JMIR Publications

ABSTRACT

Background:

Time is considered an essential determinant in the initial care of trauma patients. In Norway, the particular time indicator response time (i.e. time from dispatch center call to ambulance arrival at scene) is a controversial national quality indicator. However, no national requirements for response times have been established. There is an ongoing debate regarding the optimal configuration of the Norwegian trauma system. Recent centralization of trauma services and closure of emergency hospitals have increased distances for prehospital transports, predominantly for rural trauma patients. The impact of trauma system configuration on early trauma management in urban and rural areas is inadequately described.

Objective:

The project will assess the injured patient´s initial pathway through the trauma system and explore differences between central and rural areas in a Norwegian trauma cohort. This field is unexplored at a national level and existing evidence for an optimal organization of trauma care is still inconclusive regarding the impact of prehospital time.

Methods:

Three quantitative registry-based retrospective cohort studies are planned. The studies based on data from the Norwegian Trauma Registry (NTR) (Study 1, 2 and 3) and local Emergency Medical Communications Center (EMCC) data (Study 2). All injured adult patients admitted to a Norwegian hospital and registered in the NTR in the period 1st of January 2015 to 31st of December 2020 will be included in the analysis. Trauma registry data will be analyzed using descriptive statistical methods and relevant statistical methods to compare prehospital time in rural and central areas including regression analyses and adjusting for confounders.

Results:

The project received funding autumn 2020 and is approved by the Oslo University Hospital data protection officer, case number 18/02592. Registry data including approximately 40.000 trauma patients will be extracted during the first quarter of 2022 and analysis will begin immediately thereafter. Results are expected to be ready for publication from the third quarter of 2022.

Conclusions:

: Findings from the study will contribute to new knowledge regarding existing quality indicators and with an increasing centralization of hospitals and residents, the study will contribute to further development of the Norwegian trauma system. A high generalizability to other trauma systems is expected, given the similarities between demographical changes and trauma systems in many high-income countries.