Classification, care-seeking behaviour and pre-hospital triage of patients exposed to whiplash trauma

Classification, care-seeking behaviour and pre-hospital triage of patients exposed to a whiplash trauma Artur Tenenbaum Avdelning för samhällsmedicin och folkhälsa, Institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet, Sverige. Abstract Knowledge about the optimal first acute care level and classification after exposure to a whiplash trauma is important for the injured individual and for the healthcare system. Neck pain is ranked as the fourth most important condition in the “Global Burden of Disease Study”. Exposure to a whiplash trauma is common and many individuals seek health care. Up to 50% of those with symptoms after whiplash trauma, labelled whiplash associated disorders (WAD), face chronic health problems. The general aim of this thesis was to explore allocation of rehabilitation resources after a whiplash trauma by investigating if a Swedish classification model could be used as a complement to the Quebec Classification. Furthermore, to study gender differences in careseeking behavior immediately after whiplash trauma. A subsequent goal was to develop a risk stratification model for individuals exposed to whiplash trauma, a practical tool for medical personnel in prehospital triage after a neck trauma that results in neck pain. A prospective study was performed on 85 patients with WAD classified according to a new proposed classification system. Ten years of data from a database of injuries with more than 3000 patients exposed to a whiplash trauma were used to construct an algorithm recommending the appropriate first level of care. Finally, a survey to 188 medical practitioners exploring their recommendations for prehospital triage of patients exposed to a traffic accident resulting in neck pain. Patients with whiplash-associated disorders grade II and neuropsychological symptoms seem to have a worse prognosis for spontaneous recovery than those without. A Swedish classification system seems to be a complement to the Quebec classification. Women sought healthcare later than men after a whiplash trauma who sought hospital emergency department more often than women. Half of all individuals sought care at a hospital where only 6.4 % were hospitalized, while the other half sought care at a primary health care centre. Four risk factors were identified in patients diagnosed with WAD to predict the presence of a potentially sinister injury requiring hospital care; commotio cerebri, fracture or luxation, serious injury, and attending health care the same day as trauma. An algorithm recommending the appropriate first level of care was made. A consensus around initial pre-hospital triage of patients with a very low or very high risk for sinister injury exist. This consensus correlates well to recent findings recommending appropriate pre-hospital triage and first level of care. Conclusion: The right level of care and classification after whiplash trauma is important for the injured individual and for the healthcare system

Correction: Sahlin, E., et al. Using Nature-Based Rehabilitation to Restart a Stalled Process of Rehabilitation in Individuals with Stress-Related Mental Illness. Int. J. Environ. Res. Public Health 2015, 12, 1928–1951

The authors wish to make the following corrections to their paper published in the International Journal of Environmental Research and Public Health [1]: [...

Lower risk of fat formation and fibrosis if lymphedema is treated in time

Lymfödem är ett kroniskt sjukdomstillstånd som påverkar individens livstillfredsställelse och arbetsförmåga. Basen för all lymfödembehandling är ständig kompression, och behandlingen ska vara kontinuerlig. Patienterna bör bedömas och behandlas av ett multiprofessionellt team. Konservativ behandling innebär adekvat information till patienten, förebyggande åtgärder, kompression med strumpa och vid behov kombinerad fysikalisk ödemterapi eller kontrollerad kompressionsbehandling. Rehabiliteringsinsatserna beaktar även individens psykosociala behov. Kirurgi är aktuell endast när konservativa metoder inte haft avsedd effekt

Using Nature-Based Rehabilitation to Restart a Stalled Process of Rehabilitation in Individuals with Stress-Related Mental Illness

After a period of decrease, sick leave in Sweden due to psychiatric diagnoses is on the increase. The lack of established rehabilitation programmes for patients with stress-related mental disorders (SRMD) has opened up for the use of garden/nature in a multimodal rehabilitation context (Nature-Based Rehabilitation, NBR). Region Västra Götaland (VGR) started an NBR to offer additional rehabilitation for its employees on long-term sick leave due to SRMD, where initial care had not been sufficient. The aim was to explore whether the mental health and well-being of NBR participants had improved at the end of the NBR and at three follow-ups, and to explore the development of sick leave and health care utilization according to the NBR model (n = 57) and an occupational health service (OHS) model (n = 45). Self-assessment instruments for measuring burnout, depression, anxiety and wellbeing, and data from regional and national registers were used. Results showed decreased scores on burnout, depression and anxiety, and increased well-being scores and significantly reduced health care utilization in the NBR group. A large movement from ordinary sickness benefit to rehabilitation benefit was observed, which was not observed in the OHS group. The two groups were in different rehabilitation phases, which limited comparisons. The results point to beneficial effects of using NBR for this patient group and for enhancing a stalled rehabilitation process

Gender differences in care-seeking behavior and healthcare consumption immediately after whiplash trauma.

The aim was to study gender differences in care-seeking behavior and treatment provided immediately after whiplash trauma.Participants were residents from a defined geographical area, Skaraborg County in the southwestern part of Sweden. A cohort of 3,368 persons exposed to whiplash trauma and attending a healthcare facility immediately after the trauma between 1999 and 2008 were identified in a database. Information about gender, age, time elapsed prior to seeking care, type of healthcare contact, initial treatment provided and eventual hospitalization time was retrieved.Women sought care later than men (p = 0.00074). Women consulted primary healthcare first more often than men, who more often first sought hospital care (p = 0.0060). There were no gender differences regarding the type of treatment after trauma. Women had longer hospital admission than men (p = 0.022), indicating their injuries were at least similar to or worse than men's.Women sought healthcare later than men after whiplash trauma. Although not directly investigated in this study, it raises the question if this may reduce their probability of getting financial compensation compared to men

A risk stratification tool for prehospital triage of patients exposed to a whiplash trauma.

ObjectiveOur aim was to develop a risk stratification model to predict the presence of a potentially more sinister injury in patients exposed to a whiplash trauma.MethodsThe study base comprised of 3,115 residents who first sought healthcare contact within one week after being exposed to a whiplash trauma between 1999-2008, from within a defined geographical area, Skaraborg County in south-western Sweden. Information about gender, age, time elapsed prior to seeking care, type of health care contact, and hospitalisation was retrieved. Seventeen potential risk factors were identified and evaluated using multivariable logistic regression.ResultsOf 3,115 patients, 215 (6.9%) required hospital admission so theoretically 93% could have been initially assessed by primary health care. However, only 46% had their first contact in primary health care. All patients had symptoms resulting in a diagnosis of whiplash injury. Four risk factors were found to be associated with hospital admission: commotio cerebri (OR 31, 19-51), fracture / luxation (OR 11, 5.1-22), serious injury (OR 41, 8.0-210), and the patient sought care during the same day as the trauma (OR 5.9, 3.7-9.5). These four risk factors explained 27% of the variation for hospital admission and the area under curve (AUC) was 0.77 (0.74-0.80). Ninety-six percent of patients (2,985) had only a whiplash injury with no other injury. These could be split into those attending health care the same day as the trauma, 1,737 (56%) with a 7.1% risk for hospital admission, and those attending health care later, 1,248 (40%) with a 1.3% risk for hospital admission.ConclusionPatients with no signs of commotio cerebri, no fracture/luxation injury, no serious injury, comprising 96% of all patients exposed to a whiplash trauma can initially be referred to primary health care for initial assessment. However, those contacting the health care the same day as the trauma should be referred to a hospital for evaluation if they can't get an appointment with a general practitioner the same day

The Lund University Checklist for Incipient Exhaustion : a cross-sectional comparison of a new instrument with similar contemporary tools

BACKGROUND: Stress-related health problems (e.g., work-related exhaustion) are a societal concern in many postindustrial countries. Experience suggests that early detection and intervention are crucial in preventing long-term negative consequences. In the present study, we benchmark a new tool for early identification of work-related exhaustion-the Lund University Checklist for Incipient Exhaustion (LUCIE)-against other contextually relevant inventories and two contemporary Swedish screening scales. METHODS: A cross-sectional population sample (n = 1355) completed: LUCIE, Karolinska Exhaustion Disorder Scale (KEDS), Self-reported Exhaustion Disorder Scale (s-ED), Shirom-Melamed Burnout Questionnaire (SMBQ), Utrecht Work Engagement Scale (UWES-9), Job Content Questionnaire (JCQ), Big Five Inventory (BFI), and items concerning work-family interference and stress in private life. RESULTS: Increasing signs of exhaustion on LUCIE were positively associated with signs of exhaustion on KEDS and s-ED. The prevalence rates were 13.4, 13.8 and 7.8 %, respectively (3.8 % were identified by all three instruments). Increasing signs of exhaustion on LUCIE were also positively associated with reports of burnout, job demands, stress in private life, family-to-work interference and neuroticism as well as negatively associated with reports of job control, job support and work engagement. CONCLUSIONS: LUCIE, which is intended to detect pre-stages of ED, exhibits logical and coherent positive relations with KEDS and s-ED as well as other conceptually similar inventories. The results suggest that LUCIE has the potential to detect mild states of exhaustion (possibly representing pre-stages to ED) that if not brought to the attention of the healthcare system and treated, may develop in to ED. The prospective validity remains to be evaluated

2019-03-18 PONE-D-1812628-PLOSONE

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