Trauma Care - Implementation, Evaluation and Validation

Sammanfattning: Trauma is a major cause of death and morbidity in all ages, which makes continuous improvement of trauma care a high priority. During the last decades, Sweden’s trauma system has evolved with initiation of a national trauma registry (SweTrau) in 2011 and the Swedish National Trauma Triage criteria (SNTTC) in 2017. However, the Swedish trauma panorama has evolved as well, something this thesis aimed to explore, alongside with evaluating the safety and accuracy of the SNTTC and performing the first validation of SweTrau. Paper I is a prospective stepped-wedge cohort study, showing unchanged 30-day mortality, over- and undertriage after the implementation of the SNTTC, as well as a reduction of the lowest level of trauma call by almost 50%, proving that the SNTTC are safe to use. In Paper II, a retrospective multicentre cohort study, the SNTTC are further investigated, displaying a sensitivity of almost 85% while also assessing specificity, positive predictive value (PPV) and positive likelihood ratio (LR+). With no additional enhancing criteria found, the SNTTC are concluded to efficiently identify severely injured patients. Paper III reports the first validation of SweTrau; an on-site re-registration compared with the original registration in SweTrau. It demonstrates that the data in SweTrau is reliable, with high accuracy (85.8%), correctness (89.7%), data completeness (88.5%) and correlation (87.5%), while being comparable to international trauma registries using the Utstein template of trauma. Case completeness and timeliness are identified as areas of improvement. In Paper IV, nine-year trauma trends in two major trauma centres are analysed in a retrospective cohort study. A sharp reduction in intensive care unit admissions is seen, as well as a worrying increase in penetrating trauma (>50%) and mortality for patients with a low injury severity score (1.3%-2.7%, p=0.005), all of which require further investigation. In conclusion; this thesis has confirmed that the SNTTC are safe and efficient, as well as pin-pointed important trauma areas to focus on in the future. Finally, it has established the validity of the data in SweTrau - a major source of Swedish trauma research.