Mortality after hospital admission for trauma in Norway: A retrospective observational national cohort study

T Dehli; T Wisborg; L G Johnsen; G Brattebø; T Eken

doi:10.1016/j.injury.2023.110852

Mortality after hospital admission for trauma in Norway: A retrospective observational national cohort study

Injury. 2023 Sep;54(9):110852. doi: 10.1016/j.injury.2023.110852. Epub 2023 May 28.

Authors

T Dehli¹, T Wisborg², L G Johnsen³, G Brattebø⁴, T Eken⁵

Affiliations

¹ Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway; Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute for Clinical Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway. Electronic address: trond.dehli@unn.no.
² Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Interprofessional Rural Research Team - Finnmark, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway; Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway.
³ St. Olav's University Hospital, Department of Orthopaedic Trauma, Trondheim, Norway; Norwegian University of Science and Technology (NTNU), Department of Neuromedicine and Movement Science (INB), Trondheim, Norway.
⁴ Norwegian National Advisory Unit on Emergency Medical Communication, Department of Anaesthesia & Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
⁵ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Anaesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway.

PMID: 37302870
DOI: 10.1016/j.injury.2023.110852

Abstract

Background: National quality data for trauma care in Norway have not previously been reported. We have therefore assessed crude and risk-adjusted 30-day mortality in trauma cases after primary hospital admission on national and regional levels for 36 acute care hospitals and four regional trauma centres.

Methods: All patients in the Norwegian Trauma Registry in 2015-2018 were included. Crude and risk-adjusted 30-day mortality was assessed for the total cohort and for severe injuries (Injury Severity Score ≥16), and individual and combined effects of health region, hospital level, and hospital size were studied.

Results: 28,415 trauma cases were included. Crude mortality was 3.1% for the total cohort and 14.5% for severe injuries, with no statistically significant difference between regions. Risk-adjusted survival was lower in acute care hospitals than in trauma centres (0.48 fewer excess survivors per 100 patients, P<0.0001), amongst severely injured patients in the Northern health region (4.80 fewer excess survivors per 100 patients, P = 0.004), and in hospitals with <100 trauma admissions per year (0.65 fewer excess survivors than in hospitals with ≥100 admissions, P = 0.01). However, the only statistically significant effects in a multivariable logistic case mix-adjusted descriptive model were hospital level and health region. Case-mix adjusted odds ratio for survival for severely injured patients directly admitted to a trauma centre vs. an acute care hospital was 2.04 (95% CI 1.04-4.00, P = 0.04), and if admitted in the Northern health region vs. all other health regions was 0.47 (95% CI 0.27-0.84, P = 0.01). The proportion of cases admitted directly to the regional trauma centre in the sparsely populated Northern health region was half of that in the other regions (18.4% vs. 37.6%, P<0.0001).

Conclusion: Differences in risk-adjusted survival for severe injuries can to a large extent be attributed to whether patients are directly admitted to a trauma centre. This should have implications for planning of transport capacity in remote areas.

Keywords: Emergency service, Hospital; Epidemiology; Mortality; Norway; Trauma centers; Wounds and injuries.