Holmberg Lina, Mani Kevin, Linder Fredrik, Wanhainen Anders, Wahlgren Carl Magnus, Andréasson Håkan
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
Eur J Trauma Emerg Surg. 2024 Dec;50(6):3189-3197. doi: 10.1007/s00068-024-02601-z. Epub 2024 Jul 30.
Sweden has an established trauma system involving national trauma criteria and the Swedish trauma registry (SweTrau), since over a decade. Meanwhile, the injury panorama has evolved, with an increase in gang-related violence in the Swedish community. In this study, we aimed to investigate long-term trends in mortality, management and trauma type in two major Swedish trauma centers over a nine-year period.
All trauma patients with a New Injury Score (NISS) > 15 or a Trauma Alert (TA) call during 2013-2021 were identified in the participating centers' SweTrau registries. Data were analysed regarding mortality, proportion of emergency interventions, intensive care unit (ICU) admissions, mechanism of injury and type of trauma (penetrating or blunt). To assess trends, Chi-Squared test for trend and JoinPoint regression method were used.
A total of 10,587 patients were included in the study. Mortality remained unchanged over time in patients with NISS > 15 (10.0-10.9%, p = 0.963) but increased in patients with a TA and NISS < 15 (1.3-2.7%, p = 0.005). For NISS > 15, the proportion undergoing emergency interventions was stable (53.9%-48.8%, p = 0.297) while ICU admissions declined (62.1%-45.7%, p < 0.001). Penetrating trauma increased (12.4-19.6%, p < 0.001), including knife (10.0-15.7%, p < 0.001) and gunshot wounds (2.3-3.8%, p < 0.001), whereas accidents involving motorcycles (8.8%-7.0%, p = 0.004) and pedestrians (5.3%-2.2%, p < 0.001) decreased. Assaults (both penetrating and blunt) increased from 14.7 to 21.4% (p < 0.001).
In this trend analysis at two major Swedish trauma centers during 2013-2021, penetrating trauma increased with over 50% while traffic injuries decreased. The rise in mortality in patients with a TA and NISS < 15 is concerning and requires further evaluation, as do the reduction in ICU admissions.
十多年来，瑞典已建立了一个创伤系统，其中包括国家创伤标准和瑞典创伤登记处（SweTrau）。与此同时，受伤情况发生了变化，瑞典社区帮派相关暴力事件有所增加。在本研究中，我们旨在调查瑞典两个主要创伤中心在九年期间死亡率、治疗方式和创伤类型的长期趋势。
在参与研究的中心的SweTrau登记处中，识别出2013年至2021年期间所有新损伤评分（NISS）>15或有创伤警报（TA）呼叫的创伤患者。分析了关于死亡率、紧急干预比例、重症监护病房（ICU）入院情况、损伤机制和创伤类型（穿透性或钝性）的数据。为了评估趋势，使用了趋势卡方检验和JoinPoint回归方法。
共有10587名患者纳入研究。NISS>15的患者死亡率随时间保持不变（10.0%-10.9%，p=0.963），但TA且NISS<15的患者死亡率有所上升（1.3%-2.7%，p=0.005）。对于NISS>15的患者，接受紧急干预的比例稳定（53.9%-48.8%，p=0.297），而ICU入院率下降（62.1%-45.7%，p<0.001）。穿透性创伤增加（12.4%-19.6%，p<0.001），包括刀伤（10.0%-15.7%，p<0.001）和枪伤（2.3%-3.8%，p<0.001），而涉及摩托车的事故（8.8%-7.0%，p=0.004）和行人事故（5.3%-2.2%，p<0.001）减少。袭击（包括穿透性和钝性）从14.7%增加到21.4%（p<0.001）。
在这项对瑞典两个主要创伤中心2013年至2021年期间的趋势分析中，穿透性创伤增加了50%以上，而交通伤减少。TA且NISS<15的患者死亡率上升令人担忧，需要进一步评估，ICU入院率的下降情况也是如此。
