title: Evolution of severe trauma in Estonia comparing early versus established independence of the state.
abstract: OBJECTIVE
  Trauma mechanisms and patterns of severe injuries during the Estonian independence have not been evaluated. The aim of the study was to compare the incidence and outcomes of severe injuries between time periods of early independence from the Soviet Union and the present time.
  
  
  METHODS
  After the ethics review board approval, all adult trauma admissions to major trauma facilities in 1993-1994 and 2013-2014 with Injury Severity Score >15 were identified. Data collection included demographics, injury severity variables, interventions, and in-hospital outcomes. Primary outcome was in-hospital mortality. Secondary outcomes included incidence of penetrating trauma, hospital length of stay (HLOS), and in-hospital complications. Primary outcome difference comparing the two time segments was determined using logistic regression analysis.
  
  
  RESULTS
  A total of 1064 patients were included, 593 and 471 from 1993-1994 to 2013-2014, respectively. Incidence of penetrating trauma during 1993-1994 was 11.1 % and in 2013-2014 at 6.4 % (p = 0.007). Gunshot injuries constituted 62.1 and 23.3 % of all penetrating trauma in 1993-1994 and 2013-2014, respectively (p < 0.001). The overall mean HLOS was 15.5 ± 19.8 days and did not differ between the periods. The rate of adjusted complications showed a trend for a decreased incidence (adj. p = 0.064). Adjusted mortality rate was 50.3 and 16.4 % during 1993-1994 and 2013-2014, respectively (adj. OR 7.01; 95 % CI 4.69-10.47; p < 0.001).
  
  
  CONCLUSIONS
  Effective law enforcement, gun control, evolution of trauma system, and reduction of interpersonal violence have all contributed to a significant decrease in penetrating trauma incidence and all-cause adjusted mortality during the 20 years of Estonian independence.
authors.affiliation: School of Medicine, University of Tartu, Tartu, Estonia.|Department of Surgery, North Estonia Medical Center, J. Sütiste tee 19, 13419, Tallinn, Estonia.
authors.forename: S
authors.initials: S
authors.lastname: Saar
authors.affiliation: School of Medicine, University of Tartu, Tartu, Estonia.
authors.forename: M
authors.initials: M
authors.lastname: Sokirjanski
authors.affiliation: School of Medicine, University of Tartu, Tartu, Estonia.
authors.forename: L K
authors.initials: LK
authors.lastname: Junkin
authors.affiliation: School of Medicine, University of Tartu, Tartu, Estonia.|Department of Surgery, North Estonia Medical Center, J. Sütiste tee 19, 13419, Tallinn, Estonia.
authors.forename: J
authors.initials: J
authors.lastname: Laos
authors.affiliation: School of Medicine, University of Tartu, Tartu, Estonia.
authors.forename: A L
authors.initials: AL
authors.lastname: Laar
authors.affiliation: School of Medicine, University of Tartu, Tartu, Estonia.
authors.forename: I
authors.initials: I
authors.lastname: Merioja
authors.affiliation: School of Medicine, University of Tartu, Tartu, Estonia.|Department of Surgery, Tartu University Hospital, Tartu, Estonia.
authors.forename: U
authors.initials: U
authors.lastname: Lepner
authors.affiliation: Department of Surgery, North Estonia Medical Center, J. Sütiste tee 19, 13419, Tallinn, Estonia.
authors.forename: L
authors.initials: L
authors.lastname: Kukk
authors.affiliation: Department of Anaesthesiology, North Estonia Medical Center, Tallinn, Estonia.
authors.forename: A
authors.initials: A
authors.lastname: Remmelgas
authors.affiliation: School of Medicine, University of Tartu, Tartu, Estonia.|Department of Neurosurgery, Tartu University Hospital, Tartu, Estonia.
authors.forename: T
authors.initials: T
authors.lastname: Asser
authors.affiliation: Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.
authors.forename: K
authors.initials: K
authors.lastname: Innos
authors.affiliation: School of Medicine, University of Tartu, Tartu, Estonia.|Department of Anaesthesiology and Critical Care, Tartu University Hospital, Tartu, Estonia.
authors.forename: J
authors.initials: J
authors.lastname: Starkopf
authors.affiliation: School of Medicine, University of Tartu, Tartu, Estonia. peep.talving@regionaalhaigla.ee.|Department of Surgery, North Estonia Medical Center, J. Sütiste tee 19, 13419, Tallinn, Estonia. peep.talving@regionaalhaigla.ee.|Department of Surgery, Tartu University Hospital, Tartu, Estonia. peep.talving@regionaalhaigla.ee.
authors.forename: P
authors.initials: P
authors.lastname: Talving
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D004957:Estonia / Q000453:epidemiology; D005260:Female; D006076:Government; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D014193:Trauma Centers; D014948:Wounds, Gunshot / Q000453:epidemiology* / Q000401:mortality
keywords: Independence; Mortality; Severe trauma