Trauma epidemiology in Norway

Another PhD is done and dusted... 
It was a pleasure to attend this week's dissertation in Oslo when Thomas Kristiansen defended his thesis "Epidemiology and management of traumatic injuries: a population-based study of fatal trauma and assessment of geographical challenges in the organisation of trauma care " at the Diaconess Hospital. Great job and work well done! I've had the pleasure of being co-supervisor and co-author on several of his works. The first paper we co-wrote was on trauma systems in the Nordic countries (Trauma systems and early management of severe injuries in Scandinavia: review of the current state.) 

From T Kristiansen et al Injury. 2010 May;41(5):444-52. doi: 10.1016/j.injury.2009.05.027. Epub 2009 Jun 21.

Thomas has later published a series of paper (one yet to be published, but is now in final revisions) that constitutes the material for his thesis and PhD:


1: Kristiansen T, Rehn M, Gravseth HM, Lossius HM, Kristensen P. Paediatric trauma mortality in Norway: a population-based study of injury characteristics and urban-rural differences
trauma mortality in Norway: a population-based study of injury characteristicsand urban-rural differences. Injury. 2012 Nov;43(11):1865-72. doi:
10.1016/j.injury.2011.08.011. Epub 2011 Sep 21. PubMed PMID: 21939971.
2: Kristiansen T, Ringdal KG, Skotheimsvik T, Salthammer HK, Gaarder C, Naess PA,
Lossius HM. Implementation of recommended trauma system criteria in south-eastern Norway: a cross-sectional hospital surveyNorway: a cross-sectional hospital survey. Scand J Trauma Resusc Emerg Med. 2012
Jan 26;20:5. doi: 10.1186/1757-7241-20-5. PubMed PMID: 22281020; PubMed Central
PMCID: PMC3285082.
3: Kristiansen T, Lossius HM, Søreide K, Steen PA, Gaarder C, Næss PA. Patients Referred to a Norwegian Trauma Centre: effect of transfer distance on injury patterns, use of resources and outcomesReferred to a Norwegian Trauma Centre: effect of transfer distance on injurypatterns, use of resources and outcomes. J Trauma Manag Outcomes. 2011 Jun
16;5(1):9. doi: 10.1186/1752-2897-5-9. PubMed PMID: 21679393; PubMed Central
PMCID: PMC3135518.
4: Thomas Kristiansen, Hans M Lossius, Marius Rehn, Petter
Kristensen, Hans M Gravseth, Jo Røislien and Kjetil Søreide. Epidemiology of Trauma: a population-based study of geographical risk factors for injury deaths in the working-age population of Norway. (in press soon)

Thomas K. (far left) together with the members of the evaluation committee - and after having received the final verdict! Sigh of relief!

In addition to the work above I have previously investigated aspects of trauma epidemiology from other perspectives. One of the earliest experiences was to investigate the epidemiology of trauma deaths in our region (Stavanger area) which was published in World J Surg, 2007. In this paper, and in subsequent correspondence (Injury 2008; World J Surg 2010) and editorial work (BJS 2009), we discussed the principle of the "trimodal temporal death distribution", which I believe is a great educational model for explaining the temporal differences in relation to death causes (i.e immediate death usually occurs from non-salvagable bleeding or brain damage, most frequently outside hospital and following the accident/incident; early deaths occur from rapid bleeding that is not stopped or brain injuries not intervened on; later deaths may occur from insults to the brain, and the final mode of death is from the organ failures that follows the initial injuries). While serving a purpose as educational tool, it is simplified and obviously there is great overlap in modes and time-phrames that the researcher needs to see in relation. Also, the distribution will change somewhat from region to region, depending on the dominating mechanisms of trauma etc. If you'd like to know more details oabout this, please seek up any of the refs below or fell free to send me an email for a reprint (ksoreide@mac.com):

1: Søreide K. Temporal patterns of death after trauma: evaluation of circadian,
diurnal, periodical and seasonal trends in 260 fatal injuries. Scand J Surg.
2010;99(4):235-9. PubMed PMID: 21159595.

2: Søreide K. Epidemiology of trauma deaths: location, location, location! World 
J Surg. 2010 Jul;34(7):1720-1; author reply 1722-3. doi:
10.1007/s00268-010-0434-3. PubMed PMID: 20112018.

3: Meling T, Harboe K, Søreide K. Incidence of traumatic long-bone fractures
requiring in-hospital management: a prospective age- and gender-specific analysis
of 4890 fractures. Injury. 2009 Nov;40(11):1212-9. doi:
10.1016/j.injury.2009.06.003. Epub 2009 Jul 5. PubMed PMID: 19580968.

4: Søreide K. Epidemiology of major trauma. Br J Surg. 2009 Jul;96(7):697-8. doi:
10.1002/bjs.6643. PubMed PMID: 19526611.

5: Søreide K, Krüger AJ, Ellingsen CL, Tjosevik KE. Pediatric trauma deaths are
predominated by severe head injuries during spring and summer. Scand J Trauma
Resusc Emerg Med. 2009 Jan 22;17:3. doi: 10.1186/1757-7241-17-3. PubMed PMID:
19161621; PubMed Central PMCID: PMC2637226.

6: Krüger AJ, Søreide K. Trimodal temporal distribution of fatal trauma--fact or 
fiction? Injury. 2008 Aug;39(8):960-1; author reply 961-2. doi:
10.1016/j.injury.2008.01.007. Epub 2008 Jun 30. PubMed PMID: 18586249.

7: Søreide K, Krüger AJ, Vårdal AL, Ellingsen CL, Søreide E, Lossius HM.
Epidemiology and contemporary patterns of trauma deaths: changing place, similar 
pace, older face. World J Surg. 2007 Nov;31(11):2092-103. PubMed PMID: 17899256.