S Saar1,2, M Sokirjanski1, L K Junkin1, J Laos1,2, A L Laar1, I Merioja1, U Lepner1,3, L Kukk2, A Remmelgas4, T Asser1,5, K Innos6, J Starkopf1,7, P Talving8,9,10. 1. School of Medicine, University of Tartu, Tartu, Estonia. 2. Department of Surgery, North Estonia Medical Center, J. Sütiste tee 19, 13419, Tallinn, Estonia. 3. Department of Surgery, Tartu University Hospital, Tartu, Estonia. 4. Department of Anaesthesiology, North Estonia Medical Center, Tallinn, Estonia. 5. Department of Neurosurgery, Tartu University Hospital, Tartu, Estonia. 6. Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia. 7. Department of Anaesthesiology and Critical Care, Tartu University Hospital, Tartu, Estonia. 8. School of Medicine, University of Tartu, Tartu, Estonia. peep.talving@regionaalhaigla.ee. 9. Department of Surgery, North Estonia Medical Center, J. Sütiste tee 19, 13419, Tallinn, Estonia. peep.talving@regionaalhaigla.ee. 10. Department of Surgery, Tartu University Hospital, Tartu, Estonia. peep.talving@regionaalhaigla.ee.
Abstract
PURPOSE: 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.
PURPOSE: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: J A Asensio; J Berne; D Demetriades; J Murray; H Gomez; A Falabella; A Fox; G Velmahos; W Shoemaker; T V Berne Journal: J Trauma Date: 1997-08
Authors: Demetrios Demetriades; Matthew Martin; Ali Salim; Peter Rhee; Carlos Brown; Jay Doucet; Linda Chan Journal: J Am Coll Surg Date: 2005-12-19 Impact factor: 6.113