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  • 1.
    Ahlberg, Rickard
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Skårberg, Kurt
    Örebro universitet, Institutionen för medicinska vetenskaper. Addiction Center.
    Brus, Ole
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Kjellin, Lars
    Örebro universitet, Institutionen för hälsovetenskaper.
    Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services2016Ingår i: Substance Abuse Treatment, Prevention, and Policy, ISSN 1747-597X, E-ISSN 1747-597X, Vol. 11, nr 1, artikel-id 24Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A common alternative treatment for substance abuse is auricular acupuncture. The aim of the study was to evaluate the short and long-term effect of auricular acupuncture on anxiety, sleep, drug use and addiction treatment utilization in adults with substance abuse.

    Method: Of the patients included, 280 adults with substance abuse and psychiatric comorbidity, 80 were randomly assigned to auricular acupuncture according to the NADA protocol, 80 to auricular acupuncture according to a local protocol (LP), and 120 to relaxation (controls). The primary outcomes anxiety (Beck Anxiety Inventory; BAI) and insomnia (Insomnia Severity Index; ISI) were measured at baseline and at follow-ups 5 weeks and 3 months after the baseline assessment. Secondary outcomes were drug use and addiction service utilization. Complete datasets regarding BAI/ISI were obtained from 37/34 subjects in the NADA group, 28/28 in the LP group and 36/35 controls. Data were analyzed using Chi-square, Analysis of Variance, Kruskal Wallis, Repeated Measures Analysis of Variance, Eta square (η(2)), and Wilcoxon Signed Ranks tests.

    Results: Participants in NADA, LP and control group improved significantly on the ISI and BAI. There was no significant difference in change over time between the three groups in any of the primary (effect size: BAI, η(2) = 0.03, ISI, η(2) = 0.05) or secondary outcomes. Neither of the two acupuncture treatments resulted in differences in sleep, anxiety or drug use from the control group at 5 weeks or 3 months.

    Conclusion: No evidence was found that acupuncture as delivered in this study is more effective than relaxation for problems with anxiety, sleep or substance use or in reducing the need for further addiction treatment in patients with substance use problems and comorbid psychiatric disorders. The substantial attrition at follow-up is a main limitation of the study.

    Trial registration: Clinical Trials NCT02604706 (retrospectively registered).

  • 2.
    Björk, Tabita
    et al.
    Psychiatric Research Centre, Örebro County Council, Örebro, Sweden; Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Brus, Ole
    Örebro University Hospital, Örebro, Sweden.
    Osika, Walter
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Montgomery, Scott M.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Primary Care and Public Health, Charing Cross Hospital, Imperial College, London, UK.
    Laterality, hand control and scholastic performance: a British birth cohort study2012Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, nr 2, artikel-id e000314Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To use simple measures of laterality and hand control that can identify a greater risk of poorer scholastic ability, potentially signalling suboptimal hemispheric lateralisation.

    Design: Analysis of material from a birth cohort study.

    Setting: Members of the National Child Development Study, a British birth cohort study following people born in 1958.

    Participants: 10 612 children who undertook tests at age 11 years.

    Primary outcome measures: Teacher-administered tests of non-verbal general ability, verbal general ability, reading comprehension and mathematics.

    Results: Linear regression produced associations (and 95% CIs) with tests of verbal general ability, non-verbal general ability, reading comprehension and mathematics scores for the lowest third (compared with highest) of a left-hand control test involving picking up matches of -1.21 (-1.73 to -0.68; p<0.001), -0.72 (-1.14 to -0.29; p=0.001), -0.70 (-1.06 to -0.35; p<0.001) and -1.32 (-1.90 to -0.73; p<0.001). Among those in the lowest third of the right-hand control test score, mixed-handedness compared with right-handedness was associated with poorer scholastic performance, with regression coefficients (and 95% CIs; p values) of 1.90 (-3.01 to -0.80; p=0.001), -1.25 (-2.15 to -0.35; p=0.007), -1.28 (2.04 to -0.53; p=0.001) and -1.33 (-2.53 to -0.13; p=0.030). The estimates are for a point change in the scholastic test scores, after adjustment for sex, left-hand motor function and social class. Statistically significant associations with mixed-handedness were only observed for the lowest third of right-hand motor function.

    Conclusions: Measures involving poorer left-hand motor function may represent useful markers of reduced cognitive function possibly reflecting suboptimal hemispheric lateralisation. Crude measures of laterality such as reported non-right-handedness may be more useful for research when combined with measures of motor function.

  • 3.
    Brus, Ole
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, E.
    Department of Psychiatry, Umeå University Hospital, Umeå, Sweden.
    Hultén, Martin
    Psychiatric Neuromodulation Unit (PNU), Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.
    Landén, Mikael
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Lundberg, Johan
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Nordanskog, Pia
    Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Nordenskjöld, Axel
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Self-assessed remission rates after electroconvulsive therapy of depressive disorders2017Ingår i: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 45, s. 154-160, artikel-id S0924-9338(17)32917-6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Electroconvulsive therapy (ECT) effectively treats severe depression, but not all patients remit. The aim of the study was to identify clinical factors that associate with ECT-induced remission in a community setting.

    METHODS: Depressed patients who underwent ECT in 2011-2014 were identified from the Swedish National Quality Register for ECT. Remission was defined as self-rated Montgomery-Åsberg Depression Rating Scale scores of 0-10 after ECT. Other registers provided data on previous antidepressant use, comorbidities, and demographics.

    RESULTS: Of 1671 patients fulfilling the inclusion criteria, 42.8% achieved remission. Older age, education length over 9 years, psychotic symptoms, shorter duration of preceding antidepressant use, pulse width stimulus≥0.50ms, absence of substance use disorders, anxiety diagnosis, lamotrigine, and benzodiazepines, were associated with remission.

    CONCLUSIONS: This study shows that psychotic subtype of depression and older age are clinically relevant predictors of a beneficial ECT effect. Additionally, ECT outcomes can be further improved by optimizing the treatment technique and concomitant medication.

  • 4.
    Brus, Ole
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Hammar, Åsa
    Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
    Landén, Mikael
    Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lundberg, Johan
    Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Stockholm County Council, Stockholm, Sweden.
    Nordanskog, Pia
    Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Psychiatry, Region Östergötland, Linköping, Sweden.
    Nordenskjöld, Axel
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Centre.
    Lithium for suicide and readmission prevention after electroconvulsive therapy for unipolar depression: population-based register study2019Ingår i: BJPsych Open, E-ISSN 2056-4724, Vol. 5, nr 3, artikel-id e46Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Electroconvulsive therapy (ECT) is effective for unipolar depression but relapse and suicide are significant challenges. Lithium could potentially lower these risks, but is used only in a minority of patients.AimsThis study quantifies the effect of lithium on risk of suicide and readmission and identifies factors that are associate with readmission and suicide.

    METHOD: This population-based register study used data from the Swedish National Quality Register for ECT and other Swedish national registers. Patients who have received ECT for unipolar depression as in-patients between 2011 and 2016 were followed until death, readmission to hospital or the termination of the study at the end of 2016. Cox regression was used to estimate hazard ratios (HR) of readmission and suicide in adjusted models.

    RESULTS: Out of 7350 patients, 56 died by suicide and 4203 were readmitted. Lithium was prescribed to 638 (9%) patients. Mean follow-up was 1.4 years. Lithium was significantly associated with lower risk of suicide (P = 0.014) and readmission (HR 0.84 95% CI 0.75-0.93). The number needed to be treated with lithium to prevent one readmission was 16. In addition, the following factors were statistically associated with suicide: male gender, being a widow, substance use disorder and a history of suicide attempts. Readmission was associated with young age, being divorced or unemployed, comorbid anxiety disorder, nonpsychotic depression, more severe symptoms before ECT, no improvement with ECT, not receiving continuation ECT or antidepressants, usage of antipsychotics, anxiolytics or benzodiazepines, severity of medication resistance and number of previous admissions.

    CONCLUSIONS: More patients could benefit from lithium treatment.

  • 5.
    Eriksson, Carl
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Henriksson, Ida
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Brus, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Zhulina, Yaroslava
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Nyhlin, Nils
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Tysk, Curt
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Karolinska Institutet, Stockholm, Sweden; University College London, London, United Kingdom.
    Incidence, prevalence, and clinical outcome of anaemia in inflammatory bowel disease: A population-based cohort studyManuskript (preprint) (Övrigt vetenskapligt)
  • 6.
    Eriksson, Carl
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology.
    Henriksson, Ida
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Brus, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Zhulina, Yaroslava
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology.
    Nyhlin, Nils
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology.
    Tysk, Curt
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Incidence, prevalence and clinical outcome of anaemia in inflammatory bowel disease: a population-based cohort study2018Ingår i: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 48, nr 6, s. 638-645Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The incidence and short-term outcome of anaemia in inflammatory bowel disease (IBD) are largely unknown.

    AIM: To determine the incidence, prevalence and clinical outcome of anaemia in terms of resolution of anaemia within 12 months. We also planned to assess risk factors for anaemia in IBD.

    METHODS: A random sample of 342 patients was obtained from the population-based IBD cohort of Örebro University Hospital, Sweden, consisting of 1405 patients diagnosed between 1963 and 2010. Haemoglobin measurements recorded from 1 January 2011 to 31 December 2013 were extracted from the Clinical Chemistry data system.

    RESULTS: In Crohn's disease, the incidence rate of anaemia was 19.3 (95% CI: 15.4-23.7) per 100 person-years and the prevalence was 28.7% (CI: 22.0-36.2), compared with 12.9 (CI: 9.8-16.5) and 16.5% (CI: 11.2-22.9) for ulcerative colitis. Crohn's disease was associated with an increased incidence (OR = 1.60; CI: 1.02-2.51) and prevalence of anaemia (OR = 2.04; CI: 1.20-3.46) compared to ulcerative colitis. Stricturing disease phenotype in Crohn's disease (HR = 2.59; CI: 1.00-6.79) and extensive disease in ulcerative colitis (HR = 2.40; CI: 1.10-5.36) were associated with an increased risk of anaemia. Despite a higher probability of receiving specific therapy within 3 months from the diagnosis of anaemia, Crohn's disease patients had a worse outcome in terms of resolution of anaemia within 12 months (56% vs 75%; P = 0.03).

    CONCLUSIONS: Anaemia is a common manifestation of IBD even beyond the first years after the diagnosis of IBD. Crohn's disease is associated with both an increased risk and a worse outcome.

  • 7.
    Fischer, Per
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Hand Surgery.
    Sagerfors, Marcus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Hand Surgery.
    Brus, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Pettersson, Kurt
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Revision Arthroplasty of the Wrist in Patients With Rheumatoid Arthritis, Mean Follow-Up 6.6 Years2018Ingår i: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 43, nr 5, s. 489.e1-489.e7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Management of failed total wrist arthroplasty (TWA) can be challenging; surgical treatment options include salvage arthrodesis, revision arthroplasty, and resection arthroplasty. There are few studies regarding salvage arthrodesis, and revision arthroplasty has been infrequently investigated. The aim of the study was to report the outcome after revision arthroplasty of the wrist.

    METHODS: A retrospective cohort of 16 revision TWAs was evaluated between 2003 and 2016. Data were collected before surgery and 1 and 5 years after surgery. The indication for revision arthroplasty was failed TWA. The primary end point was implant survival. Secondary outcome measures included visual analog scale (VAS) pain scores, range of motion, handgrip strength, and functional scoring with the Canadian Occupational Performance Measure (COPM), Patient-Rated Wrist Evaluation (PRWE), and Disabilities of the Arm, Shoulder, and Hand (DASH).

    RESULTS: Mean follow-up was 6.6 years. Synthetic bone graft was used in 9 cases, allograft corticocancellous bone graft in 1 case, and cement in 6 cases. Of the 16 revision TWAs, 4 were re-revised, 1 because of infection, and 3 cases underwent total wrist arthrodesis. In the non-re-revised cases, range of motion and grip strength was preserved compared with preoperative results. The VAS pain score in activity improved, but not significantly, at 1 (median, 1; range, 0-4.5) and 5 years after surgery (median, 0) compared with before surgery (median, 5). The COPM performance and satisfaction as well as PRWE scores improved significantly at 1 year (median COPM performance, 4.8; COPM satisfaction, 5.6; and PRWE, 24) and improved, but not significantly, at the 5-year follow (median COPM performance, 4.8; COPM satisfaction, 5.0; and PRWE, 37) in the non-re-revised cases.

    CONCLUSIONS: Revision arthroplasty of the wrist is a valid motion-preserving option to wrist arthrodesis in the management of failed TWA. However, the outcome is uncertain and as many as 25% require additional surgery.

    TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

  • 8.
    Montgomery, Scott
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Clinical Epidemiology Unit, Karolinska Inst, Stockholm, Sweden ; Dept Epidemiology & Publ Health, University College London (UCL), London, England .
    Bahmanyar, Shahram
    Clinical & Epidemiological Unit, Karolinska Inst, Stockholm, Sweden; Center of Pharmacoepidemiology, Karolinska Institute, Stockholm, Sweden .
    Brus, Ole
    Örebro University Hospital, Örebro, Sweden.
    Hussein, Oula
    Örebro University Hospital, Örebro, Sweden.
    Kosma, Paraskevi
    Dept Woman & Child Health, Karolinska Institute, Stockholm, Sweden; Division of Neonatology, Karolinska Hosp, Stockholm, Sweden.
    Palme-Kilander, Charlotte
    Dept Woman & Child Health, Karolinska Institute, Stockholm, Sweden.
    Respiratory infections in preterm infants and subsequent asthma: a cohort study2013Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 10, artikel-id e004034Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate whether gestational age modifies the association of airway infections that result in hospital admission during the first year after birth, with subsequent asthma risk after age 5years.

    Setting: Hospital inpatients and a general population comparison group in Sweden followed for subsequent diagnoses in primary and secondary care.

    Participants: National registers identified 42334 children admitted to hospital for respiratory infection in their first year after birth during 1981-1995, individually matched with 211594 children not admitted to hospital for infection during their first year.

    Primary outcome Asthma diagnoses and prescribed asthma treatments after the age of 5years identified through registers.

    Results: Cox regression was used to identify a HR (and 95% CI) of 1.51 (1.47 to 1.51) for the association of respiratory infection before 1year of age with asthma after age 5years, after adjustment for sex, gestational age, chronic lung disease, maternal asthma and maternal smoking. When stratified by gestational age (and with additional adjustment for birth weight), there is statistically significant effect modification by gestational age, with the highest magnitude asthma risk among those born with a gestational age of less than 28 weeks, producing an adjusted HR of 2.22 (1.59 to 3.09). This higher magnitude asthma risk persisted until after age 10years, but differences in risk by gestational age were less pronounced for asthma after age 16years.

    Conclusions: Extremely preterm infants are most likely to have chronic respiratory sequelae following respiratory infections in early life.

  • 9.
    Montgomery, Scott
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Epidemiology and Public Health, University College London, London, UK; Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Brus, Ole
    Faculty of Medicine and Health, Örebro University, Sweden.
    Hiyoshi, Ayako
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Cao, Yang
    Rider, Jennifer
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.
    Fall, Katja
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Childhood exposures among mothers and Hodgkin's lymphoma in offspring2015Ingår i: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 39, nr 6, s. 1006-1009Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Childhood exposures in mothers, signaled by number of older and younger siblings, have lifelong consequences for aspects of immune function. We hypothesized that these may influence young adult-onset Hodgkin's lymphoma (HL) risk in offspring.

    Materials and methods: Swedish registers identified 2028 cases of young adult onset HL (diagnosed between ages 15-39 years) up to 2012 among those born since 1958; and 18,374 matched controls. Conditional logistic regression was used to assess HL risk associated with number of older and younger siblings of mothers.

    Results: Having a mother with more than two older siblings is associated with lower HL risk, and the association is statistically significant for mothers with three or more siblings, compared with none. The adjusted odds ratios (and 95% confidence intervals) are 1.04 (0.93-1.16); 0.95 (0.81-1.10); and 0.81 (0.66-0.98) for one, two, and three or more older siblings, respectively. There is no association between number of mothers' younger siblings and HL risk.

    Conclusions: Exposures during the childhood of mothers may influence young onset adult HL risk in offspring, perhaps through vertical transmission of infectious agents, or through other long-term influences on maternal immune function.

  • 10.
    Montgomery, Scott
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Karolinska Institutet, Stockholm, Sweden .
    Hassan, Ahmad
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Bahmanyar, Shahram
    Karolinska Institutet, Stockholm, Sweden; Golestan University of Medical Sciences, Gorgan, Iran .
    Brus, Ole
    Örebro University Hospital, Örebro, Sweden.
    Hussein, Oula
    Örebro University Hospital, Örebro, Sweden.
    Hiyoshi, Ayako
    Region Örebro län.
    Hillert, Jan
    Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden .
    Olsson, Tomas
    Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden .
    Fall, Katja
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro University Hospital, Örebro, Sweden.
    Mortality following a brain tumour diagnosis in patients with multiple sclerosis2013Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 11, artikel-id e003622Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: As brain tumours and their treatment may theoretically have a poorer prognosis in inflammatory central nervous system diseases such as multiple sclerosis (MS), all-cause mortality following a brain tumour diagnosis was compared between patients with and without MS. The potential role of age at tumour diagnosis was also examined.

    Setting: Hospital inpatients in Sweden with assessment of mortality in hospital or following discharge.

    Participants: Swedish national registers identified 20 543 patients with an MS diagnosis (1969–2005) and they were matched individually to produce a comparison cohort of 204 163 members of the general population without MS. Everyone with a primary brain tumour diagnosis was selected for this study: 111 with MS and 907 without MS.

    Primary and secondary outcome measures: 5-year mortality risk following brain tumour diagnosis and age at brain tumour diagnosis.

    Results: A non-statistically significant lower mortality risk among patients with MS (lower for those with tumours of high-grade and uncertain-grade malignancy and no notable difference for low-grade tumours) produced an unadjusted HR (and 95% CI) of 0.75 (0.56 to 1.02). After adjustment for age at diagnosis, grade of malignancy, sex, region of residence and socioeconomic index, the HR is 0.91 (0.67–1.24). The change in estimate was largely due to adjustment for age at brain tumour diagnosis, as patients with MS were on average 4.7 years younger at brain tumour diagnosis than those in the comparison cohort (p<0.001).

    Conclusions: Younger age at tumour diagnosis may contribute to mortality reduction in those with highgrade and uncertain-grade brain tumours. Survival following a brain tumour is not worse in patients with MS; even after age at brain tumour diagnosis and grade of malignancy are taken into account.

  • 11.
    Nordenskjöld, Axel
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Psychiatric Research Centre.
    von Knorring, Lars
    Psychiatric Research Centre, Örebro County Council, Örebro, Sweden; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
    Brus, Ole
    Örebro University Hospital, Örebro County Council, Örebro, Sweden.
    Engström, Ingemar
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Predictors of regained occupational functioning after electroconvulsive therapy (ECT) in patients with major depressive disorder: a population based cohort study2013Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 67, nr 5, s. 326-333Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: The aim of the present study is to investigate the rate of regained occupational functioning among patients treated with electroconvulsive therapy (ECT) for major depression and to define predictors of time to regained occupational functioning.

    Methods: A nested cohort study was performed of patients treated by ECT for unipolar major depressive disorder registered in the Quality register for ECT and in the Swedish Social Insurance Agency registry. Predictive values of single clinical variables and their relative importance were tested with Cox regression analysis.

    Results: 394 patients were identified. Of those, 266 were on non-permanent sick leave and 128 on disability pension during ECT. Within 1 year post-ECT, 71% of the patients with non-permanent sick leave regained occupational functioning. Factors independently associated with a statistically significant increased time to regained occupational functioning were longer duration of sick leave pre-ECT, milder depression pre-ECT, less complete improvement with ECT, benzodiazepine treatment after ECT and co-morbid substance dependence.

    Conclusions: A large proportion of the patients do not return to work within several months post-ECT. Paradoxically, patients with more severe depression pre-ECT had a reduced time to regained occupational functioning, indicating a larger effect in this patients group of the treatment. Moreover, the period with sick leave compensation might be reduced if ECT is initiated within the first 3 months of sick leave.

    Clinical implications: Most patients on non-permanent sick leave regain occupational functioning after ECT. However, it usually takes a few months even in symptomatically improved patients.

  • 12.
    Nordenskjöld, Axel
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    von Knorring, Lars
    Psychiatry Research Center, Örebro City Council, Örebro, Sweden.
    Ljung, Tomas
    Psychiatry Clinic, Falun Hospital, Falun, Sweden.
    Carlborg, Andreas
    Dept Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Danderyd Hospital, Stockholm, Sweden .
    Brus, Ole
    Psychiatry Research Center, Örebro City Council, Örebro, Sweden.
    Engström, Ingemar
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Continuation electroconvulsive therapy with pharmacotherapy versus pharmacotherapy alone for prevention of relapse of depression: A Randomized Controlled Trial2013Ingår i: Journal of ECT, ISSN 1095-0680, E-ISSN 1533-4112, Vol. 29, nr 2, s. 86-92Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The primary aim of the study was to test the hypothesis that relapse prevention with continuation electroconvulsive therapy (ECT) plus pharmacotherapy is more effective than pharmacotherapy alone after a course of ECT for depression.

    METHODS: A multicenter, nonblinded, randomized controlled trial with 2 parallel groups was performed from 2008 to 2012 in 4 hospitals in Sweden. Patients eligible had unipolar or bipolar depression and had responded to a course of ECT. The patients (n = 56) were randomly assigned (1:1) to receiving either 29 treatments of continuation ECT with pharmacotherapy or pharmacotherapy alone for 1 year. The pharmacotherapy consisted of antidepressants (98%), lithium (56%), and antipsychotics (30%). The main outcome was relapse of depression within 1 year. Relapse was defined as 20 or more points on the Montgomery Åsberg Depression Rating Scale or inpatient psychiatric care or suicide or suspected suicide. All 56 patients randomized were analyzed according to an intention to treat analysis.

    RESULTS: Sixty-one percent of the patients treated with pharmacotherapy versus 32% of the patients treated with ECT plus pharmacotherapy relapsed within 1 year (P = 0.036). The Cox proportional hazard ratio was 2.32 (1.03-5.22).Cognitive function and memory measures were stable for patients without relapse in both groups.One suspected suicide and 3 suicide attempts by intoxication occurred, all in the pharmacotherapy-alone group.

    CONCLUSIONS: The post-ECT relapse rates were substantial in both treatment groups with a statistically significant advantage for combined treatment with pharmacotherapy and continuation ECT. Further studies are needed to define indications for continuation ECT, pharmacotherapy, and their combination.

  • 13.
    Popiolek, Katarzyna
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Centre.
    Bejerot, Susanne
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Centre.
    Brus, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hammar, Åsa
    Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway: Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
    Landén, Mikael
    Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lundberg, Johan
    Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Stockholm County Council, Stockholm, Sweden.
    Nordanskog, Pia
    Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Psychiatry, Region Östergötland, Linköping, Sweden.
    Nordenskjöld, Axel
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Centre.
    Electroconvulsive therapy in bipolar depression: effectiveness and prognostic factors2019Ingår i: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 140, nr 3, s. 196-204Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Electroconvulsive therapy (ECT) is used in patients with severe forms of bipolar depression. ECT is effective but not all patients respond. The aim of this study was to determine prognostic factors for response to ECT in patients hospitalized for bipolar depression.

    METHODS: Data were obtained from several national Swedish registers. All patients with bipolar depression treated with ECT in any hospital in Sweden between 2011 and 2016 for whom information about ECT response was available were included (n = 1251). Response was defined as a score on the Clinical Global Impression - Improvement scale of one or two. Univariate and multivariate logistic regression were conducted to investigate associations between socio-demographic and clinical factors and response.

    RESULTS: Response was achieved in 80.2% patients. Older age was associated with higher response rate to ECT. Patients with comorbid obsessive-compulsive disorder or personality disorder, and patients previously treated with lamotrigine had lower response rate.

    CONCLUSION: ECT for bipolar depression was associated with very high response rates. The strongest prognostic factors were higher age, absence of comorbid obsessive-compulsive disorder or personality disorder, and less prior pharmacologic treatment.

  • 14.
    Popiolek, Katarzyna
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Brus, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Elvin, Tove
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Landen, Mikael
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Lundberg, Johan
    Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Stockholm County Council, Stockholm, Sweden.
    Nordanskog, Pia
    Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Psychiatry, Region Östergötland, Linköping, Sweden.
    Nordenskjöld, Axel
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Rehospitalization and suicide following electroconvulsive therapy for bipolar depression: A population-based register study2018Ingår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 226, s. 146-154Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Electroconvulsive therapy (ECT) is effective in bipolar depression, but relapse is common. The aim of the study was (i) to identify prognostic factors (ii) and to determine the impact of pharmacological approaches on the risk for rehospitalization or suicide.

    Methods: This register study analyzed data from individuals treated with inpatient ECT for bipolar depression. Subjects were identified using the Swedish National Patient Register between 2011 and 2014 and the Swedish National Quality Register for ECT. Other national registers provided data on psychopharmacotherapy, socio-demographic factors, and causes of death. The endpoint was the composite of rehospitalization for any psychiatric disorder, suicide attempt or completed suicide (RoS). Cox regression was used to calculate hazard ratios in univariate and multivariate models.

    Results: Data from 1255 patients were analyzed. The mean period of follow-up was 346 days.

    A total of 29%, 41%, and 52% of patients reached RoS at 3, 6, and 12 months post-discharge. A history of multiple psychiatric admissions, lower age, and post-discharge treatment with antipsychotics or benzodiazepines was associated with RoS.

    Limitations: Indication bias may have affected the results.

    Conclusions: A history of multiple hospital admissions and lower age are key predictors of the composite of rehospitalization or suicide in patients treated with ECT for bipolar depression. Lithium might be effective. By contrast, antipsychotics and benzodiazepines were associated with increased risk, but possibly this finding was influenced by indication bias.

  • 15.
    Rasmussen, Gunlög
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    Monecke, Stefan
    Alere Technologies GmbH, Jena, Germany; Institute for Medical Microbiology and Hygiene, TU Dresden, Dresden, Germany.
    Brus, Ole
    Örebro University Hospital, Örebro, Sweden.
    Ehricht, Ralf
    Alere Technologies GmbH, Jena, Germany.
    Söderquist, Bo
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden; Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Long term molecular epidemiology of methicillin-susceptible staphylococcus aureus bacteremia isolates in Sweden2014Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, nr 12, artikel-id e114276Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Staphylococcus aureus is one of the major pathogens that causes bacteremia; therefore, it is important to understand the long-term molecular epidemiology of S. aureus bacteremia infections. In particular, little is known about the population structure of methicillin-sensitive S. aureus (MSSA) compared to that of methicillin-resistant S. aureus. We investigated potential changes in the MSSA molecular epidemiology in Örebro County, Sweden, from 1980 through 2010. 400 MSSA bacteremia isolates, the first 100 isolated each decade from 1980 through 2010, were retrospectively identified and analyzed regarding assignment to clonal complexes (CCs), presence of virulence genes and antibiotic resistant determinants with DNA microarray-based genotyping. 24 different CCs were identified. Most isolates (80%) belonged to 6 predominant lineages. Of those, the number of isolates assigned to CC5 and CC15 increased, and those assigned to CC8, CC25, and CC30 decreased. The most prevalent clone, CC45, did not show a significant change in prevalence during the study period. A change in prevalence was observed for some of the virulence genes, mainly attributed with their association to certain CCs. With the exception of the common blaZ gene (encoding penicillinase), antibiotic resistance genes were only sporadically detected. In conclusion, the MSSA population structure was genetically diverse. We observed decadal changes in assignments to five predominant clones, and corresponding changes in the prevalence of some virulence genes linked to CC affiliation. In light of the restrictive antibiotics prescriptions and extensive infection control procedures in Sweden, antibiotic resistance genes were rarely detected and their prevalence unaffected during the study period.

  • 16.
    Rundgren, Sara
    et al.
    School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden.
    Brus, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Båve, Ullvi
    Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden.
    Landén, Mikael
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Lundberg, Johan
    Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden.
    Nordanskog, Pia
    Faculty of Health Sciences, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden; Department of Psychiatry, Region Östergötland, Linköping, Sweden.
    Nordenskjöld, Axel
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Improvement of postpartum depression and psychosis after electroconvulsive therapy: A population-based study with a matched comparison group2018Ingår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 235, s. 258-264Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Electroconvulsive therapy (ECT) is used to treat postpartum depression and psychosis based on clinical experience and small observational studies.

    AIMS: The primary aim was to test the hypothesis that the response rate to ECT for depression and psychosis is higher during the postpartum period than outside this period. The secondary aim was to identify predictors of a response to ECT during the postpartum period.

    MATERIALS AND METHODS: Cases with postpartum depression and/or psychosis received ECT within 6 months of delivery. A matched comparison group with depression and/or psychosis (not within the postpartum period) was identified from the Swedish National Quality Register for ECT. The improvement 1 week after ECT was classified according to the Clinical Global Impressions Scale - Improvement scale (CGI-I) as responder (CGI-I score 1-2) or non-responder (CGI-I score 3-7).

    RESULTS: 185 cases and 185 comparison group subjects were included (46% with psychosis in each groups). More cases (87.0%) than comparison group subjects (73.5%) responded to ECT (p = 0.001). Adjusted binary regression analysis revealed that more severe symptoms prior to treatment were the only statistically significant predictor of response.

    LIMITATIONS: There was no control group without ECT treatment.

    CONCLUSION: The response rate of those with postpartum depression and/or psychosis to ECT was high. The response rate of patients with psychosis or depression was higher during the postpartum period than outside it. This study supports the use of ECT for severe forms of postpartum depression and/or psychosis.

  • 17.
    Rönnqvist, Ida
    et al.
    University Health Care Research Centre, and, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Brus, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hammar, Åsa
    Department of Biological and Medical Psychology, University of Bergen; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
    Landén, Mikael
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg.
    Lundberg, Johan
    Department of Clinical Neurosci- ence, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm.
    Nordanskog, Pia
    Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping; Department of Psychiatry, Region Östergötland, Linköping, Sweden.
    Nordenskjöld, Axel
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Centre.
    Rehospitalization of Postpartum Depression and Psychosis After Electroconvulsive Therapy: A Population-Based Study With a Matched Control Group2019Ingår i: Journal of ECT, ISSN 1095-0680, E-ISSN 1533-4112, Vol. 35, nr 4, s. 264-271Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Electroconvulsive therapy (ECT) is used in some cases of postpartum depression (PPD) and postpartum psychosis (PPP). The risk of relapse for PPD and PPP after ECT is unknown. This study compared the relapse rate after ECT between women who had been treated for PPD and/or PPP and women who had been treated for depression and/or psychosis outside the postpartum period.

    METHODS: The Swedish National Quality Register for ECT and the Swedish National Patient Register were used to identify women with PPD and/or PPP who had been treated with ECT within 6 months after delivery. For each case, a control (treated with ECT but not postpartum) patient was also selected. A Kaplan-Meier estimator was used to calculate the relapse rate (defined as rehospitalization or suicide) after ECT. Cox regression was used to identify variables associated with relapse.

    RESULTS: A total of 180 patients were included in each group. The proportions of patients who suffered relapse after 6 months, 1 year, and 2 years were 28%, 31%, and 40% for the postpartum group and 39%, 50%, and 55% for the nonpostpartum group. Treatment with benzodiazepines, several previous psychiatric admissions, and the absence of improvement after ECT were associated with relapse.

    CONCLUSIONS: The risk of relapse after ECT is lower for patients with PPD and/or PPP than for patients outside the postpartum period, but the risk is nonetheless substantial in both groups.

  • 18.
    Sagerfors, Marcus
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Department of Anesthesiology and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
    Brus, Ole
    Örebro University, Örebro, Sweden.
    Pettersson, Kurt
    Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Total Wrist Arthroplasty: A Single-Center Study of 219 Cases With 5-Year Follow-up2015Ingår i: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 40, nr 12, s. 2380-2387Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To assess implant survival and radiographic loosening after total wrist arthroplasty (TWA) operated at a single tertiary referral center in Sweden.

    Methods: In a prospective cohort study, we evaluated 189 consecutive patients with a TWA(219 wrists). The wrists were implanted between 2002 and 2013. The primary end point was revision for any reason. The mean follow-up period was 7 years (range, 2-13 years). In addition, radiological examination was done for evidence of prosthetic loosening 5 years postoperatively. Implant survival was estimated using the Kaplan-Meier method. Secondary outcome measures included range of motion, visual analog scale pain scores, hand grip strength, and patient-related outcome measures.

    Results: Cumulative implant survival after 8 years was 81% for Biax, 94% for Remotion, and 95% for Maestro implants. Radiographic loosening was present in 26% of wrists with the Biax design, 18% of those with Remotion, and 2% of those with Maestro. Visual analog scale pain scores and patient-related outcome scores improved significantly for all TWAs. Improved hand grip strength was noted for all TWAs except for the Universal 2. Range of motion improved somewhat, especially for the Biax and Maestro TWAs.

    Conclusions: Good midterm to long-term results were achieved in patients undergoing TWA. Radiographic loosening did not necessarily correlate with implant survival rates, but rather to severe arthritic destruction of the wrist preoperatively. All TWA implants studied offered a high level of patient satisfaction.

  • 19.
    Sagerfors, Marcus
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Brus, Ole
    Örebro University, Örebro, Sweden.
    Rizzo, Marco
    Department of Orthopedic Surgery, Mayo Clinic, Rochester MN, USA.
    Pettersson, Kurt
    Department of Hand Surgery, Örebro University, Örebro, Sweden.
    Patient related functional outcome after total wrist arthroplasty: a single center study of 206 cases2015Ingår i: Hand Surgery, ISSN 0218-8104, Vol. 20, nr 1, artikel-id 81Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To prospectively evaluate patient related outcome measures after total wrist arthroplasty (TWA) using four different total wrist implants operated at a single referral center in Sweden.

    Methods: 206 primary TWAs were assessed preoperatively and after one year postoperatively with respect to the following eight outcome measures: Range of motion (flexion/extension, radial/ulnar deviation, pronation/supination), hand grip strength, Canadian Occupational Performance Measure (COPM), performance and satisfaction, Visual Analog Scale (VAS) pain scores at rest and in activity.

    Results: The Maestro TWA had a significantly greater improvement of radial/ulnar deviation than the Biax and Remotion TWAs. COPM performance and satisfaction improved more for the Maestro and Universal 2 prostheses than the Biax and Remotion.

    Conclusions All four TWAs offer reduced VAS-scores and improved COPM-scores with preserved hand grip strength and somewhat improved range of motion. The Maestro TWA performed favorably compared to the Remotion TWA. Implant design may affect patient related outcome.

  • 20.
    Sönnerqvist, Caroline
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Brus, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Olivecrona, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Anaesthesiology and Intensive Care, Section for Neurosurgery.
    Validation of the scandinavian guidelines for initial management of minor and moderate head trauma in children2020Ingår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Head trauma in children is common, with a low rate of clinically important traumatic brain injury. CT scan is the reference standard for diagnosis of traumatic brain injury, of which the increasing use is alarming because of the risk of induction of lethal malignancies. Recently, the Scandinavian Neurotrauma Committee derived new guidelines for the initial management of minor and moderate head trauma. Our aim was to validate these guidelines.

    METHODS: We applied the guidelines to a population consisting of children with mild and moderate head trauma, enrolled in the study: "Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study" by Kuppermann et al. (Lancet 374(9696):1160-1170, https://doi.org/10.1016/S0140-6736(09)61558-0, 2009). We calculated the negative predictive values of the guidelines to assess their ability to distinguish children without clinically-important traumatic brain injuries and traumatic brain injuries on CT scans, for whom CT could be omitted.

    RESULTS: We analysed a population of 43,025 children. For clinically-important brain injuries among children with minimal head injuries, the negative predictive value was 99.8% and the rate was 0.15%. For traumatic findings on CT, the negative predictive value was 96.9%. Traumatic finding on CT was detected in 3.1% of children with minimal head injuries who underwent a CT examination, which accounts for 0.45% of all children in this group.

    CONCLUSION: Children with minimal head injuries can be safely discharged with oral and written instructions. Use of the SNC-G will potentially reduce the use of CT.

  • 21.
    Sönnerqvist, Caroline
    et al.
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Brus, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Olivecrona, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Anaesthesia and Intensive Care, Section for Neurosurgery.
    Validation of the Scandinavian Guidelines for the Initial Management of Minor and Moderate Head Injury in Children2018Ingår i: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 35, nr 16, s. A248-A248Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: Head trauma in children is common, with a low rate of clinically-important traumatic brain injury (ciTBI). CT scan is the reference standard for diagnosis of traumatic brain injury, of which the increasing use is alarming because of the risk of induction of lethal malignancies. Recently, the Scandinavian Neurotrauma Committee (SNC) derived new guidelines for the initial management of minor and moderate head trauma (GCS 9-15) in children. Our aim was to validate the SNC guidelines by assessing the risk of a child being discharged with a ciTBI. A secondary aim was to assess the risk of a child being discharged with a TBI on CT.

    Methods: We applied the SNC guidelines to a population consisting of children with mild and moderate head trauma, enrolled in the dataset ‘‘Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study’’ (Kuppermanns et al 2009). We calculated the SNC guidelines negative predictive values to assess their ability to distinguish children without ciTBI and traumatic brain injuries on CT scans, for whom CT would be unnecessary.

    Results: We enrolled and analysed 43 025 children (mean age 7.0 years, range 0-17, 62.3% males). The prevalence of ciTBI were statistically significant lower in the group of minimal head injury as compared to the mild low-risk head injury group (p<0.001). The rate of ciTBI in the minimal head injury group was 0,15% and the negative predictive value was 99.8% for ciTBI (minimal vs mild-moderate head injury groups). Traumatic finding on CT was detected in 3.1% of the children in the minimal group who underwent a CT examination, which accounts for 0.45% of all children in the minimal head injury group. The negative predictive value was 96.9% for traumatic finding on CT.

    Conclusion: It is safe to discharge children with oral and written instructions and, according to the SNC guidelines, minimal head injury. Use of the SNC guidelines will potentially reduce the use of CT.

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