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Abdominal injuries in a low trauma volume hospital--a descriptive study from northern Sweden.

https://arctichealth.org/en/permalink/ahliterature264480
Source
Scand J Trauma Resusc Emerg Med. 2014;22:48
Publication Type
Article
Date
2014
Author
Patrik Pekkari
Per-Olof Bylund
Hans Lindgren
Mikael Öman
Source
Scand J Trauma Resusc Emerg Med. 2014;22:48
Date
2014
Language
English
Publication Type
Article
Keywords
Abdominal Injuries - diagnosis - epidemiology - therapy
Adolescent
Adult
Disease Management
Female
Follow-Up Studies
Hospital Mortality - trends
Hospitals, Low-Volume - statistics & numerical data
Humans
Incidence
Injury Severity Score
Length of Stay - trends
Male
Middle Aged
Prognosis
Retrospective Studies
Survival Rate - trends
Sweden - epidemiology
Tomography, X-Ray Computed
Trauma Centers - statistics & numerical data
Young Adult
Abstract
Abdominal injuries occur relatively infrequently during trauma, and they rarely require surgical intervention. In this era of non-operative management of abdominal injuries, surgeons are seldom exposed to these patients. Consequently, surgeons may misinterpret the mechanism of injury, underestimate symptoms and radiologic findings, and delay definite treatment. Here, we determined the incidence, diagnosis, and treatment of traumatic abdominal injuries at our hospital to provide a basis for identifying potential hazards in non-operative management of patients with these injuries in a low trauma volume hospital.
This retrospective study included prehospital and in-hospital assessments of 110 patients that received 147 abdominal injuries from an isolated abdominal trauma (n = 70 patients) or during multiple trauma (n = 40 patients). Patients were primarily treated at the University Hospital of Umeå from January 2000 to December 2009.
The median New Injury Severity Score was 9 (range: 1-57) for 147 abdominal injuries. Most patients (94%) received computed tomography (CT), but only 38% of patients with multiple trauma were diagnosed with CT
Notes
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PubMed ID
25124882 View in PubMed
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Analysis of the mechanism of injury in non-fatal vehicle-to-pedestrian and vehicle-to-bicyclist frontal crashes in Sweden.

https://arctichealth.org/en/permalink/ahliterature282876
Source
Int J Inj Contr Saf Promot. 2016 Dec;23(4):405-412
Publication Type
Article
Date
Dec-2016
Author
Mikael Öman
Rikard Fredriksson
Per-Olof Bylund
Ulf Björnstig
Source
Int J Inj Contr Saf Promot. 2016 Dec;23(4):405-412
Date
Dec-2016
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - statistics & numerical data
Adolescent
Adult
Aged
Aged, 80 and over
Bicycling - injuries - statistics & numerical data
Child
Child, Preschool
Female
Humans
Male
Middle Aged
Motor Vehicles - statistics & numerical data
Sweden - epidemiology
Wounds and Injuries - epidemiology - etiology
Young Adult
Abstract
The aim of this paper is to analyse and compare injuries and injury sources in pedestrian and bicyclist non-fatal real-life frontal passengercar crashes, considering in what way pedestrian injury mitigation systems also might be adequate for bicyclists. Data from 203 non-fatal vehicle-to-pedestrian and vehicle-to-bicyclist crashes from 1997 through 2006 in a city in northern Sweden were analysed by use of the hospitals injury data base in addition to interviews with the injured. In vehicle-to-pedestrian crashes (n = 103) head and neck injuries were in general due to hitting the windscreen frame, while in vehicle-to-bicycle crashes (n = 100) head and neck injuries were typically sustained by ground impact. Abdominal, pelvic and thoracic injuries in pedestrians and thoracic injuries in bicyclists were in general caused by impacting the bonnet. In vehicle-to-pedestrian crashes, energy reducing airbags at critical impact points with low yielding ability on the car, as the bonnet and the windscreen frame, might reduce injuries. As vehicle-to-bicyclist crashes occurred mostly in good lighting conditions and visibility and the ground impact causing almost four times as many injuries as an impact to the different regions of the car, crash avoidance systems as well as separating bicyclists from motor traffic, may contribute to mitigate these injuries.
PubMed ID
26076708 View in PubMed
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Cholecystectomy and sphincterotomy in patients with mild acute biliary pancreatitis in Sweden 1988 - 2003: a nationwide register study.

https://arctichealth.org/en/permalink/ahliterature147772
Source
BMC Gastroenterol. 2009;9:80
Publication Type
Article
Date
2009
Author
Birger Sandzén
Markku M Haapamäki
Erik Nilsson
Hans C Stenlund
Mikael Oman
Author Affiliation
Department of Surgical and Perioperative Sciences; Surgery, Umeå University Hospital, SE-901 85 Umeå, Sweden. birger.sandzen@vll.se
Source
BMC Gastroenterol. 2009;9:80
Date
2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Biliary Tract Diseases - epidemiology - mortality - surgery
Cholecystectomy - statistics & numerical data
Female
Humans
Length of Stay
Male
Middle Aged
Pancreatitis - epidemiology - mortality - surgery
Registries
Retrospective Studies
Sphincterotomy, Endoscopic - statistics & numerical data
Sweden - epidemiology
Time Factors
Abstract
Gallstones represent the most common cause of acute pancreatitis in Sweden. Epidemiological data concerning timing of cholecystectomy and sphincterotomy in patients with first attack of mild acute biliary pancreatitis (MABP) are scarce. Our aim was to analyse readmissions for biliary disease, cholecystectomy within one year, and mortality within 90 days of index admission for MABP.
Hospital discharge and death certificate data were linked for patients with first attack acute pancreatitis in Sweden 1988-2003. Mortality was calculated as case fatality rate (CFR) and standardized mortality ratio (SMR). MABP was defined as acute pancreatitis of biliary aetiology without mortality during an index stay of 10 days or shorter. Patients were analysed according to four different treatment policies: Cholecystectomy during index stay (group 1), no cholecystectomy during index stay but within 30 days of index admission (group 2), sphincterotomy but not cholecystectomy within 30 days of index admission (group 3), and neither cholecystectomy nor sphincterotomy within 30 days of index admission (group 4).
Of 11636 patients with acute biliary pancreatitis, 8631 patients (74%) met the criteria for MABP. After exclusion of those with cholecystectomy or sphincterotomy during the year before index admission (N = 212), 8419 patients with MABP remained for analysis. Patients in group 1 and 2 were significantly younger than patients in group 3 and 4. Length of index stay differed significantly between the groups, from 4 (3-6) days, (representing median, 25 and 75 percentiles) in group 2 to 7 (5-8) days in groups 1. In group 1, 4.9% of patients were readmitted at least once for biliary disease within one year after index admission, compared to 100% in group 2, 62.5% in group 3, and 76.3% in group 4. One year after index admission, 30.8% of patients in group 3 and 47.7% of patients in group 4 had undergone cholecystectomy. SMR did not differ between the four groups.
Cholecystectomy during index stay slightly prolongs this stay, but drastically reduces readmissions for biliary indications.
Notes
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PubMed ID
19852782 View in PubMed
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Fatal Vehicle-to-Bicyclist Crashes in Sweden - an In-Depth Study of injuries and vehicle sources.

https://arctichealth.org/en/permalink/ahliterature272405
Source
Ann Adv Automot Med. 2012;56:25-30
Publication Type
Article
Date
2012
Author
Rikard Fredriksson
Per-Olof Bylund
Mikael Oman
Source
Ann Adv Automot Med. 2012;56:25-30
Date
2012
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - prevention & control
Cause of Death
Head
Humans
Sweden
Thorax
Wounds and Injuries
Abstract
Designing effective vehicle-based countermeasures for vulnerable road users demands an understanding of the relationship between injury and injury source. The aim of this study was to explore this association for bicyclists in fatal real-life-crashes. All fatal crashes in Sweden where a bicyclist was killed when hit by the front of a passenger car between 2002 and 2008 were studied in detail using on-scene data. An analysis was performed to determine the body region containing the injury causing death, and the point of the car accountable for the fatal injury. These crashes were then compared to a previous study with the same selection criteria for vehicle-to-pedestrian fatal crashes.A combined analysis revealed that the dominating injury mechanism was head/neck injury from the windshield area. The most frequent injurious windshield parts were structural; the frame and lower parts of the glass area with instrument panel situated within the head's line of motion. This study indicates that bicyclists' injury sources were located more rearwardly on the car (e.g. windshield relative to hood), in comparison to injury sources in fatal vehicle-to-pedestrian crashes.If countermeasures to prevent fatal bicyclist injury in vehicle impacts were to be concentrated on mitigating head and thorax impact to the structural parts of the windshield, a dominant share of fatal bicyclist crashes could be prevented. This study shows that pedestrian countermeasures also have a potential for reducing injury in bicyclist crashes, but indicating that these countermeasures should be extended to address higher areas of the windshield.
Notes
Cites: Accid Anal Prev. 2003 Nov;35(6):927-4012971928
Cites: Traffic Inj Prev. 2003 Mar;4(1):74-8214522665
Cites: Traffic Inj Prev. 2011 Dec;12(6):604-1322133337
Cites: Leg Med (Tokyo). 2009 Apr;11 Suppl 1:S324-619261507
Cites: Accid Anal Prev. 2010 Nov;42(6):1672-8120728616
Cites: Ann Adv Automot Med. 2008 Oct;52:193-819026236
PubMed ID
23169113 View in PubMed
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Surgery for acute gallbladder disease in Sweden 1989-2006--a register study.

https://arctichealth.org/en/permalink/ahliterature116824
Source
Scand J Gastroenterol. 2013 Apr;48(4):480-6
Publication Type
Article
Date
Apr-2013
Author
Birger Sandzén
Markku M Haapamäki
Erik Nilsson
Hans C Stenlund
Mikael Oman
Author Affiliation
Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden. birger.sandzen@vll.se
Source
Scand J Gastroenterol. 2013 Apr;48(4):480-6
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Cholecystectomy - methods
Cholecystectomy, Laparoscopic - methods
Cholecystitis, Acute - surgery
Emergencies
Gallbladder Diseases - diagnosis - mortality - surgery
Gallstones - surgery
Humans
Length of Stay
Medical Records Systems, Computerized
Registries
Surgical Procedures, Elective - methods
Sweden
Time Factors
Treatment Outcome
Abstract
Since early 1970s, prospective randomized controlled trials have emphasized the advantages of early cholecystectomy in patients with acute cholecystitis, compared to elective delayed cholecystectomy. The aim of this investigation was to study surgery for acute gallbladder disease in Sweden during a 15-year period when open cholecystectomy was replaced by a laparoscopic procedure.
Data from the Swedish National Patient Register and the Cause of Death Register 1988-2006 comprising hospital stays with a primary diagnosis of gallbladder/gallstone disease in Sweden were retrieved. Patients were analyzed with reference to timing of cholecystectomy, length of hospital stay, and mortality.
Emergency cholecystectomy at index (first) admission or at readmission within 2 years of index admission was performed in 32.2% and 6.1% of patients, respectively. Elective cholecystectomy within 2 years of index admission was performed in 20.3% patients, whereas 41.3% of all patients did not undergo cholecystectomy within 2 years. Standardized mortality ratio did not significantly change during the audit period. Total hospital stay (days at index stay and subsequent stay(s) for biliary diagnoses within 2 years) was shorter for patients who had emergency cholecystectomy at first admission compared to patients with later or no cholecystectomy within 2 years.
Around 30% of patients with acute gallbladder disease were operated with cholecystectomy during the first admission with no time trend from 1990 through 2004. A total of 40% of patients with acute gallbladder disease were not cholecystectomized within 2 years. Analysis of outcome of long-term conservative treatment is warranted.
PubMed ID
23356689 View in PubMed
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Treatment of common bile duct stones in Sweden 1989-2006: an observational nationwide study of a paradigm shift.

https://arctichealth.org/en/permalink/ahliterature124225
Source
World J Surg. 2012 Sep;36(9):2146-53
Publication Type
Article
Date
Sep-2012
Author
Birger Sandzén
Markku M Haapamäki
Erik Nilsson
Hans C Stenlund
Mikael Oman
Author Affiliation
Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 85, Umeå, Sweden. birger.sandzen@vll.se
Source
World J Surg. 2012 Sep;36(9):2146-53
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Cholecystectomy - adverse effects - statistics & numerical data - trends
Common Bile Duct - surgery
Female
Gallstones - complications - therapy
Humans
Incidence
Infant
Infant, Newborn
Male
Middle Aged
Pancreatitis - epidemiology - etiology
Patient Readmission - statistics & numerical data
Registries
Sphincterotomy, Endoscopic - adverse effects - statistics & numerical data - trends
Sweden - epidemiology
Treatment Outcome
Young Adult
Abstract
The preferred strategies for treatment of common bile duct stones have changed from choledochotomy with cholecystectomy to sphincterotomy with or without cholecystectomy. The aim of the present study was to compare the effectiveness of these treatment strategies on a nationwide level in Sweden.
All patients with hospital care for benign biliary diagnoses 1988-2006 were identified in Swedish registers. Patients with common bile duct stones and a first admission with choledochotomy and or endoscopic sphincterotomy from 1989 through 2006 comprised the study group. These patients were analyzed with respect to readmission for biliary diagnoses and acute pancreatitis.
Incidence of open and laparoscopic choledochotomy decreased from 19.4 to 5.2, whereas endoscopic sphincterotomy increased from 5.1 to 26.1 per 100,000 inhabitants per year, respectively. Among patients treated for common bile duct stones (n = 26,815), 60.0 % underwent cholecystectomy during the first hospital admission in 1989-1994, compared to 30.1 % in 2001-2006. The treatment strategy that included endoscopic sphincterotomy was associated with more readmissions for biliary diagnoses and increased risk for acute pancreatitis than the treatment strategy with choledochotomy. However, patients treated with endoscopic sphincterotomy and concurrent cholecystectomy at the index admission had the lowest risk of readmission.
Cholecystectomy has been increasingly separated from treatment of bile duct stones, and endoscopic sphincterotomy has superseded choledochotomy as a first alternative for bile duct clearance in Sweden. In patients fit for surgery, clearance of the common bile duct can be combined with cholecystectomy, as it probably reduces the need for biliary related readmissions.
Notes
Comment In: World J Surg. 2012 Sep;36(9):2154-522669401
PubMed ID
22610264 View in PubMed
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6 records – page 1 of 1.