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Comparison of risk-adjusted survival in two Scandinavian Level-I trauma centres.

Ghorbani P, Ringdal KG, Hestnes M, Skaga NO, Eken T, Ekbom A, Strömmer L - Scand J Trauma Resusc Emerg Med (2016)

Bottom Line: OUH had a larger proportion of patients >65 years (16.0 % vs. 13.4 %, p <0.001) and greater comorbidity (ASA-PS ≥3: 14.6 % vs. 6.9 %, p <0.001) compared with KUH.The frequency of helicopter transport and presence of prehospital physicians was higher at OUH compared with KUH (27.6 % vs. 15.5 % and 30.5 % vs. 3.7 %, both p <0.001).Secondary admissions were 5.2-fold more common at OUH compared with KUH (p <0.001).

View Article: PubMed Central - PubMed

Affiliation: Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden. poya.ghorbani@karolinska.se.

ABSTRACT

Background: Assessment of trauma-system performance is important for improving the care of injured patients. The aim of the study was to compare risk-adjusted survival in two Scandinavian Level-I trauma centres.

Methods: This was an observational, retrospective study of prospectively-collected trauma registry data for patients >14 years from Karolinska University Hospital - Solna (KUH), Sweden, and Oslo University Hospital - Ullevål (OUH), Norway, from 2009-2011. Probability of survival (Ps) was calculated according to the Trauma and Injury Severity Score (TRISS) method. Risk-adjusted survival per patient was calculated by assigning every patient a value corresponding to gained or lost fractional life: Each survivor contributed a reward of 1-Ps and each death a penalty of -Ps. The sum of penalties and rewards, corresponding to the difference between expected and actual mortality, was compared between the centres. We present the data as excess survivors per 100 trauma patients.

Results: There were 4485 admissions at KUH and 3591 at OUH. The proportion of severely injured patients was higher at OUH compared with KUH (Injury Severity Score [ISS] >15: 33.9 % vs. 21.1 %, p <0.001). OUH had a larger proportion of patients >65 years (16.0 % vs. 13.4 %, p <0.001) and greater comorbidity (ASA-PS ≥3: 14.6 % vs. 6.9 %, p <0.001) compared with KUH. The frequency of helicopter transport and presence of prehospital physicians was higher at OUH compared with KUH (27.6 % vs. 15.5 % and 30.5 % vs. 3.7 %, both p <0.001). Secondary admissions were 5.2-fold more common at OUH compared with KUH (p <0.001). There were no differences in 30-day mortality for severely injured patients (ISS >15). Risk-adjusted survival rate was higher at OUH than at KUH for primary (0.59 vs. 0.51) but lower for secondary (1.41 vs. 2.85) admissions (both p <0.001).

Conclusion: Adjustments for age as a continuous variable and comorbidity should be made when comparing risk-adjusted survival between hospitals, but this is not possible with the TRISS model. A survival prediction model that takes this into account may be a better choice for Scandinavian trauma populations. The current study could not rule out the influence of the system differences between the centres on risk-adjusted survival.

No MeSH data available.


Related in: MedlinePlus

Median hospital LOS (a), median days in ICU (b) and median hospital LOS in patients that were admitted to ICU (c), at KUH and OUH stratified by ISS category. LOS: Length of stay; ICU: Intensive care unit; KUH: Karolinska University Hospital-Solna; OUH: Oslo University Hospital-Ullevål; ISS: Injury Severity Score. **p <0.01, ***p <0.001 vs. KUH
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Fig2: Median hospital LOS (a), median days in ICU (b) and median hospital LOS in patients that were admitted to ICU (c), at KUH and OUH stratified by ISS category. LOS: Length of stay; ICU: Intensive care unit; KUH: Karolinska University Hospital-Solna; OUH: Oslo University Hospital-Ullevål; ISS: Injury Severity Score. **p <0.01, ***p <0.001 vs. KUH

Mentions: Trauma patients were more frequently admitted to the ICU at OUH than at KUH and median ICU and hospital LOS were longer (Table 3). Patients with less severe injuries (ISS 1-15) were admitted to the ICU more frequently at OUH than at KUH (17.0 % [n =403] vs. 8.3 % [n =294], p <0.001). The opposite was the case in the group with ISS 16-40 (45.9 % [n =506] vs. 57.8 % [n =488], p <0.001). There was no significant difference in ICU admissions in the group with ISS >40 between the two hospitals. Severely injured patients (ISS 16-40) had a longer median ICU LOS and a shorter median hospital LOS at OUH than at KUH (Fig. 2). For patients treated in the ICU, the median hospital LOS was shorter in all ISS categories at OUH compared to KUH.Fig. 2


Comparison of risk-adjusted survival in two Scandinavian Level-I trauma centres.

Ghorbani P, Ringdal KG, Hestnes M, Skaga NO, Eken T, Ekbom A, Strömmer L - Scand J Trauma Resusc Emerg Med (2016)

Median hospital LOS (a), median days in ICU (b) and median hospital LOS in patients that were admitted to ICU (c), at KUH and OUH stratified by ISS category. LOS: Length of stay; ICU: Intensive care unit; KUH: Karolinska University Hospital-Solna; OUH: Oslo University Hospital-Ullevål; ISS: Injury Severity Score. **p <0.01, ***p <0.001 vs. KUH
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4862151&req=5

Fig2: Median hospital LOS (a), median days in ICU (b) and median hospital LOS in patients that were admitted to ICU (c), at KUH and OUH stratified by ISS category. LOS: Length of stay; ICU: Intensive care unit; KUH: Karolinska University Hospital-Solna; OUH: Oslo University Hospital-Ullevål; ISS: Injury Severity Score. **p <0.01, ***p <0.001 vs. KUH
Mentions: Trauma patients were more frequently admitted to the ICU at OUH than at KUH and median ICU and hospital LOS were longer (Table 3). Patients with less severe injuries (ISS 1-15) were admitted to the ICU more frequently at OUH than at KUH (17.0 % [n =403] vs. 8.3 % [n =294], p <0.001). The opposite was the case in the group with ISS 16-40 (45.9 % [n =506] vs. 57.8 % [n =488], p <0.001). There was no significant difference in ICU admissions in the group with ISS >40 between the two hospitals. Severely injured patients (ISS 16-40) had a longer median ICU LOS and a shorter median hospital LOS at OUH than at KUH (Fig. 2). For patients treated in the ICU, the median hospital LOS was shorter in all ISS categories at OUH compared to KUH.Fig. 2

Bottom Line: OUH had a larger proportion of patients >65 years (16.0 % vs. 13.4 %, p <0.001) and greater comorbidity (ASA-PS ≥3: 14.6 % vs. 6.9 %, p <0.001) compared with KUH.The frequency of helicopter transport and presence of prehospital physicians was higher at OUH compared with KUH (27.6 % vs. 15.5 % and 30.5 % vs. 3.7 %, both p <0.001).Secondary admissions were 5.2-fold more common at OUH compared with KUH (p <0.001).

View Article: PubMed Central - PubMed

Affiliation: Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden. poya.ghorbani@karolinska.se.

ABSTRACT

Background: Assessment of trauma-system performance is important for improving the care of injured patients. The aim of the study was to compare risk-adjusted survival in two Scandinavian Level-I trauma centres.

Methods: This was an observational, retrospective study of prospectively-collected trauma registry data for patients >14 years from Karolinska University Hospital - Solna (KUH), Sweden, and Oslo University Hospital - Ullevål (OUH), Norway, from 2009-2011. Probability of survival (Ps) was calculated according to the Trauma and Injury Severity Score (TRISS) method. Risk-adjusted survival per patient was calculated by assigning every patient a value corresponding to gained or lost fractional life: Each survivor contributed a reward of 1-Ps and each death a penalty of -Ps. The sum of penalties and rewards, corresponding to the difference between expected and actual mortality, was compared between the centres. We present the data as excess survivors per 100 trauma patients.

Results: There were 4485 admissions at KUH and 3591 at OUH. The proportion of severely injured patients was higher at OUH compared with KUH (Injury Severity Score [ISS] >15: 33.9 % vs. 21.1 %, p <0.001). OUH had a larger proportion of patients >65 years (16.0 % vs. 13.4 %, p <0.001) and greater comorbidity (ASA-PS ≥3: 14.6 % vs. 6.9 %, p <0.001) compared with KUH. The frequency of helicopter transport and presence of prehospital physicians was higher at OUH compared with KUH (27.6 % vs. 15.5 % and 30.5 % vs. 3.7 %, both p <0.001). Secondary admissions were 5.2-fold more common at OUH compared with KUH (p <0.001). There were no differences in 30-day mortality for severely injured patients (ISS >15). Risk-adjusted survival rate was higher at OUH than at KUH for primary (0.59 vs. 0.51) but lower for secondary (1.41 vs. 2.85) admissions (both p <0.001).

Conclusion: Adjustments for age as a continuous variable and comorbidity should be made when comparing risk-adjusted survival between hospitals, but this is not possible with the TRISS model. A survival prediction model that takes this into account may be a better choice for Scandinavian trauma populations. The current study could not rule out the influence of the system differences between the centres on risk-adjusted survival.

No MeSH data available.


Related in: MedlinePlus