Forskningsartikler
Forskningsbidrag til økt forståelse, bedre beslutningsgrunnlag og videreutvikling av traumebehandlingen nasjonalt.
Is there a weekend effect on mortality rate and outcome for moderate and severe traumatic brain injury? A population-based, observational cohort study.
Purpose: The aim of the study was to analyse patient and injury characteristics and the effects of weekend admissions on mortality rate and outcome after moderate and severe traumatic brain injuries.
Methods: This is an observational cohort study based on data from a prospectively maintained regional trauma registry in South Western Norway. Patients with moderate and severe traumatic brain injury admitted between January 1st, 2004 and December 31st, 2019 were included in this study.
Results: During the study period 688 patients were included in the study with similar distribution between moderate (n = 318) and severe (n = 370) traumatic brain injury. Mortality rate was 46% in severe and 13% in moderate traumatic brain injury. Two hundred and thirty-one (34%) patients were admitted during weekends. Patients admitted during weekends were significantly younger (median age (IQR) 32.0 (25.5-67.0) vs 47.0 (20.0-55.0), p < 0.001). Pre-injury ASA 1 was significantly more common in patients admitted during weekends (n = 146, 64%, p = 0.001) while ASA 3 showed significance during weekdays compared to weekends (n = 101, 22%, p = 0.013). On binominal logistic regression analysis mortality rate was significantly higher with older age (OR 1.03, 95% CI for OR 1.02-1.04, p < 0.001) and increasing TBI severity (OR 7.08, 95% CI for OR 4.67-10.73, p < 0.001).
Conclusions: Mortality rate and poor clinical outcome remain high in severe traumatic brain injury. While a higher number of patients are admitted during the weekend, mortality rate does not differ from weekday admissions.
Injury. 2025;56(1):112063.
Accuracy of the Norwegian trauma protocol. An observational population study from South-Western Norway.
Background: The Norwegian trauma plan was established in 2007 and renewed in 2017 defining national trauma team activation (TTA) criteria. Norwegian studies validating the performance of previous TTA protocols have found overtriage and undertriage to be out of line with the quality indicators set in the national trauma plan, but studies have not yet been published validating the new TTA protocol.
Material and method: This was a registry study of a prospectively maintained database in the period from 01/01/2018 to 12/31/2020. Data were collected from the Trauma Registry including prehospital documents. A total of 1519 patients were eligible, of which 95 were excluded, yielding a study population of 1424 patients. All patients were evaluated for a total of 29 criteria in four criteria groups: 1 Physiology, 2 Anatomical injury, 3 Mechanism of injury, and 4 Special considerations. Overtriage, undertriage, sensitivity and positive predictive value (PPV) were estimated for the current and alternative TTA protocols, criteria groups, and single criteria.
Results: The current Norwegian TTA protocol involving criteria groups 1-3 had a total sensitivity of 84.8 %, hence an undertriage of 15.2 % (95 % confidence interval, 11.1-20.3 %), and PPV of 19.2 % hence an overtriage of 80.8 % (78.3-83.1 %). Patients 60 years and older had an undertriage of 21.6 %, whilst patients under 60 years of age had an undertriage of 11.2 %. A TTA protocol including criteria group 4 as well yielded a lower undertriage (5.6 %) without significantly increasing overtriage (81.7 %), and a TTA protocol with criteria group 4 replacing group 3 yielded an undertriage of 7.4 % and an overtriage of 81.0 %. Criteria group 3 Mechanism of injury was the criteria group with the most overtriage, at 95 %. Patients that did not meet any criteria had a similar overtriage of 94 %.
Conclusion: Both overtriage and undertriage are out of line with the goals set in the Norwegian trauma plan. Undertriage is often caused by older patients that do not fulfill the trauma criteria in the current TTA protocol. Mechanism of injury increases overtriage but does not reduce undertriage. The TTA protocol could be improved by changing the composition of criteria groups, removal of single criteria with low PPV, and by better compliance to the existing criteria.
Bjorke G, Dalen I, Thorsen K.
Injury. 2023;54(12):111160.
Prevalence of use and impairment from drugs and alcohol among trauma patients: A national prospective observational study.
Background: Being under the influence of psychoactive substances increases the risk of involvement in and dying from a traumatic event. The study is a prospective population-based observational study that aims to determine the prevalence of use and likely impairment from psychoactive substances among patients with suspected severe traumatic injury.
Method: This study was conducted at 35 of 38 Norwegian trauma hospitals from 1 March 2019 to 29 February 2020. All trauma admissions for patients aged ≥ 16 years admitted via trauma team activation during the study period were eligible for inclusion. Blood samples collected on admission were analysed for alcohol, benzodiazepines, benzodiazepine-like hypnotics (Z-drugs), opioids, stimulants, and cannabis (tetrahydrocannabinol).
Results: Of the 4878 trauma admissions included, psychoactive substances were detected in 1714 (35 %) and in 771 (45 %) of these, a combination of two or more psychoactive substances was detected. Regarding the level of impairment, 1373 (28 %) admissions revealed a concentration of one or more psychoactive substances indicating likely impairment, and 1052 (22 %) highly impairment. Alcohol was found in 1009 (21 %) admissions, benzodiazepines and Z-drugs in 613 (13 %), opioids in 467 (10 %), cannabis in 352 (7 %), and stimulants in 371 (8 %). Men aged 27-43 years and patients with violence-related trauma had the highest prevalence of psychoactive substance use with respectively 424 (50 %) and 275 (80 %) testing positive for one or more compounds.
Conclusion: The results revealed psychoactive substances in 35 % of trauma admissions, 80 % of which were likely impaired at the time of traumatic injury. A combination of several psychoactive substances was common, and younger males and patients with violence-related injuries were most often impaired. Injury prevention strategies should focus on high-risk groups and involve the prescription of controlled substances. We should consider toxicological screening in trauma admissions and incorporation of toxicological data into trauma registries.
Brathen CC, Jorgenrud BM, Bogstrand ST, Gjerde H, Rosseland LA, Kristiansen T.
Transfusion practice in Central Norway – a regional cohort study in patients suffering from major haemorrhage.
Background: In patients with major hemorrhage, balanced transfusions and limited crystalloid use is recommended in both civilian and military guidelines. This transfusion strategy is often applied in the non-trauma patient despite lack of supporting data. The aim of this study was to describe the current transfusion practice in patients with major hemorrhage of both traumatic and non-traumatic etiology in Central Norway, and discuss if transfusions are in accordance with appropriate massive transfusion protocols.
Methods: In this retrospective observational cohort study, data from four hospitals in Central Norway was collected from 01.01.2017 to 31.12.2018. All adults (≥18 years) receiving massive transfusion (MT) and alive on admission were included. MT was defined as transfusion of ≥10 units of packed red blood cells (PRBC) within 24 hours, or ≥ 5 units of PRBC during the first 3 hours after admission to hospital. Clinical data was collected from the hospital blood bank registry (ProSang) and electronic patient charts (CareSuite PICIS). Patients undergoing cardiothoracic surgery or extracorporeal membrane oxygenation treatment were excluded.
Results: A total of 174 patients were included in the study, of which 85.1% were non-trauma patients. Seventy-six per cent of all patients received plasma:PRBC in a ratio ≥ 1:2 (high ratio) and 59.2% of patients received platelets:PRBC in a ratio ≥ 1:2 (high ratio). 32.2% received a plasma:PRBC-ratio ≥ 1:1, and 23.6% platelet:PRBC-ratio ≥ 1:1. Median fluid infusion of crystalloids in all patients was 5750 mL. Thirty-seven per cent of all patients received tranexamic acid, 53.4% received calcium and fibrinogen concentrate was administered in 9.2%.
Conclusions: Most patients had a non-traumatic etiology. The majority was transfused with high ratios of plasma:PRBC and platelet:PRBC, but not in accordance with the aim of the local protocol (1:1:1). Crystalloids were administered liberally for both trauma and non-trauma patients. There was a lower use of hemostatic adjuvants than recommended in the local transfusion protocol. Awareness to local protocol should be increased.
Injury. 2021;52(3):450–9.
Epidemiology of geriatric trauma patients in Norway: A nationwide analysis of Norwegian Trauma Registry data, 2015-2018. A retrospective cohort study.
Introduction: Geriatric patients have a high risk of poor outcomes after trauma and is a rapid-increasing group within the trauma population. Given the need to ensure that the trauma system is targeted, efficient, accessible, safe and responsive to all age groups the aim of the present study was to explore the epidemiology and characteristics of the Norwegian geriatric trauma population and assess differences between age groups within a national trauma system.
Materials and methods: This retrospective analysis is based on data from the Norwegian Trauma Registry (2015-2018). Injury severity was scaled using the Abbreviated Injury Scale (AIS), and the New Injury Severity Score (NISS). Trauma patients 16 years or older with NISS ≥9 were included, dichotomized into age groups 16-64 years (Group 1, G1) and ≥65 years (Group 2, G2). The groups were compared with respect to differences in demographics, injury characteristics, management and outcome. Descriptive statistics and relevant parametric and non-parametric tests were used.
Results: Geriatric patients proved to be at risk of sustaining severe injuries. Low-energy falls predominated in G2, and the AIS body regions ‘Head’ and ‘Pelvis and lower extremities’ were most frequently injured. Crude 30-day mortality was higher in G2 compared to G1 (G1: 2.9 vs. G2: 13.6%, P<0.01) and the trauma team activation (TTA) rate was lower (G1: 90 vs. G2: 73%, P<0.01). A lower proportion of geriatric patients were treated by a physician prehospitally (G1: 30 vs. G2: 18%, [NISS 15-24], P<0.01) and transported by air-ambulance (G1: 24 vs. G2: 14%, [NISS 15-24], P<0.01). Median time from alarm to hospital admission was longer for geriatric patients (G1: 71 vs. G2: 78 min [NISS 15-24], P<0.01), except for the most severely injured patients (NISS≥25).
Conclusion: In this nationwide study comparing adult and geriatric trauma patients, geriatric patients were found to have a higher mortality, receive less frequently advanced prehospital treatment and transportation, and a lower TTA rate. This is surprising in the setting of a Nordic country with free access to publicly funded emergency services, a nationally implemented trauma system with requirements to pre- and in-hospital services and a national trauma registry with high individual level coverage from all trauma-receiving hospitals. Further exploration and a deeper understanding of these differences is warranted.
Scand J Trauma Resusc Emerg Med. 2023;31(1):34.
Care pathways and factors associated with interhospital transfer to neurotrauma centers for patients with isolated moderate-to-severe traumatic brain injury: a population-based study from the Norwegian trauma registry.
Background: Systems ensuring continuity of care through the treatment chain improve outcomes for traumatic brain injury (TBI) patients. Non-neurosurgical acute care trauma hospitals are central in providing care continuity in current trauma systems, however, their role in TBI management is understudied. This study aimed to investigate characteristics and care pathways and identify factors associated with interhospital transfer to neurotrauma centers for patients with isolated moderate-to-severe TBI primarily admitted to acute care trauma hospitals.
Methods: A population-based cohort study from the national Norwegian Trauma Registry (2015-2020) of adult patients (≥ 16 years) with isolated moderate-to-severe TBI (Abbreviated Injury Scale [AIS] Head ≥ 3, AIS Body < 3 and maximum 1 AIS Body = 2). Patient characteristics and care pathways were compared across transfer status strata. A generalized additive model was developed using purposeful selection to identify factors associated with transfer and how they affected transfer probability.
Results: The study included 1735 patients admitted to acute care trauma hospitals, of whom 692 (40%) were transferred to neurotrauma centers. Transferred patients were younger (median 60 vs. 72 years, P < 0.001), more severely injured (median New Injury Severity Score [NISS]: 29 vs. 17, P < 0.001), and had lower admission Glasgow Coma Scale (GCS) scores (≤ 13: 55% vs. 27, P < 0.001). Increased transfer probability was significantly associated with reduced GCS scores, comorbidity in patients < 77 years, and increasing NISSs until the effect was inverted at higher scores. Decreased transfer probability was significantly associated with increasing age and comorbidity, and distance between the acute care trauma hospital and the nearest neurotrauma center, except for extreme NISSs.
Conclusions: Acute care trauma hospitals managed a substantial burden of isolated moderate-to-severe TBI patients primarily and definitively, highlighting the importance of high-quality neurotrauma care in non-neurosurgical hospitals. The transfer probability declined with increasing age and comorbidity, suggesting that older patients were carefully selected for transfer to specialized care.
J Trauma Acute Care Surg. 2022;93(4):503–12.
Differences in time-critical interventions and radiological examinations between adult and older trauma patients: A national register-based study.
Background: Older trauma patients are reported to receive lower levels of care than younger adults. Differences in clinical management between adult and older trauma patients hold important information about potential trauma system improvement targets. The aim of this study was to compare prehospital and early in-hospital management of adult and older trauma patients, focusing on time-critical interventions and radiological examinations.
Methods: Retrospective analysis of the Norwegian Trauma Registry for 2015 through 2018. Trauma patients 16 years or older met by a trauma team and with New Injury Severity Score of 9 or greater were included, dichotomized into age groups 16 years to 64 years and 65 years or older. Prehospital and emergency department clinical management, advanced airway management, chest decompression, and admission radiological examinations was compared between groups applying descriptive statistics and appropriate statistical tests.
Results: There were 9543 patients included, of which 28% (n = 2711) were 65 years or older. Older patients, irrespective of injury severity, were less likely attended by a prehospital doctor/paramedic team (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.57-0.71), conveyed by air ambulance (OR, 0.65; 95% CI, 0.58-0.73), and transported directly to a trauma center (OR, 0.86; 95% CI, 0.79-0.94). Time-critical intervention and primary survey radiological examination rates only differed between age groups among patients with New Injury Severity Score of 25 or greater, showing lower rates for older adults (advanced airway management: OR, 0.60; 95% CI, 0.47-0.76; chest decompression: OR, 0.46; 95% CI, 0.25-0.85; x-ray chest: OR, 0.54; 95% CI, 0.39-0.75; x-ray pelvis: OR, 0.69; 95% CI, 0.57-0.84). However, for the patients attended by a doctor/paramedic team, there were no management differences between age groups.
Conclusion: Older trauma patients were less likely to receive advanced prehospital care compared with younger adults. Older patients with very severe injuries received fewer time-critical interventions and radiological examinations. Improved dispatch of doctor/paramedic teams to older adults and assessment of the impact the observed differences have on outcome are future research priorities.
Injury. 2023;54(9):110852.
Mortality after hospital admission for trauma in Norway: A retrospective observational national cohort study.
Background: National quality data for trauma care in Norway have not previously been reported. We have therefore assessed crude and risk-adjusted 30-day mortality in trauma cases after primary hospital admission on national and regional levels for 36 acute care hospitals and four regional trauma centres.
Methods: All patients in the Norwegian Trauma Registry in 2015-2018 were included. Crude and risk-adjusted 30-day mortality was assessed for the total cohort and for severe injuries (Injury Severity Score ≥16), and individual and combined effects of health region, hospital level, and hospital size were studied.
Results: 28,415 trauma cases were included. Crude mortality was 3.1% for the total cohort and 14.5% for severe injuries, with no statistically significant difference between regions. Risk-adjusted survival was lower in acute care hospitals than in trauma centres (0.48 fewer excess survivors per 100 patients, P<0.0001), amongst severely injured patients in the Northern health region (4.80 fewer excess survivors per 100 patients, P = 0.004), and in hospitals with <100 trauma admissions per year (0.65 fewer excess survivors than in hospitals with ≥100 admissions, P = 0.01). However, the only statistically significant effects in a multivariable logistic case mix-adjusted descriptive model were hospital level and health region. Case-mix adjusted odds ratio for survival for severely injured patients directly admitted to a trauma centre vs. an acute care hospital was 2.04 (95% CI 1.04-4.00, P = 0.04), and if admitted in the Northern health region vs. all other health regions was 0.47 (95% CI 0.27-0.84, P = 0.01). The proportion of cases admitted directly to the regional trauma centre in the sparsely populated Northern health region was half of that in the other regions (18.4% vs. 37.6%, P<0.0001).
Conclusion: Differences in risk-adjusted survival for severe injuries can to a large extent be attributed to whether patients are directly admitted to a trauma centre. This should have implications for planning of transport capacity in remote areas.
Dent Traumatol. 2021;37(2):240–6.
Dentoalveolar injuries, bicycling accidents and helmet use in patients referred to a Norwegian Trauma Centre: A 12-year prospective study.
Background/aim: Despite its many benefits, bicycling carries the risk of accidents. Although numerous studies have reported the effect of helmet use on traumatic brain injury, it remains unclear if, and to what extent, helmet use reduces the risk of facial injuries. This is particularly true in regard to injuries of the lower face. In addition, there is limited evidence of the effect of helmet use on dentoalveolar injuries. Thus, the aim of this study was to determine the frequency and distribution of dentoalveolar injuries in bicycling accidents and to explore the influence of helmet use.
Material and methods: A total of 1543 bicyclists were included from the trauma registry of a Norwegian tertiary trauma center over a 12-year period. Data were collected prospectively, including patient characteristics, type of injury, and helmet use. The prevalence of dentoalveolar injuries was assessed in conjunction with helmet use and facial fractures.
Results: Twenty-five percent of the patients had maxillofacial injuries, and 18% of those with facial fractures exhibited concomitant dentoalveolar injuries. The most common type of dentoalveolar injury was tooth fracture (39%). The most frequent location of facial fractures with combined dentoalveolar injuries was the maxilla, which had fractured in 32 patients. Women had a higher risk of sustaining dentoalveolar injuries compared to men (odds ratio 1.50, 95% confidence interval 1.02-2.22). There were 1257 patients (81%) who had reliable registration of helmet use; 54% of these wore a helmet, while 46% did not. Helmet users had an increased risk of dentoalveolar injuries compared to non-helmeted bicyclists (adjusted odds ratio 1.54, 95% confidence interval 1.02-2.31).
Conclusions: Dentoalveolar injuries are fairly common in trauma patients admitted to a trauma center following bicycling accidents. Bicycling helmets are associated with an increased risk of dentoalveolar injuries.
Dent Traumatol. 2022;38(5):424–30.
Anatomical distribution of mandibular fractures from severe bicycling accidents: A 12-year experience from a Norwegian level 1 trauma center.
Background/aim: The mandible makes up a substantial part of the lower face, and is susceptible to injury. Even in helmeted cyclists, accidents may lead to fractures of the mandible because conventional helmets provide little protection to the lower part of the face. In addition, some studies indicate that helmets may lead to an increased risk of mandibular fractures. Thus, the aim of this study was to examine the anatomic distribution of mandibular fractures in injured cyclists and to assess if helmet use influenced the fracture locations.
Material and methods: Data from a Norwegian Level 1 trauma center were collected in the Oslo University Hospital Trauma Registry over a 12-year period. Of 1543 injured cyclists, the electronic patient charts of 62 cyclists with fractures of the mandible were retrospectively evaluated in detail. Demographic data, helmet use, and fracture type were assessed.
Results: Sixty-two patients (4%) had fractures of the mandible, and women had an increased risk (OR 2.49, 95% CI 1.49-4.16, p < .001). The most common fracture site was the mandibular body, followed by the condyle. Isolated mandibular fractures occurred in 45% of the patients and 55% had other concomitant facial fractures. There were 42% of the patients with fractures in multiple sites of the mandible, and 42% had a concomitant dentoalveolar injury. Half of the cyclists were wearing a helmet at the time of the accident and 39% were not. There was no significant difference in fracture distribution between the helmeted and non-helmeted groups.
Conclusions: Fracture of the mandibular body was the most prevalent mandibular fracture type following bicycle accidents. Women had an increased risk of mandibular fractures compared with men, whereas helmet wearing did not affect the anatomical fracture site.
BMJ Open. 2024;14(1):e079161.
A qualitative longitudinal study of traumatic orthopaedic injury survivors’ experiences with pain and the long-term recovery trajectory.
Objectives: To explore trauma patients’ experiences of the long-term recovery pathway during 18 months following hospital discharge.
Design: Longitudinal qualitative study.
Setting and participants: Thirteen trauma patients with injuries associated with pain that had been interviewed 6 weeks after discharge from Oslo University Hospital in Norway, were followed up with an interview 18 months postdischarge.
Method: The illness trajectory framework informed the data collection, with semistructured, in-depth interviews that were analysed thematically.
Results: Compared with the subacute phase 6 weeks postdischarge, several participants reported exacerbated mental and physical health, including increased pain during 18 months following discharge. This, andalternating periods of deteriorated health status during recovery, made the pathway unpredictable. At 18 months post-discharge, participants were coping with experiences of reduced mental and physical health and socioeconomic losses. Three main themes were identified: (1) coping with persistent pain and reduced physical function, (2) experiencing mental distress without access to mental healthcare and (3) unmet needs for follow-up care. Moreover, at 18 months postdischarge, prescribed opioids were found to be easily accessible from GPs. In addition to relieving chronic pain, motivations to use opioids were to induce sleep, reduce withdrawal symptoms and relieve mental distress.
Conclusions and implications: The patients’ experiences from this study establish knowledge of several challenges in the trauma population’s recovery trajectories, which may imply that subacute health status is a poor predictor of long-term outcomes. Throughout recovery, the participants struggled with physical and mental health needs without being met by the healthcare system. Therefore, it is necessary to provide long-term follow-up of trauma patients’ health status in the specialist health service based on individual needs. Additionally, to prevent long-term opioid use beyond the subacute phase, there is a need to systematically follow-up and reassess motivations and indications for continued use throughout the recovery pathway.
Acta Neurochir (Wien). 2024;166(1):132.
The association between head injury and facial fracture treatment: an observational study of hospitalized bicyclists from a level 1 trauma centre.
Purpose: To compare the types of facial fractures and their treatment in bicyclists admitted to a level 1 trauma centre with major and minor-moderate head injury.
Methods: Retrospective analysis of data from bicycle-related injuries in the period 2005-2016 extracted from the Oslo University Hospital trauma registry.
Results: A total of 967 bicyclists with head injuries classified according to the Abbreviated Injury Scale (AIS) were included. The group suffering minor-moderate head injury (AIS Head 1-2) included 518 bicyclists, while 449 bicyclists had major head injury (AIS Head 3-6). The mean patient age was 40.2 years (range 3-91 years) and 701 patients (72%) were men. A total of 521 facial fractures were registered in 262 patients (on average 2 facial fractures per bicyclist). Bicyclists with major head injury exhibited increased odds for facial fractures compared to bicyclists with minor-moderate head injury (sex and age adjusted odds ratio (OR) 2.75, 95% confidence interval (CI) 2.03-3.72, p < 0.001. More specifically, there was increased odds for all midface fractures, but no difference for mandible fractures. There was also increased odds for orbital reconstruction in cyclist with major head injury compared to bicyclist with minor-moderate head injury (adjusted OR 3.34, 95% CI 1.30-8.60, p = 0.012).
Conclusion: Bicyclists with more severe head injuries had increased odds for midface fractures and surgical correction of orbital fractures. During trauma triage, the head and the face should be considered as one unit.
J Craniofac Surg. 2024;35(5):1325–8.
Do Bicycle Helmets Protect Against Facial Fractures? An Observational Study From a Level 1 Trauma Centre.
This study investigates the impact of helmet use on the incidence of facial fractures in bicycle accidents. Analyzing data from hospitalized bicyclists between 2005 and 2016, the research focused on the correlation between helmet usage and various facial fractures. The study included 1256 bicyclists with known helmet use, among whom 277 individuals (22%) were identified with a total of 521 facial fractures. The findings revealed a significant reduction in the likelihood of facial fractures among helmeted cyclists compared with those without helmets (odds ratio, 0.65; confidence interval, 0.50-0.85; P=0.002). Specifically, the odds of sustaining fractures in the zygoma, orbit, nose, and maxilla were decreased by 47%, 46%, 43%, and 33%, respectively, among helmeted cyclists. However, helmet use did not significantly alter the odds of mandible fractures. Overall, the use of helmets in bicycling significantly lowered the risk of midface fractures but showed no notable effect on mandible fractures in severe cycling incidents.
J Craniofac Surg. 2023;34(1):34–9.
Facial Fractures and Their Relation to Head and Cervical Spine Injuries in Hospitalized Bicyclists.
Bicyclists are vulnerable road users. The authors aimed to characterise facial fractures and their association with head and neck injuries in bicyclists admitted to a Scandinavian Level 1 trauma center with a catchment area of ~3 million inhabitants. Data from bicycle-related injuries in the period 2005 to 2016 were extracted from the Oslo University Hospital trauma registry. Variables included were age; sex; date of injury; abbreviated injury scale (AIS) codes for facial skeletal, head and neck injuries; and surgical procedure codes for treatment of facial fractures. Anatomical injury was classified according to AIS98. A total of 1543 patients with bicycle-related injuries were included. The median age was 40 years (quartiles 53, 25), and 1126 (73%) were men. Overall, 652 fractures were registered in 339 patients. Facial fractures were observed in all age groups; however, the proportion rose with increasing age. Bicyclists who suffered from facial fractures more often had a concomitant head injury (AIS head >1) than bicyclists without facial fractures (74% vs. 47%), and the odds ratio for facial fracture(s) in the orbit, maxilla and zygoma were significantly increased in patients with AIS head >1 compared to patients with AIS head=1. In addition, 17% of patients with facial fractures had a concomitant cervical spine injury versus 12% of patients without facial fractures. This results showed that facial fractures were common among injured bicyclists and associated with both head and cervical spine injury. Thus, a neurological evaluation of these patients are mandatory, and a multidisciplinary team including maxillofacial and neurosurgical competence is required to care for these patients.
Copyright © 2022 by Mutaz B. Habal, MD.
Emerg Med J. 2022;39(7):521–6.
Needs assessment of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major haemorrhage: a cross-sectional study.
Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) can be used as an adjunct treatment in traumatic abdominopelvic haemorrhage, ruptured abdominal aortic aneurysms, postpartum haemorrhage (PPH), gastrointestinal bleeding and iatrogenic injuries during surgery. This needs assessment study aims to determine the number of patients eligible for REBOA in a typical Norwegian population.
Methods: This was a retrospective cross-sectional study based on data obtained from blood bank registries and the Norwegian Trauma Registry for the years 2017-2018. Patients who received ≥4 units of packed red blood cells (PRBCs) within 6 hours and met the anatomical criteria for REBOA or patients with relevant Abbreviated Injury Scale codes with concurrent hypotension or transfusion of ≥4 units of PRBCs within 6 hours were identified. A detailed two-step chart review was performed to identify potentially eligible REBOA candidates. Descriptive data were collected and compared between subgroups using non-parametric tests for statistical significance.
Results: Of 804 patients eligible for inclusion, 53 patients were regarded as potentially REBOA eligible (corresponding to 5.7 per 100 000 adult population/year). Of these, 19 actually received REBOA. Among the identified eligible patients, 44 (83%) had a non-traumatic aetiology. Forty-two patients (79%) were treated at a tertiary care hospital. Fourteen (78%) of the REBOA procedures were due to PPH.
Conclusion: The number of patients potentially eligible for REBOA after haemorrhage is low, and most cases are non-traumatic. Most patients were treated at a tertiary care hospital. The exclusion of non-traumatic patients results in a substantial underestimation of the number of potentially REBOA-eligible patients.
Scand J Trauma Resusc Emerg Med. 2024;32(1):133.
Adherence to national trauma triage criteria in Norway: a cross-sectional study.
Background: Norwegian hospitals employed individual trauma triage criteria until 2015 when nationwide criteria were implemented. There is a lack of empirical evidence regarding adherence to Norwegian national criteria for activation of the trauma team (NTrC) and the decision-making processes regarding trauma team activation (TTA) within Norwegian trauma hospitals. The objectives of this study were to investigate institutional adherence to the NTrC and to investigate similarities and differences in the decision-making process leading to TTA in Norwegian trauma hospitals.
Methods: A digital semi-structured questionnaire regarding adherence to criteria, TTA decision-making and criteria documentation was distributed to all Norwegian trauma hospitals (n = 38) in the spring of 2022. Contact details of trauma coordinators and registrars were provided by the Norwegian Trauma Registry secretariat. Follow-up telephone interviews were conducted at the investigator’s discretion in cases of non-respondents or need to clarify answers.
Results: Thirty-eight trauma hospitals were invited to answer the survey, where 35 hospitals responded (92%), making 35 the denominator of the results. Thirty-four (97.1%) hospitals stated that they followed NTrC. Thirty-three (94.3%) of the responding hospitals provided documentation of their criteria in use, of which twenty-eight (80%) of responding hospitals adhered to the NTrC. Three (8.6%) hospitals employed a tiered TTA approach with different sized teams. In addition four hospitals (11.4%) used specialized teams to meet the needs of defined patient groups (e.g. geriatric patients, traumatic brain injury). Twenty-one (60%) of the responding hospitals had written guidelines on who could perform TTA and in 18 hospitals (51.4%) TTA could be performed by pre-hospital personnel. Twenty-three (65.7%) of the hospitals documented which criteria that were used for TTA.
Conclusion: There is good adherence to the national criteria for activation of the trauma team among Norwegian trauma hospitals after implementation of national guidelines. Individual hospitals argue the use of certain local criteria and trauma team activation decision-making processes to increase their precision in specific patient populations and demographics. Further steps should be done to reduce the variation in TTA decision-making processes among hospitals and improve documentation quality.
Alcohol Alcohol. 2024;59(3).
Identifying excessive chronic alcohol use with phosphatidylethanol in patients with suspected severe injury-results from the IDART study.
Introduction: Acute and chronic alcohol use are well-known risk factors for accidents and injuries, and concurrent psychoactive drug use can increase injury risk further. Phosphatidylethanol (PEth) 16:0/18:1 is a biomarker used to determine alcohol consumption the previous 3-4 weeks. The aim was to investigate the prevalence of chronic alcohol use in trauma patients, as determined by PEth 16:0/18:1 concentrations, and how excessive chronic alcohol use relate to demographic variables, injury mechanisms and drug use.
Setting: Patients received at Norwegian trauma hospitals from March 2019 to February 2020. The study is part of the Impairing Drugs and Alcohol as Risk factors for Traumatic Injuries study.
Methods: All patients aged ≥ 16 years received with trauma team were included in the study. Data on injury date and mechanism, gender and age was registered. Blood samples were analyzed for 22 psychoactive medicinal and illicit drugs, ethanol and phosphatidylethanol 16:0/18:1. Regression analyses were conducted to assess associations between alcohol use and gender, age, injury mechanism and drug use.
Results and conclusion: Of the 4845 patients included in the study, 10% had PEth 16:0/18:1 concentration ≥ 600 nM (~430 ng/mL), indicative of excessive chronic alcohol use. Being male, between 44-61 years old, involved in violence, and testing positive for medicinal drugs was associated with excessive chronic alcohol use.Excessive chronic alcohol use was common among males, middle-aged, patients with violence as injury mechanism and those with medicinal drug use. These findings emphasize the need to detect and treat excessive chronic alcohol use among trauma patients.
BMJ Mil Health. 2025;171(4):288–9.
Removal of tourniquets: the next step in saving lives and limbs.
No abstract available
World J Surg. 2021;45(5):1340–8.
Structured and Systematic Team and Procedure Training in Severe Trauma: Going from ‘Zero to Hero’ for a Time-Critical, Low-Volume Emergency Procedure Over Three Time Periods.
Background: Resuscitative emergency thoracotomy is a potential life-saving procedure but is rarely performed outside of busy trauma centers. Yet the intervention cannot be deferred nor centralized for critically injured patients presenting in extremis. Low-volume experience may be mitigated by structured training. The aim of this study was to describe concurrent development of training and simulation in a trauma system and associated effect on one time-critical emergency procedure on patient outcome.
Methods: An observational cohort study split into 3 arbitrary time-phases of trauma system development referred to as ‘early’, ‘developing’ and ‘mature’ time-periods. Core characteristics of the system is described for each phase and concurrent outcomes for all consecutive emergency thoracotomies described with focus on patient characteristics and outcome analyzed for trends in time.
Results: Over the study period, a total of 36 emergency thoracotomies were performed, of which 5 survived (13.9%). The «early» phase had no survivors (0/10), with 2 of 13 (15%) and 3 of 13 (23%) surviving in the development and mature phase, respectively. A decline in ‘elderly’ (>55 years) patients who had emergency thoracotomy occurred with each time period (from 50%, 31% to 7.7%, respectively). The gender distribution and the injury severity scores on admission remained unchanged, while the rate of patients with signs on life (SOL) increased over time.
Conclusion: The improvement over time in survival for one time-critical emergency procedure may be attributed to structured implementation of team and procedure training. The findings may be transferred to other low-volume regions for improved trauma care.
J Rehabil Med. 2024;56:jrm40078.
Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries.
Objective: To describe the needs for subacute inpatient rehabilitation and community-based healthcare services, rehabilitation, and social support in patients with moderate-to-severe traumatic injury in the first 6 months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet needs.
Design: Multicentre prospective cohort study.
Subjects: Of 601 persons (75% males), mean (standard deviation) age 47 (21) years, admitted to trauma centres in 2020 with moderate-to-severe injury, 501 patients responded at the 6-month follow-up and thus were included in the analyses.
Methods: Sociodemographic and injury-related characteristics were recorded at inclusion. Estimation of needs was assessed with the Rehabilitation Complexity Scale Extended-Trauma and the Needs and Provision Complexity Scale on hospital discharge. Provision of services was recorded 6 months post-injury. Multivariable logistic regressions explored associations between baseline variables and unmet inpatient rehabilitation and community-based service needs.
Results: In total, 20% exhibited unmet needs for subacute inpatient rehabilitation, compared with 60% for community-based services. Predictors for unmet community-based service needs included residing in less central areas, profound injury severity, severe head injury, and rehabilitation referral before returning home.
Conclusion: Inadequate provision of healthcare and rehabilitation services, particularly in the municipalities, resulted in substantial unmet needs in the first 6 months following injury.
Inj Epidemiol. 2023;10(1):20.
Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study.
Background: Previous studies have demonstrated that the trauma population has needs for rehabilitation services that are best provided in a continuous and coordinated way. The discharge destination after acute care is the second step to ensuring quality of care. There is a lack of knowledge regarding the factors associated with the discharge destination for the overall trauma population. This paper aims to identify sociodemographic, geographical, and injury-related factors associated with discharge destination following acute care at trauma centers for patients with moderate-to-severe traumatic injuries.
Methods: A multicenter, population-based, prospective study was conducted with patients of all ages with traumatic injury [New Injury Severity Score (NISS) > 9] admitted within 72 h after the injury to regional trauma centers in southeastern and northern Norway over a 1-year period (2020).
Results: In total, 601 patients were included; a majority (76%) sustained severe injuries, and 22% were discharged directly to specialized rehabilitation. Children were primarily discharged home, and most of the patients ≥ 65 years to their local hospital. Depending on the centrality of their residence [Norwegian Centrality Index (NCI) 1-6, where 1 is most central], we found that patients residing in NCI 3-4 and 5-6 areas sustained more severe injuries than patients residing in NCI 1-2 areas. An increase in the NISS, number of injuries, or a spinal injury with an Abbreviated Injury Scale (AIS) ≥ 3 was associated with discharge to local hospitals and specialized rehabilitation than to home. Patients with an AIS ≥ 3 head injury (RRR 6.1, 95% Confidence interval 2.80-13.38) were significantly more likely to be discharged to specialized rehabilitation than patients with a less severe head injury. Age < 18 years was negatively associated with discharge to a local hospital, while NCI 3-4, preinjury comorbidity, and increased severity of injuries in the lower extremities were positively associated.
Conclusions: Two-thirds of the patients sustained severe traumatic injury, and 22% were discharged directly to specialized rehabilitation. Age, centrality of the residence, preinjury comorbidity, injury severity, length of hospital stay, and the number and specific types of injuries were factors that had the greatest influence on discharge destination.
J Clin Med. 2023;12(16).
Functional Outcomes at 6 and 12 Months Post-Injury in a Trauma Centre Population with Moderate-to-Severe Traumatic Injuries.
This study aims to evaluate the global functional outcomes after moderate-to-severe traumatic injury at 6 and 12 months and to examine the sociodemographic and injury-related factors that predict these outcomes. A prospective cohort study was conducted in which trauma patients of all ages with a New Injury Severity Score > 9 who were discharged alive from two regional trauma centres in Norway over a one-year period (2020) were included. The Glasgow Outcome Scale Extended (GOSE) score was used to analyse the functional outcomes. Regression analyses were performed to investigate the predictors of the GOSE score. Follow-up assessments were obtained from approximately 85% of the 601 included patients at both time points. The mean (SD) GOSE score was 6.1 (1.6) at 6 months and 6.4 (1.6) at 12 months, which corresponds to an upper-moderate disability. One-half of the patients had a persistent disability at 12 months post-injury. The statistically significant predictors of a low GOSE score at both time points were more pre-injury comorbidity, a higher number of injuries, and higher estimated rehabilitation needs, whereas a thorax injury with an Abbreviated Injury Scale ≥ 3 predicted higher GOSE scores. A high Glasgow Coma Scale score at admission predicted a higher GOSE score at 6 months. This study strengthens the evidence base for the functional outcomes and predictors in this population.
Scand J Trauma Resusc Emerg Med. 2023;31(1):50.
Excellent agreement of Norwegian trauma registry data compared to corresponding data in electronic patient records.
Background: The Norwegian Trauma Registry (NTR) is designed to monitor and improve the quality and outcome of trauma care delivered by Norwegian trauma hospitals. Patient care is evaluated through specific quality indicators, which are constructed of variables reported to the registry by certified registrars. Having high-quality data recorded in the registry is essential for the validity, trust and use of data. This study aims to perform a data quality check of a subset of core data elements in the registry by assessing agreement between data in the NTR and corresponding data in electronic patient records (EPRs).
Methods: We validated 49 of the 118 variables registered in the NTR by comparing those with the corresponding ones in electronic patient records for 180 patients with a trauma diagnosis admitted in 2019 at eight public hospitals. Agreement was quantified by calculating observed agreement, Cohen’s Kappa and Gwet’s first agreement coefficient (AC1) with 95% confidence intervals (CIs) for 27 nominal variables, quadratic weighted Cohen’s Kappa and Gwet’s second agreement coefficient (AC2) for five ordinal variables. For nine continuous, one date and seven time variables, we calculated intraclass correlation coefficient (ICC).
Results: Almost perfect agreement (AC1 /AC2/ ICC > 0.80) was observed for all examined variables. Nominal and ordinal variables showed Gwet’s agreement coefficients ranging from 0.85 (95% CI: 0.79-0.91) to 1.00 (95% CI: 1.00-1.00). For continuous and time variables there were detected high values of intraclass correlation coefficients (ICC) between 0.88 (95% CI: 0.83-0.91) and 1.00 (CI 95%: 1.00-1.00). While missing values in both the NTR and EPRs were in general negligeable, we found a substantial amount of missing registrations for a continuous «Base excess» in the NTR. For some of the time variables missing values both in the NTR and EPRs were high.
Conclusion: All tested variables in the Norwegian Trauma Registry displayed excellent agreement with the corresponding variables in electronic patient records. Variables in the registry that showed missing data need further examination.
Injury. 2024;55(6):111459.
Functional outcome and associations with prehospital time and urban-remote disparities in trauma: A Norwegian national population-based study.
Background: There is a lack of knowledge regarding the functional outcomes of patients after trauma. Remote areas in Norway has been associated with an increased risk of trauma-related mortality. However, it is unknown how this might influence trauma-related morbidity. The aim of this study was to assess the functional outcomes of patients in the Norwegian trauma population and the relationship between prehospital time and urban-remote disparities on functional outcome.
Methods: This registry-based study included 34,611 patients from the Norwegian Trauma Registry from 2015 – 2020. Differences in study population characteristics and functional outcomes as measured on the Glasgow Outcome Scale (GOS) at discharge were analysed. Three multinomial regression models were performed to assess the association between total prehospital time and urban-remote disparities and morbidity reported as GOS categories.
Results: Ninety-four per cent of trauma patients had no disability or moderate disability at discharge. Among patients with severe disability or vegetative state, 81 % had NISS > 15. Patients with fall-related injuries had the highest proportion of severe disability or vegetative state. Among children and adults, every minute increase in total prehospital time was associated with higher odds of moderate disability. Urban areas were associated with higher odds of moderate disability in all age groups, whereas remote areas were associated with higher odds of severe disability or vegetative state in elderly patients. NISS was associated with a worse functional outcome.
Conclusions: The majority of trauma patients admitted to a trauma hospital in Norway were discharged with minimal change in functional outcome. Patients with severe injuries (NISS > 15) and patients with injuries from falls experienced the greatest decline in function. Every minute increase in total prehospital time was linked to an increased likelihood of moderate disability in children and adults. Furthermore, incurring injuries in urban areas was found to be associated with higher odds of moderate disability in all age groups, while remote areas were found to be associated with higher odds of severe disability or vegetative state in elderly patients.
Scand J Trauma Resusc Emerg Med. 2023;31(1):53.
Effect of urban vs. remote settings on prehospital time and mortality in trauma patients in Norway: a national population-based study.
Background: Norway has a diverse population pattern and often long transport distances from injury sites to hospitals. Also, previous studies have found an increased risk of trauma-related mortality in remote areas in Norway. Studies on urban vs. remote differences on trauma outcomes from other countries are sparse and they report conflicting results.The aim of the present study was to investigate differences in prehospital time intervals in urban and remote areas in Norway and assess how prehospital time and urban vs. remote settings were associated with mortality in the Norwegian trauma population.
Methods: We performed a population-based study of trauma cases included in the Norwegian Trauma Registry from 2015 to 2020. 28,988 patients met the inclusion criteria. Differences in study population characteristics and prehospital time intervals (response time, on-scene time and transport time) were analyzed. The Norwegian Centrality Index score was used for urban vs. remote classification. Descriptive statistics and relevant non-parametric tests with effect size measurements were used. A binary logistic regression model, adjusted for confounding factors, was performed.
Results: The prehospital time intervals increased significantly from urban to remote areas.Adjusted for control variables we found a significant relationship between prolonged on-scene time and higher odds of mortality. Also, suburban areas compared with remote areas were associated with higher odds of mortality.
Conclusion: In this nationwide study comparing prehospital time intervals in urban and remote areas, we found that prehospital time intervals in remote areas exceeded those in urban areas. Prolonged on-scene time was found to be associated with higher odds of mortality, but remoteness itself was not.
JMIR Res Protoc. 2022;11(6):e30656.
Assessing Trauma Management in Urban and Rural Populations in Norway: A National Register-Based Research Protocol.
Background: Time is considered an essential determinant in the initial care of trauma patients. In Norway, response time (ie, time from dispatch center call to ambulance arrival at scene) is a controversial national quality indicator. However, no national requirements for response times have been established. There is an ongoing debate regarding the optimal configuration of the Norwegian trauma system. The recent centralization of trauma services and closure of emergency hospitals have increased prehospital transport distances, predominantly for rural trauma patients. However, the impact of trauma system configuration on early trauma management in urban and rural areas is inadequately described.
Objective: The project will assess injured patients’ initial pathways through the trauma system and explore differences between central and rural areas in a Norwegian trauma cohort. This field is unexplored at the national level, and existing evidence for an optimal organization of trauma care is still inconclusive regarding the impact of prehospital time.
Methods: Three quantitative registry-based retrospective cohort studies are planned. The studies are based on data from the Norwegian Trauma Registry (NTR; studies 1, 2, and 3) and the local Emergency Medical Communications Center (study 2). All injured patients admitted to a Norwegian hospital and registered in the NTR in the period between January 1, 2015, and December 31, 2020, will be included in the analysis. Trauma registry data will be analyzed using descriptive and relevant statistical methods to compare prehospital time in rural and central areas, including regression analyses and adjusting for confounders.
Results: The project received funding in fall 2020 and was approved by the Oslo University Hospital data protection officer, case number 18/02592. Registry data including approximately 40,000 trauma patients will be extracted during the first quarter of 2022, and analysis will begin immediately thereafter. Results are expected to be ready for publication from the third quarter of 2022.
Conclusions: Findings from the study will contribute to new knowledge regarding existing quality indicators and with an increasing centralization of hospitals and residents, the study will contribute to further development of the Norwegian trauma system. A high generalizability to other trauma systems is expected, given the similarities between demographical changes and trauma systems in many high-income countries.
Neuroepidemiology. 2023;57(3):185–96.
The Epidemiology of Moderate and Severe Traumatic Brain Injury in Central Norway.
Introduction: Few studies account for prehospital deaths when estimating incidence and mortality rates of moderate and severe traumatic brain injury (msTBI). In a population-based study, covering both urban and rural areas, including also prehospital deaths, the aim was to estimate incidence and mortality rates of msTBI. Further, we studied the 30-day and 6-month case-fatality proportion of severe TBI in relation to age.
Methods: All patients aged ≥17 years who sustained an msTBI in Central Norway were identified by three sources: (1) the regional trauma center, (2) the general hospitals, and (3) the Norwegian Cause of Death Registry. Incidence and mortality rates were standardized according to the World Health Organization’s world standard population. Case-fatality proportions were calculated by the number of deaths from severe TBI at 30 days and 6 months, divided by all patients with severe TBI.
Results: The overall incidence rates of moderate and severe TBI were 4.9 and 6.7 per 100,000 person-years, respectively, increasing from age 70 years. The overall mortality rate was 3.4 per 100,000 person-years, also increasing from age 70 years. Incidence and mortality rates were highest in men. The case-fatality proportion in people with severe TBI was 49% in people aged 60-69 years and 81% in people aged 70-79 years.
Conclusion: The overall incidence and mortality rates for msTBI in Central Norway were low but increased from age 70 years, and among those ≥80 years of age with severe TBI, nearly all died. Overall estimates are strongly influenced by high incidence and mortality rates in the elderly, and studies should therefore report age-specific estimates, for better comparison of incidence and mortality rates.
Injury. 2023;54(1):183–8.
Close to zero preventable in-hospital deaths in pediatric trauma patients – An observational study from a major Scandinavian trauma center.
Background: In line with international trends, initial treatment of trauma patients has changed substantially over the last two decades. Although trauma is the leading cause of death and disability in children globally, in-hospital pediatric trauma related mortality is expected to be low in a mature trauma system. To evaluate the performance of a major Scandinavian trauma center we assessed treatment strategies and outcomes in all pediatric trauma patients over a 16-year period.
Methods: A retrospective cohort study of all trauma patients under the age of 18 years admitted to a single institution from 1st of January 2003 to 31st of December 2018. Outcomes for two time periods were compared, 2003-2009 (Period 1; P1) and 2010-2018 (Period 2; P2). Deaths were further analyzed for preventability by the institutional trauma Mortality and Morbidity panel.
Results: The study cohort consisted of 3939 patients. A total of 57 patients died resulting in a crude mortality of 1.4%, nearly one quarter of the study cohort (22.6%) was severely injured (Injury Severity Score > 15) and mortality in this group decreased from 9.7% in P1 to 4.1% in P2 (p<0.001). The main cause of death was brain injury in both periods, and 55 of 57 deaths were deemed non-preventable. The rate of emergency surgical procedures performed in the emergency department (ED) decreased during the study period. None of the 11 ED thoracotomies in non-survivors were performed after 2013.
Conclusion: A dedicated multidisciplinary trauma service with ongoing quality improvement efforts secured a low in-hospital mortality among severely injured children and a decrease in futile care. Deaths were shown to be almost exclusively non-preventable, pointing to the necessity of prioritizing prevention strategies to further decrease pediatric trauma related mortality.
Scand J Trauma Resusc Emerg Med. 2021;29(1):169.
Dispatch accuracy of physician-staffed emergency medical services in trauma care in south-east Norway: a retrospective observational study.
Background: Selection of incidents and accurate identification of patients that require assistance from physician-staffed emergency medical services (P-EMS) remain essential. We aimed to evaluate P-EMS availability, the underlying criteria for dispatch, and the corresponding dispatch accuracy of trauma care in south-east Norway in 2015, to identify areas for improvement.
Methods: Pre-hospital data from emergency medical coordination centres and P-EMS medical databases were linked with data from the Norwegian Trauma Registry (NTR). Based on a set of conditions (injury severity, interventions performed, level of consciousness, incident category), trauma incidents were defined as complex, warranting P-EMS assistance, or non-complex. Incident complexity and P-EMS involvement were the main determinants when assessing the triage accuracy. Undertriage was adjusted for P-EMS availability and response and transport times.
Results: Among 19,028 trauma incidents, P-EMS were involved in 2506 (13.2%). The range of overtriage was 74-80% and the range of undertriage was 20-32%. P-EMS readiness in the event of complex incidents ranged from 58 to 70%. The most frequent dispatch criterion was «Police/fire brigade request immediate response» recorded in 4321 (22.7%) of the incidents. Criteria from the groups «Accidents» and «Road traffic accidents» were recorded in 10,875 (57.2%) incidents, and criteria from the groups «Transport reservations» and «Unidentified problem» in 6025 (31,7%) incidents. Among 4916 patient pathways in the NTR, 681 (13.9%) could not be matched with pre-hospital data records.
Conclusions: Both P-EMS availability and dispatch accuracy remain suboptimal in trauma care in south-east Norway. Dispatch criteria are too vague to facilitate accurate P-EMS dispatch, and pre-hospital data is inconsistent and insufficient to provide basic data for scientific research. Future dispatch criteria should focus on the care aspect of P-EMS. Better tools for both dispatch and incident handling for the emergency medical coordination centres are essential. In general, coordination, standardisation, and integration of existing data systems should enhance the quality of trauma care and increase patient safety.
J Rehabil Med. 2023;55:jrm6552.
Adherence to Guidelines for Acute Rehabilitation in the Norwegian Trauma Plan.
Objective: To evaluate adherence to 3 central operational recommendations for acute rehabilitation in the Norwegian trauma plan.
Methods: A prospective multi-centre study of 538 adults with moderate and severe trauma with New Injury Severity Score > 9.
Results: Adherence to the first recommendation, assessment by a physical medicine and rehabilitation physician within 72 h following admission to the intensive care unit (ICU) at the trauma centre, was documented for 18% of patients. Adherence to the second recommendation, early rehabilitation in the intensive care unit, was documented for 72% of those with severe trauma and ≥ 2 days ICU stay. Predictors for early rehabilitation were ICU length of stay and spinal cord injury. Adherence to the third recommendation, direct transfer of patients from acute ward to a specialized rehabilitation unit, was documented in 22% of patients, and occurred more often in those with severe trauma (26%), spinal cord injury (54%) and traumatic brain injury (39%). Being employed, having head or spinal chord injury and longer ICU stay were predictors for direct transfer to a specialized rehabilitation unit.
Conclusion: Adherence to acute rehabilitation guidelines after trauma is poor. This applies to documented early assessment by a physical medicine and rehabilitation physician, and direct transfer from acute care to rehabilitation after head and extremity injuries. These findings indicate a need for more systematic integration of rehabilitation in the acute treatment phase after trauma.
Scand J Trauma Resusc Emerg Med. 2022;30(1):51.
Differences in characteristics between patients >/= 65 and < 65 years of age with orthopaedic injuries after severe trauma.
Aim: Many trauma patients have associated orthopaedic injuries at admission. The existing literature regarding orthopaedic trauma often focuses on single injuries, but there is a paucity of information that gives an overview of this group of patients. Our aim was to describe the differences in characteristics between polytrauma patients ≥ 65 and < 65 years of age suffering orthopaedic injuries.
Methods: Patients registered in the Norwegian Trauma Registry (NTR) with an injury severity score (ISS) > 15 and orthopaedic injuries, who were admitted to Haukeland University Hospital in 2016-2018, were included. Data retrieved from the patients’ hospital records and NTR were analysed. The patients were divided into two groups based on age.
Results: The study comprised 175 patients, of which 128 (73%) and 47 (27%) were aged < 65 (Group 1) and ≥ 65 years (Group 2), respectively. The ISS and the new injury severity score (NISS) were similar in both groups. The dominating injury mechanism was traffic-related and thoracic injury was the most common location of main injury in both groups. The groups suffered a similar number of orthopaedic injuries. A significantly higher proportion of Group 1 underwent operative treatment for their orthopaedic injuries than in Group 2 (74% vs. 53%). The mortality in Group 2 was significantly higher than that in Group 1 (15% vs. 3%). In Group 2 most deaths were related to traffic injuries (71%). High energy falls and traffic-related incidents caused the same number of deaths in Group 1. In Group 1 abdominal injuries resulted in most deaths, while head injuries was the primary reason for deaths in Group 2.
Conclusions: Although the ISS and NISS were similar, mortality was significantly higher among patients aged ≥ 65 years compared to patients < 65 years of age. The younger age group underwent more frequently surgery for orthopaedic injuries than the elderly. There may be multiple reasons for this difference, but our study does not have sufficient data to draw any conclusions. Future studies may provide a deeper understanding of what causes treatment variation between age groups, which would hopefully help to further develop strategies to improve outcome for the elderly polytrauma patient.
JMIR Res Protoc. 2022;11(3):e37723.
Correction: Rehabilitation Needs, Service Provision, and Costs in the First Year Following Traumatic Injuries: Protocol for a Prospective Cohort Study.
No abstract available
Front Neurol. 2024;15:1411692.
Risk of epilepsy after traumatic brain injury: a nationwide Norwegian matched cohort study.
Background: Post-traumatic epilepsy (PTE) is a well-known complication of traumatic brain injury (TBI). Although several risk factors have been identified, prediction of PTE is difficult. Changing demographics and advances in TBI treatment may affect the risk of PTE. Our aim was to provide an up-to-date estimate of the incidence of PTE by linking multiple nationwide registers.
Methods: Patients with TBI admitted to hospital 2015-2018 were identified in the Norwegian Trauma Registry and matched to trauma-free controls on sex and birth year according to a matched cohort design. They were followed up for epilepsy in nationwide registers 2015-2020. Cumulative incidence of epilepsy in TBI patients and controls was estimated taking competing risks into account. Analyses stratified by the Abbreviated Injury Scale (AIS) severity score, Glasgow Coma Scale score and age were conducted for the TBI group. Occurrence of PTE in different injury types was visualized using UpSet plots.
Results: In total, 8,660 patients and 84,024 controls were included in the study. Of the patients, 3,029 (35%) had moderate to severe TBI. The cumulative incidence of epilepsy in the TBI group was 3.1% (95% Confidence Interval [CI] 2.8-3.5%) after 2 years and 4.0% (3.6-4.5%) after 5 years. Corresponding cumulative incidences in the control group were 0.2% (95% CI 0.2-0.3%) and 0.5% (0.5-0.6%). The highest incidence was observed in patients with severe TBI according to AIS (11.8% [95% CI 9.7-14.4%] after 2 years and 13.2% [10.8-16.0%] after 5 years) and in patients >40 years of age.
Conclusion: Patients with TBI have significantly higher risk of developing epilepsy compared to population controls. However, PTE incidence following moderate-severe TBI was notably lower than what has been reported in several previously published studies.
BMJ Open. 2021;11(5):e046954.
Injury Prevention and long-term Outcomes following Trauma-the IPOT project: a protocol for prospective nationwide registry-based studies in Norway.
Introduction: Traumatic injuries constitute a major cause of mortality and morbidity. Still, the public health burden of trauma in Norway has not been characterised using nationwide registry data. More knowledge is warranted on trauma risk factors and the long-term outcomes following trauma. The Injury Prevention and long-term Outcomes following Trauma project will establish a comprehensive research database. The Norwegian National Trauma Registry (NTR) will be merged with several data sources to pursue the following three main research topics: (1) the public health burden of trauma to society (eg, excess mortality and disability-adjusted life-years (DALYs)), (2) trauma aetiology (eg, socioeconomic factors, comorbidity and drug use) and (3) trauma survivorship (eg, survival, drug use, use of welfare benefits, work ability, education and income).
Methods and analysis: The NTR (n≈27 000 trauma patients, 2015-2018) will be coupled with the data from Statistics Norway, the Norwegian Patient Registry, the Cause of Death Registry, the Registry of Primary Health Care and the Norwegian Prescription Database. To quantify the public health burden, DALYs will be calculated from the NTR. To address trauma aetiology, we will conduct nested case-control studies with 10 trauma-free controls (drawn from the National Population Register) matched to each trauma case on birth year, sex and index date. Conditional logistic regression models will be used to estimate trauma risk according to relevant exposures. To address trauma survivorship, we will use cohort and matched cohort designs and time-to-event analyses to examine various post-trauma outcomes.
Ethics and dissemination: The project is approved by the Regional Committee for Medical Research Ethics. The project’s data protection impact assessment is approved by the data protection officer. Results will be disseminated to patients, in peer-reviewed journals, at conferences and in the media.
Acta Obstet Gynecol Scand. 2024;103(5):965–9.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) as adjunct treatment in life threatening postpartum hemorrhage: Fourteen years’ experience from a single Norwegian center.
Introduction: Postpartum hemorrhage (PPH) remains a global health problem. The introduction of resuscitative endovascular balloon occlusion of the aorta (REBOA) in 2008 sought to enhance the management of hemorrhagic shock during PPH. In this study, we present a single Norwegian center’s experience with REBOA as a supportive treatment in combating life threatening PPH.
Material and methods: This is a historical cohort study from St Olav’s University Hospital, with data from period 2008-2021. It includes all patients who underwent REBOA as an adjunct treatment due to life threatening PPH, analyzing the outcomes and trends over a 14-year period.
Results: A total of 37 patients received REBOA as an adjunct treatment. All procedures were technically successful, achieving hemodynamic stability with an immediate average increase in systolic blood pressure of 36 ± 22 mmHg upon initial balloon inflation. Additionally, a downward trend was noted in the frequency of hysterectomies and the volume of blood transfusions required over time. No thromboembolic complications were observed.
Conclusions: Our 14 years of experience at St Olav’s Hospital suggests that REBOA serves as a safe and effective adjunct interventional technique for managing life-threatening PPH. Furthermore, the findings indicate that incorporating a multidisciplinary approach to enable rapid aortic occlusion can potentially reduce the necessity for blood transfusions and hysterectomies.
Eur J Trauma Emerg Surg. 2022;48(5):3803–11.
Changing from a two-tiered to a one-tiered trauma team activation protocol: a before-after observational cohort study investigating the clinical impact of undertriage.
Background: The aim of this study was to compare the effect of the change in TTA protocol from a two-tier to one-tier, with focus on undertriage and mortality.
Material and methods: A before-after observational cohort study based on data extracted from the Stavanger University Hospital Trauma registry in the transition period from two-tier to a one-tier TTA protocol over two consecutive 1-year periods (2017-2018). Comparative analysis was done between the two time-periods for descriptive characteristics and outcomes. The main outcomes of interest were undertriage and mortality.
Results: During the study period 1234 patients were included in the registry, of which 721 (58%) were in the two-tier and 513 (42%) in the one-tier group. About one in five patients (224/1234) were severely injured (ISS > 15). Median age was 39 in the two-tier period and 43 years in the one-tier period (p = 0.229). Median ISS was 5 for the two-tier period vs 9, in the one-tier period (p = 0.001). The undertriage of severely injured patients in the two-tier period was 18/122 (15%), compared to 31/102 (30%) of patients in the one-tier period (OR = 2.5; 95% CI 1.8-4.52). Overall mortality increased significantly between the two TTA protocols, from 2.5 to 4.7% (p = 0.033), OR 0.51 (0.28-0.96) CONCLUSION: A protocol change from two-tiered TTA to one-tiered TTA increased the undertriage in our trauma system. A two-tiered TTA may be beneficial for better patient care.
Scand J Trauma Resusc Emerg Med. 2025;33(1):125.
Correction: Demography, emergency interventions and outcome after severe pelvic injuries: a two-decade registry study from South- Western Norway.
No abstract available
Scand J Trauma Resusc Emerg Med. 2021;29(1):125.
Pre-injury dispensing of psychoactive prescription drugs in a ten years trauma population: a retrospective registry analysis.
Background: The use of psychoactive prescription drugs is associated with increased risk of traumatic injury, and has negative impact on clinical outcome in trauma patients. Previous studies have focused on specific drugs or subgroups of patients. Our aim was to examine the extent of psychoactive drug dispensing prior to injury in a comprehensive population of trauma patients.
Methods: The Oslo University Hospital Trauma Registry provided data on all trauma patients admitted to the trauma centre between 2005 and 2014. We linked the data to Norwegian Prescription Database data from 2004. Opioids, benzodiazepines, z-hypnotics, gabapentinoids, and centrally acting sympathomimetics dispensed during the year before trauma of each patient were identified. We determined the pre-trauma annual prevalence of dispensing and mean annual cumulative defined daily doses (DDD) for each drug class, and compared results with corresponding figures in the general population, using standardised ratios. For each drug class, dispensing 14 days preceding trauma was analysed in patients sustaining severe injury and compared with patients sustaining non-severe injury.
Results: 12,713 patients (71% male) were included. Median age was 36 years. 4891 patients (38%) presented with severe injury (Injury Severity Score > 15). The ratio between annual prevalence of dispensed prescriptions for trauma patients and the general population, adjusted for age and sex, was 1.5 (95% confidence interval 1.4-1.6) for opioids, 2.1 (2.0-2.2) for benzodiazepines, 1.7 (1.6-1.8) for z-hypnotics, 1.9 (1.6-2.2) for gabapentinoids, and 1.9 (1.6-2.2) for centrally acting sympathomimetics. Compared with the general population, mean annual cumulative DDD of opioids and benzodiazepines dispensed to trauma patients were more than two and three times as high, respectively, in several age groups below 70 years. The prevalence of dispensing 14 days pre-trauma was higher in severely injured patients for opioids, benzodiazepines, and z-hypnotics compared with patients without severe injury.
Conclusions: Our results support previous findings that the prevalence of psychoactive drug use is high among trauma patients. In terms of both frequency and amounts, the pre-injury dispensing of psychoactive drugs to trauma patients supersedes that of the general population, especially in younger patients.
Tidsskr Nor Laegeforen. 2022;142(8).
Injuries after violence and accidents – the forgotten pandemic?
No abstract available
Eur J Trauma Emerg Surg. 2022;48(6):4473–80.
Characteristics, image findings and clinical outcome of moderate and severe traumatic brain injury among severely injured children: a population-based cohort study.
Purpose: The aim of this study was to explore patient and injury characteristics, image findings, short-term clinical outcome and time trends of moderate and severe traumatic brain injury in severely injured children.
Methods: This study is an observational cohort study based on prospectively collected data from an institutional trauma registry database covering all trauma patients in South West Norway. All paediatric patients registered in the database between 01.01.2004 and 31.12.2019 were included.
Results: During the 16 years-study periods, 82 paediatric patients with moderate (n = 42) and severe (n = 40) traumatic brain injury were identified. Median age was 13.0 years, 45% were female and median Glasgow Coma Scale score at admission was 9.0. Cranial fractures were common image findings in both groups. Cerebral contusions (32%) and epidural hematomas (29%) were more commonly found in moderate traumatic brain injury; cerebral contusions (49%), diffuse axonal injury (31%) and cerebral oedema (46%) were more prominent in severe traumatic brain injury. All children with moderate traumatic brain injury survived and favourable outcome was registered in 98%. Overall mortality in the severe traumatic brain injury cohort was 38% (thereof 25% due to TBI) and only 38% had a favourable short-term outcome.
Conclusions: In this population-based study on paediatric trauma patients over a period of 16 years severe traumatic brain injury in children still had a considerably high mortality and a higher proportion of patients experienced an unfavourable clinical short-term outcome. Moderate traumatic brain injury resulted in favourable clinical outcome.
World J Surg. 2022;46(12):2850–7.
Incidence, Mechanisms of Injury and Mortality of Severe Traumatic Brain Injury: An Observational Population-Based Cohort Study from New Zealand and Norway.
Background: Comparing trauma registry data from different countries can help to identify possible differences in epidemiology, which may help to improve the care of trauma patients.
Methods: This study directly compares the incidence, mechanisms of injuries and mortality of severe TBI based on population-based data from the two national trauma registries from New Zealand and Norway. All patients prospectively registered with severe TBI in either of the national registries for the 4-year study period were included. Patient and injury variables were described and age-adjusted incidence and mortality rates were calculated.
Results: A total of 1378 trauma patients were identified of whom 751 (54.5%) from New Zealand and 627 (45.5%) from Norway. The patient cohort from New Zealand was significantly younger (median 32 versus 53 years; p < 0.001) and more patients from New Zealand were injured in road traffic crashes (37% versus 13%; p < 0.001). The age-adjusted incidence rate of severe TBI was 3.8 per 100,000 in New Zealand and 2.9 per 100,000 in Norway. The age-adjusted mortality rates were 1.5 per 100,000 in New Zealand and 1.2 per 100,000 in Norway. The fatality rates were 38.5% in New Zealand and 34.2% in Norway (p = 0.112).
Conclusions: Road traffic crashes in younger patients were more common in New Zealand whereas falls in elderly patients were the main cause for severe TBI in Norway. The age-adjusted incidence and mortality rates of severe TBI among trauma patients are similar in New Zealand and Norway. The fatality rates of severe TBI are still considerable with more than one third of patients dying.
World Neurosurg. 2022;165:e452–e6.
Pandemic for Patients with Severe Traumatic Brain Injury-A Nationwide, Observational Cohort Study.
Background: Containment measures during the coronavirus disease of 2019 (COVID-19) pandemic have resulted in a substantial reduction in treatment of injury. The effect of the COVID-19 pandemic on the epidemiology and mortality of severe traumatic brain injury on a national, population-based level is unknown.
Methods: Data on all patients with severe traumatic brain injury between 2017 and 2020 were retrieved from the National Trauma Registry of Norway. The study cohort was derived from the pandemic period (March 12 to December 31, 2020) and the control cohort from the prepandemic years 2017 to 2019. The outcome measures were 30-day mortality, in-hospital mortality, and discharge destination.
Results: This study included 522 trauma patients with severe traumatic brain injury, 387 (74.1%) in the prepandemic and 135 (25.9%) in the pandemic period. Length of stay increased significantly during the pandemic period (4 vs. 3 days; P = 0.014). The 30-day mortality rate was 39% (n = 149) in the prepandemic versus 38% (n = 52) pandemic period (P = 0.998). In-hospital mortality was 33% (n = 128) in the prepandemic versus 33% (n = 44) in the pandemic period (P = 0.920). There were no statistically significant differences in discharge destination besides the number of patients discharged to home in the pandemic period (P = 0.003). When adjusted for clinical relevant factors such as age, gender, and head injury severity, the mortality outcomes did not change during the pandemic period.
Conclusions: The containment and lockdown measures during the COVID-19 pandemic in Norway did not affect the number of patients or mortality of patients with severe traumatic brain injury.
Injury. 2022;53(10):3130–8.
Epidemiology of abdominal trauma: An age- and sex-adjusted incidence analysis with mortality patterns.
Purpose: Abdominal injuries may occur in up to one-third of all patients who suffer severe trauma, but little is known about epidemiological trends and characteristics in a Northern European setting. This study investigated injury demographics, and epidemiological trends in trauma patients admitted with abdominal injuries.
Methods: This was an observational cohort study of all consecutive patients admitted to Stavanger University Hospital (SUH) with a documented abdominal injury between January 2004 and December 2018. Injury demographics, age- and sex-adjusted incidence, and mortality patterns are analyzed across three time periods.
Results: Among 7202 admitted trauma patients, 449 (6.2%) suffered abdominal injuries. The median age was 31 years, and the age increased significantly over time (from a median of 25 years to a median of 38.5 years; p = 0.020). Patients with ASA 2 and 3 increased significantly over time. Men accounted for 70% (316/449). The injury mechanism was blunt in 91% (409/449). Transport-related accidents were the most frequent cause of injury in 57% (257/449). The median Injury Severity Score (ISS) was 21, and the median New Injury Severity Score (NISS) was 25. The annual adjusted incidence of all abdominal injuries was 7.2 per 100,000. Solid-organ injuries showed an annual adjusted incidence of 5.7 per 100,000. The most frequent organ injury was liver injury, found in 38% (169/449). Multiple abdominal injuries were recorded in 44% (197/449) and polytrauma in 51% (231/449) of the patients. Overall 30-day mortality was 12.5% (56/449) and 90-day mortality 13.6% (61/449).
Conclusion: The overall adjusted incidence rate of abdominal injuries remained stable. Age at presentation increased by over a decade, more often presenting with pre-existing comorbidities (ASA 2 and 3). The proportion of polytrauma patients was significantly reduced over time. Mortality rates were declining, although not statistically significant.
Br J Surg. 2023;110(9):1035–8.
Splenic injury from blunt trauma.
No abstract available
Injury. 2025;56(1):111884.
Incidence, severity and changes of abnormal vital signs in trauma patients: A national population-based analysis.
Background: Physiological criteria are used to assess the potential severity of injury in the early phase of a trauma patient’s care trajectory. Few studies have described the extent of abnormality in vital signs and different combinations of these at a national level. Aim of the study was to identify physiologic abnormalities in trauma patients and describe different combinations of abnormalities and changes between the pre-hospital and emergency department (ED) settings.
Method: Norwegian Trauma Registry (NTR) data between 01.01.15 – 31.12.18, where evaluated on the prevalence and characteristics of abnormal physiologic variables. Primary outcome were rates of hypoventilation (respiratory rate [RR] < 10 breaths per min), hyperventilation (RR > 29 breaths per min), hypotension (systolic blood pressure [SBP] < 90 mmHg), and reduced level of consciousness (Glasgow Coma Scale [GCS] < 13).
Results: A total of 24,482 patients were included. Documented values for RR, SBP and GCS were 77.6%, 78.5% and 81.9% in the pre-hospital phase, and the corresponding percentages in the ED were 95.5%, 99.2% and 98.6%, respectively. In the pre-hospital phase, 3,615 (14.8%) patients had at least one abnormal vital sign, whereas the corresponding numbers in the ED, were 3,616 (14.8%) patients. The most frequent combination was low GCS and hyperventilation. A worsened RTS-score from pre-hospital phase to the ED was observed for RR, SBP and GCS in 3.9%, 1.2% and 1.9% of incidents, respectively. Overall 30-day mortality was 3.1% (n=752). Of these, 60.8% had abnormal vital signs, with decreased GCS as the most prevalent (61.3%).
Conclusion: Most trauma patients had normal vital signs. According to the RTS-score, there were few deteriorations in RR, SBP and GCS between pre-hospital phase and the ED. The most frequent abnormality was low GCS, with a higher proportion in those who died within 30 days.
Eur J Trauma Emerg Surg. 2024;50(3):995–1001.
Characteristics and demography of low energy fall injuries in patients > 60 years of age: a population-based analysis over a decade with focus on undertriage.
Background: An increasing group of elderly patients is admitted after low energy falls. Several studies have shown that this patient group tends to be severely injured and is often undertriaged.
Methods: Patients > 60 years with low energy fall (< 1 m) as mechanism of injury were identified from the Stavanger University Hospital trauma registry. The study period was between 01.01.11 and 31.12.20. Patient and injury variables as well as clinical outcome were described. Undertriage was defined as patients with a major trauma, i.e., Injury Severity Score (ISS) > 15, without trauma team activation. Statistical analysis was performed using the Chi-squared test for categorical variables and the Mann-Whitney U test for continuous variables.
Results: Over the 10-year study period, 388 patients > 60 years with low energy fall as mechanism of injury were identified. Median age was 78 years (IQR 68-86), and 53% were males. The location of major injury was head injury in 41% of the patients, lower extremities in 19%, and thoracic injuries in 10%. Thirty-day mortality was 13%. Fifty percent were discharged to home, 31% to nursing home, 9% in hospital mortality, and the remaining 10% were transferred to other hospitals or rehabilitation facilities. Ninety patients had major trauma, and the undertriage was 48% (95% confidence interval, 38 to 58%).
Conclusions: Patients aged > 60 years with low energy falls are dominated by head injuries, and the 30-day mortality is 13%. Patients with major trauma are undertriaged in half the cases mandating increased awareness of this patient group.
Scand J Trauma Resusc Emerg Med. 2025 May 1;33(1):78. doi: 10.1186/s13049-025-01390-7.
The Norwegian national trauma registry: development process and essential data insights.
Background: Understanding trauma epidemiology, patient demographics, injury characteristics, and outcomes is essential for optimising trauma systems. The Norwegian Trauma Registry (NTR) monitors and improves the Norwegian Trauma System, setting care standards and overseeing system development. The registry was officially recognised as a national register in 2013. This study outlines the establishment of the population-based national registry and provides an overview of selected data.
Methods: Norway’s trauma system includes trauma centres, acute care hospitals, and prehospital services. The registry collects injury details, clinical outcomes, and patient experiences. Local NTR databases that are linked to a central database are maintained at each hospital, and only certified data registrars can enter and validate data. This enables data linkages across hospitals. The NTR includes potentially severely injured patients but also includes undertriaged patients (defined as severely injured patients who are not met by a trauma team activation upon hospital arrival). Descriptive statistics were used to analyse data from trauma patients registered between 2015 and 2023. Patient-Reported Outcome Measures (PROMs) from 2022 were also assessed.
Results: From 2015 to 2023, 78 275 trauma patients were recorded, with annual patient inclusion rising from 7586 in 2015 to 9759 in 2023. All 38 Norwegian hospitals contributed data in 2023. Median age was 41 years (IQR: 21-62), and 66.5% were men. The highest injury rate was among those aged 15-24 years. Penetrating injuries accounted for 4.6% of cases. Severely injured patients with New Injury Severity Score (NISS) ≥ 16 totalled 16 678 (21.3%), while 10 509 (13.4%) had an Injury Severity Score (ISS) ≥ 16. Polytrauma was identified in 3783 (4.9%) of patients using the Newcastle definition and in 2508 (3.2%) patients using the Berlin definition. In 2023, a trauma team was activated for 8731(89.4%) patients recorded in the registry. PROMs data from 2022 showed that 47.2% (1018/2157) of the patients reported anxiety or depression 12 months post-injury. Among those without physical injuries, 8.0% (11/138) were out of work or education. Of the severely injured patients (NISS ≥ 16) who were employed or in education prior to the injury, 26.4% (83/314) had not returned to work or education after 12 months.
Conclusions: The Norwegian Trauma Registry has been successfully implemented in all trauma hospitals in Norway, enabling comprehensive data collection to support trauma care improvements and research.
JAMA Network Open Vol. 9, No. 1
Risk of Suicide in Patients With Traumatic Injuries
Importance Previous studies suggest that critically injured patients are at increased risk of suicide following discharge, but these have mainly been single-center studies or had limited data on comorbidities and socioeconomic factors.
Objective To examine the risk of suicide after hospitalization for traumatic injuries.
Design, Setting, and Participants This nationwide register-based cohort study used data from 5 Norwegian nationwide health registries and Statistics Norway between 2014 and 2020. Patients registered in the Norwegian Trauma Registry (NTR) for whom trauma team activation at hospital arrival was mandated by national guidelines between 2015 and 2018 were matched to general-population controls on gender and birth year in a 1:10 ratio according to a matched cohort design. Patients discharged alive were followed-up for a minimum of 2 years. All Norwegian hospitals treating patients with traumatic injuries provide data to the NTR. The final analysis was conducted in April 2025.
Exposures Traumatic injury, admitted to hospital, and registered in the NTR.
Main Outcomes and Measures The outcome of interest was suicide, as registered in the Norwegian Cause of Death Registry. Cumulative incidence ratios (CIR) of suicide with 95% CIs, taking nonsuicidal death as a competing event into account, were estimated. Adjustments for Charlson Comorbidity Index, previous psychiatric illness, and socioeconomic position (SEP) were conducted using inverse probability of treatment weights.
Results A total of 25 536 patients with traumatic injuries (165 897 [67%] male; mean [SD] age, 41 [23] years) were matched to 247 095 controls, with a mean (SD) age of 41 (23) years and 68% male. The cumulative incidences of suicide were 0.18% at 2 years and 0.34% and 5 years for patients with traumatic injuries and 0.02% at 2 years and 0.05% at 5 years for controls (2-year CIR, 9.3 [95% CI, 5.4-13.0]; 5-year CIR, 6.9 [95% CI, 4.4-9.1]). Patients with traumatic injury were older at the age of suicide compared with controls (mean [SD] age, 43 [19] years vs 36 [17] years; P = .03) and female patients with traumatic injury had higher incidence of suicide compared with female controls (36% vs 17%; P = .005).
Conclusions and Relevance In this cohort study of patients in Norway discharged alive after critical injury, a 9-fold increased risk of suicide after 2 years was observed. These findings suggest that follow-up is warranted for possible psychological distress in this patient group.
