The relationship between NACA score and the outcome measures was assessed using receiver operating characteristic (ROC) curves. RESULTS A total of 1533 patients were included in the analysis; uninjured and dead victims were excluded per protocol. Overall mortality rate of the patients with NACA score 1-6 was 5.2%. Trauma patients with NACA score 1-6 had overall mortality rate of 1.9% (12/625) and non-trauma patients 7.4% (67/908). The NACA score's ability to predict mortality was assessed by using ROC area under curve (AUC) and was 0.86 for all, 0.82 for non-trauma and 0.98 for trauma patients. The NACA score's ability to predict a need for respiratory therapy within 24 h revealed an AUC of 0.90 for all patients combined. CONCLUSION The NACA score had good discrimination for predicting mortality and need for respiratory therapy. It is thus useful as a tool to measure overall severity of the patient population in this kind of emergency medicine system.
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Affiliation(s)
- L. RAATINIEMI
- Department of Anaesthesiology and Intensive Care Hammerfest Hospital Finnmark Health Trust Hammerfest
- Department of Anaesthesiology Lapland Central Hospital Rovaniemi Finland
| | - K. MIKKELSEN
- Department of Anaesthesiology and Intensive Care Hammerfest Hospital Finnmark Health Trust Hammerfest
| | - K. FREDRIKSEN
- Division of Emergency Medical Services University Hospital of North Norway Tromsø Norway
- Anaesthesia and Critical Care Research Group, Department of Clinical Medicine, Faculty of Health Sciences University of Tromsø Tromsø Norway
| | - T. WISBORG
- Department of Anaesthesiology and Intensive Care Hammerfest Hospital Finnmark Health Trust Hammerfest
- Anaesthesia and Critical Care Research Group, Department of Clinical Medicine, Faculty of Health Sciences University of Tromsø Tromsø Norway
- Norwegian Trauma Competency Service Oslo University Hospital Oslo Norway
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Bakke HK, Hansen IS, Bendixen AB, Morild I, Lilleng PK, Wisborg T. Fatal injury as a function of rurality-a tale of two Norwegian counties. Scand J Trauma Resusc Emerg Med 2013; 21:14. [PMID: 23453161 PMCID: PMC3599718 DOI: 10.1186/1757-7241-21-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 02/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many 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. METHODS We 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. RESULTS Finnmark 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. CONCLUSIONS This 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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Affiliation(s)
- Håkon Kvåle Bakke
- Faculty of Health Sciences, IKM, University of Tromsø, Tromsø 9037, Norway.
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Trauma-related Preventable Deaths in Berlin 2010: Need to Change Prehospital Management Strategies and Trauma Management Education. World J Surg 2013; 37:1154-61. [DOI: 10.1007/s00268-013-1964-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wright S, Marlenga B, Lee BC. Childhood agricultural injuries: an update for clinicians. Curr Probl Pediatr Adolesc Health Care 2013; 43:20-44. [PMID: 23395394 DOI: 10.1016/j.cppeds.2012.08.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/23/2012] [Accepted: 08/03/2012] [Indexed: 10/27/2022]
Abstract
Every three days a child dies in an agriculture-related incident, and every day 45 children are injured in the United States. These tragedies should not be regarded as "accidents," as they often follow predictable and preventable patterns. Prevention is not only possible, but vital, since many of these injuries are almost immediately fatal. Major sources of fatal injuries are machinery, motor vehicles, and drowning. Tractor injuries alone account for one-third of all deaths. The leading sources of nonfatal injuries are structures and surfaces, animals (primarily horses), and vehicles (primarily all-terrain vehicles [ATVs]). Children living on farms are at a higher risk than hired workers, and are unprotected by child labor laws. Preschool children and older male youth are at the highest risk for fatal injury, while nonfatal injury was most common among boys aged 10-15 years. Multiple prevention strategies have been developed, yet economic and cultural barriers often impede their implementation. Educational campaigns alone are often ineffective, and must be coupled with re-engineering of machines and safety devices to reduce fatalities. Legislation has the potential to improve child safety, yet political and economic pressures often prohibit changes in child labor laws and mandated safety requirements. Clinicians play a pivotal role in injury prevention, and should actively address common rural risk-taking behaviors as part of the routine office visit in order to help prevent these tragedies.
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Affiliation(s)
- Suzanne Wright
- Marshfield Clinic Pediatric Residency, Department of Pediatrics, Marshfield, WI 54449, USA.
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TANNVIK TD, BAKKE HK, WISBORG T. A systematic literature review on first aid provided by laypeople to trauma victims. Acta Anaesthesiol Scand 2012; 56:1222-7. [PMID: 22897491 PMCID: PMC3495299 DOI: 10.1111/j.1399-6576.2012.02739.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2012] [Indexed: 11/28/2022]
Abstract
Death from trauma is a significant and international problem. Outcome for patients suffering out-of-hospital cardiac arrests is significantly improved by early cardiopulmonary resuscitation. The usefulness of first aid given by laypeople in trauma is less well established. The aim of this study was to review the existing literature on first aid provided by laypeople to trauma victims and to establish how often first aid is provided, if it is performed correctly, and its impact on outcome. A systematic review was carried out, according to preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, of all studies involving first aid provided by laypeople to trauma victims. Cochrane, Embase, Medline, Pubmed, and Google Scholar databases were systematically searched. Ten eligible articles were identified involving a total of 5836 victims. Eight studies were related to patient outcome, while two studies were simulation based. The proportion of patients who received first aid ranged from 10.7% to 65%. Incorrect first aid was given in up to 83.7% of cases. Airway handling and haemorrhage control were particular areas of concern. One study from Iraq investigated survival and reported a 5.8% reduction in mortality. Two retrospective autopsy-based studies estimated that correct first aid could have reduced mortality by 1.8-4.5%. There is limited evidence regarding first aid provided by laypeople to trauma victims. Due to great heterogeneity in the studies, firm conclusions can not be drawn. However, the results show a potential mortality reduction if first aid is administered to trauma victims. Further research is necessary to establish this.
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Affiliation(s)
- T. D. TANNVIK
- Department of Anaesthesiology and Intensive Care Hammerfest Hospital Hammerfest Norway
| | - H. K. BAKKE
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences University of Tromsø Tromsø Norway
| | - T. WISBORG
- Department of Anaesthesiology and Intensive Care Hammerfest Hospital Hammerfest Norway
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences University of Tromsø Tromsø Norway
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Clark DE, Qian J, Sihler KC, Hallagan LD, Betensky RA. The distribution of survival times after injury. World J Surg 2012; 36:1562-70. [PMID: 22402976 DOI: 10.1007/s00268-012-1549-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The distribution of survival times after injury has been described as "trimodal," but several studies have not confirmed this. The purpose of this study was to clarify the distribution of survival times after injury. METHODS We defined survival time (t(s)) as the interval between injury time and declared death time. We constructed histograms for t(s) ≤ 150 min from the 2004-2007 Fatality Analysis Reporting System (FARS, for traffic crashes) and National Violent Death Reporting System (NVDRS, for homicides). We estimated statistical models in which death times known only within intervals were treated as interval-censored. For confirmation, we also obtained EMS response times (t(r)), prehospital times (t(p)), and hospital times (t(h)) for decedents in the 2008 National Trauma Data Bank (NTDB) with t(s) = t(p) + t(h) ≤ 150. We approximated times until circulatory arrest (t(x)) as t(r) for patients pulseless at the injury scene, t(p) for other patients pulseless at hospital admission, and t(s) for the rest; for any declared t(s), we calculated mean t(x)/t(s). We used this ratio to estimate t(x) for hospital deaths in FARS or NVDRS and provide independent support for using interval-censored methods. RESULTS FARS and NVDRS deaths were most frequent in the first few minutes. Both showed a second peak at 35-40 min after injury, corresponding to peaks in hospital deaths. Third peaks were not present. Estimated t(x) in FARS and NVDRS did not show second peaks and were similar to estimates treating some death times as interval-censored. CONCLUSIONS Increases in frequency of survival times at 35-40 min are primarily artifacts created because declaration of death in hospitals is delayed until completing resuscitative attempts. By avoiding these artifacts, interval censoring methods are useful for analysis of injury survival times.
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Affiliation(s)
- David E Clark
- Department of Surgery, Maine Medical Center, 887 Congress Street, Suite 210, Portland, ME 04102, USA.
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Wisborg T, Montshiwa TR, Mock C. Trauma research in low- and middle-income countries is urgently needed to strengthen the chain of survival. Scand J Trauma Resusc Emerg Med 2011; 19:62. [PMID: 22024376 PMCID: PMC3219714 DOI: 10.1186/1757-7241-19-62] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 10/24/2011] [Indexed: 01/17/2023] Open
Abstract
Trauma is a major - and increasing - cause of death, especially in low- and middle income countries. In all countries rural areas are especially hard hit, and the distribution of physicians is skewed towards cities. To reduce avoidable deaths from injury all links in the chain of survival after trauma needs strengthening. Prioritizing in each country should be done by local researchers, but little research on injuries emerges from low- and middle income countries. Researchers in these countries need support and collaboration from their peers in industrialized countries. This partnership will be of mutual benefice.
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Affiliation(s)
- Torben Wisborg
- Department of Acute Care, Hammerfest Hospital, Hammerfest, Norway.
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