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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2018

Open Access 01-12-2018 | Original research

Decreased risk adjusted 30-day mortality for hospital admitted injuries: a multi-centre longitudinal study

Authors: Robert Larsen, Denise Bäckström, Mats Fredrikson, Ingrid Steinvall, Rolf Gedeborg, Folke Sjoberg

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2018

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Abstract

Background

The interpretation of changes in injury-related mortality over time requires an understanding of changes in the incidence of the various types of injury, and adjustment for their severity. Our aim was to investigate changes over time in incidence of hospital admission for injuries caused by falls, traffic incidents, or assaults, and to assess the risk-adjusted short-term mortality for these patients.

Methods

All patients admitted to hospital with injuries caused by falls, traffic incidents, or assaults during the years 2001–11 in Sweden were identified from the nationwide population-based Patient Registry. The trend in mortality over time for each cause of injury was adjusted for age, sex, comorbidity and severity of injury as classified from the International Classification of diseases, version 10 Injury Severity Score (ICISS).

Results

Both the incidence of fall (689 to 636/100000 inhabitants: p = 0.047, coefficient − 4.71) and traffic related injuries (169 to 123/100000 inhabitants: p < 0.0001, coefficient − 5.37) decreased over time while incidence of assault related injuries remained essentially unchanged during the study period. There was an overall decrease in risk-adjusted 30-day mortality in all three groups (OR 1.00; CI95% 0.99–1.00). Decreases in traffic (OR 0.95; 95% CI 0.93 to 0.97) and assault (OR 0.93; 95% CI 0.87 to 0.99) related injuries was significant whereas falls were not during this 11-year period.

Discussion

Risk-adjustment is a good way to use big materials to find epidemiological changes. However after adjusting for age, year, sex and risk we find that a possible factor is left in the pre- and/or in-hospital care.

Conclusions

The decrease in risk-adjusted mortality may suggest changes over time in pre- and/or in-hospital care. A non-significantdecrease in risk-adjusted mortality was registered for falls, which may indicate that low-energy trauma has not benefited for the increased survivability as much as high-energy trauma, ie traffic- and assault related injuries.
Literature
1.
MacKenzie EJ. Epidemiology of injuries: current trends and future challenges. Epidemiol Rev. 2000;22:112–9.CrossRefPubMed
2.
Sise RG, Calvo RY, Spain DA, Weiser TG, Staudenmayer KL. The epidemiology of trauma-related mortality in the United States from 2002 to 2010. J Trauma Acute Care Surg. 2014;76:913–9. discussion920CrossRefPubMed
3.
Stephenson S, Henley G, Harrison JE, Langley JD. Diagnosis based injury severity scaling: investigation of a method using Australian and New Zealand hospitalisations. Inj Prev. 2004;10:379–83.CrossRefPubMedPubMedCentral
4.
Osler TM, Cohen M, Rogers FB, Camp L, Rutledge R, Shackford SR. Trauma registry injury coding is superfluous: a comparison of outcome prediction based on trauma registry International Classification of Diseases-Ninth Revision (ICD-9) and hospital information system ICD-9 codes. J Trauma. 1997;43:253–6. discussion256–7CrossRefPubMed
5.
Osler T, Rutledge R, Deis J, Bedrick E. ICISS: an international classification of disease-9 based injury severity score. J Trauma. 1996;41:380–6. discussion386–8CrossRefPubMed
6.
Hartholt KA, van Beeck EF, Polinder S, van der Velde N, Van Lieshout EMM, Panneman MJM, et al. Societal Consequences of Falls in the Older Population: Injuries, Healthcare Costs, and Long-Term Reduced Quality of Life. J Trauma Acute Care Surg. 2011;71:748–53.CrossRef
7.
Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, et al. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet. 2009;374:881–92.CrossRefPubMed
8.
Gedeborg R, Chen L-H, Thiblin I, Byberg L, Melhus H, Michaëlsson K, et al. Prehospital injury deaths—Strengthening the case for prevention. J Trauma Acute Care Surg. 2012;72:765–72.CrossRefPubMed
9.
WHO Library Cataloguing-in-Publication Data. International Statistical Classification of Diseases and Related Health Problems. - 10th revision, ed 2010. 3v. Malta 2011 pp1-201
10.
Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim J-L, Reuterwall C, et al. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450.CrossRefPubMedPubMedCentral
11.
Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A. The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol. 2009;24:659–67.CrossRefPubMedPubMedCentral
12.
Ghorbani P, Falkén M, Riddez L, Sundelöf M, Oldner A, Strömmer L. Clinical review is essential to evaluate 30-day mortality after trauma. Scand J Trauma Resusc Emerg Med. 2014;22:18.CrossRefPubMedPubMedCentral
13.
Skaga NO, Eken T, Jones JM, Steen PA. Different definitions of patient outcome: Consequences for performance analysis in trauma. Injury. 2008;39:612–22.CrossRefPubMed
14.
Van Haren RM, Thorson CM, Curia E, Schulman CI, Namias N, Livingstone AS, et al. Impact of definitions on trauma center mortality rates and performance. J Trauma Acute Care Surg. 2012;73:1512–6.CrossRefPubMed
15.
Rutledge R, Osler T, Emery S, Kromhout-Schiro S. The end of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, ninth revision-based prediction tool, outperforms both ISS and TRISS as predictors of trauma patient survival, hospital charges, and hospital length of stay. J Trauma. 1998;44:41–9.CrossRefPubMed
16.
Gagné M, Moore L, Beaudoin C, Batomen Kuimi BL, Sirois M-J. Performance of ICD-based injury severity measures used to predict in-hospital mortality: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2016;80:419–26.CrossRefPubMed
17.
Gedeborg R, Warner M, Chen L-H, Gulliver P, Cryer C, Robitaille Y, et al. Internationally comparable diagnosisspecific survival probabilities for calculation of the ICD-10–based Injury Severity Score. J Trauma Acute Care Surg. 2014;76:358–65.CrossRefPubMed
18.
Gedeborg R, Svennblad B, Byberg L, Michaëlsson K, Thiblin I. Prediction of mortality risk in victims of violent crimes. Forensic Sci. Int. 2017;281:92–7.CrossRefPubMed
19.
Davie G, Cryer C, Langley J. Improving the predictive ability of the ICD-based Injury Severity Score. Inj Prev. 2008;14:250–5.CrossRefPubMed
20.
Petrey LB, Weddle RJ, Richardson B, Gilder R, Reynolds M, Bennett M, et al. Trauma patient readmissions: Why do they come back for more? J Trauma Acute Care Surg. 2015;79:717–24. discussion724–5CrossRefPubMed
21.
Moore L, Stelfox HT, Turgeon AF, Nathens AB, Lavoie A, Bourgeois G, et al. Derivation and validation of a quality indicator for 30-day unplanned hospital readmission to evaluate trauma care. J Trauma Acute Care Surg. 2014;76:1310–6.CrossRefPubMed
22.
Moore L, Lavoie A, Bourgeois G, Lapointe J. Donabedian's structure-process-outcome quality of care model: Validation in an integrated trauma system. J Trauma Acute Care Surg. 2015;78:1168–75.CrossRefPubMed
23.
Gagné M, Moore L, Beaudoin C, Batomen Kuimi BL, Sirois M-J. Performance of International Classification of Diseases-based injury severity measures used to predict in-hospital mortality: A systematic review and meta-analysis. J Trauma Acute Care Surg. 2016;80:419–26.CrossRefPubMed
24.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefPubMed
25.
Christensen S, Johansen MB, Christiansen CF, Jensen R, Lemeshow S. Comparison of Charlson comorbidity index with SAPS and APACHE scores for prediction of mortality following intensive care. Clin Epidemiol. 2011;3:203–11.CrossRefPubMedPubMedCentral
26.
27.
28.
Moore L, Lavoie A, Bergeron E, Emond M. Modeling Probability-Based Injury Severity Scores in Logistic Regression Models: The Logit Transformation Should Be Used. J Trauma. 2007;62:601–5.CrossRefPubMed
29.
Bergström MF, Byberg L, Melhus H, Michaëlsson K, Gedeborg R. Extent and consequences of misclassified injury diagnoses in a national hospital discharge registry. Inj. Prev. 2011;17:108–13.CrossRefPubMed
30.
Blomberg H, Svennblad B, Michaelsson K, Byberg L, Johansson J, Gedeborg R. Prehospital Trauma Life Support Training of Ambulance Caregivers and the Outcomes of Traffic-Injury Victims in Sweden. ACS. 2013;217:1010–2.
31.
Johansson J, Blomberg H, Svennblad B, Wernroth L, Melhus H, Byberg L, et al. Prehospital Trauma Life Support (PHTLS) training of ambulance caregivers and impact on survival of trauma victims. Resuscitation. 2012;83:1259–64.CrossRefPubMed
32.
Potenza BM, Hoyt DB, Coimbra R, Fortlage D, Holbrook T, Hollingsworth-Fridlund P, et al. The epidemiology of serious and fatal injury in San Diego County over an 11-year period. Journal Trauma. 2004;56:68–75.CrossRef
33.
34.
Meisler R, Thomsen AB, Theilade P, Abildstrøm H, BORGE P, Treschow M, et al. Age-related differences in mechanism, cause, and location of trauma deaths. Minerva Anestesiol. 2011;77:592–7.PubMed
35.
Curtis EM, van der Velde R, Moon RJ. Epidemiology of fractures in the United Kingdom 1988–2012: Variation with age, sex, geography, ethnicity and socioeconomic status. Bone. 2016;87:19–26.CrossRefPubMedPubMedCentral
36.
Kalesan B, Mobily ME, Keiser O, Fagan JA, Galea S. Firearm legislation and firearm mortality in the USA: a crosssectional, state-level study. Lancet. 2016;387:1847–55.CrossRefPubMed
37.
Fahimi J, Larimer E, Hamud-Ahmed W, Anderson E, Schnorr CD, Yen I, et al. Long-term mortality of patients surviving firearm violence. Inj. Prev. 2016;22:129–34.CrossRefPubMed
38.
39.
Gomez D, Haas B, de Mestral C, Sharma S, Hsiao M, Zagorski B, et al. Gender-associated differences in access to trauma center care: A population-based analysis. Surgery. 2012;152:179–85.CrossRefPubMed
Metadata
Title
Decreased risk adjusted 30-day mortality for hospital admitted injuries: a multi-centre longitudinal study
Authors
Robert Larsen
Denise Bäckström
Mats Fredrikson
Ingrid Steinvall
Rolf Gedeborg
Folke Sjoberg
Publication date
01-12-2018
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-018-0485-2

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