Psychoactive substances have major impact on injuries in rural arctic Norway – A prospective observational study

Background - Rural areas have increased injury mortality with a high pre-hospital death rate. Knowledge concerning the impact of psychoactive substances on injury occurrence is lacking for rural arctic Norway. These substances are also known to increase pre-, per- and postoperative risk. The aim was by prospective observational design to investigate the prevalence and characteristics of psychoactive substance use among injured patients in Finnmark county. Methods - From January 2015 to August 2016, patients ≥18 years admitted to hospitals in Finnmark due to injury were approached when competent. Blood was analysed for ethanol, sedatives, opioids, hypnotics and illicit substances in consenting patients, who completed a questionnaire gathering demographic factors, self-reported use/behaviour and incident circumstances. Results - In 684 injured patients who consented to participation (81% consented), psychoactive substances were detected in 35.7%, alcohol being the most prevalent (23%). Patients in whom substances were detected were more often involved in violent incidents (odds ratio 8.92 95% confidence interval 3.24-24.61), indicated harmful use of alcohol (odds ratio 3.56, 95% confidence interval 2.34-5.43), reported the incident being a fall (odds ratio 2.21, 95% confidence interval 1.47-3.33) and presented with a reduced level of consciousness (odds ratio 3.91, 95% confidence interval 1.58-9.67). Subgroup analysis revealed significant associations between testing positive for a psychoactive substance and being diagnosed with a head injury or traumatic brain injury. Conclusion - A significant proportion of injured patients had used psychoactive substances prior to admission. Use was associated with violence, falls, at-risk alcohol consumption, decreased level of consciousness on admittance and head injury

Associations between heavy episodic drinking and alcohol related injuries: a case control study

Background: Alcohol is a significant risk factor for injuries. This study addresses 1) whether the risk of alcohol related injury increases with frequency of heavy episodic drinking (HED) in a linear fashion, and 2) whether a small group of high risk drinkers accounts for the majority of alcohol related injuries. Methods: We applied a case – control design. Cases were BAC positive injured patients (n = 534) and controls were respondents to a general population survey in Norway (n = 1947). Age and gender adjusted association between self-reported past year HED frequency and alcohol related injury risk was estimated in logistic regression models for all alcohol related injuries and for violence injuries and accident injuries separately. Results: An increase in HED was associated with an increase in risk of alcohol related injury, resembling a linear risk function. The small fraction of high risk drinkers (6.6%) accounted for 41.6% of all alcohol related injuries, thus lending support to the validity of the prevention paradox. Conclusion: There is a strong relationship between frequency of heavy episodic drinking and risk of alcohol related injuries, yet the majority of alcohol related injuries are found among drinkers who are not in the high risk group. Keywords: Alcohol, Heavy episodic drinking, Injuries, Accidents, Violence, Case control study, Prevention parado

Registrerer få hjertestanser

Bakgrunn: Studier fra andre land viser stor variasjon i forekomst og overlevelse etter hjerte- lunge-redning (HLR) på intensivavdelinger. Det foreligger få studier på dette området i Norge. Hensikt: Å kartlegge forekomst og overlevelse etter HLR samt få oversikt over hvordan HLR ble registrert. Metode: Vi foretok en tverrsnittsstudie av 14 intensivavdelinger på Oslo universitetssykehus gjennom hele 2013. Pasienter med diagnoser og prosedyrekoder for hjertestans, ventrikkelarytmier og HLR ble identifisert i pasientadministrative systemer. Vi inkluderte alle tilfellene der diagnoser og prosedyrekoder ble bekreftet i pasientjournalen, i studieutvalget. Deretter sammenliknet vi med de tilfellene som var registrert i det interne kvalitetsregisteret for hjertestans. Resultat: Blant 15 101 intensivinnleggelser fant vi 117 (0,8 prosent) tilfeller av HLR fordelt på 99 pasienter. Av 91 voksne (> 18 år) var 64 (70 prosent) menn. Gjennomsnittsalderen var 63 år. Antall voksne som overlevde til utskrivning fra sykehuset var 44 (48 prosent). Overlevelsen for kvinner var signifikant lavere enn for menn: 8 (30 prosent) kvinner overlevde mot 36 (56 prosent) menn, (p = 0,023). Kun 32 (32 prosent) av alle pasientene var registrert i vårt interne hjertestansregister. Konklusjon: Knapt én av hundre intensivinnleggelser fikk HLR. Halvparten av pasientene overlevde til utskrivning etter HLR. En tredjedel av disse pasientene var registrert i det interne hjertestansregisteret. Forekomst og registrering av HLR er lav, mens overlevelsen er høy sammenliknet med tilsvarende studier fra andre land

The importance of alcohol in elderly’s hospital admissions for fall injuries: a population case-control study

Background: Fall injuries account for a substantial part of the health burden among elderly persons, and they often affect life quality severely and impose large societal costs. Alcohol intoxication is a well-known risk factor for accidental injuries, but less is known about this association among elderly people. In this study, our aim was to assess whether risk of fall injuries among the elderly is elevated with an intoxication-oriented drinking pattern. Method: We applied a population case-control design and data from persons aged 60 years and over in Norway. Cases comprised patients with fall injuries admitted to a hospital emergency department ( n = 424), and controls were participants in general population surveys ( n = 1859). Drinking pattern was assessed from self-reports of drinking frequency and intoxication frequency. Age and gender-adjusted association between fall injury and drinking pattern was estimated in logistic regression models. Fall injuries were considered alcohol-related if blood alcohol concentration exceeded 0.01% and/or the patient reported alcohol intake within six hours prior to injury. Results: The risk of fall injuries was highly elevated among those reporting drinking to intoxication monthly or more often ( OR = 10.2, 95% CI 5.5–19.0). Among cases, the vast majority of those with alcohol-related fall injuries (64 of 68) reported drinking to intoxication. Conclusions: A drinking pattern comprising alcohol intoxication elevated the risk of fall injuries among elderly people. As alcohol use is a modifiable risk factor, the findings suggest a potential to curb the number of fall injuries and their consequences by employing effective strategies to prevent intoxication drinking among the elderly

Quality of care, resource use and patient outcome by use of emergency response team compared with standard care for critically ill medical patients in the emergency department: a retrospective single-centre cohort study from Norway

Objective The study aimed to investigate quality of care, resource use and patient outcome in management by an emergency response team versus standard care for critically ill medical patients in the emergency department (ED). The emergency response team was multidisciplinary and had eight members, with a registrar in internal medicine as team leader. Design Register-based retrospective cohort study. Setting Tertiary hospital in Norway. Participants The study included 1120 patients with National Early Warning Score 2 (NEWS2) 5–10 points from 2015 and 2016. Patients missing ≥3 NEWS2 part scores, <18 years and with orders ‘Not for ICU’ or ‘Not for resuscitation’ were excluded. Outcome measures Quality of care: pain assessment documented, analgesics given within 20 min, complete set of vital signs documented and antibiotics within 60 min if sepsis. Resource use: >3 diagnostic interventions, critical care in the ED and ED length of stay (LOS) <180 min. Patient outcome: intensive care unit (ICU) admission, ICU LOS <66 hours, hospital LOS <194 hours and mortality. Results The median age was 66 years, 53.5% were male, 44.3% were admitted to the ICU and the mortality rate was 10.6%. Altogether 691 patients received team management and 429 standard care. Team management had a positive association with ‘complete set of vital signs documented’ (OR 1.720, CI 1.254 to 2.360), ‘analgesics given within 20 minutes’ (OR 3.268, CI 1.375 to 7.767) and ‘antibiotics within 60 minutes if sepsis’ (OR 7.880, CI 3.322 to 18.691), but a negative association with ‘ pain assessment documented’ (OR 0.068, CI 0.037 to 0.128). Team management was also associated with ‘critical care in the ED’ (OR 9.900, CI 7.127 to 13.751), ‘ED LOS <180 min’ (OR 2.944, CI 2.070 to 4.187), ‘ICU admission’ (OR 2.763, CI 1.962 to 3.891) and ‘mortality’ (OR 1.882, CI 1.142 to 3.102). Conclusions Team management showed positive results for quality of care and resource use. The results for later outcomes such as mortality, ICU LOS and hospital LOS were more ambiguous

Characteristics, management and outcome of critically ill general medical patients in the Emergency Department: An observational study

Background Critically ill general medical patients are an increasing group in the Emergency Department (ED). This register-based cohort study aimed to examine these patients’ characteristics, ED management and outcome, and investigate factors associated with ICU admission. Methods The study comprised all adult medical triage 1 patients treated by a specialized multidisciplinary team in 2015 and 2016. Univariate and multivariate analysis were used. Results 1294 patients were included. Mean age was 59 years, 56% (n = 725) were male, mean National Early Warning Score 2 (NEWS2) was 7, intensive care unit (ICU) admission was 56.8% (n = 735) and mortality rate was 16.8% (n = 217). Median ED length of stay (LOS) was 1.6 h, 1.2 h if admitted to ICU. The most frequent discharge diagnosis was acute poisoning (24.0%, n = 308). Younger age, male gender, arriving at nighttime weekdays, higher NEWS2 at arrival, critical care interventions or medications in the ED was associated with ICU admission. Conclusion More than half of the patients were admitted to ICU, and the mortality rate was 16.8%. A large proportion was diagnosed with acute poisoning. Younger age, higher NEWS and critical care in ED were associated with ICU admission. The short ED LOS suggests that management by a multidisciplinary team is beneficial