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Nikula, A., Lundeberg, S., Ryd Rinder, M., Lääperi, M., Sandholm, K., Castrén, M. & Kurland, L. (2024). A randomized double-blind trial of intranasal dexmedetomidine versus intranasal esketamine for procedural sedation and analgesia in young children. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 32(1), Article ID 16.
Öppna denna publikation i ny flik eller fönster >>A randomized double-blind trial of intranasal dexmedetomidine versus intranasal esketamine for procedural sedation and analgesia in young children
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2024 (Engelska)Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 32, nr 1, artikel-id 16Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: Procedural sedation and analgesia are commonly used in the Emergency Departments. Despite this common need, there is still a lack of options for adequate and safe analgesia and sedation in children. The objective of this study was to evaluate whether intranasal dexmedetomidine could provide more effective analgesia and sedation during a procedure than intranasal esketamine.

METHODS: This was a double-blind equally randomized (1:1) superiority trial of 30 children aged 1-3 years presenting to the Emergency Department with a laceration or a burn and requiring procedural sedation and analgesia. Patients were randomized to receive 2.0 mcg/kg intranasal dexmedetomidine or 1.0 mg/kg intranasal esketamine. The primary outcome measure was highest pain (assessed using Face, Legs, Activity, Cry, Consolability scale (FLACC)) during the procedure. Secondary outcomes were sedation depth, parents' satisfaction, and physician's assessment. Comparisons were done using Mann-Whitney U test (continuous variables) and Fisher's test (categorical variables).

RESULTS: Adequate analgesia and sedation were reached in 28/30 patients. The estimated sample size was not reached due to changes in treatment of minor injuries and logistical reasons. The median (IQR) of highest FLACC was 1 (0-3) with intranasal dexmedetomidine and 5 (2-6.75) with intranasal esketamine, (p-value 0.09). 85.7% of the parents with children treated with intranasal dexmedetomidine were "very satisfied" with the procedure and sedation compared to the 46.2% of those with intranasal esketamine, (p-value 0.1). No severe adverse events were reported during this trial.

CONCLUSIONS: This study was underpowered and did not show any difference between intranasal dexmedetomidine and intranasal esketamine for procedural sedation and analgesia in young children. However, the results support that intranasal dexmedetomidine could provide effective analgesia and sedation during procedures in young children aged 1-3 years with minor injuries. TRIAL REGISTRATION: Eudra-CT 2017-00057-40, April 20, 2017. https://eudract.ema.europa.eu/.

Ort, förlag, år, upplaga, sidor
BioMed Central (BMC), 2024
Nyckelord
Analgesia, Children, Dexmedetomidine, Esketamine, Intranasal, Procedure, Sedation
Nationell ämneskategori
Anestesi och intensivvård
Identifikatorer
urn:nbn:se:oru:diva-112097 (URN)10.1186/s13049-024-01190-5 (DOI)001178117100001 ()38439043 (PubMedID)
Anmärkning

Open Access funding provided by University of Helsinki (including Helsinki University Central Hospital). Personal research funding for doctoral research from Päivikki and Sakari Sohlberg Foundation, Stiftelsen Samariten, Finska läkaresällskapet.

Tillgänglig från: 2024-03-05 Skapad: 2024-03-05 Senast uppdaterad: 2024-04-04Bibliografiskt granskad
Westman, A., Kurland, L. & Hugelius, K. (2024). Non-technical skills needed by medical disaster responders: a scoping review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 32(1), Article ID 25.
Öppna denna publikation i ny flik eller fönster >>Non-technical skills needed by medical disaster responders: a scoping review
2024 (Engelska)Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 32, nr 1, artikel-id 25Artikel, forskningsöversikt (Refereegranskat) Published
Abstract [en]

Background: There is no universal agreement on what competence in disaster medicine is, nor what competences and personal attributes add value for disaster responders. Some studies suggest that disaster responders need not only technical skills but also non-technical skills. Consensus of which non-technical skills are needed and how training for these can be provided is lacking, and little is known about how to apply knowledge of non-technical skills in the recruitment of disaster responders. Therefore, this scoping review aimed to identify the non-technical skills required for the disaster medicine response.

Method: A scooping review using the Arksey & O´Malley framework was performed. Structured searches in the databases PuBMed, CINAHL Full Plus, Web of Science, PsycInfo and Scopus was conducted. Thereafter, data were structured and analyzed.

Results: From an initial search result of 6447 articles, 34 articles were included in the study. These covered both quantitative and qualitative studies and different contexts, including real events and training. The most often studied real event were responses following earthquakes. Four non-technical skills stood out as most frequently mentioned: communication skills; situational awareness; knowledge of human resources and organization and coordination skills; decision-making, critical-thinking and problem-solving skills. The review also showed a significant lack of uniform use of terms like skills or competence in the reviewed articles.

Conclusion: Non-technical skills are skills that disaster responders need. Which non-technical skills are most needed, how to train and measure non-technical skills, and how to implement non-technical skills in disaster medicine need further studies.

Ort, förlag, år, upplaga, sidor
BioMed Central (BMC), 2024
Nyckelord
Competence, Disaster, Disaster responders, Non-technical skills
Nationell ämneskategori
Annan klinisk medicin
Identifikatorer
urn:nbn:se:oru:diva-112784 (URN)10.1186/s13049-024-01197-y (DOI)001196965800001 ()38566146 (PubMedID)2-s2.0-85189203105 (Scopus ID)
Forskningsfinansiär
Örebro universitet
Tillgänglig från: 2024-04-03 Skapad: 2024-04-03 Senast uppdaterad: 2024-04-15Bibliografiskt granskad
Garcia-Castrillo, L., Cadamuro, J., Dodt, C., Lauwaert, D., Hachimi-Idrissi, S., Van Der Linden, C., . . . Sehmi, K. (2024). Recommendations for blood sampling in emergency departments from the European Society for Emergency Medicine (EUSEM), European Society for Emergency Nursing (EuSEN), and European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase. Executive summary. Clinical Chemistry and Laboratory Medicine
Öppna denna publikation i ny flik eller fönster >>Recommendations for blood sampling in emergency departments from the European Society for Emergency Medicine (EUSEM), European Society for Emergency Nursing (EuSEN), and European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase. Executive summary
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2024 (Engelska)Ingår i: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331Artikel i tidskrift (Refereegranskat) Epub ahead of print
Abstract [en]

AIM: Blood Sampling Guidelines have been developed to target European emergency medicine-related professionals involved in the blood sampling process (e.g. physicians, nurses, phlebotomists working in the ED), as well as laboratory physicians and other related professionals. The guidelines population focus on adult patients. The development of these blood sampling guidelines for the ED setting is based on the collaboration of three European scientific societies that have a role to play in the preanalytical phase process: EuSEN, EFLM, and EUSEM. The elaboration of the questions was done using the PICO procedure, literature search and appraisal was based on the GRADE methodology. The final recommendations were reviewed by an international multidisciplinary external review group.

RESULTS: The document includes the elaborated recommendations for the selected sixteen questions. Three in pre-sampling, eight regarding sampling, three post-sampling, and two focus on quality assurance. In general, the quality of the evidence is very low, and the strength of the recommendation in all the questions has been rated as weak. The working group in four questions elaborate the recommendations, based mainly on group experience, rating as good practice.

CONCLUSIONS: The multidisciplinary working group was considered one of the major contributors to this guideline. The lack of quality information highlights the need for research in this area of the patient care process. The peculiarities of the emergency medical areas need specific considerations to minimise the possibility of errors in the preanalytical phase.

Ort, förlag, år, upplaga, sidor
Walter de Gruyter, 2024
Nyckelord
Blood sampling, blood tests, emergency department, haemolysis, preanalytical errors, venipuncture
Nationell ämneskategori
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Identifikatorer
urn:nbn:se:oru:diva-113035 (URN)10.1515/cclm-2024-0059 (DOI)001197995700001 ()38581294 (PubMedID)
Tillgänglig från: 2024-04-09 Skapad: 2024-04-09 Senast uppdaterad: 2024-04-15Bibliografiskt granskad
Stassen, W., Tsegai, A. & Kurland, L. (2023). A Retrospective Geospatial Simulation Study of Helicopter Emergency Medical Services' Potential Time Benefit Over Ground Ambulance Transport in Northern South Africa.. Air Medical Journal, 42(6), 440-444
Öppna denna publikation i ny flik eller fönster >>A Retrospective Geospatial Simulation Study of Helicopter Emergency Medical Services' Potential Time Benefit Over Ground Ambulance Transport in Northern South Africa.
2023 (Engelska)Ingår i: Air Medical Journal, ISSN 1067-991X, E-ISSN 1532-6497, Vol. 42, nr 6, s. 440-444Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: One of the most important benefits of helicopter emergency medical services (HEMS) is a time benefit, either through expedited access to the casualty or a reduction in the transport time to definitive care. However, HEMS utilization does not come without risk to the public and crew or at an insignificant cost. Cost is an essential consideration for health policy decisions, especially in low- to middle-income countries, such as South Africa. The aim of this study was to determine whether there is a time benefit of HEMS dispatch in South Africa compared with simulated driving time. A secondary aim was to determine the distance from the incident site to the hospital at which a time benefit can be guaranteed.

METHODS: A retrospective study was undertaken by comparing the prehospital times of patients who underwent HEMS transportation with simulated ground emergency medical services (GEMS) transportation times. Handwritten patient records of actual flights were reviewed and analyzed. The actual flight times recorded were used to calculate the helicopter transport time, activation to scene time, scene time, and scene to hospital time. Times were assigned based on a nonsimultaneous dispatch model, as is used in South Africa. For each helicopter mission, Google Maps (Google Inc, Mountain View, CA) was used to simulate the fastest ground route from the same location of the incident to the same receiving hospital corrected for typical traffic trends. The actual HEMS and simulated GEMS times were compared using the paired t-test. Linear regression analysis was performed to determine a minimum driving distance at which HEMS provides a time benefit.

RESULTS: A total of 118 HEMS transports were analyzed, the majority of which were trauma related (n = 115, 97%). HEMS transport resulted in a mean time deficit of -15 minutes (95% confidence interval, -18 to -11; P < .05) compared with simulated GEMS drive times. After regression, HEMS transport provides a time benefit at a driving distance greater than 119 km.

CONCLUSION: The current study demonstrated that there was rarely a time benefit for actual primary emergency responses when HEMS was used compared with simulated driving time of GEMS transport. Using a nonsimultaneous dispatch model, a time benefit only occurs when the driving distance from the incident site to the hospital is greater than 119 km. There is an urgent need to critically evaluate HEMS utilization in the South African context.

Ort, förlag, år, upplaga, sidor
Elsevier, 2023
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:oru:diva-110966 (URN)10.1016/j.amj.2023.07.005 (DOI)37996179 (PubMedID)2-s2.0-85166942514 (Scopus ID)
Tillgänglig från: 2024-01-23 Skapad: 2024-01-23 Senast uppdaterad: 2024-03-06Bibliografiskt granskad
Strålin, K., Linder, A., Brink, M., Benjaminsson-Nyberg, P., Svefors, J., Bengtsson-Toni, M., . . . Kurland, L. (2023). Design of a national patient-centred clinical pathway for sepsis in Sweden. Infectious Diseases, 55(10), 716-724
Öppna denna publikation i ny flik eller fönster >>Design of a national patient-centred clinical pathway for sepsis in Sweden
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2023 (Engelska)Ingår i: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 55, nr 10, s. 716-724Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: The World Health Organization has adopted a resolution on sepsis and urged member states to develop national processes to improve sepsis care. In Sweden, sepsis was selected as one of the ten first diagnoses to be addressed, when the Swedish government in 2019 allocated funds for patient-centred clinical pathways in healthcare. A national multidisciplinary working group, including a patient representative, was appointed to develop the patient-centred clinical pathway for sepsis.

METHODS: The working group mapped challenges and needs surrounding sepsis care and included a survey sent to all emergency departments (ED) in Sweden, and then designed a patient-centred clinical pathway for sepsis.

RESULTS: The working group decided to focus on the following four areas: (1) sepsis alert for early detection and management optimisation for the most severely ill sepsis patients in the ED; (2) accurate sepsis diagnosis coding; (3) structured information to patients at discharge after sepsis care and (4) structured telephone follow-up after sepsis care. A health-economic analysis indicated that the implementation of the clinical pathway for sepsis will most likely not drive costs. An important aspect of the clinical pathway is implementing continuous monitoring of performance and process indicators. A national working group is currently building up such a system for monitoring, focusing on extraction of this information from the electronic health records systems.

CONCLUSION: A national patient-centred clinical pathway for sepsis has been developed and is currently being implemented in Swedish healthcare. We believe that the clinical pathway and the accompanying monitoring will provide a more efficient and equal sepsis care and improved possibilities to monitor and further develop sepsis care in Sweden.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2023
Nyckelord
SOFA score, Sepsis, clinical pathway, discharge coding, sepsis alert, sepsis recovery
Nationell ämneskategori
Anestesi och intensivvård
Identifikatorer
urn:nbn:se:oru:diva-107467 (URN)10.1080/23744235.2023.2234033 (DOI)001035690300001 ()37477232 (PubMedID)2-s2.0-85163827076 (Scopus ID)
Tillgänglig från: 2023-08-09 Skapad: 2023-08-09 Senast uppdaterad: 2024-01-16Bibliografiskt granskad
Becker, J., Kurland, L., Höglund, E. & Hugelius, K. (2023). Dynamic ambulance relocation: a scoping review. BMJ Open, 13(12), Article ID e073394.
Öppna denna publikation i ny flik eller fönster >>Dynamic ambulance relocation: a scoping review
2023 (Engelska)Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 13, nr 12, artikel-id e073394Artikel, forskningsöversikt (Refereegranskat) Published
Abstract [en]

Objectives Dynamic ambulance relocation means that the operators at a dispatch centre place an ambulance in a temporary location, with the goal of optimising coverage and response times in future medical emergencies. This study aimed to scope the current research on dynamic ambulance relocation.

Design A scoping review was conducted using a structured search in PubMed, Scopus and Web of Science. In total, 21 papers were included.

Results Most papers described research with experimental designs involving the use of mathematical models to calculate the optimal use and temporary relocations of ambulances. The models relied on several variables, including distances, locations of hospitals, demographic-geological data, estimation of new emergencies, emergency medical services (EMSs) working hours and other data. Some studies used historic ambulance dispatching data to develop models. Only one study reported a prospective, real-time evaluation of the models and the development of technical systems. No study reported on either positive or negative patient outcomes or real-life chain effects from the dynamic relocation of ambulances.

Conclusions Current knowledge on dynamic relocation of ambulances is dominated by mathematical and technical support data that have calculated optimal locations of ambulance services based on response times and not patient outcomes. Conversely, knowledge of how patient outcomes and the working environment are affected by dynamic ambulance dispatching is lacking. This review has highlighted several gaps in the scientific coverage of the topic. The primary concern is the lack of studies reporting on patient outcomes, and the limited knowledge regarding several key factors, including the optimal use of ambulances in rural areas, turnaround times, domino effects and aspects of working environment for EMS personnel. Therefore, addressing these knowledge gaps is important in future studies.

Ort, förlag, år, upplaga, sidor
BMJ Publishing Group Ltd, 2023
Nyckelord
accident & emergency medicine, organisation of health services, systematic review, health services administration & management
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:oru:diva-110434 (URN)10.1136/bmjopen-2023-073394 (DOI)001171839300004 ()2-s2.0-85179899873 (Scopus ID)
Tillgänglig från: 2023-12-18 Skapad: 2023-12-18 Senast uppdaterad: 2024-03-20Bibliografiskt granskad
Brown, R., Kurland, L. & Lojo Rial, C. (2023). How should we train emergency physicians for Quality and Safety activities?. European journal of emergency medicine, 30(6), 391-392
Öppna denna publikation i ny flik eller fönster >>How should we train emergency physicians for Quality and Safety activities?
2023 (Engelska)Ingår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 30, nr 6, s. 391-392Artikel i tidskrift, Editorial material (Refereegranskat) Published
Ort, förlag, år, upplaga, sidor
Lippincott Williams & Wilkins, 2023
Nationell ämneskategori
Anestesi och intensivvård
Identifikatorer
urn:nbn:se:oru:diva-108396 (URN)10.1097/MEJ.0000000000001081 (DOI)001089396400005 ()37729042 (PubMedID)2-s2.0-85175356708 (Scopus ID)
Tillgänglig från: 2023-09-21 Skapad: 2023-09-21 Senast uppdaterad: 2024-01-16Bibliografiskt granskad
Tuerxun, K., Eklund, D., Wallgren, U., Dannenberg, K., Repsilber, D., Kruse, R., . . . Kurland, L. (2023). Predicting sepsis using a combination of clinical information and molecular immune markers sampled in the ambulance. Scientific Reports, 13(1), Article ID 14917.
Öppna denna publikation i ny flik eller fönster >>Predicting sepsis using a combination of clinical information and molecular immune markers sampled in the ambulance
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2023 (Engelska)Ingår i: Scientific Reports, E-ISSN 2045-2322, Vol. 13, nr 1, artikel-id 14917Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Sepsis is a time dependent condition. Screening tools based on clinical parameters have been shown to increase the identification of sepsis. The aim of current study was to evaluate the additional predictive value of immunological molecular markers to our previously developed prehospital screening tools. This is a prospective cohort study of 551 adult patients with suspected infection in the ambulance setting of Stockholm, Sweden between 2017 and 2018. Initially, 74 molecules and 15 genes related to inflammation were evaluated in a screening cohort of 46 patients with outcome sepsis and 50 patients with outcome infection no sepsis. Next, 12 selected molecules, as potentially synergistic predictors, were evaluated in combination with our previously developed screening tools based on clinical parameters in a prediction cohort (n = 455). Seven different algorithms with nested cross-validation were used in the machine learning of the prediction models. Model performances were compared using posterior distributions of average area under the receiver operating characteristic (ROC) curve (AUC) and difference in AUCs. Model variable importance was assessed by permutation of variable values, scoring loss of classification as metric and with model-specific weights when applicable. When comparing the screening tools with and without added molecular variables, and their interactions, the molecules per se did not increase the predictive values. Prediction models based on the molecular variables alone showed a performance in terms of AUCs between 0.65 and 0.70. Among the molecular variables, IL-1Ra, IL-17A, CCL19, CX3CL1 and TNF were significantly higher in septic patients compared to the infection non-sepsis group. Combing immunological molecular markers with clinical parameters did not increase the predictive values of the screening tools, most likely due to the high multicollinearity of temperature and some of the markers. A group of sepsis patients was consistently miss-classified in our prediction models, due to milder symptoms as well as lower expression levels of the investigated immune mediators. This indicates a need of stratifying septic patients with a priori knowledge of certain clinical and molecular parameters in order to improve prediction for early sepsis diagnosis.Trial registration: NCT03249597. Registered 15 August 2017.

Ort, förlag, år, upplaga, sidor
Nature Portfolio, 2023
Nationell ämneskategori
Infektionsmedicin
Identifikatorer
urn:nbn:se:oru:diva-108188 (URN)10.1038/s41598-023-42081-6 (DOI)001066443900002 ()37691028 (PubMedID)2-s2.0-85170487168 (Scopus ID)
Forskningsfinansiär
Örebro universitetNyckelfondenLaerdal Foundation for Acute MedicineKK-stiftelsen, 20160044 20200017
Anmärkning

This study was supported by grants from Nyckelfonden, Laerdal, Falck Foundation, Knowledge Foundation (20160044, 20200017), the Emergency Department of Södersjukhuset, Stockholm, and Örebro University.

Tillgänglig från: 2023-09-11 Skapad: 2023-09-11 Senast uppdaterad: 2024-01-16Bibliografiskt granskad
Wu, L., Chen, X., Khalemsky, A., Li, D., Zoubeidi, T., Lauque, D., . . . Bellou, A. (2023). The Association between Emergency Department Length of Stay and In-Hospital Mortality in Older Patients Using Machine Learning: An Observational Cohort Study. Journal of Clinical Medicine, 12(14), Article ID 4750.
Öppna denna publikation i ny flik eller fönster >>The Association between Emergency Department Length of Stay and In-Hospital Mortality in Older Patients Using Machine Learning: An Observational Cohort Study
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2023 (Engelska)Ingår i: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 12, nr 14, artikel-id 4750Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The association between emergency department (ED) length of stay (EDLOS) with in-hospital mortality (IHM) in older patients remains unclear. This retrospective study aims to delineate the relationship between EDLOS and IHM in elderly patients. From the ED patients (n = 383,586) who visited an urban academic tertiary care medical center from January 2010 to December 2016, 78,478 older patients (age ≥60 years) were identified and stratified into three age subgroups: 60-74 (early elderly), 75-89 (late elderly), and ≥90 years (longevous elderly). We applied multiple machine learning approaches to identify the risk correlation trends between EDLOS and IHM, as well as boarding time (BT) and IHM. The incidence of IHM increased with age: 60-74 (2.7%), 75-89 (4.5%), and ≥90 years (6.3%). The best area under the receiver operating characteristic curve was obtained by Light Gradient Boosting Machine model for age groups 60-74, 75-89, and ≥90 years, which were 0.892 (95% CI, 0.870-0.916), 0.886 (95% CI, 0.861-0.911), and 0.838 (95% CI, 0.782-0.887), respectively. Our study showed that EDLOS and BT were statistically correlated with IHM (p < 0.001), and a significantly higher risk of IHM was found in low EDLOS and high BT. The flagged rate of quality assurance issues was higher in lower EDLOS ≤1 h (9.96%) vs. higher EDLOS 7 h <t≤ 8 h (1.84%). Special attention should be given to patients admitted after a short stay in the ED and a long BT, and new concepts of ED care processes including specific areas and teams dedicated to older patients care could be proposed to policymakers.

Ort, förlag, år, upplaga, sidor
MDPI, 2023
Nyckelord
Boarding time, emergency department, in-hospital mortality, length of stay, machine learning, older adults
Nationell ämneskategori
Omvårdnad Anestesi och intensivvård
Identifikatorer
urn:nbn:se:oru:diva-107484 (URN)10.3390/jcm12144750 (DOI)001037443600001 ()37510865 (PubMedID)2-s2.0-85166332423 (Scopus ID)
Anmärkning

This research was supported by the Youth Science Fund of the National Natural Science Foundation of China (Grant No. 61802149).

Tillgänglig från: 2023-08-09 Skapad: 2023-08-09 Senast uppdaterad: 2024-01-16Bibliografiskt granskad
Schell, C. O., Wellhagen, A., Lipcsey, M., Kurland, L., Bjurling-Sjöberg, P., Stålsby Lundborg, C., . . . Baker, T. (2023). The burden of critical illness among adults in a Swedish region-a population-based point-prevalence study. European Journal of Medical Research, 28(1), Article ID 322.
Öppna denna publikation i ny flik eller fönster >>The burden of critical illness among adults in a Swedish region-a population-based point-prevalence study
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2023 (Engelska)Ingår i: European Journal of Medical Research, ISSN 0949-2321, E-ISSN 2047-783X, Vol. 28, nr 1, artikel-id 322Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Patients with critical illness have a high risk of mortality. Key decision-making in the health system affecting the outcomes of critically ill patients requires epidemiological evidence, but the burden of critical illness is largely unknown. This study aimed to estimate the prevalence of critical illness in a Swedish region. Secondary objectives were to estimate the proportion of hospital inpatients who are critically ill and to describe the in-hospital location of critically ill patients.

Methods: A prospective, multi-center, population-based, point-prevalence study on specific days in 2017-2018. All adult (> 18 years) in-patients, regardless of admitting specially, in all acute hospitals in Sörmland, and the patients from Sörmland who had been referred to university hospitals, were included. Patients in the operating theatres, with a psychiatric cause of admission, women in active labor and moribund patients, were excluded. All participants were examined by trained data collectors. Critical illness was defined as "a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and a potential for reversibility". The presence of one or more severely deranged vital signs was used to classify critical illness. The prevalence of critical illness was calculated as the number of critically ill patients divided by the number of adults in the region.

Results: A total of 1269 patients were included in the study. Median age was 74 years and 50% of patients were female. Critical illness was present in 133 patients, resulting in an adult population prevalence of critical illness per 100,000 people of 19.4 (95% CI 16.4-23.0). The proportion of patients in hospital who were critically ill was 10.5% (95% CI 8.8-12.3%). Among the critically ill, 125 [95% CI 94.0% (88.4-97.0%)] were cared for in general wards.

Conclusions. The prevalence of critical illness was higher than previous, indirect estimates. One in ten hospitalized patients were critically ill, the large majority of which were cared for in general wards. This suggests a hidden burden of critical illness of potential public health, health system and hospital management significance.

Ort, förlag, år, upplaga, sidor
BioMed Central (BMC), 2023
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:oru:diva-108194 (URN)10.1186/s40001-023-01279-0 (DOI)001064985300003 ()37679836 (PubMedID)2-s2.0-85170177206 (Scopus ID)
Forskningsfinansiär
Karolinska Institutet
Anmärkning

Funding agencies:

Centre for Clinical Research Soermland, Uppsala University, Sweden (COS) DLL-652801

Regional Research Council Mid Sweden (COS, AW) RFR-931271

 

Tillgänglig från: 2023-09-11 Skapad: 2023-09-11 Senast uppdaterad: 2024-01-16Bibliografiskt granskad
Organisationer
Identifikatorer
ORCID-id: ORCID iD iconorcid.org/0000-0003-3290-4111

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