title: The epidemiology of Scottish trauma: A comparison of pre-hospital and in-hospital deaths, 2000 to 2011.
abstract: OBJECTIVE
  To characterise the temporal trends and urban-rural distribution of fatal injuries in Scotland through the analysis of mortality data collected by the National Records of Scotland.
  
  
  METHODS
  The prospectively collected NRS database was queried using ICD-10 codes for all Scottish trauma deaths during the period 2000 to 2011. Patients were divided into pre-hospital and in-hospital groups depending on the location of death. Incidence was plotted against time and linear regression was used to identify temporal trends.
  
  
  RESULTS
  A total of 13,100 deaths were analysed. There were 4755 (36.3%) patients in the pre-hospital group with a median age (IQR) of 42 (28-58) years. The predominant cause of pre-hospital death related to vehicular injury (27.8%), which had a decreasing trend over the study period (p = 0.004). In-hospital, patients had a median age of 80 (58-88) years and the majority (67.0%) of deaths occurred following a fall on the level. This trend was shown to increase over the decade of study (p = 0.020). In addition, the incidence of urban incidents remained static, but the rate of rural fatal trauma decreased (p < 0.001).
  
  
  CONCLUSIONS
  Around a third of Scottish trauma patients die prior to hospital admission and the predominant mechanism of injury is due to road traffic accidents. This contrasts with in-hospital deaths, which are mainly observed in elderly patients following a fall from standing height. Further research is required to determine the preventability of fatal traumatic injury in Scotland.
authors.affiliation: Academic Unit of Surgery, Glasgow Royal Infirmary, Glasgow, UK; The Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Morrison
authors.affiliation: Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Liam Z
authors.initials: LZ
authors.lastname: Yapp
authors.affiliation: Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Beattie
authors.affiliation: Wishaw General Hospital, Wishaw, UK.
authors.forename: Eimar
authors.initials: E
authors.lastname: Devlin
authors.affiliation: Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Milan
authors.initials: M
authors.lastname: Samarage
authors.affiliation: Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Craig
authors.initials: C
authors.lastname: McCaffer
authors.affiliation: Aberdeen Royal Infirmary, Aberdeen, UK; Health Services Research Unit, University of Aberdeen, UK. Electronic address: jan.jansen@abdn.ac.uk.
authors.forename: Jan O
authors.initials: JO
authors.lastname: Jansen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012606:Scotland / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality*
keywords: Scottish trauma; Trauma epidemiology