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Linder, F., Holmberg, L., Björck, M., Juhlin, C., Thorbjörnsen, K., Wisinger, J., . . . Mani, K. (2019). A prospective stepped wedge cohort evaluation of the new national trauma team activation criteria in Sweden - the TRAUMALERT study.. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27(1), Article ID 52.
Open this publication in new window or tab >>A prospective stepped wedge cohort evaluation of the new national trauma team activation criteria in Sweden - the TRAUMALERT study.
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2019 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, no 1, article id 52Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Trauma triage based on prehospital information facilitates correct allocation of in-hospital resources. The Swedish national two-tier trauma team activation (TTA) criteria were revised in 2016. The current study aimed to evaluate the safety and efficacy of the new criteria.

METHODS: Five centres covering trauma care for 1.2 million inhabitants registered all trauma patients prospectively in the Swedish trauma registry (SweTrau) prior to and after stepwise introduction of new TTA criteria within the cohort (a prospective stepped-wedge cohort study design; period August 2016-November 2017). Evaluation of full- and limited-TTA frequency, under- and overtriage were performed at equal duration before and after this change.

RESULTS: The centres registered 1948 patients, 1882 (96.6%) of which were included in the study. With new criteria, frequency of full-TTA was unchanged, while limited-TTA decreased with 46.3% (from 988 to 531). 30-day trauma mortality was unchanged. The overtriage was 107/150 (71.3%) with former criteria, and 104/144 (72.2%) with new criteria, p = 0.866. Undertriage was 50/1037 (4.8%) versus 39/551 (7.1%), p = 0.063. Undertriage was consistently > 20% in patients with fall injury. Among patients with Injury Severity Score (ISS) > 15, 50/93 (53.8%) did not initiate full-TTA with former, vs 39/79 (49.4%) with new criteria, p = 0.565. Age > 60-years was a risk factor for undertriage (OR 2.89, p < 0.001), while low fall injuries indicated a trend (OR 2.70, p = 0.051).

CONCLUSIONS: The newly implemented Swedish TTA criteria result in a reduction in limited TTA frequency, indicating an increased efficiency in use of resources. The over- and undertriage is unchanged compared to former criteria, thus upholding patient safety.

Keywords
Epidemiology, Patient safety, Prospective stepped wedge cohort design, Trauma, Triage, Wounds and injuries
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-383430 (URN)10.1186/s13049-019-0619-1 (DOI)000466508600002 ()31039800 (PubMedID)
Available from: 2019-05-14 Created: 2019-05-14 Last updated: 2019-11-21Bibliographically approved
Grip, O., Wanhainen, A. & Björck, M. (2019). Acute Aortic Occlusion: Nationwide Cohort Study [Letter to the editor]. Circulation, 139(2), 292-294
Open this publication in new window or tab >>Acute Aortic Occlusion: Nationwide Cohort Study
2019 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 139, no 2, p. 292-294Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2019
Keywords
arterial occlusive diseases, embolism, graft occlusion, vascular, ischemia, thrombosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-379086 (URN)10.1161/CIRCULATIONAHA.118.036420 (DOI)000459428700019 ()30615512 (PubMedID)
Available from: 2019-03-12 Created: 2019-03-12 Last updated: 2019-03-12Bibliographically approved
Mani, K. & Björck, M. (2019). Alternatives to Randomised Controlled Trials for the Poor, the Impatient, and When Evaluating Emerging Technologies. European Journal of Vascular and Endovascular Surgery, 57(4), 598-599
Open this publication in new window or tab >>Alternatives to Randomised Controlled Trials for the Poor, the Impatient, and When Evaluating Emerging Technologies
2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 4, p. 598-599Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2019
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-383053 (URN)10.1016/j.ejvs.2018.10.026 (DOI)000464932200028 ()30509892 (PubMedID)
Available from: 2019-05-08 Created: 2019-05-08 Last updated: 2019-05-08Bibliographically approved
Linder, F., Holmberg, L., Eklöf, H., Björck, M., Juhlin, C. & Mani, K. (2019). Better compliance with triage criteria in trauma would reduced costs with maintained patient safety. European journal of emergency medicine, 26(4), 283-288
Open this publication in new window or tab >>Better compliance with triage criteria in trauma would reduced costs with maintained patient safety
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2019 (English)In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 26, no 4, p. 283-288Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate trauma triage criteria in terms of compliance, undertriage, and overtriage and identify risk factors for mistriage.

METHODS: In a retrospective cohort study, all consecutive trauma patients at a University Hospital in Sweden in 2012 were included. Patients were stratified into three groups on the basis of trauma team activation (full trauma team, limited trauma team, and no trauma team). Case records were reviewed for mechanism of injury, vital signs, and injuries. Compliance with alert criteria was evaluated and injury severity score combined with the Matrix method was used for assessment of overtriage and undertriage.

RESULTS: A total of 1424 trauma patients were included in the study. Seventy-three (5.1%) patients activated a full trauma team, 732 (51.4%) a limited trauma team, and 619 (43.5%) did not activate any trauma team. Undertriage was 2.7% [95% confidence interval (CI): 1.9-3.8%] and overtriage was 34.2% (95% CI: 23.5-46.3%) in the complete cohort. Compliance with 'trauma triage criteria' was assessed by comparing actual alerts with what was estimated to be the correct alert levels on the basis of prehospital case records. Compliance with full trauma team criteria was 80% (68-88%), limited trauma team was 54% (51-58%), and no trauma team was 79% (76-82%). Assuming full compliance with trauma criteria, the Matrix method resulted in an undertriage of 2.3% (95% CI: 1.6-3.3%) and an overtriage of 42.6% (95% CI: 32.4-53.2%).

CONCLUSION: The overtriage and undertriage in this study is in line with the recommendations of the American College of Surgeons Committee on Trauma. However, better compliance with trauma alert criteria would result in fewer trauma team activations without affecting patient safety.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-383431 (URN)10.1097/MEJ.0000000000000544 (DOI)000480684900011 ()29438134 (PubMedID)
Available from: 2019-05-14 Created: 2019-05-14 Last updated: 2019-09-30Bibliographically approved
Björck, M. (2019). Can we learn anything from the dinosaurs?. European Journal of Vascular and Endovascular Surgery, 57(3), 399-399
Open this publication in new window or tab >>Can we learn anything from the dinosaurs?
2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 3, p. 399-399Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2019
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-381526 (URN)10.1016/j.ejvs.2018.10.035 (DOI)000461902200015 ()30553581 (PubMedID)
Available from: 2019-04-11 Created: 2019-04-11 Last updated: 2019-04-11Bibliographically approved
Wanhainen, A., Verzini, F., Van Herzeele, I., Allaire, E., Bown, M., Cohnert, T., . . . Szeberin, Z. (2019). Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. European Journal of Vascular and Endovascular Surgery, 57(1), 8-93
Open this publication in new window or tab >>Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms
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2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 1, p. 8-93Article in journal (Refereed) Published
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-377705 (URN)10.1016/j.ejvs.2018.09.020 (DOI)000458013000004 ()30528142 (PubMedID)
Note

ESVS Guidelines Committee : Gert J. de Borst (chair) (Utrecht, Netherlands), Nabil Chakfe (Stratsbourg, France), Sebastian Debus (Hamburg, Germany), Rob Hinchliffe (Brinstol, United Kingdom), Stavros Kakkos (Patras, Greece), Igor Koncar (guideline coordinator) (Belgrade, Serbia), Philippe Kolh (Liege, Belgium), Jes S. Lindholt (Odense, Denmark), Melina de Vega (Bilbao, Spain), Frank Vermassen (Ghent, Belgium).

Document reviewers: Martin Björck (Uppsala, Sweden), Stephen Cheng (Hong Kong, China), Ronald Dalman (Stanford, USA), Lazar Davidovic (Belgrade, Serbia), Konstantinos Donas (Munster, Germany), Jonothan Earnshaw (Gloucester, United Kingdom), Hans-Henning Eckstein (Munich, Germany), Jonathan Golledge (Queensland, Australia), Stephan Haulon (Paris, France), Tara Mastracci (London, United Kingdom), Ross Naylor (Leicester, United Kingdom), Jean-Baptiste Ricco (Poitiers, France), Hence Verhagen (Rotterdam, Netherlands).

Available from: 2019-02-25 Created: 2019-02-25 Last updated: 2019-02-25Bibliographically approved
Venermo, M., Sprynger, M., Desormais, I., Björck, M., Brodmann, M., Cohnert, T., . . . Aboyans, V. (2019). Editor's Choice - Follow-up of Patients After Revascularisation for Peripheral Arterial Diseases: A Consensus Document From the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society for Vascular Surgery. European Journal of Vascular and Endovascular Surgery, 58(5), 641-653
Open this publication in new window or tab >>Editor's Choice - Follow-up of Patients After Revascularisation for Peripheral Arterial Diseases: A Consensus Document From the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society for Vascular Surgery
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2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 58, no 5, p. 641-653Article in journal (Refereed) Published
Abstract [en]

Peripheral arterial diseases comprise different clinical presentations, from cerebrovascular disease down to lower extremity artery disease, from subclinical to disabling symptoms and events. According to clinical presentation, the patient's general condition, anatomical location and extension of lesions, revascularisation may be needed in addition to best medical treatment. The 2017 European Society of Cardiology guidelines in collaboration with the European Society for Vascular Surgery have addressed the indications for revascularisation. While most cases are amenable to either endovascular or surgical revascularisation, maintaining long-term patency is often challenging. Early and late procedural complications, but also local and remote recurrences frequently lead to revascularisation failure. The rationale for surveillance is to propose the accurate implementation of preventive strategies to avoid other cardiovascular events and disease progression and avoid recurrence of symptoms and the need for redo revascularisation. Combined with vascular history and physical examination, duplex ultrasound scanning is the pivotal imaging technique for identifying revascularisation failures. Other non-invasive examinations (ankle and toe brachial index, computed tomography scan, magnetic resonance imaging) at regular intervals can optimise surveillance in specific settings. Currently, optimal revascularisation surveillance programmes are not well defined and systematic reviews addressing long-term results after revascularisation are lacking. We have systematically reviewed the literature addressing follow-up after revascularisation and we propose this consensus document as a complement to the recent guidelines for optimal surveillance of revascularised patients beyond the perioperative period.

Keywords
Revascularisation, peripheral arterial disease, follow-up, restenosis
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-397634 (URN)10.1016/j.ejvs.2019.06.017 (DOI)000493954400003 ()31685166 (PubMedID)
Available from: 2019-11-22 Created: 2019-11-22 Last updated: 2019-11-22Bibliographically approved
Behrendt, C.-A., Björck, M., Schwaneberg, T., Debus, E. S., Cronenwett, J., Sigvant, B., . . . Zeller, T. (2019). Editor's Choice - Recommendations for Registry Data Collection for Revascularisations of Acute Limb Ischaemia: A Delphi Consensus from the International Consortium of Vascular Registries. European Journal of Vascular and Endovascular Surgery, 57(6), 816-821
Open this publication in new window or tab >>Editor's Choice - Recommendations for Registry Data Collection for Revascularisations of Acute Limb Ischaemia: A Delphi Consensus from the International Consortium of Vascular Registries
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2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 6, p. 816-821Article in journal (Refereed) Published
Abstract [en]

Objective: To develop a minimum core data set for evaluation of acute limb ischaemia (ALI) revascularisation treatment and outcomes that would enable collaboration among international registries. Methods: A modified Delphi approach was used to achieve consensus among international multidisciplinary vascular specialists and registry members of the International Consortium of Vascular Registries (ICVR). Variables identified in the literature or suggested by the expert panel, and variables, including definitions, currently used in 15 countries in the ICVR, were assessed to define both a minimum core and an optimum data set to register ALI treatment. Clinical relevance and practicability were both assessed, and consensus was defined as >= 80% agreement among participants. Results: Of 40 invited experts, 37 completed a preliminary survey and 31 completed the two subsequent Delphi rounds via internet exchange and face to face discussions. In total, 117 different items were generated from the various registry data forms, an extensive review of the literature, and additional suggestions from the experts, for potential inclusion in the data set. Ultimately, 35 items were recommended for inclusion in the minimum core data set, including 23 core items important for all registries, and an additional 12 more specific items for registries capable of capturing more detail. These 35 items supplement previous data elements recommended for registering chronic peripheral arterial occlusive disease treatment. Conclusion: A modified Delphi study allowed 37 international vascular registry experts to achieve a consensus recommendation for a minimum core and an optimum data set for registries covering patients who undergo ALI revascularisation. Continued global harmonisation of registry infrastructure and definition of items allows international comparisons and global quality improvement. Furthermore, it can help to define and monitor standards of care and enable international research collaboration.

Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2019
Keywords
Acute limb ischaemia, Consensus development, Delphi technique, Health services research, Registries
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-390033 (URN)10.1016/j.ejvs.2019.02.023 (DOI)000471825900016 ()31128987 (PubMedID)
Available from: 2019-08-07 Created: 2019-08-07 Last updated: 2019-08-07Bibliographically approved
Högberg, D., Björck, M., Mani, K., Svensjö, S. & Wanhainen, A. (2019). Five Year Outcomes in Men Screened for Carotid Artery Stenosis at 65 Years of Age: A Population Based Cohort Study. European Journal of Vascular and Endovascular Surgery, 57(6), 759-766
Open this publication in new window or tab >>Five Year Outcomes in Men Screened for Carotid Artery Stenosis at 65 Years of Age: A Population Based Cohort Study
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2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 6, p. 759-766Article in journal (Refereed) Published
Abstract [en]

Objective: This study aimed to determine the outcome of 65 year old men five years after carotid ultrasound screening, as well as risk factors for disease progression. Methods: All 65 year old men living in the county of Uppsala 2007-2009 were invited to an ultrasound examination of both carotid arteries and re-invited at age 70. The cohort was grouped into normal carotids, plaque without significant stenosis, moderate stenosis (50-79%), and severe stenosis (80-99%). The rate of disease progression was assessed from ultrasound data. Data on mortality, ipsilateral neurological events, risk factors, and medication were obtained from patient records and population registries. Results: Among men participating in carotid screening at age 65, 3,057 were re-screened at age 70. In those with normal carotids (n = 2,318), 23 (1.0%) progressed to a moderate stenosis, and four (0.2%) to a symptomatic severe stenosis. Among those with plaque (n = 696), 25 (3.6%) progressed to moderate stenosis, and eight (1.1%) to severe stenosis, of whom four (0.6%) had symptoms. Of 31 men with 50-79% stenosis, four (12.9%) had progressed to a severe stenosis, of whom two (6.5%) developed symptoms. Five of twelve subjects (42%) with 80-99% stenosis developed symptoms. Disease regression was present among 289/692 plaque (41.7%) and 16/33 stenosis (48.4%). In multivariable analysis, smoking, coronary artery disease and hypercholesterolemia were associated with disease progression. The proportions of antiplatelet, statin, and antihypertensive treatment in the population at age 70 were 22%, 29%, and 55%, respectively. Conclusion: Men with plaques and moderate stenosis have a good prognosis, but in those with severe stenosis there is a high risk of neurological events.

Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2019
Keywords
Atherosclerotic plaque, Carotid stenosis, Mortality, Natural history, Stroke rate
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-390031 (URN)10.1016/j.ejvs.2019.02.005 (DOI)000471825900003 ()31142437 (PubMedID)
Funder
Swedish Research Council, K2013-64X-20406-07-3
Available from: 2019-08-07 Created: 2019-08-07 Last updated: 2019-08-07Bibliographically approved
Conte, M. S., Bradbury, A. W., Kolh, P., White, J. V., Dick, F., Fitridge, R., . . . Wang, S. (2019). Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. European Journal of Vascular and Endovascular Surgery, 58(1), S1-S109
Open this publication in new window or tab >>Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia
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2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 58, no 1, p. S1-S109Article in journal (Refereed) Published
Abstract [en]

Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.

Place, publisher, year, edition, pages
Saunders Elsevier, 2019
Keywords
Chronic limb-threatening ischemia, Critical limb ischemia, Peripheral artery disease, Diabetes, Foot ulcer, Endovascular intervention, Bypass surgery, Practice guideline, Evidence-based medicine
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-390918 (URN)10.1016/j.ejvs.2019.05.006 (DOI)000473323500001 ()31182334 (PubMedID)
Available from: 2019-08-15 Created: 2019-08-15 Last updated: 2019-08-15Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-6561-9734

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