manuscript.Rmd

---
title: "Manuscript title here"
output: html_document
author: "Your name here"
bibliography: bibliography.bib
csl: vancouver.csl
---

```{r setup, include=FALSE}
knitr::opts_chunk$set(echo = TRUE)
```

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<!-- Structure and most comments are from the Strengthening the
reporting of observational studies in epidemiology (STROBE) statement,
see https://www.strobe-statement.org/. For more explanations see the
paper Strengthening the Reporting of Observational Studies in
Epidemiology (STROBE):explanation and elaboration.  -->

<!-- Indicate the study’s design with a commonly used term in the
title, for example: "Associations between resuscitation interventions
and opportunities for improvement in adult trauma patients: A cohort
study" -->

Abstract
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<!-- Provide in the abstract an informative and balanced summary of
what was done and what was found. Not more than 300 words. -->

Background
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Methods
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Results
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Conclusion
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Introduction
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investigation being reported. End by stating the aim or specific
objectives, including any prespecified hypotheses. The introduction
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Injury is still a major cause of death around the world, taking the lives of around 4,4 million people each year, almost 8% of all deaths [@World_Health_Organization_2021]. In the United States, trauma is the 4th leading cause of death among the general population and the leading cause for people between the ages of 1 and 44 [@AAST_2020]. It is also an important cause hospitalization and morbitidity among all age groups, including seniors, and are responsible for an estimated 10% of all years lived with a disability globally [@connolly_woo_lampron_perry_2018] [@World_Health_Organization_2021]. To combat this, dedicated trauma centers exist that have been shown to lower mortality but also improve functional outcome in trauma patients [@Nirula_Brasel_2006].

Trauma teams are multidisciplinary and operate in these centers. They consist of individuals from the specialities of emergency medicine, surgery, intensive care, nursing and support staff and are lead by a team leader. Their aim is to rapidly assess and stabilise the patient, prioritise their injuries and arrange for site of definitive care. Emergency physicians are often the personnel activating the trauma code using anatomical and physiological criterias, mechanism of injury and information obtained from emergency service personnel.

Trauma patients brought to trauma centers may receive immediate or delayed treatment depending on what protocols are present at the facility and how they are being followed [@ryb2012delayed]. In the case of a delayed trauma team activation (DTTA) it can often be attributed to insensitivity in triage protocol and failure to recognize injury patterns [@Hoyt_Hollingsworth-Fridlund_Winchell_Simons_Holbrook_Fortiage_1994]. Studies have also shown that different factors such as age over 55, nonwhite ethnicity, blunt assault among others was linked to a higher risk of DTTA [@ryb2012delayed].

This study will assess delayed treatment at the Karolinska University Hospital in Solna between the years 2012 and 2022 through the trauma registry and trauma care quality databse. Our objectives are to analyse how different factors are associated with delayed treatment in patients.




Methods 
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Study design
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This is a registry based cohort study using data from the trauma registry and trauma care quality database at the Karolinska University Hospital in Solna. The trauma registry includes about 12000 patients treated between 2012 and 2022. The trauma care quality database is a subset of the trauma registry and includes about 6000 patients selected for review between 2014 and 2022. The outcome is delayed treatment, as identified by the multidisciplinary review board and recorded in the trauma care quality database. This project will link the two databases and assess how different patient level factors, such as age, sex, mechanism of injury, and injury severity, are associated with delayed treatment using logistic regression. A 5% significance level and 95% confidence levels will be used.

Setting
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periods of recruitment, exposure, follow-up, and data collection -->

Participants
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methods of selection of participants. Describe methods of
follow-up. For matched studies, give matching criteria and number of
exposed and unexposed -->

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sources and + methods of case ascertainment and control
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controls. For matched studies, give matching criteria and the number
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sources and methods of selection of participants -->

Variables and data sources/measurements
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confounders, and effect modifiers. Give diagnostic criteria, if
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Bias 
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Study size 
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Quantitative variables
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analyses. If applicable, describe which groupings were chosen and why
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Statistical methods
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for confounding

(b) Describe any methods used to examine subgroups and interactions

(c) Explain how missing data were addressed 

(d) 

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Case-control study:If applicable, explain how matching of cases and
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-->

Results
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<!-- 

Participants
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(a) Report numbers of individuals at each stage of study—eg numbers
potentially eligible, examined for eligibility, confirmed eligible,
included in the study, completing follow-up, and analysed

(b) Give reasons for non-participation at each stage

(c) Consider use of a flow diagram

Descriptive data
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clinical, social) and information on exposures and potential
confounders

(b) Indicate number of participants with missing data for each
variable of interest

(c) Cohort study — Summarise follow-up time (eg, average and total
amount)

Outcome data
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over time

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summary measures of exposure

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measures

Main results
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Other analyses 
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and sensitivity analyses 
-->

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Discussion
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<!--

Key results
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Limitations
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Discuss limitations of the study, taking into account sources of
potential bias or imprecision.  Discuss both direction and magnitude
of any potential bias

Interpretation
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Generalisability
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-->

Conclusion
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References
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