Epidemiology and management of traumatic injuries: a population-based study of fatal trauma and assessment of geographical challenges in the organisation of trauma care

Abstract

The World Health Organisation estimates that traumatic injuries are among the leading global causes of death. Studies have shown that a formalised and structured organisation of trauma care, termed trauma systems, have reduced mortality after injury. The centralisation of management to specialised trauma hospitals for the most severely injured patients is a key component of trauma systems. This centralisation causes challenges for rural areas; optimal pre-hospital triage, stabilisation at local hospitals, and efficient interhospital transfers are recommended strategies to ensure access to trauma care for rural populations in a trauma system. Trauma systems have yet to be implemented in any of the Scandinavian countries, including Norway. The aim of this study was to address geographical challenges in the development a trauma system and to analyse the urban–rural epidemiology of fatal trauma in Norway. Accessing trauma registry data at OUH Ulleval, the thesis showed an increasing trend in interhospital transfers from local hospitals to Ulleval in the period 2001–2008. With longer transfer distances, patients were more often severely injured and multitraumatised. Surveying the 19 referring local hospitals in the south-eastern health trust revealed deficiencies in trauma training and triage protocols for interhospital transfers. Based on central registry data from Statistics Norway, the annual incidence rate for fatal trauma in Norway was found to be 4.8 and 28.7 per 100,000 children and adults, respectively. The quarter of the population living in the most rural municipalities had 33% higher risk of dying from an injury compared with the remaining population. More patients also died before reaching hospital in rural areas. To ensure both quality and equality in a Norwegian trauma system, improving access to centralised care for rural populations is a challenge that must be prioritised.