Trauma care performance and patient outcomes - insights from a major trauma center 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 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, ASA score, injury type. 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 mechanism 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. Adjusted linear regression showed a reduction in time to computed tomography of 7.5 minutes in 2022–2023 compared to 2017 (P = 0.014). Conclusion Improvements in trauma care are achievable within a mature trauma system, as reflected by reduced mortality and shorter time to computed tomography despite an aging population with increasing comorbidity. However, the specific drivers of improvements are difficult to identify, and future studies should explore how individual components of pre-hospital and in-hospital care contribute to trauma outcomes.