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Sjöberg, Folke
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Larsson Viksten, J., Engerström, L., Steinvall, I., Samuelsson, A., Fredrikson, M., Walther, S. & Sjöberg, F. (2019). Children aged 0-16 admitted to Swedish intensive care units and paediatric intensive care units showed low mortality rates.. Acta Paediatrica, 108(8), 1460-1466
Open this publication in new window or tab >>Children aged 0-16 admitted to Swedish intensive care units and paediatric intensive care units showed low mortality rates.
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2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 8, p. 1460-1466Article in journal (Refereed) Published
Abstract [en]

AIM: This study described the basic characteristics of children aged 0-16 years who were treated in intensive care units (ICUs) and paediatric ICUs (PICUs), compared their outcomes and examined any causes of death.

METHODS: This was a retrospective cohort study of admissions to 74 ICUs and three PICUs in Sweden that were recorded in the Swedish Intensive Care Registry from January 1, 2008 to December 31, 2012.

RESULTS: We retrieved data on 12 756 children who were admitted 17 003 times. The case mix differed between the ICUs, which were mainly admissions for injuries, accidents and observation, and PICUs, which were mainly admissions for malformations, genetic abnormalities and respiratory problems (p < 0.001). The median stays in the ICUs and PICUs were 1.4 and 3.5 days (p < 0.001), respectively. The respective crude mortality rates were 1.1% and 2.0, and the Paediatric Index of Mortality version 2 standardised mortality ratios were 0.43 and 0.50. None of these differences were significant. Most deaths were within 24 hours: About 57% in the ICUs, mainly from brain anomalies, and 13% in the PICUs, mainly from circulatory problems.

CONCLUSION: Sweden had a low mortality rate in both ICUs and PICUs and the children admitted to these two types of unit differed.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
Child mortality, Demographics, Intensive care unit, Length of stay, Paediatric intensive care unit
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-154075 (URN)10.1111/apa.14708 (DOI)000474935600016 ()30582755 (PubMedID)
Funder
Region Östergötland
Note

Funding agencies: Region Ostergotland and Linkoping University

Available from: 2019-01-29 Created: 2019-01-29 Last updated: 2019-07-30
Larsen, R., Bäckström, D., Fredrikson, M., Steinvall, I., Rolf, G. & Sjöberg, F. (2019). Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27(1), Article ID 24.
Open this publication in new window or tab >>Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study
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2019 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, no 1, article id 24Article in journal (Refereed) Published
Abstract [en]

Background: A female survival advantage after injury has been observed, and animal models of trauma have suggested either hormonal or genetic mechanisms as component causes. Our aim was to compare age and riskadjusted sex-related mortality in hospital for the three most common mechanisms of injury in relation to hormonal effects as seen by age.

Methods: All hospital admissions for injury in Sweden during the period 2001–2011 were retrieved from the National Patient Registry and linked to the Cause of Death Registry. The International Classification of Diseases Injury Severity Score (ICISS) was used to adjust for injury severity, and the Charlson Comorbidity Index to adjust for comorbidity. Age categories (0–14, 15–50, and ≥ 51 years) were used to represent pre-menarche, reproductive and post- menopausal women.

Results: Women had overall a survival benefit (OR 0.51; 95% CI 0.50 to 0.53) after adjustment for injury severity and comorbidity. A similar pattern was seen across the age categories (0–14 years OR 0.56 (95% CI 0.25 to 1.25), 15–50 years OR 0.70 (95% CI 0.57 to 0.87), and ≥ 51 years OR 0.49 (95% CI 0.48 to 0.51)).

Conclusion: In this 11-year population-based study we found no support for an oestrogen-related mechanism to explain the survival advantage for females compared to males following hospitalisation for injury.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Risk-adjusted mortality; ICISS; Trauma; injury; Nationwide; Epidemiological
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-155087 (URN)10.1186/s13049-019-0597-3 (DOI)000461309000001 ()30871611 (PubMedID)
Note

Funding agencies: Linkoping University, Linkoping, Sweden; Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns

Available from: 2019-03-15 Created: 2019-03-15 Last updated: 2019-04-17Bibliographically approved
Elmasry, M., Mirdell, R., Tesselaar, E., Farnebo, S., Sjöberg, F. & Steinvall, I. (2019). Laser speckle contrast imaging in children with scalds: Its influence on timing of intervention, duration of healing and care, and costs. Burns, 45(4), 798-804
Open this publication in new window or tab >>Laser speckle contrast imaging in children with scalds: Its influence on timing of intervention, duration of healing and care, and costs
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2019 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 4, p. 798-804Article in journal (Refereed) Published
Abstract [sv]

Background

Scalds are the most common type of burn injury in children, and the initial evaluation of burn depth is a problem. Early identification of deep dermal areas that need excision and grafting would save unnecessary visits and stays in hospital. Laser speckle contrast imaging (LSCI) shows promise for the evaluation of this type of burn. The aim of this study was to find out whether perfusion measured with LSCI has an influence on the decision for operation, duration of healing and care period, and costs, in children with scalds.

Methods

We studied a group of children with scalds whose wounds were evaluated with LSCI on day 3–4 after injury during the period 2012–2015. Regression (adjustment for percentage total body surface area burned (TBSA%), age, and sex) was used to analyse the significance of associations between degree of perfusion and clinical outcome.

Results

We studied 33 children with a mean TBSA% of 6.0 (95% CI 4.4–7.7)%. Lower perfusion values were associated with operation (area under the receiver-operating characteristic curve 0.86, 95% CI 0.73–1.00). The perfusion cut-off with 100% specificity for not undergoing an operation was ≥191 PU units (66.7% sensitivity and 72.7% accurately classified). Multivariable analyses showed that perfusion was independently associated with duration of healing and care period.

Conclusion

Lower perfusion values, as measured with LSCI, are associated with longer healing time and longer care period. By earlier identification of burns that will be operated, perfusion measurements may further decrease the duration of care of burns in children with scalds.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Laser speckle contrast imaging; Burns; Scalds; Perfusion; Outcome; Children
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-154872 (URN)10.1016/j.burns.2019.02.001 (DOI)000467914900006 ()30827850 (PubMedID)2-s2.0-85062153561 (Scopus ID)
Note

Funding agencies: Linkoping University, Linkoping, Sweden; Burn Centre, Department of Hand Surgery, Plastic Surgery, and Burns

Available from: 2019-03-02 Created: 2019-03-02 Last updated: 2019-07-01Bibliographically approved
Abdelrahman, I., Steinvall, I., Elmasry, M. & Sjöberg, F. (2019). Lidocaine infusion has a 25% opioid-sparing effect on background pain after burns: A prospective, randomised, double-blind, controlled trial. Burns
Open this publication in new window or tab >>Lidocaine infusion has a 25% opioid-sparing effect on background pain after burns: A prospective, randomised, double-blind, controlled trial
2019 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409Article in journal (Refereed) In press
Abstract [en]

Background

The pain of a burn mainly results from the inflammatory cascade that is induced by the injured tissue, and is classified as background, breakthrough, procedural and postoperative pain. High doses of opioids are usually needed to treat background pain, so its management includes a combination of types of analgesia to reduce the side effects. Lidocaine given intravenously has been shown in two small, uncontrolled studies to have an appreciable effect on pain after burns.

Objectives

In this prospective double-blind controlled trial we aimed to examine and quantify the opioid-sparing effect of a continuous infusion of lidocaine for the treatment of background pain during the early period after a burn.

Methods

Adult patients injured with burns of >10 total body surface area burned (TBSA%) and treated with a morphine based patient-controlled analgesia device (PCA) were randomised to have either lidocaine infusion starting with a bolus dose (1 mg lidocaine/kg) followed by continuous infusion (180 mg lidocaine/hour) or a placebo infusion, for seven consecutive days. Total daily consumption of opioids (mg) and amount of pain (visual analogue score, VAS) were recorded.

Results

We included 19 patients, 10 of whom were given a lidocaine infusion. There were no differences between groups in VAS, TBSA%, time of enrolment to the study since the initial burn, or duration of hospital stay. The opioid consumption in the lidocaine group declined by roughly 25% during the period of the study.

Conclusion

An intravenous infusion of lidocaine was safe and had an opioid-sparing effect when treating background pain in burns.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Lidocaine infusion, Background pain, Burns, Opioid sparing effect, Randomized controlled trial
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-160128 (URN)10.1016/j.burns.2019.08.010 (DOI)31493952 (PubMedID)
Available from: 2019-09-06 Created: 2019-09-06 Last updated: 2019-09-11Bibliographically approved
Grossmann, B., Nilsson, A., Sjöberg, F. & Nilsson, L. (2019). Rectal ketamine during paediatric burn wound dressing procedures: a randomised dose-finding study. Burns, 45(5), 1081-1088
Open this publication in new window or tab >>Rectal ketamine during paediatric burn wound dressing procedures: a randomised dose-finding study
2019 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 5, p. 1081-1088Article in journal (Refereed) Published
Abstract [en]

Background

Worldwide, ketamine is used during paediatric procedures, but no recommendations are available regarding a suitable dose for rectal administration during procedures involving high levels of pain and/or anxiety such as burn wound dressing change.

Methods

We evaluated three different single doses of rectally administered racemic ketamine mixed with a fixed dose of 0.5 mg/kg of midazolam. In total, 90 children – aged 6 months to 4 years – were randomised 1:1:1 to receive 4 mg/kg (K-4 group), 6 mg/kg (K-6 group) or 8 mg/kg (K-8 group) of racemic ketamine for a maximum of three consecutive procedures. Primary outcome measure was procedural pain evaluated by Face, Legs, Activity, Cry, Consolability (FLACC) behavioural scale. Secondary outcome included feasibility and recovery time. Patient safety was evaluated using surrogate outcomes.

Results

In total, 201 procedures in 90 children aged 19 ± 8 months were completed. The median maximum pain was FLACC 0 in all groups (p = 0.141). The feasibility was better for groups K-6 (p = 0.049) and K-8 (p = 0.027) compared with K-4, and the mean recovery time was the longest for group K-8 (36 ± 22 min) compared with groups K-4 (25 ± 15 min; p = 0.003) and K-6 (27 ± 20 min; p = 0.025). Median maximum sedation measured by the University of Michigan Sedation Scale (UMSS) was higher in group K-8 compared with group K-4 (p < 0.0001) and K-6 (p = 0.023). One child in group K-8 had a study drug-related serious adverse event — laryngospasm/airway obstruction. No rescue analgosedative medication was administered for group K-6.

Conclusions

A rectally administered mixture of racemic ketamine (6 mg/kg) and midazolam (0.5 mg/kg) during paediatric burn dressing procedures with a duration of approximately 30 min provides optimal conditions regarding pain relief, feasibility, recovery time and patient safety, with no need for rescue analgosedative medication.

Place, publisher, year, edition, pages
Pergamon Press, 2019
National Category
Anesthesiology and Intensive Care Public Health, Global Health, Social Medicine and Epidemiology Surgery
Identifiers
urn:nbn:se:liu:diva-156837 (URN)10.1016/j.burns.2018.12.012 (DOI)000470856100010 ()31060760 (PubMedID)2-s2.0-85065014700 (Scopus ID)
Note

Funding agencies: County Council of Ostergotland, Sweden

Available from: 2019-05-14 Created: 2019-05-14 Last updated: 2019-07-15Bibliographically approved
Samuelsson, L., Tydén, J., Herwald, H., Hultin, M., Walldén, J., Steinvall, I., . . . Johansson, J. (2019). Renal clearance of heparin-binding protein and elimination during renal replacement therapy: Studies in ICU patients and healthy volunteers. PLoS ONE, 14(8), Article ID e0221813.
Open this publication in new window or tab >>Renal clearance of heparin-binding protein and elimination during renal replacement therapy: Studies in ICU patients and healthy volunteers
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 8, article id e0221813Article in journal (Refereed) Published
Abstract [en]

Background: Heparin-binding protein (HBP) is released by neutrophils upon activation, and elevated plasma levels are seen in inflammatory states like sepsis, shock, cardiac arrest, and burns. However, little is known about the elimination of HBP. We wanted to study renal clearance of HBP in healthy individuals and in burn patients in intensive care units (ICUs). We also wished to examine the levels of HBP in the effluent of renal replacement circuits in ICU patients undergoing continuous renal replacement therapy (CRRT).less thanbr /greater thanMethods: We measured plasma and urine levels of HBP and urine flow rate in 8 healthy individuals and 20 patients in a burn ICU. In 32 patients on CRRT, we measured levels of HBP in plasma and in the effluent of the CRRT circuit.less thanbr /greater thanResults: Renal clearance of HBP (median (IQR) ml/min) was 0.19 (0.08-0.33) in healthy individuals and 0.30 (0.01-1.04) in burn ICU patients. In ICU patients with cystatin C levels exceeding 1.44 mg/l, clearance was 0.45 (0.15-2.81), and in patients with cystatin C below 1.44 mg/l clearance was lower 0.28 (0.14-0.55) (p = 0.04). Starting CRRT did not significantly alter plasma levels of HBP (p = 0.14), and the median HBP level in the effluent on CRRT was 9.1 ng/ml (IQR 7.8-14.4 ng/ml).less thanbr /greater thanConclusion: In healthy individuals and critically ill burn patients, renal clearance of HBP is low. It is increased when renal function is impaired. Starting CRRT in critically ill patients does not alter plasma levels of HBP significantly, but HBP can be found in the effluent. It seems unlikely that impaired kidney function needs to be considered when interpreting concentrations of HBP in previous studies. Starting CRRT does not appear to be an effective way of reducing HBP concentrations.

Place, publisher, year, edition, pages
Public Library of Science, 2019
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-160129 (URN)10.1371/journal.pone.0221813 (DOI)000485058200055 ()
Available from: 2019-09-06 Created: 2019-09-06 Last updated: 2019-09-30
Skog, M., Sivlér, P., Steinvall, I., Aili, D., Sjöberg, F. & Elmasry, M. (2019). The Effect of Enzymatic Digestion on Cultured Epithelial Autografts. Cell Transplantation, 28(5), 638-644
Open this publication in new window or tab >>The Effect of Enzymatic Digestion on Cultured Epithelial Autografts
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2019 (English)In: Cell Transplantation, ISSN 0963-6897, E-ISSN 1555-3892, Vol. 28, no 5, p. 638-644Article in journal (Refereed) Published
Abstract [en]

Severe burns are often treated by means of autologous skin grafts, preferably following early excision of the burnt tissue. In the case of, for example, a large surface trauma, autologous skin cells can be expanded in vitro prior to transplantation to facilitate the treatment when insufficient uninjured skin is a limitation. In this study we have analyzed the impact of the enzyme (trypsin or accutase) used for cell dissociation and the incubation time on cell viability and expansion potential, as well as expression of cell surface markers indicative of stemness. Skin was collected from five individuals undergoing abdominal reduction surgery and the epidermal compartment was digested in either trypsin or accutase. Trypsin generally generated more cells than accutase and with higher viability; however, after 7 days of subsequent culture, accutase-digested samples tended to have a higher cell count than trypsin, although the differences were not significant. No significant difference was found between the enzymes in median fluorescence intensity of the analyzed stem cell markers; however, accutase digestion generated significantly higher levels of CD117- and CD49f-positive cells, but only in the 5 h digestion group. In conclusion, digestion time appeared to affect the isolated cells more than the choice of enzyme.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
autografts, cell culture, epithelial cells, keratinocytes, stem cells
National Category
Medical Biotechnology (with a focus on Cell Biology (including Stem Cell Biology), Molecular Biology, Microbiology, Biochemistry or Biopharmacy)
Identifiers
urn:nbn:se:liu:diva-156422 (URN)10.1177/0963689719833305 (DOI)000477971000013 ()30983404 (PubMedID)
Note

Funding agencies: Integrative Regenerative Medicine (IGEN) center at Linkoping University

Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-08-19
Cirillo, M. D., Mirdell, R., Sjöberg, F. & Pham, T. (2019). Time-Independent Prediction of Burn Depth using Deep Convolutional Neural Networks. Journal of Burn Care & Research
Open this publication in new window or tab >>Time-Independent Prediction of Burn Depth using Deep Convolutional Neural Networks
2019 (English)In: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488Article in journal (Refereed) In press
Abstract [en]

We present in this paper the application of deep convolutional neural networks, which are a state-of-the-art artificial intelligence (AI) approach in machine learning, for automated time-independent prediction of burn depth. Colour images of four types of burn depth injured in first few days, including normal skin and background, acquired by a TiVi camera were trained and tested with four pre-trained deep convolutional neural networks: VGG-16, GoogleNet, ResNet-50, and ResNet-101. In the end, the best 10-fold cross-validation results obtained from ResNet- 101 with an average, minimum, and maximum accuracy are 81.66%, 72.06% and 88.06%, respectively; and the average accuracy, sensitivity and specificity for the four different types of burn depth are 90.54%, 74.35% and 94.25%, respectively. The accuracy was compared to the clinical diagnosis obtained after the wound had healed. Hence, application of AI is very promising for prediction of burn depth and therefore can be a useful tool to help in guiding clinical decision and initial treatment of burn wounds.

Place, publisher, year, edition, pages
Oxford University Press, 2019
Keywords
Burn depth, time-independent prediction, deep convolutional neural network, artificial intelligence
National Category
Surgery Medical Image Processing Other Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-157386 (URN)10.1093/jbcr/irz103 (DOI)31187119 (PubMedID)
Available from: 2019-06-11 Created: 2019-06-11 Last updated: 2019-06-27Bibliographically approved
Abdelrahman, I., Steinvall, I., Fredrikson, M., Sjöberg, F. & Elmasry, M. (2019). Use of the burn intervention score to calculate the charges of the care of burns. Burns, 45(2), 303-309
Open this publication in new window or tab >>Use of the burn intervention score to calculate the charges of the care of burns
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2019 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 2, p. 303-309Article in journal (Refereed) Published
Abstract [en]

Background To our knowledge this is the first published estimate of the charges of the care of burns in Sweden. The Linköping Burn Interventional Score has been used to calculate the charges for each burned patient since 1993. The treatment of burns is versatile, and depends on the depth and extension of the burn. This requires a flexible system to detect the actual differences in the care provided. We aimed to describe the model of burn care that we used to calculate the charges incurred during the acute phase until discharge, so it could be reproduced and applied in other burn centres, which would facilitate a future objective comparison of the expenses in burn care. Methods All patients admitted with burns during the period 2010–15 were included. We analysed clinical and economic data from the daily burn scores during the acute phase of the burn until discharge from the burn centre. Results Total median charge/patient was US$ 28 199 (10th–90th centiles 4668-197 781) for 696 patients admitted. Burns caused by hot objects and electricity resulted in the highest charges/TBSA%, while charges/day were similar for the different causes of injury. Flame burns resulted in the highest mean charges/admission, probably because they had the longest duration of stay. Mean charges/patient increased in a linear fashion among the different age groups. Conclusion Our intervention-based estimate of charges has proved to be a valid tool that is sensitive to the procedures that drive the costs of the care of burns such as large TBSA%, intensive care, and operations. The burn score system could be reproduced easily in other burn centres worldwide and facilitate the comparison regardless of the differences in the currency and the economic circumstances.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Burns;Charges;Intervention score;Costs;Payments
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-153636 (URN)10.1016/j.burns.2018.12.007 (DOI)000461044900004 ()
Note

Funding agencies: Department of Hand Surgery, Plastic Surgery, and Burns; Linkoping University, Linkoping, Sweden

Available from: 2019-01-06 Created: 2019-01-06 Last updated: 2019-04-01
Pompermaier, L., Elmasry, M., Abdelrahman, I., Fredrikson, M., Sjöberg, F. & Steinvall, I. (2018). Are there any differences in the provided burn care between men and women? A retrospective study. Burns & Trauma, 6, Article ID 22.
Open this publication in new window or tab >>Are there any differences in the provided burn care between men and women? A retrospective study
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2018 (English)In: Burns & Trauma, E-ISSN 2321-3876, Vol. 6, article id 22Article in journal (Refereed) Published
Abstract [en]

Background

Disparity between medical treatment for men and women has been recorded worldwide. However, it is difficult to find out if the disparities in both the use of resources and outcome depend entirely on sex-related discrimination. Our aim was to investigate if there are differences in burn treatments between the sexes.

Methods

All patients admitted with burns to Linköping University Hospital during the 16-year period 2000–2015 were included. Interventions were prospectively recorded using the validated Burn SCoring system (BSC). Data were analysed using a multivariable panel regression model adjusted for age, percentage total body surface area (%TBSA), and in-hospital mortality.

Results

A total of 1363 patients were included, who generated a total of 22,301 daily recordings while they were inpatients. Males were 70% (930/1363). Sex was not an independent factor for daily scores after adjustment for age, %TBSA, and mortality in hospital (model R2=0.60, p < 0.001).

Conclusion

We found no evidence of inequity between the sexes in treatments given in our burn centre when we had adjusted for size of burn, age, and mortality. BSC seems to be an appropriate model in which to evaluate sex-related differences in the delivery of treatments.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Burn care; Intervention score; Sex; Trauma model; Workload
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-150365 (URN)10.1186/s41038-018-0125-0 (DOI)000442159400001 ()30123802 (PubMedID)
Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2019-04-18Bibliographically approved
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