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Multicenter Study
. 2018 Apr 3;26(1):24.
doi: 10.1186/s13049-018-0485-2.

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

Robert Larsen  1   2   3   4 , Denise Bäckström  5   6   7 , Mats Fredrikson  5 , Ingrid Steinvall  8 , Rolf Gedeborg  9 , Folke Sjoberg  5   10   7   8
Affiliations
Multicenter Study

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

Robert Larsen et al. Scand J Trauma Resusc Emerg Med. .

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.

Keywords: Epidemiological; ICISS; Injury; Nationwide; Risk-adjusted mortality; Trauma.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Regional Ethics Review Board in Linkoping, Sweden.

Consent for publication

Not applicable.

Competing interests

No conflicts of interest where declared by the authors. However Rolf Gedeborg is also employed by the Medical Products Agency, an agency of the Swedish government. The views expressed in this paper may not reflect the views of the Medical Products Agency.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart showing the selection of the patients studied. “Other trauma” includes all other injuries. “Multiple groups” are the observations that were coded in two groups at the same time. *The Diagnosis-specific Survival Probability was calculated on the Trauma database
Fig. 2
Fig. 2
The incidence of injuries /100000 person years over the period by mechanism of injury
Fig. 3
Fig. 3
a. Crude incidence of death within 30 days (total number of deaths/100000 inhabitants). b. Crude incidence of 30-day mortality/100000 inhabitants of injuries over the years by mechanism of injury
See this image and copyright information in PMC

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