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Injuries are not accidents!: an emergency-department population-based epidemiological study of injuries with special reference to trauma recidivism hip fractures and geriatric falls
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
2021 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

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 strength

The 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...

Abstract [sv]

Skador är ett gigantiskt globalt folkhälsoproblem som enligt WHO dödar fler människor än tuberkulos, malaria och AIDS tillsammans. Skador drabbar individen med smärta/invaliditet, samhället med vårdkostnader och produktionsbortfall. Sverige har varit föregångare i trafiksäkerhetsarbetet, inom arbetslivets risker och inom barnsäkerhetsarbetet. År 2020 omkom 190 individer i trafiken, vilket är det lägsta antalet någonsin. Dödliga fall däremot, som senaste åren passerat över 1500 årligen, uppmärksammas betydligt mindre, kanske pga. att de ofta uppkommer i hemmet, drabbar äldre kvinnor och sannolikt också att de betraktas som ej möjliga att förebygga. Fallskador dödar fler än alla andra skador tillsammans och är nu det största trauma-problemet i rika länder.

Vi analyserade 220 014 skadetillfällen som registrerats på akutmottagningen i Umeå 1993– 2014 i en bred översikt av skadepanoramat, med speciell inriktning på fall, den viktigaste och vanligaste skademekanismen. Vilka skadar sig flera gånger? Hur ökar tidigare skador risken för nya skador? Detta är speciellt intressant för höftfraktur. Målet är att förbättra det skadeförebyggande arbetet.

Umeå hade en yngre befolkning än krans-kommunerna och närheten till akuten ökade umeåbornas akutbesök jämfört med de övriga kommunerna. Fallskador stod för nästan hälften, och hem- och fritidsskador dominerade panoramat. Efter medelåldern utgjorde fall ungefär samma procentuella andel av alla skademekanismer som den kronologiska åldern. Trafikskadorna utgjorde en femtedel, varav de cykelrelaterade utgjorde knappt hälften.

Frakturer stod för en fjärdedel av alla skador, hälften hos äldre, och ansvarade för hela 75% av alla skade-relaterade vårddagarna. Men även mjukdelsskador var viktiga och utgjorde ungefär hälften av skadorna och en väsentlig del av vårddagarna på sjukhus.

Upprepade skador utgjorde hos vuxna 40% av alla skador, vanligast hos unga män och äldre kvinnor. Att drabbas av en fraktur eller stukning ökade risken att ådra sig ytterligare en allvarlig skada. Hos yngre män fann vi att även hjärnskakning ökade risken för förnyad allvarlig skada. Med ökad ålder ökade risken betydligt för upprepad allvarlig skada. En 90- årig kvinna hade 10 gånger högre risk än en 20-årig.

Tidigare skador gav en måttlig riskökning för höftfraktur. Även här framkommer att fraktur är den vanligaste skadetypen som föregår en höftfraktur. 40% av alla som drabbas av en höftfraktur har haft en eller flera tidigare skador och de som drabbas av höftfraktur är mer skadebenägna än de som inte drabbas av höftfraktur. Flera tidigare skador ökar också risken för framtida höftfraktur. Vi fann att 12% av alla med höftfraktur drabbas av en ytterligare höftfraktur.

Förekomsten av höftfraktur ökar med en faktor på cirka 100 under livet—en exceptionell åldersfördelning, vilket troligen beror mer på falltendens och oförmåga att parera fall än enbart på benskörhet. Skadorna visar nämligen ett åldersrelaterat anatomiskt mönster där frakturerna i nedre extremiteten blir allt vanligare, och även centralt lokaliserade, närmare bålen. Även mjukdelsskador i ansikte/huvud ökar med åldern vilket också visar betydelsen av att kunna ta mot sig och dämpa rörelseenergin.iiiFör alla andra skadesituationer utom fall finns en utbyggd skadeprofylax. Antalet 80+ ökar kontinuerligt och kommer att ytterligare belasta sjukvården i framtiden. Tidigare frakturer med även andra skador och andra kända riskfaktorer som finns dokumenterade i patientjournalen borde kunna användas i ett riktat preventionsarbete. Men för att få kraftfull effekt krävs många andra åtgärder och inte minst informationskampanjer riktade till befolkningen. Att skador uppstår till följd av slump eller otur är en vanlig åsikt som är djupt rotad hos oss människor och som måste ändras. Resultaten av de massiva insatser som gjorts inom trafiken och arbetslivet har visat att det är möjligt; tiden är nu inne för att minska antalet fallskador. Regeringen har en nollvision för trafik-”olyckor” och formulerade 2015 en målsättning att halvera fallskadorna hos gamla. Men vad har hänt?

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet , 2021. , s. 41
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2131
Nyckelord [en]
injury, population, fractures, contusions, sprains, fall injuries
Nationell ämneskategori
Ortopedi
Forskningsämne
ortopedi
Identifikatorer
URN: urn:nbn:se:umu:diva-182818ISBN: 978-91-7855-525-3 (tryckt)ISBN: 978-91-7855-526-0 (digital)OAI: oai:DiVA.org:umu-182818DiVA, id: diva2:1552635
Disputation
2021-05-28, Triple Helix, Universitetsledningshuset, Zoom, meeting ID: 687 3603 1313, Umeå, 13:00 (Svenska)
Opponent
Handledare
Forskningsfinansiär
Region Norrbotten, NLL-941997Tillgänglig från: 2021-05-07 Skapad: 2021-05-05 Senast uppdaterad: 2021-05-06Bibliografiskt granskad
Delarbeten
1. A population-based 220,014- injury event cohort 1993-2014 Umeå, Sweden
Öppna denna publikation i ny flik eller fönster >>A population-based 220,014- injury event cohort 1993-2014 Umeå, Sweden
Visa övriga...
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Abstract [en]

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.

Nyckelord
Injury Database, epidemiology, geography, injury
Nationell ämneskategori
Ortopedi
Forskningsämne
ortopedi
Identifikatorer
urn:nbn:se:umu:diva-182817 (URN)
Forskningsfinansiär
Region Västerbotten
Tillgänglig från: 2021-05-05 Skapad: 2021-05-05 Senast uppdaterad: 2024-04-11
2. Epidemiologic patterns of injuries treated at the emergency department of a Swedish medical center
Öppna denna publikation i ny flik eller fönster >>Epidemiologic patterns of injuries treated at the emergency department of a Swedish medical center
2015 (Engelska)Ingår i: Injury Epidemiology, E-ISSN 2197-1714, Vol. 2, nr 3, s. ?-Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: The injury spectrum published in the literature has mainly been presented for a certain age group, as elderly or for a certain type of injury, as fracture and often restricted to in-hospital care cases. Our objective was to give an overview of the major types of injuries for all age groups and trends in the adult population.

Methods: We analyzed 68,159 adult injury events, which occurred between 1999 and 2008  and was treated at the Emergency Department of Umea University Hospital. All these injuries are registered in a database. The injuries were analyzed depending on frequency, type of injury, and activity at the time of injury. Incidence rates were calculated using population data from Statistics Sweden.

Results: Injury event incidence varied between 614 (2004) and 669 (2007) per 10,000 persons. The most common injury was a fracture, although contusions and wounds were also frequent. Fractures were responsible for almost three quarters of hospital days related to injury. The risk for fractures increased with age, as did contusions and concussions, whereas sprains decreased with age. Fracture incidence increased among the 50- to 59-year age group for both women and men. Fall-related injuries increased significantly for middle-aged adults. Sports-related and work injuries decreased, while injuries occurring during leisure time increased the most.

Conclusion: A fracture is the most frequent type of injury for adults and accounts for the largest proportion of the trauma care burden. Contusions are also common and responsible for a significant proportion of the in-hospital days. Injuries caused by a fall increased among middle-age adults imply a need for an extension of fall prevention programs.

Ort, förlag, år, upplaga, sidor
Springer, 2015
Nyckelord
Injury, Fracture, Contusion, Strain, Wound, Fall, Epidemiology
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-116824 (URN)10.1186/s40621-014-0033-0 (DOI)2-s2.0-85024479063 (Scopus ID)
Tillgänglig från: 2016-02-12 Skapad: 2016-02-12 Senast uppdaterad: 2024-01-16Bibliografiskt granskad
3. Trauma recidivism at an emergency department of a Swedish medical center
Öppna denna publikation i ny flik eller fönster >>Trauma recidivism at an emergency department of a Swedish medical center
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2016 (Engelska)Ingår i: Injury Epidemiology, E-ISSN 2197-1714, Vol. 3, artikel-id 22Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: To inform targeted prevention, we studied patterns of trauma recidivism and whether a first injury predicts the risk for a recurrent injury.

METHODS: In a population-based study of 98,502 adult injury events 1999-2012, at the emergency department of Umeå University Hospital, Sweden, we compared non-recidivists with recidivists in terms of patients' sex, age, type of injury and severity of the injury.

RESULTS: Thirty-six percent of all patients suffered recurrent injuries, which were associated with a higher proportion of inpatient care and more hospital days. Young men and elderly women were at the highest risk for trauma recidivism. At 20 to 24 years, men had a 2.4 (CI 95 % 2.3-2.5) higher risk than women, a 90 years old woman had almost a 10-fold higher risk for another moderate/severe injury than a 20 years old one. A fracture were associated with a hazard ratio of 1.28 (CI 95 % 1.15-1.42) among men younger than 65 years and 1.31 (CI 95 % 1.12-1.54) for men older than 65 years for a subsequent moderate/severe injury. For women younger than 65 years a fracture was associated with a hazard ratio of 1.44 (CI 95 % 1.28-1.62) for a subsequent moderate/severe injury. A sprain carries a higher risk for a new moderate/severe injury for both men and women and in both age groups; the hazard ratio was 1.13 (CI 95 % 1.00-1.26) for men younger than 65 years, 1.42 (CI 95 % 1.01-1.99) for men older than 65 years, 1.19 (CI 95 % 1.05-1.35) for women younger than 65 years and 1.26 (CI 95 % 1.02-1.56) for women older than 65 years. A higher degree of injury severity was associated with a higher risk for a new moderate/severe injury.

CONCLUSION: Trauma recidivism is common and represents a large proportion of all injured. Age and sex are associated with the risk for new injury. Injury types and severity, also have implications for future injury.

Nationell ämneskategori
Kirurgi
Identifikatorer
urn:nbn:se:umu:diva-127497 (URN)10.1186/s40621-016-0087-2 (DOI)27747558 (PubMedID)
Tillgänglig från: 2016-11-14 Skapad: 2016-11-14 Senast uppdaterad: 2024-01-16Bibliografiskt granskad
4. What happens before and after a hip fracture?
Öppna denna publikation i ny flik eller fönster >>What happens before and after a hip fracture?
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Abstract [en]

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. 

Nyckelord
hip fracture, epidemiology
Nationell ämneskategori
Ortopedi
Forskningsämne
ortopedi
Identifikatorer
urn:nbn:se:umu:diva-182800 (URN)
Forskningsfinansiär
Region Norrbotten, NLL-941997
Tillgänglig från: 2021-05-05 Skapad: 2021-05-05 Senast uppdaterad: 2021-05-06
5. Geriatric falls. A Population-based study 27,402 injury events in people 65 years and older
Öppna denna publikation i ny flik eller fönster >>Geriatric falls. A Population-based study 27,402 injury events in people 65 years and older
Visa övriga...
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Abstract [en]

Background:  In rich countries falls are one of the commonest injuries, killing more people than all other injury mechanisms together, incapacitating orders of magnitude more, and are responsible for >70% of all trauma hospital beds.

Materials:  All injuries admitted to the emergency department, 1993-2014, Umeå university hospital, Sweden were registered, e.g., mechanism, injury, localization, type, severity score and treatment, 220,014 injury events. Here we look at 27,402 falls in people over 64.

Results:  Geriatric fall injuries were 12.5% of all admissions, responsible for 40.7% of all trauma-related hospital days. Fall was the only injury mechanism where women dominated. Between 65-69, falls were 64% of all injuries; for 90+ not less than 93%. With age, severity score increased: between 65 and 69, 10% had score ≥ 3; in 90+, 29% had. Hip fractures increased from 6.2% to 24.4% of all injuries. There was no apparent association between recorded fall height and severity score. Both fractures and soft tissue injuries became more common in the lower extremity, and also more proximal.

Conclusions: The changing age/sex patterns in type and localization indicate that extraskeletal factors govern the injury localization/type, not only bone strength. The injury distribution and increasing severity with age, also indicate that not only fall tendency, but also deficient neuromuscular reflexes that distribute the kinetic energy matter; impact can be high even after a fall from standing or less. Therefore, secondary fracture prevention should involve all fall injuries, and also aim at all modifiable risk factors.

Nyckelord
fall injuries, geriatric falls
Nationell ämneskategori
Ortopedi
Forskningsämne
ortopedi
Identifikatorer
urn:nbn:se:umu:diva-182803 (URN)
Forskningsfinansiär
Region Norrbotten, NLL-941997
Tillgänglig från: 2021-05-05 Skapad: 2021-05-05 Senast uppdaterad: 2024-04-11

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