Is the performance of acute appendectomy at different times of day equal, in terms of postoperative complications, readmission, death, and length of hospital stay? A Swedish retrospective cohort study of 4950 patients.

PURPOSE: Appendicitis is one of the most common acute surgical conditions globally, and hence appendectomy is a common procedure performed around the clock in many hospitals. The aim of the current study was to determine whether acute appendectomy due to acute appendicitis performed during day, evening, and night was equally safe, in terms of postoperative complications, readmission, death, and length of hospital stay. METHODS: A retrospective single-center cohort study, using a local quality register of all consecutive acute appendectomies performed at the Department of Surgery, Södersjukhuset, Stockholm, Sweden. During the study period from December 2015 to August 2022, 4950 patients were included. Risk of complications, readmission, and death were determined using multivariable logistic regression models. Association with length of hospital stay was determined using multiple linear regression. RESULTS: There was no significant difference in the associated risk of postoperative complications, readmission within 30 days, or death, regardless of when appendectomy was performed. Using daytime surgery as reference, hospital stay was shortened by 4.21 h (P = 0.008) for evening surgery and by 6.71 h (P < 0.001) for nightly surgery. CONCLUSION: Risks of postoperative complications, readmission, and death were similar regardless of when acute appendectomy was performed. However, surgery during evening and night was associated with shortened hospital stay, as compared to daytime surgery.

Long-term health-related quality of life after trauma with and without traumatic brain injury: a prospective cohort study.

To purpose was to assess and compare the health-related quality of life (HRQoL) and risk of depression two years after trauma, between patients with and without traumatic brain injury (TBI) in a mixed Swedish trauma cohort. In this prospective cohort study, TBI and non-TBI trauma patients included in the Swedish Trauma registry 2019 at a level II trauma center in Stockholm, Sweden, were contacted two years after admission. HRQoL was assessed with RAND-36 and EQ-5D-3L, and depression with Montgomery Åsberg depression Rating Scale self-report (MADRS-S). Abbreviated Injury Score (AIS) head was used to grade TBI severity, and American Society of Anesthesiologists (ASA) score was used to assess comorbidities. Data were compared using Chi-squared test, Mann Whitney U test and ordered logistic regression, and Bonferroni correction was applied. A total of 170 of 737 eligible patients were included. TBI was associated with higher scores in 5/8 domains of RAND-36 and 3/5 domains of EQ-5D (p < 0.05). No significant difference in MADRS-S. An AIS (head) of three or higher was associated with lower scores in five domains of RAND-36 and two domains of EQ-5D but not for MADRS-S. An ASA-score of three was associated with lower scores in all domains of both RAND-36 (p < 0.05, except mental health) and EQ-5D (p < 0.001, except anxiety/depression), but not for MADRS-S. In conclusion, patients without TBI reported a lower HRQoL than TBI patients two years after trauma. TBI severity assessed according to AIS (head) was associated with HRQoL, and ASA-score was found to be a predictor of HRQoL, emphasizing the importance of considering pre-injury health status when assessing outcomes in TBI patients.

Health-related quality of life and prosthesis use among patients amputated due to peripheral arterial disease - a one-year follow-up.

PURPOSE: A major amputation affects the patients' independence, well-being and HRQoL. However, prosthesis use and the impact on the patient's HRQoL are scarcely described. The aim was to compare HRQoL between walker and non-walker amputees. Secondary aim was to evaluate prosthesis use and habits. METHOD: Ninety-eight patients with a major amputation due to peripheral arterial disease were included during 2014-2018. They were interviewed using EQ-5D-3L (HRQoL), Stanmore Harold Wood mobility grade (prosthesis use) and Houghton scale (prosthesis habits). RESULTS: Seventy-three patients completed the one-year follow-up, out of them 56 got a prosthesis. Twenty-three used it to walk both inside and outside. EQ-5D-3L at follow-up was increased in all patients in comparison to baseline (0.16 versus 0.59, p < 0.001). Patients walking with prosthesis had the largest improvement (0.12 versus 0.78, p < 0.001). A sub-analysis aiming to study the importance of independent movement showed an improved HRQoL at follow-up among those classified as prosthesis-user (p<0.001) and walker (p<0.001), but not among non-prosthesis users (p = 0.245). CONCLUSION: Learning how to use, not exclusively to walk with, a prosthesis after an amputation is important for the patients' HRQoL. At follow-up, patients using their prosthesis to walk or to move to a wheelchair, showed an improved HRQoL compared to baseline.IMPLICATIONS FOR REHABILITATION Walking ability with a prosthesis is important for the patient's perceived HRQoL after an amputation.Rehabilitation of amputees should focus on independence and movability and not only on walking ability.Wider use of prescribing prostheses after an amputation also to those predicted as non-walkers, may increase the number of patients with independence and improved HRQoL.When using their prosthesis for independent movement, patients who were otherwise unable to walk due to their amputation were able to achieve HRQoL comparable to walking amputees.

Risk factors for reamputations in patients amputated after revascularization for critical limb-threatening ischemia.

OBJECTIVE: Despite vascular intervention, patients with critical limb-threatening ischemia (CLTI) have a high risk of amputation. Furthermore, this group has a high risk for stump complications and reamputation. The primary aim of this study was to identify risk factors predicting reamputation after a major lower limb amputation in patients revascularized because of CLTI. The secondary aim was to investigate mortality after major lower limb amputation. METHODS: There were 288 patients who underwent a major ipsilateral amputation after revascularization because of CLTI in Stockholm, Sweden, during 2007 to 2013. The main outcome was ipsilateral reamputation. RESULTS: Of 288 patients, 50 patients had a reamputation and 222 died during the 11-year follow-up. Patients with ischemic pain as an indication for primary amputation had nearly four times higher risk for a reamputation compared with those with a nonhealing ulcer (subdistribution hazard ratio, 3.55; confidence interval, 1.55-8.17). Higher age was associated with an increased risk for death in the multivariable analysis (hazard ratio, 1.03; confidence interval, 1.02-1.04). CONCLUSIONS: Patients with ischemic pain as an indication for amputation have an elevated risk of reamputation. Ischemic pain may be indicative of a more extensive and proximal ischemia compared with patients with foot tissue loss. An extended evaluation of the preoperative circulation before amputation may facilitate the choice of amputation level and could lead to a reduction of reamputations.

Risk factors for amputation are influenced by competing risk of death in patients with critical limb ischemia.

OBJECTIVE: Patients with critical limb ischemia (CLI) have a high risk of amputation and death. Death is a competing risk that affects the estimated amputation risk. Our aim was to find the specific risk factors for amputation for patients with CLI using competing risk analyses and compared these results with those from standard Cox regression analysis. METHODS: Patients who had undergone revascularization for CLI (2009-2013, with follow-up data until 2017) in Stockholm were identified from the Swedish National Registry for Vascular Surgery. The main outcome was major amputation. The risk factors for amputation were assessed using competing risk analysis and compared with the risk factors for amputation-free survival identified using Cox proportional hazards regression analysis. RESULTS: Of 855 patients with CLI, 178 had required a major amputation and 415 had died during the 8-year follow-up period. In the competing risk regression, age (subdistribution hazard ratio [sub-HR], 0.98; 95% confidence interval [CI], 0.97-1.00), ambulatory status (independent vs bedridden; sub-HR, 4.10; 95% CI, 2.14-7.86), and ischemic wound vs rest pain (sub-HR, 3.03; 95% CI, 1.72-5.36) were associated with amputation, considering death as a competing risk. In contrast, Cox regression analysis identified female vs male (hazard ratio [HR], 0.77; 95% CI, 0.64-0.94), age (HR, 1.02; 95% CI, 1.01-1.03), renal impairment (HR, 2.08; 95% CI, 1.61-2.67), ambulatory status (independent vs bedridden; HR, 3.45; 95% CI, 2.30-5.18), and ischemic wound vs rest pain (HR, 2.41; 95% CI, 1.78-3.25) as risk factors. CONCLUSIONS: The risk factors associated with amputation differed when analyzing the data using competing risk regression vs Cox regression. The differences between the analyses indicated that a risk exists for biased estimates using standard survival methods when a strong competing risk such as death is present.

Retained sex toys: an increasing and possibly preventable medical condition.

PURPOSE: Retained foreign rectal objects may require surgical removal. To estimate the magnitude of this problem, we report the incidence and treatment of retained rectal objects at a large emergency hospital, and calculate incidence rates at the national level in Sweden. METHODS: All local patient records during 2009-2017 with the diagnosis foreign body in anus and rectum (ICD-10 T185) were accessed and analyzed retrospectively. All Swedish in- and outpatient visits during 2005-2016 with the code T185 were accessed from the National Patient Register. RESULTS: We show an increasing incidence in rectal foreign bodies in Swedish national data. The increase was most noticeable in men, and in our local register there was an overrepresentation of sex toys leading to laparotomy and stoma. CONCLUSIONS: To mitigate surgical cost and comorbidity, policies to decrease the risk of retained sex toys could be considered.

Trends in the Management of Acute Appendicitis in a Single-Center Quality Register Cohort of 5,614 Patients.

Acute appendicitis is one of the most common reasons for emergency surgery. At Stockholm South General Hospital, information on all patients - 15 years or older - undergoing surgery for acute appendicitis is included in a quality register. Data on surgical method, preoperative imaging, hospital stay, intraoperative findings, and 30-day complications were recorded for each patient. From January 2004 to December 2014, 5,614 consecutive patients were registered. The percentage of patients examined with preoperative imaging increased from 30% in 2004 to 93% in 2014. The use of laparoscopic appendectomy increased from 6 to 79%. Negative appendectomies decreased from 7.5-10 to 1.7%. The mean perforation rate was 28.6%. Some form of postoperative complication occurred in 6.6% of those on whom laparoscopy was performed and 10.5% of those who underwent an open surgery, with a significant difference (p < 0.001) in the rate of surgical site infections (surgical site infections, higher in open cases) but with no difference in the number of deep postoperative abscesses. The overall hospital stay decreased from 2004 to 2014 for perforated and non-perforated appendicitis. The overall 30-day mortality rate was 0.12%. Changes in preoperative imaging and treatment strategy for appendicitis during this period resulted in a lower rate of negative appendectomies with acceptable complication rates and shortened hospital stay.

The patient's experience of amputation due to peripheral arterial disease.

It is not uncommon that patients with peripheral arterial disease (PAD) need to undergo a lower limb amputation, with or without previous revascularization attempts. Despite that, the patient's experience of the amputation has been scarcely studied. The aim of this qualitative study was to describe the patient's experience of amputation due to PAD. Thirteen interviews were conducted with vascular patients who had undergone a lower limb amputation at tibia, knee, or femoral level. Data were analyzed with content analysis. Our findings of the patient's experiences during the amputation process resulted in three themes with additional time sequences: the decision phase "From irreversible problem to amputation decision", the surgical phase "A feeling of being in a vacuum," and the rehabilitation phase "Adaptation to the new life". One main finding was that the patients felt abandoned during the surgical period. Despite that, most of the participants were satisfied with the decision, some of them even regretted that they had not undergone an amputation earlier in the process. It is important for the patient's well-being to develop a partnership with the surgeon to increase a feeling of being participating in the care. Vascular patients need better information on lower limb amputation, and its consequences so as to be better prepared for the whole process. To increase the patient's quality of life and reduce unnecessary suffering, amputation may be presented earlier in the process as a valuable treatment option.

Surgical decision-making in acute appendicitis.

BACKGROUND: Acute appendicitis is one of the most common acute abdominal conditions. Among other parameters, the decision to perform surgical exploration in suspected appendicitis involves diagnostic accuracy, patient age and co-morbidity, patient's own wishes, the surgeon's core medical values, expected natural course of non-operative treatment and priority considerations regarding the use of limited resources. Do objective clinical findings, such as radiology and laboratory results, have greater impact on decision-making than "soft" clinical variables? In this study we investigate the parameters that surgeons consider significant in decision-making in cases of suspected appendicitis; specifically we describe the process leading to surgical intervention in real settings. The purpose of the study was to explore the process behind the decision to undertake surgery on a patient with suspected appendicitis as a model for decision-making in surgery. METHODS: All appendectomy procedures (n = 201) at the Department of Surgery at Karolinska University Hospital performed in 2009 were retrospectively evaluated. Every two consecutive patients seeking for abdominal pain after each case undergoing surgery were included as controls. Signs and symptoms documented in the medical records were registered according to a standardized protocol. The outcome of this retrospective review formed the basis of a prospective registration of patients undergoing appendectomy. During a three- month period in 2011, the surgeons who made the decision to perform acute appendectomy on 117 consecutive appendectomized patients at the Karolinska University Hospital, Huddinge, and Södersjukhuset, were asked to answer a questionnaire about symptoms, signs and diagnostic measures considered in their treatment decision. They were also asked which three symptoms, signs and diagnostic measures had the greatest impact on their decision to perform appendectomy. RESULTS: In the retrospective review, tenderness in the right fossa had the greatest impact (OR 76) on treatment decision. In the prospective registration, the most frequent symptom present at treatment decision was pain in the right fossa (94 %). Tenderness in the right fossa (69 %) was also most important for the decision to perform surgery. Apart from local status, image diagnostics and blood sample results had the greatest impact. CONCLUSION: Local tenderness in the right fossa, lab results and the results of radiological investigations had the greatest impact on treatment decision.

Translation and validation of the wound-specific quality of life instrument Cardiff Wound Impact Schedule in a Swedish population.

PURPOSE: To translate and validate the wound-specific health-related quality of life instrument, the Cardiff Wound Impact Schedule (CWIS) in a Swedish population. METHODS: The instrument was first translated into Swedish, using the Standard Linguistic Validation Process. The Swedish version of the CWIS was then tested for its psychometric properties in a Swedish context. A total of 117 patients with acute and hard-to-heal wounds were included. The patients were asked to fill in the Swedish version of the CWIS and the generic instrument SF-36 at baseline and after 1 week. Patients with acute wounds were also asked to fill in both instruments after 6 weeks. RESULTS: Face validity and content validity were assessed by patients and an expert group, and judged as good. Criterion validity was calculated with correlation between CWIS and SF-36, reaching moderate to high values. Reliability of the three domains of the CWIS measured with internal consistency and test-retest stability was acceptable to excellent. Internal responsiveness was assessed with standardised response mean and showed moderate to high sensitivity. CONCLUSIONS: This study concludes that the Swedish version of CWIS is a valid and reliable tool for measuring health-related quality of life in patients with acute and hard-to-heal wounds.

Patients' experience of advanced wound treatment-a qualitative study.

INTRODUCTION: Each patient experiences wound treatment differently, and it is important to enhance the knowledge of the impact of the treatment to be able to individualize patient care. METHODS: This descriptive qualitative study aims to describe the experience of patients with wounds treated with advanced moist wound therapy (AMWT) and negative pressure wound therapy (NPWT). Data were collected from 15 diaries written by patients during their treatment, and analyzed with content analysis. RESULTS: The results identified an overall theme of "threat to normality," and 3 subcategories including "impact on daily life," "manageability," and "powerlessness." CONCLUSION: While there were many similarities in the descriptions of the patients in the 2 groups, there also were unique features for each treatment group. For patients treated with AMWT, the main concern was pain. For patients treated with NPWT, the main concern was the optimal functioning of the machine. Patients undergoing wound treatment have different focuses, concerns, and needs related to treatment modality. It is important for health care personnel to carry this in mind to be able to individualize patient care. .

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UNLABELLED:  The aim of this retrospective study was to identify risk factors related to unsuccessful treatment and complications with negative pressure wound therapy (NPWT). METHODS: A consecutive series of patients treated with NPWT for wounds of various etiologies (n = 87) from 2005-2007 at a general hospital in a large city (Stockholm, Sweden) were assessed for risk for unsuccessful treatment and complications associated with NPWT. RESULTS: Twenty-nine percent of the patients treated with NPWT had unsuccessful treatment results. The strongest risk factors associated with unsuccessful treatment were pressure ulcers (OR 4.6) or a positive culture for Staphylococci (OR 3.4). The complication rate was 21%, of which 14 patients had to terminate treatment. A positive culture for either Staphylococci or Pseudomonas was strongly associated (P = 0.001) with risk of complications during NPWT treatment. Patients with insufficient peripheral circulation in the extremities had a risk of both unsuccessful treatment and complications. CONCLUSION: The findings of the present study stress the importance of evaluating bacterial cultures and adequate antibiotic therapy when infection is suspected. The status of the patient's peripheral macrocirculation in the lower extremities seems to have a significant impact on the risk of unsuccessful treatment or complications. Therefore, is it of great importance to evaluate peripheral circulation status before initializing NPWT. .

Negative pressure wound therapy - a descriptive study.

 To address a persistent lack of evidence regarding the clinical outcomes of negative pressure wound therapy (NPWT) and identify which patient groups are most likely to benefit from NPWT, a retrospective, descriptive study was conducted to describe outcomes of this treatment modality when used in clinical practice. Charts from a consecutive series of 87 patients (median age 68 years, range 16 - 92 years) who received NPWT during a period of 24 months were abstracted to a statistical software file. Patient demographics, history, and comorbidity variables as well as treatment outcomes were obtained from the computerized in- and outpatient record system. Treatment outcomes were grouped as successful (goal of care was met) or not successful (goal of care was not met). Successful treatment was noted for a total of 62 patients (71%) with a median treatment time of 17 days. The proportion of patients with a successful outcome was significantly higher in patients with infectious, postoperative, and traumatic wounds than in patients with wounds related to peripheral vascular disease or pressure ulcers (P = 0.001). Treatment complications were observed in 18 patients (21%); five were related to infection. Quality-of-life concerns were noted as a reason for stopping treatment in four patients and equipment problems were recorded for two patients receiving NPWT in the home. This study confirms previous re- search that NPWT may be an effective and safe treatment method for acute wounds but further studies are needed to evaluate treatment efficacy and effectiveness in patients with peripheral vascular disease or pressure-induced wounds. Results also suggest that research protocols should include patient quality-of-life outcomes.

High prevalence of an active cytomegalovirus infection in the appendix of immunocompetent patients with acute appendicitis.

BACKGROUND: Appendicitis is a very common surgical diagnosis with unclear pathology. Human cytomegalovirus (HCMV) can modulate our immune system and has been associated with inflammatory bowel disease (IBD) and various other inflammatory diseases. METHODS: We investigated the association between HCMV and acute appendicitis in 14 immunocompetent patients. Tissue sections from 10 AIDS patients with verified HCMV infection were used as positive controls, and uninflamed intestinal tissue sections from 12 patients were used as negative controls. RESULTS: Cells double positive for HCMV early antigens and IL-6/IL-8 were observed in the appendices of 64.3% of appendicitis patients (9 of 14) by immunohistochemical analysis. HCMV late antigen was found in the appendices of 42.9% of the acute appendicitis patients (6 of 14). Latent HCMV appendix infection, as verified by in situ hybridization, as well as HCMV IgG, was observed in 78.6% of patients (11 of 14). The study samples from all 6 healthy appendices were negative for HCMV early and late antigens, although 50% (3 of 6) were HCMV IgG and HCMV DNA positive. CONCLUSIONS: We have shown that HCMV infection of the appendix is associated with acute appendicitis (P = 0.002) and possibly with the severity of the disease. Our study identified HCMV as a pathogen to be sought for in the appendicitis patient group, possibly allowing further medical treatment of these patients.

Pancreatic cancer in sweden 1980-2000: a population-based study of hospitalized patients concerning time trends in curative surgery and other interventional therapies.

Progress has been made during the last few decades in the treatment of patients with pancreatic cancer. In this population-based study, the time trends in curative surgery and the choice of palliative invasive therapies in Sweden over two decades are analyzed. Patients treated for pancreatic carcinoma in Sweden during 1980-2000 were identified in the Swedish Hospital Discharge Register and the Cancer Register. These data were matched with those in the Register of Causes of Death in Sweden. Data were identified and analyzed for 16,758 patients for three periods: 1980-1986 (n = 5775), 1987-1993 (n = 6096), and 1994-2000 (n = 4887). The rate of pancreatic resection increased 7.2%, 10.9%, and 15.1% (P < 0.0001) during the three respective periods. Palliative interventions decreased from 46.8% in the first period to 41.7% in the last period. On comparing the first and the last periods, biliary bypass operations were found to decrease (from 45.9% to 18.1%), as well as gastric bypass procedures (from 33.8% to 22.8%; P < 0.0001). Interventions by percutaneous transhepatic cholangiography (PTC) remained constant (10%-11%). Endoscopic therapy increased from 10.8% to 49.0%, as did the number of procedures per patient, from 1.3 to 1.7 (P < 0.0001) in the first and last periods, respectively. In 1980, the mean hospital stay was 40 days after resection and 30 days after palliative intervention. In 2000, the corresponding numbers were 26 days and 18 days (P < 0.001), respectively. During the past two decades, the rate of pancreatic resections in Sweden increased significantly. There was also a dramatic drop in palliative open surgery and a simultaneous increase in endoscopic interventions. Hospital stays decreased by more than a third.

Evidence of active cytomegalovirus infection and increased production of IL-6 in tissue specimens obtained from patients with inflammatory bowel diseases.

Recent reports have focused interest on human cytomegalovirus (HCMV) in inflammatory bowel diseases (IBD). Our aim in this study was to examine the frequency of HCMV-infected intestinal cells in tissue sections obtained from patients with IBD, and to investigate if HCMV-infected intestinal cells produce the proinflammatory cytokine IL-6. We studied intestinal tissue sections from 13 patients with ulcerative colitis, 10 with Crohn's disease, 10 cancer patients without intestinal inflammation, and 10 samples from HCMV-infected AIDS patients. HCMV-DNA was detected by in situ hybridization in sections obtained from 12/13 patients with ulcerative colitis, in 10 with Crohn's disease, in 10/10 samples from HCMV-infected AIDS patients, but not in any of the 10 samples that were obtained from uninflamed tissues. HCMV-specific antigens were detected in samples from all HCMV-infected AIDS patients, in 11/13 sections from patients with ulcerative colitis, in 10/10 samples from patients with Crohn's disease, but not in sections from uninflamed tissues. Cells were double positive for an HCMV early antigen and IL-6 in 10/13 sections from patients with ulcerative colitis, in all patients with Crohn's disease, and in 4/10 samples from AIDS patients. In conclusion, these results suggest that active HCMV infection in the intestine is very frequent in patients with IBD, and may contribute to the inflammatory process through an increased production of IL-6.

[Injuries and mortality in motorcycle and moped accidents in Sweden 1987-1994. Advanced age and male sex are risk factors of fatal moped and motorcycle accidents]. / Skador och mortalitet vid MC- och mopedolyckor i sverige 1987-1994. Hög ålder och manligt kön riskfaktorer för död i moped- och mc-olyckor.

Data from the Swedish Hospital Discharge Registry were analysed, years 1987-1994 inclusive. The registry includes all living patients admitted to Swedish hospitals. Patients admitted after moped or motor-cycle accidents were studied. A total of 4,716 mopedists and 8,927 motor-cycle riders were admitted in the given time frame. The median age of mopedists was 16 and that of motor-cycle riders 22 years. 85% of mopedists were male, while 95% of motor-cycle drivers and 55% of motor-cycle passengers were male. The injury distribution in both groups was quite similar with fractures and cerebral concussion dominating, although fractures of the arm and vertebrae were considerably more common in motor-cycle riders. The incidence of hospital admission after accidents did not change over time in mopedists, but decreased in motorcyclists. Accidents involving both types of vehicles occurred more commonly in the countryside. High age and male sex was associated with increased mortality in mopedists, while high age and being a passenger was associated with higher death rates in admitted motor-cyclists.

Injured moped riders who required admission to hospital in Sweden from 1987 to 1994.

OBJECTIVES: To find out the incidence, extent of injury, medical consequences, and mortality rate of moped riders involved in crashes in Sweden. DESIGN: Retrospective case study. SETTING: The Swedish Hospital Discharge Register (SHDR). SUBJECTS: 4716 moped riders, a total of 5857 admissions to Swedish hospitals from 1987-94. INTERVENTIONS: Statistical analysis of the Register. MAIN OUTCOME MEASURES: Incidence of injured moped riders in Sweden, mortality rate, types of injuries, and medical consequences. RESULTS: From 1987 to 1994, Swedish hospitals admitted 4716 moped riders (5857 admissions) injured in crashes, which corresponds to a mean of 8.5 injured/100 000 population a year. Of these 3993 were male (85%) and 723 female (15%), with a median age of 16 years (range 3-93). Twenty-four percent of those admitted to hospital spent more than a week there. The annual number of injured moped riders did not change significantly during this period. The total number of deaths in hospital was 59 (1%). Among those who died in hospital, 32 (54%) had head injuries, 16 (27%) fractures, and 5 (9%) abdominal or thoracic injuries. CONCLUSION: The number of injured moped riders in Sweden is low. Fractures of the extremities were most common, followed by injuries to the head and brain. The usual victim was a teenager or young man. Of the patients treated in hospital few died, most of whom were elderly men.

Injuries in 8927 patients admitted after motor-cycle crashes in Sweden 1987-1994 inclusive.

OBJECTIVE: To discover morbidity and mortality rates after motor-cycle crashes on the national level in Sweden. DESIGN: Retrospective study. SETTING: Teaching hospital, Sweden. INTERVENTIONS: Extraction of data from International Classification of Diseases (ICD) codes E819C (motor-cycle drivers) and E819D (motor-cycle passengers) recorded in the Swedish Hospital Discharge Register (SHDR) between 1987 and 1994. MAIN OUTCOME MEASURES: Injury distribution, medical consequences, mortality, survival, and incidence by age, sex and geographical area. RESULTS: The number of people admitted to hospital after motor-cycle crashes decreased significantly during the period (from 1743 in 1987 to 1258 in 1994, p < 0.001). The most frequent injuries among drivers and passengers alike were fractures of the legs, arms, and vertebrae, followed by injuries to the head and brain. The in-hospital mortality was lower among drivers (n = 172, 2.2%) than among passengers (n = 31,3.3%). CONCLUSION: The incidence of injuries after motor-cyclist crashes decreased during the study period. The most common victims were young men with fractures and brain injuries. Those at most risk of dying were older passengers.