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Trivedi DJ, Bass GA, Forssten MP, Scheufler KM, Olivecrona M, Cao Y, Ahl Hulme R, Mohseni S. The significance of direct transportation to a trauma center on survival for severe traumatic brain injury. Eur J Trauma Emerg Surg 2022; 48:2803-2811. [PMID: 35226114 PMCID: PMC9360055 DOI: 10.1007/s00068-022-01885-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/17/2022] [Indexed: 11/05/2022]
Abstract
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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Affiliation(s)
- Dhanisha Jayesh Trivedi
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85, Örebro, Sweden
| | - Gary Alan Bass
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, PA, 19104, USA
| | - Maximilian Peter Forssten
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85, Örebro, Sweden
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden
| | - Kai-Michael Scheufler
- Division of Neurosurgery, Department of Neurosurgery, Orebro University Hospital, Örebro, Sweden
- Medical School, Heinrich-Heine-University, Düsseldorf, Germany
| | - Magnus Olivecrona
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden
- Division of Neurosurgery, Department of Neurosurgery, Orebro University Hospital, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, 701 82, Örebro, Sweden
| | - Rebecka Ahl Hulme
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden
- Department of Surgery, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85, Örebro, Sweden.
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden.
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Wilhelms SB, Wilhelms DB. Emergency department admissions to the intensive care unit - a national retrospective study. BMC Emerg Med 2021; 21:122. [PMID: 34688248 PMCID: PMC8540137 DOI: 10.1186/s12873-021-00517-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background Emergency departments (EDs) see a rising number of patients, but only a small fraction of ED patients need immediate intensive care. The characteristics of these patients are mostly unknown and there is reason to believe that there are large inter-hospital differences in thresholds for intensive care admissions from the ED. The purpose of this study was to give a nationwide overview of ED admissions directly to intensive care units. Methods We used the Swedish Intensive care Registry to identify all patients admitted to intensive care from the ED (January 1, 2013 until June 7, 2018). The primary outcome was discharge diagnosis after intensive care (primary ICU diagnosis code). ICU mortality and” ICU admission due to only observation” were analyzed as secondary outcomes. Results 110,072 ICU admissions were included, representing 94,546 unique patients. Intoxication, trauma and neurological conditions were the most common causes for intensive care, but large variations according to age, sex and hospital type were seen. Intoxication was the most prevalent diagnosis in young adults (46.8% of admissions in 18–29 years old), whereas infectious diseases predominated in the elderly (17.0% in 65–79 years old). Overall, ICU mortality was 7.2%, but varied substantially with age, sex, type of hospital and medical condition. Cardiac conditions had the highest mortality rates, reaching 32.9%. The mortality was higher in academic centers compared to rural hospitals (9.3% vs 5.0%). It was more common to be admitted to ICU for only observation in rural hospitals than in academic centers (20.1% vs 7.8%). Being admitted to ICU only for observation was most common in patients with intoxication (30.6%). Conclusions Overall, intoxication was the most common cause for ICU admission from the ED. However, causes of ED ICU admissions differ substantially according to age, sex and hospital type. Being admitted to the ICU only for observation was most common in intoxicated patients. Trial registration Not applicable (no interventions). Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00517-0.
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Affiliation(s)
- Susanne B Wilhelms
- Department of Anaesthesia and Intensive Care in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Daniel B Wilhelms
- Department of Emergency Medicine in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Träff H, Hagander L, Salö M. Association of transport time with adverse outcome in paediatric trauma. BJS Open 2021; 5:6272166. [PMID: 33963365 PMCID: PMC8105622 DOI: 10.1093/bjsopen/zrab036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/10/2021] [Indexed: 11/15/2022] Open
Abstract
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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Affiliation(s)
- Helen Träff
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden
| | - Lars Hagander
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden.,Department of Paediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Martin Salö
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden.,Department of Paediatric Surgery, Skåne University Hospital, Lund, Sweden
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Ydenius V, Larsen R, Steinvall I, Bäckström D, Chew M, Sjöberg F. Impact of hospital type on risk-adjusted, traffic-related 30-day mortality: a population-based registry study. BURNS & TRAUMA 2021; 9:tkaa051. [PMID: 33732745 PMCID: PMC7946621 DOI: 10.1093/burnst/tkaa051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/20/2020] [Indexed: 11/12/2022]
Abstract
Background Traffic incidents are still a major contributor to hospital admissions and trauma-related mortality. The aim of this nationwide study was to examine risk-adjusted traffic injury mortality to determine whether hospital type was an independent survival factor. Methods Data on all patients admitted to Swedish hospitals with traffic-related injuries, based on International Classification of Diseases codes, between 2001 and 2011 were extracted from the Swedish inpatient and cause of death registries. Using the binary outcome measure of death or survival, data were analysed using logistic regression, adjusting for age, sex, comorbidity, severity of injury and hospital type. The severity of injury was established using the International Classification of Diseases Injury Severity Score (ICISS). Results The final study population consisted of 152,693 hospital admissions. Young individuals (0-25 years of age) were overrepresented, accounting for 41% of traffic-related injuries. Men were overrepresented in all age categories. Fatalities at university hospitals had the lowest mean (SD) ICISS 0.68 (0.19). Regional and county hospitals had mean ICISS 0.75 (0.15) and 0.77 (0.15), respectively, for fatal traffic incidents. The crude overall mortality in the study population was 1193, with a mean ICISS 0.72 (0.17). Fatalities at university hospitals had the lowest mean ICISS 0.68 (0.19). Regional and county hospitals had mean ICISS 0.75 (0.15) and 0.77 (0.15), respectively, for fatal traffic incidents.When regional and county hospitals were merged into one group and its risk-adjusted mortality compared with university hospitals, no significant difference was found. A comparison between hospital groups with the most severely injured patients (ICISS ≤0.85) also did not show a significant difference (odds ratio, 1.13; 95% confidence interval, 0.97-1.32). Conclusions This study shows that, in Sweden, the type of hospital does not influence risk adjusted traffic related mortality, where the most severely injured patients are transported to the university hospitals and centralization of treatment is common.
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Affiliation(s)
- Viktor Ydenius
- Department of Biomedical and Clinical Sciences (BVK), Linköping University, Linköping, Sweden
| | - Robert Larsen
- Department of Biomedical and Clinical Sciences (BVK), Linköping University, Linköping, Sweden.,Department of Anaesthesiology and Intensive care, Linköping University Hospital, Sweden
| | - Ingrid Steinvall
- Department of Biomedical and Clinical Sciences (BVK), Linköping University, Linköping, Sweden.,Department of Hand Surgery, Plastic Surgery and Burns Linköping University Hospital, Sweden
| | | | - Michelle Chew
- Department of Biomedical and Clinical Sciences (BVK), Linköping University, Linköping, Sweden.,Department of Anaesthesiology and Intensive care, Linköping University Hospital, Sweden
| | - Folke Sjöberg
- Department of Biomedical and Clinical Sciences (BVK), Linköping University, Linköping, Sweden.,Department of Anaesthesiology and Intensive care, Linköping University Hospital, Sweden.,Department of Hand Surgery, Plastic Surgery and Burns Linköping University Hospital, Sweden
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al-Ayoubi F, Eriksson H, Myrelid P, Wallon C, Andersson P. Distribution of emergency operations and trauma in a Swedish hospital: need for reorganisation of acute surgical care? Scand J Trauma Resusc Emerg Med 2012; 20:66. [PMID: 22985447 PMCID: PMC3568729 DOI: 10.1186/1757-7241-20-66] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 09/11/2012] [Indexed: 11/10/2022] Open
Abstract
Background Subspecialisation within general surgery has today reached further than ever. However, on-call time, an unchanged need for broad surgical skills are required to meet the demands of acute surgical disease and trauma. The introduction of a new subspecialty in North America that deals solely with acute care surgery and trauma is an attempt to offer properly trained surgeons also during on-call time. To find out whether such a subspecialty could be helpful in Sweden we analyzed our workload for emergency surgery and trauma. Methods Linköping University Hospital serves a population of 257 000. Data from 2010 for all patients, diagnoses, times and types of operations, surgeons involved, duration of stay, types of injury and deaths regarding emergency procedures were extracted from a prospectively-collected database and analyzed. Results There were 2362 admissions, 1559 emergency interventions; 835 were mainly abdominal operations, and 724 diagnostic or therapeutic endoscopies. Of the 1559 emergency interventions, 641 (41.1%) were made outside office hours, and of 453 minor or intermediate procedures (including appendicectomy, cholecystectomy, or proctological procedures) 276 (60.9%) were done during the evenings or at night. Two hundred and fifty-four patients were admitted with trauma and 29 (11.4%) required operation, of whom general surgeons operated on eight (3.1%). Thirteen consultants and 11 senior registrars were involved in 138 bowel resections and 164 cholecystectomies chosen as index operations for standard emergency surgery. The median (range) number of such operations done by each consultant was 6 (3–17) and 6 (1–22). Corresponding figures for senior registrars were 7 (0–11) and 8 (1–39). Conclusion There was an uneven distribution of exposure to acute surgical problems and trauma among general surgeons. Some were exposed to only a few standard emergency interventions and most surgeons did not operate on a single patient with trauma. Further centralization of trauma care, long-term positions at units for emergency surgery and trauma, and subspecialisation in the fields of emergency surgery and trauma, might be options to solve problems of low volumes.
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Affiliation(s)
- Fawzi al-Ayoubi
- Department of Surgery, Linköping University Hospital, Linköping, Sweden
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Kanhere MH, Kanhere HA, Cameron A, Maddern GJ. Does patient volume affect clinical outcomes in adult intensive care units? Intensive Care Med 2012; 38:741-51. [DOI: 10.1007/s00134-012-2519-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 02/21/2012] [Indexed: 11/29/2022]
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Rubiano S, Gil F, Celis-Rodriguez E, Oliveros H, Carrasquilla G. Critical care in Colombia: differences between teaching and nonteaching intensive care units. A prospective cohort observational study. J Crit Care 2011; 27:104.e9-17. [PMID: 21703811 DOI: 10.1016/j.jcrc.2011.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 03/01/2011] [Accepted: 03/05/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to determine the differences in the efficacy and efficiency in providing critical care to hospitalized patients in teaching vs nonteaching intensive care units (ICUs) in Colombia. METHODS A prospective cohort observational study was conducted. LOCATION This study was conducted in 11 teaching and 8 nonteaching ICUs. From June 1 until December 31, 2005, data on 826 patients admitted consecutively to teaching ICUs and 825 patients admitted to nonteaching ICUs were analyzed. MEASUREMENTS Acute Physiology and Chronic Health Evaluation II, Simplified Therapeutic Intervention Scoring System, ICU discharge status (dead or alive) and ICU length of stay, and standardized mortality ratios were considered in this study. A logistic regression and robust linear regression were performed. RESULTS There were no differences in mortality (P = .25). Standardized mortality was less than 1 for both types of units. The teaching ICUs length of stay was 1 day longer (P < .01). Resource use is 25% higher in teaching units (P = .01). When the Simplified Therapeutic Intervention Scoring System score on the last day was from 21 to 35, a higher ratio of patients from the nonteaching ICUs was observed going floor or home when discharged from the ICU (P < .01). CONCLUSIONS Nonteaching ICUs discharge patients earlier than do teaching ICUs, but the effect of it remains to be clarified with further studies addressing questions as what happens after ICU discharge.
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Affiliation(s)
- Sandra Rubiano
- Clinical Studies Department, Centro de Estudios e Investigación en Salud, CEIS; Health Research and Studies Center-CEIS, Fundacion Santa Fe de Bogota, Bogota, Colombia.
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Reinikainen M, Laru-Sompa R, Loisa P, Lund V, Kairi P. Outcomes may have been no better after trauma care in university-level intensive care units. Acta Anaesthesiol Scand 2010; 54:1036; author reply 1036-7. [PMID: 20701599 DOI: 10.1111/j.1399-6576.2010.02246.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ala-Kokko T, Ohtonen P, Koskenkari J, Laurila J. Reply. Acta Anaesthesiol Scand 2010. [DOI: 10.1111/j.1399-6576.2010.02269.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bäckström D, al-Ayoubi F, Steinvall I, Fredrikson M, Sjöberg F. Outcome of trauma patients. Acta Anaesthesiol Scand 2010; 54:902-3; author reply 903. [PMID: 20649522 DOI: 10.1111/j.1399-6576.2010.02237.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ala-Kokko TI, Ohtonen P, Koskenkari J, Laurila J. Reply. Acta Anaesthesiol Scand 2010. [DOI: 10.1111/j.1399-6576.2010.02250.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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