| 1. |
|
|
| 2. |
- Albaaj, Hussein, et al.
(författare)
-
Patient and process factors associated with opportunities for improvement in trauma care : a registry-based study
- 2023
-
Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central (BMC). - 1757-7241. ; 31:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background Trauma is one of the leading causes of morbidity and mortality worldwide. Morbidity and mortality review of selected patient cases is used to improve the quality of trauma care by identifying opportunities for improvement (OFI). The aim of this study was to assess how patient and process factors are associated with OFI in trauma care.Methods We conducted a registry-based study using all patients between 2017 and 2021 from the Karolinska University Hospital who had been reviewed regarding the presence of OFI as defined by a morbidity and mortality conference. We used bi- and multivariable logistic regression to assess the associations between the following patient and process factors and OFI: age, sex, respiratory rate, systolic blood pressure, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), survival at 30 days, highest hospital care level, arrival on working hours, arrival on weekends, intubation status and time to first computed tomography (CT).Results OFI was identified in 300 (5.8%) out of 5182 patients. Age, missing Glasgow Coma Scale, time to first CT, highest hospital care level and ISS were statistically significantly associated with OFI.Conclusion Several patient and process factors were found to be associated with OFI, indicating that patients with moderate to severe trauma and those with delays to first CT are at the highest odds of OFI.
|
|
| 3. |
- Bartha, Erzsebet, et al.
(författare)
-
ASA classification and surgical severity grading used to identify a high-risk population, a multicenter prospective cohort study in Swedish tertiary hospitals
- 2021
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 65:9, s. 1168-1177
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Identification of surgical populations at high risk for negative outcomes is needed for clinical and research purposes. We hypothesized that combining two classification systems, ASA (American Society of Anesthesiology physical status) and surgical severity, we could identify a high-risk population before surgery. We aimed to describe postoperative outcomes in a population selected by these two classifications system.Methods: Data were collected in a Swedish multicentre, time-interrupted prospective, consecutive cohort study. Eligibility criteria were age >= 18 years, ASA >= 3, elective or emergent, major to Xmajor/complex (Specialist Procedure Codes used in United Kingdom), gastrointestinal, urogenital or orthopaedic procedures. Postoperative morbidity was identified by the Postoperative Morbidity Survey on postoperative days 3 +/- 1, 7 +/- 1, 10 + 5 and graded for severity by the Clavien-Dindo system. Mortality was assessed at 30, 180 and 360 days.Results: Postoperative morbidity was 78/48/47 per cent on postoperative days 3/7/10. Majority of morbidities (67.5 per cent) were graded as >1 by Clavien-Dindo. Any type of postoperative morbidity graded >1 was associated with increased risk for death up to one year. The mortality was 5.7 per cent (61/1063) at 30 days, 13.3 per cent (142/1063) at 6 months and 19.1 per cent (160/1063) at 12 months.Conclusion: Severity classification as major to Xmajor/complex and ASA >= 3 could be used to identify a high-risk surgical population concerning postoperative morbidity and mortality before surgery. Combining the two systems future electronic data extraction is possible of a high-risk population in tertiary hospitals.
|
|
| 4. |
- Bartha, Erzsebet, et al.
(författare)
-
Combining functional dependency and ASA III classification for risk stratification-predictors, risk factors, and outcomes following major surgery study (NCT02626546)
- 2017
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 61:8, s. 1011-1011
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: In elderly reclassification of ASA3 class by functional dependency improved prediction of postoperative mortality. We hypothesized that such a reclassification could improve the risk prediction of adverse outcomes also following high risk surgery.Method: We analyzed data collected by the PROFS study in four Swedish academic hospitals. The inclusion criteria were: adults, ASA≥3, major or xmajor/complex surgery (UK surgical severity coding). ASA 3 patients were reclassified into ASA 3a (functionally independent) and 3b (functionally dependent). The adverse outcomes were postoperative complications (yes/no) screened by Postoperative Morbidity Survey (days 3, 7, 10) and mortality (30-day). Complications graded ≥2 by Clavien-Dindo classification were considered. The predictive value of reclassification was analyzed by logistic regression models.Results: Between 2015 Nov2th and 2016 Feb19th 1089 patients were include; 13 were excluded (violation of inclusion criteria), 3 were lost to follow-up and 1073 were analyzed. ASA 3b (vs ASA 3a) patients had higher risk for mortality and for postoperative complications at days 7 and 10. ASA 4 (vs ASA 3) patients had higher risk of all adverse outcomes (Table 1). When age was added in the regression model ASA 3b patients still had higher risk for postoperative complications at day 10, but the significance disappeared when also urgency was added.Conclusion: The loss of significance by adding urgency in the model might be attributed to the dominance of urgent procedures in ASA3b and ASA4 groups. Reclassification of ASA 3 patients by dependency is recommended, as it may predict adverse outcomes and support clinical judgment.
|
|
| 5. |
- Bartha, Erzsebet, et al.
(författare)
-
Performance of prediction models of postoperative mortality in high-risk surgical patients in swedish university hospitals : Predictors, Risk factors and Outcome Following major Surgery study (PROFS study NCT02626546)
- 2017
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 61:8, s. 1056-1057
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: There are several progn ostic prediction models that estimate the probability of postoperative mortality. The role of these models is to support clinical decisions. Before implementation of a prediction model in routine care, it is necessary to analyze its performance in the target population. Our aim was to analyze the performance of four different prediction models of postoperative mortality in a high-risk surgical population.Methods: Data collected from 2015-11-01 until 2016-02-15 in a prospective consecutive observational study (PROFS study) in four university hospitals was used. The inclusion criteria were adult, ASA classification ≥3, and major/complex upper or lower gastrointestinal, urogenital or orthoped ic surgery (UK surgical severity codingA XA PPP). Four prediction models were evaluated: Surgical Outcome Risk Tool (SORT), Surgical APGAR, P-POSSUM and Surgical Risk Scale (SRS). The outcome measure was 90-day mortality. We evaluated the discrimination of the models by area under receiver operator characteristic curve (AUC ROC) before and after recalibration.Results: In total, 1 089 patients were included. Thirteen patients were excluded due to erroneous inclusion, and another three were lost to follow-up, so data from 1 073 was used in this analysis. The mean age was 73 years, the presence of malignancy was 41%, and 90-day mortality was 13% (n = 140). The SORT model had the best discrimination both before and after recalibration. The P-POSSUM model improved after recalibration. The SRS model overestimated, whereas the APGAR model underestimated, the risk of mortality.Conclusions: The original SORT model is promising and could be incorporated as decision support for high-risk surgical patients.
|
|
| 6. |
|
|
| 7. |
- Brattström, Olof
(författare)
-
Trauma in a Scandinavian urban region : epidemiological aspects on risk factors and outcome
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Trauma as a disease is a global health problem and for patients surviving the initial injury and early resuscitation phase, later complications contribute largely to morbidity and mortality. Awareness of risk factors, early recognition and appropriate treatment of complications are likely to have a significant influence on outcome. Early identification of patients at risk may contribute to optimising initial resuscitation, intensive care and long-term outcome. This thesis is based on four studies using epidemiological data from local and national registries. The aims of this thesis were to study incidence and risk factors for complications and mortality in severe trauma and the influence of socioeconomic factors and comorbidity on the risk of becoming a trauma victim. Study I was a cohort study of 164 trauma patients admitted to the central intensive care unit at the Karolinska University Hospital, Stockholm. We found an incidence of multiple organ failure, acute lung injury and severe sepsis of 40.2%, 25.6% and 31.1% respectively. 30-and 90-day post-injury mortality was 10.4%. Intensive care unit-complications and death were not uniformly affected by the different risk factors. In study II we investigated the influence of gender and comorbidity on 30-and 360-day survival of individuals registered in the trauma registry at Karolinska University Hospital, Stockholm between January 2005 and August 2008. In addition we evaluated survival over time in relation to the general population. The influence of gender and comorbidity on outcome after trauma differed over time. Male gender was an independent risk factor for mortality at one year but not at 30-days post injury and the effect of gender seemed to be restricted to elderly patients. The presence of comorbidity became a significant risk factor beyond 30 days after trauma. A persistent excess mortality in comparison to the general population was seen among men one year after trauma, standardized mortality ratio 3.8 (95% CI 2.8 - 5.1). Our aim of study III was to report the overall incidence of pneumonia in intensive care unit-treated trauma patients and to investigate risk factors for development post injury pneumonia following severe trauma. The study cohort consisted of 322 trauma patients admitted to the central intensive care unit at the Karolinska University Hospital, Stockholm between February 2007 and July 2011. The incidence of pneumonia was 26% during their first 10 days in the ICU. Reduced consciousness was an independent risk factor for development of pneumonia after severe injury. Study IV was a case-control study, cases (n = 7382) were defined as all patients 15 years or older registered in the trauma registry with a first trauma admission between January 2005 and December 2010. A random selection of 36760 age, gender and municipality matched controls were extracted from the Total population registry. Our aim was to study the influence of socioeconomic factors and comorbidity on the risk of becoming a trauma victim. Level of education and income as well as substance abuse, psychiatric, and somatic comorbidity were all independent risk factors for trauma. Active substance abuse strongly influenced the risk for trauma and had a time dependent pattern.
|
|
| 8. |
|
|
| 9. |
- Kalman, Sigridur, et al.
(författare)
-
Postoperative complications in high-risk surgical patients - predictors, risk factors, and outcomes following major surgery study (PROFS study NCT02626546) : validation of three prediction models
- 2017
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 61:8, s. 1056-1056
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Postoperative complications increase the risk of death 2–3 years postoperatively. Prediction of complications can support clinical decisions. Before clinical use of any prediction model, validation is reasonable. We aimed to validatethree models: Revised Cardiac Risk Index (RCRI), ARISCAT and POSSUM.Methods: The PROF S-study was performed in four Swedish university hospitals. Patients werere cruited between 2015-11-01 and 2016-02-15. Inclusion criteria were adults, ASA classification ≥3, major/complex upper and lower gastrointestinal, urogenital or orthopedic surgery. Complications were screened on days 3, 7 and 10 by the postoperative morbidity survey (POMS). Only patients with grade≥2 (Clavien-Dindo classification) were accounted for. Study outcomes were cardiovascular (RCRI model) and pulmonary (ARISCAT model) complications, and a composite of the POMS domains (POSSUM model). Discrimination was evaluated by C-statistics (area under receiver operator characteristic curve; AUC ROC).Results: The number of patients included was 1089. Thirteen patients were excluded due to wrong inclusion, and another three were lost to follow-up. Presen ce of malignancy was 41%. Patient characteristics and outcomes are displayed in Table 1. The RCRI underestimated the risk for cardiovascular complications, and discrimination was low (AUC ROC 0.64; 95% CI 0.59–0.68). The prediction by the ARISCAT model was fair (AUC 0.72; CI 0.69–0.76). The POSSUM model had poor /fair discrimination (AUC 0.70; CI 0.67–0.73).Conclusions: The ARISCAT model predicted pulmonary complications with fair discrimina-tion and so could be used as decision support. Parameters with significant odds ratios of the RCRI and POSSU M models might be used as complements of clinical judgement.
|
|
| 10. |
- Wihlke, Gunilla, et al.
(författare)
-
Long-term follow-up of patients treated for traumatic injury regarding physical and psychological function and health-related quality of life
- 2021
-
Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer. - 1863-9933 .- 1863-9941. ; 47:1, s. 129-135
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose Trauma patients often suffer for long time after their injury with physical and psychological problems. Patient-reported outcome measurements (PROM) help us to understand outcomes beyond mortality. The aim of the study was to describe a sample of Swedish trauma patients, regarding their physical function, psychological morbidity, and quality of life after trauma. Methods The study population was sourced from the Swedish Trauma Register: taking 1 month of data from five hospitals, over three consecutive years. 218 patients met the inclusion criteria, 147 data sets were used. Inclusion criteria included: age >= 18; New Injury Severity Scale (NISS) >= 9; and discharged alive. Data were collected at 3, 6, and 12 months after the trauma. EuroQol-5D (EQ-5D), Posttraumatic Symptom Scale-10 (PTSS-10) questionnaires and Glasgow Outcome Score (GOS) instrument were used with additional questions about pain and return to work. Results 12 months after the trauma: full functional recovery (GOS 5) was seen in 68% of the patients; 59% reported difficult or moderate pain or discomfort; and 44.5% of the patients had returned to work. In EQ-5D mobility dimension, no recovery was evident between 6 and 12 months. Twenty percent of the patients had significant symptoms for PTSD after 6 months and 16% after 3 months and 12 months. Conclusion Trauma patients had decreased physical function and psychological morbidity up to 1 year after the initial injury. Incorporating PROM in the follow-up after trauma is important to understand the patient's perspective of care and treatment.
|
|
