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Publications (10 of 18) Show all publications
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: 2019-05-20Bibliographically 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
Zachrisson, K., Herlitz, H., Lönn, L., Falkenberg, M. & Eklöf, H. (2017). Duplex ultrasound for identifying renal artery stenosis: direct criteria re-evaluated. Acta Radiologica, 58(2), 176-182
Open this publication in new window or tab >>Duplex ultrasound for identifying renal artery stenosis: direct criteria re-evaluated
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2017 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 58, no 2, p. 176-182Article in journal (Refereed) Published
Abstract [en]

Background: Renal artery duplex ultrasound (RADUS) is an established method for diagnosis of renal artery stenosis (RAS), but there is no consensus regarding optimal RADUS criteria. Purpose: To define optimal cutoff values for RADUS parameters when screening for RAS using intra-arterial transstenotic pressure gradient measurement (PGM) as reference. Material and Methods: The renal arteries of 58 consecutive patients evaluated for renovascular hypertension were examined by RADUS and PGM. Conclusive measurements with both methods were obtained in 76 arteries. Hemodynamically significant RAS was defined as PGM >= 15 mmHg and was found in 43 of the 76 arteries. RADUS parameters included renal artery peak systolic velocity (PSV) and the renal-aortic ratio (RAR) of flow velocities. Receiver operating characteristic curves (ROCs) and Youden's index were used to calculate optimal RADUS criteria for RAS. Results: When traditional RADUS criteria for RAS were used, with a combination of PSV >= 180 cm/s and RAR >= 3.5, the sensitivity was 62% and the specificity was 91%. When RADUS criteria were optimized for sensitivity, then RAR >= 2.6 alone resulted in a sensitivity of 89% and a specificity of 69%. Conclusion: The RAR >= 2.6 is a more sensitive criterion than traditional RADUS criteria when screening patients with clinical suspicion of RAS.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2017
Keywords
Vascular, Doppler ultrasound, arteries, kidney, hypertension
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-319570 (URN)10.1177/0284185116641345 (DOI)000394268600007 ()27069093 (PubMedID)
Available from: 2017-04-06 Created: 2017-04-06 Last updated: 2017-11-29Bibliographically approved
Linder, F., Mani, K., Juhlin, C. & Eklöf, H. (2016). Routine whole body CT of high energy trauma patients leads to excessive radiation exposure. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 24(1)
Open this publication in new window or tab >>Routine whole body CT of high energy trauma patients leads to excessive radiation exposure
2016 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, no 1Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Whole body computed tomography (WBCT) is an important adjunct in trauma care, which is often part of standard protocol in initial management of trauma patients. However, WBCT exposes patients to a significant dose of radiation. The use of WBCT was assessed in a modern trauma cohort in Sweden.

METHODS: A two-center retrospective cohort study was performed. All consecutive trauma alert patients at a university hospital (July-December 2008), and a rural county hospital (January 2009- December 2010) were included. Patients were stratified into three groups (high, intermediate and low risk) based on documented suspected injuries at primary survey at the site of accident or at the emergency department. Injury severity score (ISS) was calculated. Case records were reviewed for clinical and radiological findings at the time of trauma, and during a ≥36 months of follow-up period to identify possible missed injuries.

RESULTS: A total of 523 patients were included in the study (university hospital n = 273; rural county hospital n = 250), out of which 475 patients (91.0 %) underwent radiological examinations, 290 patients (55.4 %) underwent WBCT, which identified trauma related findings in 125 patients (43.1 % of those examined). The high-risk group (n = 62) had a mean age of 38.5 years (21.1 SD). Mean ISS was 16.48 (18.14 SD). In this group, WBCT resulted in a positive finding in 38 (74.5 %) patients. In the intermediate-risk group (n = 322; mean age 37.66, 20.24 SD) ISS was 4.42 (6.30 SD). A positive finding on WBCT was found in 87 of the intermediate group patients (44.8 %). The low-risk group (n = 139; mean age 32.5 years; 21.4 SD) had a mean ISS of 0.84 (1.57 SD) with no positive findings on WBCT and no missed injuries in medical records at ≥36 months.

DISCUSSION: The risk of developing radiation induced cancer is significant for young people if exposed to relatively high dose radiation as is the case in WBCT. WBCT in high-energy trauma is important for planning of treatment in severely injured patients while it can be questioned in the seemingly not injured where it is used mainly to permit early discharge from the ED.

CONCLUSIONS: Risk stratification criteria could in this retrospective study identify high energy trauma patients not in need of radiological imaging. WBCT in high-energy trauma does not affect patient care if the patient is mentally alert, not intoxicated nor shows signs of other than minor injuries when evaluated by a trauma-team. The risk of missing important traumatic findings in these patients is very low. Observation of the patient with reexamination instead of imaging may be considered in this group of often young patients where radiation dose is an issue.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-278958 (URN)10.1186/s13049-016-0199-2 (DOI)000370592500001 ()26817669 (PubMedID)
Available from: 2016-02-26 Created: 2016-02-26 Last updated: 2018-02-14Bibliographically approved
Wiklund, E., Koskinen, S. K., Linder, F., Åslund, P.-E. & Eklöf, H. (2016). Whole body computed tomography for trauma patients in the Nordic countries 2014: survey shows significant differences and a need for common guidelines. Acta Radiologica, 57(6), 750-757
Open this publication in new window or tab >>Whole body computed tomography for trauma patients in the Nordic countries 2014: survey shows significant differences and a need for common guidelines
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2016 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 57, no 6, p. 750-757Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Whole body computed tomography in trauma (WBCTT) is a standardized CT examination of trauma patients. It has a relatively high radiation dose. Therefore, well-defined clinical indications and imaging protocols are needed. This information regarding Nordic countries is limited.

PURPOSE: To identify Nordic countries' WBCTT imaging protocols, radiation dose, and integration in trauma care, and to inquire about the need for common Nordic guidelines.

MATERIAL AND METHODS: A survey with 23 multiple choice questions or free text responses was sent to 95 hospitals and 10 trauma centers in and outside the Nordic region, respectively. The questions were defined and the hospitals selected in collaboration with board members of "Nordic Forum for Trauma and Emergency Radiology" (www.nordictraumarad.com).

RESULTS: Two Nordic hospitals declined to take part in the survey. Out of the remaining 93 Nordic hospitals, 56 completed the questionnaire. Arterial visualization is routine in major trauma centers but only in 50% of the Nordic hospitals. The CT scanner is located within 50 m of the emergency department in all non-Nordic trauma centers but only in 60% of Nordic hospitals. Radiation dose for WBCTT is in the range of 900-3600 mGy × cm. Of the 56 responding Nordic hospitals, 84% have official guidelines for WBCTT. Eighty-nine percent of the responders state there is a need for common guidelines.

CONCLUSION: Scanning protocols, radiation doses, and routines differ significantly between hospitals and trauma centers. Guideline for WBCTT is presently defined locally in most Nordic hospitals. There is an interest in most Nordic hospitals to endorse new and common guidelines for WBCTT.

Keywords
CT; adults; trauma; radiation safety; equipment; contrast agents - intravenous
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-282885 (URN)10.1177/0284185115597718 (DOI)000375726300018 ()26271124 (PubMedID)
Available from: 2016-04-07 Created: 2016-04-07 Last updated: 2018-02-14Bibliographically approved
Westerberg, P.-A., Linde, T., Eklöf, H. & Ljunggren, Ö. (2012). Osteomalaci på grund av tumörorsakad fosfatbrist: Fokus på FGF23 i fysiologi och klinik. Läkartidningen, 109(32-33), 1414-1416
Open this publication in new window or tab >>Osteomalaci på grund av tumörorsakad fosfatbrist: Fokus på FGF23 i fysiologi och klinik
2012 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 32-33, p. 1414-1416Article in journal (Other academic) Published
Abstract [en]

Oncogenic osteomalacia is a rare syndrome caused by a small tumor, of mesenchymal origin, that produces FGF23. FGF23 is a recently described bone derived factor closely regulated by calcitriol and phosphate load. In a feedback loop it increases renal phosphate loss and decreases calcitriol activation. Unregulated production of FGF23 by a tumor causes negative phosphate balance and deficient mineralization of the skeleton, with pain and fractures as a consequence. We have used determination of a venous gradient of FGF23 as an aid in localizing FGF23 producing tumors in 10 cases. In eight cases the tumor has been removed, one patient awaits further examination and in one case it has not been possible to localize the tumor.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-205356 (URN)22953430 (PubMedID)
Available from: 2013-08-16 Created: 2013-08-16 Last updated: 2017-12-06Bibliographically approved
Westerberg, P.-A., Linde, T., Eklöf, H. & Ljunggren, Ö. (2011). Repeated venous sampling for determination of a gradient of fibroblast growth factor 23 for localization of an osteomalacia causing tumor. Acta Endocrinologica, 7(3), 395-403
Open this publication in new window or tab >>Repeated venous sampling for determination of a gradient of fibroblast growth factor 23 for localization of an osteomalacia causing tumor
2011 (English)In: Acta Endocrinologica, ISSN 1841-0987, E-ISSN 1843-066X, Vol. 7, no 3, p. 395-403Article in journal (Refereed) Published
Abstract [en]

Background: Oncogenic osteomalacia (OOM) is a rare syndrome caused by a tumor that produces a phosphaturic factor: fibroblast growth factor 23 (FGF23). These tumors can be extremely difficult to localize because they are small, slow growing and cause no local Symptoms.

Patient and methods: Venous sampling for detection of a gradient of FGF23 has been used to limit the area of further imaging. We describe a case of OOM in a 73-year old woman, with two years of spontaneous fractures, severe musculoskeletal pain and phosphate wasting.

Results: Her scrum FGF23 level was increased and whole-body intravenous sampling (11 sites) revealed a FGF23 gradient from the right leg. The second sampling indicated that the source of FGF23 was below the knee, but imaging studies, including magnetic resonance imaging and octreotide scintigraphy, were not conclusive. A third sampling demonstrated increasing FGF23 the more distal one came in the lower leg. Imaging of the forefoot finally identified a 10 mm tumor that was removed. Histopathological examination showed a phosphaturic mesenchymal tumor of mixed connective tissue type. The phosphate level and symptoms improved in days after surgery.

Conclusion: Repeated determinations of a venous gradient of FGF23 may be used to localize tumors of OOM.

Keywords
osteomalacia, oncogenic, FGF23, hypophosphatemia
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-160523 (URN)10.4183/aeb.2011.395 (DOI)000295494000012 ()
Available from: 2011-10-25 Created: 2011-10-25 Last updated: 2017-12-08Bibliographically approved
Eklöf, H., Bergqvist, D., Hägg, A., Gottsäter, A., Kahan, T., Dimény, E., . . . Nyman, R. (2010). ASTRAL-studiens konklusion ifrågasätts: Experter eniga om indikationer för behandling av njurartärstenos. Läkartidningen, 107(36), 2102-2104
Open this publication in new window or tab >>ASTRAL-studiens konklusion ifrågasätts: Experter eniga om indikationer för behandling av njurartärstenos
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2010 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 36, p. 2102-2104Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-134135 (URN)21043200 (PubMedID)
Available from: 2010-11-22 Created: 2010-11-22 Last updated: 2017-12-12Bibliographically approved
Eklöf, H., Bergqvist, D., Hägg, A. & Nyman, R. (2009). Outcome after endovascular revascularization of atherosclerotic renal artery stenosis. Acta Radiologica, 50(3), 256-64
Open this publication in new window or tab >>Outcome after endovascular revascularization of atherosclerotic renal artery stenosis
2009 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 50, no 3, p. 256-64Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: With an aging population, more patients might be treated for atherosclerotic renal artery stenosis (ARAS). The goal of this treatment is to achieve a dialysis-free life or a well-controlled blood pressure with reduced risks of cardiovascular complications. PURPOSE: To analyze the clinical outcome of percutaneous transluminal renal artery angioplasty without stenting (PTRA) or with stenting (PTRS) for ARAS at one center. MATERIAL AND METHODS: The study group comprised 152 patients who underwent 203 PTRA/PTRS. All had hypertension, and 45% had azotemia. A retrospective collection of baseline and postprocedural number of antihypertensive drugs, blood pressure, and serum creatinine were analyzed during a follow-up of 3-18 months. RESULTS: Technical success rate was 95%, and clinical benefit was seen in 63% of patients. Complications included a 30-day mortality rate of 1.5%, a total complication rate of 35%, and major adverse events in 13%. The major adverse events were highly related to azotemia. Major adverse events within 30 days, with permanent disability, were seen in 5% and almost exclusively in patients with moderate or severe renal impairment. A subgroup analysis of 28 patients with renal duplex resistive index (RI) pre-PTRA/S and 6 months' follow-up showed a benefit of PTRA/PTRS in 17 (68%) of the 25 patients with RI <80 and in all three (100%) of the patients with RI >or=80. CONCLUSION: Endovascular treatment of ARAS has an excellent technical success rate, with a clinical improvement rate of >60%. However, it is associated with a considerable complication rate. Serious complications are seen mainly in azotemic patients. Predictors of clinical response could not be identified. Renal duplex RI is questioned as a predictor of clinical outcome.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-118812 (URN)10.1080/02841850802668563 (DOI)000264220100002 ()19172426 (PubMedID)
Available from: 2010-02-23 Created: 2010-02-23 Last updated: 2017-12-12Bibliographically approved
Eklöf, H., Radecka, E. & Liss, P. (2007). Teleradiology Uppsala-Sydney for nighttime emergencies: preliminary experience. Acta Radiologica, 48(8), 851-853
Open this publication in new window or tab >>Teleradiology Uppsala-Sydney for nighttime emergencies: preliminary experience
2007 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 48, no 8, p. 851-853Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The development of digital imaging systems for radiology in combination with the possibility to transfer large quantities of data over the Internet has increased the interest in teleradiology. Transferring nighttime examinations to an evaluation center in a daytime zone may provide improved patient security, better working hours for radiologists, and reduced costs for emergency radiological services. PURPOSE: To evaluate the time required for transferring radiological information from Uppsala (Sweden) to Sydney (Australia). MATERIAL AND METHODS: A radiologist in Sydney reported on radiological examinations performed in Uppsala. The time required for downloading 75 examinations and returning 24 reports was registered. RESULTS: Downloading was completed in <60 min for all conventional radiological examinations, but only 44% of computed tomography (CT) examinations with >65 images. Reports were completed in <10 min. Turnaround time was directly related to the time required for downloading the images. The Sydney report was available in Uppsala within 30 min of the in-house report in 79% of examinations. CONCLUSION: The main challenge for emergency teleradiology is the time required for downloading large volumes of data over the Internet.

Keywords
Technology assessments, teleradiology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-104872 (URN)10.1080/02841850701422120 (DOI)000250006800007 ()17924215 (PubMedID)
Available from: 2009-05-29 Created: 2009-05-29 Last updated: 2017-12-13Bibliographically approved
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