Severe Trauma in Estonia: 256 consecutive cases analysed and the impact on outcomes comparing two regions.
OBJECTIVE
The purpose of this study was to investigate epidemiology of severe injuries in Estonia while comparing outcomes at regional trauma facilities.


METHODS
After the ethics review board approval, all consecutive trauma admissions with Injury Severity Score (ISS) > 15 to North Estonia Medical Center/Tallinn Children's Hospital (NEMC + TCH) and Tartu University Hospital (TUH) were identified between 1/1/2013 and 31/12/2013. Data collection included demographics, admission data, injury severity variables, interventions, and in-hospital outcomes. Primary outcome was in-hospital mortality. Secondary outcomes were complications per Clavien-Dindo and hospital length of stay (HLOS). Logistic regression analysis was used to compare adjusted mortality between the two regional hospitals.


RESULTS
A total of 256 patients met inclusion criteria. The mean ISS for the cohort was 23.6 ± 7.8, 13.3 % were hypotensive on admission, and 44.1 % had a Glasgow Coma Scale < 9. Overall rate of complications was 40.2 % that did not differ between the facilities. The mean HLOS at the NEMC + TCH and the TUH were 20.1 ± 25.1 and 10.5 ± 11.2 days (p < 0.001), respectively. Overall mortality was 20.7 % (n = 53). Mortality was 25.4 and 14.9 % for the NEMC + TCH and the TUH, respectively (p = 0.04). Logistic regression analysis resulted in comparable mortality at the regional trauma facilities (adj. OR 1.38; 95 % CI 0.66-2.92; p value 0.39).


CONCLUSIONS
The annual incidence of injuries with ISS > 15 was 256 cases with overall mortality at 20.7 % in Estonia. We observed comparable adjusted outcomes at the major regional trauma facilities. This study contains benchmarking data on severely injured patients in Estonia providing potential for future trauma care evaluation and regional outcome comparisons.
Faculty of Health Sciences, University of Tartu, Tartu, Estonia.
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Saar
Faculty of Health Sciences, University of Tartu, Tartu, Estonia.
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Merioja
Division of Trauma, Goethe University Hospital, Frankfurt, Germany.
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Lustenberger
Faculty of Health Sciences, University of Tartu, Tartu, Estonia.|Department of Surgery, Tartu University Hospital, Tartu, Estonia.
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Lepner
Faculty of Health Sciences, University of Tartu, Tartu, Estonia.|Department of Neurosurgery, Tartu University Hospital, Tartu, Estonia.
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Asser
Faculty of Health Sciences, University of Tartu, Tartu, Estonia.|Department of Anaesthesiology and Intensive Care, Children's Clinic, Tartu University Hospital, Tartu, Estonia.
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Metsvaht
Department of Anaesthesiology and Intensive Care, Tallinn Children's Hospital, Tallinn, Estonia.
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Ilmoja
Department of Surgery, Acute Care Surgery, North Estonia Medical Center, J. Sütiste tee 19, 13419, Tallinn, Estonia.
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Kukk
Faculty of Health Sciences, University of Tartu, Tartu, Estonia.|Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia.
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Starkopf
Faculty of Health Sciences, University of Tartu, Tartu, Estonia. peep.talving@ut.ee.|Department of Surgery, Tartu University Hospital, Tartu, Estonia. peep.talving@ut.ee.|Department of Surgery, Acute Care Surgery, North Estonia Medical Center, J. Sütiste tee 19, 13419, Tallinn, Estonia. peep.talving@ut.ee.
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Talving
D000328:Adult; D017677:Age Distribution; D019985:Benchmarking; D004957:Estonia / Q000453:epidemiology; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D017678:Sex Distribution; D014193:Trauma Centers / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality* / Q000628:therapy
Complications; Incidence; Mortality; Severe injury