Introduction and aimThe Spanish flu reached Sweden in June 1918, and at least one-third of the population (then 5.8 million) became infected. Some 34,500 persons (5.9 per 1,000 people) died from influenza during the first year of the pandemic (when acute pneumonia is included, the number of deaths rose to 7.1 per 1,000 people). In this historical look back at the pandemic, our aim was to review the epidemiological impact on the Swedish county of Uppsala, the clinical outcomes and the economic impact on the regional hospital; a relevant backgound to consider the impact of a future virulent pandemic. We also focused on how the pandemic was perceived by the medical community and by health care authorities.MethodsHealth care reports, statistics, daily newspapers, medical journals, and records of patients treated for influenza at the Uppsala Academic Hospital from July 1918 to June 1919 were included in our review.ResultsAn influenza related mortality rate of 693 persons (5.1 per 1,000 people) was reported in the Uppsala region from 1918–1919; from July 1918 to June 1919, 384 patients were treated for influenza at the Uppsala Academic Hospital. The first wave peaked in November 1918 with case fatality rates up to 30%; a second wave peaked in April 1919 with a lower rate of mortality. Of the patients treated, a total of 66 died. Of these, 60% were 20–29 years of age, and 85% were less than 40 years old. Autopsy reports revealed pneumonia in 89% of the cases; among these, 47% were hemorrhagic, 18% were bilateral, and 45% had additional extrapulmonary organ involvement. Signs of severe viral disease were documented, but secondary bacterial disease was the primary cause of death in the majority of cases.ConclusionThe epidemiologic and pathologic results were in accordance with other publications of this time period. The costs of running the hospital doubled from 1917 to 1920 and then reversed by 45%. Today, an influenza pandemic of the same virulence would paralyze health care systems and result in extremely high financial costs and rates of mortality.

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Background and purpose: Trauma causes over 4 million annual deaths globally and accounts for over 10% of the global burden of disease. Trauma patients often sustain multiple injuries in multiple organ systems. We aimed to investigate the proportion and distribution of musculoskeletal injuries in adult trauma patients.Patients and methods: This is a register-based study using data from the national Swedish trauma register (SweTrau) collected in 2015–2019. By categorizing Abbreviated Injury Scale (AIS) codes into different injury types, we provide a detailed description of the types of musculoskeletal injuries that occurred in trauma patients.Results: 51,335 cases were identified in the register. After exclusion of 7,696 cases that did not have any trauma diagnosis (AIS codes) registered from the trauma and 6,373 patients aged < 18, a total of 37,266 patients were included in the study. 15,246 (41%) had sustained musculoskeletal injury. Of the patients with musculoskeletal injuries, 7,733 (51%) had more than 1 such injury. Spine injuries were the most common injury location (n = 7,083 patients, 19%) followed by lower extremity injuries (n = 5,943 patients, 16%) and upper extremity injuries (n = 6,273 patients, 17%). Fractures were the dominating injury type with 30,755 (87%) of injuries being a fracture.Conclusion: 41% of the trauma patients had at least 1 musculoskeletal injury. A spine injury was the most common injury location. Fractures was the dominating injury type constituting 87% of all injuries. We also found that half the patients (51%) with spine or extremity injuries had ≥ 2 such injuries.

Purpose Trauma causes over 4 million annual deaths globally and accounts for over 10 % of the global burden of disease. Trauma patients often sustain multiple injuries in multiple organ systems. This study aims to investigate the incidence of orthopaedic injuries in adult trauma patients.MethodsThe study was a register-based study using data from the national Swedish trauma register – SweTrau. The inclusion criteria for the register are all patients with a trauma that activated the trauma team at the admitting hospital, or patients admitted without trauma team activation but with NISS (New Injury Severity Score) >15. By categorizing Abbreviated Injury Scale (AIS) codes into different orthopaedic injury types, we provided a detailed description of what types of orthopaedic injuries that occurred in trauma patients.ResultsA total of 37266 patients were included in the study. A total of 15246 (40%) patients had sustained any orthopaedic injury, and 7733 (51%) patients had more than one orthopaedic injury. Spine injuries were the most common type of injury affecting 19% (n= 7083) of all trauma patients, followed by injuries of the upper extremities (n=6273, 17%) and lower extremities (n=5943, 16%). Fractures were the domination type of orthopaedic injury (n=30755, 87%). Traffic injury was the most common injury mechanism with almost half (n= 18112, 49%) of the patients being admitted after some sort of traffic related incidentConclusionOrthopaedic injuries are common in trauma and occur in 40% of trauma patients. Slightly more than half of the patients with orthopaedic injury had ≥2 orthopaedic injuries.