| 1. |
- Bergdahl, Carl, et al.
(författare)
-
Completeness in the Swedish Fracture Register and the Swedish National Patient Register: An Assessment of Humeral Fracture Registrations
- 2021
-
Ingår i: Clinical Epidemiology. - 1179-1349. ; 13, s. 325-333
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: Register-based clinical research is important. However, it is essential that the collected data are reliable for the registers to be a valuable source of information. This study evaluated the quality of humeral fracture data in the Swedish Fracture Register (SFR) and in the Swedish National Patient Register (NPR). Furthermore, a model for improved case ascertainment was developed for future validation processes. Materials and Methods: Data were obtained from the NPR and SFR for all individuals aged >= 16 years with an acute humeral fracture ICD-code treated at Sahlgrenska University Hospital. The true number of humeral fractures ("gold standard") was determined by crosslinkage between the two registers and a medical charts review. The completeness of registrations in each register was measured as the proportion of registrations compared with the gold standard, and accuracy was measured as positive predictive values (PPV). Results: The NPR demonstrated a high level of completeness (97%) and lower accuracy (PPV 70%) for acute humeral fractures, whereas the SFR had slightly lower completeness (88%) but perfect accuracy (PPV 100%). The most common systematic error was the registration of re-admissions as acute fractures in the NPR (84% of all erroneous registrations). With this knowledge, an adjustment model for NPR data was constructed to increase the accuracy of fracture registrations (PPV 92%) without excluding valid registrations. Conclusion: Data from the NPR tend to overestimate the true number of fractures, and proper case selection is needed in order for the data to function as a solid basis for epidemiological research and healthcare planning. In contrast, the SFR constitutes a complete, accurate and efficient source of information.
|
|
| 2. |
- Bergvall, M., et al.
(författare)
-
Validity of classification of distal radial fractures in the Swedish fracture register
- 2021
-
Ingår i: Bmc Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 22:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundDistal radial fractures (DRF) are one of the most common fractures with a small peak in incidence among young males and an increasing incidence with age among women. The reliable classification of fractures is important, as classification provides a framework for communicating effectively on clinical cases. Fracture classification is also a prerequisite for data collection in national quality registers and for clinical research. Since its inception in 2011, the Swedish Fracture Register (SFR) has collected data on more than 490,000 fractures. The attending physician classifies the fracture according to the AO/OTA classification upon registration in the SFR. Previous studies regarding the classification of distal radial fractures (DRF) have shown difficulties in inter- and intra-observer agreement. This study aims to assess the accuracy of the registration of DRF in adults in the SFR as it is carried out in clinical practice.MethodsA reference group of three experienced orthopaedic trauma surgeons classified 128 DRFs, randomly retrieved from the SFR, at two classification sessions 6 weeks apart. The classification the reference group agreed on was regarded as the gold standard classification for each fracture. The accuracy of the classification in the SFR was defined as the agreement between the gold standard classification and the classification in the SFR. Inter- and intra-observer agreement was evaluated and the degree of agreement was calculated as Cohen's kappa.ResultsThe accuracy of the classification of DRF in the SFR was kappa=0.41 (0.31-0.51) for the AO/OTA subgroup/group and kappa=0.48 (0.36-0.61) for the AO/OTA type. This corresponds to moderate agreement. Inter-observer agreement ranged from kappa 0.22-0.48 for the AO/OTA subgroup/group and kappa 0.48-0.76 for the AO/OTA type. Intra-observer agreement ranged from kappa 0.52-0.70 for the AO/OTA subgroup/group and kappa 0.71-0.76 for the AO/OTA type.ConclusionsThe study shows moderate accuracy in the classification of DRF in the SFR. Although the degree of accuracy for DRF appears to be lower than for other fracture locations, the accuracy shown in the current study is similar to that in previous studies of DRF.
|
|
| 3. |
- Schmidt, Viktor, et al.
(författare)
-
Epidemiology, treatment, and mortality of 3,983 scapula fractures from the Swedish fracture register
- 2024
-
Ingår i: Journal of shoulder and elbow surgery. - : Elsevier. - 1058-2746 .- 1532-6500.
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Scapula fractures are relatively uncommon, accounting for <1% of all fractures and approximately 3-5% of shoulder girdle fractures. This study comprehensively describes the epidemiology, fracture classification, treatment, and mortality associated with scapula fractures within a large adult Swedish population.METHODS: This observational study included all patients ≥18 years old at the time of injury with a scapula fracture (ICD S42.1) registered in the Swedish Fracture Register between March 2011 and June 2020. Variables studied were age, sex, and injury mechanism, including energy level, fracture classification, associated fractures, treatment, and mortality.RESULTS: We included 3,930 patients (mean age 58 years, SD 18, 64% men) with 3,973 scapula fractures. Some 22% of the fractures were caused by high-energy trauma and 21% had at least one associated fracture. High energy-injuries were most common in glenoid neck (44%) and scapular body (35%) fractures. However, same-level falls were the most common cause of glenoid rim (62%) and intra-articular glenoid (55%) fractures. Clavicle fractures (9%) and proximal humerus fractures (5%) were the most commonly associated fractures. The most common fracture types were the glenoid rim (n=1,289, 32%) and scapular body (n=1,098, 28%) fractures. Nonoperative treatment was performed in 81% of patients. Glenoid rim and intra-articular glenoid fractures were treated operatively in over 30% of cases. The mortality rate for the whole cohort was 4% at 1 year.CONCLUSIONS: Scapula fractures are predominately sustained by men. High energetic injuries and associated fractures are present in one in five patients. Nonoperative treatment is chosen in four of five patients, but for some fracture types one in three undergo surgery.
|
|
| 4. |
- Amilon, Sofia, 1982, et al.
(författare)
-
How common are refractures in childhood? a study based on 40,000 paediatric fractures from the Swedish Fracture Register
- 2023
-
Ingår i: Bone & Joint Journal. - 2049-4394. ; 105B:8, s. 928-934
-
Tidskriftsartikel (refereegranskat)abstract
- Aims The aim of this study was to describe the incidence of refractures among children, follow-ing fractures of all long bones, and to identify when the risk of refracture decreases. Methods All patients aged under 16 years with a fracture that had occurred in a bone with ongo-ing growth (open physis) from 1 May 2015 to 31 December 2020 were retrieved from the Swedish Fracture Register. A new fracture in the same segment within one year of the pri-mary fracture was regarded as a refracture. Fracture localization, sex, lateral distribution, and time from primary fracture to refracture were analyzed for all long bones. Results Of 40,090 primary fractures, 348 children (0.88%) sustained a refracture in the same long bone segment. The diaphyseal forearm was the long bone segment most commonly affected by refractures (n = 140; 3.4%). The median time to refracture was 147 days (inter-quartile range 82 to 253) in all segments of the long bones combined. The majority of the refractures occurred in boys (n = 236; 67%), and the left side was the most common side to refracture (n = 220; 62%). The data in this study suggest that the risk of refracture decreas-es after 180 days in the diaphyseal forearm, after 90 days in the distal forearm, and after 135 days in the diaphyseal tibia. Conclusion Refractures in children are rare. However, different fractured segments run a different threat of refracture, with the highest risk associated with diaphyseal forearm fractures. The data in this study imply that children who have sustained a distal forearm fracture should avoid hazardous activities for three months, while children with a diaphyseal forearm fracture should avoid these activities for six months, and for four and a half months if they have sustained a diaphyseal tibia fracture.
|
|
| 5. |
- Bergdahl, Carl
(författare)
-
Humeral fractures - Epidemiology, treatment and reoperations in the Swedish Fracture Register
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Fractures are common, but the knowledge on outcomes, treatment methods or the actual number of fractures treated each year has been sparse. With the introduction of the Swedish Fracture Register (SFR) in 2011, the prospective registration and analysis of detailed population-based fracture data was made possible for the first time. Aim: The overall aim of this thesis was to analyse the quality of data in the SFR and to determine whether, and to which extent, the SFR can be used in epidemiological research. Particularly, the incidence of humeral fractures and the mortality associated with proximal humeral fractures were analysed, and changes in treatment practice for proximal humeral fractures in recent years were evaluated. Methods: All the papers in this thesis were based on fracture registrations in the SFR. Comparisons with other data sources were made; fracture registrations in the National Patient Register (NPR) were used to examine data quality, and information from Statistics Sweden were used to calculate fracture incidence and to compare mortality rates between fracture patients and the general population. Result: In this thesis, Study I demonstrates that 88% of humeral fractures were registered in the SFR, and that all registrations were valid fracture registrations. The SFR therefore constitutes a complete, accurate and efficient source of information, well suited to epidemiological research. In contrast, data from the NPR contain a large proportion of non-valid fracture registrations and need to be improved in order to function as a solid basis for epidemiological research. Studies II-IV in this thesis demonstrate that the incidence of humeral fractures, regardless of fractured segment, increases significantly after the age of 50 years and is predominantly related to low-energy falls. This indicates the important influence of age-related risk factors, such as osteoporosis. Moreover, a proximal humeral fracture is associated with a substantially increased mortality, especially within the first weeks following the fracture. Male gender and low-energy trauma mechanisms were two independent risk factors for death following a humeral fracture. Finally, there was no significant change in the overall proportion of patients treated surgically between 2011 and 2017. However, considerable changes within the different surgical treatment modalities were observed. The use of plate fixation decreased significantly, while the use of intramedullary nails and reversed shoulder arthroplasty increased. Unfortunately, these changes in treatment practice did not affect the reoperation rate, which continued to be high throughout the study period. Conclusion: The SFR is a reliable tool for population-based observational research. Data from the SFR demonstrate that proximal humeral fractures predominately affect frail people. A surprisingly high reoperation rate calls for awareness of the importance of choosing the right treatment to the right patient.
|
|
| 6. |
- Bergdahl, Carl, et al.
(författare)
-
Mortality after a proximal humeral fracture
- 2020
-
Ingår i: Bone and Joint Journal. - 2049-4394 .- 2049-4408. ; 102-B, s. 1484-1490
-
Tidskriftsartikel (refereegranskat)abstract
- © 2020 The British Editorial Society of Bone & Joint Surgery Aims The aims of this study were to investigate the mortality following a proximal humeral fracture. Data from a large population-based fracture register were used to quantify 30-day, 90-day, and one-year mortality rates after a proximal humeral fracture. associations between the risk of mortality and the type of fracture and its treatment were assessed, and mortality rates were compared between patients who sustained a fracture and the general population. methods all patients with a proximal humeral fracture recorded in the Swedish Fracture register between 2011 and 2017 were included in the study. Those who died during follow-up were identified via linkage with the Swedish Tax Agency population register. Age- and sex-adjusted controls were retrieved from Statistics Sweden and standardized mortality ratios (Smrs) were calculated. results a total of 18,452 patients who sustained a proximal humeral fracture were included. Their mean age was 68.8 years (16 to 107) and the majority (13,729; 74.4%) were women. a total of 310 (1.68%) died within 30 days, 615 (3.33%) within 90 days, and 1,445 (7.83%) within one year after the injury. The mortality in patients sustaining a fracture and the general population was 1,680/100,000 and 326/100,000 at 30 days, 3,333/100,000 and 979/100,000 at 90 days, and 7,831/100,000 and 3,970/100,000 at one year, respectively. Increasing age, male sex, low-energy trauma, type a fracture, concomitant fractures, and non-surgical treatment were all independent factors associated with an increased risk of mortality. Conclusion Compared with the general population, patients sustaining a proximal humeral fracture have a significantly higher risk of mortality up to one year after the injury. The risk of mortality is five times higher during the first 30 days, diminishing to two times higher at one year, suggesting that these patients constitute a strikingly frail group, in whom appropriate immediate management and medical optimization are required.
|
|
| 7. |
- Bergdahl, Carl, et al.
(författare)
-
No change in reoperation rates despite shifting treatment trends: a population-based study of 4,070 proximal humeral fractures
- 2021
-
Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 92:6, s. 651-657
-
Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Clear and acknowledged treatment algorithms for proximal humeral fractures (PHFs) are lacking. Nevertheless, a change in treatment trends, including a change towards more reversed shoulder arthroplasties (RSA), has been observed during recent years. We examined the effect of these changes on reoperation rates. Patients and methods - Between 2011 and 2017, 4,070 PHFs treated at Sahlgrenska University Hospital were registered prospectively in the Swedish Fracture Register (SFR) and followed up until 2019 (mean follow-up of 4.5 years). Data on all reoperations were gathered from the SFR and from medical records. Results - The majority of PHFs were treated non-surgically and the proportion increased slightly, but not statistically significantly, during the study period (from 76% to 79%). Of the surgically treated fractures, the proportion fixed with a plate decreased from 47% to 25%, while the use of RSA increased 9-fold (from 2.0% to 19%). 221 patients underwent 302 reoperations. For those primarily treated surgically, the reoperation rate was 17%. Among treatment modalities, plate fixation was associated with the highest reoperation rate (21%). Rate of reoperations remained constant during the study period, both for the entire study cohort and for the surgically treated patients Interpretation - During the study period, treatment changes that are in accordance with recently published treatment recommendations were observed. However, these treatment changes did not affect the reoperation rate. Treatment with a plate, intramedullary nail, or hemiarthroplasty was associated with the highest reoperation rates. The fact that almost every 4th surgical procedure was a reoperation indicates a need for further improvement of modern treatment concepts for PHFs.
|
|
| 8. |
- Hugosson, Jonas, 1955, et al.
(författare)
-
Eighteen-year follow-up of the Göteborg Randomized Population-based Prostate Cancer Screening Trial : effect of sociodemographic variables on participation, prostate cancer incidence and mortality
- 2018
-
Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 52:1, s. 27-37
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: This study examined whether previously reported results, indicating that prostate-specific antigen (PSA) screening can reduce prostate cancer (PC) mortality regardless of sociodemographic inequality, could be corroborated in an 18 year follow-up. Materials and methods: In 1994, 20,000 men aged 50–64 years were randomized from the Göteborg population register to PSA screening or control (1:1) (study ID: ISRCTN54449243). Men in the screening group (n = 9950) were invited for biennial PSA testing up to the median age of 69 years. Prostate biopsy was recommended for men with PSA ≥2.5 ng/ml. Last follow-up was on 31 December 2012. Results: In the screening group, 77% (7647/9950) attended at least once. After 18 years, 1396 men in the screening group and 962 controls had been diagnosed with PC [hazard ratio 1.51, 95% confidence interval (CI) 1.39–1.64]. Cumulative PC mortality was 0.98% (95% CI 0.78–1.22%) in the screening group versus 1.50% (95% CI 1.26–1.79%) in controls, an absolute reduction of 0.52% (95% CI 0.17–0.87%). The rate ratio (RR) for PC death was 0.65 (95% CI 0.49–0.87). To prevent one death from PC, the number needed to invite was 231 and the number needed to diagnose was 10. Systematic PSA screening demonstrated greater benefit in PC mortality for men who started screening at age 55–59 years (RR 0.47, 95% CI 0.29–0.78) and men with low education (RR 0.49, 95% CI 0.31–0.78). Conclusions: These data corroborate previous findings that systematic PSA screening reduces PC mortality and suggest that systematic screening may reduce sociodemographic inequality in PC mortality.
|
|
| 9. |
- Hugosson, Jonas, 1955, et al.
(författare)
-
Mortality results from the Göteborg randomised population-based prostate-cancer screening trial.
- 2010
-
Ingår i: The lancet oncology. - 1474-5488. ; 11:8, s. 725-32
-
Tidskriftsartikel (refereegranskat)abstract
- Prostate cancer is one of the leading causes of death from malignant disease among men in the developed world. One strategy to decrease the risk of death from this disease is screening with prostate-specific antigen (PSA); however, the extent of benefit and harm with such screening is under continuous debate.
|
|
| 10. |
- Möller, Michael, 1957, et al.
(författare)
-
The Swedish Fracture Register - ten years of experience and 600,000 fractures collected in a National Quality Register
- 2022
-
Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background Before the creation of the Swedish Fracture Register (SFR), there was no national quality register that prospectively collects data regarding all types of fractures regardless of treatment in an emergency setting. Observational data on fractures registered in a sustainable way may provide invaluable tools for quality improvements in health care and research. Description Ten years after its implementation, the Swedish Fracture Register has 100% coverage among orthopaedic and trauma departments in Sweden. The completeness of registrations reached in 2020 69-96% for hip fractures at the different departments, with the majority reporting a completeness above 85%. The Swedish Fracture Register is a fully web-based national quality register created and run by orthopaedic professionals, with financial support from public healthcare providers and the government. All users have full access to both the registration platform and all aggregated statistics in real time. The web-based platform was created for use in health quality registers and it has easily gained acceptance among users. The register has gradually developed by the addition of more fracture types and skeletal parts. Research activity is high and 31 scientific publications have been published since 2016. The strategy from the start was to publish validation data and basic epidemiological data. However, over the past few years, publications on outcomes, such as re-operations and mortality, have been published and four register-based, randomised, controlled trials are ongoing. Conclusion It is possible to create a fracture register, to gain professional acceptance and to collect fracture data in a sustainable way on a national level if the platform is easy to use. Such a platform can also be used as a randomisation platform for prospective studies.
|
|
