News

The research area Care and Rescue is expanding its research portfolio with six new associated projects. This area contains research aimed at saving lives and reducing injuries during the critical hour following a traffic accident, such as improved incident detection and assessment, improved on-scene care and rescue and as well as reducing secondary long-term effects of traffic accidents. The area has great potential and is still fairly unexplored, proper care after a traffic accident is extremely important in reducing suffering. The Research area director Bengt-Arne Sjöqvist comments on the new six projects:
“The fact that researchers want to associate their projects with SAFER is a very good grade for our research platform. The researchers see the added value and know that cooperation with SAFER can often give significant benefits to raising their research to a next level”.

Below is a summary of the new projects and links to publications.

1. Computerized clinical decision support to improve trauma triage and risk assessment: A Low fidelity OSISP prototype
As a part of a work carried out within SAFER a new algorithm for On-scene injury severity prediction (OSISP) of car passengers involved in road crashes have been proposed (Buendia et al 2015). The OSISP algorithm uses only crash characteristics that are feasible to assess at the scene of crash. This way a multi-variate logistic regression model was designed to assess the probability of a car occupant being severely injured following a crash. Using this algorithm in the prehospital stage have the potential to improve triage accuracy. This study is initiated by Prehospital ICT Arena (PICTA) at Lindholmen Science Park in Gothenburg, and the purpose is to design a low fidelity clinical field test prototype of the OSISP algorithm which in a next stage can be developed into a practical clinical evaluation solution. The proposed solution includes a low fidelity prototype of a mobile App with capability to upload registered data to a server, e.g. cloud-based. The App shall be designed to naturally fit into the normal workflow and processes carried out by the ambulance crew. If the final solution is successfully evaluated in the clinical practice, the ambition is to integrate the algorithms in other ambulance ICT-platforms like Ortivus MobiMed or SAAB Paratus.

2. Computerized Clinical Decision Support to Improve the Trauma Care Process: High Fidelity On-Scene Injury Severity Prediction Prototype
A Master’s thesis in Master Programme in Biomedical Engineering by Ion Olaetxea Azkarate-Askatsua
 
Abstract
In Sweden, as in most countries, the accuracy of triage of road crash patients appears to be low. There is a need for new complementary tools to improve the accuracy. An algorithm for On-Scene Injury Severity Prediction (OSISP) of car passengers involved in road crashes has been developed at the SAFER Vehicle and Traffic Safety Centre at Chalmers. The use of this algorithm in the prehospital stage has the potential to become a complementary tool to improve the triage accuracy. In this thesis, an implementation of the algorithm has been developed for use in Android smartphones. The App format has been designed to naturally fit into the normal workflow of ambulance personnel, via iterative refinements considering´feedback from prehospital experts. The user is asked to provide Accident Characteristics for the OSISP algorithm to calculate the risk of severe injury, e.g. age, gender, airbag deployment, belt use, environment, type of accident and posted speed limit. According to the calculated risk, an example of how the clinical decision support may look like is presented. The App logs the data to a server via an File Transfer Protocol implementation. Data is sent through a mobile network or WiFi and automatically uploaded to the server when a network becomes available. Based on input from interviews, a possibility to triage several patients at the same time has been implemented. The final solution has been confirmed to appear to be usable in the field by several ambulance nurses. This solution is ready for implementation in a clinical study and evaluation of the OSISP algorithm. If the solution is successfully evaluated, the ambition is to integrate the algorithm in other ambulance ICT-platforms.

The project has been financed by Financed by Medtech West.

Link to project: http://studentarbeten.chalmers.se/publication/252176-an-it-solution-for-clinical-evaluation-of-an-on-scene-injury-severity-prediction-algorithm-intended

3. Traumatic Brain Injury

Part 1: Detecting Chronic Subdural Hematoma with Microwave Technology - An open study evaluating the sensitivity and specificity of a microwave-based device,
Medfield Strokefinder MD100, to detect chronic subdural hematoma (CSH), by comparing measurements on patients recruited for surgery of chronic subdural hematoma to an age- and gender-matched group of healthy volunteers •

Publication: Ljungqvist J, Candefjord S, Persson M, Jönsson L, Skoglund T & Elam M. Clinical evaluation of a microwave-based device for detection of traumatic intracranial hemorrhage. Journal of Neurotrauma 2017, doi:10.1089/neu.2016.4869
Link to publication: https://www.ncbi.nlm.nih.gov/pubmed/28287909

Part 2: Detecting Traumatic Intracranial Haemorrhage with Microwave Technology - An open study evaluating the diagnostic accuracy of a microwave-based device to detect traumatic intracranial haemorrhage (TICH), by comparing measurements on trauma patients with confirmed vs excluded TICH

This study is ongoing, see https://clinicaltrials.gov/show/NCT02728908

4. Prehospital transportation decisions for patients sustaining major trauma in road traffic crashes: a comparison between US and Sweden
A master thesis by Magdalena Krawczuk and Patrycja Kozajda, Gdansk University of Technology.

Abstract
In 2012, road traffic crashes (RTC) accounted for almost a quarter of injury deaths in the world. The World Health Organization (WHO) estimated that in 2013 RTC killed 1.25 million people. Therefore, RTC became the tenth leading cause of death in the world, and the leading cause of death among children and young people below the age of 45. The present study was therefore designed to assess proportions and characteristics of patients sustaining minor and major trauma in RTC and transported to either a trauma center (TC) or a non-trauma center (non-TC) in the US and Sweden and to compare results from the countries. The aim was to evaluate what the prehospital transportation decisions on the scene of accident were and to understand the purposes for the decision in both countries. Currently in Sweden, there exists no trauma care system similar to the system established in the US. However, University Hospitals in Sweden provide a high level of care comparable to TCs in US. Thus, a comparison between Sweden and US, with a well established trauma care system, may contribute to establish major trauma destination policies in Sweden.
The data were selected from the National Automotive Sampling System - Crashworthiness Data System (NASS-CDS) and Swedish TRaffic Accident Data Acquisition (STRADA) database for US and Sweden, respectively. The data from RTC that occurred from 2010 to 2015 were analysed. For the given years there were a total of 45,075 patients from RTC reported by the police in US and 39,733 patients reported by police and hospitals in Sweden. However, not all cases were analysed. Patients
below age 18, patients with missing value for Injury Severity Score (ISS) and patients for which transport to hospital was not provided or was unknown, were excluded from analysis. Thus, the final sample consisted of 10 289 patients and 31 415 patients for US and Sweden, respectively.
An analysis of the patient characteristics sustaining major trauma in comparison with patients sustaining minor trauma (ISS < 15) and an analysis of major trauma patients transported to a TC versus non-TC was conducted. The variables that were analysed for both countries were sex, age and location of road RTC (rural or urban area). In addition, an analysis of race and BMI level was conducted for the US. Due to lack of data, the analysis of race and BMI for Sweden was not possible.
The proportions of patients sustaining minor trauma and transported to TC were 55.7% and 19.1% in US and Sweden, respectively. The proportions of patients sustaining major trauma and transported to TC were 87.6% in US and 31.9% in Sweden. The proportion of patients sustaining minor trauma and major trauma, and the proportions of patients sustaining major trauma transported to TC and non-TC, for each country and between both countries were analysed. Chi-square tests were performed to find statistically significant differences. Proportions of patients aged > 55, proportions of males, and proportions of patients involved in RTC in urban environment differed with
statistical significance (P < 0.05) between the two countries.
The conducted study reveals that in Sweden many RTC patients with severe injury are transported to hospital with a lower level of care. This may be caused by undertriage or by lack of formal designated trauma care system and major trauma destination policies in Sweden. The opposite situation is presented in US, where observed results indicate low undertriage but at the price of high overtriage which may be linked to the field triage protocol where it is stated that "When in doubt, transport to a trauma center".
This study offers a unique insight into the rate of prehospital transportation decisions for major RTC and points out the large differences between US and Sweden.

5. On Scene Injury Severity Prediction (OSISP) Improvement Using Data Science.
More information will be distributed.

6. Prehospital transportation decisions for patients sustaining major trauma in road traffic crashes in Sweden

The objective of this study was to evaluate the proportion and characteristics of patients sustaining major trauma in road traffic crashes (RTCs) who could benefit from direct transportation to a trauma center (TC). Currently, there is no national classification of TC in Sweden. In this study, 7 university hospitals (UHs) in Sweden were selected to represent a TC level I or level II. These UHs have similar capabilities as the definition for level I and level II TC in the United States. Major trauma was defined as Injury Severity Score (ISS) > 15. A total of 117,730 patients who were transported by road or air ambulance were selected from the Swedish TRaffic Accident Data Acquisition (STRADA) database between 2007 to 2014. An analysis of the patient characteristics sustaining major trauma in comparison with patients sustaining minor trauma (ISS < 15) was conducted. Major trauma patients transported to a TC versus non-TC were further analysed with respect to injured body region and road user type. Approximately 3% (n = 3, 411) of patients sustained major trauma. Thirty-eight percent of major trauma patients were transported to a TC, and 62% were transported to a non-TC. This results in large proportions of patients with Abbreviated Injury Scale (AIS) 3+ injuries being transported to a non-TC.  The number of AIS 3+ head injuries for major trauma patients transported to a TC versus non-TC were similar, whereas a larger number of AIS 3+ thorax injuries were present in the non-TC group. The non-TC major trauma patients had a higher probability of traveling in a car, truck, or bus and to be involved in a crash in a rural location. Our results show that the majority of RTC major trauma patients are transported to a non-TC. This may cause unnecessary morbidity and mortality. These findings can guide the development of improved prehospital treatment guidelines, protocols and decision support systems.

Publication: Candefjord S, Buendia R, Caragounis EC, Sjöqvist BA & Fagerlind H. Prehospital transportation decisions for patients sustaining major trauma in road traffic crashes in Sweden. Traffic Injury Prevention vol 17 pp. 16–20, 2016

Link to publication: http://www.tandfonline.com/doi/full/10.1080/15389588.2016.1198872