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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2016 | Original research

Comparison of risk-adjusted survival in two Scandinavian Level-I trauma centres

Authors: Poya Ghorbani, Kjetil Gorseth Ringdal, Morten Hestnes, Nils Oddvar Skaga, Torsten Eken, Anders Ekbom, Lovisa Strömmer

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2016

Abstract

Background

Assessment of trauma-system performance is important for improving the care of injured patients. The aim of the study was to compare risk-adjusted survival in two Scandinavian Level-I trauma centres.

Methods

This was an observational, retrospective study of prospectively-collected trauma registry data for patients >14 years from Karolinska University Hospital – Solna (KUH), Sweden, and Oslo University Hospital – Ullevål (OUH), Norway, from 2009-2011. Probability of survival (Ps) was calculated according to the Trauma and Injury Severity Score (TRISS) method. Risk-adjusted survival per patient was calculated by assigning every patient a value corresponding to gained or lost fractional life: Each survivor contributed a reward of 1-Ps and each death a penalty of -Ps. The sum of penalties and rewards, corresponding to the difference between expected and actual mortality, was compared between the centres. We present the data as excess survivors per 100 trauma patients.

Results

There were 4485 admissions at KUH and 3591 at OUH. The proportion of severely injured patients was higher at OUH compared with KUH (Injury Severity Score [ISS] >15: 33.9 % vs. 21.1 %, p <0.001). OUH had a larger proportion of patients >65 years (16.0 % vs. 13.4 %, p <0.001) and greater comorbidity (ASA-PS ≥3: 14.6 % vs. 6.9 %, p <0.001) compared with KUH. The frequency of helicopter transport and presence of prehospital physicians was higher at OUH compared with KUH (27.6 % vs. 15.5 % and 30.5 % vs. 3.7 %, both p <0.001). Secondary admissions were 5.2-fold more common at OUH compared with KUH (p <0.001). There were no differences in 30-day mortality for severely injured patients (ISS >15). Risk-adjusted survival rate was higher at OUH than at KUH for primary (0.59 vs. 0.51) but lower for secondary (1.41 vs. 2.85) admissions (both p <0.001).

Conclusion

Adjustments for age as a continuous variable and comorbidity should be made when comparing risk-adjusted survival between hospitals, but this is not possible with the TRISS model. A survival prediction model that takes this into account may be a better choice for Scandinavian trauma populations. The current study could not rule out the influence of the system differences between the centres on risk-adjusted survival.

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Title: Comparison of risk-adjusted survival in two Scandinavian Level-I trauma centres
Authors: Poya Ghorbani
Kjetil Gorseth Ringdal
Morten Hestnes
Nils Oddvar Skaga
Torsten Eken
Anders Ekbom
Lovisa Strömmer
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2016
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-016-0257-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Comparison of risk-adjusted survival in two Scandinavian Level-I trauma centres

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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