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Severe Trauma in Estonia: 256 consecutive cases analysed and the impact on outcomes comparing two regions

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Abstract

Purpose

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.

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Authors and Affiliations

  1. Faculty of Health Sciences, University of Tartu, Tartu, Estonia

    S. Saar, I. Merioja, U. Lepner, T. Asser, T. Metsvaht, J. Starkopf & P. Talving

  2. Division of Trauma, Goethe University Hospital, Frankfurt, Germany

    T. Lustenberger

  3. Department of Surgery, Tartu University Hospital, Tartu, Estonia

    U. Lepner & P. Talving

  4. Department of Neurosurgery, Tartu University Hospital, Tartu, Estonia

    T. Asser

  5. Department of Anaesthesiology and Intensive Care, Children’s Clinic, Tartu University Hospital, Tartu, Estonia

    T. Metsvaht

  6. Department of Anaesthesiology and Intensive Care, Tallinn Children’s Hospital, Tallinn, Estonia

    M. L. Ilmoja

  7. Department of Surgery, Acute Care Surgery, North Estonia Medical Center, J. Sütiste tee 19, 13419, Tallinn, Estonia

    L. Kukk & P. Talving

  8. Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia

    J. Starkopf

Authors
  1. S. Saar
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  2. I. Merioja
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  3. T. Lustenberger
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  4. U. Lepner
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  5. T. Asser
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  7. M. L. Ilmoja
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  8. L. Kukk
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  9. J. Starkopf
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  10. P. Talving
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Corresponding author

Correspondence to P. Talving.

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Conflict of interest

Sten Saar, Ingrid Merioja, Thomas Lustenberger, Urmas Lepner, Toomas Asser, Mari-Liis Ilmoja, Tuuli Metsvaht, Leonhard Kukk, Joel Starkopf and Peep Talving declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Saar, S., Merioja, I., Lustenberger, T. et al. Severe Trauma in Estonia: 256 consecutive cases analysed and the impact on outcomes comparing two regions. Eur J Trauma Emerg Surg 42, 497–502 (2016). https://doi.org/10.1007/s00068-015-0568-y

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  • DOI: https://doi.org/10.1007/s00068-015-0568-y

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