Faculty of Health Sciences, University of Tartu, Tartu, Estonia.
Division of Trauma, Goethe University Hospital, Frankfurt, Germany.
Eur J Trauma Emerg Surg. 2016 Aug;42(4):497-502. doi: 10.1007/s00068-015-0568-y. Epub 2015 Sep 2.
The purpose of this study was to investigate epidemiology of severe injuries in Estonia while comparing outcomes at regional trauma facilities.
After the ethics review board approval, all consecutive trauma admissions with Injury Severity Score (ISS) > 15 to North Estonia Medical Center/Tallinn Children's Hospital (NEMC + TCH) and Tartu University Hospital (TUH) were identified between 1/1/2013 and 31/12/2013. Data collection included demographics, admission data, injury severity variables, interventions, and in-hospital outcomes. Primary outcome was in-hospital mortality. Secondary outcomes were complications per Clavien-Dindo and hospital length of stay (HLOS). Logistic regression analysis was used to compare adjusted mortality between the two regional hospitals.
A total of 256 patients met inclusion criteria. The mean ISS for the cohort was 23.6 ± 7.8, 13.3 % were hypotensive on admission, and 44.1 % had a Glasgow Coma Scale < 9. Overall rate of complications was 40.2 % that did not differ between the facilities. The mean HLOS at the NEMC + TCH and the TUH were 20.1 ± 25.1 and 10.5 ± 11.2 days (p < 0.001), respectively. Overall mortality was 20.7 % (n = 53). Mortality was 25.4 and 14.9 % for the NEMC + TCH and the TUH, respectively (p = 0.04). Logistic regression analysis resulted in comparable mortality at the regional trauma facilities (adj. OR 1.38; 95 % CI 0.66-2.92; p value 0.39).
The annual incidence of injuries with ISS > 15 was 256 cases with overall mortality at 20.7 % in Estonia. We observed comparable adjusted outcomes at the major regional trauma facilities. This study contains benchmarking data on severely injured patients in Estonia providing potential for future trauma care evaluation and regional outcome comparisons.
本研究旨在调查爱沙尼亚严重创伤的流行病学情况，并比较区域性创伤机构的治疗结果。
在伦理审查委员会批准后，我们于 2013 年 1 月 1 日至 12 月 31 日期间，在北爱沙尼亚医疗中心/塔林儿童医院（NEMC+TCH）和塔尔图大学医院（TUH）连续收集所有创伤严重程度评分（ISS）＞15 的创伤患者的资料。数据收集包括人口统计学、入院数据、损伤严重程度变量、干预措施和院内转归。主要结局为院内死亡率。次要结局为 Clavien-Dindo 并发症发生率和住院时间（HLOS）。我们使用逻辑回归分析比较了两家区域性医院的调整后死亡率。
共纳入 256 名患者。该队列的平均 ISS 为 23.6±7.8，入院时低血压患者占 13.3%，格拉斯哥昏迷量表评分＜9 分的患者占 44.1%。总的并发症发生率为 40.2%，两家医院的并发症发生率无差异。NEMC+TCH 和 TUH 的平均 HLOS 分别为 20.1±25.1 和 10.5±11.2 天（p＜0.001）。总的死亡率为 20.7%（n=53）。NEMC+TCH 和 TUH 的死亡率分别为 25.4%和 14.9%（p=0.04）。逻辑回归分析显示区域性创伤机构的死亡率相当（调整后比值比 1.38；95%置信区间 0.66-2.92；p 值 0.39）。
爱沙尼亚每年 ISS＞15 的创伤发病率为 256 例，总体死亡率为 20.7%。我们观察到主要区域性创伤机构的治疗结果相当。本研究提供了爱沙尼亚严重创伤患者的基准数据，为未来创伤治疗评估和区域性结果比较提供了潜在依据。
