Comprehensive epidemiological assessment of trauma incidents at a level I trauma center

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
Jan	66	27	23	10	62	88	66	78	104	107	128	90	811
Feb	70	29	15	15	99	102	93	97	88	128	135	86	956
Mar	65	43	22	17	128	146	128	140	135	192	204	111	1331
Apr	79	51	15	25	128	193	132	140	145	189	198	121	1416
May	122	57	20	34	150	203	167	177	189	280	229	155	1783
Jun	118	57	37	27	155	221	189	165	190	273	230	173	1835
Jul	111	66	43	35	160	211	180	178	197	224	272	150	1827
Aug	129	55	41	25	223	267	198	197	195	226	296	193	2045
Sep	92	52	36	38	242	261	201	249	234	302	277	185	2169
Oct	110	45	24	27	157	259	218	204	216	270	236	131	1897
Nov	11	6	3	2	17	43	42	27	42	36	24	11	264
Dec	17	8	4	2	28	35	26	33	35	26	20	17	251
Total	989	496	283	257	1549	2029	1640	1685	1770	2253	2211	1423	16585

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
Falls	1236	665	973	693	857	606	704	602	455	726	4225	3292	45.32	1
Other trauma	387	200	436	281	289	192	253	222	134	139	1599	1034	15.88	2
Road Traffic Accidents	199	96	361	269	356	279	316	308	170	159	1402	1111	15.15	3
Violence	210	80	388	194	283	199	162	108	48	23	1191	604	10.82	4
Cutting/stabbing	155	58	381	199	259	138	176	98	52	45	1023	538	9.41	5
Mechanical injuries	54	39	65	55	70	32	64	26	19	15	272	167	2.65	6
Winter sports injuries	5	2	21	9	14	2	1	3	2	0	43	16	0.36	7
Animal bite	6	5	5	11	3	4	3	1	0	2	17	20	0.22	8
Burns	3	0	2	0	4	0	2	1	1	2	12	3	0.09	9
Electrical injuries	1	0	0	0	2	0	1	0	0	0	4	0	0.02	10
Total	2257	1142	2634	1712	2337	1455	1683	1372	882	1111	9793	6792	100

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
Falls	4758 (63.30)	2012 (26.77)	641 (8.53)	286 (3.80)	7517 (100.00)
Other trauma	1576 (59.86)	542 (20.85)	255 (9.68)	92 (3.49)	2633 (100.00)
Road traffic accidents	1399 (55.67)	666 (26.50)	342 (13.61)	106 (4.22)	2513 (100.00)
Violence	581 (32.37)	956 (53.26)	235 (13.09)	23 (1.28)	1795 (100.00)
Cutting/stabbing	1359 (89.37)	142 (9.10)	52 (3.33)	8 (0.51)	1561 (100.00)
Mechanical injuries	293 (66.74)	91 (20.73)	43 (9.79)	12 (2.73)	439 (100.00)
Winter sports injury	43 (72.88)	6 (10.17)	4 (6.78)	6 (10.17)	59 (100.00)
Animal bite	30 (81.08)	4 (10.81)	1 (2.70)	2 (5.88)	37 (100.00)
Burns	9 (60.00)	5 (33.33)	1 (6.66)	0 (0.00)	15 (100.00)
Electrical injuries	4 (100.00)	0 (0.00)	0 (0.00)	0 (0.00)	4 (100.00)
Total	10052 (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.