title: Prehospital transportation decisions for patients sustaining major trauma in road traffic crashes in Sweden.
abstract: The objective of this study was to evaluate the proportion and characteristics of patients sustaining major trauma in road traffic crashes (RTCs) who could benefit from direct transportation to a trauma center (TC).
  
  
  
  Currently, there is no national classification of TC in Sweden. In this study, 7 university hospitals (UHs) in Sweden were selected to represent a TC level I or level II. These UHs have similar capabilities as the definition for level I and level II TC in the United States. Major trauma was defined as Injury Severity Score (ISS) > 15. A total of 117,730 patients who were transported by road or air ambulance were selected from the Swedish TRaffic Accident Data Acquisition (STRADA) database between 2007 to 2014. An analysis of the patient characteristics sustaining major trauma in comparison with patients sustaining minor trauma (ISS < 15) was conducted. Major trauma patients transported to a TC versus non-TC were further analysed with respect to injured body region and road user type.
  
  
  
  Approximately 3% (n = 3, 411) of patients sustained major trauma. Thirty-eight percent of major trauma patients were transported to a TC, and 62% were transported to a non-TC. This results in large proportions of patients with Abbreviated Injury Scale (AIS) 3+ injuries being transported to a non-TC.  The number of AIS 3+ head injuries for major trauma patients transported to a TC versus non-TC were similar, whereas a larger number of AIS 3+ thorax injuries were present in the non-TC group. The non-TC major trauma patients had a higher probability of traveling in a car, truck, or bus and to be involved in a crash in a rural location.
  
  
  
  Our results show that the majority of RTC major trauma patients are transported to a non-TC. This may cause unnecessary morbidity and mortality. These findings can guide the development of improved prehospital treatment guidelines, protocols and decision support systems.
authors: a Department of Signals and Systems , Chalmers University of Technology , Gothenburg , Sweden.|b SAFER Vehicle and Traffic Safety Centre at Chalmers , Gothenburg , Sweden.|c MedTech West, Sahlgrenska University Hospital , Gothenburg , Sweden.
authors: Stefan
authors: S
authors: Candefjord
authors: a Department of Signals and Systems , Chalmers University of Technology , Gothenburg , Sweden.|b SAFER Vehicle and Traffic Safety Centre at Chalmers , Gothenburg , Sweden.|c MedTech West, Sahlgrenska University Hospital , Gothenburg , Sweden.|d School of Health Sciences, University of Borås , Borås , Sweden.
authors: Ruben
authors: R
authors: Buendia
authors: e Trauma Unit, Department of Surgery, Sahlgrenska University Hospital , Gothenburg , Sweden.|f Department of Surgery , Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.
authors: Eva-Corina
authors: EC
authors: Caragounis
authors: a Department of Signals and Systems , Chalmers University of Technology , Gothenburg , Sweden.|b SAFER Vehicle and Traffic Safety Centre at Chalmers , Gothenburg , Sweden.|c MedTech West, Sahlgrenska University Hospital , Gothenburg , Sweden.
authors: Bengt Arne
authors: BA
authors: Sjöqvist
authors: b SAFER Vehicle and Traffic Safety Centre at Chalmers , Gothenburg , Sweden.|g Department of Applied Mechanics , Chalmers University of Technology , Gothenburg , Sweden.|h Neuroscience Research Australia and School of Medical Sciences, University of New South Wales , Sydney , New South Wales , Australia.
authors: Helen
authors: H
authors: Fagerlind
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D016208:Databases, Factual; D004632:Emergency Medical Services; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D013548:Sweden / Q000453:epidemiology; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000209:etiology* / Q000628:therapy*
keywords: Major trauma; post-crash; prehospital care; road traffic crashes; trauma center; triage