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  • 1.
    Al-Ayoubi, Fawzi
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Eriksson, Helene
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Myrelid, Pär
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Wallon, Conny
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Andersson, Peter
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Uneven distribution of emergency operations and lack of trauma: a call for reorganization of acute surgical care?2012Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Subspecialisation within general surgery has today reached further than ever. However, on-call time, an unchanged need for broad surgical skills are required to meet the demands of acute surgical disease and trauma. The introduction of a new subspecialty in North America that deals solely with acute care surgery and trauma is an attempt to offer properly trained surgeons also during on-call time. To find out whether such a subspecialty could be helpful in Sweden we analyzed our workload for emergency surgery and trauma. METHODS: Linkoping University Hospital serves a population of 257 000. Data from 2010 for all patients, diagnoses, times and types of operations, surgeons involved, duration of stay, types of injury and deaths regarding emergency procedures were extracted from a prospectively-collected database and analyzed. RESULTS: There were 2362 admissions, 1559 emergency interventions; 835 were mainly abdominal operations, and 724 diagnostic or therapeutic endoscopies. Of the 1559 emergency interventions, 641 (41.1%) were made outside office hours, and of 453 minor or intermediate procedures (including appendicectomy, cholecystectomy, or proctological procedures) 276 (60.9%) were done during the evenings or at night. Two hundred and fifty-four patients were admitted with trauma and 29 (11.4%) required operation, of whom general surgeons operated on eight (3.1%). Thirteen consultants and 11 senior registrars were involved in 138 bowel resections and 164 cholecystectomies chosen as index operations for standard emergency surgery. The median (range) number of such operations done by each consultant was 6 (3--17) and 6 (1--22). Corresponding figures for senior registrars were 7 (0--11) and 8 (1--39). CONCLUSION: There was an uneven distribution of exposure to acute surgical problems and trauma among general surgeons. Some were exposed to only a few standard emergency interventions and most surgeons did not operate on a single patient with trauma. Further centralization of trauma care, long-term positions at units for emergency surgery and trauma, and subspecialisation in the fields of emergency surgery and trauma, might be options to solve problems of low volumes.

  • 2.
    Altgärde, Jakob
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Redéen, Stefan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Hilding, Niclas
    Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Akutkliniken.
    Drott, Peder
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Horse-related trauma in children and adults during a two year period2014Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 22, nr 40Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Horse riding, with almost 200,000 participants, is the eighth most popular sport in Sweden. Severe injuries can occur with horse riding accidents which is well documented. This study was undertaken to investigate if injuries associated with horse riding are common, which type of injuries occur, what mechanisms are involved and to estimate the costs to the society. Material and methods: All patients attending the emergency department at Link ping University Hospital, during the years 2003-2004, due to horse related trauma were prospectively recorded. The patients were divided into two groups according to age, 147 children and 141 adults. The medical records were retrospectively scrutinized. Results: The most common mechanism of injury was falling from the horse. Most commonly, minor sprains and soft tissue injuries were seen, but also minor head injuries and fractures, mainly located in the upper limb. In total 26 adults and 37 children were admitted. Of these 63 patients 19 were considered having a serious injury. In total, four patients needed treatment in intensive care units. The total cost in each group was 200,000 Euro/year. Conclusion: Horse riding is a sport with well known risks. Our results corresponds to the literature, however we have not observed the same incidence of serious injuries. In contrast we find these to be fairly uncommon. The injuries are mainly minor, with a small risk of long term morbidity. Over time regulations and safety equipment seem to have decreased the number of serious accidents.

  • 3.
    Andersson Hagiwara, Magnus
    et al.
    University of Boras, Sweden.
    Nilsson, Lena
    Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning.
    Stromsoe, Anneli
    Malardalens Hogskola, Sweden.
    Axelsson, Christer
    University of Boras, Sweden.
    Kangstrom, Anna
    University of Boras, Sweden.
    Herlitz, Johan
    University of Boras, Sweden.
    Patient safety and patient assessment in pre-hospital care: a study protocol2016Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, nr 14Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Patient safety issues in pre-hospital care are poorly investigated. The aim of the planned study is to survey patient safety problems in pre-hospital care in Sweden. Methods/Design: The study is a retro-perspective structured medical record review based on the use of 11 screening criteria. Two instruments for structured medical record review are used: a trigger tool instrument designed for pre-hospital care and a newly development instrument designed to compare the pre-hospital assessment with the final hospital assessment. Three different ambulance organisations are participating in the study. Every month, one rater in each organisation randomly collects 30 medical records for review. With guidance from the review instrument, he/she independently reviews the record. Every month, the review team meet for a discussion of problematic reviews. The results will be analysed with descriptive statistics and logistic regression. Discussion: The findings will make an important contribution to knowledge about patient safety issues in prehospital care.

  • 4.
    Djärv, T.
    et al.
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Axelsson, C.
    Univ Coll Boras, Sweden.
    Herlitz, J.
    Karolinska Inst, Sweden; Univ Coll Borås, Sweden.
    Strömsoe, A.
    Malardalen Univ, Sweden.
    Israelsson, Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Kalmar Cty Hosp, Sweden; Linnaeus Univ, Sweden.
    Claesson, A.
    Karolinska Inst, Sweden; Univ Coll Boras, Sweden.
    Traumatic cardiac arrest in Sweden 1990-2016-a population-based national cohort study2018Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, artikkel-id 30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Trauma is a main cause of death among young adults worldwide. Patients experiencing a traumatic cardiac arrest (TCA) certainly have a poor prognosis but population-based studies are sparse. Primarily to describe characteristics and 30-day survival following a TCA as compared with a medical out-of-hospital cardiac arrest (medical CA). Methods: A cohort study based on data from the nationwide, prospective population-based Swedish Registry for Cardiopulmonary Resuscitation (SRCR), a medical cardiac arrest registry, between 1990 and 2016. The definition of a TCA in the SRCR is a patient who is unresponsive with apnoea where cardiopulmonary resuscitation and/or defibrillation have been initiated and in whom the Emergency Medical Services (EMS, mainly a nurse-based system) reported trauma as the aetiology. Outcome was overall 30-day survival. Descriptive statistics as well as multivariable logistic regression models were used. Results: In all, between 1990 and 2016, 1774 (2.4%) cases had a TCA and 72,547 had a medical CA. Overall 30-day survival gradually increased over the years, and was 3.7% for TCAs compared to 8.2% following a medical CA (p amp;lt; 0.01). Among TCAs, factors associated with a higher 30-day survival were bystander witnessed and having a shockable initial rhythm (adjusted OR 2.67, 95% C.I. 1.15-6.22 and OR 8.94 95% C.I. 4.27-18.69, respectively). Discussion: Association in registry-based studies do not imply causality but TCA had short time intervals in the chain of survival as well as high rates of bystander-CPR. C onclusion: In a medical CA registry like ours, prevalence of TCAs is low and survival is poor. Registries like ours might not capture the true incidence. However, many individuals do survive and resuscitation in TCAs should not be seen futile.

  • 5.
    Johansson, Joakim
    et al.
    The research and development unit, Jämtland county council, Östersund, Sweden.
    Sjöberg, Jonas
    Department of Anaesthesiology and Intensive Care, Östersund hospital, Östersund, Sweden.
    Nordgren, Marie
    Department of Anaesthesiology and Intensive Care, Östersund hospital, Östersund, Sweden.
    Sandström, Erik
    Department of Anaesthesiology and Intensive Care, Östersund hospital, Östersund, Sweden.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Zetterström, Henrik
    Department of Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
    Prehospital analgesia using nasal administration of S-ketamine – a case series2013Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, nr 38Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Pain is a problem that often has to be addressed in the prehospital setting. The delivery of analgesia may sometimes prove challenging due to problems establishing intravenous access or a harsh winter environment. To solve the problem of intravenous access, intranasal administration of drugs is used in some settings. In cases where vascular access was foreseen or proved hard to establish (one or two missed attempts) on the scene of the accident we use nasally administered S-Ketamine for prehospital analgesia. Here we describe the use of nasally administered S-Ketamine in 9 cases. The doses used were in the range of 0,45-1,25 mg/kg. 8 patients were treated in outdoor winter-conditions in Sweden. 1 patient was treated indoor. VAS-score decreased from a median of 10 (interquartile range 8-10) to 3 (interquartile range 2-4). Nasally administered S-Ketamine offers a possible last resource to be used in cases where establishing vascular access is difficult or impossible. Side-effects in these 9 cases were few and non serious. Nasally administered drugs offer a needleless approach that is advantageous for the patient as well as for health personnel in especially challenging selected cases. Nasal as opposed to intravenous analgesia may reduce the time spent on the scene of the accident and most likely reduces the need to expose the patient to the environment in especially challenging cases of prehospital analgesia. Nasal administration of S-ketamine is off label and as such we only use it as a last resource and propose that the effect and safety of the treatment should be further studied.

  • 6.
    Lampi, Maria
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Katastrofmedicinskt centrum.
    Junker, Johan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Katastrofmedicinskt centrum.
    Berggren, Peter
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Katastrofmedicinskt centrum.
    Jonson, Carl-Oscar
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Katastrofmedicinskt centrum.
    Vikström, Thore
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Katastrofmedicinskt centrum.
    Pre-hospital triage performance after standardized trauma courses2017Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 25, artikkel-id 53Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The pre-hospital triage process aims at identifying and prioritizing patients in the need of prompt intervention and/or evacuation. The objective of the present study was to evaluate triage decision skills in a Mass Casualty Incident drill. The study compares two groups of participants in Advanced Trauma Life Support and Pre-Hospital Trauma Life Support courses. Methods: A questionnaire was used to deal with three components of triage of victims in a Mass Casualty Incident: decision-making; prioritization of 15 hypothetical casualties involved in a bus crash; and prioritization for evacuation. Swedish Advanced Trauma Life Support and Pre-Hospital Trauma Life Support course participants filled in the same triage skills questionnaire just before and after their respective course. Results: One hundred fifty-three advanced Trauma Life Support course participants were compared to 175 Pre-Hospital Trauma Life Support course participants. The response rates were 90% and 95%, respectively. A significant improvement was found between pre-test and post-test for the Pre-Hospital Trauma Life Support group in regards to decision-making. This difference was only noticeable among the participants who had previously participated in Mass Casualty Incident drills or had experience of a real event (pre-test mean +/- standard deviation 2.4 +/- 0.68, post-test mean +/- standard deviation 2.60 +/- 0.59, P = 0.04). No improvement was found between pre-test and post-test for either group regarding prioritization of the bus crash casualties or the correct identification of the most injured patients for immediate evacuation. Conclusions: Neither Advanced Trauma Life Support nor Pre-Hospital Trauma Life Support participants showed general improvement in their tested triage skills. However, participation in Mass Casualty Incident drills or experience of real events prior to the test performed here, were shown to be advantageous for Pre-Hospital Trauma Life Support participants. These courses should be modified in order to assure proper training in triage skills.

  • 7.
    Larsen, Robert
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Bäckström, Denise
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Fredrikson, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Steinvall, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Gedeborg, Rolf
    Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Decreased risk adjusted 30-day mortality for hospital admitted injuries: a multi-centre longitudinal study2018Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, nr 1, artikkel-id 24Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The interpretation of changes in injury-related mortality over time requires an understanding of changes in the incidence of the various types of injury, and adjustment for their severity. Our aim was to investigate changes over time in incidence of hospital admission for injuries caused by falls, traffic incidents, or assaults, and to assess the risk-adjusted short-term mortality for these patients.less thanbr /greater thanMethods: All patients admitted to hospital with injuries caused by falls, traffic incidents, or assaults during the years 2001-11 in Sweden were identified from the nationwide population-based Patient Registry. The trend in mortality over time for each cause of injury was adjusted for age, sex, comorbidity and severity of injury as classified from the International Classification of diseases, version 10 Injury Severity Score (ICISS).less thanbr /greater thanResults: Both the incidence of fall (689 to 636/100000 inhabitants: p = 0.047, coefficient - 4.71) and traffic related injuries (169 to 123/100000 inhabitants: p less than 0.0001, coefficient - 5.37) decreased over time while incidence of assault related injuries remained essentially unchanged during the study period. There was an overall decrease in risk-adjusted 30-day mortality in all three groups (OR 1.00; CI95% 0.99-1.00). Decreases in traffic (OR 0.95; 95% CI 0.93 to 0.97) and assault (OR 0.93; 95% CI 0.87 to 0.99) related injuries was significant whereas falls were not during this 11-year period.less thanbr /greater thanDiscussion: Risk-adjustment is a good way to use big materials to find epidemiological changes. However after adjusting for age, year, sex and risk we find that a possible factor is left in the pre- and/or in-hospital care.less thanbr /greater thanConclusions: The decrease in risk-adjusted mortality may suggest changes over time in pre- and/or in-hospital care. A non-significantdecrease in risk-adjusted mortality was registered for falls, which may indicate that low-energy trauma has not benefited for the increased survivability as much as high-energy trauma, ie traffic- and assault related injuries.

  • 8.
    Larsen, Robert
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning.
    Bäckström, Denise
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN. Life Regiment Hussars, K3 Karlsborg, Sweden.
    Fredrikson, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Steinvall, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Rolf, Gedeborg
    Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Sweden.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning.
    Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study2019Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, nr 1, artikkel-id 24Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 9.
    Magnusson, Carl
    et al.
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Axelsson, Christer
    Univ Boras, Sweden.
    Nilsson, Lena
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Stromsoe, Anneli
    Dalarna Univ Falun, Sweden; Cty Council Dalarna, Sweden.
    Munters, Monica
    Reg Dalarna, Sweden.
    Herlitz, Johan
    Univ Boras, Sweden.
    Hagiwara, Magnus Andersson
    Univ Boras, Sweden.
    The final assessment and its association with field assessment in patients who were transported by the emergency medical service2018Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, artikkel-id 111Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BackgroundIn patients who call for the emergency medical service (EMS), there is a knowledge gap with regard to the final assessment after arriving at hospital and its association with field assessment.AimIn a representative population of patients who call for the EMS, to describe a) the final assessment at hospital discharge and b) the association between the assessment in the field and the assessment at hospital discharge.MethodsThirty randomly selected patients reached by a dispatched ambulance each month between 1 Jan and 31 Dec 2016 in one urban, one rural and one mixed ambulance organisation in Sweden took part in the study. The exclusion criteria were ageamp;lt;18years, dead on arrival, transport between health-care facilities and secondary missions. Each patient received a unique code based on the ICD code at hospital discharge and field assessment.ResultsIn all, 1080 patients took part in the study, of which 1076 (99.6%) had a field assessment code. A total of 894 patients (83%) were brought to a hospital and an ICD code (ICD-10-SE) was available in 814 patients (91% of these cases and 76% of all cases included in the study). According to these ICD codes, the most frequent conditions were infection (15%), trauma (15%) and vascular disease (9%). The most frequent body localisation of the condition was the thorax (24%), head (16%) and abdomen (13%). In 118 patients (14% of all ICD codes), the condition according to the ICD code was judged as time critical. Among these cases, field assessment was assessed as potentially appropriate in 75% and potentially inappropriate in 12%.ConclusionAmong patients reached by ambulance in Sweden, 83% were transported to hospital and, among them, 14% had a time-critical condition. In these cases, the majority were assessed in the field as potentially appropriate, but 12% had a potentially inappropriate field assessment. The consequences of these findings need to be further explored.

  • 10.
    Mazzocato, Pamela
    et al.
    Karolinska Institute, Sweden.
    Unbeck, Maria
    Karolinska Institute, Sweden.
    Elg, Mattias
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten. Linköpings universitet, HELIX Vinn Excellence Centre.
    Gustaf Skoldenberg, Olof
    Karolinska Institute, Sweden.
    Thor, Johan
    Karolinska Institute, Sweden; Jonköping University, Sweden.
    Unpacking the key components of a programme to improve the timeliness of hip-fracture care: a mixed-methods case study2015Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, nr 93Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Delay to surgery for patients with hip fracture is associated with higher incidence of post-operative complications, prolonged recovery and length of stay, and increased mortality. Therefore, many health care organisations launch improvement programmes to reduce the wait for surgery. The heterogeneous application of similar methods, and the multifaceted nature of the interventions, constrain the understanding of which method works, when, and how. In complex acute care settings, another concern is how changes for one patient group influence the care for other groups. We therefore set out to analyse how multiple components of hip-fracture improvement efforts aimed to reduce the time to surgery influenced that time both for hip-fracture patients and for other acute surgical orthopaedic inpatients. Methods: This study is an observational mixed-methods single case study of improvement efforts at a Swedish acute care hospital, which triangulates control chart analysis of process performance data over a five year period with interview, document, and non-participant observation data. Results: The improvement efforts led to an increase in the monthly percentage of hip-fracture patients operated within 24 h of admission from an average of 47 % to 83 %, with performance predictably ranging between 67 % and 98 % if the process continues unchanged. Meanwhile, no significant changes in lead time to surgery for other acute surgical orthopaedic inpatients were observed. Interview data indicated that multiple intervention components contributed to making the process more reliable. The triangulation of qualitative and quantitative data, however, indicated that key changes that improved performance were the creation of a process improvement team and having an experienced clinician coordinate demand and supply of surgical services daily and enhance pre-operative patient preparation. Conclusions: Timeliness of surgery for patients with hip fracture in a complex hospital setting can be substantially improved without displacing other patient groups, by involving staff in improvement efforts and actively managing acute surgical procedures.

  • 11.
    Nilsson, Abraham
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Katastrofmedicinskt centrum.
    Åslund, Kristian
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Katastrofmedicinskt centrum.
    Lampi, Maria
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Katastrofmedicinskt centrum.
    Nilsson, Heléne
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Katastrofmedicinskt centrum.
    Jonson, Carl-Oscar
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Katastrofmedicinskt centrum.
    Improved and sustained triage skills in firemen after a short training intervention2015Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, nr 81, s. 1-6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: A previous study has shown no measurable improvement in triage accuracy among physicians attending the Advanced Trauma Life Support (ATLS) course and suggests a curriculum revision regarding triage. Other studies have indicated that cooperative learning helps students acquire knowledge. Objective: The present study was designed to evaluate the effectiveness of trauma cards in triage training for firemen. Methods: Eighty-six firemen were randomly assigned into two groups: the trauma card group and the direct instruction group. Both groups received the same 30-min PowerPoint lecture on how to perform triage according to the Sort Assess Lifesaving interventions Treatment and transport (SALT) Mass Casualty Triage Algorithm. In the trauma card group, the participants were divided into groups of 3-5 and instructed to triage 10 trauma victims according to the descriptions on the trauma cards. In the direct instruction group, written forms about the same 10 victims were used and discussed as a continuation of the PowerPoint lecture. Total training time was 60 min for both groups. A test was distributed before and after the educational intervention to measure the individual triage skills. The same test was applied again 6 months later. Results: There was a significant improvement in triage skills directly after the intervention and this was sustained 6 months later. No significant difference in triage skills was seen between the trauma card group and the direct instruction group. Previous experience of multi-casualty incidents, years in service, level of education or age did not have any measurable effects on triage accuracy. Conclusions: One hour of triage training with the SALT Mass Casualty Triage Algorithm was enough to significantly improve triage accuracy in both groups of firemen with sustained skills 6 months later. Further studies on the first assessment on scene versus patient outcome are necessary to provide evidence that this training can improve casualty outcome. The efficacy and validity of trauma cards for disaster management training need to be tested in future studies.

  • 12.
    Nilsson, Heléne
    et al.
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet.
    Rüter, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum.
    Attitudes on the use of priority tags2007Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 15, s. 71-73Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Prioritising of victims as well as the use of priority tags in different colours is an important part of all training in patient management at disasters and major incidents. The actual use of priority tags in incidents and disasters has so far not been systematically studied. The aim of this study was to demonstrate attitudes among researchers as well as prehospital personnel on the actual use of priority tags. In 38 KAMEDO reports issued by the Swedish National Board of Health and Welfare describing major incidents and disasters from 1977-2004, we found no documentation on the use of priority tags. In a questionnaire to personnel within the prehospital medical system 133 (68%) replied that they only have used priority tags in training. 20 (10%) had used priority tags in a real accident/incident and 43 (21%) answered that they have never used priority tags. Reports from incidents should include the issues on the use of priority tags and clearly defi ned criteria on prioritising and labelling of patients at an incident/disaster, as well as in daily work, should be defi ned.

  • 13.
    Nilsson, Heléne
    et al.
    Region Östergötland, Katastrofmedicinskt centrum. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Katastrofmedicin. Linköpings universitet, Hälsouniversitetet.
    Vikström, Tore
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Katastrofmedicin. Linköpings universitet, Hälsouniversitetet.
    Jonson, Carl-Oscar
    Region Östergötland, Katastrofmedicinskt centrum. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Katastrofmedicin. Linköpings universitet, Hälsouniversitetet.
    Performance indicators for initial regional medical response to major incidents: a possible quality control tool2012Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, nr 81Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Timely decisions concerning mobilization and allocation of resources and distribution of casualties are crucial in medical management of major incidents. The aim of this study was to evaluate documented initial regional medical responses to major incidents by applying a set of 11 measurable performance indicators for regional medical command and control and test the feasibility of the indicators.

    Methods

    Retrospective data were collected from documentation from regional medical command and control at major incidents that occurred in two Swedish County Councils. Each incident was assigned to one of nine different categories and 11 measurable performance indicators for initial regional medical command and control were systematically applied. Two-way analysis of variance with one observation per cell was used for statistical analysis and the post hoc Tukey test was used for pairwise comparisons.

    Results

    The set of indicators for regional medical command and control could be applied in 102 of the130 major incidents (78%), but 36 incidents had to be excluded due to incomplete documentation. The indicators were not applicable as a set for 28 incidents (21.5%) due to different characteristics and time frames. Based on the indicators studied in 66 major incidents, the results demonstrate that the regional medical management performed according to the standard in the early phases (1–10 min after alert), but there were weaknesses in the secondary phase (10–30 min after alert). The significantly lowest scores were found for Indicator 8 (formulate general guidelines for response) and Indicator 10 (decide whether or not resources in own organization are adequate).

    Conclusions

    Measurable performance indicators for regional medical command and control can be applied to incidents that directly or indirectly involve casualties provided there is sufficient documentation available. Measurable performance indicators can enhance follow- up and be used as a structured quality control tool as well as constitute measurable parts of a nationally based follow-up system for major incidents. Additional indicators need to be developed for hospital-related incidents such as interference with hospital infrastructure.

  • 14.
    Nord, Anette
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Svensson, Leif
    Karolinska Institute, Sweden.
    Claesson, Andreas
    Karolinska Institute, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Hult, Håkan
    Karolinska Institute, Sweden.
    Kreitz-Sandberg, Susanne
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och didaktik. Linköpings universitet, Utbildningsvetenskap.
    Nilsson, Lennart
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    The effect of a national web course "Help-Brain-Heart" as a supplemental learning tool before CPR training: a cluster randomised trial2017Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 25, artikkel-id 93Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The effectiveness of cardiopulmonary resuscitation (CPR) learning methods is unclear. Our aim was to evaluate whether a web course before CPR training, teaching the importance of recognition of symptoms of stroke and acute myocardial infarction (AMI) and a healthy lifestyle, could influence not only theoretical knowledge but also practical CPR skills or willingness to act in a cardiac arrest situation. Methods: Classes with 13-year-old students were randomised to CPR training only (control) or a web course plus CPR training (intervention). Data were collected (practical test and a questionnaire) directly after training and at 6 months. CPR skills were evaluated using a modified Cardiff test (12-48 points). Knowledge on stroke symptoms (0-7 points), AMI symptoms (0-9 points) and lifestyle factors (0-6 points), and willingness to act were assessed by the questionnaire. The primary endpoint was CPR skills at 6 months. CPR skills directly after training, willingness to act and theoretical knowledge were secondary endpoints. Training and measurements were performed from December 2013 to October 2014. Results: Four hundred and thirty-two students were included in the analysis of practical skills and self-reported confidence. The mean score for CPR skills was 34 points after training (control, standard deviation [SD] 4.4; intervention, SD 4.0; not significant [NS]); and 32 points at 6 months for controls (SD 3.9) and 33 points for intervention (SD 4.2; NS). At 6 months, 73% (control) versus 80% (intervention; P = 0.05) stated they would do compressions and ventilation if a friend had a cardiac arrest, whereas 31% versus 34% (NS) would perform both if the victim was a stranger. One thousand, two hundred and thirty-two students were included in the analysis of theoretical knowledge; the mean scores at 6 months for the control and intervention groups were 2.8 (SD 1.6) and 3.2 (SD 1.4) points (P amp;lt; 0.001) for stroke symptoms, 2.6 (SD 2.0) and 2.9 (SD 1.9) points (P = 0.008) for AMI symptoms and 3.2 (SD 1.2) and 3.4 (SD 1.0) points (P amp;lt; 0.001) for lifestyle factors, respectively. Discussion: Use of online learning platforms is a fast growing technology that increases the flexibility of learning in terms of location, time and is available before and after practical training. Conclusions: A web course before CPR training did not influence practical CPR skills or willingness to act, but improved the students theoretical knowledge of AMI, stroke and lifestyle factors.

  • 15.
    Radestad, Monica
    et al.
    Karolinska Institutet, Department of Clinical Science and Education and Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden .
    Nilsson, Heléne
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet.
    Castren, Maaret
    Karolinska Institutet, Department of Clinical Science and Education and Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden .
    Svensson, Leif
    Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden .
    Ruter, Anders
    Sophiahemmet University College, Stockholm, Sweden .
    Gryth, Dan
    Karolinska Institutet, Department of Physiology and Pharmacology and Section of Anaesthesiology and Intensive care, Stockholm, Sweden .
    Combining performance and outcome indicators can be used in a standardized way: a pilot study of two multidisciplinary, full-scale major aircraft exercises2012Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, nr 58Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Disaster medicine is a fairly young scientific discipline and there is a need for the development of new methods for evaluation and research. This includes full-scale disaster exercisers. A standardized concept on how to evaluate these exercises, could lead to easier identification of pitfalls caused by system-errors in the organization. The aim of this study was to demonstrate the feasibility of using a combination of performance and outcome indicators so that results can be compared in standardized full-scale exercises.

    Methods

    Two multidisciplinary, full-scale exercises were studied in 2008 and 2010. The panorama had the same setup. Sets of performance indicators combined with indicators for unfavorable patient outcome were recorded in predesigned templates. Evaluators, all trained in a standardized way at a national disaster medicine centre, scored the results on predetermined locations; at the scene, at hospital and at the regional command and control.

    Results

    All data regarding the performance indicators of the participants during the exercises were obtained as well as all data regarding indicators for patient outcome. Both exercises could therefore be compared regarding performance (processes) as well as outcome indicators. The data from the performance indicators during the exercises showed higher scores for the prehospital command in the second exercise 15 points and 3 points respectively. Results from the outcome indicators, patient survival and patient complications, demonstrated a higher number of preventable deaths and a lower number of preventable complications in the exercise 2010. In the exercise 2008 the number of preventable deaths was lower and the number of preventable complications was higher.

    Conclusions

    Standardized multidisciplinary, full-scale exercises in different settings can be conducted and evaluated with performance indicators combined with outcome indicators enabling results from exercises to be compared. If exercises are performed in a standardized way, results may serve as a basis for lessons learned. Future use of the same concept using the combination of performance indicators and patient outcome indicators may demonstrate new and important evidence that could lead to new and better knowledge that also may be applied during real incidents.

  • 16.
    Schilling, Ulf Martin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Akutkliniken.
    Emergency physicians are more accurate in detecting pulmonary embolism at the emergency department then internal medicine physicians2010Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 9, artikkel-id P13Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background

    Detecting pulmonary embolism (PE) is a major problem at the ED. Final diagnosis often is made by CT-scan. Due to specialisation in emergency medicine emergency physicians might perform better than internal medicine physicians in detecting PE. To confirm this hypothesis, a single center retrospective cohort-study was performed.

    Methods

    During the three-month periods (march till may) 2007 and 2008 the findings in all patients undergoing pulmonary CT at our emergency department were reviewed. The investigations were attributed to emergency physician (EP) or internal medicine physician (IP). Negative and positive investigations were evaluated, and the number of patients treated by the respective group were calculated. Statistical analysis was performed by the Students-T-test, and probability levels of 5% were accepted as significant.

    Results

    In 2007, a total of 2847 patients attended for medical problems. 576 were treated by EP (20.23%). In 2008, 2408 patients searched for medical problems and 625 (25.95%) were attended by EP. EP ordered a total of 34 pulmonary CT 2007 and 35 in 2008. 17.64% (2007)/22.86% (2008) of these resulted in the diagnosis of PE. IP ordered a 77 (2007) and 64 (2008) pulmonary CT, with positive findings in 12.98% (2007)/10.93% (2008). EP ordered pulmonary CT for 5.9% (2007)/5.6% (2008) of their patients, whilst IP performed CT-scans in 3.39% (2007)/3.59% (2008) (p = 0.0108). This means that EP have a higher index of suspicion for the diagnosis of PE at the emergency department (1.74 (2007)/1.56 (2008).

    CT-scans were positive in 1.04% (2007)/1.28% (2008) for the EP, and in 0.43% (2007)/0.39% (2008) for the IP (p < 0.01). EP are more accurate in detecting PE at the emergency department (OR 2.43(2007)/3.26(2008).

    At the hospital including the emergency department were 14.29% (2007)/14.15% (2008) of CT-scans positive. No significant difference could be found between the positive findings for all the hospital compared to the EP (p = 0.38) or IP (p = 0.27).

    Conclusion

    Emergency physicians seem to have a higher index of suspicion for PE than internal medicine physicians and are more accurate in detecting PE at the emergency department. Compared with the total of our university hospital, emergency physicians are at least comparable in diagnosing PE.

  • 17.
    Wakasugi, Masahiro
    et al.
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum.
    Nilsson, Heléne
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet.
    Hornwall, Johan
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum. Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Vikström, Tore
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet.
    Rüter, Anders
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum.
    Can performance indicators be used for pedagogic purposes in disaster medicine training?2009Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 17, nr 15Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Although disaster simulation trainings were widely used to test hospital disaster plans and train medical staff, the teaching performance of the instructors in disaster medicine training has never been evaluated. The aim of this study was to determine whether the performance indicators for measuring educational skill in disaster medicine training could indicate issues that needed improvement.

    METHODS: The educational skills of 15 groups attending disaster medicine instructor courses were evaluated using 13 measurable performance indicators. The results of each indicator were scored at 0, 1 or 2 according to the teaching performance.

    RESULTS: The total summed scores ranged from 17 to 26 with a mean of 22.67. Three indicators: 'Design', 'Goal' and 'Target group' received the maximum scores. Indicators concerning running exercises had significantly lower scores as compared to others.

    CONCLUSION: Performance indicators could point out the weakness area of instructors' educational skills. Performance indicators can be used effectively for pedagogic purposes.

  • 18.
    Winstedt, Dag
    et al.
    Lund University, Sweden.
    Tynngård, Nahreen
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Transfusionsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Diagnostikcentrum, Klinisk immunologi och transfusionsmedicin.
    Olanders, Knut
    Lund University, Sweden.
    Schott, Ulf
    Lund University, Sweden.
    Free oscillation rheometry monitoring of haemodilution and hypothermia and correction with fibrinogen and factor XIII concentrates2013Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Haemodilution and hypothermia induce coagulopathy separately, but their combined effect on coagulation has not been widely studied. Fibrinogen concentrate can correct dilutional coagulopathy and has an additional effect when combined with factor XIII concentrate. However, their effect on dilutional coagulopathy concomitant with hypothermia has not been studied previously. Free oscillation rheometry – FOR (Reorox®) – is a novel viscoelastic haemostatic assay that has not been studied in this context before.

    Methods

    Blood from 10 healthy volunteers was diluted by 33% with hydroxyethyl starch or Ringer’s acetate solutions. Effects of fibrinogen added in vitro with and without factor XIII were studied at 33°C and 37°C. Coagulation velocity (coagulation time) and clot strength (elasticity) were assessed with FOR. Coagulation was initiated in vitro with thromboplastin alone, or thromboplastin plus a platelet inhibitor.

    Results

    Hydroxyethyl starch increased the coagulation time and decreased clot strength significantly more than Ringer’s acetate solution, both in the presence and absence of a platelet inhibitor. There was a significant interaction between haemodilution with hydroxyethyl starch and hypothermia, resulting in increased coagulation time. After addition of fibrinogen, coagulation time shortened and elasticity increased, with the exception of fibrinogen-dependent clot strength (i.e., elasticity in the presence of a platelet inhibitor) after hydroxyethyl starch haemodilution. Factor XIII had an additional effect with fibrinogen on fibrinogen-dependent clot strength in blood diluted with Ringer’s acetate solution. Hypothermia did not influence any of the coagulation factor effects.

    Conclusions

    Both haemodilution and mild hypothermia impaired coagulation. Coagulopathy was more pronounced after haemodilution with hydroxyethyl starch than with Ringer’s acetate. Addition of fibrinogen with factor XIII was unable to reverse hydroxyethyl starch induced clot instability, but improved coagulation in blood diluted with Ringer’s acetate solution. Fibrinogen improved coagulation irrespective of hypothermia.

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