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Sjöberg, Folke
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Publications (10 of 204) Show all publications
Pompermaier, L., Steinvall, I., Elmasry, M., Thorfinn, J. & Sjöberg, F. (2017). Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study.. Burns.
Open this publication in new window or tab >>Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study.
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2017 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409Article in journal (Refereed) Epub ahead of print
Abstract [en]

INTRODUCTION: The Baux score - the sum of age and total body surface area burned (TBSA %) - is a good predictor of mortality has a high specificity but low sensitivity. Our aim was to examine the causes of death in patients who die with Baux scores of <100, which may explain the lower sensitivity and possibly affect the prediction of mortality.

METHODS: All patients admitted to our centre for burn care from 1993 to 2015 (n=1946) were included in this retrospective, descriptive, exploratory study. The study group comprised those patients who died with Baux scores of <100 (n=23), and their medical charts were examined for the cause of death and for coexisting diseases.

RESULTS: Crude mortality was 5% (93/1946) for the overall cohort, and a quarter of the patients who died (23/93) had Baux scores of less than 100 (range 64-99). In this latter group, flame burns were the most common (18/23), the median (10th-90th centile) age was 70 (46-86) years and for TBSA 21 (5.0-40.5) %, of which 7 (0-27.0) % of the area was full thickness. The main causes of death in 17 of the 23 were classified as "other than burn", being cerebral disease (n=9), cardiovascular disease (n=6), and respiratory failure (n=2). Among the remaining six (burn-related) deaths, multiple organ failure (predominantly renal failure) was responsible. When we excluded the cases in which the cause of death was not related to the burn, the Baux mortality prediction value improved (receiver operating characteristics area under the curve, AUC) from 0.9733 (95% CI 0.9633-0.9834) to 0.9888 (95% CI 0.9839-0.9936) and the sensitivity estimate increased from 45.2% to 53.9%.

CONCLUSION: Patients with burns who died with a Baux score <100 were a quarter of all the patients who died. An important finding is that most of these deaths were caused by reasons other than the burn, usually cerebrovascular disease. This may be the explanation why the sensitivity of the Baux score is low, as factors other than age and TBSA % explain the fatal outcome.

Place, publisher, year, edition, pages
Elsevier, 2017
Keyword
Baux score, Burns, Cause of death, Mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-142898 (URN)10.1016/j.burns.2017.07.014 (DOI)28830698 (PubMedID)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2017-11-09
Bäckström, D., Steinvall, I. & Sjöberg, F. (2017). Change in child mortality patterns after injuries in Sweden: a nationwide 14-year study.. European Journal of Trauma and Emergency Surgery, 43(3), 343-349.
Open this publication in new window or tab >>Change in child mortality patterns after injuries in Sweden: a nationwide 14-year study.
2017 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 43, no 3, 343-349 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Sweden has one of the world's lowest child injury mortality rates, but injuries are still the leading cause of death among children. Child injury mortality in the country has been declining, but this decline seems to decrease recently. Our objective was therefore to further examine changes in the mortality of children's death from injury over time and to assess the contribution of various effects on mortality. The underlying hypothesis for this investigation is that the incidence of lethal injuries in children, still is decreasing and that this may be sex specific.

PATIENTS AND METHODS: We studied all deaths from injury in Sweden under-18-year-olds during the 14 years 1999-2012. We identified those aged under 18 whose underlying cause of death was recorded as International Classification of Diseases, 10th Revision (ICD-10) diagnosis from V01 to X39 in the Swedish cause of death, where all dead citizens are registered.

RESULTS: From the 1 January 1999 to 31 December 2012, 1213 children under the age of 18 died of injuries in Sweden. The incidence declined during this period (r = -0.606, p = 0.02) to 3.3 deaths/100,000 children-years (95 % CI 2.6-4.2). Death from unintentional injury was more common than that after intentional injury (p < 0.0001). There was a reduction in the incidence of unintentional injuries during the study period (r = -0.757, p = 0.03). The most common causes of death were injury to the brain (n = 337, 41 %), followed by drowning (n = 109, 13 %). The number of deaths after intentional injury increased (r = 0.585, p = 0.03) and at the end of the period was 1.5 deaths/100,000 children-years. The most common causes of death after intentional injuries were asphyxia (n = 177, 45 %), followed by injury to the brain (n = 76, 19 %).

DISCUSSION: Mortality patterns in injured children in Sweden have changed from being dominated by unintentional injuries to a more equal distribution between unintentional and intentional injuries as well as between sexes and the overall rate has declined further. These findings are important as they might contribute to the preventive work that is being done to further reduce mortality in injured children.

Place, publisher, year, edition, pages
Springer, 2017
Keyword
Children, Injury, Mortality, Scandinavia, Trauma
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-135548 (URN)10.1007/s00068-016-0660-y (DOI)000402789500010 ()27084542 (PubMedID)
Note

Funding agencies: Swedish Carnegie Hero Fund

Available from: 2017-03-16 Created: 2017-03-16 Last updated: 2017-11-02Bibliographically approved
Bäckström, D., Larsen, R., Steinvall, I., Fredrikson, M., Gedeborg, R. & Sjöberg, F. (2017). Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing.. European Journal of Trauma and Emergency Surgery.
Open this publication in new window or tab >>Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing.
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2017 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Injury is an important cause of death in all age groups worldwide, and contributes to many losses of human and economic resources. Currently, we know a few data about mortality from injury, particularly among the working population. The aim of the present study was to examine death from injury over a period of 14 years (1999-2012) using the Swedish Cause of Death Registry (CDR) and the National Patient Registry, which have complete national coverage.

METHOD: CDR was used to identify injury-related deaths among adults (18 years or over) during the years 1999-2012. ICD-10 diagnoses from V01 to X39 were included. The significance of changes over time was analyzed by linear regression.

RESULTS: The incidence of prehospital death decreased significantly (coefficient -0.22, r (2) = 0.30; p = 0.041) during the study period, while that of deaths in hospital increased significantly (coefficient 0.20, r (2) = 0.75; p < 0.001). Mortality/100,000 person-years in the working age group (18-64 years) decreased significantly (coefficient -0.40, r (2) = 0.37; p = 0.020), mainly as a result of decrease in traffic-related deaths (coefficient -0.34, r (2) = 0.85; p < 0.001). The incidence of deaths from injury among elderly (65 years and older) patients increased because of the increase in falls (coefficient 1.71, r (2) = 0.84; p < 0.001) and poisoning (coefficient 0.13, r (2) = 0.69; p < 0.001).

CONCLUSION: The epidemiology of injury in Sweden has changed during recent years in that mortality from injury has declined in the working age group and increased among those people 64 years old and over.

Place, publisher, year, edition, pages
Springer, 2017
Keyword
Elderly, Injury, Mortality, Prehospital, Trauma, Working age
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-142763 (URN)10.1007/s00068-017-0827-1 (DOI)28825159 (PubMedID)
Available from: 2017-11-02 Created: 2017-11-02 Last updated: 2017-12-04Bibliographically approved
Abdelrahman, I., Elmasry, M., Olofsson, P., Steinvall, I., Fredrikson, M. & Sjöberg, F. (2017). Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care.. PLoS ONE, 12(3), Article ID e0174579.
Open this publication in new window or tab >>Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care.
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 3, e0174579Article in journal (Refereed) Published
Abstract [en]

Patients and Methods: Surgically managed burn patients admitted between 2010-14 were included. Operative stay was defined as the time from admission until the last operation, postoperative stay as the time from the last operation until discharge. The difference in variation was analysed with F-test. A retrospective review of medical records was done to explore reasons for extended postoperative stay. Multivariable regression was used to assess factors associated with operative stay and postoperative stay.less thanbr /greater thanResults: Operative stay/TBSA% showed less variation than total duration/TBSA% (F test = 2.38, pless than0.01). The size of the burn, and the number of operations, were the independent factors that influenced operative stay (R2 0.65). Except for the size of the burn other factors were associated with duration of postoperative stay: wound related, psychological and other medical causes, advanced medical support, and accommodation arrangements before discharge, of which the two last were the most important with an increase of (mean) 12 and 17 days (pless than0.001, R2 0.51).less thanbr /greater thanConclusion: Adjusted operative stay showed less variation than total hospital stay and thus can be considered a more accurate outcome measure for surgically managed burns. The size of burn and number of operations are the factors affecting this outcome measure.

Place, publisher, year, edition, pages
Public Library of Science, 2017
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-136275 (URN)10.1371/journal.pone.0174579 (DOI)000399175000022 ()
Note

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

Available from: 2017-04-05 Created: 2017-04-05 Last updated: 2017-11-29
Abdelrahman, I., Elmasry, M., Steinvall, I., Fredrikson, M. & Sjöberg, F. (2017). Improvement in mortality at a National Burn Centre since 2000: Was it the result of increased resources?. Medicine (Baltimore, Md.), 96(25), Article ID e6727.
Open this publication in new window or tab >>Improvement in mortality at a National Burn Centre since 2000: Was it the result of increased resources?
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2017 (English)In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 25, e6727Article in journal (Refereed) Published
Abstract [en]

Abstract The aim of this study was to find out whether the charging costs (calculated using interventional burn score) increased as mortality decreased. During the last 2 decades, mortality has declined significantly in the Linköping Burn Centre. The burn score that we use has been validated as a measure of workload and is used to calculate the charging costs of each burned patient. We compared the charging costs and mortality in 2 time periods (2000–2007 and 2008–2015). A total of 1363 admissions were included. We investigated the change in the burn score, as a surrogate for total costs per patient. Multivariable regression was used to analyze risk-adjusted mortality and burn score. The median total body surface area % (TBSA%) was 6.5% (10–90 centile 1.0–31.0), age 33 years (1.3–72.2), duration of stay/ TBSA% was 1.4 days (0.3–5.3), and 960 (70%) were males. Crude mortality declined from 7.5% in 2000–2007 to 3.4% in 2008–2015, whereas the cumulative burn score was not increased (P=.08). Regression analysis showed that risk-adjusted mortality decreased (odds ratio 0.42, P=.02), whereas the adjusted burn score did not change (P=.14, model R2 0.86). Mortality decreased but there was no increase in the daily use of resources as measured by the interventional burn score. The data suggest that the improvements in quality obtained have been achieved within present routines for care of patients (multidisciplinary/ orientated to patients’ safety).

Abbreviation: TBSA% = total body surface area %.

Place, publisher, year, edition, pages
Wolters Kluwer, 2017
Keyword
burn, cost, hospital billing charge, interventional score, mortality, resources, survival
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-138833 (URN)10.1097/md.0000000000006727 (DOI)000404116900001 ()28640072 (PubMedID)
Note

Funding agencies: Department of Plastic and Hand Surgery Linkoping University Hospital; Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden

Available from: 2017-06-26 Created: 2017-06-26 Last updated: 2017-08-07
Abdelrahman, I. M., Elmasry, M., Steinvall, I. & Sjöberg, F. (2017). Response to comments on: A prospective randomized cost billing comparison of local fasciocutaneous perforator versus free Gracilis flap reconstruction for lower limb in a developing economy [Letter to the editor]. Journal of Plastic, Reconstructive & Aesthetic Surgery, 70(9), 1307-1308.
Open this publication in new window or tab >>Response to comments on: A prospective randomized cost billing comparison of local fasciocutaneous perforator versus free Gracilis flap reconstruction for lower limb in a developing economy
2017 (English)In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 70, no 9, 1307-1308 p.Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2017
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-139724 (URN)10.1016/j.bjps.2017.06.014 (DOI)000410902100027 ()28688867 (PubMedID)2-s2.0-85021804889 (Scopus ID)
Available from: 2017-08-14 Created: 2017-08-14 Last updated: 2017-10-24Bibliographically approved
Elmasry, M., Steinvall, I., Thorfinn, J., Abdelrahman, I., Olofsson, P. & Sjöberg, F. (2017). Staged excisions of moderate-sized burns compared with total excision with immediate autograft: an evaluation of two strategies.. International journal of burns and trauma, 7(1), 6-11.
Open this publication in new window or tab >>Staged excisions of moderate-sized burns compared with total excision with immediate autograft: an evaluation of two strategies.
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2017 (English)In: International journal of burns and trauma, ISSN 2160-2026, Vol. 7, no 1, 6-11 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Different surgical techniques have evolved since excision and autografting became the treatment of choice for deep burns in the 1970s. The treatment plan at the Burn Center, Linköping University Hospital, Sweden, has shifted from single-stage excision and immediate autografting to staged excisions and temporary cover with xenografts before autografting. The aim of this study was to find out if the change in policy resulted in extended duration of hospital stay/total body surface area burned (LOS/TBSA%).

METHODS: Retrospective clinical cohort including surgically-managed patients with burns of 15%-60% TBSA% within each treatment group. The first had early full excisions of deep dermal and full thickness burns and immediate autografts (1997-98), excision and immediate autograft group) and the second had staged excisions before final autografts using xenografts for temporary cover (2010-11, staged excision group).

RESULTS: The study included 57 patients with deep dermal and full-thickness burns, 28 of whom had excision and immediate autografting, and 29 of whom had staged excisions with xenografting before final autografting. Adjusted (LOS/TBSA%) was close to 1, and did not differ between groups. Mean operating time for the staged excision group was shorter and the excised area/operation was smaller. The total operating time/TBSA% did not differ between groups.

CONCLUSION: Staged excisions with temporary cover did not affect adjusted LOS/TBSA% or total operating time. Staged excisions may be thought to be more expensive because of the cost of covering the wound between stages, but this needs to be further investigated as do the factors that predict long term outcome.

Place, publisher, year, edition, pages
E-Century Publishing Corporation, 2017
Keyword
Burn surgery, moderate sized burns, xenografts
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-135745 (URN)28123862 (PubMedID)
Available from: 2017-03-20 Created: 2017-03-20 Last updated: 2017-10-24Bibliographically approved
Ericsson, E., Tesselaar, E. & Sjöberg, F. (2016). Effect of Electrode Belt and Body Positions on Regional Pulmonary Ventilation- and Perfusion-Related Impedance Changes Measured by Electric Impedance Tomography. PLoS ONE, 11(6), e0155913.
Open this publication in new window or tab >>Effect of Electrode Belt and Body Positions on Regional Pulmonary Ventilation- and Perfusion-Related Impedance Changes Measured by Electric Impedance Tomography
2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 6, e0155913- p.Article in journal (Refereed) Published
Abstract [en]

Ventilator-induced or ventilator-associated lung injury (VILI/VALI) is common and there is an increasing demand for a tool that can optimize ventilator settings. Electrical impedance tomography (EIT) can detect changes in impedance caused by pulmonary ventilation and perfusion, but the effect of changes in the position of the body and in the placing of the electrode belt on the impedance signal have not to our knowledge been thoroughly evaluated. We therefore studied ventilation-related and perfusion-related changes in impedance during spontaneous breathing in 10 healthy subjects in five different body positions and with the electrode belt placed at three different thoracic positions using a 32-electrode EIT system. We found differences between regions of interest that could be attributed to changes in the position of the body, and differences in impedance amplitudes when the position of the electrode belt was changed. Ventilation-related changes in impedance could therefore be related to changes in the position of both the body and the electrode belt. Perfusion-related changes in impedance were probably related to the interference of major vessels. While these findings give us some insight into the sources of variation in impedance signals as a result of changes in the positions of both the body and the electrode belt, further studies on the origin of the perfusion-related impedance signal are needed to improve EIT further as a tool for the monitoring of pulmonary ventilation and perfusion.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2016
National Category
Physiology
Identifiers
urn:nbn:se:liu:diva-130067 (URN)10.1371/journal.pone.0155913 (DOI)000377218700010 ()27253433 (PubMedID)
Available from: 2016-07-06 Created: 2016-07-06 Last updated: 2018-01-10
Sjöberg, F. & Orwelius, L. (2016). Follow-up after intensive care. In: Bertrand Guidet, Andreas Valentin, Hans Flaatten (Ed.), Quality management in intensive care: a practical guide (pp. 180-186). Cambridge: Cambridge University Press.
Open this publication in new window or tab >>Follow-up after intensive care
2016 (English)In: Quality management in intensive care: a practical guide / [ed] Bertrand Guidet, Andreas Valentin, Hans Flaatten, Cambridge: Cambridge University Press, 2016, 180-186 p.Chapter in book (Other academic)
Place, publisher, year, edition, pages
Cambridge: Cambridge University Press, 2016
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-126608 (URN)9781107503861 (ISBN)
Available from: 2016-03-31 Created: 2016-03-31 Last updated: 2016-11-15Bibliographically approved
Tyden, J., Herwald, H., Sjöberg, F. & Johansson, J. (2016). Increased Plasma Levels of Heparin-Binding Protein on Admission to Intensive Care Are Associated with Respiratory and Circulatory Failure. PLoS ONE, 11(3), e0152035.
Open this publication in new window or tab >>Increased Plasma Levels of Heparin-Binding Protein on Admission to Intensive Care Are Associated with Respiratory and Circulatory Failure
2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 3, e0152035- p.Article in journal (Refereed) Published
Abstract [en]

Purpose Heparin-binding protein (HBP) is released by granulocytes and has been shown to increase vascular permeability in experimental investigations. Increased vascular permeability in the lungs can lead to fluid accumulation in alveoli and respiratory failure. A generalized increase in vascular permeability leads to loss of circulating blood volume and circulatory failure. We hypothesized that plasma concentrations of HBP on admission to the intensive care unit (ICU) would be associated with decreased oxygenation or circulatory failure. Methods This is a prospective, observational study in a mixed 8-bed ICU. We investigated concentrations of HBP in plasma at admission to the ICU from 278 patients. Simplified acute physiology score (SAPS) 3 was recorded on admission. Sequential organ failure assessment (SOFA) scores were recorded daily for three days. Results Median SAPS 3 was 58.8 (48-70) and 30-day mortality 64/278 (23%). There was an association between high plasma concentrations of HBP on admission with decreased oxygenation (p&lt;0.001) as well as with circulatory failure (p&lt;0.001), after 48-72 hours in the ICU. There was an association between concentrations of HBP on admission and 30-day mortality (p = 0.002). ROC curves showed areas under the curve of 0,62 for decreased oxygenation, 0,65 for circulatory failure and 0,64 for mortality. Conclusions A high concentration of HBP in plasma on admission to the ICU is associated with respiratory and circulatory failure later during the ICU care period. It is also associated with increased 30-day mortality. Despite being an interesting biomarker for the composite ICU population its predictive value at the individual patient level is low.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2016
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-127786 (URN)10.1371/journal.pone.0152035 (DOI)000372701200089 ()27007333 (PubMedID)
Available from: 2016-05-12 Created: 2016-05-12 Last updated: 2017-11-30
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