Asset Details
Do you wish to reserve the book?
Higher hospital level does not improve 30-day survival after road traffic accidents
Hey, we have placed the reservation for you!
By the way, why not check out events that you can attend while you pick your title.
Oops! Something went wrong.
Looks like we were not able to place the reservation. Kindly try again later.
Are you sure you want to remove the book from the shelf?
Higher hospital level does not improve 30-day survival after road traffic accidents
Do you wish to request the book?
Higher hospital level does not improve 30-day survival after road traffic accidents
Please be aware that the book you have requested cannot be checked out. If you would like to checkout this book, you can reserve another copy
We have requested the book for you!
Your request is successful and it will be processed during the Library working hours. Please check the status of your request in My Requests.
Oops! Something went wrong.
Looks like we were not able to place your request. Kindly try again later.
Journal Article
Higher hospital level does not improve 30-day survival after road traffic accidents
2025
Overview
Globally, road traffic accidents (RTAs) remain a major cause of death, particularly among individuals aged 15–30 years. While Sweden has been at the forefront of traffic safety through the
Vision Zero
initiative, in-hospital management remains crucial in determining RTA outcomes. Drawing on North American evidence suggesting improved survival at trauma centres, the Swedish healthcare system has increasingly emphasised trauma centralisation. However, comprehensive national data from Sweden are scarce. Given the country’s unique demographic and geographic characteristics, including vast sparsely populated areas, direct comparisons with other Western systems are challenging. We analysed the epidemiology and risk factors for 30-day mortality among 95,954 RTA-related hospital admissions in Sweden between 2008 and 2021. Predictors included the ICD-based Injury Severity Score (ICISS), age, sex, Charlson Comorbidity Index (CCI), year of event, and hospital level. Mortality risk was modelled using explainable artificial intelligence (XAI) via Extreme Gradient Boosting (XGBoost) with SHapley Additive exPlanations (SHAP), alongside conventional multivariable logistic regression for comparison. The most influential predictors of 30-day mortality, in descending order, were ICISS, age, CCI, event year, hospital level, and sex. A clear trend toward centralisation was observed, with Level 1 hospitals admitting the most severely injured patients. However, after risk adjustment, the hospital level was not independently associated with 30-day mortality. The XAI model outperformed logistic regression in both discrimination and calibration, confirming these findings. This study represents a comprehensive national analysis of in-hospital outcomes following RTAs in Europe. ICISS, age, sex, and comorbidity influenced mortality risk, while overall survival improved over time. The assumption that trauma centralisation confers a universal survival advantage does not appear to hold in the Swedish context. These findings underscore the need to re-evaluate trauma system design under Scandinavian conditions—ensuring that timely access to hospital care is not compromised by centralisation.
Publisher
Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
Subject
/ 692/700
/ Accidents, Traffic - mortality
/ Accidents, Traffic - statistics & numerical data
/ Adult
/ Age
/ Aged
/ Anesthesiology and Intensive Care
/ Assaults
/ Codes
/ Datasets
/ Female
/ Hospitalization - statistics & numerical data
/ Hospitals - statistics & numerical data
/ Humanities and Social Sciences
/ Humans
/ Male
/ Medicinska och farmaceutiska grundvetenskaper
/ Personal identification numbers
/ Science
/ Sex
/ Survival
/ Traffic
/ Trauma
/ Trauma Centers - statistics & numerical data
