Abbreviated Injury Scale: not a reliable basis for summation of injury severity in trauma facilities?

Background: Injury severity is most frequently classified using the Abbreviated Injury Scale (AIS) as a basis for the Injury Severity Score (ISS) and the New Injury Severity Score (NISS), which are used for assessment of overall injury severity in the multiply injured patient and in outcome prediction. European trauma registries recommended the AIS 2008 edition, but the levels of inter-rater agreement and reliability of ISS and NISS, associated with its use, have not been reported.

Methods: Nineteen Norwegian AIS-certified trauma registry coders were invited to score 50 real, anonymised patient medical records using AIS 2008.

Law, ethics and clinical judgment in end-of-life decisions--how do Norwegian doctors think?

Aim: According to Norwegian law, an autonomous patient has the right to refuse life-prolonging treatment. If the patient is not defined as dying, however, health personnel are obliged to instigate life-saving treatment in an emergency situation even against the patient's wishes. The purpose of this study was to investigate how doctors' attitudes and knowledge agree with these legal provisions, and how the statutory provision on emergency situations influences the principle of patient autonomy for severely ill, but not dying, patients.

Dynamic effects of adrenaline (epinephrine) in out-of-hospital cardiac arrest with initial pulseless electrical activity (PEA).

Background: In cardiac arrest, pulseless electrical activity (PEA) is a challenging clinical syndrome. In a randomized study comparing intravenous (i.v.

Classification of comorbidity in trauma: the reliability of pre-injury ASA physical status classification.

Background: Pre-injury comorbidities can influence the outcomes of severely injured patients. Pre-injury comorbidity status, graded according to the American Society of Anesthesiologists Physical Status (ASA-PS) classification system, is an independent predictor of survival in trauma patients and is recommended as a comorbidity score in the Utstein Trauma Template for Uniform Reporting of Data. Little is known about the reliability of pre-injury ASA-PS scores.

A field evaluation of real-life motor vehicle accidents: presence of unrestrained objects and their association with distribution and severity of patient injuries.

Moving objects may pose an added threat to car occupants in motor vehicle accidents (MVAs). However, to our knowledge, there have only been two case studies published on the subject. For the present study, accident reports and photo documentation from MVAs were collected on-scene by dedicated paramedics.

Outcome when adrenaline (epinephrine) was actually given vs. not given - post hoc analysis of a randomized clinical trial.

Purpose Of The Study: IV line insertion and drugs did not affect long-term survival in an out-of-hospital cardiac arrest (OHCA) randomized clinical trial (RCT). In a previous large registry study adrenaline was negatively associated with survival from OHCA. The present post hoc analysis on the RCT data compares outcomes for patients actually receiving adrenaline to those not receiving adrenaline.

Patients Referred to a Norwegian Trauma Centre: effect of transfer distance on injury patterns, use of resources and outcomes.

Background: Triage and interhospital transfer are central to trauma systems. Few studies have addressed transferred trauma patients. This study investigated transfers of variable distances to OUH (Oslo University Hospital, Ullevål), one of the largest trauma centres in Europe.

Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial.

Context: Intravenous access and drug administration are included in advanced cardiac life support (ACLS) guidelines despite a lack of evidence for improved outcomes. Epinephrine was an independent predictor of poor outcome in a large epidemiological study, possibly due to toxicity of the drug or cardiopulmonary resuscitation (CPR) interruptions secondary to establishing an intravenous line and drug administration.

Objective: To determine whether removing intravenous drug administration from an ACLS protocol would improve survival to hospital discharge after out-of-hospital cardiac arrest.

High school students as ambassadors of CPR--a model for reaching the most appropriate target population?

Background: There is mismatch in age between those usually trained in CPR and those witnessing out-of-hospital cardiac arrest with mean age reported at 30 and 65 years old, respectively. Two tier mass CPR self-training with manikin-DVD sets using school children has been reported. We have studied high school students as first tier and encouraged them to train older people.

Out-of hospital advanced life support with or without a physician: effects on quality of CPR and outcome.

Background: The presence of physicians is believed to facilitate optimal management of out-of-hospital cardiac arrest, but has not been sufficiently documented.

Methods: Adult non-traumatic cardiac arrests treated by Oslo EMS between May 2003 and April 2008 were prospectively registered. Patients were categorized according to being treated by the physician-manned ambulance (PMA) or by regular paramedic-manned ambulances (non-PMA).

Which factors influence spontaneous state transitions during resuscitation?

Background: The clinical state (i.e. ventricular fibrillation/tachycardia: VF/VT, asystole: ASY, pulseless electrical activity: PEA, or return of spontaneous circulation, ROSC) during cardiopulmonary resuscitation determines patient management.

The effect of transport on quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest.

Introduction: Most manikin and clinical studies have found decreased quality of CPR during transport to hospital. We wanted to study quality of CPR before and during transport for out-of-hospital cardiac arrest patients and also whether quality of CPR before initiation of transport was different from the quality in patients only receiving CPR on scene.

Materials And Methods: Quality of CPR was prospectively registered with a modified defibrillator for consecutive cases of out-of-hospital cardiac arrest in three ambulance services during 2002-2005.

Using ontologies to integrate and share resuscitation data from diverse medical devices.

Objective: To propose a method for standardised data representation and demonstrate a technology that makes it possible to translate data from device dependent formats to this standard representation format.

Methods And Results: Outcome statistics vary between emergency medical systems organising resuscitation services. Such differences indicate a potential for improvement by identifying factors affecting outcome, but data subject to analysis have to be comparable.

Development of the probability of return of spontaneous circulation in intervals without chest compressions during out-of-hospital cardiac arrest: an observational study.

Background: One of the factors that limits survival from out-of-hospital cardiac arrest is the interruption of chest compressions. During ventricular fibrillation and tachycardia the electrocardiogram reflects the probability of return of spontaneous circulation associated with defibrillation. We have used this in the current study to quantify in detail the effects of interrupting chest compressions.

Comparison of mechanical characteristics of the human and porcine chest during cardiopulmonary resuscitation.

Background: Most studies investigating cardiopulmonary resuscitation (CPR) interventions or functionality of mechanical CPR devices have been performed using porcine models. The purpose of this study was to identify differences between mechanical characteristics of the human and porcine chest during CPR.

Material And Methods: CPR data of 90 cardiac arrest patients was compared to data of 14 porcine from two animal studies.

Representing resuscitation data-Considerations on efficient analysis of quality of cardiopulmonary resuscitation.

Objective: To discuss challenges in representing resuscitation data from Utstein style reports and devices like defibrillators with focus on unified and efficient handling of variety of resuscitation research objectives.

Methods And Results: Information on therapy such as shock delivery, chest compressions and ventilation can be extracted from defibrillators. A method for merging this information with cardiac rhythm annotated from ECGs, yields a representation of the resuscitation episode with cardiac rhythm also giving information on response to therapy.

Precision of field triage in patients brought to a trauma centre after introducing trauma team activation guidelines.

Background: Field triage is important for regional trauma systems providing high sensitivity to avoid that severely injured are deprived access to trauma team resuscitation (undertriage), yet high specificity to avoid resource over-utilization (overtriage). Previous informal trauma team activation (TTA) at Ulleval University Hospital (UUH) caused imprecise triage. We have analyzed triage precision after introduction of TTA guidelines.

Progressing from initial non-shockable rhythms to a shockable rhythm is associated with improved outcome after out-of-hospital cardiac arrest.

Background: Cardiac arrest patients with initial non-shockable rhythm progressing to shockable rhythm have been reported to have inferior outcome to those remaining non-shockable. We wanted to confirm this observation in our prospectively collected database, and assess whether differences in cardiopulmonary resuscitation (CPR) quality could help to explain any such difference in outcome.

Materials And Methods: All out-of-hospital cardiac arrest (OHCA) cases in the Oslo EMS between May 2003 and April 2008 were retrospectively studied, and cases with initial asystole or pulseless electrical activity (PEA) were selected.

The Utstein template for uniform reporting of data following major trauma: a joint revision by SCANTEM, TARN, DGU-TR and RITG.

Background: In 1999, an Utstein Template for Uniform Reporting of Data following Major Trauma was published. Few papers have since been published based on that template, reflecting a lack of international consensus on its feasibility and use. The aim of the present revision was to further develop the Utstein Template, particularly with a major reduction in the number of core data variables and the addition of more precise definitions of data variables.