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)
```

<!-- This is an R Markdown document. Markdown is a simple formatting
syntax for authoring HTML, PDF, and MS Word documents. For more
details on using R Markdown see http://rmarkdown.rstudio.com -->

<!-- This is a comment and will not be present in the compiled
document. Try "knitting" this document by clicking the knit button up
to the left, or by running `rmarkdown::render("manuscript.Rmd")` in
the console and you should only see headings -->

<!-- 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
========

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

Background
----------

Methods
-------

Results
-------

Conclusion
----------

Introduction
============

Trauma is a global issue affecting millions of people every year worldwide<!-- Cite the latest global burden of disease study -->. The exact numbers differ due to different methods of gathering data, and data availability<!-- Adequate comment, and something you can elaborate on in the KI version. You don't need it here in the manuscript--> Worldwide, somewhere between 4-6 million people die every year due to trauma, and around 40 million get permanently injured and 100 million people get temporarily injured each year (cite). In Sweden, during 2023, 5221 people died due to trauma (cite socialstyrelsen). 

The level of care a trauma patient receive can differ between hospitals, regions and countries. The level of care can differ according to severity of injury, but also according to local regulations, space and economical concerns. Level of care can be categorized according to five categories in order of most care to least care, emergency department, general ward, operating theatre, high dependency unit and critical care unit<!-- This is the way to categorise level of in-hospital care that you will use, but it makes sense to also discuss other ways to define level of care in your KI paper-->. Depending on the severity of the injury each patient supposedly ends up in a higher care level. A higher care level equals more doctors, nurses and staff, as well as access to more complex machinery. However, it also equals a higher cost, and a larger drain of resources. 

In this paper we aim to assess the association between level of care and opportunities for improvement among adult trauma patients. Opportunities for improvement can be categorized as factors affecting morbidity and mortality<!-- I would introduce opportunities for improvement earlier, perhaps as its own paragraph-->. We will also discuss whether patients end up in the right care level according to the severity of their injuries, or if they end up in a potentially higher care level then required, thus costing money and resources. 


<!-- Explain the scientific background and rationale for the
investigation being reported. End by stating the aim or specific
objectives, including any prespecified hypotheses. The introduction
should not be longer than 1-1.5 pages, typically 4-5 paragraphs, each
6-8 lines long. Support every statement with a citation -->

This is some random text.

You can cite document here like this [@exampleKey9999]. Open the file
bibliography.bib to learn more.

Methods 
=======

We will use the patient data register at Karolinska institute trauma center from 2013-2023, thus making a single center retrospective cohort study. We will search for opportunities that improve mortality and morbidity in regard to care level. 


Study design
------------

<!-- Present key elements of study design -->

Setting
-------

<!-- Describe the setting, locations, and relevant dates, including
periods of recruitment, exposure, follow-up, and data collection -->

Participants
------------

<!-- Cohort study: Give the eligibility criteria, and the sources and
methods of selection of participants. Describe methods of
follow-up. For matched studies, give matching criteria and number of
exposed and unexposed -->

<!-- Case-control study: Give the eligibility criteria, and the
sources and + methods of case ascertainment and control
selection. Give the rationale for the choice of cases and
controls. For matched studies, give matching criteria and the number
of controls per case -->

<!-- Cross-sectional study: Give the eligibility criteria, and the
sources and methods of selection of participants -->

Variables and data sources/measurements
---------------------------------------

<!-- Clearly define all outcomes, exposures, predictors, potential
confounders, and effect modifiers. Give diagnostic criteria, if
applicable. For each variable of interest, give sources of data and
details of methods of assessment (measurement). Describe comparability
of assessment methods if there is more than one group -->

Bias 
----

<!-- Describe any efforts to address potential sources of bias -->

Study size 
----------

<!-- Explain how the study size was arrived at -->

Quantitative variables
----------------------

<!-- Explain how quantitative variables were handled in the
analyses. If applicable, describe which groupings were chosen and why
-->

Statistical methods
-------------------

<!-- 

(a) Describe all statistical methods, including those used to control
for confounding

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

(c) Explain how missing data were addressed 

(d) 

Cohort study: If applicable, explain how loss to follow-up was addressed 

Case-control study:If applicable, explain how matching of cases and
controls was addressed

Cross-sectional study: If applicable, describe analytical methods
taking account of sampling strategy

(e) Describe any sensitivity analyses
-->

Results
=======

<!-- 

Participants
------------

(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
----------------

(a) Give characteristics of study participants (eg demographic,
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
------------

Cohort study — Report numbers of outcome events or summary measures
over time

Case-control study — Report numbers in each exposure category, or
summary measures of exposure

Cross-sectional study — Report numbers of outcome events or summary
measures

Main results
------------

(a) Give unadjusted estimates and, if applicable, confounder-adjusted
estimates and their precision (eg, 95% confidence interval). Make
clear which confounders were adjusted for and why they were included

(b) Report category boundaries when continuous variables were
categorized

(c) If relevant, consider translating estimates of relative risk into
absolute risk for a meaningful time period

Other analyses 
--------------

Report other analyses done—eg analyses of subgroups and interactions,
and sensitivity analyses 
-->

You can include code in this document like this:

```{r main, echo=FALSE}
source("main.R") ## This "imports" the main script file of your project and run any code in it
```

You can also embed plots:

```{r plot, echo=FALSE}
plot(pressure)
```

You can also mix text and code, so called inline code, like this: `r 2+5`.

Discussion
==========

<!--

Key results
-----------
Summarise key results with reference to study objectives

Limitations
-----------

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

Interpretation
--------------

Give a cautious overall interpretation of results considering
objectives, limitations, multiplicity of analyses, results from
similar studies, and other relevant evidence

Generalisability
----------------

Discuss the generalisability (external validity) of the study results

-->

Conclusion
==========

<!-- Give a short conclusion, corresponding to the aim -->

References
==========

<!-- Do not edit by hand, references will be inserted and formatted automatically once you knit this document -->