Scand J Trauma Resus
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Scand J Trauma Resus · Nov 2016
Multicenter Study Observational StudyOutcomes after helicopter versus ground emergency medical services for major trauma--propensity score and instrumental variable analyses: a retrospective nationwide cohort study.
Because of a lack of randomized controlled trials and the methodological weakness of currently available observational studies, the benefits of helicopter emergency medical services (HEMS) over ground emergency medical services (GEMS) for major trauma patients remain uncertain. The aim of this retrospective nationwide cohort study was to compare the mortality of adults with serious traumatic injuries who were transported by HEMS and GEMS, and to analyze the effects of HEMS in various subpopulations. ⋯ HEMS was associated with a significantly lower mortality than GEMS in adult patients with major traumatic injuries after adjusting for measured and unmeasured confounders.
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Scand J Trauma Resus · Nov 2016
Randomized Controlled Trial Multicenter StudyA statistical analysis protocol for the time-differentiated target temperature management after out-of-hospital cardiac arrest (TTH48) clinical trial.
The TTH48 trial aims to determine whether prolonged duration (48 hours) of targeted temperature management (TTM) at 33 (±1) °C results in better neurological outcomes compared to standard duration (24 hours) after six months in comatose out-of-hospital cardiac arrest (OHCA) patients. ⋯ We present a detailed statistical analysis protocol (SAP) that specifies how primary and secondary outcomes should be evaluated. We also predetermine covariates for adjusted analyses and pre-specify sub-groups for sensitivity analyses. This pre-planned SAP will reduce analysis bias and add validity to the findings of this trial on the effect of length of TTM on important clinical outcomes after cardiac arrest.
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Scand J Trauma Resus · Nov 2016
Randomized Controlled Trial Multicenter StudyHeel pressure ulcer, prevention and predictors during the care delivery chain - when and where to take action? A descriptive and explorative study.
Hazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Pressure ulcer prevalence is still at unreasonably high levels, causing increased healthcare costs and suffering for patients. Recent biomedical research reveals that the first signs of cell damage could arise within minutes. However, few studies have investigated optimal pressure ulcer prevention in the initial stage of the care process, e.g. in the ambulance care or at the emergency department. The aim of the study was to describe heel pressure ulcer prevalence and nursing actions in relation to pressure ulcer prevention during the care delivery chain, for older patients with neurological symptoms or reduced general condition. Another aim was to investigate early predictors for the development of heel pressure ulcer during the care delivery chain. ⋯ In the ambulance and at the emergency department, skin inspection seems to be appropriate for preventing pressure ulcer. However, carrying out risk assessment with a validated instrument is of significant importance at the ward level. This would also be an appropriate level of resource use. Context-specific actions for pressure ulcer prevention should be incorporated into the care of the patient from the very beginning of the care delivery chain.
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Scand J Trauma Resus · Nov 2016
Multicenter Study Observational StudyTraumatic brain injury patient volume and mortality in neurosurgical intensive care units: a Finnish nationwide study.
Differences in outcomes after traumatic brain injury (TBI) between neurosurgical centers exist, although the reasons for this are not clear. Thus, our aim was to assess the association between the annual volume of TBI patients and mortality in neurosurgical intensive care units (NICUs). ⋯ We did not find any association between annual TBI patient volume and 6-month mortality in NICUs. These findings should be interpreted taking into account that we only included NICUs, which by international standards all treated high volumes of TBI patients, and that we were not able to study the effect of NICU volume on neurological outcome.
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Scand J Trauma Resus · Nov 2016
Multicenter StudyHemodynamic, management, and outcomes of patients admitted to emergency department with heart failure.
Heart failure is one of the leading reasons for hospitalization in developed countries. Our goal was to describe the hemodynamic vital signs (heart rate and systolic blood pressure) of patients presenting to the emergency department (ED) with heart failure and to describe the frequency of adverse events for patients presenting with various heart rate and systolic blood pressure values. ⋯ We found a relatively high frequency of serious adverse events among patients who present to the ED with heart failure, particularly among the patients having low systolic blood pressure and high heart rate.