Retrospective Study Open Access
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2024; 12(35): 6808-6814
Published online Dec 16, 2024. doi: 10.12998/wjcc.v12.i35.6808
Comprehensive epidemiological assessment of trauma incidents at a level I trauma center
Zhao-Yin Su, Yi-Feng Lin, Yu-Li He, Yao Liu, The First Clinical College of Medicine, Lanzhou University, Lanzhou 730000, Gansu Province, China
Hui Wei, Wei-Ning Wang, School of Stomatology, Lanzhou University, Lanzhou 730000, Gansu Province, China
Ru-Bing Lin, Department of Orthopedics, Shenzhen Children’s Hospital, Shenzhen 518000, Guangdong Province, China
Ya-Tao Liu, Department of Anesthesia, First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Nerich Michael, Department of Trauma Surgery, University Hospital Regensburg, Regensburg 93053, Bavaria, Germany
ORCID number: Zhao-Yin Su (0009-0007-0037-0529); Ya-Tao Liu (0000-0002-7423-0090).
Co-first authors: Zhao-Yin Su and Hui Wei.
Author contributions: Su ZY, Wei H, Wang WN, Lin YF, Liu YT, and Michael N designed the research study; Su ZY, Wei H, Wang WN, Lin YF, and He YL performed the research; Liu Y, Lin RB, Liu YT, and Michael N contributed new reagents and analytic tools; Su ZY, Wei H, Wang WN, and Lin YF analyzed the data and wrote the manuscript. All authors read and approved the final manuscript. Su ZY and Wei H are co-first authors of this study, reflecting the equal importance of their contributions. Su ZY was responsible for the experimental design and data collection of this study. He led the planning and execution of the experiments and provided solutions to key technical issues during data collection. Additionally, Su ZY participated in the preliminary data analysis and the creation of charts, offering valuable perspectives for data interpretation. Wei H was responsible for data analysis and manuscript writing. She applied advanced statistical methods to thoroughly analyze the experimental data, ensuring the accuracy and scientific validity of the results. Wei H was also the principal writer of the manuscript, responsible for organizing the research findings and composing the discussion section, clearly articulating the scientific significance and practical applications of the research findings. Both authors engaged in frequent discussions and collaborations throughout the research process, jointly discussing the direction of the research and interpretation of the results, ensuring the high-quality completion of the study. Each author made indispensable contributions within their areas of expertise, collectively driving the success of the research project.
Supported by Ministry of Science and Technology Senior Foreign Expert Program, No. G2019028023 and No. G2020028007; National College Student Innovation and Entrepreneurship Program, No. 202210730172; Medical Innovation and Development Project of Lanzhou University, No. lzuyxcx-2022-99; and Joint Research Fund Project of Gansu Province, No. 23JRRA1496.
Institutional review board statement: This study received an ethical exemption from the Ethics Committee of the First Hospital of Lanzhou University because its retrospective design and did not disclose any patient information.
Informed consent statement: No information about the corresponding subjects was involved in this study.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ya-Tao Liu, MD, Chief Doctor, Department of Anesthesia, First Hospital of Lanzhou University, No. 199 Donggang West Road, Chengguan District, Lanzhou 730000, Gansu Province, China. doctorliuyt@163.com
Received: July 1, 2024
Revised: August 12, 2024
Accepted: August 27, 2024
Published online: December 16, 2024
Processing time: 115 Days and 6.1 Hours

Abstract
BACKGROUND

The continuous development of social and economic progress and ongoing enhancement of infrastructure construction has led to drastic changes in the occurrence of trauma.

AIM

To analyze the epidemiological characteristics of trauma in Lanzhou City to provide theoretical references for improving quality of trauma care.

METHODS

A retrospective analysis of clinical data from 16585 trauma patients treated at the First Hospital of Lanzhou University Trauma Center from November 1, 2021 to October 31, 2023 was conducted. Data including age, sex, time of trauma, cause of trauma, and major injured body parts were statistically analyzed.

RESULTS

A total of 18235 patients were admitted, with complete data for 16585 cases. Of these, 9793 were male and 6792 were female (male-to-female ratio of 1.44:1). The peak times for trauma occurrence were 10 AM-12 PM and 6-10 PM, and the peak months were from May to October. The leading causes of trauma were falls (45.32%), other trauma (15.88%), road traffic accidents (15.15%), violence (10.82%), cutting/stabbing (9.41%), mechanical injuries (2.65%), winter sports injuries (0.36%), animal bites (0.22%), burns (0.09%), and electrical injuries (0.02%). The distribution of majorly injured body parts showed statistical significance, with limbs/skin being the most affected followed by the head/neck, chest/abdomen, and back.

CONCLUSION

Medical institutions and government agencies can implement preventive measures and policies based on the characteristics of trauma determined in this study to enhance the quality and level of trauma care.

Key Words: Trauma and injury; Injury; Trauma center; Epidemiology; Disease analysis

Core Tip: The data analyzed in this study revealed that the incidence of trauma is higher in males than females and that falls are the primary cause of trauma. The incidence of trauma peaks in the summer and autumn seasons compared to winter and spring and during periods of increased activity throughout the day. Limb and skin traumas were the most common. These findings can serve as guidelines for medical institutions and government agencies to improve the quality and standards of trauma care. Implementation of targeted preventive measures and policies tailored to the characteristics of trauma will be beneficial.



INTRODUCTION

As socioeconomic conditions continue to improve and infrastructure development accelerates, there has been a consistent year-on-year increase in accidental injuries[1]. Trauma is a significant contributor to mortality, accounting for 9% of global fatalities, and it represents the leading cause of death among younger populations[2]. Survivors often face extended rehabilitation periods and difficulties returning to their previous lives, which imposes a considerable socioeconomic burden[3]. Research in traumatic epidemiology is of paramount importance due to the profound impact of trauma on individuals and society[4,5]. The value of trauma databases in patient management has been well-documented and has underscored their role in improving care[6,7].

Despite significant advancements in trauma medicine globally, China remains in the early stages of developing specialized trauma departments. The First Hospital of Lanzhou University, located in northwestern China, serves as a critical medical center for Lanzhou city and Gansu province. Since June 2021, it has implemented a comprehensive trauma registration system and maintains a dedicated trauma database. To address the disparity between trauma medicine development in China and global standards, we conducted a retrospective analysis of trauma cases from our hospital database. This study aimed to elucidate the epidemiological characteristics of these cases with the goal of enhancing trauma care quality and reducing mortality and disability rates.

MATERIALS AND METHODS
Data sources

The data utilized in this study were sourced from the trauma database of the First Hospital of Lanzhou University, which is recognized as a Gansu Provincial Level I Trauma Center. Stringent quality control measures were implemented to ensure the integrity and precision of the dataset. We analyzed the comprehensive information on all trauma patients admitted to the hospital from November 1, 2021 to October 31, 2023, which totaled 18235 individuals. The exported dataset included essential demographic factors such as age, sex, cause of trauma, and major injured body parts. The dataset underwent careful screening to exclude patients with incomplete data. After completing the data exclusion process, a total of 16585 patients with complete information were retained for analysis. This study received an ethical exemption from the Ethics Committee of the First Hospital of Lanzhou University because of its retrospective design, which did not disclose any patient information.

Study methods

The identification of trauma causes adhered to the classification method prescribed by the Medical Priority Dispatch System. Concurrently, the allocation of trauma sites followed the methodology delineated in the Trauma Index[8]. A categorization strategy was employed, wherein the aggregate occurrences of trauma with unspecified causes or sites were collectively designated as ‘other trauma’. This all-encompassing category included a diverse range of trauma types for which specific details about either the cause or the site were indeterminable.

Statistical analysis

Descriptive statistical analysis was conducted using Microsoft Excel 16.0 and SPSS 27.0 software (IBM Corp., Armonk, NY, United States). Various parameters, including the month of trauma occurrence, temporal distribution, composition of trauma causes, distribution of major injured body parts, and patient age, were systematically documented. Intergroup comparisons were performed using χ2 analysis, with statistical significance set at P < 0.05. When conducting multiple comparisons Bonferroni correction was employed to address the potential of increasing the probability of type I errors (false positives).

RESULTS
Basic information

Between November 1, 2021 and October 31, 2023, a total of 16585 trauma patients with complete data were admitted to our trauma center. Among them, 9793 were male and 6792 were female, resulting in a male-to-female ratio of 1.44:1. The age of the patients ranged from 1-month-old to 97-years-old, with a mean age of 34.17 ± 20.90 years. The age range for males was 1-year-old to 95-years-old, with a mean age of 31.91 ± 19.78 years, while the age range of females was 1-month-old to 97-years-old, with a mean age of 37.43 ± 22.01 years.

Temporal distribution

The distribution of trauma incidents demonstrated a diurnal pattern, with the lowest incidence recorded in the early morning hours. A notable increase in trauma cases was observed during two distinct periods: Between 10 AM and 12 PM; and later, between 6 PM and 10 PM. There was a significant increase in trauma cases from May to October, with the peak in August and September. Conversely, the winter months from November to February exhibited a marked decrease in the number of trauma cases, as detailed in Table 1.

Table 1 Time distribution of trauma.
Months/hours
0-2
2-4
4-6
6-8
8-10
10-12
12-14
14-16
16-18
18-20
20-22
22-24
Total
Jan662723106288667810410712890811
Feb702915159910293978812813586956
Mar654322171281461281401351922041111331
Apr795115251281931321401451891981211416
May1225720341502031671771892802291551783
Jun1185737271552211891651902732301731835
Jul1116643351602111801781972242721501827
Aug1295541252232671981971952262961932045
Sep925236382422612012492343022771852169
Oct1104524271572592182042162702361311897
Nov116321743422742362411264
Dec178422835263335262017251
Total9894962832571549202916401685177022532211142316585
Distribution of causes of trauma

Falls were the cause of most of the trauma cases followed by other trauma, road traffic accidents, violence, cutting/stabbing, mechanical injuries, winter sports injuries, animal bites, burns, and electrical injuries. There were 3399 cases in the 14 years and below age group, 4346 cases in the 15-30 years age group, 3792 cases in the 31-44 years age group, 3055 cases in the 45-59 years age group, and 1993 cases in the 60 years and above age group. For all causes of injury, the number of male patients was higher than female, except in cases of animal bites. Additionally, the male-to-female ratio of trauma cases was 1.28:1, which was the only cause of trauma that was lower than the overall ratio of 1.44:1 in all patients. This indicates that there are sex differences in the distribution of trauma causes, with most causes more prevalent in males. More details can be found in Table 2.

Table 2 Distribution of causes of trauma.
Cause of trauma
≤ 14 (age)
15-30 (age)
31-44 (age)
45-59 (age)
≥ 60 (age)
Total
Component ratio (%)
Rank
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Falls12366659736938576067046024557264225329245.321
Other trauma3872004362812891922532221341391599103415.882
Road Traffic Accidents199963612693562793163081701591402111115.153
Violence210803881942831991621084823119160410.824
Cutting/stabbing1555838119925913817698524510235389.415
Mechanical injuries543965557032642619152721672.656
Winter sports injuries52219142132043160.367
Animal bite6551134310217200.228
Burns30204021121230.099
Electrical injuries1000201000400.0210
Total22571142263417122337145516831372882111197936792100
Distribution of major injured body parts

The data indicated that injuries to the limbs and skin were the most common, followed by those to the head and neck. Trauma to the chest and abdomen occurred less frequently than head and neck injuries, and back traumas were the rarest. This pattern of injury incidence was statistically significant (P < 0.001), highlighting considerable differences in both the prevalence and types of injuries related to different causes. Detailed information on the incidence of each majorly injured body part is provided in Table 3.

Table 3 Distribution of trauma sites in patients with different causes of trauma, n (%).
Cause of injury
Limbs/skin
Head/neck
Chest/abdomen
Back
Total
Falls4758 (63.30)2012 (26.77)641 (8.53)286 (3.80)7517 (100.00)
Other trauma1576 (59.86)542 (20.85)255 (9.68)92 (3.49)2633 (100.00)
Road traffic accidents1399 (55.67)666 (26.50)342 (13.61)106 (4.22)2513 (100.00)
Violence581 (32.37)956 (53.26)235 (13.09)23 (1.28)1795 (100.00)
Cutting/stabbing1359 (89.37)142 (9.10)52 (3.33)8 (0.51)1561 (100.00)
Mechanical injuries293 (66.74)91 (20.73)43 (9.79)12 (2.73)439 (100.00)
Winter sports injury43 (72.88)6 (10.17)4 (6.78)6 (10.17)59 (100.00)
Animal bite30 (81.08)4 (10.81)1 (2.70)2 (5.88)37 (100.00)
Burns9 (60.00)5 (33.33)1 (6.66)0 (0.00)15 (100.00)
Electrical injuries4 (100.00)0 (0.00)0 (0.00)0 (0.00)4 (100.00)
Total10052 (60.61)4424 (26.67)1574 (9.49)535 (3.23)16585 (100.00)
DISCUSSION
Characteristics of trauma cases

From November 1, 2021 to October 31, 2023, a cohort of 16585 trauma patients was analyzed, with a predominant representation of young and middle-aged adults, which aligns with several global research findings[3,9-14]. The incidence of trauma in the 15-59 years age group accounted for 69.84% of all cases. Our group surpassed the incidence for this population (63.35%) in another study[15]. In contrast, children aged 0-14 years, who make up 17.95% of the population in China[15], represented 20.49% of the trauma cases in our institution. The elderly population, aged ≥ 60 years, constituted 18.70% of the population in China but accounted for only 12.02% of the trauma cases observed[15].

These data suggest a higher incidence of trauma among the younger population compared to the elderly population, potentially correlating with their occupational engagement and frequent participation in social activities. The 15-30 years age group is arguably the most active group and unsurprisingly constituted the largest percentage of trauma cases. Individuals in this age bracket are often the only children in their family due to the historical one-child policy. This results in particularly detrimental outcomes to both their families and society.

Males were more susceptible to trauma than females. Similar research findings have also been reported in multiple countries including the United Kingdom, Germany, and Japan[13,16,17]. This disparity may be attributed to greater involvement in physically demanding and injury-prone sectors such as construction and transportation by males[18].

Temporal analysis revealed that the least number of trauma cases occurred in the early morning hours. The peak times for trauma were observed between 10 AM to 12 PM and 6 PM to 10 PM. The morning peak correlates with high production and traffic activities, increasing the likelihood of trauma incidents. The evening period covers the post-work rush hour and nighttime activities. This increases the chance of traffic accidents and various mishaps, which may significantly escalate trauma occurrences[19,20]. Seasonally, trauma incidents peaked during the summer and autumn months (June to October), with a notable decline in the winter months (November to February). In Lanzhou, the warmer climate and heightened social activities during June to October contribute to a higher rate of trauma incidents.

Falls were the predominant cause of trauma. This is likely a consequence of the varied topography and elevation of Lanzhou coupled with an increase in infrastructure development projects in recent years. Another study from Germany reported that the primary cause of trauma was impact followed by falls, sports injuries, and traffic accidents[17]. Causes of trauma are likely to vary between geographic and cultural regions. Trauma resulting from road traffic is one of the major causes of trauma. Due to the expansion of private vehicle ownership and sustained economic development, road traffic in the region is becoming increasingly complex, leading to a significant rise in road traffic accidents.

Our study also highlighted significant variations in the body part injured by trauma. These data reveal areas in which trauma centers and hospitals can prepare to effectively treat trauma cases.

Prevention and treatment of trauma

Comprehensive preventive measures are imperative to decrease the incidence of trauma. There is a crucial need to intensify educational efforts and provide adequate safety equipment to increase occupational safety. Moreover, it is essential to bolster the widespread dissemination of information about occupational safety. Equally important is the reinforcement of traffic regulations and the promotion of traffic safety awareness to reduce the incidence of road accidents. The enhancement of civic education would foster a stronger understanding of the legal system among citizens, thereby increasing legal awareness and self-protection measures to diminish the occurrence of adverse events. Caution is advised to prevent injuries from animal bites, including specifically from pets. Pet owners should be reminded that immediate medical attention is necessary in the event of such incidents.

There is an urgent need to improve the trauma registry system and establish a comprehensive trauma database[6,7,20-22]. This involves conducting thorough epidemiological analyses of trauma, thereby facilitating targeted and effective treatment strategies based on the identified patterns and characteristics of trauma incidents[7]. The result of these efforts would enhance the quality of trauma care and minimize the adverse impacts of trauma. This multidimensional approach necessitates collaboration among national entities, society, healthcare institutions, and individuals. The insights gained from epidemiological studies of trauma inform the development of relevant legal frameworks as well as serve as a crucial reference for healthcare facilities to enhance the quality of trauma care.

Prevention and treatment of trauma contributes to alleviating familial and societal pressures. However, it simultaneously requires collective efforts at the national, societal, hospital, and individual levels. Trauma epidemiological analyses summarize the patterns of occurrence and development of trauma, which provides a basis for the formulation of relevant trauma laws and regulations. They also serve as a reference for improving the quality of trauma care in hospitals.

Limitations

This study reported the epidemiological characteristics of a large cohort of patients who experienced trauma. However, it is difficult to conduct large-scale follow-up on these patients due to the mild injuries, short hospital stays, and large number of patients. Therefore, there is still a lack of long-term prognosis and quality of life assessment for trauma patients. Long-term studies of treated patients who experienced trauma should include assessments of quality of life, functional recovery, and mental health. These types of studies will lead to a better understanding of treatment effectiveness and can provide comprehensive rehabilitation support for patients.

CONCLUSION

Trauma predominantly affects young and middle-aged individuals, with a higher incidence observed in males compared to females. Among the various mechanisms of trauma, falls were identified as the leading cause of trauma. Seasonal variations in trauma incidence revealed that injuries are more prevalent during the summer and autumn months, and the frequency of trauma cases peaked during periods of increased human activity throughout the day. Limb/skin trauma were the most common locations of trauma injuries. To address these patterns, medical institutions and government agencies should implement targeted preventive measures and policies tailored to the specific characteristics of trauma. These strategies could significantly improve the quality and effectiveness of trauma care, ultimately enhancing patient outcomes.

Footnotes

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Medicine, research and experimental

Country of origin: China

Peer-review report’s classification

Scientific Quality: Grade C

Novelty: Grade C

Creativity or Innovation: Grade B

Scientific Significance: Grade C

P-Reviewer: Gupta L S-Editor: Qu XL L-Editor: A P-Editor: Chen YX

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