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Search Results: 1 - 10 of 1538 matches for " Rehn Marius "
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Improving adjustments for older age in pre-hospital assessment and care
Rehn Marius
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2013, DOI: 10.1186/1757-7241-21-4
Abstract: Population estimates projects a significant increase in the geriatric population making elderly trauma patients more common. The geriatric trauma patients experience higher incidence of pre-existing medical conditions, impaired age-dependent physiologic reserve, use potent drugs and suffer from trauma system related shortcomings that influence outcomes. To improve adjustments for older age in pre-hospital assessment and care, several initiatives should be implemented. Decision-makers should make system revisions and introduce advanced point-of-care initiatives to improve outcome after trauma for the elderly.
Revisiting the value of pre-hospital tracheal intubation: an all time systematic literature review extracting the Utstein airway core variables
Hans Lossius, Stephen JM Sollid, Marius Rehn, David J Lockey
Critical Care , 2011, DOI: 10.1186/cc9973
Abstract: We performed an all time systematic search according to the PRISMA guidelines of Medline and EMBASE to identify original research pertaining to pre-hospital TI in adult patients.From 1,076 identified records, 73 original papers were selected. Information was extracted according to an Utstein template for data reporting from in-the-field advanced airway management. Fifty-nine studies were from North American EMS systems. Of these, 46 (78%) described services in which non-physicians conducted TI. In 12 of the 13 non-North American EMS systems, physicians performed the pre-hospital TI. Overall, two were randomised controlled trials (RCTs), and 65 were observational studies. None of the studies presented the complete set of recommended Utstein airway variables. The median number of core variables reported was 10 (max 21, min 2, IQR 8-12), and the median number of fixed system variables was 5 (max 11, min 0, IQR 4-8). Among the most frequently reported variables were "patient category" and "service mission type", reported in 86% and 71% of the studies, respectively. Among the least-reported variables were "co-morbidity" and "type of available ventilator", both reported in 2% and 1% of the studies, respectively.Core data required for proper interpretation of results were frequently not recorded and reported in studies investigating TI in adults. This makes it difficult to compare scientific reports, assess their validity, and extrapolate to other EMS systems. Pre-hospital TI is a complex intervention, and terminology and study design must be improved to substantiate future evidence based clinical practice.Tracheal intubation (TI) to secure the airway of severely ill or injured patients is a critical intervention regularly conducted by emergency medical service (EMS) providers throughout the world. This activity is based on the assumption that, in keeping with in-hospital practice, a compromised airway should be secured as early as possible to ensure adequate ventilation a
Inter-hospital transfer: the crux of the trauma system, a curse for trauma registries
Hans Lossius, Thomas Kristiansen, Kjetil G Ringdal, Marius Rehn
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2010, DOI: 10.1186/1757-7241-18-15
Abstract: In a recent article published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Professor Katsaragakis and colleagues depict patient flow through what they describe as a non-trauma-system setting in Greece [1]. Their study contributes to a growing body of inter-hospital transfer studies and provides an opportunity to comment on the complexity of analyzing trauma transfer.The development of a dedicated trauma system to deal effectively with severely injured patients was initiated in the early 1980's, with the American College of Surgeons (ACS) playing a leading role [2]. The trauma system, as described by the ACS, is a purposeful organisation of health care resources that ensures the optimal treatment of injured patients [3]. Inclusive trauma systems define roles for all levels and types of health care facilities and personnel that provide care for trauma patients from the scene of injury to rehabilitation. During the last decades of the 20th century, several studies reported increased survival rates after the creation of such dedicated trauma systems [4]. A number of European countries are adapting these principles, and networks of trauma hospitals are evolving [5-7].The demand for cost reduction and centralisation of advanced health care services has lead to a shift of specialist resources and severely injured patients away from local hospitals towards regional centres and university hospitals. The local hospital has become a potentially hazardous diversion for major trauma patients, thereby necessitating safe and efficient pre-hospital triage and inter-hospital transfer procedures.Organised trauma systems with dedicated trauma centres ensure (at least in theory) that patients in need of specialist resources are brought directly to an appropriate level of care. However, not all injured patients should be brought directly to a trauma centre, and the quality of care prior to reaching the trauma centre may have significant impact on patient
Prognostic models for the early care of trauma patients: a systematic review
Marius Rehn, Pablo Perel, Karen Blackhall, Hans Lossius
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2011, DOI: 10.1186/1757-7241-19-17
Abstract: We systematically reviewed models for the early care of trauma patients that included 2 or more predictors obtained from the evaluation of an adult trauma victim, investigated their quality and described their characteristics.We screened 4 939 records for eligibility and included 5 studies that derivate 5 prognostic models and 9 studies that validate one or more of these models in external populations. All prognostic models intended to change clinical practice, but none were tested in a randomised clinical trial. The variables and outcomes were valid, but only one model was derived in a low-income population. Systolic blood pressure and level of consciousness were applied as predictors in all models.The general impression is that the models perform well in predicting survival. However, there are many areas for improvement, including model development, handling of missing data, analysis of continuous measures, impact and practicality analysis.Trauma is a major global contributor to premature death and disability. The burden of injuries is especially notable in low and middle-income countries and is expected to rise during the coming decades [1,2]. Harm from major trauma may be minimized through early access to pre-hospital [2] and in-hospital trauma care [3]. A majority of trauma related deaths occur during the pre-hospital period or in the initial hours after injury. Emergency medical service (EMS) providers must therefore rapidly assess trauma severity in order to identify patients that require prompt referral to an appropriate hospital [2,3] and to ensure that necessary diagnostic and therapeutic interventions are initiated upon admission. However, early recognition of major trauma remains a challenge due to occult injuries, unpredictable evolution of symptoms, and the complexities of evaluating patients in the early hours after injury.If patients only suffering minor injuries bypass the local clinic (overtriage; false-positives), the regional hospital will be ove
Calculating trauma triage precision: effects of different definitions of major trauma
Lossius Hans,Rehn Marius,Tjosevik Kjell E,Eken Torsten
Journal of Trauma Management & Outcomes , 2012, DOI: 10.1186/1752-2897-6-9
Abstract: Background Triage is the process of classifying patients according to injury severity and determining the priority for further treatment. Although the term “major trauma” represents the reference against which over- and undertriage rates are calculated, its definition is inconsistent in the current literature. This study aimed to investigate the effects of different definitions of major trauma on the calculation of perceived over- and undertriage rates in a Norwegian trauma cohort. Methods We performed a retrospective analysis of patients included in the trauma registry of a primary, referral trauma centre. Two “traditional” definitions were developed based on anatomical injury severity scores (ISS >15 and NISS >15), one “extended” definition was based on outcome (30-day mortality) and mechanism of injury (proximal penetrating injury), one ”extensive” definition was based on the “extended” definition and on ICU resource consumption (admitted to the ICU for >2 days and/or transferred intubated out of the hospital in ≤2 days), and an additional four definitions were based on combinations of the first four. Results There were no significant differences in the perceived under- and overtriage rates between the two “traditional” definitions (NISS >15 and ISS >15). Adding “extended” and “extensive” to the “traditional” definitions also did not significantly alter perceived under- and overtriage. Defining major trauma only in terms of the mechanism of injury and mortality, with or without ICU resource consumption (the “extended” and “extensive” groups), drastically increased the perceived overtriage rates. Conclusion Although the proportion of patients who were defined as having sustained major trauma increased when NISS-based definitions were substituted for ISS-based definitions, the outcomes of the triage precision calculations did not differ significantly between the two scales. Additionally, expanding the purely anatomic definition of major trauma by including proximal penetrating injury, 30-day mortality, ICU LOS greater than 2 days and transferred intubated out of the hospital at ≤2 days did not significantly influence the perceived triage precision. We recommend that triage precision calculations should include anatomical injury scaling according to NISS. To further enhance comparability of trauma triage calculations, researchers should establish a consensus on a uniform definition of major trauma.
A concept for major incident triage: full-scaled simulation feasibility study
Marius Rehn, Jan E Andersen, Trond Vigerust, Andreas J Krüger, Hans M Lossius
BMC Emergency Medicine , 2010, DOI: 10.1186/1471-227x-10-17
Abstract: The learners participated in two standardised bus crash simulations: without and with competence of TAS-triage and access to TAS-triage equipment. The instructors calculated triage accuracy and measured time consumption while the learners participated in a self-reported before-after study. Each question was scored on a 7-point Likert scale with points labelled "Did not work" (1) through "Worked excellent" (7).Among the 93 (85%) participating emergency service professionals, 48% confirmed the existence of a major incident triage system in their service, whereas 27% had access to triage tags. The simulations without TAS-triage resulted in a mean over- and undertriage of 12%. When TAS-Triage was used, no mistriage was found. The average time from "scene secured to all patients triaged" was 22 minutes (range 15-32) without TAS-triage vs. 10 minutes (range 5-21) with TAS-triage. The participants replied to "How did interdisciplinary cooperation of triage work?" with mean 4,9 (95% CI 4,7-5,2) before the course vs. mean 5,8 (95% CI 5,6-6,0) after the course, p < 0,001.Our modified triage Sieve tool is feasible, time-efficient and accurate in allocating priority during simulated bus accidents and may serve as a candidate for a future national standard for major incident triage.A major incident has occurred when incident location, severity, type or number of victims require extraordinary resources. Major incidents are heterogeneous by nature and their unexpectedness favours an "all-hazards" approach. Since rescue capacity varies within systems, a major incident for a rural emergency service may not apply to a larger urban emergency service [1]. Rapid access to advanced major incident management have proven to optimize resource use and improve patient outcome [2].Major incident management involves responders from multiple rescue services and it traverses geographical and jurisdictional lines. Further, it involves multiple tasks such as leadership, preparation, risk-evaluation
Precision of field triage in patients brought to a trauma centre after introducing trauma team activation guidelines
Marius Rehn, Torsten Eken, Andreas Krüger, Petter Steen, Nils Skaga, Hans Lossius
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2009, DOI: 10.1186/1757-7241-17-1
Abstract: Retrospective analysis of 7 years (2001–07) of prospectively collected trauma registry data for all patients with TTA or severe injury, defined as at least one of the following: Injury Severity Score (ISS) > 15, proximal penetrating injury, admitted ICU > 2 days, transferred intubated to another hospital within 2 days, dead from trauma within 30 days. Interhospital transfers to UUH and patients admitted by non-healthcare personnel were excluded. Overtriage is the fraction of TTA where patients are not severely injured (1-positive predictive value); undertriage is the fraction of severely injured admitted without TTA (1-sensitivity).Of the 4 659 patients included in the study, 2 221 (48%) were severely injured. TTA occurred 4 440 times, only 2 002 of which for severely injured (overtriage 55%). Overall undertriage was 10%. Mechanism of injury was TTA criterion in 1 508 cases (34%), of which only 392 were severely injured (overtriage 74%). Paramedic-manned prehospital services provided 66% overtriage and 17% undertriage, anaesthetist-manned services 35% overtriage and 2% undertriage. Falls, high age and admittance by paramedics were significantly associated with undertriage. A Triage-Revised Trauma Score (RTS) < 12 in the emergency department reduced the risk for undertriage compared to RTS = 12 (normal value). Field RTS was documented by anaesthetists in 64% of the patients compared to 33% among paramedics.Patients subject to undertriage had an ISS-adjusted Odds Ratio for 30-day mortality of 2.34 (95% CI 1.6–3.4, p < 0.001) compared to those correctly triaged to TTA.Triage precision had not improved after TTA guideline introduction. Anaesthetists perform precise trauma triage, whereas paramedics have potential for improvement. Skewed mission profiles makes comparison of differences in triage precision difficult, but criteria or the use of them may contribute. Massive undertriage among paramedics is of grave concern as patients exposed to undertriage had increased ris
RE: Field triage in trauma – do the data really justify the conclusions?
Marius Rehn, Torsten Eken, Andreas Krüger, Petter Steen, Nils Skaga, Hans Lossius
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2009, DOI: 10.1186/1757-7241-17-25
Abstract: Thank you for your interest in our article; "Precision of field triage in patients brought to a trauma centre after introducing trauma team activation guidelines" [1], which gives us the opportunity for expounding some conclusions that could be open for misinterpretation.We agree with Dr. Sandberg that paramedics and anaesthetists conduct missions with very skewed profiles. We suspect that this mission-selection bias applies to all anaesthetists-manned services, regardless of transport method. The differences in task profile may be beyond the scope of statistical adjustment contributing to a contra-comparison line of argumentation. This is a problem in most epidemiologic studies. What is found is an association between factors; a good starting point for prospective intervention studies. In this case possibly testing changes in one or more of the links in the triage chain. Hopefully, readers agree with us in our statement "skewed mission profiles make comparison of differences in triage precision difficult".Dr. Sandberg correctly states that the formal decision to activate the trauma team is not made in-field, but in-hospital by the ED nurse. We still used the term field triage, in an attempt to differentiate the study from those that describe traditional ED triage algorithms. Regardless of where the formal decision is made, triage decisions made before the patient arrives in the ED are based upon information gathered in-field and the triage decision have in-field consequences.We agree with Dr. Sandberg that it is difficult to isolate the aetiology of over- and undertriage. Over- and undertriage rates reflect a chain of events. We did not attempt to identify the link in this chain with most potential for improvement. This is reflected in our recommended improvement initiatives that address every major link in the trauma triage chain: improved on-scene patient evaluation, better routines in communicating patient data from EMS units to the nurse coordinator in the ED,
Oslo government district bombing and Ut?ya island shooting July 22, 2011: The immediate prehospital emergency medical service response
Stephen JM Sollid, Rune Rimstad, Marius Rehn, Anders R Nakstad, Ann-Elin Tomlinson, Terje Strand, Hans Heimdal, Jan Nilsen, M?rten Sandberg, Collaborating group
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2012, DOI: 10.1186/1757-7241-20-3
Abstract: A retrospective and observational study was conducted based on data from the EMS systems involved and the public domain. The study was approved by the Data Protection Official and was defined as a quality improvement project.We describe the timeline and logistics of the EMS response, focusing on alarm, dispatch, initial response, triage and evacuation. The scenes in the Oslo government district and at Ut?ya island are described separately.Many EMS units were activated and effectively used despite the occurrence of two geographically separate incidents within a short time frame. Important lessons were learned regarding triage and evacuation, patient flow and communication, the use of and need for emergency equipment and the coordination of helicopter EMS.On July 22, 2011, Norway was struck by two terrorist attacks. In the first attack, a car bomb exploded in the Oslo government district. The bomb comprised an ammonium nitrate/fuel oil (ANFO) mixture or "fertiliser bomb". Eight people were killed in the explosion. Two hours later, a lone gunman attacked a political youth camp on Ut?ya island, approximately 40 kilometres from Oslo, and killed 69 civilians. A single perpetrator carried out both attacks.The scale of the July 22, 2011 attacks and the resulting emergency medical service (EMS) response was unprecedented in Norway. The massive EMS response crossed jurisdictional lines and involved responders from multiple agencies throughout the region. In this paper, we describe the immediate prehospital EMS response to the July 22, 2011 attacks.The backbone of the Norwegian EMS is provided by on-call general practitioners (GPs) and ground ambulances [1]. According to national regulations, all ambulance units must be staffed by at least one certified emergency medical technician (EMT) [2]. However, most units are staffed by two EMTs, and in most urban systems, at least one EMT is a trained paramedic. The ambulance service is government-funded and organised under local healt
A New Species of Roach of the Genus Kakerlac (Loboptera Auct.)From Southern Texas
James A. G. Rehn
Psyche , 1904, DOI: 10.1155/1904/75607
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