Trauma research in the Nordic countries, 1995-2018 - a systematic review

Elisabeth Jeppesen, Valdemar Vea Iversen, Ingrid Schrøder Hansen, Eirik Reierth, Torben Wisborg, Elisabeth Jeppesen, Valdemar Vea Iversen, Ingrid Schrøder Hansen, Eirik Reierth, Torben Wisborg

Abstract

Background: Trauma is a major cause of mortality and reduced quality of life. Most trauma-related research originates from trauma centres, and there are limited available data regarding the treatment of trauma patients throughout the Nordic countries. These countries differ from economically similar countries due to their cold climate, mix of rural and urban areas, and the long distances separating many residents from a trauma centre. Research funders and the general public expect trauma research to focus on all links in the treatment chain. Here we conducted a systematic review to assess the amount of trauma-related research from the Nordic countries between January 1995 and April 2018, and the distribution of this research among different countries and different parts of the trauma treatment chain.

Methods: A systematic literature search was conducted in Medline, Embase, the Cochrane Library, Web of Science, and Scopus. We included studies concerning the trauma population from Nordic countries, and published between January 1995 and April 2018. Two independent reviewers screened titles and abstracts, and performed data extraction from full-text articles.

Results: The literature search yielded 5117 titles and abstracts, of which 844 full-text articles were included in our analysis. During this period, the annual number of publications increased. Publications were equally distributed among Norway, Sweden, and Denmark in terms of numbers; however, Norway had more publications relative to inhabitants. There were fewer overall publications from Finland and Iceland. We identified mostly cohort studies and very few randomized controlled trials. Studies focused on the level of care were predominantly epidemiological studies. Research at the pre-hospital level was three-fold more frequent than research on other elements of the trauma treatment chain.

Conclusion: The rate of publications in the field of trauma care in the Nordic countries has increased over recent years. However, several parts of the trauma treatment chain are still unexplored and most of the available studies are observational studies with low research evidence.

Keywords: Nordic countries; Systematic review; Trauma research; Trauma system.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
MeSH terms and text words
Fig. 2
Fig. 2
PRISMA flow diagram for selection of included and excluded studies
Fig. 3
Fig. 3
Distribution of included studies, sorted by year
Fig. 4
Fig. 4
Distribution of included studies, sorted by Nordic countries

References

    1. World Health Organization . WH. World Health Statistics. Geneva: WHO; 2014.
    1. Beck B, Bray JE, Cameron P, et al. Resuscitation attempts and duration in traumatic out-of-hospital cardiac arrest. Resuscitation. 2017;111:14–21. doi: 10.1016/j.resuscitation.2016.11.011.
    1. Morrison JJ, Yapp LZ, Beattie A, et al. The epidemiology of Scottish trauma: a comparison of pre-hospital and in-hospital deaths, 2000 to 2011. Surgeon. 2016;14(1):1–6. doi: 10.1016/j.surge.2015.02.001.
    1. Cameron PA, Gabbe BJ, Cooper DJ, Walker T, Judson R, McNeil J. A statewide system of trauma care in Victoria: effect on patient survival. Med J Aust. 2008;189(10):546–550. doi: 10.5694/j.1326-5377.2008.tb02176.x.
    1. Gabbe BJ, Simpson PM, Sutherland AM, Wolfe R, Fitzgerald MC, Judson R, Cameron PA. Improved functional outcomes for major trauma patients in a regionalized, inclusive trauma system. Ann Surg. 2012;255(6):1009–1015. doi: 10.1097/SLA.0b013e31824c4b91.
    1. MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, Salkever DS, Scharfstein DO. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366–378. doi: 10.1056/NEJMsa052049.
    1. Nathens AB, Jurkovich GJ, Cummings P, Rivara FP, Maier RV. The effect of organized systems of trauma care on motor vehicle crash mortality. JAMA. 2000;283(15):1990–1994. doi: 10.1001/jama.283.15.1990.
    1. Kristiansen T, Søreide K, Ringdal K, Rehn M, Krüger AJ, Reite A, et al. Trauma systems and early management of severe injuries in Scandinavia: review and current status. Injury. 2010;41(5):444–452. doi: 10.1016/j.injury.2009.05.027.
    1. Uleberg O, Pape K, Kristiansen T, Romundstad PR, Klepstad P. Population-based analysis of the impact of trauma on longer-term functional outcomes. Br J Surg. 2019;106(1):65–73. doi: 10.1002/bjs.10965.
    1. Uleberg O, Vinjevoll O-P, Kristiansen T, Klepstad P. Norwegian trauma care: a national cross-sectional survey of all hospitals involved in the management of major trauma patients. Scand J Trauma Resusc Emerg Med. 2014;22:64. doi: 10.1186/s13049-014-0064-0.
    1. Davenport RA, Tai N, West A, Bouamra O, Aylwin C, Woodford M, McGinley A, Lecky F, Walsh MS, Brohi K. A major trauma Centre is a specialty hospital not a hospital of specialties. Br J Surg. 2010;97(1):109–117. doi: 10.1002/bjs.6806.
    1. Covidence: .
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097.
    1. Merlin T, Weston A, Tooher R. Extending an evidence hierarchy to include topics other than treatment: revising the Australian 'levels of evidence'. BMC Med Res Methodol. 2009;9:34. doi: 10.1186/1471-2288-9-34.
    1. Chiara O, Cimbanassi S, Pitidis A, Vesconi S. Preventable trauma deaths: from panel review to population based-studies. World J Emerg Surg. 2006;1(1):12. doi: 10.1186/1749-7922-1-12.
    1. Lockey DJ. The shootings in Oslo and Utøya island July 22, 2011: lessons for theInternational EMS community. Scand J Trauma Resusc Emerg Med. 2012;20:4. doi: 10.1186/1757-7241-20-4.
    1. Sollid SJM, Rimstad R, Rehn M, Nakstad AR, Tomlinson A-E, Strand T, et al. Oslo government district bombing and Utøya island shooting July 22, 2011: Theimmediate prehospital emergency medical service response. Scand J Trauma Resusc Emerg Med. 2012;20:3. doi: 10.1186/1757-7241-20-3.
    1. Wisborg T, Brattebø G, Brinchmann-Hansen Å, Uggen PE, Hansen KS. Effects of Nationwide training of multi-professional trauma teams in Norwegian hospitals. J Trauma. 2008;64:1613–1618. doi: 10.1097/TA.0b013e31812eed68.
    1. Schünemann H, Brożek J, Guyatt G, Oxman A. GRADE handbook for grading quality of evidence and strength of recommendations. The GRADE Working Group. 2013.
    1. Sperry JL, Guyette FX, Brown JB, Yazer MH, Triulzi DJ, Early-Young BJ, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med. 2018;379(4):315–326. doi: 10.1056/NEJMoa1802345.
    1. Moore HB, Moore EE, Chapman MP, McVaney K, Bryskiewicz G, Blechar R, et al. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. Lancet. 2018;392(10144):283–291. doi: 10.1016/S0140-6736(18)31553-8.

Source: PubMed

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