| 1. |
- Ahl, Rebecka, 1987-, et al.
(author)
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Digital rectal examination for initial assessment of the multi-injured patient : Can we depend on it?
- 2016
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In: Annals of Medicine and Surgery. - : Elsevier. - 2049-0801. ; 9, s. 77-81
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Journal article (peer-reviewed)abstract
- Background: Digital rectal examination (DRE) is part of the assessment of trauma patients as recommended by ATLS (R). The theory behind is to aid early diagnosis of potential lower intestinal, urethral and spinal cord injuries. Previous studies suggest that test characteristics of DRE are far from reliable. This study examines the correlation between DRE findings and diagnosis and whether DRE findings affect subsequent management.Materials and methods: Patients with ICD-10 codes for spinal cord, urethral and lower intestinal injuries were identified from the trauma registry at an urban university hospital between 2007 and 2011. A retrospective review of electronic medical records was carried out to analyse DRE findings and subsequent management.Results: 253 patients met the inclusion criteria with a mean age of 44 +/- 20 years and mean ISS of 26 +/- 16. 160 patients had detailed DRE documentation with abnormal findings in 48%. Sensitivity rate was 0.47. Correlational analysis between examination findings and diagnosis gave a kappa of 0.12. Subsequent management was not altered in any case due to DRE findings.Conclusion: DRE in trauma settings has low sensitivity and does not change subsequent management. Excluding or postponing this examination should therefore be considered. (C) 2016 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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| 2. |
- Ahl, Rebecka, 1987-, et al.
(author)
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Does beta-blockade reduce the risk of depression in patients with isolated severe extracranial injuries?
- 2017
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In: World Journal of Surgery. - New York : Springer. - 0364-2313 .- 1432-2323. ; 41:7, s. 1801-1806
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Journal article (peer-reviewed)abstract
- BACKGROUND: Approximately half of trauma patients develop post-traumatic depression. It is suggested that beta-blockade impairs trauma memory recollection, reducing depressive symptoms. This study investigates the effect of early beta-blockade on depression following severe traumatic injuries in patients without significant brain injury.METHODS: Patients were identified by retrospectively reviewing the trauma registry at an urban university hospital between 2007 and 2011. Severe extracranial injuries were defined as extracranial injuries with Abbreviated Injury Scale score ≥3, intracranial Abbreviated Injury Scale score <3 and an Injury Severity Score ≥16. In-hospital deaths and patients prescribed antidepressant therapy ≤1 year prior to admission were excluded. Patients were stratified into groups based on pre-admission beta-blocker status. The primary outcome was post-traumatic depression, defined as receiving antidepressants ≤1 year following trauma.RESULTS: Five hundred and ninety-six patients met the inclusion criteria with 11.4% prescribed pre-admission beta-blockade. Patients receiving beta-blockers were significantly older (57 ± 18 vs. 42 ± 17 years, p < 0.001) with lower Glasgow Coma Scale score (12 ± 3 vs. 14 ± 2, p < 0.001). The beta-blocked cohort spent significantly longer in hospital (21 ± 20 vs. 15 ± 17 days, p < 0.01) and intensive care (4 ± 7 vs. 3 ± 5 days, p = 0.01). A forward logistic regression model was applied and predicted lack of beta-blockade to be associated with increased risk of depression (OR 2.7, 95% CI 1.1-7.2, p = 0.04). After adjusting for group differences, patients lacking beta-blockers demonstrated an increased risk of depression (AOR 3.3, 95% CI 1.2-8.6, p = 0.02).CONCLUSIONS: Pre-admission beta-blockade is associated with a significantly reduced risk of depression following severe traumatic injury. Further investigation is needed to determine the beneficial effects of beta-blockade in these instances.
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| 3. |
- Ahl, Rebecka, 1987-, et al.
(author)
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Risk factors for depression following traumatic injury : An epidemiological study from a scandinavian trauma center
- 2017
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In: Injury. - : Elsevier. - 0020-1383 .- 1879-0267. ; 48:5, s. 1082-1087
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Journal article (peer-reviewed)abstract
- INTRODUCTION: A significant proportion of patients suffer depression following traumatic injuries. Once manifested, major depression is challenging to overcome and its presence risks impairing the potential for physical rehabilitation and functional recovery. Risk stratification for early detection and intervention in these instances is important. This study aims to investigate patient and injury characteristics associated with an increased risk for depression.METHODS: All patients with traumatic injuries were recruited from the trauma registry of an urban university hospital between 2007 and 2012. Patient and injury characteristics as well as outcomes were collected for analysis. Patients under the age of eighteen, prescribed antidepressants within one year of admission, in-hospital deaths and deaths within 30days of trauma were excluded. Pre- and post-admission antidepressant data was requested from the national drugs registry. Post-traumatic depression was defined as the prescription of antidepressants within one year of trauma. To isolate independent risk factors for depression a multivariable forward stepwise logistic regression model was deployed.RESULTS: A total of 5981 patients met the inclusion criteria of whom 9.2% (n=551) developed post-traumatic depression. The mean age of the cohort was 42 [standard deviation (SD) 18] years and 27.1% (n=1620) were females. The mean injury severity score was 9 (SD 9) with 18.4% (n=1100) of the patients assigned a score of at least 16. Six variables were identified as independent predictors for post-traumatic depression. Factors relating to the patient were female gender and age. Injury-specific variables were penetrating trauma and GCS score of≤8 on admission. Furthermore, intensive care admission and increasing hospital length of stay were predictors of depression.CONCLUSION: Several risk factors associated with the development of post-traumatic depression were identified. A better targeted in-hospital screening and patient-centered follow up can be offered taking these risk factors into consideration.
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| 4. |
- Ahl, Rebecka, 1987-
(author)
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The Association Between Beta-Blockade and Clinical Outcomes in the Context of Surgical and Traumatic Stress
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Traumatic injury and major abdominal surgery are areas in general surgery associated with high rates of morbidity and mortality. The overall colorectal cancer surgery mortality rate is around 4%, with that for emergency surgery more than twice as high as for planned. Surgical morbidity varies between 25% and 45%. Around half of trauma patients develop low mood. In one quarter of patients this becomes permanent. Depression is known to impede physical rehabilitation and recovery. The onset of physiological stress, driven by adrenergic hyperactivity following traumatic and surgical injury is hypothesized to contribute to these adverse outcomes. Interest has therefore been sparked into blocking adrenergic receptor activation.Papers I and II investigated the role of beta-blocker therapy in preventing post-traumatic depression following severe traumatic brain injury (Paper I) and severe extracranial injury (Paper II). The Karolinska University Hospital Trauma Registry was used to identify patients admitted between 2007 and 2011. In Paper I (n = 545), patients on pre-injury beta-blocker therapy were matched to beta-blocker naïve patients with equivalent injury burden. Results revealed that beta-blocked patients exhibited a 60% reduced risk of needing antidepressant therapy within one year of trauma. In Paper II (n = 596), the lack of beta-blocker use before extracranial trauma was linked to a three-fold increase in the risk of antidepressant initiation.Papers III-V explored the role of pre-operative beta-blocker therapy in patients undergoing surgery for colorectal cancer between 2007 and 2016, identified using the nationwide Swedish Colorectal Cancer Registry. Paper III (n = 3,187) identified a 69% reduction in the risk of 30-day mortality in beta-blocked patients. Paper IV (n = 22,337) outlined long-term survival benefits for patients on beta-blocker therapy prior to undergoing elective surgery for colon cancer. Beta-blocked patients showed a risk reduction of 42% for 1-year all-cause mortality and 18% for 5-year cancerspecific mortality. Similarly, patients on beta-blocker therapy who underwent surgery for rectal cancer demonstrated improved survival up to one year after surgery with a risk reduction of 57% and a reduction in anastomotic failure and infectious complications in Paper V (n = 11,966).
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| 5. |
- Ahl, Rebecka, 1987-, et al.
(author)
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β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome : a matched case control study
- 2017
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In: European Journal of Trauma and Emergency Surgery. - : Springer Berlin/Heidelberg. - 1863-9933 .- 1863-9941. ; 43:6, s. 783-789
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Journal article (peer-reviewed)abstract
- PURPOSE: Severe traumatic brain injury (TBI) is the predominant cause of death and disability following trauma. Several studies have observed improved survival in TBI patients exposed to β-blockers, however, the effect on functional outcome is poorly documented.METHODS: Adult patients with severe TBI (head AIS ≥ 3) were identified from a prospectively collected TBI database over a 5-year period. Patients with neurosurgical ICU length of stay <48 h and those dying within 48 h of admission were excluded. Patients exposed to β-blockers ≤ 48 h after admission and who continued with treatment until discharge constituted β-blocked cases and were matched to non β-blocked controls using propensity score matching. The outcome of interest was Glasgow Outcome Scores (GOS), as a measure of functional outcome up to 12 months after injury. GOS ≤ 3 was considered a poor outcome. Bivariate analysis was deployed to determine differences between groups. Odds ratio and 95% CI were used to assess the effect of β-blockers on GOS.RESULTS: 362 patients met the inclusion criteria with 21% receiving β-blockers during admission. After propensity matching, 76 matched pairs were available for analysis. There were no statistical differences in any variables included in the analysis. Mean hospital length of stay was shorter in the β-blocked cases (18.0 vs. 26.8 days, p < 0.01). The risk of poor long-term functional outcome was more than doubled in non-β-blocked controls (OR 2.44, 95% CI 1.01-6.03, p = 0.03).CONCLUSION: Exposure to β-blockers in patients with severe TBI appears to improve functional outcome. Further prospective randomized trials are warranted.
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| 6. |
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| 7. |
- Englund, Liselotte, 1964-, et al.
(author)
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Bombattentatet i Oslo och skjutningarna på Utøya 2011 : Kamedo-rapport 97
- 2012
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Reports (other academic/artistic)abstract
- Fredagen den 22 juli 2011 kl. 15.25 detonerade en sprängladdning i regeringskvarteret i centrala Oslo. Bomben var mycket kraftig – åtta personer dödades, minst 90 skadades och kringliggande byggnader fick omfattande skador. Senare samma eftermiddag klev en man som utgav sig för att vara polis iland på ön Utøya, där det norska Arbeiderpartiets ungdomsförbund höll ett sommarläger. Väl iland på ön började mannen skjuta omkring sig. När han senare greps av polis hade 69 personer dödats och 65 skadats. De flesta var barn eller ungdomar. Händelserna den 22 juli involverade stora delar av det norska samhället. De många skadade krävde stora insatser från hälso- och sjukvården och det fanns ett stort behov av psykosocialt stöd till de många överlevande och deras anhöriga, samt till de avlidnas anhöriga. Vidare väckte händelserna ett mycket stort medialt intresse som de berörda aktörerna var tvungna att förhålla sig till.Rapporten omfattar en diskussion kring den norska hanteringen av 22 juli 2011, samt hur det svenska samhället hade kunnat hantera en motsvarande händelse.Tre huvudområden belyses: hälso- och sjkukvård, psykosocialt stöd samt kommunikation och mediehantering.
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| 8. |
- Englund, Liselotte, 1964-, et al.
(author)
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The bomb attack in Oslo and the shootings at Utøya, 2011 : Kamedo report 97
- 2012
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Reports (other academic/artistic)abstract
- The Kamedo observer reports study the medical, psychological, organizational and social aspects of disasters. This report summaries experiences from the bomb attack in Oslo and the shootings at Utøya, 2011. That may be valuable for the further development of the Swedish disaster preparedness system.
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| 9. |
- Junuzovic, Mensura, 1970-
(author)
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Firearm deaths in Sweden : epidemiology with emphasis on accidental deaths and prevention
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Prevention of firearm deaths and injuries is an important public health issue that may save human lives. The aim of this thesis was to investigate the epidemiology and attributes of accidental firearm fatalities in Sweden, and to provide a basis for further preventive measures. Data were obtained from the database of the National Board of Forensic Medicine, the National Patient Register, the Prescribed Drug Register, the Firearm Register, and from questionnaire responses.All 48 accidental firearm fatalities that involved hunting in 1983-2008 were investigated (Paper I). The victims’ mean age was 50 years, 96% were males. During moose hunting, most victims were mistaken for game (41%), whereas during small game hunting, fatalities were mostly related to falls (31%) and improper weapon handling (15%). Hunters’ habits and attitudes towards preventive measures and their experience of firearm incidents were investigated through a questionnaire, which was sent to 1,000 hunters (Paper II). The response rate was approximately 50%. The mean age of the respondents was 54 years and females accounted for 5%. One quarter of the respondents stated that they had witnessed a firearm incident caused by another hunter, of which more than half suggested that improper handling of the weapon and inappropriate hunting strategies were the main causes of these events.All 43 accidental non-hunting firearm deaths in Sweden 1983-2012 were investigated (Paper III). In 56% of cases, the fatality was caused by another person. Victims were mostly young males (mean age 25 years). The main cause of the incidents was human error. The majority of cases (63%) involved legal firearm. Most victims killed by illegal firearm (85%) were under the influence of alcohol and/or drugs at the time of death. Both the risk of being killed as a result of hunting (Paper I) and non-hunting accidental firearm injury (Paper III) decreased after the introduction of the mandatory hunter’s exam in 1985 (p < 0.001).Firearm deaths in Sweden including 52 accidental fatalities and 3 cases with undetermined manner of death in 1987-2013, as well as 213 suicides and 23 solved homicides in 2012-2013, were studied (Paper IV). The number of firearm suicides was positively correlated to the number of licensed firearm owners. Legal firearm use predominated in firearm suicides and accidental deaths, illegal in firearm homicides. The majority of the shooters in accidental deaths and suicides had no registered visits to inpatient care or specialized outpatient care. Less than half (42%) of all suicide victims had had a health care contact due to mental health problems. Physician’s mandatory reporting to the police of patients deemed unsuitable for possessing a firearm license did not include any of the suicide victims and the shooters in accidental deaths.This thesis confirmed that accidental firearm deaths are rare, and indicates that the firearm law changes in 1985 contributed to a decline of such fatalities. Human error was the main “cause” of the fatalities and future prevention measures should target improper weapon handling. Physician’s mandatory reporting to the police was suboptimal and barely contributed to the decline of accidental firearm deaths. If streamlined it may, however, represent an important prevention strategy in firearm suicides, claiming most lives among firearm deaths. A significant fraction of non-hunting fatalities, firearm suicides and homicides was associated with illegal firearm use, a fact calling for prevention issues targeting such firearm use.
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| 10. |
- Lindahl, Andreas, 1974-
(author)
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Neuroendocrine Stress Response after Burn Trauma
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Some aspects of the stress response during acute intensive care for severe burns are described and quantified by measuring hormonal and neuroendocrine patterns and relating these to organ function in the short term. This includes an assessment of whether there are markers for the severity of stress that are better than conventional descriptors of the severity of a burn in predicting failing organ function.P-CgA after a major burn injury is an independent and better predictor of organ dysfunction assessed as SOFA score than the traditionally used TBSA% burned. The results also suggest that the extent of neuroendocrine activation is related to organ dysfunction, and this motivates a more extensive effort to evaluate P-CgA as a prognostic marker with respect to mortality and long-term outcome.P-NT-proBNP exhibited a complex pattern with considerable inter-individual and day-to-day variations. Values of P-NT-proBNP were related to size of burn, water accumulation and systemic inflammatory response. A considerable covariation with trauma response and SOFA scores was observed in day by day analyses, but with weight change only on day 2.Maximum P-NT-proBNP showed a stronger correlation with SOFA score on day 14, with mortality, and with LOS, than did age and TBSA% burned. High values were also independent predictors of all subsequent SOFA scores up to two weeks after injury.P-NT-proBNP and NT-proANP reflect and predict organ function after burn injury similarly, notwithstanding a significantly larger intra-individual variability for P-NT-proBNP. P-NT-proBNP, but not NT-proANP, reflects the systemic inflammatory trauma response.Free cortisol concentration was related to the size of burns, as was the circadian cortisol rhythm. This effect of burn size was, at least in part, related to its effect on organ function.This thesis points to the fact that the stress response is richly interwoven, and cannot be adequately assessed by one biomarker only. All biomarkers studied here can be viewed as representing efferent limbs of the stress reaction, and they would need to be supplemented by biomarkers representing individual physiologic responses that follow the stress signaling.
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