Injuries after violence and accidents – the forgotten pandemic?

Oddvar Uleberg; Thomas Kristiansen; Trond Nordseth; Jo Steinson Stenehjem; Jon Michael Gran; Thomas Clausen; Olav Røise; Leiv Arne Rosseland

doi:10.4045/tidsskr.22.0261

Injuries after violence and accidents – the forgotten pandemic?

Norwegian

Oddvar Uleberg, Thomas Kristiansen, Trond Nordseth, Jo Steinson Stenehjem, Jon Michael Gran, Thomas Clausen, Olav Røise, Leiv Arne Rosseland

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Oddvar Uleberg

oddvar.uleberg@stolav.no

Oddvar Uleberg, PhD, specialist in anaesthesiology and senior consultant at the Department of Emergency Medicine and Pre-hospital Services, St Olav's Hospital, Trondheim University Hospital, and post-doctoral fellow at the Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital.

The author has completed the ICMJE form and declares no conflicts of interest.

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Thomas Kristiansen

Thomas Kristiansen, PhD, specialist in anaesthesiology and senior consultant at the Division of Emergencies and Critical Care, Oslo University Hospital, and researcher at the Faculty of Medicine, University of Oslo.

The author has completed the ICMJE form and declares no conflicts of interest.

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Trond Nordseth

Trond Nordseth, PhD, specialist in anaesthesiology and senior consultant.

The author has completed the ICMJE form and declares the following conflicts of interest: He has received internal funding from Oslo University Hospital.

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Jo Steinson Stenehjem

Jo Steinson Stenehjem, PhD in epidemiology and researcher at the Research Department, Cancer Registry of Norway.

The author has completed the ICMJE form and declares no conflicts of interest.

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Jon Michael Gran

Jon Michael Gran, associate professor of biostatistics at the University of Oslo.

The author has completed the ICMJE form and declares no conflicts of interest.

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Thomas Clausen

Thomas Clausen, head of centre and professor at the Norwegian Centre for Addiction Research (SERAF), University of Oslo.

The author has completed the ICMJE form and declares no conflicts of interest.

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Olav Røise

Olav Røise, chief medical executive at the Norwegian National Trauma Registry and research manager and professor at the Division of Orthopaedic Surgery, Oslo University Hospital and the University of Oslo.

The author has completed the ICMJE form and declares no conflicts of interest.

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Leiv Arne Rosseland

Leiv Arne Rosseland, professor of anaesthesiology at the Department of Clinical Medicine, University of Oslo, and research manager at the Division of Emergencies and Prehospital Care, Department of Research and Development, Oslo University Hospital.

The author has completed the ICMJE form and declares no conflicts of interest.

Article

All information on injuries should be collected in a national injury registry devised for research. This will pave the way for a new strategy for injury prevention.

We have insufficient knowledge about the prevalence of injuries after violence and accidents. How many injuries can be prevented, how do the injured people cope, and what is the total cost for Norway?

In 2009, the government submitted a national strategy for prevention of accidents that cause personal injury (1). The current knowledge base is fragmented and consists of many different data registries that vary greatly in terms of quality and degree of completeness. However, the coronavirus pandemic has shown us that it is possible both to monitor prevalence at the individual level and to react quickly with targeted interventions at the national level.

How many are injured?

Each year, approximately 12 % of the Norwegian population seek medical assistance for injuries (2). More than one-half of these are treated by the primary healthcare services and are therefore excluded from most studies that describe injuries resulting from accidents (2). The Norwegian National Trauma Registry (NTR) includes those who are most severely injured, with a degree of coverage in excess of 90 % at the individual level. In 2020, this comprised only 9 008 of the 600 000 patients who injure themselves each year (2, 3).

However, the coronavirus pandemic has shown us that it is possible both to monitor the prevalence at the individual level and to react quickly with targeted interventions at the national level

In 1990, the Norwegian Institute of Public Health established the National Injury Registry, which was intended to include all injuries irrespective of the degree of seriousness. This registry was discontinued in 2003 for economic reasons (4). A new injury registry was established in 2009, with a renewed intention to include all injuries irrespective of their degree of seriousness (4). In 2019, it was declared that the quality of the data in this registry was inadequate to provide a satisfactory overview of the burden of injuries (4).

Long-term consequences

Over the last 50 years there has been a clear decline in the number of fatal accidents, mainly as a result of fewer road accident fatalities (5). However, approximately 2000 persons still die from their injuries (5). It has been shown that many survivors of injuries suffer from significant mental and physical sequelae (6, 7). In parallel we can see a worrying increase in the use of strong opioids in Norway, which indicates that many people are living with chronic pain (8). Reports indicate that 58 % of the injury/trauma patients are afflicted by pain, 35 % have problems related to anxiety and depression, and 75 % report a reduced quality of life after their injury (9).

There is no complete economic overview of the costs that injuries inflict on Norwegian society. An estimate of costs associated with injuries sustained in the home, in schools and during leisure activities amounted to approximately NOK 200 billion per year (5). However, an overview of the total cost profile that includes the disease burden, costs to the health services and loss of production has proved difficult to estimate.

What can we learn from the COVID-19 pandemic?

Patients with injuries caused by accidents or violence are more likely to survive than previously, but they experience an abrupt change in their situation. No standard patient pathway is available for serious injuries. The health system fails to sufficiently follow up the patients, and long-term health problems as well as use and abuse of strong analgesics is an increasing problem. Despite good intentions we have no overview of long-term consequences and costs to society.

Despite good intentions we have no overview of long-term consequences and costs to society

In the management of the COVID-19 pandemic, a preparedness registry for COVID-19 was quickly established. In addition, the Norwegian Intensive Care Registry was quickly adapted to record intensive care of COVID-19 patients (10, 11). The Norwegian Institute of Public Health continuously monitors research that describes the potential long-term consequences of a COVID-19 infection (12, 13). In June 2021, the Coronavirus Commission submitted a report that evaluated the authorities' management of the pandemic (13). In this report, the costs of the pandemic, measured in terms of loss of value creation, were estimated at more than NOK 330 billion for the years 2020–2023 (13).

To prevent injuries from violence and accidents from being forgotten, increased effort and involvement by professionals, researchers and politicians are required. The COVID-19 pandemic has shown that this is possible. We suggest that all information on injuries that is not included in the Norwegian National Trauma Registry be coordinated in a national injury registry devised for research as part of a new national strategy for prevention of injuries.

References

1.
Ulykker i Norge – Nasjonal strategi for forebygging av ulykker som medfører personskade 2009–2014. https://www.regjeringen.no/globalassets/upload/hod/vedlegg/ulykker_i_norge-hefte.pdf Accessed 22.3.2022.
2.
Ohm E, Holvik K, Madsen C et al. Incidence of injuries in Norway: linking primary and secondary care data. Scand J Public Health 2020; 48: 323–30. [PubMed][CrossRef]
3.
Nasjonalt traumeregister. https://www.kvalitetsregistre.no/register/skade-og-intensiv/nasjonalt-traumeregister Accessed 22.3.2022.
4.
Trygg Trafikk. Helsevesenbasert skaderegistrering som verktøy for å forebygge trafikkulykker. https://www.tryggtrafikk.no/wp-content/uploads/2019/11/Skaderegistreringsrapport2019_nett_oppslag.pdf Accessed 22.3.2022.
5.
Folkehelseinstituttet. Injuries in Norway. https://www.fhi.no/en/op/hin/injuries/injuries-in-Norway/ Accessed 22.3.2022.
6.
Gabbe BJ, Simpson PM, Cameron PA et al. Long-term health status and trajectories of seriously injured patients: A population-based longitudinal study. PLoS Med 2017; 14: e1002322. [PubMed][CrossRef]
7.
Finstad J, Røise O, Rosseland LA et al. Discharge from the trauma centre: exposure to opioids, unmet information needs and lack of follow up-a qualitative study among physical trauma survivors. Scand J Trauma Resusc Emerg Med 2021; 29: 121. [PubMed][CrossRef]
8.
Odsbu I, Handal M, Borchgrevink PC et al. Endringer i opioidbruken i Norge må tas på dypeste alvor. Tidsskr Nor Legeforen 2022; 142. doi: 10.4045/tidsskr.21.0909. [PubMed][CrossRef]
9.
Ulvik A, Kvåle R, Wentzel-Larsen T et al. Quality of life 2-7 years after major trauma. Acta Anaesthesiol Scand 2008; 52: 195–201. [PubMed][CrossRef]
10.
Folkehelseinstituttet. Beredskapregisteret for covid-19. https://www.fhi.no/sv/smittsomme-sykdommer/corona/norsk-beredskapsregister-for-covid-19/ Accessed 22.3.2022.
11.
2022. Norsk Pandemiregister. https://helse-bergen.no/norsk-pandemiregister Accessed 22.3.2022.
12.
Folkehelseinstituttet. Senfølger etter covid-19. https://www.fhi.no/publ/2022/senfolger-etter-covid-19.-hurtigoversikt-2022-ny-versjon/ Accessed 22.3.2022.
13.
NOU 2021: 6. Myndighetenes håndtering av koronapandemien – Rapport fra Koronakommisjonen. https://files.nettsteder.regjeringen.no/wpuploads01/blogs.dir/421/files/2021/04/Koronakommisjonens_rapport_NOU.pdf Accessed 22.3.2022.

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Fyrtårnprosjektet – et nytt nasjonalt skaderegister

Johan Lund,
Anne Mette Bjerkan,
Marianne Dahlhaug,
Inger Dahlstrøm,
Marte Lillehagen Garnes,
Else Karin Grøholt,
Grete Mathisrud

02.08.2022:

I et debattinnlegg 23. mai 2022 etterlyses det et nasjonalt register som kan samle all informasjon om skader (1) . Samferdsels- og Helse- og omsorgsdepartementet er allerede i gang med dette arbeidet, og det er opprettet et «fyrtårnprosjekt» for å få et slikt nasjonalt register (2).

Statistisk sentralbyrås statistikk over trafikkulykker med personskade er basert på politiets registrering og danner grunnlaget for myndighetenes trafikksikkerhetsarbeid. I en rapport fra Trygg Trafikk ble det dokumentert at statistikken kun fanger opp i underkant av 40 prosent av de hardt skadde som behandles i helsetjenesten (3). Med ufullstendig oversikt over det reelle antallet skadde blir det utfordrende å målrette trafikksikkerhetstiltak og vite om tiltak virker.

Rapporten om fyrtårnprosjektet (2) tilrår at det etableres et «fyrtårnprosjekt» for å samle inn fullstendige skadedata ved ti utvalgte sykehus og sju kommunale legevakter. Formålet er å bedre kvaliteten på registrering av skadedata etter trafikkulykker og få en tilnærmet komplett oversikt over alle hardt skadde og et representativt utvalg av lettere skader. Fyrtårnprosjektet skal i tillegg sikre god registrering av alle typer skader i enhetene som deltar og støtte erfaringsoverføring. Data fra fyrtårnprosjektet kan anvendes som kunnskapsgrunnlag i arbeidet med å forebygge personskader i trafikken, og relevante data skal regelmessig formidles til aktuelle aktører. Prosjektet skal også fremme analyse og bruk av data for alle typer skader og ulykker til samfunnsplanlegging lokalt og nasjonalt, og legge til rette for forskning.

Departementene besluttet høsten 2021 å opprette fyrtårnprosjektet med oppstart i 2022. Fyrtårnprosjektet har en foreløpig tidsramme på tre til fem år.

Sykehusene og legevaktene ansetter en 20 % skadekoordinator for å etablere rutiner og følge opp registrering av et felles minimums datasett – FMDS. Alle skader skal registreres. Årlig vil ca. 160 000 skader fra spesialisthelsetjenesten og 30 000 fra primærhelsetjenesten bli registrert. Det legges opp til nært samarbeid med traumeregistrarene ved de 10 sykehusene og med Nasjonalt traumeregister for å få statistikk over de registrerte traumene. Representativiteten er beregnet til å være god, men må kontrolleres jevnlig for å sikre valid modellering til nasjonale tall.

Helsedirektoratet skal lede fyrtårnprosjektet, og har ansvar for å sikre gode data i samarbeid med de ti sykehusene og de sju kommunale legevaktene som inngår i prosjektet. Folkehelseinstituttet har ansvar for å analysere data og levere statistikk til Statens vegvesen. Målet er at registreringen blir komplett og at valid statistikk over trafikkulykkesskader og andre skader blir produsert i 2023.

Dette prosjektet er unikt og ønsket. Prosjektet går på tvers av sykehus, kommunale legevakter, departementer, direktorater, forskningsinstitusjoner og flere registre. Dersom prosjektet lykkes, kan det bli permanent. I så fall vil vi ha oppnådd målet om å skape et nytt nasjonalt register hvor data over alle skader blir registrert. Det vil kunne gi valid statistikk og være et godt grunnlag for forskning og forebygging.

Litteratur

Uleberg O, Kristiansen T, Nordseth T et al. Skader etter vold og ulykker – den glemte pandemi? Tidsskr Nor Legeforen 2022; 142. doi: 10.4045/tidssk.22.0261
Trygg Trafikk. Fyrtårnprosjektet - Forbedre trafikkulykkesstatistikken basert på helsedata. Oslo: Trygg Trafikk, 2021. https://www.tryggtrafikk.no/wp-content/uploads/2022/04/Fyrta%CC%8Arnsprosjektet2021_nett_oppslag.pdf. Lest 13.6.22.
Trygg Trafikk. Helsevesenbasert skaderegistrering som verktøy for å forebygge trafikkulykker. Oslo: Trygg Trafikk, 2019. https://www.tryggtrafikk.no/wp-content/uploads/2022/04/Skaderegistreringsrapport2019_justert.pdf Lest 13.6.22.

This article was published more than 12 months ago and we have therefore closed it for new comments.

Published: 23 May 2022

Tidsskr Nor Legeforen 23 May 2022 Vol. 142.

doi:

10.4045/tidsskr.22.0261

Received 28.3.2022, accepted 12.4.2022.

Published: 23 May 2022

Tidsskr Nor Legeforen 2022 Vol. 142.

doi: 10.4045/tidsskr.22.0261

Received 28.3.2022, accepted 12.4.2022.

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Injuries after violence and accidents – the forgotten pandemic?

How many are injured?

Long-term consequences

What can we learn from the COVID-19 pandemic?

Fyrtårnprosjektet – et nytt nasjonalt skaderegister

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