Does injury pattern among major road trauma patients influence prehospital transport decisions regardless of the distance to the nearest trauma centre? - a retrospective study.
Injury pattern
Major trauma
Road traffic injury
Trauma system
Undertriage
Journal
Scandinavian journal of trauma, resuscitation and emergency medicine
ISSN: 1757-7241
Titre abrégé: Scand J Trauma Resusc Emerg Med
Pays: England
ID NLM: 101477511
Informations de publication
Date de publication:
13 Feb 2019
13 Feb 2019
Historique:
received:
18
11
2018
accepted:
30
01
2019
entrez:
15
2
2019
pubmed:
15
2
2019
medline:
10
4
2019
Statut:
epublish
Résumé
Prehospital undertriage occurs when the required level of care for a major trauma patient is underestimated and the patient is transported to a lower-level emergency care facility. One possible reason is that the pattern of injuries exceeding a certain severity threshold is not easily recognizable in the field. The present study aims to examine whether the injury patterns of major road trauma patients are associated with trauma centre transport decisions in Sweden, controlling for the distance from the crash to the nearest trauma centre and other patient characteristics. The Swedish Traffic Accident Data Acquisition (STRADA) database was queried from April 2011 to March 2017. Teaching hospitals with neurosurgery capabilities were classified as trauma centres (TC), all other hospitals were classified as other emergency departments (ED). Injury Severity Score ≥ 13 was used as the threshold for major trauma. Ten common injury patterns were derived from the STRADA data; six patterns included serious neuro trauma to the head or spine. The remaining four patterns were: other severe injuries, moderate to serious abdomen injuries, serious thorax injuries and all other remaining injury patterns. Logistic regression was used to analyse the effect of injury patterns, age, sex and distance from crash to nearest TC on transport decision (TC or ED). Of the 2542 patients, 38.0% were transported to a TC, equating to a prehospital undertriage of 62%. Over half (59.4%) of the patients had four or more Abbreviated Injury Scale (AIS) 2+ injuries. After controlling for age, sex and distance to nearest TC, only patients sustaining serious head injuries together with other severe injuries had significantly higher odds of being transported to a TC (OR = 4.18, 95% CI: 2.03, 8.73). The odds of being transported to a TC decreased by 5% with every kilometre further away the crash location was to the nearest TC. These results highlight that there is considerable prehospital undertriage in Sweden and suggest that distance to nearest TC is more influential in transport decisions than injury pattern. These results can be used to further develop prehospital transportation guidelines and designation of trauma centres.
Sections du résumé
BACKGROUND
BACKGROUND
Prehospital undertriage occurs when the required level of care for a major trauma patient is underestimated and the patient is transported to a lower-level emergency care facility. One possible reason is that the pattern of injuries exceeding a certain severity threshold is not easily recognizable in the field. The present study aims to examine whether the injury patterns of major road trauma patients are associated with trauma centre transport decisions in Sweden, controlling for the distance from the crash to the nearest trauma centre and other patient characteristics.
METHODS
METHODS
The Swedish Traffic Accident Data Acquisition (STRADA) database was queried from April 2011 to March 2017. Teaching hospitals with neurosurgery capabilities were classified as trauma centres (TC), all other hospitals were classified as other emergency departments (ED). Injury Severity Score ≥ 13 was used as the threshold for major trauma. Ten common injury patterns were derived from the STRADA data; six patterns included serious neuro trauma to the head or spine. The remaining four patterns were: other severe injuries, moderate to serious abdomen injuries, serious thorax injuries and all other remaining injury patterns. Logistic regression was used to analyse the effect of injury patterns, age, sex and distance from crash to nearest TC on transport decision (TC or ED).
RESULTS
RESULTS
Of the 2542 patients, 38.0% were transported to a TC, equating to a prehospital undertriage of 62%. Over half (59.4%) of the patients had four or more Abbreviated Injury Scale (AIS) 2+ injuries. After controlling for age, sex and distance to nearest TC, only patients sustaining serious head injuries together with other severe injuries had significantly higher odds of being transported to a TC (OR = 4.18, 95% CI: 2.03, 8.73). The odds of being transported to a TC decreased by 5% with every kilometre further away the crash location was to the nearest TC.
CONCLUSION
CONCLUSIONS
These results highlight that there is considerable prehospital undertriage in Sweden and suggest that distance to nearest TC is more influential in transport decisions than injury pattern. These results can be used to further develop prehospital transportation guidelines and designation of trauma centres.
Identifiants
pubmed: 30760302
doi: 10.1186/s13049-019-0593-7
pii: 10.1186/s13049-019-0593-7
pmc: PMC6375202
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
18Références
Accid Anal Prev. 2017 Jan;98:149-156
pubmed: 27723516
J Trauma. 1997 Dec;43(6):922-5; discussion 925-6
pubmed: 9420106
N Engl J Med. 2006 Jan 26;354(4):366-78
pubmed: 16436768
J Trauma. 1974 Mar;14(3):187-96
pubmed: 4814394
Prehosp Emerg Care. 2012 Oct-Dec;16(4):456-62
pubmed: 22738367
Accid Anal Prev. 2014 Nov;72:422-32
pubmed: 25146496
Scand J Trauma Resusc Emerg Med. 2012 Sep 10;20:63
pubmed: 22964071
MMWR Recomm Rep. 2012 Jan 13;61(RR-1):1-20
pubmed: 22237112
Ann Adv Automot Med. 2011;55:255-65
pubmed: 22105401
Traffic Inj Prev. 2016 Sep;17 Suppl 1:16-20
pubmed: 27586097
Lancet Neurol. 2014 Aug;13(8):844-54
pubmed: 25030516
J Trauma Manag Outcomes. 2012 Aug 17;6(1):9
pubmed: 22902009
J Am Coll Surg. 2010 Dec;211(6):804-11
pubmed: 21036070
Accid Anal Prev. 2015 Jul;80:193-200
pubmed: 25912101
Injury. 2016 Jan;47(1):109-15
pubmed: 26283084
J Emerg Med. 2011 Jun;40(6):623-8
pubmed: 18930373
Scand J Trauma Resusc Emerg Med. 2008 Aug 28;16:7
pubmed: 18957069
J Trauma. 2006 Jun;60(6):1250-6; discussion 1256
pubmed: 16766968
Lancet. 2017 Sep 16;390(10100):1211-1259
pubmed: 28919117
Injury. 2009 Sep;40(9):907-11
pubmed: 19540488
J Trauma. 2006 Feb;60(2):371-8; discussion 378
pubmed: 16508498
EClinicalMedicine. 2018 Aug 05;2-3:13-21
pubmed: 31193723
Ann Surg. 2015 Mar;261(3):565-72
pubmed: 24424142