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- Bellner, Johan, et al.
(författare)
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Behov av handläggningsrutiner för lätt skallskadade patienter
- 1999
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Ingår i: Läkartidningen. - 0023-7205. ; 96:47, s. 5196-5198
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Tidskriftsartikel (refereegranskat)abstract
- Developing guidelines for quality assurance in the management of head injury requires knowledge concerning present management practice. We studied management of minor head injury (MHI) using a cross-sectional mail survey of 76 Swedish hospitals. In 96% of the hospitals, initial patient evaluation, frequently performed by inexperienced physicians, entails neurological assessment according to the Swedish Reaction Level Scale or the Glasgow Coma Scale, while computerised tomography (CT) is used routinely in 4%. This survey indicates great variability in the management of MHI in hospitals in Sweden. Fifteen (21%) hospitals consistently hospitalize all MHI patients for overnight observation, while 56 (79%) have established criteria for early discharge of selected patients. Routines for neurological assessment are satisfactory, while CT scan for skull fracture and early diagnosis of intracranial complications is usually not performed.
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- Bellner, Johan, et al.
(författare)
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Diagnostic criteria and the use of ICD-10 codes to define and classify minor head injury.
- 2003
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Ingår i: Journal of Neurology, Neurosurgery and Psychiatry. - : BMJ. - 1468-330X .- 0022-3050. ; 74:3, s. 351-352
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Epidemiological research on the incidence of traumatic head injuries relies on the correct definition and classification of the injury. OBJECTIVE: To address the use of diagnostic criteria and ICD-10 codes to define minor head injury in Swedish hospitals managing patients with head injury. METHODS: A questionnaire was mailed to all 76 Swedish hospitals managing head injuries. The hospitals were asked what diagnostic criteria they use to define minor head injury, and which ICD-10 codes they use to classify such injuries. RESULTS: 72 hospitals (95%) responded to the survey. The most common criterion was loss of consciousness (76%), followed by post-traumatic amnesia (38%). Almost half the hospitals used other signs and symptoms to define minor head injury. The ICD-10 code S.06 (intracranial injury) was used by 51 of the hospitals (91%). CONCLUSIONS: It is essential that there should be common definitions, classifications, and registration of minor head injuries. The wide variation in definition and classification found in this study emphasises the importance of improved implementation of the present guidelines.
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- Bellner, Johan, et al.
(författare)
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Survey of the management of patients with minor head injuries in hospitals in Sweden
- 1999
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Ingår i: Acta Neurologica Scandinavica. - 1600-0404. ; 100:6, s. 355-359
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Development of guidelines for quality assurance in head injury care has to be based on knowledge about how today's management is organized. To address the need for guidelines in minor head injury (MHI), the authors studied management practice in Sweden. METHODS: We performed a cross-sectional mail survey including all 76 hospitals treating head-injured patients. The questionnaire outlined present management practice in MHI; including routines for clinical and radiological examinations, in-hospital observation, discharge criteria and follow-up. RESULTS: The initial evaluation is frequently performed by inexperienced physicians. The level of consciousness is assessed according to the Swedish Reaction Level Scale or the Glasgow Coma Scale in 96% of the hospitals. Routine computerized tomography is used in 4%. Skull radiography is not routinely performed. Eighty percent of the hospitals discharge selected patients without in-hospital observation and most (93%) offer no routine follow-up. CONCLUSIONS: This survey shows a variation in the management of MHI in hospitals in Sweden. Routines for assessment of consciousness level are satisfactory, but CT scan for detection of skull fracture and early diagnoses of intracranial complications is usually not performed. Guidelines should be based on present routines including decision rules for CT scan.
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| 7. |
- Bellner, Johan, et al.
(författare)
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Transkraniell dopplermätning avspeglar intrakraniellt tryck
- 2005
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Ingår i: Läkartidningen. - 0023-7205. ; 102:11, s. 840-844
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Tidskriftsartikel (refereegranskat)abstract
- Vid intrakraniell patologi, speciellt om patienten är medvetslös, är kunskap om det intrakraniella trycket av särskilt värde i neurointensivvård. Intraventrikulär kateter för mätning av intrakraniellt tryck har varit etablerad standard i årtionden. Exakta mätningar är möjliga endast genom invasiva tryckmätare. För att undersöka sambandet mellan intrakraniellt tryck och pulsatilt index, erhållet med transkraniell doppler, har vi genomfört en prospektiv studie. Registreringar av intrakraniellt tryck gjordes parallellt med alla dopplerundersökningar. En stark, signifikant korrelation sågs mellan intrakraniellt tryck och pulsatilt index med en korrelationskoefficient på 0,938. För detektion av ett intrakraniellt tryck >20 mm Hg i en population med intrakraniellt tryck mellan 10 och 40 mm Hg hade metoden – för alla mätningar – en sensitivitet på 0,83 och en specificitet på 0,99. Hos patienter med misstänkt förhöjt intrakraniellt tryck eller hos patienter där förhöjt intrakraniellt tryck måste uteslutas kan mätningar av pulsatilt index vara av stort värde.
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| 8. |
- Björkman-Burtscher, Isabella, et al.
(författare)
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Aneurysm clip MR artifacts. Titanium versus stainless steel and influence of imaging parameters
- 1998
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Ingår i: Acta Radiologica. - 1600-0455. ; 39:1, s. 70-76
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to evaluate the extent to which titanium aneurysm clips could improve the quality of MR imaging compared with stainless steel clips, and to determine whether the clip artifacts could be reduced by controlling certain MR imaging parameters in frequently used pulse sequences. MATERIAL AND METHODS: The metal artifacts induced by 3 aneurysm clips were compared in 3 pulse sequences. The clips were: a Yasargil titanium aneurysm clip FT 752 T; a Yasargil standard aneurysm clip FE 752 K; and, for comparison, a ferromagnetic Scoville aneurysm clip En-58J. The pulse sequences were: spin echo (SE); gradient echo (GE); and fast SE. An evaluation was made of 3 imaging parameters with regard to their influence on the size of the metal artifacts. The parameters were: bandwidth; echo time (TE); and echo-train length. RESULTS: The titanium clip showed artifacts that were about 60% smaller than those from the stainless steel clip. The only parameter that influenced artifact size to any major degree was bandwidth in the SE sequences but not in the GE sequences. GE sequences induced larger artifacts than SE sequences and showed larger artifacts with longer TE. CONCLUSION: Titanium aneurysm clips reduced MR artifacts by approximately 60% compared to stainless steel clips. Artifacts were further reduced by using SE-based sequences with a high bandwidth or, if necessary, GE sequences with a low TE.
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- Christensen, Jakob Hakon, et al.
(författare)
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Preservation of the blood brain barrier and cortical neuronal tissue by liraglutide, a long acting glucagon-like-1 analogue, after experimental traumatic brain injury.
- 2015
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:3
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Tidskriftsartikel (refereegranskat)abstract
- Cerebral edema is a common complication following moderate and severe traumatic brain injury (TBI), and a significant risk factor for development of neuronal death and deterioration of neurological outcome. To this date, medical approaches that effectively alleviate cerebral edema and neuronal death after TBI are not available. Glucagon-like peptide-1 (GLP-1) has anti-inflammatory properties on cerebral endothelium and exerts neuroprotective effects. Here, we investigated the effects of GLP-1 on secondary injury after moderate and severe TBI. Male Sprague Dawley rats were subjected either to TBI by Controlled Cortical Impact (CCI) or sham surgery. After surgery, vehicle or a GLP-1 analogue, Liraglutide, were administered subcutaneously twice daily for two days. Treatment with Liraglutide (200 μg/kg) significantly reduced cerebral edema in pericontusional regions and improved sensorimotor function 48 hours after CCI. The integrity of the blood-brain barrier was markedly preserved in Liraglutide treated animals, as determined by cerebral extravasation of Evans blue conjugated albumin. Furthermore, Liraglutide reduced cortical tissue loss, but did not affect tissue loss and delayed neuronal death in the thalamus on day 7 post injury. Together, our data suggest that the GLP-1 pathway might be a promising target in the therapy of cerebral edema and cortical neuronal injury after moderate and severe TBI.
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