Department of Surgical Sciences-Anesthesiology and Intensive Care, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
J Trauma Acute Care Surg. 2012 Mar;72(3):765-72. doi: 10.1097/TA.0b013e3182288272.
To determine the frequency and characteristics of prehospital deaths compared with hospital deaths in different subpopulations with severe injuries.
Population-based cohort study using person-based linkage of the Swedish nationwide hospital discharge register with death certificate data. In all, 28,715 injury deaths were identified among 419,137 cases of severe injury during 1998 to 2004. Prehospital deaths were defined as autopsied out-of-hospital deaths with injury as the underlying cause. Their impact on mortality prediction was assessed using the International Classification of Disease Injury Severity Score with the C statistic as a measure of discrimination.
The majority of all injury deaths occurred either at the scene or before hospitalization. Among persons younger than 65 years, for each hospital death there were nine prehospital deaths. A high proportion of deaths from drowning, suffocation, and firearm injuries were prehospital (85, 82, and 67% of all cases, respectively). More than 90% of hospital deaths resulted from unintentional injuries, while only 43% of prehospital deaths were unintentional. The largest increase in a cause-specific case fatality risk estimate was seen for poisoning, where inclusion of prehospital deaths increased the risk estimate from 1.6% to 22.8%. Injury mortality prediction based on International Classification of Disease Injury Severity Score improved when prehospital deaths were added to hospital data (C statistic increased from 0.86 to 0.93).
Prehospital deaths constitute the majority of trauma deaths and differ in major characteristics from hospital deaths. The high proportion of prehospital deaths among young and middle aged people highlights the potential impact of preventive efforts.
III.
确定不同亚群中严重创伤患者的院前死亡与院内死亡的频率和特征。
采用基于人群的队列研究，使用瑞典全国性医院出院登记处与死亡证明数据的个体链接。1998 年至 2004 年间共确定了 419137 例严重创伤病例中的 28715 例创伤死亡。将尸检证实的院外创伤为根本死因的院前死亡定义为尸检证实的院外死亡。使用国际疾病伤害严重程度分类损伤严重度评分来评估其对死亡率预测的影响，C 统计量作为区分度的衡量标准。
大多数所有创伤死亡发生在现场或入院前。在 65 岁以下的人群中，每例院内死亡有 9 例院前死亡。溺水、窒息和枪支伤害导致的死亡大多发生在院前（分别为 85%、82%和 67%）。超过 90%的医院死亡是由非故意损伤引起的，而只有 43%的院前死亡是由非故意损伤引起的。特定原因的病死率风险估计值增加最大的是中毒，将院前死亡纳入后，风险估计值从 1.6%增加到 22.8%。将院前死亡数据添加到医院数据后，基于国际疾病伤害严重度分类损伤严重度评分的创伤死亡率预测得到改善（C 统计量从 0.86 增加到 0.93）。
院前死亡构成了创伤死亡的大部分，与医院死亡在主要特征上有所不同。在中青年人群中院前死亡的高比例突出了预防工作的潜在影响。
III。
