title: Outcome after red trauma alarm at an urban Swedish hospital: implications for prevention.
abstract: OBJECTIVE
  We applied the new injury severity scoring system and studied mechanisms of injury and risk factors for mortality, in order to find potential preventive measures, in the present Scandinavian trauma cohort triaged through red trauma alarm according to the Medical Emergency Triage and Treatment System.
  
  
  METHODS
  Individuals were identified in hospital and forensic records. New injury severity scoring system >15 was defined as major trauma. Inter-rater reliability of new injury severity scoring system was expressed as intra-class correlation coefficient with 95% confidence intervals.
  
  
  RESULTS
  There were 125 major and 303 minor traumas. The intra-class correlation coefficient was 0.83 (95% confidence intervals 0.58-0.94) for major trauma and intra-class correlation coefficient was 0.96 (95% confidence intervals 0.89-0.98) for minor trauma. Traffic (37%) and fall (31%) accidents were the leading mechanisms of injury. Elderly (aged ⩾65 years) were at an increased risk of fall accidents (p<0.001). The overall 3 month mortality rate was 10.3% (2% for new injury severity scoring system 16-24, 39% for new injury severity scoring system 25-40 and 68% for new injury severity scoring system >40). A higher new injury severity scoring system score (p<0.001), higher age (p<0.001), shock at admission (p<0.001), intensive care unit stay (p<0.004) and administration of massive red blood cell transfusion (p<0.048) were associated with mortality. Thirty-three patients underwent forensic autopsy and were tested positive for one or multiple drugs in 52% and 33%, respectively.
  
  
  CONCLUSIONS
  The high prevalence of detected drugs among those undergoing forensic toxicological examination suggests that toxicology screening should be integrated into all red trauma alarm admissions, which may have implications on prevention of future trauma morbidity and mortality.
authors: Department of Surgery, Skåne University Hospital, Sweden.
authors: Ali
authors: A
authors: Bagher
authors: Emergency Medicine, Skåne University Hospital, Sweden.
authors: Lina
authors: L
authors: Andersson
authors: National Board of Forensic Medicine, Sweden Unit for Forensic Medicine, Department of Clinical Sciences, Lund University, Sweden.
authors: Carl Johan
authors: CJ
authors: Wingren
authors: National Board of Forensic Medicine, Sweden Unit for Forensic Medicine, Department of Clinical Sciences, Lund University, Sweden.
authors: Anders
authors: A
authors: Ottosson
authors: Department of Surgery, Skåne University Hospital, Sweden.
authors: Sakarias
authors: S
authors: Wangefjord
authors: Vascular Centre, Skåne University Hospital, Sweden stefan.acosta@telia.com.
authors: Stefan
authors: S
authors: Acosta
mesh_terms: D000328:Adult; D005260:Female; D053593:Forensic Toxicology; D017052:Hospital Mortality; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D015599:Trauma Severity Indices; D014218:Triage / Q000379:methods*; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy; D055815:Young Adult
keywords: Trauma; forensic autopsy; forensic toxicology; new injury severity score; outcome; prevention