Department of Emergency Medicine (Evans), Queen's University; ICES Queen's (Evans, Li), Kingston, Ont.; Department of Psychiatry (Seitz), University of Calgary, Calgary, Alta.
CMAJ Open. 2021 Mar 8;9(1):E208-E214. doi: 10.9778/cmajo.20200209. Print 2021 Jan-Mar.
Although Ontario has an established trauma system, it experiences a substantial burden of morbidity and mortality from injury. Our objective was to describe patterns of fatal injury in Ontario, with a focus on location of death (out of hospital, trauma or non-trauma centre) and receipt of surgical intervention before death.
We conducted a retrospective population-based cohort study using linked administrative data on fatal injuries in children and adults (no age restrictions) in Ontario between 2000 and 2016. We identified injury-related deaths in the Ontario Registrar General Death database. We developed descriptive statistics for injury characteristics and causes of death. We calculated the fatal injury incidence rate for each year of the study. The primary outcome was cause of death; the secondary outcome was receipt of surgical intervention.
The analysis included 19 408 people. The mean annual incidence of fatal injury averaged 8.7 (95% confidence interval 7.7-9.6) per 100 000. The most common mechanisms of injury were motor vehicle collisions (12 065, 62.2%), followed by gunshot wounds (3134, 16.1%) and falls (2387, 12.3%). Deaths frequently occurred out of hospital (72.6%), rather than at a trauma centre (14.2%) or non-trauma centre (13.2%). Patients treated at trauma centres were significantly more likely to receive a surgical intervention (standardized difference 0.6) than those treated at non-trauma centres.
Most injury deaths in Ontario occur in the out-of-hospital setting or are managed at non-trauma centres; many patients receive no surgical intervention before death. There are likely opportunities to improve access to specialized injury care in Ontario's trauma system.
尽管安大略省已经建立了创伤系统，但它仍面临着大量与伤害相关的发病率和死亡率。我们的目的是描述安大略省致命性伤害的模式，重点关注死亡地点（院外、创伤或非创伤中心）以及在死亡前接受手术干预的情况。
我们使用安大略省 2000 年至 2016 年期间的致命性伤害相关的、链接的行政数据进行了一项回顾性基于人群的队列研究。我们在安大略省注册总署死亡数据库中确定了与伤害相关的死亡。我们对伤害特征和死亡原因进行了描述性统计。我们计算了研究期间每年的致命性伤害发生率。主要结局是死亡原因，次要结局是接受手术干预的情况。
分析共纳入 19408 人。致命性伤害的平均年发生率为 8.7（95%置信区间 7.7-9.6）/100000。最常见的受伤机制是机动车碰撞（12065 例，62.2%），其次是枪伤（3134 例，16.1%）和跌倒（2387 例，12.3%）。死亡通常发生在院外（72.6%），而非创伤中心（14.2%）或非创伤中心（13.2%）。在创伤中心接受治疗的患者接受手术干预的可能性显著高于在非创伤中心接受治疗的患者（标准化差异 0.6）。
安大略省的大多数伤害死亡发生在院外或在非创伤中心管理；许多患者在死亡前未接受手术干预。安大略省创伤系统可能有机会改善获得专门的伤害治疗的机会。
