Trauma care performance and patient outcomes - insights from a major trauma centre in Sweden

PURPOSE: Trauma is a leading cause of death among individuals under 45 years of age. Evaluating trauma system performance over time is important but inherently difficult due to concurrent changes in patient demographics, case-mix and care processes. The aim of this study was to describe temporal changes in patient demographics, injury severity and trauma care at a major trauma centre in Sweden from 2017 to 2023. We hypothesised that risk-adjusted 30-day mortality decreased and that time to computed tomography was reduced over the study period. METHODS: A retrospective cohort study was conducted using data from the Karolinska Trauma Registry, including all trauma patients aged > 15 years fulfilling criteria for full trauma team activation, admitted between January 2017 and August 2023. Multivariable logistic regression was used to assess changes in 30-day mortality over time, adjusted for age, sex, injury severity category, ASA score and injury type. Time from arrival to computed tomography was analysed by linear regression and, because the distribution was skewed, by quantile (median) regression. RESULTS: A total of 5,615 trauma patients were included. Over the study period, the patient population became older, and ASA scores increased, while injury severity and the proportion of penetrating injury remained unchanged. In multivariable logistic regression with 2017 as reference, the odds of 30-day mortality in 2022-2023 were lower (OR 0.61, 95% CI 0.43-0.88, P = 0.008) after adjusting for confounders. Median time to computed tomography decreased from 31 to 21 min; the adjusted difference in 2022-2023 compared with 2017 was - 7.5 min by linear regression (P = 0.014) and - 10.4 min by quantile regression (95% CI - 11.5 to - 9.2, P < 0.001). CONCLUSION: Our findings are consistent with improvements in trauma care within a mature trauma system, with shorter median time to computed tomography and lower 30-day mortality despite an aging population with increasing comorbidity. However, the specific drivers of these changes are difficult to identify, and future studies should explore how individual components of pre-hospital and in-hospital care contribute to trauma outcomes.