| 1. |
- Hellström, Magnus, et al.
(författare)
-
A population-based 220,014- injury event cohort 1993-2014 Umeå, Sweden
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Injury kills more people than AIDS, malaria, and tuberculosis—together. In rich countries fall injuries dominate quantitatively, while other mechanisms as traffic and occupational injuries decrease. This is a descriptive macro-perspective of the entire injury as a data repository and reference to further more comprehensive studies, e.g., socio-demography, comorbidity, drugs and trauma recidivism.A population-based registration of patients admitted to an emergency department was done 1993-2014.Of the 220,014 injury events, 43% were fall injuries, 12% transportation injuries; assault 4%; 18% were hospitalized; 0.2% were fatal. Young men and old women were at the highest risk for injury. There were 23% fractures in the entire material, increasing to 40% in senescence, whereof 40% hip fractures. With age, fracture locations changed from distal to proximal, and from upper to lower extremity. Fall injuries accounted for 80% of all trauma-related hospital days, mostly old people. The spatial distribution of the population is heavily skewed, spanning from urban core areas to rural peripheries.This is a description of a population-based injury panorama to further studies linking cause, mechanism and type of injury to available medical, sociologic and economic information. Age and sex affected the type, soft tissue injury/fracture and anatomic location, i.e., proximal/distal and upper/lower extremity. At the beginning and end of life, endogenic risk factors are more dominant than in adulthood where exogenic factors dominate. It therefore seems reasonable to believe that it should be possible to substantially prevent injuries by using multipronged analyses to design specific interventions. Injuries are not accidents.
|
|
| 2. |
|
|
| 3. |
- Röding, Fredrik, 1969-
(författare)
-
Injuries are not accidents! : an emergency-department population-based epidemiological study of injuries with special reference to trauma recidivism hip fractures and geriatric falls
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Injury is a major public health problem. In rich countries fall injures now kill more people than all other injury mechanisms together, because of global ageing and large-scale sustainable injury prevention programs for all other injury mechanisms but falls. Injuries from falls in the young are often trivial, but in old people falls may have devastating consequences.We used the Umeå Injury Database, 1993 – 2014, 220,014 injury events attended to by the emergency department: e.g., type of injury, localization, mechanism, activity and severity. Logistic regression was used to evaluate injury trends, Cox regression for associations between injury type, severity and recidivism.Fractures were responsible for 1⁄4 of all injuries and for 3⁄4 of trauma inpatient days. Fractures and contusions became more common with increasing age while sprains and wounds decreased with age. Injuries due to fall increased during the study period.Recurrent injuries accounted for some 40%, mostly in young men and in old women. Prior fractures and sprains were strongest predictors for recurrent serious injuries.The hip fracture incidence fell for the most important age/sex groups during the 22-year period, but the total number increased with 3,5%, due to an increasing elderly population. 40% of all hip fracture patients had sustained a previous injury. Multiple previous injuries also increase the risk of future hip fracture. No less than 12% hip fracture patients suffered a new one. With age, injury pattern changed, with more lower extremity fractures that also were more proximally located. Soft tissue injuries to the head/face also increased, also indicating that the ability to reduce and spread the impact of the kinetic energy is a key factor in geriatric trauma, in addition to tissue strengthThe most common, expensive and devastating injury mechanism, falls, are still outrageously neglected, especially concerning injury prevention, which has been so successful in reducing road traffic- and workplace-related deaths. Why? A common misconception is the primitive belief is that fall injuries are fated and therefore inevitable. There are also few economic and legal drivers to prevent falls, especially recurrent ones. Another reason is that GDPR has prohibited the injury database. Statistics on fall injuries are necessary for targeting preventive interventions. Without spying, no clue. On-line feedback of official statistics should be used to monitor the results. There are no technical, just legal hurdles. The Swedish parliament has since 1997 flagged a zero vision for road traffic injuries; in 2015 the government also launched a more modest goal for a 50% reduction of falls in the elderly. So far, nothing has happened...
|
|
| 4. |
- Röding, Fredrik, 1969-
(författare)
-
What happens before and after a hip fracture?
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: One of the strongest risk factors in medicine in general is that one has had a condition before. In fragility fracture prior fracture is a well-known risk factor for a new one. But how about other injuries? And how is the injury panorama before and after a hip fracture?Method: In Umeå, Sweden, all injury events at the emergency department were registered population-based, 1993-2014. We analyzed 60,590 injury events in people >50, comparing prior injuries in hip 4,619 hip fracture patients to 29,211 patients without hip fracture.Results: Hip fracture patients had had more prior injuries than controls. These differences were larger below 75. Also, other injuries had a predictive power for hip fracture, some 80- 60 % lower than fractures. In all, injuries had only a moderate power to predict hip fracture. The events clustered around the index hip fracture; before and afterwards, because of the high mortality. However, not less than 12% got a second hip fracture, 2% on the same side. On both sides, the second was more often than not of the same type as the first one, which may perhaps indicate constitutional factors.Conclusion: Trauma recidivism can be measured. All injuries should used to target secondary prevention—but should be supplemented with other readily available robust patient record data for spotting persons with a very high fall/fracture risk, e.g., residence, multimorbidity and polypharmacy. Considering the dismal outcome of hip fracture, it seems a god idea to emulate injury prevention models in, e.g., road traffic. For this we need on-line statistics of health care data.
|
|
