Introduction
Patients and methods
Study subjects
Study parameters
Statistical analysis
Results
Overall patient characteristics
Total (n =6865) | Males (n=4851) | Females (n=2014) | P-value | |
---|---|---|---|---|
Age (years) mean ± SD | 49.9 ± 21.0 | 47.7 ± 20.2 | 55.4 ± 22.0 | <0.0001 |
Age groups (%) | ||||
16-44 years | 2861 (41.7) | 2212 (45.5) | 652 (32.4) | <0.0001 |
45-54 years | 1083 (15.8) | 821 (16.9) | 261 (13.0) | <0.0001 |
55+ years | 2921 (42.5) | 1818 (37.5) | 1101 (54.7) | <0.0001 |
ISS median (range) | 25.0(16-75) | 25.0 (16-75) | 24.0 (16-75) | <0.0001 |
ISS categorical (%) | ||||
16-24 | 3417 (49.8) | 2376 (49.0) | 1041 (51.7) | 0.044 |
25-50 | 3309 (48.2) | 2369 (48.8) | 940 (46.7) | 0.108 |
51-75 | 139 (2.0) | 106 (2.2) | 33 (1.6) | 0.171 |
Blunt mechanism of injury (%) | 6396 (93.2) | 4478 (92.3) | 1918 (95.2) | <0.0001 |
AIS cranial ≥ 3 (%) | 4502 (65.6) | 3068 (63.2) | 1434 (71.2) | <0.0001 |
AIS thorax ≥ 3 (%) | 2944 (42.9) | 2237 (46.1) | 707 (35.1) | <0.0001 |
AIS abdomen ≥ 3 (%) | 738 (10.8) | 547 (11.3) | 191 (9.5) | 0.032 |
SBP ≤ 89 mmHg at admission (%) | 429 (6.2) | 330 (6.8) | 99 (4.9) | 0.008 |
GCS at admission median (range) | 14.0 (3-15) | 14.0 (3-15) | 14.0 (3-15) | 0.048 |
P-HEMS assistance (%) | 2432 (35.4) | 1847 (38.1) | 585 (29.0) | <0.0001 |
Prehospital intubation (%) | 2057 (30.0) | 1500 (30.9) | 557 (27.7) | 0.009 |
Intubation at ED (%) | 2912 (42.4) | 2120 (43.7) | 792 (39.3) | 0.003 |
Total (n=2861) | Males (n=2209) | Females (n=652) | P-value | |
---|---|---|---|---|
Age (years) mean ± SD | 29.0 ± 8.4 | 29.1 ± 8.4 | 28.6 ± 8.6 | 0.180 |
ISS median (range) | 25.0 (16-75) | 25.0 (16-75) | 25.0 (16-75) | 0.072 |
ISS categorical (%) | ||||
16-24 | 1348 (47.1) | 1024 (46.4) | 324 (49.7) | 0.134 |
25-50 | 1428 (49.9) | 1118 (50.6) | 310 (47.5) | 0.169 |
51-75 | 85 (3.0) | 67 (3.0) | 18 (2.8) | 0.719 |
Blunt mechanism of injury (%) | 2580 (90.2) | 1971 (89.2) | 609 (93.4) | 0.002 |
AIS cranial ≥ 3 (%) | 1704 (59.6) | 1313 (59.4) | 391 (60.0) | 0.808 |
AIS thorax ≥ 3 (%) | 1455 (50.9) | 1140 (51.6) | 315 (48.3) | 0.139 |
AIS abdomen ≥ 3 (%) | 474 (16.6) | 358 (16.2) | 116 (17.8) | 0.339 |
SBP ≤ 89 mmHg at admission (%) | 201 (7.0) | 165 (7.5) | 36 (5.5) | 0.217 |
GCS at admission median (range) | 13.0 (3-15) | 13.0 (3-15) | 14.0 (3-15) | 0.110 |
P-HEMS assistance (%) | 1218 (42.6) | 963 (43.6) | 255 (39.1) | 0.110 |
Prehospital intubation (%) | 895 (31.3) | 709 (32.1) | 186 (28.5) | 0.225 |
Intubation at ED (%) | 1285 (44.9) | 1012 (45.8) | 273 (41.9) | 0.184 |
Overall clinical outcomes
Total (n =6865) | Males (n=4851) | Females (n=2014) | P-value | |
---|---|---|---|---|
LOS (days) mean (range) | 15.0 (0-220) | 15.3 (0-202) | 14.2 (0-220) | 0.070 |
ICU stay (days) mean (range) | 5.7 (0-200) | 5.8 (0-184) | 5.3 (0-200) | <0.0001 |
ICU admission rate (%) | 3638 (53.0) | 2646 (54.5) | 992 (49.3) | <0.001 |
In-hospital mortality rate (%) | 1223 (17.8) | 851 (17.5) | 372 (18.5) | 0.379 |
24h mortality rate (%) | 508 (7.4) | 369 (7.6) | 139 (6.9) | 0.334 |
The overall association between 24-h mortality and gender
Total (n=2861) | Males (n=2209) | Females (n=652) | P-value | |
---|---|---|---|---|
LOS (days) mean (range) | 15.9 (0-220) | 15.6 (0-201) | 17.3 (0-220) | 0.081 |
ICU stay (days) mean (range) | 6.1 (0-200) | 5.8 (0-114) | 6.9 (0-200) | 0.651 |
ICU admission rate (%) | 1649 (57.6) | 1275 (57.7) | 374 (57.4) | 0.458 |
In-hospital mortality rate (%) | 364 (12.7) | 296 (13.4) | 68 (10.4) | 0.046 |
24h mortality rate (%) | 192 (6.7) | 159 (7.2) | 33 (5.1) | 0.055 |
24h mortality | In-hospital mortality | ICU admission | |||||||
---|---|---|---|---|---|---|---|---|---|
Variable | OR | 95% CI | P - value | OR | 95% CI | P - value | OR | 95% CI | P - value |
Male Gender | 1.049 | 0.829-1.327 | 0.693 | 1.020 | 0.865-1.204 | 0.811 | 1.205 | 1.046-1.388 | 0.010 |
Age, years | |||||||||
16-44 | REF | <0.0001a | REF | <0.0001a | REF | 0.002a | |||
45-54 | 0.972 | 0.688-1.373 | 0.872 | 1.232 | 0.961-1.580 | 0.100 | 0.906 | 0.749-1.096 | 0.311 |
55+ | 2.179 | 1.715-2.767 | <0.0001 | 3.922 | 3.284-4.684 | <0.0001 | 0.770 | 0.665-0.891 | <0.0001 |
Blunt MOI | 0.477 | 0.338-0.674 | <0.0001 | 0.561 | 0.422-0.745 | <0.0001 | 0.734 | 0.562-0.959 | 0.023 |
P-HEMS | 1.321 | 1.042-1.675 | 0.021 | 1.212 | 1.021-1.439 | 0.028 | 1.234 | 1.057-1.441 | 0.008 |
Admission at ED, year | |||||||||
2004-2006 | 1.548 | 0.800-2.992 | 0.194 | 1.315 | 0.826-2.094 | 0.249 | 0.724 | 0.492-1.066 | 0.102 |
2007-2009 | 2.214 | 1.615-3.035 | <0.0001 | 1.533 | <0.0001 | 1.014 | 0.832-1.235 | 0.893 | |
2010-2012 | 1.441 | 1.070-1.940 | 0.016 | 1.224 | 1.230-1.909 | 0.049 | 0.615 | 0.523-0.724 | <0.0001 |
2013-2014 | REF | <0.0001a | REF | 1.001-1.498 | <0.0001a | REF | <0.0001a | ||
ISS | |||||||||
16-24 | REF | <0.0001a | REF | <0.0001a | REF | <0.0001a | |||
25-50 | 2.985 | 2.235-3.987 | <0.0001 | 3.653 | 3.029-4.407 | <0.0001 | 2.190 | 1.898-2.526 | <0.0001 |
51-75 | 3.873 | 2.302-6.514 | <0.0001 | 8.657 | 5.646-13.274 | <0.0001 | 2.126 | 1.139-3.970 | 0.018 |
AIS Thorax ≥ 3 | 0.647 | 0.514-0.814 | <0.0001 | 0.593 | 0.499-0.705 | <0.0001 | 2.053 | 1.757-2.399 | <0.0001 |
AIS Abdomen ≥ 3 | 1.646 | 1.202-2.255 | 0.002 | 1.405 | 1.088-1.813 | 0.009 | 1.776 | 1.406-2.245 | <0.0001 |
Prehospital intubation | 2.042 | 1.605-2.598 | <0.0001 | 1.674 | 1.405-1.994 | <0.0001 | 0.756 | 0.640-0.893 | 0.001 |
SBP ≤89 mmHg at ED | 5.502 | 4.179-7.245 | <0.0001 | 3.030 | 2.358-3.895 | <0.0001 | 0.372 | 0.281-0.494 | <0.0001 |
GCS ≤8 at ED | 9.221 | 6.287-13.526 | <0.0001 | 5.200 | 4.139-6.532 | <0.0001 | 2.262 | 1.841-2.778 | <0.0001 |
RTS≤12 at ED | 1.034 | 0.667-2.670 | 0.880 | 1.352 | 1.034-1.767 | 0.027 | 3.460 | 2.844-4.209 | <0.0001 |
AIS Head ≥ 3 | 1.479 | 1.196-1.829 | <0.0001 | 1.155 | 0.977-1.365 | 0.091 |
The overall association between in-hospital mortality and gender
The overall association between ICU admission and gender
Patient characteristics of those aged 16- to 44-years
Clinical outcomes in the 16- to 44 age group
24h mortality | In-hospital mortality | ICU admission | |||||||
---|---|---|---|---|---|---|---|---|---|
Variable | OR | 95% CI | P- value | OR | 95% CI | P- value | OR | 95% CI | P- value |
Male Gender | 0.939 | 0.567-1.554 | 0.806 | 1.158 | 0.827-1.621 | 0.393 | 0.982 | 0.799-1.208 | 0.867 |
Blunt MOI | 0.231 | 0.107-0.498 | <0.0001 | 0.327 | 0.215-0.497 | <0.0001 | 1.563 | 0.927-2.638 | 0.094 |
ISS | |||||||||
16-24 | REF | <0.0001a | REF | <0.0001a | REF | <0.0001a | |||
25-50 | 6.546 | 3.447-12.432 | <0.0001 | 3.769 | 2.527-5.621 | <0.0001 | 3.463 | 2.769-4.332 | <0.0001 |
51-75 | 8.090 | 2.153-30.399 | 0.002 | 7.858 | 4.105-15.041 | <0.0001 | 9.550 | 4.370-20.868 | <0.0001 |
Prehospital intubation | 2.305 | 1.687-3.149 | <0.0001 | 1.262 | 1.000-1.593 | 0.050 | |||
SBP ≤89 mmHg at ED | 4.173 | 2.186-7.965 | <0.0001 | 4.638 | 3.096-6.949 | <0.0001 | 1.807 | 1.233-2.647 | 0.002 |
GCS ≤8 at ED | 4.251 | 2.200-8.215 | <0.0001 | 13.266 | 7.688-22.890 | <0.0001 | 4.434 | 3.365-5.844 | <0.0001 |
RTS≤12 at ED | 3.293 | 1.340-8.094 | 0.009 | 0.868 | 0.476-1.585 | 0.646 | 1.615 | 1.167-2.234 | 0.004 |
AIS Head ≥ 3 | 1.795 | 0.978-3.296 | 0.059 | 2.189 | 1.491-3.215 | <0.0001 | |||
AIS Thorax ≥ 3 | 0.603 | 0.363-1.004 | 0.052 | 0.601 | 0.446-0.812 | 0.001 | 0.569 | 0.453-0.714 | <0.0001 |
AIS Abdomen ≥ 3 | 1.565 | 1.076-2.276 | 0.019 | 1.532 | 1.006-2.333 | 0.047 | |||
Admission at ED, year | |||||||||
2004-2006 | 1.247 | 0.524-2.968 | 0.617 | ||||||
2007-2009 | 2.489 | 1.654-3.746 | <0.0001 | ||||||
2010-2012 | 1.775 | 1.209-2.605 | 0.003 | ||||||
2013-2014 | REF | <0.0001a |
The association between 24-h mortality and gender in the 16- to 44 age group
<24h mortality | In-hospital mortality | ICU admission | |||||||
---|---|---|---|---|---|---|---|---|---|
Variable | OR | 95% CI | P - value | OR | 95% CI | P - value | OR | 95% CI | P - value |
Male Gender | 1.100 | 0.867-1.394 | 0.433 | 1.085 | 0.917-1.283 | 0.341 | 1.192 | 1.035-1.374 | 0.015 |
Age, years | |||||||||
16-40 | REF | REF | <0.0001a | REF | REF | <0.0001a | REF | REF | <0.0001a |
41-60 | 1.147 | 0.866-1.518 | 0.338 | 1.468 | 1.196-1.802 | <0.0001 | 0.876 | 0.746-1.029 | 0.108 |
60+ | 2.784 | 2.142-3.619 | <0.0001 | 5.336 | 4.381-6.499 | <0.0001 | 0.708 | 0.603-0.832 | <0.0001 |
Blunt MOI | 0.462 | 0.327-0.654 | <0.0001 | 0.539 | 0.405-0.717 | <0.0001 | 0.739 | 0.566-0.965 | 0.027 |
P-HEMS | 1.321 | 1.041-1.676 | 0.022 | 1.217 | 1.024-1.447 | 0.026 | 1.227 | 1.051-1.433 | 0.010 |
Admission at ED, year | |||||||||
2004-2006 | 1.593 | 0.820-3.095 | 0.170 | 1.382 | 0.864-2.211 | 0.177 | 0.720 | 0.489-1.061 | 0.097 |
2007-2009 | 2.269 | 1.651-3.119 | <0.0001 | 1.589 | 1.272-1.984 | <0.0001 | 1.011 | 0.830-1.232 | 0.914 |
2010-2012 | 1.463 | 1.085-1.974 | 0.013 | 1.244 | 1.014-1.526 | 0.036 | 0.615 | 0.523-0.723 | <0.0001 |
2013-2014 | REF | REF | <0.0001a | REF | REF | <0.0001 | REF | REF | <0.0001 |
ISS | |||||||||
16-24 | REF | REF | <0.0001a | REF | REF | <0.0001 | REF | REF | <0.0001a |
25-50 | 3.069 | 2.288-4.117 | <0.0001 | 3.692 | 3.055-4.463 | <0.0001 | 2.199 | 1.906-2.538 | <0.0001 |
51-75 | 4.083 | 2.414-6.905 | <0.0001 | 8.834 | 5.745-13.585 | <0.0001 | 2.109 | 1.130-3.938 | 0.019 |
AIS Thorax ≥ 3 | 0.645 | 0.509-0.819 | <0.0001 | 0.608 | 0.510-0.724 | <0.0001 | 2.048 | 1.752-2.394 | <0.0001 |
AIS Abdomen ≥ 3 | 1.667 | 1.207-2.304 | 0.002 | 1.492 | 1.154-1.929 | 0.002 | 1.756 | 1.389-2.220 | <0.0001 |
Prehospital intubation | 2.095 | 1.645-2.669 | <0.0001 | 1.721 | 1.443-2.053 | <0.0001 | 0.755 | 0.639-0.892 | 0.001 |
SBP ≤89 mmHg at ED | 5.456 | 4.140-7.188 | <0.0001 | 2.976 | 2.315-3.827 | <0.0001 | 0.374 | 0.282-0.496 | <0.0001 |
GCS ≤8 at ED | 9.535 | 6.496-13.998 | <0.0001 | 5.464 | 4.335-6.886 | <0.0001 | 2.260 | 1.840-2.776 | <0.0001 |
RTS≤12 at ED | 1.029 | 0.663-1.597 | 0.897 | 1.357 | 1.036-1.777 | 0.027 | 3.464 | 2.848-4.215 | <0.0001 |
AIS Head ≥ 3 | 1.461 | 1.180-1.810 | 0.001 | 1.163 | 0.984-1.374 | 0.077 |
Early (<24h) mortality | In-hospital mortality | ICU admission | |||||||
---|---|---|---|---|---|---|---|---|---|
Variable | OR | 95% CI | P- value | OR | 95% CI | P- value | OR | 95% CI | P- value |
Male Gender | 1.498 | 0.903-2.484 | 0.117 | 1.224 | 0.847-1.767 | 0.282 | 1.057 | 0.810-1.379 | 0.682 |
Blunt MOI | 2.377 | 1.425-3.964 | 0.001 | 3.196 | 2.055-4.968 | <0.0001 | |||
ISS | |||||||||
16-24 | REF | REF | 0.009 | REF | REF | <0.0001a | REF | REF | <0.0001a |
25-50 | 2.234 | 1.314-3.798 | 0.003 | 3.408 | 2.217-5.239 | <0.0001 | 2.256 | 1.754-2.902 | <0.0001 |
51-75 | 2.610 | 1.168-5.834 | 0.019 | 6.834 | 3.404-13.722 | <0.0001 | 1.432 | 0.628-3.265 | 0.393 |
Prehospital intubation | 3.304 | 2.109-5.176 | <0.0001 | 2.376 | 1.700-3.322 | <0.0001 | 0.576 | 0.430-0.773 | <0.0001 |
SBP ≤89 mmHg at ED | 7.482 | 4.645-12.052 | <0.0001 | 4.278 | 2.780-6.583 | <0.0001 | 0.302 | 0.188-0.485 | <0.0001 |
GCS ≤8 at ED | 15.046 | 7.050-32.111 | <0.0001 | 14.074 | 7.740-25.593 | <0.0001 | 2.828 | 1.969-4.063 | <0.0001 |
RTS≤12 at ED | 0.842 | 0.436-1.625 | 0.608 | 4.390 | 3.089-6.238 | <0.0001 | |||
AIS Head ≥ 3 | 0.495 | 0.328-0.747 | 0.001 | ||||||
AIS Thorax ≥ 3 | 1.676 | 1.107-2.537 | 0.015 | 1.520 | 1.100-2.101 | 0.011 | 0.532 | 0.418-0.678 | <0.0001 |
AIS Abdomen ≥ 3 | 0.589 | 0.365-0.949 | 0.030 | 0.593 | 0.399-0.881 | 0.010 | 0.527 | 0.382-0.729 | <0.0001 |
Admission at ED, year | |||||||||
2004-2006 | 0.768 | 0.190-3.098 | 0.711 | 1.101 | 0.425-2.852 | 0.843 | 0.711 | 0.371-1.362 | 0.304 |
2007-2009 | 3.543 | 1.957-6.414 | <0.0001 | 2.790 | 1.788-4.355 | <0.0001 | 0.863 | 0.606-1.230 | 0.415 |
2010-2012 | 1.522 | 0.848-2.732 | 0.160 | 1.749 | 1.145-2.674 | 0.010 | 0.473 | 0.352-0.635 | <0.0001 |
2013-2014 | REF | REF | <0.0001a | REF | REF | <0.0001a | REF | REF | <0.0001a |