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Observational Study
. 2025 May 8;167(1):134.
doi: 10.1007/s00701-025-06557-w.

Regional variation in traumatic brain injury patterns, management and mortality: a nationwide Swedish cohort study

Francisco Leal-Méndez  1 , Anders Lewén  2 , Amanda Gu  2 , Anders Hånell  2 , Lina Holmberg  3 , Per Enblad  2 , Fredrik Linder  3 , Teodor Svedung Wettervik  2
Affiliations
Observational Study

Regional variation in traumatic brain injury patterns, management and mortality: a nationwide Swedish cohort study

Francisco Leal-Méndez et al. Acta Neurochir (Wien). .

Abstract

Background: Sweden covers a large land area, but is sparsely populated. The country is divided into six heterogenous healthcare regions, each with different geographic conditions and referral patterns when it comes to traumatic brain injury (TBI). This study aimed to explore the variation in demography, injury patterns, care pathways, management, and mortality (30 d) for TBI patients within the country.

Methods: A nationwide, observational study, using data from the Swedish Trauma Registry (SweTrau) between 2018-2022, was performed. A total of 5036 TBI patients were included. Data on demography, admission status (through Glasgow Coma Scale [GCS] value at arrival at first managing hospital), injury-related variables, and mortality (30 d) were evaluated.

Results: The median age was 65 years (interquartile range 46-78), and the majority of patients were male, had sustained fall-related injuries, and were conscious upon admission. Slight, but significant differences (p < 0.05) existed among the regions in these variables. In multivariate logistic regression models, the healthcare region (p < 0.05) was independently associated with patient referral to a university hospital (as compared to care at a local hospital alone), craniotomy rate, and receiving an intracranial pressure-monitoring device, after adjustment for demographic and injury variables. In similar regressions regarding mortality, specific healthcare regions (p < 0.05) were independently associated with said outcome.

Conclusions: The study highlights, from a systems-level perspective, that there was a significant variation in care pathways and management among the six healthcare regions in Sweden, which might have impacted on clinical outcome. These findings call for more granular studies to understand which aspects of patient management that were particularly beneficial or detrimental for patient survival and recovery.

Keywords: Craniotomy; Epidemiology; Neurointensive care; Outcome; Traumatic brain injury.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Human ethics and consent to participate: The study was approved by the Swedish Ethical Review Authority (Dnr 2023–07084-01) for the use of SweTrau registry data. Informed consent was not required; however, participants had the opportunity to opt out of data registration and request the removal of their registered data from SweTrau.

Figures

Fig. 1
Fig. 1
Flow chart of patient inclusion. In this study, 5036 patients over the age of 16 years in the SweTrau register with TBI (ICD-10 codes S06.0 to S06.9) who had been treated at any ICU in Sweden from the 1 st of January 2018 to the 31 st of December 2022 were included. ICD, International Classification of Diseases; ICU, Intensive Care Unit; TBI, Traumatic Brain Injury
Fig. 2
Fig. 2
Map of Sweden divided into its six healthcare regions. Pop, Population; TBI, Traumatic brain injury; UH, University hospital. Cpm/year, Cases per million and year
See this image and copyright information in PMC

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