Musculoskeletal injuries in trauma patients: a Swedish nationwide register study including 37,266 patients
DOI:
https://doi.org/10.2340/17453674.2023.11960Keywords:
epidemiology, fractures, incidence, injury mechanism, musculoskeletal , orthopaedic injury, traumaAbstract
Background and purpose: Trauma causes over 4 million annual deaths globally and accounts for over 10% of the global burden of disease. Trauma patients often sustain multiple injuries in multiple organ systems. We aimed to investigate the proportion and distribution of musculoskeletal injuries in adult trauma patients.
Patients and methods: This is a register-based study using data from the national Swedish trauma register (SweTrau) collected in 2015–2019. By categorizing Abbreviated Injury Scale (AIS) codes into different injury types, we provide a detailed description of the types of musculoskeletal injuries that occurred in trauma patients.
Results: 51,335 cases were identified in the register. After exclusion of 7,696 cases that did not have any trauma diagnosis (AIS codes) registered from the trauma and 6,373 patients aged < 18, a total of 37,266 patients were included in the study. 15,246 (41%) had sustained musculoskeletal injury. Of the patients with musculoskeletal injuries, 7,733 (51%) had more than 1 such injury. Spine injuries were the most common injury location (n = 7,083 patients, 19%) followed by lower extremity injuries (n = 5,943 patients, 16%) and upper extremity injuries (n = 6,273 patients, 17%). Fractures were the dominating injury type with 30,755 (87%) of injuries being a fracture.
Conclusion: 41% of the trauma patients had at least 1 musculoskeletal injury. A spine injury was the most common injury location. Fractures was the dominating injury type constituting 87% of all injuries. We also found that half the patients (51%) with spine or extremity injuries had ≥ 2 such injuries.
Downloads
References
Haagsma J A, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany E C, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev 2016; 22: 3-18. DOI: https://doi.org/10.1136/injuryprev-2015-041616
Beerekamp M S H, de Muinck Keizer R J O, Schep N W L, Ubbink D T, Panneman M J M, Goslings J C. Epidemiology of extremity fractures in the Netherlands. Injury 2017; 48: 1355-62. DOI: https://doi.org/10.1016/j.injury.2017.04.047
Fitschen-Oestern S, Lippross S, Lefering R, Klüter T, Behrendt P, Weuster M, et al. Missed hand and forearm injuries in multiple trauma patients: an analysis from the TraumaRegister DGU®. Injury 2020; 51: 1608-17. DOI: https://doi.org/10.1016/j.injury.2020.04.022
Weber C D, Solomon L B, Lefering R, Horst K, Kobbe P, Hildebrand F, et al. Which risk factors predict knee ligament injuries in severely injured patients? Results from an international multicenter analysis. J Clin Med 2020; 9(5): 1437. DOI: https://doi.org/10.3390/jcm9051437
Weber C D, Hildebrand F, Kobbe P, Lefering R, Sellei R M, Pape H C. Epidemiology of open tibia fractures in a population-based database: update on current risk factors and clinical implications. Eur J Trauma Emerg Surg 2019; 45: 445-53. DOI: https://doi.org/10.1007/s00068-018-0916-9
DiMaggio C, Ayoung-Chee P, Shinseki M, Wilson C, Marshall G, Lee D C, et al. Traumatic injury in the United States: in-patient epidemiology 2000–2011. Injury 2016; 47: 1393-403. DOI: https://doi.org/10.1016/j.injury.2016.04.002
Vestergaard V, Pedersen A B, Tengberg P T, Troelsen A, Schrøder H M. 20-year trends of distal femoral, patellar, and proximal tibial fractures: a Danish nationwide cohort study of 60,823 patients. Acta Orthop 2020; 91: 109-14. DOI: https://doi.org/10.1080/17453674.2019.1698148
Bergh C, Wennergren D, Möller M, Brisby H. Fracture incidence in adults in relation to age and gender: a study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area. PLoS One 2020; 15: e0244291. DOI: https://doi.org/10.1371/journal.pone.0244291
Committee on Emergency Medicine ICa, (DGU) TMotGTS. Annual Report 2021—TraumaRegister DGU®; 2021.
Chang M C. NTDB Annual Report 2016. American College of Surgeons; 2016. Available from: https://www.facs.org/media/ez1hpdcu/ntdb-annual-report-2016.pdf.
Network TARN. Major trauma in older people; 2017. Available from: https://www.tarn.ac.uk/content/downloads/3793/Major%20Trauma%20in%20Older%20People%202017.pdf.
Skaga N O, Eken T, Hestnes M, Jones J M, Steen P A. Scoring of anatomic injury after trauma: AIS 98 versus AIS 90—do the changes affect overall severity assessment? Injury 2007; 38: 84-90. DOI: https://doi.org/10.1016/j.injury.2006.04.123
Osler T, Baker S P, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma 1997; 43: 9225; discussion 925-6. DOI: https://doi.org/10.1097/00005373-199712000-00009
SWETRAU Svenska traumaregistret årsrapport 2019. Available from: http://rcsyd.se/swetrau/wp-content/uploads/sites/10/2020/09/A%CC%8Arsrapport-SweTrau-2019.pdf.
Ringdal K G, Coats T J, Lefering R, Di Bartolomeo S, Steen P A, Røise O, et al. The Utstein template for uniform reporting of data following major trauma: a joint revision by SCANTEM, TARN, DGU-TR and RITG. Scand J Trauma Resusc Emerg Med 2008; 16: 7. DOI: https://doi.org/10.1186/1757-7241-16-7
Holmberg L, Frick Bergström M, Mani K, Wanhainen A, Andréasson H, Linder F. Validation of the Swedish Trauma Registry (SweTrau). Eur J Trauma Emerg Surg 2023: 1-11. DOI: https://doi.org/10.1007/s00068-023-02244-6
Avraham J B, Bhandari M, Frangos S G, Levine D A, Tunik M G, DiMaggio C J. Epidemiology of paediatric trauma presenting to US emergency departments: 2006–2012. Inj Prev 2019; 25: 136-43. DOI: https://doi.org/10.1136/injuryprev-2017-042435
Buschmann C, Kühne C A, Lösch C, Nast-Kolb D, Ruchholtz S. Major trauma with multiple injuries in German children: a retrospective review. J Pediatr Orthop 2008; 28: 1-5. DOI: https://doi.org/10.1097/BPO.0b013e31815b4d90
Gioffrè-Florio M, Murabito L M, Visalli C, Pergolizzi F P, Famà F. Trauma in elderly patients: a study of prevalence, comorbidities and gender differences. G Chir 2018; 39: 35-40. DOI: https://doi.org/10.11138/gchir/2018.39.1.035
MacGregor A J, Mayo J A, Dougherty A L, Girard P J, Galarneau M R. Injuries sustained in noncombat motor vehicle accidents during Operation Iraqi Freedom. Injury 2012; 43: 1551-5. DOI: https://doi.org/10.1016/j.injury.2011.04.017
Shi B, Liu G, Li L, Tang S, Wang J, Xie M, et al. [Injury characteristics and therapeutic strategy of patients injured in “8·8” Jiuzhaigou earthquake]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018; 32: 358-62.
Teisch L F, Allen C J, Tashiro J, Golpanian S, Lasko D, Namias N, et al. Injury patterns and outcomes following pediatric bicycle accidents. Pediatr Surg Int 2015; 31: 1021-5. DOI: https://doi.org/10.1007/s00383-015-3756-2
Holmes J F, Miller P Q, Panacek E A, Lin S, Horne N S, Mower W R. Epidemiology of thoracolumbar spine injury in blunt trauma. Acad Emerg Med 2001; 8: 866-72. DOI: https://doi.org/10.1111/j.1553-2712.2001.tb01146.x
Jiang J Y. Head trauma in China. Injury 2013; 44: 1453-7. DOI: https://doi.org/10.1016/j.injury.2012.08.045
Banerjee M, Bouillon B, Shafizadeh S, Paffrath T, Lefering R, Wafaisade A. Epidemiology of extremity injuries in multiple trauma patients. Injury 2013; 44: 1015-21. DOI: https://doi.org/10.1016/j.injury.2012.12.007
Dziubinski D, Abramczyk U, Ciechanowicz D, Kozlowski J, Pakulski C, Zyluk A. An analysis of causes of trauma, spectrum of injuries and treatment outcomes in patients treated at Multitrauma Centre of the University Teaching Hospital No 1 in Szczecin in 2015. Comparison of results from years 2015 and 2007. Pol Przegl Chir 2019; 91: 29-35. DOI: https://doi.org/10.5604/01.3001.0013.2953
Niemi-Nikkola V, Saijets N, Ylipoussu H, Kinnunen P, Pesälä J, Mäkelä P, et al. Traumatic spinal injuries in northern Finland. Spine (Phila Pa 1976) 2018; 43: E45-e51. DOI: https://doi.org/10.1097/BRS.0000000000002214
Gerbershagen H J, Dagtekin O, Isenberg J, Martens N, Ozgür E, Krep H, et al. Chronic pain and disability after pelvic and acetabular fractures: assessment with the Mainz Pain Staging System. J Trauma 2010; 69: 128-36. DOI: https://doi.org/10.1097/TA.0b013e3181bbd703
Lundin N, Huttunen T T, Enocson A, Marcano A I, Felländer-Tsai L, Berg H E. Epidemiology and mortality of pelvic and femur fractures: a nationwide register study of 417,840 fractures in Sweden across 16 years: diverging trends for potentially lethal fractures. Acta Orthop 2021; 92: 323-328. DOI: https://doi.org/10.1080/17453674.2021.1878329
Registry ANZT. Annualrepo rt 1 July 2020 to 30 June 2021; 2021.
Sabariah Faizah Jamaluddin M A W, Mohd Yusof Abdul Wahab, Yeoh, Tze Ming I M S. National Trauma Database January 2009 to December 2009 fourth report. National Trauma Database and Ministry of Health Malaysia; 2009. Available from: http://www.acrm.org.my/ntrd/report/ntrdReport_2009.pdf.
Forum IT. Road safety report 2020 Sweden. Paris: OECD; 2020.
Persad I J, Reddy R S, Saunders M A, Patel J. Gunshot injuries to the extremities: experience of a UK trauma centre. Injury 2005; 36: 407-11. DOI: https://doi.org/10.1016/j.injury.2004.08.003
Uchino H, Kong V Y, Pantelides A, Anderson J, O’Neill H, Bruce J L, et al. The scourge of knife crime: trends in knife-related assault managed at a major centre in South Africa. S Afr J Surg 2020; 58: 150-3. DOI: https://doi.org/10.17159/2078-5151/2020/v58n3a3251
Leucht P, Fischer K, Muhr G, Mueller E J. Epidemiology of traumatic spine fractures. Injury 2009; 40: 166-72. DOI: https://doi.org/10.1016/j.injury.2008.06.040
Additional Files
Published
How to Cite
License
Copyright (c) 2023 Jonas Holtenius, Hans E Berg, Anders Enocson
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
