Pål Aksel Næss

• Brooks, Adam; Joyce, Danielle; Gouveia, Santiago; Burak, Marta; LaValle, Angelo & Reilly, John Joe [Show all 15 contributors for this article] (2026). Outcomes following non-operative management for severe liver trauma: a UK multicentre observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 34. doi: 10.1186/s13049-026-01576-7. Full text in Research Archive Show summary

  Background Patients with severe liver injury may carry a high risk of complications with significant mortality. Non-operative management (NOM) is increasingly common for severe injuries and may be associated with lower morbidity when compared with surgery. Objective To evaluate the incidence of NOM for severe liver trauma (American Association for the Surgery of Trauma (AAST) Grade IV and V) and compare outcomes for NOM vs operative management. Methods All patients admitted between 2012–2022 with severe liver trauma to Birmingham and Nottingham Major Trauma Centres (MTCs) were identified from a validated dataset. Outcomes were compared between those managed by surgery vs treated by NOM. Adjusted multivariable logistic regression models were used to determine the odds ratio (OR) and 95% confidence interval (95% CI) for surgical management, survival rates, and development of liver-specific complications (adjusting for age, sex, ISS, AAST grade, polytrauma). Results There were 190 patients; median age 28 years (IQR 20–41); 134 (71%) were male. Median ISS was 27 (IQR 17–41). Overall mortality was 7% (14/190). 122/190 (64%) patients were managed initially by NOM, with only 8/122 (7%) requiring subsequent surgery. Multivariable logistic regression models showed higher ISS, lower SBP on admission, Grade V injuries and penetrating trauma to be independent predictors for surgical treatment. 34/190(18%) patients had liver-specific complications. There was no difference between NOM and operative management groups for 30-day mortality (p = 0.145), but patients in the NOM group had shorter ICU (p < 0.001) and total lengths of stay (p < 0.001) compared to the operative group. Conclusion In this modern MTC setting, a high proportion of patients with severe liver trauma were managed by NOM with a low failure rate. Overall mortality rate was low, but liver-specific complications were common. These data support the evolution of traumatic liver injury management in the UK and favour NOM even in severe liver injuries where patient physiology allows.

• Hardcastle, Timothy C.; Gaarder, Aslaug Christine; Balogh, Zsolt; D'amours, Scott; Davis, Kimberly A. & Gupta, Amit [Show all 15 contributors for this article] (2025). Guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC): Enhanced Recovery After Surgery (ERAS) and International Association for Trauma Surgery and Intensive Care (IATSIC) Society Recommendations: Part 3: Trauma Ethics and Systems Aspects. World Journal of Surgery. ISSN 0364-2313. 49(8), p. 2055–2065. doi: 10.1002/wjs.70003. Full text in Research Archive Show summary

  ABSTRACT Background Enhanced recovery after surgery (ERAS) protocols reduce length of stay, complications, and costs for elective surgical procedures. It remains challenging to implement ERAS concepts in the acute trauma patient due to deranged physiological reserve from the penetrating or blunt trauma producing altered physiology. However, systems of care improve access to early intervention and potentially reduce mortality. These consensus guidelines examine optimal pre‐hospital, resuscitation‐room, intra‐ and post‐operative treatment, systems of ethical management, and overall care for trauma patients in the post‐resuscitation phase of care. The guideline is presented in three parts, this being part 3. Methods Experts in aspects of management of trauma surgical patients and intensive care were invited to contribute by the International ERAS Society and IATSIC. Pubmed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements using the patient intervention comparator outcome (PICO) consensus questions created by the expert group. Studies were selected with particular attention to randomized clinical trials, systematic reviews, meta‐analyses, and large cohort studies; reviewed; and summarized recommendations were graded using the grading of recommendations, assessment, development and evaluation (GRADE) system. These recommendations based on current best evidence, with extrapolation from elective patient studies where appropriate, were followed by a modified two‐round Delphi method to validate final recommendations. Several ERAS components are already standard of care within national and society guidelines and are endorsed. The bulk of the text focuses on key areas pertaining specifically to trauma care of major trauma and polytrauma in the ICU‐requiring group. Results Overall 37 aspects of trauma care were considered with multiple PICO questions and sub‐points. Consensus was reached after two rounds of a modified Delphi process involving all authors, with minor adjustments to some phrasing required but with 87% overall agreement on all statements (100% agreement on 31 of the main statement sets, prior to minor edits to address the points of difference for the rest with 100% total agreement thereafter). None were rejected outright. The recommendations and level of evidence for each aspect of trauma care that may impact on improved recovery and reduced length of hospital stay are presented with grade of recommendation. Conclusions Four main areas of relevance to ethics and systems are presented as part 3. The guidelines are based on current best evidence for an ERAS approach to patients who have had major injuries and polytrauma. These guidelines are not exhaustive but collate the best available evidence on important components of care for this patient population. As some of the evidence is extrapolated from elective surgery and non‐trauma emergency surgery, some of the components need further evaluation in future studies.

• Hardcastle, Timothy C.; Gaarder, Aslaug Christine; Balogh, Zsolt; D'amours, Scott; Davis, Kimberly A. & Gupta, Amit [Show all 15 contributors for this article] (2025). Guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC): Enhanced Recovery After Surgery (ERAS) and International Association for Trauma Surgery and Intensive Care (IATSIC) Society Recommendations: Paper 2: Postoperative and Intensive Care Recommendations. World Journal of Surgery. ISSN 0364-2313. 49(8), p. 2054–2054. doi: 10.1002/wjs.70004. Full text in Research Archive Show summary

  ABSTRACT Background Enhanced recovery after surgery (ERAS) protocols reduce length of stay, complications, and costs for elective surgical procedures. It remains challenging to implement ERAS concepts in the acute trauma patient due to deranged physiological reserve from the penetrating or blunt trauma producing altered physiology. However, systems of care improve access to early intervention and potentially reduce mortality. These consensus guidelines examine optimal prehospital, resuscitation‐room, intraoperative and postoperative treatment, systems of ethical management, and overall care for trauma patients in the postresuscitation phase of care. The guideline is presented in three parts, this being Part 2. Methods Experts in aspects of management of trauma surgical patients and intensive care were invited to contribute by the International ERAS Society and IATSIC. PubMed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements using the patient, intervention, comparator outcome (PICO) consensus questions created by the expert group. Studies were selected with particular attention to randomized clinical trials, systematic reviews, meta‐analyses, and large cohort studies; reviewed and summarized recommendations were graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. These recommendations based on current best evidence, with extrapolation from elective patient studies, where appropriate, were followed by a modified two‐round Delphi method to validate final recommendations. Several ERAS components are already standard of care within national and society guidelines and are endorsed. The bulk of the text focuses on key areas pertaining specifically to trauma care of major trauma and polytrauma in the ICU‐requiring group. Results Overall, 37 aspects of trauma care were considered, with multiple PICO questions and subpoints. Consensus was reached after two rounds of a modified Delphi process involving all authors, with minor adjustments to some phrasing required, but with 87% overall agreement on all statements (100% agreement on 31 of the main statement sets, prior to minor edits to address the points of difference for the rest, with 100% total agreement thereafter). None were rejected outright. The recommendations and level of evidence for each aspect of trauma care that may impact on improved recovery and reduced length of hospital stay are presented with grade of recommendation. Conclusions This paper presents the results of the postoperative care and ICU aspects. The guidelines are based on current best evidence for an ERAS approach to patients who have had major injuries and polytrauma. These guidelines are not exhaustive but collate the best available evidence on important components of care for this patient population. As some of the evidence is extrapolated from elective surgery and nontrauma emergency surgery, some of the components need further evaluation in future studies.

• Hardcastle, Timothy C.; Gaarder, Aslaug Christine; Balogh, Zsolt; D'amours, Scott; Davis, Kimberly A. & Gupta, Amit [Show all 15 contributors for this article] (2025). Guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC): Enhanced Recovery After Surgery (ERAS) Society and International Association of Trauma Surgery and Intensive Care (IATSIC) Recommendations: Paper 1: Initial Care—Pre and Intraoperative Care Until ICU, Including Non-Operative Management. World Journal of Surgery. ISSN 0364-2313. 49(8), p. 1997–2028. doi: 10.1002/wjs.70002. Full text in Research Archive Show summary

  Background Enhanced recovery after surgery (ERAS) protocols reduce length of stay, complications, and costs for elective surgical procedures. It remains challenging to implement ERAS concepts in the acute trauma patient due to deranged physiological reserve from the penetrating or blunt trauma producing altered physiology. However, systems of care improve access to early intervention and potentially reduce mortality. These consensus guidelines examine optimal pre-hospital, resuscitation-room, intra-, and post-operative treatment, systems of ethical management, and overall care for trauma patients in the post-resuscitation phase of care. The guideline is presented in three parts, this being part 1. Methods Experts in aspects of management of trauma surgical patients and intensive care were invited to contribute by the International ERAS Society and IATSIC. PubMed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements using the patient intervention comparator outcome (PICO) consensus questions created by the expert group. Studies were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses, and large cohort studies, reviewed, and summarized recommendations were graded using the grading of recommendations, assessment, development and evaluation (GRADE) system. These recommendations based on current best evidence, with extrapolation from elective patient studies, where appropriate, were followed by a modified two-round Delphi method to validate final recommendations. Several ERAS components are already standard of care within national and society guidelines and are endorsed. The bulk of the text focuses on key areas pertaining specifically to trauma care of major trauma and polytrauma in the ICU-requiring group. Results Overall 37 aspects of trauma care were considered with multiple PICO questions and sub-points. Consensus was reached after two rounds of a modified Delphi process involving all authors, with minor adjustments to some phrasing required, but with 87% overall agreement on all statements (100% agreement on 31 of the main statement sets, prior to minor edits to address the points of difference for the rest with 100% total agreement thereafter). None were rejected outright. The recommendations and level of evidence for each aspect of trauma care that may impact on improved recovery and reduced length of hospital stay are presented with grade of recommendation. Conclusions The guidelines relating to initial care and decision-making are presented in part 1 of the Guidelines. These guidelines are based on current best evidence for an ERAS approach to patients who have had major injuries and polytrauma. The guidelines are not exhaustive but collate the best available evidence on important components of care for this patient population. As some of the evidence is extrapolated from elective surgery and non-trauma emergency surgery, some of the components need further evaluation in future studies.

• Ringen, Amund Hovengen; Jørgensen, Rachel; Wisborg, Torben; Gaarder, Aslaug Christine & Næss, Pål Aksel (2025). Adolescent optimism - Coping well after severe injury: A qualitative study. Injury. ISSN 0020-1383. 56(5), p. 112278–112278. doi: 10.1016/j.injury.2025.112278. Full text in Research Archive
• Schäfer, Christoph; Moksnes, Håkon Øgreid; Rasmussen, Mari Storli; Hellstrøm, Torgeir; Soberg, Helene Lundgaard & Røise, Olav [Show all 15 contributors for this article] (2025). Early Injury-Related Predictors of Disability 6 Months After Moderate to Severe Trauma: A Longitudinal Study. Disabilities. 5(3). doi: 10.3390/disabilities5030073. Full text in Research Archive Show summary

  Trauma often causes long-lasting functional impairment, but the extent varies across populations. This study investigated disability six months after moderate to severe injury and identified sociodemographic and early injury-related predictors, including estimated rehabilitation complexity. Further, we assessed the implementation of direct transfer from acute care in the trauma centre to specialised inpatient rehabilitation, bypassing local hospitals. In this prospective study 398 adults, treated from January 2020 to January 2021 at two Norwegian trauma centres, were included. Self-reported disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0. Ordinal logistic regression was applied to identify predictors of the 6-month disability outcome. At follow-up, 22% reported no disability, 49% mild/moderate and 29% severe. In multivariable analyses, low education, comorbidities, number of injuries and higher estimated rehabilitation complexity at discharge from acute care were significantly associated with greater disability. Only 20% were transferred directly to specialised inpatient rehabilitation, while 17% went via local hospitals. Participants with orthopaedic injuries and women were less likely to be transferred directly. In summary, most participants experienced some disability at 6 months. Indirect pathways to specialised rehabilitation via local hospitals remained common. Understanding predictors of disability and optimising rehabilitation pathways may improve trauma rehabilitation outcomes, highlighting the need for guidelines that identify patients with high rehabilitation needs.

• Næss, Pål Aksel & Gaarder, Aslaug Christine (2025). Managing a mass casualty, lessons learned. Current Opinion in Anaesthesiology. ISSN 0952-7907. 38(2), p. 136–140. doi: 10.1097/ACO.0000000000001457. Full text in Research Archive
• Gaarder, Aslaug Christine; Næss, Pål Aksel; Marzi, Ingo & Hietbrink, Falco (2025). Education and continued professional development. European Journal of Trauma and Emergency Surgery. ISSN 1863-9933. 51(1). doi: 10.1007/s00068-025-02831-9. Full text in Research Archive
• Elveos, Marlene Mauseth; Skari, Hans; Mørk, Kaja; Schistad, Ole & Næss, Pål Aksel (2025). Fri ernæring etter operasjon for pylorusstenose. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(3). doi: 10.4045/tidsskr.24.0168. Full text in Research Archive
• Harrison, Ewen M.; Gobin, N.; Freitas, A.V.; Hall, N.; Kim, S. & Negida, A. [Show all 2,935 contributors for this article] (2024). Development and external validation of the 'Global Surgical-Site Infection' (GloSSI) predictive model in adult patients undergoing gastrointestinal surgery. British Journal of Surgery. ISSN 0007-1323. 111(6). doi: 10.1093/bjs/znae129. Full text in Research Archive
• Lindsay, Charlotte; Davenport, Ross; Baksaas-Aasen, Kjersti; Kolstadbråten, Knut Magne; Næss, Pål Aksel & Curry, Nicola [Show all 13 contributors for this article] (2024). CORRECTION OF TRAUMA-INDUCED COAGULOPATHY BY GOAL DIRECTED THERAPY: A SECONDARY ANALYSIS OF THE ITACTIC TRIAL. Anesthesiology. ISSN 0003-3022. doi: 10.1097/ALN.0000000000005183. Full text in Research Archive Show summary

  Background Trauma hemorrhage induces a coagulopathy with a high associated mortality rate. The Implementing Treatment Algorithms for the Correction of Trauma Induced Coagulopathy (ITACTIC) randomized trial tested two goal-directed treatment algorithms for coagulation management: one guided by conventional coagulation tests and one by viscoelastic hemostatic assays (viscoelastic). The lack of a difference in 28-day mortality led the authors to hypothesize that coagulopathic patients received insufficient treatment to correct coagulopathy. Methods During ITACTIC, two sites were coenrolling patients into an ongoing prospective observational study, which included serial blood sampling at the same intervals as in ITACTIC. The subgroup in both studies had conventional and viscoelastic test results for each patient available for analysis. A goal-directed treatment was defined as one triggered by an ITACTIC algorithm. Coagulopathy was defined as rotational thromboelastometry EXTEM A5 less than 40 mm. The primary outcome was correction of coagulopathy by the 12th unit of erythrocyte transfusion during resuscitation. Results Full viscoelastic and conventional coagulation test results were available for 133 patients. Of these patients, 71% were coagulopathic on admission, and 16% developed a coagulopathy during resuscitation. ITACTIC viscoelastic hemostatic assay group patients were more likely to receive goal-directed treatment than the standard group (76% vs. 47%; odds ratio, 3.73; 95% CI, 1.64 to 8.49; P = 0.002). However, only 54% of patients received goal-directed treatment, and only 20% corrected their coagulopathy (vs. 0% with empiric treatment alone; not significant). Median time to first goal-directed treatment was 68 (53 to 88) min for viscoelastic and 110 (77 to 123) min for standard (P = 0.005). Conclusions In ITACTIC, many bleeding trauma patients did not receive an indicated goal-directed treatment. Interventions arrived late during resuscitation and were only partially effective at correcting coagulopathy.

• Aarhus, Mads; MIRZAMOHAMMADI, JALAL; Rønning, Pål Andre; Strøm, Mona; Glott, Thomas & Rizvi, Syed Ali Mujtaba [Show all 15 contributors for this article] (2024). Time from injury to acute surgery for patients with traumatic cervical spinal cord injury in South-East Norway. Frontiers in Neurology. 15. doi: 10.3389/fneur.2024.1420530. Full text in Research Archive Show summary

  Background: The recommended treatment for cervical spinal cord injury (cSCI) is surgical decompression and stabilization within 24 h after injury. The aims of the study were to estimate our institutional compliance with this recommendation and identify potential factors associated with surgical delay. Methods: Population-based retrospective database study of patients operated for cSCI in 2015–2022 within the South-East Norway Health Region (3.1 million inhabitants). Data extracted were demographics, injury description, management timeline, place of primary triage [local hospital (LH) or neurotrauma center (NTC)]. Main outcome variables were: (1) time from injury to surgery at NTC, (2) time from injury to admission NTC, and (3) time from admission NTC to surgery. Results: We found 243 cSCI patients having acute neck surgery. Their median age was 63 years (IQR 47–74 years), 77% were male, 48% were ≥65 years old. Primary triage at an LH occurred in 150/243 (62%). The median time from injury to acute surgery was 27.8 h (IQR 15.4–61.9 h), and 47% had surgery within 24 h. The median time from injury to NTC admission was 5.6 h (IQR 1.9–19.4 h), and 67% of the patients were admitted to the NTC within 12 h. Significant factors associated with increased time from injury to NTC admission were transfer via LH, severe preinjury comorbidities, less severe cSCI, time of injury other than night, absence of multiple injuries. The median time from NTC admission to surgery was 16.7 h (IQR 9.5–31.0 h), and 70% had surgery within 24 h. Significant factors associated with increased time from NTC admission to surgery were increasing age and non-translational injury morphology. Conclusion: Less than half of the patients with cSCI were operated on within the recommended 24 h time frame after injury. To increase the fraction of early surgery, we suggest the following: (1) patients with clinical suspicion of cSCI should be transported directly to the NTC from the scene of the accident, (2) MRI should be performed only at the NTC, (3) at the NTC, surgery should commence on the same calendar day as arrival or as the first operation the following day.

• Ringen, Amund Hovengen; Baksaas-Aasen, Kjersti; Skaga, Nils Oddvar; Wisborg, Torben; Gaarder, Aslaug Christine & Næss, Pål Aksel (2023). Close to zero preventable in-hospital deaths in pediatric trauma patients – An observational study from a major Scandinavian trauma center. Injury. ISSN 0020-1383. 54(1), p. 183–188. doi: 10.1016/j.injury.2022.07.043. Full text in Research Archive Show summary

  Background: In line with international trends, initial treatment of trauma patients has changed substantially over the last two decades. Although trauma is the leading cause of death and disability in children globally, in-hospital pediatric trauma related mortality is expected to be low in a mature trauma system. To evaluate the performance of a major Scandinavian trauma center we assessed treatment strategies and outcomes in all pediatric trauma patients over a 16-year period. Methods: A retrospective cohort study of all trauma patients under the age of 18 years admitted to a single institution from 1st of January 2003 to 31st of December 2018. Outcomes for two time periods were compared, 2003–2009 (Period 1; P1) and 2010–2018 (Period 2; P2). Deaths were further analyzed for preventability by the institutional trauma Mortality and Morbidity panel. Results: The study cohort consisted of 3939 patients. A total of 57 patients died resulting in a crude mortality of 1.4%, nearly one quarter of the study cohort (22.6%) was severely injured (Injury Severity Score > 15) and mortality in this group decreased from 9.7% in P1 to 4.1% in P2 (p<0.001). The main cause of death was brain injury in both periods, and 55 of 57 deaths were deemed non-preventable. The rate of emergency surgical procedures performed in the emergency department (ED) decreased during the study period. None of the 11 ED thoracotomies in non-survivors were performed after 2013. Conclusion: A dedicated multidisciplinary trauma service with ongoing quality improvement efforts secured a low in-hospital mortality among severely injured children and a decrease in futile care. Deaths were shown to be almost exclusively non-preventable, pointing to the necessity of prioritizing prevention strategies to further decrease pediatric trauma related mortality.

• Ringen, Amund Hovengen; Fatland, Andrè; Skaga, Nils Oddvar; Gaarder, Aslaug Christine & Næss, Pål Aksel (2023). Pediatric renal trauma: 17 years of experience at a major Scandinavian trauma center. Trauma Surgery and Acute Care Open (TSACO). 8(1). doi: 10.1136/tsaco-2023-001207. Full text in Research Archive Show summary

  Background Children are at increased risk of renal injuries from blunt trauma due to their anatomic constitution. The kidney is injured in 5–20% of pediatric patients with blunt abdominal trauma. During the last decades, the management of pediatric renal injuries has evolved toward non-operative management (NOM) unless the patient is hemodynamically compromised. The aim of the present study was to assess contemporary treatment strategies and evaluate outcomes in pediatric patients with renal injuries admitted to a major Scandinavian trauma center. Methods A retrospective cohort study of all trauma patients under 18 years admitted to our institution from January 1, 2003 to December 31, 2019 with main focus on patients with renal injury. Outcomes for two time periods were compared, 2003–2009 (Period 1; P1) and 2010–2019 (Period 2; P2), and the study cohort was also stratified into age groups, survivors and non-survivors and severity of renal injury. Results In total, there were 4230 pediatric patients included in Oslo University Hospital Trauma Registry during this 17-year period and of these 115 (2.7%) had a renal injury. Nephrectomy was performed in four (3.5%) of the patients, angiographic embolization five (4.3%) and ureteral stent placement was performed in six patients (5.2%) due to urinary extravasation. Seven patients died, implying a crude mortality of 6.1%, with one exception secondary to traffic-related incidents. None of the deaths were attributed to renal injury and mortality fell to 1.2% in P2. Discussion This study on contemporary pediatric renal trauma care is one of the largest from a single institution outside the USA. Our results clearly show that NOM, including minimally invasive procedures in selected cases, is achievable in more than 90% of cases with low mortality and morbidity.

• Gaski, Iver Anders; Næss, Pål Aksel; Baksaas-Aasen, Kjersti; Skaga, Nils Oddvar & Gaarder, Aslaug Christine (2023). Achieving balanced transfusion early in critically bleeding trauma patients: An observational study exploring the effect of attending trauma surgical presence during resuscitation. Trauma Surgery and Acute Care Open (TSACO). 8(1). doi: 10.1136/tsaco-2023-001160. Full text in Research Archive Show summary

  Background After 15 years of damage control resuscitation (DCR), studies still report high mortality rates for critically bleeding trauma patients. Adherence to massive hemorrhage protocols (MHPs) based on a 1:1:1 ratio of plasma, platelets, and red blood cells (RBCs) as part of DCR has been shown to improve outcomes. We wanted to assess MHP use in the early (6 hours from admission), critical phase of DCR and its impact on mortality. We hypothesized that the presence of an attending trauma surgeon during all MHP activations from 2013 would contribute to improving institutional resuscitation strategies and patient outcomes. Methods We conducted a retrospective analysis of all trauma patients receiving ≥10 RBCs within 6 hours of admission and included in the institutional trauma registry between 2009 and 2019. The cohort was divided in period 1 (P1): January 2009–August 2013, and period 2 (P2): September 2013–December 2019 for comparison of outcomes. Results A total of 141 patients were included, 81 in P1 and 60 in P2. Baseline characteristics were similar between the groups for Injury Severity Score, lactate, Glasgow Coma Scale, and base deficit. Patients in P2 received more plasma (16 units vs. 12 units; p&lt;0.01), resulting in a more balanced plasma:RBC ratio (1.00 vs. 0.74; p&lt;0.01), and platelets:RBC ratio (1.11 vs. 0.92; p&lt;0.01). All-cause mortality rates decreased from P1 to P2, at 6 hours (22% to 8%; p=0.03), at 24 hours (36% vs 13%; p&lt;0.01), and at 30 days (48% vs 30%, p=0.03), respectively. A stepwise logistic regression model predicted an OR of 0.27 (95% CI 0.08 to 0.93) for dying when admitted in P2. Conclusions Achieving balanced transfusion rates at 6 hours, facilitated by the presence of an attending trauma surgeon at all MHP activations, coincided with a reduction in all-cause mortality and hemorrhage-related deaths in massively transfused trauma patients at 6 hours, 24 hours, and 30 days. Level of evidence IV.

• Johansson, Pär I.; Eriksen, Christian Fenger; Bovbjerg, Pernille E.; Gaarder, Aslaug Christine; Pall, Marlene & Henriksen, Hanne Hee [Show all 13 contributors for this article] (2023). Prostacyclin in trauma patients with hemorrhagic shock: A randomized clinical trial. Journal of Trauma and Acute Care Surgery. ISSN 2163-0755. 96(3), p. 476–481. doi: 10.1097/TA.0000000000004150. Full text in Research Archive Show summary

  BACKGROUND A main cause of trauma morbidity and mortality is multiple-organ failure, and endotheliopathy has been implicated. Pilot studies indicate that low-dose prostacyclin improves endothelial functionality in critically ill patients, suggesting that this intervention may improve trauma patient outcome. METHODS We conducted a multicenter, randomized, blinded, clinical investigator-initiated trial in 229 trauma patients with hemorrhagic shock who were randomized 1:1 to 72 hours infusion of the prostacyclin analog iloprost (1 ng/kg/min) or placebo. The primary outcome was the number of intensive care unit (ICU)–free days alive within 28 days of admission. Secondary outcomes included 28-day all-cause mortality and hospital length of stay. RESULTS The mean number of ICU-free days alive within 28 days was 15.64 days in the iloprost group versus 13.99 days in the placebo group (adjusted mean difference, −1.63 days [95% confidence interval (CI), −4.64 to 1.38 days]; p = 0.28). The 28-day mortality was 18.8% in the iloprost group versus 19.6% in the placebo group (odds ratio, 1.01 [95% CI, 0.51–2.0]; p = 0.97). The mean hospital length of stay was 19.96 days in the iloprost group versus 27.32 days in the placebo group (adjusted mean difference, 7.84 days [95% CI, 1.66–14.02 days], p = 0.01). CONCLUSION Iloprost did not result in a statistically significant increase in the number of ICU-free days alive within 28 days of admission, whereas it was safe and a statistically significant reduction in hospital length of stay was observed. Further research on prostacyclin in shocked trauma patients is warranted. LEVEL OF EVIDENCE Therapeutic/Care Management; Level II.

• Kachapila, Mwayi; Monahan, Mark; Ademuyiwa, Adesoji O.; Adinoyi, Yakubu Momohsani; Biccard, Bruce M. & George, Christina [Show all 1,785 contributors for this article] (2023). Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries. BJA Open. 7. doi: 10.1016/j.bjao.2023.100207. Full text in Research Archive Show summary

  Background This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

• Schäfer, Christoph; Moksnes, Håkon Øgreid; Rasmussen, Mari Storli; Hellstrøm, Torgeir; Søberg, Helene L. & Røise, Olav [Show all 15 contributors for this article] (2023). Adherence to Guidelines for Acute Rehabilitation in the Norwegian Trauma Plan. Journal of Rehabilitation Medicine. ISSN 1650-1977. 55. doi: 10.2340/jrm.v55.6552. Full text in Research Archive Show summary

  Objective: To evaluate adherence to 3 central operational recommendations for acute rehabilitation in the Norwegian trauma plan.<p> <p>Methods: A prospective multi-centre study of 538 adults with moderate and severe trauma with New Injury Severity Score >9. <p>Results: Adherence to the first recommendation, assessment by a physical medicine and rehabilitation physician within 72 h following admission to the intensive care unit (ICU) at the trauma centre, was documented for 18% of patients. Adherence to the second recommendation, early rehabilitation in the intensive care unit, was documented for 72% of those with severe trauma and ≥2 days ICU stay. Predictors for early rehabilitation were ICU length of stay and spinal cord injury. Adherence to the third recommendation, direct transfer of patients from acute ward to a specialized rehabilitation unit, was documented in 22% of patients, and occurred more often in those with severe trauma (26%), spinal cord injury (54%) and traumatic brain injury (39%). Being employed, having head or spinal chord injury and longer ICU stay were predictors for direct transfer to a specialized rehabilitation unit. <p>Conclusion: Adherence to acute rehabilitation guidelines after trauma is poor. This applies to documented early assessment by a physical medicine and rehabilitation physician, and direct transfer from acute care to rehabilitation after head and extremity injuries. These findings indicate a need for more systematic integration of rehabilitation in the acute treatment phase after trauma.

• Moksnes, Håkon Øgreid; Schäfer, Christoph; Rasmussen, Mari Storli; Søberg, Helene L.; Røise, Olav & Anke, Audny Gabriele Wagner [Show all 15 contributors for this article] (2023). Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study. Injury Epidemiology. 10. doi: 10.1186/s40621-023-00431-y. Full text in Research Archive Show summary

  Background - Previous studies have demonstrated that the trauma population has needs for rehabilitation services that are best provided in a continuous and coordinated way. The discharge destination after acute care is the second step to ensuring quality of care. There is a lack of knowledge regarding the factors associated with the discharge destination for the overall trauma population. This paper aims to identify sociodemographic, geographical, and injury-related factors associated with discharge destination following acute care at trauma centers for patients with moderate-to-severe traumatic injuries.<p> <p>Methods - A multicenter, population-based, prospective study was conducted with patients of all ages with traumatic injury [New Injury Severity Score (NISS) > 9] admitted within 72 h after the injury to regional trauma centers in southeastern and northern Norway over a 1-year period (2020).<p> <p>Results - In total, 601 patients were included; a majority (76%) sustained severe injuries, and 22% were discharged directly to specialized rehabilitation. Children were primarily discharged home, and most of the patients ≥ 65 years to their local hospital. Depending on the centrality of their residence [Norwegian Centrality Index (NCI) 1–6, where 1 is most central], we found that patients residing in NCI 3–4 and 5–6 areas sustained more severe injuries than patients residing in NCI 1–2 areas. An increase in the NISS, number of injuries, or a spinal injury with an Abbreviated Injury Scale (AIS) ≥ 3 was associated with discharge to local hospitals and specialized rehabilitation than to home. Patients with an AIS ≥ 3 head injury (RRR 6.1, 95% Confidence interval 2.80–13.38) were significantly more likely to be discharged to specialized rehabilitation than patients with a less severe head injury. Age < 18 years was negatively associated with discharge to a local hospital, while NCI 3–4, preinjury comorbidity, and increased severity of injuries in the lower extremities were positively associated.<p> <p>Conclusions - Two-thirds of the patients sustained severe traumatic injury, and 22% were discharged directly to specialized rehabilitation. Age, centrality of the residence, preinjury comorbidity, injury severity, length of hospital stay, and the number and specific types of injuries were factors that had the greatest influence on discharge destination.

• Moksnes, Håkon Øgreid; Schäfer, Christoph; Rasmussen, Mari Storli; Søberg, Helene L.; Røise, Olav & Anke, Audny Gabriele Wagner [Show all 15 contributors for this article] (2023). Functional Outcomes at 6 and 12 Months Post-Injury in a Trauma Centre Population with Moderate-to-Severe Traumatic Injuries. Journal of Clinical Medicine. 12(16). doi: 10.3390/jcm12165300. Full text in Research Archive Show summary

  This study aims to evaluate the global functional outcomes after moderate-to-severe traumatic injury at 6 and 12 months and to examine the sociodemographic and injury-related factors that predict these outcomes. A prospective cohort study was conducted in which trauma patients of all ages with a New Injury Severity Score > 9 who were discharged alive from two regional trauma centres in Norway over a one-year period (2020) were included. The Glasgow Outcome Scale Extended (GOSE) score was used to analyse the functional outcomes. Regression analyses were performed to investigate the predictors of the GOSE score. Follow-up assessments were obtained from approximately 85% of the 601 included patients at both time points. The mean (SD) GOSE score was 6.1 (1.6) at 6 months and 6.4 (1.6) at 12 months, which corresponds to an upper-moderate disability. One-half of the patients had a persistent disability at 12 months post-injury. The statistically significant predictors of a low GOSE score at both time points were more pre-injury comorbidity, a higher number of injuries, and higher estimated rehabilitation needs, whereas a thorax injury with an Abbreviated Injury Scale ≥ 3 predicted higher GOSE scores. A high Glasgow Coma Scale score at admission predicted a higher GOSE score at 6 months. This study strengthens the evidence base for the functional outcomes and predictors in this population.

• Vigstedt, Martin; Baksaas-Aasen, Kjersti; Henriksen, Hanne; Maegele, Marc; Stanworth, Simon & Juffermans, Nicole P. [Show all 12 contributors for this article] (2022). Thrombelastography (TEG® 6s) early amplitudes predict maximum amplitude in severely injured trauma patients. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 82(6), p. 508–512. doi: 10.1080/00365513.2022.2119599. Full text in Research Archive
• Hietbrink, Falco; Mohseni, Shahin; Mariani, Diego; Næss, Pål Aksel; Rey-Valcárcel, Cristina & Biloslavo, Alan [Show all 12 contributors for this article] (2022). What trauma patients need: the European dilemma. European Journal of Trauma and Emergency Surgery. ISSN 1863-9933. doi: 10.1007/s00068-022-02014-w. Full text in Research Archive
• Breen, Jan Mario; Næss, Pål Aksel; Hansen, Trond Boye; Gaarder, Aslaug Christine; Klemmetsen, Harald & Stray-Pedersen, Arne (2022). Young adults in motor vehicle collisions in Norway: user safety errors observed in majority of cases with severe or fatal injuries. Forensic Science, Medicine, and Pathology. ISSN 1547-769X. 18(4), p. 456–469. doi: 10.1007/s12024-022-00541-x. Full text in Research Archive Show summary

  Abstract Purpose We performed a multidisciplinary investigation of young adults involved in motor vehicle collisions (MVCs) to elucidate injury mechanisms and the role of passive safety equipment such as seat belts and airbags. Methods MVCs resulting in death or serious injuries to the driver or passengers aged 16–24 years in southeastern Norway during 2013–2016 were investigated upon informed consent. We assessed the crash scene, the motor vehicle (MV) interior and exterior, and analyzed data from medical records, forensic autopsies and reports from police and civil road authorities. Results This study included 229 young adult occupants involved in 212 MVCs. The Maximum Abbreviated Injury Scale (MAIS) score was ≥2 in 111 occupants, of which 22 were fatalities. In 59% (65/111) of the cases with MAIS score ≥2 injuries, safety errors and occupant protection inadequacies were considered to have contributed to the injury outcome. Common errors were seatbelt non-use and misuse, carrying insecure luggage, and the seat back being too reclined. MAIS score ≥2 head/neck injuries were observed in side impacts despite correct seatbelt use, related to older MVs lacking side airbag curtains. The independent risk factors for MAIS score ≥2 injuries included not using a seatbelt, driving under the influence of alcohol or drugs, nighttime driving, side impacts, heavy collision partner, and MV deformation. Conclusion User safety errors (not using a seatbelt, seatbelt misuse, excessive seat-back reclining, and insecure cargo) and a lack of occupant protection in older MVs resulted in young adults sustaining severe or fatal injuries in MVCs.

• Reuter, Anna; Rogge, Lisa; Monahan, Mark; Kachapila, Mwayi; Morton, Dion G & Davies, Justine I [Show all 50 contributors for this article] (2022). Global economic burden of unmet surgical need for appendicitis. British Journal of Surgery. ISSN 0007-1323. 109(10), p. 995–1003. doi: 10.1093/bjs/znac195. Full text in Research Archive Show summary

  Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was USD 92 492 million using approach 1 and USD 73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was USD 95 004 million using approach 1 and USD 75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially.

• Amstel, Paul Van; Ghazzaoui, Ali El; Hall, Nigel J.; Wester, Tomas; Morini, Francesco & Lee, Johanna H. Van Der [Show all 97 contributors for this article] (2022). Paediatric appendicitis: International study of management in the COVID-19 pandemic. British Journal of Surgery. ISSN 0007-1323. 109(11), p. 1044–1048. doi: 10.1093/bjs/znac239. Full text in Research Archive
• Næss, Pål Aksel & Gaarder, Aslaug Christine (2022). Hemodynamisk stabil? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(16). doi: 10.4045/tidsskr.22.0660. Full text in Research Archive
• Jørgensen, Jørgen Joakim; Monrad-Hansen, Peter Wiel; Gaarder, Aslaug Christine & Næss, Pål Aksel (2021). Disaster preparedness should represent an augmentation of the everyday trauma system, but are we prepared? Trauma Surgery and Acute Care Open (TSACO). doi: 10.1136/tsaco-2021-000760. Full text in Research Archive
• Breen, Jan Mario; Næss, Pål Aksel; Gaarder, Christine & Stray-Pedersen, Arne (2021). Autopsy findings in drivers and passengers from fatal motor vehicle collisions: limited differences in injury patterns and toxicological test results. Forensic Science, Medicine, and Pathology. ISSN 1547-769X. 17(2), p. 235–246. doi: 10.1007/s12024-021-00359-z. Full text in Research Archive Show summary

  Abstract We performed a retrospective study of the injuries and characteristics of occupant fatalities in motor vehicle collisions in southeast Norway. The goal was to provide updated knowledge of injuries sustained in modern vehicles and detect possible differences in injury pattern between drivers and passengers. Forensic autopsy reports, police, and collision investigation reports from 2000 to 2014 were studied, data extracted and analyzed. A total of 284 drivers, 80 front-seat passengers, and 37 rear-seat passengers were included, of which 67.3% died in front collisions, 13.7% in near-side impacts, 13.5% in rollovers and 5.5% in other/combined collisions. Overall, 80.5% died within one hour after the crash. The presence of fatal injuries to the head, neck, thorax and abdomen were observed in 63.6%, 10.7%, 61.6% and 27.4% respectively. All occupants with severe injuries to the head or neck had signs of direct impact with contact point injuries to the skin or skull. Injuries to the heart and spleen were less common in front-seat passengers compared to drivers. Seat belt abrasions were more common and lower extremity fractures less common in both front-seat and rear-seat passengers compared to drivers. Blood alcohol and/or drug concentrations suggestive of impairment were present in 30% of all occupants, with alcohol more often detected among front-seat passengers compared to drivers. Few driver-specific and passenger-specific patterns of injury could be identified. When attempting to assess an occupant’s seating position within a vehicle, autopsy findings should be interpreted with caution and only in conjunction with documentation from the crash scene.

• Saar, Sten; Jørgensen, Jørgen Joakim; Lemma, Aurora; Gaarder, Aslaug Christine; Næss, Pål Aksel & Leppaniemi, Ari [Show all 11 contributors for this article] (2021). Selective non-operative management of penetrating abdominal injuries at Northern European trauma centers: the NordiPen Study. European Journal of Trauma and Emergency Surgery. ISSN 1863-9933. doi: 10.1007/s00068-021-01749-2. Full text in Research Archive
• Søberg, Helene Lundgaard; Moksnes, Håkon Øgreid; Anke, Audny; Røise, Olav; Røe, Ellen-Cecilie Treu & Aas, Eline [Show all 20 contributors for this article] (2021). Rehabilitation Needs, Service Provision, and Costs in the First Year Following Traumatic Injuries: Protocol for a Prospective Cohort Study. JMIR Research Protocols. 10(4), p. 1–10. doi: 10.2196/25980. Full text in Research Archive Show summary

  Background: Traumatic injuries, defined as physical injuries with sudden onset, are a major public health problem worldwide. There is a paucity of knowledge regarding rehabilitation needs and service provision for patients with moderate and major trauma, even if rehabilitation research on a spectrum of specific injuries is available.<p> <p>Objective: This study aims to describe the prevalence of rehabilitation needs, the provided services, and functional outcomes across all age groups, levels of injury severity, and geographical regions in the first year after trauma. Direct and indirect costs of rehabilitation provision will also be assessed. The overarching aim is to better understand where to target future efforts.<p> <p>Methods: This is a population-based prospective follow-up study. It encompasses patients of all ages with moderate and severe acute traumatic injury (New Injury Severity Score >9) admitted to the regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Sociodemographic and injury data will be collected. Upon hospital discharge, rehabilitation physicians estimate rehabilitation needs. Rehabilitation needs are assessed by the Rehabilitation Complexity Scale Extended–Trauma (RCS E–Trauma; specialized inpatient rehabilitation), Needs and Provision Complexity Scale (NPCS; community-based rehabilitation and health care service delivery), and Family Needs Questionnaire–Pediatric Version (FNQ-P). Patients, family caregivers, or both will complete questionnaires at 6- and 12-month follow-ups, which are supplemented by telephone interviews. Data on functioning and disability, mental health, health-related quality of life measured by the EuroQol Questionnaire (EQ-5D), and needs and provision of rehabilitation and health care services are collected by validated outcome measures. Unmet needs are represented by the discrepancies between the estimates of the RCS E–Trauma and NPCS at the time of a patient’s discharge and the rehabilitation services the patient has actually received. Formal service provision (including admission to inpatient- or outpatient-based rehabilitation), informal care, and associated costs will be collected.<p> <p>Results: The project was funded in December 2018 and approved by the Regional Committee for Medical and Health Research Ethics in October 2019. Inclusion of patients began at Oslo University Hospital on January 1, 2020, and at the University Hospital of North Norway on February 1, 2020. As of February 2021, we have enrolled 612 patients, and for 286 patients the 6-month follow-up has been completed. Papers will be drafted for publication throughout 2021 and 2022.<p> <p>Conclusions: This study will improve our understanding of existing service provision, the gaps between needs and services, and the associated costs for treating patients with moderate and major trauma. This may guide the improvement of rehabilitation and health care resource planning and allocation.

• SCHISTAD, Magnus; Skari, Hans; KHOSHNEWISZADEH, BEHZAD; Schistad, Ole & Næss, Pål Aksel (2020). Magneter i tarmen. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140(18), p. 1–2. doi: 10.4045/tidsskr.20.0460. Full text in Research Archive
• Drake, Thomas M.; Pata, Francesco; Ghosh, Dhruv; Ademuyiwa, Adesoji O; Arnaud, Alexis P & Bhangu, Aneel [Show all 56 contributors for this article] (2020). Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort study. BMJ Global Health. doi: 10.1136/bmjgh-2020-003429. Full text in Research Archive Show summary

  Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

• Baksaas-Aasen, Kjersti; Gall, Lewis; Stensballe, Jakob; Juffermans, Nicole P.; Curry, Nicola & Maegele, Marc [Show all 27 contributors for this article] (2020). Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial. Intensive Care Medicine. ISSN 0342-4642. p. 49–59. doi: 10.1007/s00134-020-06266-1. Full text in Research Archive Show summary

  Purpose Contemporary trauma resuscitation prioritizes control of bleeding and uses major haemorrhage protocols (MHPs) to prevent and treat coagulopathy. We aimed to determine whether augmenting MHPs with Viscoelastic Haemostatic Assays (VHA) would improve outcomes compared to Conventional Coagulation Tests (CCTs). Methods This was a multi-centre, randomized controlled trial comparing outcomes in trauma patients who received empiric MHPs, augmented by either VHA or CCT-guided interventions. Primary outcome was the proportion of subjects who, at 24 h after injury, were alive and free of massive transfusion (10 or more red cell transfusions). Secondary outcomes included 28-day mortality. Pre-specified subgroups included patients with severe traumatic brain injury (TBI). Results Of 396 patients in the intention to treat analysis, 201 were allocated to VHA and 195 to CCT-guided therapy. At 24 h, there was no difference in the proportion of patients who were alive and free of massive transfusion (VHA: 67%, CCT: 64%, OR 1.15, 95% CI 0.76–1.73). 28-day mortality was not different overall (VHA: 25%, CCT: 28%, OR 0.84, 95% CI 0.54–1.31), nor were there differences in other secondary outcomes or serious adverse events. In pre-specified subgroups, there were no differences in primary outcomes. In the pre-specified subgroup of 74 patients with TBI, 64% were alive and free of massive transfusion at 24 h compared to 46% in the CCT arm (OR 2.12, 95% CI 0.84–5.34). Conclusion There was no difference in overall outcomes between VHA- and CCT-augmented-major haemorrhage protocols.

• Breen, Jan Mario; Næss, Pål Aksel; Hansen, Trond Boye; Gaarder, Christine & Stray-Pedersen, Arne (2020). Serious motor vehicle collisions involving young drivers on Norwegian roads 2013–2016: Speeding and driver-related errors are the main challenge. Traffic Injury Prevention. ISSN 1538-9588. 21(6), p. 382–388. doi: 10.1080/15389588.2020.1770237. Full text in Research Archive Show summary

  Objective: Motor vehicle collisions (MVCs) are a leading cause of death and acute disability among young adults worldwide. We performed a prospective study of young drivers involved in severe MVCs, investigating the critical events leading up to a collision with an emphasis on driver-related factors and collision culpability. Methods: A study was conducted in southeastern Norway of all drivers younger than 25 years who were involved in high-energy MVCs resulting in immediate hospitalization during 2013–2016. Collision investigators evaluated the exterior and interior of the motor vehicle (MV) within 24 h. Complementary information was obtained from interviews of collision victims, ambulance personnel and witnesses, from police reports, and medical records. Results: There were 145 young drivers included during a 3-year study period, representing an estimated incidence of 29 per 100,000 drivers with registered driving licenses. Ninety-two percent (133/145) were considered culpable of initiating the MVC, and only 2% of the critical factors preceding the collision were not related to the driver. There were 74% (108/145) males, the median MV (motor vehicle) age age was 14 years, and 86% (125/145) of the MVs were passenger cars. The MVCs predominantly occurred on rural roads (90%, 130/145). Among the culpable drivers, speeding behavior was the main predisposing factor in 80% (106/133) of the collisions. Driving at excessive speed was associated with single-vehicle collisions (87%, 74/85) and the presence of passengers (89%, 56/63). Compared to nonculpable drivers, culpable drivers were more often younger than 21years (66% vs 33%, p = 0.031), had obtained their license less than 2 years previously (68% vs 20%, p = 0.004), and were more likely to have been drinking or using drugs (27% vs 0%, p = 0.039). The overall rate of seatbelt use was 79% (114/145). Conclusion: The vast majority of injury-causing MVCs involving young drivers are initiated by those drivers. These incidents are characterized by male drivers with little driving experience who are operating old cars on rural roads at excessive speeds. Driving under the influence of alcohol or drugs is also not uncommon. These issues should be targeted in future preventive measures.

• Brooks, Adam; Reilly, John-Joe; Hope, Carla; Navarro, Alex; Næss, Pål Aksel & Gaarder, Christine (2020). Evolution of non-operative management of liver trauma. Trauma Surgery and Acute Care Open (TSACO). 5(1), p. 1–4. doi: 10.1136/tsaco-2020-000551. Full text in Research Archive Show summary

  The management of complex liver injury has changed during the last 30 years. Operative management has evolved into a non-operative management (NOM) approach, with surgery reserved for those who present in extremis or become hemodynamically unstable despite resuscitation. This NOM approach has been associated with improved survival rates in severe liver injury and has been the mainstay of treatment for the last 20 years. Patients that fail NOM and require emergency surgery are associated with increased morbidity and mortality. Better patient selection may have an impact not only on the rate of failure of NOM, but the mortality rate associated with it. The aim of this article is to review the evidence that helped shape the evolution of liver injury management during the last 30 years.

• Kolstadbråten, Knut Magne; Spreng, Ulrich Johannes; Wisløff-Aase, Kristin; Gaarder, Christine; Næss, Pål Aksel & Ræder, Johan (2019). Incidence of chronic pain 6 y after major trauma. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 63(8), p. 1074–1078. doi: 10.1111/aas.13380. Full text in Research Archive Show summary

  Background Life saving measures is the main focus in the initial treatment of major trauma. In surviving patients, chronic pain may be a serious problem, but the long term incidence and potential risk factors are not very well studied. Methods All adult trauma patients included in the institutional trauma registry in 2007 were assessed for eligibility. Among exclusion criteria were: Injury Severity Score < 9, endotracheal intubation before or during admission, spinal cord lesion, known chronic drug or substance abuse, major surgery within 3 h after admission. A patient questionnaire was sent out 6 y after injury focusing on frequency and intensity of pain. A subgroup analysis was done in patients with thoracic injuries, comparing patients with epidural analgesia (EDA) and patients without. Results Sixty‐eight patients were included in the study. Sixty‐nine percent reported pain 6 y after injury and 24% had severe pain. The severity of the injury was a risk factor for development of chronic pain, whereas pain during initial hospital stay was not. In patients with thoracic injuries there was no correlation between initial treatment with EDA and decreased incidence of chronic pain, however patient numbers were small. Opioids were the main analgesics used initially; no patients received non‐steroidal anti‐inflammatory drugs or peripheral nerve blocks during the first 24 h. Conclusion Two thirds of the trauma patients had chronic pain 6 y after injury and one out of four had severe pain. The initial pain treatment was focused on opioids.

• Thomas, Hannah S.; Weiser, Thomas G.; Drake, Thomas M.; Knight, Stephen R.; Fairfield, Cameron & Ademuyiwa, Adesoji O. [Show all 50 contributors for this article] (2019). Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy. British Journal of Surgery. ISSN 0007-1323. 106(2), p. 103–112. doi: 10.1002/bjs.11051. Full text in Research Archive Show summary

  Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P < 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P < 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high‐HDI countries (risk difference −9·4 (95 per cent c.i. −11·9 to −6·9) per cent; P < 0·001), but the relationship was reversed in low‐HDI countries (+12·1 (+7·0 to +17·3) per cent; P < 0·001). In multivariable models, checklist use was associated with a lower 30‐day perioperative mortality (OR 0·60, 0·50 to 0·73; P < 0·001). The greatest absolute benefit was seen for emergency surgery in low‐ and middle‐HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low‐HDI countries was half that in high‐HDI countries.

• Glasbey, James C.; Adisa, Adewale O.; Costas-Chavarri, Ainhoa; Qureshi, Ahmad U.; Allen-Ingabire, Jean C. & Salem, Hosni Khairy [Show all 50 contributors for this article] (2019). Global variation in anastomosis and end colostomy formation following left-sided colorectal resection. BJS Open. 3, p. 403–414. doi: 10.1002/bjs5.50138. Full text in Research Archive Show summary

  Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.

• Juffermans, Nicole P.; Wirtz, Mathijs R; Balvers, Kirsten; Baksaas-Aasen, Kjersti; Dieren, Susan van & Gaarder, Christine [Show all 13 contributors for this article] (2019). Towards patient-specific management of trauma hemorrhage: the effect of resuscitation therapy on parameters of thromboelastometry. Journal of Thrombosis and Haemostasis. ISSN 1538-7933. 17(3), p. 441–448. doi: 10.1111/jth.14378. Full text in Research Archive
• Ringen, Amund Hovengen; Gaski, Iver Anders; RUSTAD, HEGE; Skaga, Nils Oddvar; Gaarder, Christine & Næss, Pål Aksel (2019). Improvement in geriatric trauma outcomes in an evolving trauma system. Trauma Surgery and Acute Care Open (TSACO). 4(1), p. 1–5. doi: 10.1136/tsaco-2018-000282. Full text in Research Archive Show summary

  The elderly trauma patient has increased mortality compared with younger patients. During the last 15 years, initial treatment of severely injured patients at Oslo University Hospital Ulleval (OUHU) has changed resulting in overall improved outcomes. Whether this holds true for the elderly trauma population needs exploration and was the aim of the present study.We performed a retrospective study of 2628 trauma patients 61 years or older admitted to OUHU during the 12-year period, 2002–2013. The population was stratified based on age (61–70 years, 71–80 years, 81 years and older) and divided into time periods: 2002–2009 (P1) and 2010–2013 (P2). Multiple logistic regression models were constructed to identify clinically relevant core variables correlated with mortality and trauma team activation rate.Crude mortality decreased from 19% in P1 to 13% in P2 (p&lt;0.01) with an OR of 0.77 (95 %CI 0.65 to 0.91) when admitted in P2. Trauma team activation rates increased from 53% in P1 to 72% in P2 (p&lt;0.01) with an OR of 2.16 (95% CI 1.93 to 2.41) for being met by a trauma team in P2. Mortality increased from 10% in the age group 61–70 years to 26% in the group above 80 years. Trauma team activation rates decreased from 71% in the age group 61–70 years to 50% in the age group older than 80 years. Median ISS were 17 in all three age groups and in both time periods.Development of a multidisciplinary dedicated trauma service is associated with increased trauma team activation rate as well as survival in geriatric trauma patients. As expected, mortality increased with age, although inversely related to the likelihood of being met by a trauma team. Trauma team activation should be considered for all trauma patients older than 70 years.Level of evidenceLevel IV.

• Baksaas-Aasen, Kjersti; Dieren, Susan van; Balvers, Kirsten; Juffermans, Nicole P.; Næss, Pål Aksel & Rourke, Claire [Show all 15 contributors for this article] (2018). Data-driven development of ROTEM and TEG algorithms for the management of trauma hemorrhage: A prospective observational multicenter study. Annals of Surgery. ISSN 0003-4932. 270(6), p. 1178–1185. doi: 10.1097/SLA.0000000000002825. Full text in Research Archive
• Laursen, Thomas H.; Meyer, Martin A.S.; Meyer, Anna Sina P.; Gaarder, Christine; Næss, Pål Aksel & Stensballe, Jakob [Show all 8 contributors for this article] (2018). Thromboelastography early amplitudes in bleeding and coagulopathic trauma patients: Results froom a multicenter study. Journal of Trauma and Acute Care Surgery. ISSN 2163-0755. 84(2), p. 334–341. doi: 10.1097/TA.0000000000001735. Full text in Research Archive
• Mørk, Kaja; Skari, Hans; Schistad, Ole & Næss, Pål Aksel (2018). Kirurgisk behandling av pylorusstenose. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(7), p. 642–647. doi: 10.4045/tidsskr.17.0619. Full text in Research Archive
• Gaski, Iver Anders; Skattum, Jorunn Pettersen; Brooks, Adam; Koyama, Tomohide; Eken, Torsten & Næss, Pål Aksel [Show all 7 contributors for this article] (2018). Decreased mortality, laparotomy, and embolization rates for liver injuries during a 13-year period in a majosr Scandinavian trauma center. Trauma Surgery and Acute Care Open (TSACO). 3. doi: 10.1136/tsaco-2018-000205. Full text in Research Archive
• Gaarder, Christine; Gaski, Iver Anders & Næss, Pål Aksel (2017). Spleen and liver injuries: When to operate? Current Opinion in Critical Care. ISSN 1070-5295. 23(6), p. 520–526. doi: 10.1097/MCC.0000000000000458. Full text in Research Archive
• Dehli, Trond; Skattum, Jorunn Pettersen; Christensen, Bjørn Jostein; Vinjevoll, Ole-Petter; Rolandsen, Bent-Åge & Gaarder, Christine [Show all 8 contributors for this article] (2017). Treatment of splenic trauma in Norway: A retrospective cohort study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 25(112). doi: 10.1186/s13049-017-0457-y. Full text in Research Archive Show summary

  Background: Non-operative management of splenic injuries has become the treatment of choice in hemodynamically stable patients over the last decades. The aim of the study is to describe the incidence, initial treatment and early outcome of patients with splenic injuries on a national level.<br> Methods: All hospitals in Norway admitting trauma patients were invited to participate in the study. The study period was January through December 2013. The hospitals delivered anonymous data on primarily admitted patients with splenic injury.<br> Results: Three of the four regional trauma centers and 26 of the remaining 33 acute care hospitals delivered data on a total of 151 patients with splenic injury indicating an incidence of 4 splenic injuries per 100,000 inhabitants/year, and a median of 4 splenic injuries per hospital per year. A total of 128 (85%) patients were successfully treated non-operatively including 20 patients who underwent an angiographic procedure. The remaining 23 (15%) patients underwent open splenectomy or spleen-preserving surgery.<br> Conclusion: Most patients with splenic injuries are managed non-operatively. Despite the low number of splenic injuries per hospital, the results indicate satisfactory outcome on a national level.

• Breen, Jan Mario; Næss, Pål Aksel; Gjerde, Hallvard; Gaarder, Christine & Stray-Pedersen, Arne (2017). The significance of preexisting medical conditions, alcohol/drug use and suicidal behavior for drivers in fatal motor vehicle crashes: a retrospective autopsy study. Forensic Science, Medicine, and Pathology. ISSN 1547-769X. 14(1), p. 4–17. doi: 10.1007/s12024-017-9934-x. Full text in Research Archive
• Baksaas-Aasen, Kjersti; Gall, Lewis; Eaglestone, Simon; Rourke, Claire; Juffermans, Nicole P. & Goslings, J. Carel [Show all 15 contributors for this article] (2017). iTACTIC - implementing Treatment Algorithms for the Correction of Trauma-Induced Coagulopathy: Study protocol for a multicentre, randomised controlled trial. Trials. 18:486, p. 1–13. doi: 10.1186/s13063-017-2224-9. Full text in Research Archive
• Koyama, Tomohide; Skattum, Jorunn Pettersen; Engelsen, Peder Christian Grendstad; Eken, Torsten; Gaarder, Christine & Næss, Pål Aksel (2016). Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 24:139, p. 1–5. doi: 10.1186/s13049-016-0329-x. Full text in Research Archive Show summary

  Background Although nonoperative management (NOM) has become standard care, optimal treatment of liver injuries in children is still challenging since many of these patients have multiple injuries. Moreover, the role of angiography remains poorly defined, and a high index of suspicion of complications is warranted. This study reviews treatment and outcomes in children with liver injuries at a major Scandinavian trauma centre over a 12-year period. Methods Patients <17 years old with liver injury admitted to Oslo University Hospital Ullevaal during the period 2002-2013 were retrospectively reviewed. Data were compiled from the institutional trauma registry and medical records. Results A total of 66 children were included. The majority was severely injured as reflected by a median injury severity score of 20.5 (mean 22.2). NOM was attempted in 60 (90.9%) patients and was successful in 57, resulting in a NOM success rate of 95.0% [95% CI 89.3 to 100]. Only one of the three NOM failures was liver related, occurred in the early part of the study period, and consisted in operative placement of drains for bile leak. Two (3.0%) patients underwent angiographic embolization (AE). Complications occurred in 18 (27.3% [95 % CI 16.2 to 38.3]) patients. Only 2 (3.0%) patients had liver related complications, in both cases bile leak. Six (9.1%) patients underwent therapeutic laparotomy for non-liver related injuries. Two (3.0%) patients died secondary to traumatic brain injury. Discussion This single institution paediatric liver injury cohort confirms high attempted NOM and NOM success rates even in patients with high grade injuries and multiple accompanying injuries. AE can be a useful NOM adjunct in the treatment of paediatric liver injuries, but is seldom indicated. Moreover, bile leak is the most common liver-related complication and the need for liver-related surgery is very infrequent. Conclusion NOM is the treatment of choice in almost all liver injuries in children, with operative management and interventional radiology very infrequently indicated.

• Young, Victoria Solveig; Eggesbø, Heidi Beate; Gaarder, Christine; Næss, Pål Aksel & Enden, Tone Rønnaug (2016). Radiology response in the emergency department during a mass casualty incident: a retrospective study of the two terrorist attacks on 22 July 2011 in Norway. European Journal of Radiology. ISSN 0720-048X. 27(7), p. 2828–2834. doi: 10.1007/s00330-016-4677-8. Full text in Research Archive Show summary

  Objectives: To describe the use of radiology in the emergency department (ED) in a trauma centre during a mass casualty incident, using a minimum acceptable care (MAC) strategy in which CT was restricted to potentially severe head injuries. Methods: We retrospectively studied the initial use of imaging on patients triaged to the trauma centre following the twin terrorist attacks in Norway on 22 July 2011. Results: Nine patients from the explosion and 15 from the shooting were included. Fourteen patients had an Injury Severity Score >15. During the first 15 h, 22/24 patients underwent imaging in the ED. All 15 gunshot patients had plain films taken in the ED, compared to three from the explosion. A CT was performed in 18/24 patients; ten of these were completed in the ED and included five non-head CTs, the latter representing deviations from the MAC strategy. No CT referrals were delayed or declined. Mobilisation of radiology personnel resulted in a tripling of the staff. Conclusions: Plain film and CT capacity was never exceeded despite deviations from the MAC strategy. An updated disaster management plan will require the radiologist to cancel non-head CTs performed in the ED until no additional MCI patients are expected.

• Næss, Pål Aksel; Engeseth, Kristian; Grøtta, Ole Jørgen; Andersen, Geir Øystein & Gaarder, Christine (2016). Minimal invasive treatment of life-treathening bleeding caused by cardiopulmonary resuscitation-associated liver injury: a case report. Journal of Medical Case Reports. 10:132, p. 1–4. doi: 10.1186/s13256-016-0926-3. Full text in Research Archive Show summary

  BACKGROUND: Life-threatening bleeding caused by liver injury due to chest compressions is a rare complication in otherwise successful cardiopulmonary resuscitation. Surgical intervention has been suggested to achieve bleeding control; however, reported mortality is high. In this report, we present a brief literature review and a case report in which use of a less invasive strategy was followed by an uneventful recovery. CASE PRESENTATION: A 37-year-old white woman was admitted after out-of-hospital cardiac arrest. Bystander cardiopulmonary resuscitation was immediately performed, followed by advanced cardiopulmonary resuscitation that included tracheal intubation, mechanical chest compressions, and external defibrillation with return of spontaneous circulation. Upon hospital admission, the patient's blood pressure was 94/45 mmHg and her heart rate was 110 beats per minute. Her electrocardiogram showed no signs of ST-segment elevations or Q-wave development. Coronary angiography revealed a proximal thrombotic occlusion of the left anterior descending coronary artery. Successful recanalization, after thrombus aspiration and balloon dilation followed by stent implant, was verified with normalized anterograde flow. Immediately after the patient's arrival in the intensive cardiac care unit, a drop in her blood pressure to 60/30 mmHg and a hemoglobin concentration of 4.5 g/dl were noticed. Transfusion was started, and bedside abdominal ultrasound examination revealed free intraperitoneal fluid. Computed tomography of the abdomen revealed liver injury with active extravasation from the cranial surface of the right lobe and a massive hemoperitoneum. The patient was coagulopathic and acidotic with a body temperature of 33.5 °C. A minimally invasive treatment strategy, including angiography and selective trans-catheter arterial embolization, were performed in combination with percutaneous evacuation of 4.5 L of intraperitoneal blood. After completion of these procedures, the patient was hemodynamically stable. She was weaned off mechanical ventilation 2 days later and made an uneventful recovery. She was discharged to a local hospital on day 13 without neurological disability. CONCLUSIONS: Although rare, bleeding caused by liver injury due to chest compressions can be life-threatening after successful cardiopulmonary resuscitation. Reported mortality is high after surgical intervention, and patients may benefit from less invasive treatment strategies such as those presented in this case report.

• Gaski, Iver Anders; Barckman, Jeppe; Næss, Pål Aksel; Skaga, Nils Oddvar; Madsen, Jan Erik & Kløw, Nils-Einar [Show all 8 contributors for this article] (2016). Reduced need for extraperitoneal pelvic packing for severe pelvic fractures is associated with improved resuscitation strategies. Journal of Trauma and Acute Care Surgery. ISSN 2163-0755. 81(4), p. 644–651. doi: 10.1097/TA.0000000000001139. Full text in Research Archive
• Majak, Piotr & Næss, Pål Aksel (2016). Rib fractures in trauma patients: does operative fixation improve outcome? Current Opinion in Critical Care. ISSN 1070-5295. 22(6), p. 572–577. doi: 10.1097/MCC.0000000000000364. Full text in Research Archive
• Jørgensen, Jørgen Joakim; Næss, Pål Aksel & Gaarder, Christine (2016). Injuries caused by fragmenting rifle ammunition. Injury. ISSN 0020-1383. 47(9), p. 1951–1954. doi: 10.1016/j.injury.2016.03.023. Full text in Research Archive
• Koyama, Tomohide; Hamada, Hirohisa; Nishida, Masamichi; Næss, Pål Aksel; Gaarder, Christine & sakamoto, t (2016). Defining the optimal cut-off values for liver enzymes in diagnosing blunt liver injury. BMC Research Notes. 9(1). doi: 10.1186/s13104-016-1863-3. Full text in Research Archive
• Næss, Pål Aksel; Wiborg, Joachim; Kjellevold, Kristin & Gaarder, Christine (2015). Tension gastrothorax: Acute life-threatening manifestation of late onset congenital diaphragmatic hernia (CDH) in children. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 23(1). doi: 10.1186/s13049-015-0129-8. Full text in Research Archive
• Gaarder, Christine; Holtan, Anders & Næss, Pål Aksel (2015). Prehospital point-of-care monitoring and goal-directed therapy: Does it make a difference? Journal of Trauma and Acute Care Surgery. ISSN 2163-0755. 78(6), p. 60–64. doi: 10.1097/TA.0000000000000635. Full text in Research Archive
• Hagemo, Jostein Skjalg; Christiaans, Sarah C.; Stanworth, Simon J.; Brohi, Karim H.; Johansson, Pär I. & Goslings, J. Carel [Show all 8 contributors for this article] (2015). Detection of acute traumatic coagulopathy and massive transfusion requirements by means of rotational thromboelastometry: An international prospective validation study. Critical Care. ISSN 1364-8535. 19(97). doi: 10.1186/s13054-015-0823-y. Full text in Research Archive
• Skattum, Jorunn Pettersen; Løkke, Ruth J.; Titze, Thomas Larsen; Bechensteen, Anne Grete; Aaberge, Ingeborg Sundsvalen & Osnes, Liv T. N. [Show all 9 contributors for this article] (2014). Preserved function after angioembolisation of splenic injury in children and adolescents: A case control study. Injury. ISSN 0020-1383. 45(1), p. 156–159. doi: 10.1016/j.injury.2012.10.036. Full text in Research Archive
• Skjerven-Martinsen, Marianne; Næss, Pål Aksel; Hansen, Trond Boye; Gaarder, Christine; Lereim, Inggard & Stray-Pedersen, Arne (2014). A prospective study of children aged <16 years in motor vehicle collisions in Norway: Severe injuries are observed predominantly in older children and are associated with restraint misuse. Accident Analysis and Prevention. ISSN 0001-4575. 73, p. 151–162. doi: 10.1016/j.aap.2014.09.004. Full text in Research Archive
• Hagemo, Jostein Skjalg; Stanworth, Simon; Juffermans, Nicole P.; Brohi, Karim; Cohen, Mitchell Jay & Johansson, Pär I. [Show all 10 contributors for this article] (2014). Prevalence, predictors and outcome of hypofibrinogenaemia in trauma: A multicentre observational study. Critical Care. ISSN 1364-8535. 18(2). doi: 10.1186/cc13798. Full text in Research Archive Show summary

  Introduction Exsanguination due to trauma-induced coagulopathy is a continuing challenge in emergency trauma care. Fibrinogen is a crucial factor for haemostatic competence, and may be the factor that reaches critically low levels first. Early fibrinogen substitution is advocated by a number of authors. Little evidence exists regarding the indications for fibrinogen supplementation in the acute phase. This study aims to estimate the prevalence of hypofibrinogenaemia in a multi-center trauma population, and to explore how initial fibrinogen concentration relates to outcome. Also, factors contributing to low fibrinogen levels are identified. Methods Patients arriving in hospital less than 180 minutes post-injury requiring full trauma team activation in four different centers were included in the study. Time from injury, patient demographics, injury severity scores (ISS) and 28 days outcome status were recorded. Initial blood samples for coagulation and blood gas were analyzed. Generalized additive regression, piecewise linear regression, and multiple linear regression models were used for data analyses. Results Out of 1,133 patients we identified a fibrinogen concentration ≤1.5g/L in 8.2%, and <2 g/L in 19.2%. A non-linear relationship between fibrinogen concentration and mortality was detected in the generalized additive and piecewise linear regression models. In the piecewise linear regression model we identified a breakpoint for optimal fibrinogen concentration at 2.29 g/L (95% confidence interval (CI): 1.93 to 2.64). Below this value the odds of death by 28 days was reduced by a factor of 0.08 (95% CI: 0.03 to 0.20) for every unit increase in fibrinogen concentration. Low age, male gender, lengthened time from injury, low base excess and high ISS were unique contributors to low fibrinogen concentrations on arrival. Conclusions Hypofibrinogenaemia is common in trauma and strongly associated with poor outcome. Below an estimated critical fibrinogen concentration value of 2.29 g/L a dramatic increase in mortality was detected. This finding indicates that the negative impact of low fibrinogen concentrations may have been previously underestimated. A number of clinically identifiable factors are associated with hypofibrinogenaemia. They should be considered in the management of massively bleeding patients. Interventional trials with fibrinogen substitution in high-risk patients need to be undertaken.

• Groven, Sigrid; Gaarder, Christine; Eken, Torsten; Skaga, Nils Oddvar & Næss, Pål Aksel (2014). Abdominal injuries in a major Scandinavian trauma center - performance assessment over an 8 year period. Journal of Trauma Management & Outcomes. 8(1). doi: 10.1186/1752-2897-8-9. Full text in Research Archive
• Skattum, Jorunn Pettersen; Gaarder, Christine & Næss, Pål Aksel (2014). Splenic artery embolisation in children and adolescents-An 8 year experience. Injury. ISSN 0020-1383. 45(1), p. 160–163. doi: 10.1016/j.injury.2012.10.015. Full text in Research Archive
• Mansoor, Saira Mauland; Tunold, Jon-Anders; Næss, Pål Aksel; TRONDSEN, ERIK; Gaarder, Christine & Skattum, Jorunn Pettersen (2014). Kurs i basale kirurgiske ferdigheter. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(9), p. 935–934. doi: 10.4045/tidsskr.13.0737. Full text in Research Archive Show summary

  BAKGRUNN På Basic Surgical Skills (BSS)-kurset gjennomgås grunnleggende kirurgiske teknikker. Kurset ble første gang avholdt i Norge i 2009. Denne studien ble gjennomført for å evaluere læringsutbyttet av kurset. MATERIALE OG METODE Deltakere fra fire påfølgende kurs ble forespurt om å delta i studien og ble testet i tre praktiske øvelser umiddelbart før og etter kurset. Prestasjonene ble målt ved hjelp av Objective Structured Assessment of Technical Skills (OSATS) på to av øvelsene og tidsbruk på den siste. I tillegg gjennomførte deltakerne to selvevalueringer av de gjennomgåtte øvelsene, én før og én etter kurset. RESULTATER Totalt 57 av 65 kursdeltakere ble inkludert i studien. Median skår ble brukt som mål på læringsutbytte. Deltakernes skår var signifikant høyere for alle de tre praktiske øvelsene etter gjennomført kurs sammenliknet med skår før kursdeltakelse (p < 0,001). Selvevalueringen indikerte at deltakerne følte seg mer kompetente etter gjennomført kurs. FORTOLKNING Studien indikerer at BSS-kurset gir bedre basale kirurgiske ferdigheter. I mangel av tilsvarende kurs i grunnutdanningen bør det vurderes innført som obligatorisk i den kirurgiske utdanningen i Norge.

• Skattum, Jorunn Pettersen; Næss, Pål Aksel; Eken, Torsten & Gaarder, Christine (2013). Refining the role of splenic angiographic embolization in high-grade splenic injuries. Journal of Trauma and Acute Care Surgery. ISSN 2163-0755. 74(1), p. 100–103. doi: 10.1097/TA.0b013e31827890b2. Full text in Research Archive
• Groven, Sigrid; Næss, Pål Aksel; Skaga, Nils Oddvar & Gaarder, Christine (2013). Effects of moving emergency trauma laparotomies from the ED to a dedicated OR. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 21:72. doi: 10.1186/1757-7241-21-72. Full text in Research Archive
• Hagemo, Jostein Skjalg; Næss, Pål Aksel; Johansson, Pär I.; Windeløv, NA; Cohen, MJ & Røislien, Jo [Show all 10 contributors for this article] (2013). Evaluation of TEG (R) and RoTEM (R) inter-changeability in trauma patients. Injury. ISSN 0020-1383. 44(5), p. 600–605. doi: 10.1016/j.injury.2012.11.016. Full text in Research Archive
• Brockamp, Thomas; Maegele, Marc; Gaarder, Christine; Goslings, J Carel; Cohen, Mitchell J & Lefering, Rolf [Show all 15 contributors for this article] (2013). Comparison of the predictive performance of the BIG, TRISS, and PS09 score in an adult trauma population derived from multiple international trauma registries. Critical Care. ISSN 1364-8535. 17(4). doi: 10.1186/cc12813. Full text in Research Archive
• Martinsen, Marianne Skjerven; Næss, Pål Aksel; Hansen, Trond Boye; Staff, Trine & Stray-Pedersen, Arne (2013). Observational study of child restraining practice on Norwegian high-speed roads: Restraint misuse poses a major threat to child passenger safety. Accident Analysis and Prevention. ISSN 0001-4575. 59, p. 479–486. doi: 10.1016/j.aap.2013.07.023. Full text in Research Archive
• Hagemo, Jostein Skjalg; Jørgensen, Jørgen Joakim; Ostrowski, Sisse R.; Holtan, Anders; Gundersen, Yngvar & Johansson, Pär I. [Show all 8 contributors for this article] (2013). Changes in fibrinogen availability and utilization in an animal model of traumatic coagulopathy. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. doi: 10.1186/1757-7241-21-56. Full text in Research Archive Show summary

  Background Impaired haemostasis following shock and tissue trauma is frequently detected in the trauma setting. These changes occur early, and are associated with increased mortality. The mechanism behind trauma-induced coagulopathy (TIC) is not clear. Several studies highlight the crucial role of fibrinogen in posttraumatic haemorrhage. This study explores the coagulation changes in a swine model of early TIC, with emphasis on fibrinogen levels and utilization of fibrinogen.Methods A total of 18 landrace pigs were anaesthetized and divided into four groups. The Trauma-Shock group (TS) were inflicted bilateral blast femoral fractures with concomitant soft tissue injury by a high-energy rifle shot to both hind legs, followed by controlled exsanguination. The Shock group (S) was exposed to shock by exsanguination, whereas a third group was exposed to trauma only (T). A fourth group (C) served as control. Physiological data, haematological measurements, blood gas analyses and conventional coagulation assays were recorded at baseline and repeatedly over 60 minutes. Thrombelastometry were performed by means of the tissue factor activated ExTEM assay and the platelet inhibiting FibTEM assay. Data were statistically analysed by repeated measurements analyses method.Results A significant reduction of fibrinogen concentration was observed in both the TS and S groups. INR increased significantly in the S group and differed significantly from the TS group. Maximum clot firmness (MCF) of the ExTEM assay was significantly reduced over time in both TS and S groups. In the FibTEM assay a significant shortening of the clotting time and an increase in MCF was observed in the TS group compared to the S group.Conclusion Despite a reduction in clotting capability measured by ExTEM MCF and a reduced fibrinogen concentration, extensive tissue trauma may induce an increased fibrin based clotting activity that attenuates the hypocoagulable tendency in exsanguinated animals.

• Skattum, Jorunn Pettersen; Næss, Pål Aksel & Gaarder, Christine (2012). Non-operative management and immune function after splenic injury. British Journal of Surgery. ISSN 0007-1323. 99, p. 59–65. doi: 10.1002/bjs.7764. Full text in Research Archive
• Kristiansen, Thomas; Ringdal, Kjetil G.; Skotheimsvik, Tarjei; Salthammer, Halvor Kjørholt; Gaarder, Christine & Næss, Pål Aksel [Show all 7 contributors for this article] (2012). Implementation of recommended trauma system criteria in south-eastern Norway: a cross-sectional hospital survey. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 20. doi: 10.1186/1757-7241-20-5. Full text in Research Archive Show summary

  Background: Formalized trauma systems have shown beneficial effects on patient survival and have harvested great recognition among health care professionals. In spite of this, the implementation of trauma systems is challenging and often met with resistance. Recommendations for a national trauma system in Norway were published in 2007. We wanted to assess the level of implementation of these recommendations. Methods: A survey of all acute care hospitals that receive severely injured patients in the south-eastern health region of Norway was conducted. A structured questionnaire based on the 2007 national recommendations was used in a telephone interview of hospital trauma personnel between January 17 and 21, 2011. Seventeen trauma system criteria were identified from the recommendations. Results: Nineteen hospitals were included in the study and these received more than 2000 trauma patients annually via their trauma teams. Out of the 17 criteria that had been identified, the hospitals fulfilled a median of 12 criteria. Neither the size of the hospitals nor the distance between the hospitals and the regional trauma centre affected the level of trauma resources available. The hospitals scored lowest on the criteria for transfer of patients to higher level of care and on the training requirements for members of the trauma teams. Conclusion: Our study identifies a major shortcoming in the efforts of regionalizing trauma in our region. The findings indicate that training of personnel and protocols for inter-hospital transfer are the major deficiencies from the national trauma system recommendations. Resources for training of personnel partaking in trauma teams and development of inter-hospital transfer agreements should receive immediate attention.

• Skattum, Jorunn Pettersen; Titze, Thomas Larsen; Dormagen, Johann Baptist; Aaberge, Ingeborg Sundsvalen; Bechensteen, Anne Grete & Gaarder, Per Ivar Brachel [Show all 9 contributors for this article] (2012). Preserved splenic function after angioembolisation of high grade injury. Injury. ISSN 0020-1383. 43(1), p. 62–66. doi: 10.1016/j.injury.2010.06.028. Full text in Research Archive
• Kristiansen, Thomas; Søreide, Kjetil; Ringdal, Kjetil G.; Rehn, Marius; Krüger, Andreas J. & Reite, Andreas [Show all 9 contributors for this article] (2012). Trauma systems and early management of severe injuries in Scandinavia: review and current status. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 04(17). doi: 10.1186/1757-7241-17-S3-O29. Full text in Research Archive
• Gaarder, Christine; Jørgensen, Jørgen Joakim; Kolstadbråten, Knut Magne; Isaksen, Knut Steinar; Skattum, Jorunn Pettersen & Rimstad, Rune [Show all 11 contributors for this article] (2012). The twin terrorist attacks in Norway on July 22, 2011: The trauma center response. Journal of Trauma and Acute Care Surgery. ISSN 2163-0755. 73(1), p. 269–275. doi: 10.1097/TA.0b013e31825a787f. Full text in Research Archive
• Groven, Sigrid; Eken, Torsten; Skaga, Nils Oddvar; Røise, Olav; Næss, Pål Aksel & Gaarder, Christine (2011). Long-Lasting Performance Improvement After Formalization of a Dedicated Trauma Service. Journal of Trauma. ISSN 0022-5282. 70(3), p. 569–574. doi: 10.1097/TA.0b013e31820d1a9b. Full text in Research Archive
• Dormagen, Johann Baptist; MEYERDIERKS, OLIVER; Gaarder, Christine; Næss, Pål Aksel; Sandvik, Leiv & Klow, Nils-Einar (2011). Contrast-Enhanced Ultrasound of the Injured Spleen After Embolization - Comparison with Computed Tomography. Ultraschall in der Medizin. ISSN 0172-4614. 32(5), p. 485–491. doi: 10.1055/s-0029-1246003. Full text in Research Archive Show summary

  Purpose: The aim of this study was to compare the diagnostic performance of contrast-enhanced ultrasound (CEUS) to computed tomography (CT) in trauma patients after splenic embolization. Materials and Methods: 22 patients (17 male and 5 female) with a mean age of 32 (15 - 57 years) were studied with ultrasound (US), CEUS and CT in 23 early follow-up examinations 5 days (range: 0-12 days) after intervention and 17 late follow-up examinations 69 days (range: 52 - 189 days) after intervention. Perisplenic fluid, hematoma, laceration, infarction, scars and injury grade were evaluated. US and CEUS readings were performed independently by two radiologist, blinded to the CT results. Results: The sensitivity and specificity for CEUS at early follow-up were 85% and 70% for perisplenic fluid, 80% and 94% for subcapsular hematomas, 83% and 73% or lacerations and 75% and 87% for infarctions, respectively. The sensitivity and specificity at late follow-up were 60% and 100% for subcapsular hematomas, 91% and 67% for intrasplenic hematomas, 100% and 93% for lacerations and 89% and 100% for scars, respectively. The overall sensitivity and specificity for all lesions were 87% and 88% at early follow-up (n=138) and 85% and 95% at late follow-up (n=102), respectively. Compared to CT, CEUS underestimated the injury grade in 2/40 cases and overestimated the injury grade in 3/40 cases. Conclusion: CEUS is a useful tool for the detection of post-traumatic lesions. It is comparable to CT in follow-up after splenic embolization and may replace CT in follow-up studies.

• Groven, Sigrid; Næss, Pål Aksel; TRONDSEN, ERIK & Gaarder, Christine (2011). A national survey on temporary and delayed abdominal closure in Norwegian hospitals. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 19. doi: 10.1186/1757-7241-19-51. Full text in Research Archive
• Kristiansen, Thomas; Lossius, Hans Morten; Søreide, Kjetil; Steen, Petter Andreas; Gaarder, Christine & Næss, Pål Aksel (2011). Patients referred to a Norwegian trauma centre: effect of transfer distance on injury patterns, use of resources and outcomes. Journal of Trauma Management & Outcomes. 5(1), p. 9–9. doi: 10.1186/1752-2897-5-9. Full text in Research Archive Show summary

  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. Methods: Patients included in the OUH trauma registry from 2001 to 2008 were included in the study. Demographic, injury, management and outcome data were abstracted. Patients were grouped according to transfer distance: ≤20 km, 21-100 km and > 100 km. Results: Of the 7.353 included patients, 5.803 were admitted directly, and 1.550 were transferred. The number of transfers per year increased, and there was no reduction in injury severity during the study period. Seventy-six per cent of the transferred patients were severely injured. With greater transfer distances, injury severity increased, and there were larger proportions of traffic injuries, polytrauma and hypotensive patients. With shorter distances, patients were older, and head injuries and injuries after falls were more common. The shorter transfers less often activated the trauma team: ≤20 km -34%; 21-100 km -51%; > 100 km -61%, compared to 92% of all directly admitted patients. The mortality for all transferred patients was 11%, but was unequally distributed according to transfer distance. Conclusion: This study shows heterogeneous characteristics and high injury severity among interhospital transfers. The rate of trauma team assessment was low and should be further examined. The mortality differences should be interpreted with caution as patients were in different phases of management. The descriptive characteristics outlined may be employed in the development of triage protocols and transfer guidelines.

• Skjerven-Martinsen, Marianne; Næss, Pål Aksel; Hansen, Trond Boye; Rognum, Torleiv Ole; Lereim, Inggard & Stray-Pedersen, Arne (2011). In-depth evaluation of real-world car collisions: fatal and severe injuries in children are predominantly caused by restraint errors and unstrapped cargo. Traffic Injury Prevention. ISSN 1538-9588. 12(5), p. 491–499. doi: 10.1080/15389588.2011.596868. Full text in Research Archive
• Krogvold, Lars; Henrichsen, Thore Andre; Bjerre, Anna Kristina; Brackman, Damien; Døllner, Henrik & Gudmundsdottir, Helga [Show all 9 contributors for this article] (2011). Clinical aspects of a nationwide epidemic of severe haemolytic uremic syndrome (HUS) in children. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 19. doi: 10.1186/1757-7241-19-44. Full text in Research Archive Show summary

  Background: Report a nationwide epidemic of Shiga toxin-producing E. coli (STEC) O103:H25 causing hemolytic uremic syndrome (D+HUS) in children. Methods: Description of clinical presentation, complications and outcome in a nationwide outbreak. Results: Ten children (median age 4.3 years) developed HUS during the outbreak. One of these was presumed to be a part of the outbreak without microbiological proof. Eight of the patients were oligoanuric and in need of dialysis. Median need for dialysis was 15 days; one girl did not regain renal function and received a kidney transplant. Four patients had seizures and/or reduced consciousness. Cerebral oedema and herniation caused the death of a 4-year-old boy. Two patients developed necrosis of colon with perforation and one of them developed non-autoimmune diabetes. Conclusion: This outbreak of STEC was characterized by a high incidence of HUS among the infected children, and many developed severe renal disease and extrarenal complications. A likely explanation is that the O103:H25 (eae and stx2-positive) strain was highly pathogen, and we suggest that this serotype should be looked for in patients with HUS caused by STEC, especially in severe forms or outbreaks.

• Kristiansen, Thomas; Søreide, Kjetil; Ringdal, Kjetil G.; Rehn, Marius; Krüger, Andreas J. & Reite, Andreas [Show all 9 contributors for this article] (2010). Trauma systems and early management of severe injuries in Scandinavia: Review of the current state. Injury. ISSN 0020-1383. 41(5), p. 444–452. doi: 10.1016/j.injury.2009.05.027. Full text in Research Archive
• Negård, Anne; Løberg, Else Marit; Næss, Pål Aksel; Eriksen, Morten & Klow, Nils-Einar (2010). Feasibility of MRI in experimentally induced inflammatory small bowel disease: a pilot study in a porcine model. Digestive Diseases and Sciences. ISSN 0163-2116. 55(1), p. 14–20. doi: 10.1007/s10620-008-0707-y. Full text in Research Archive
• Negård, Anne; Løberg, Else Marit; Næss, Pål Aksel; Eriksen, Morten & Klow, Nils-Einar (2010). Feasibility of MRI in Experimentally Induced Inflammatory Small Bowel Disease: A Pilot Study in a Porcine Model. Digestive Diseases and Sciences. ISSN 0163-2116. 55(1), p. 14–20. doi: 10.1007/s10620-008-0707-y. Full text in Research Archive
• Gaarder, Christine; Kroepelien, Christian Fredrik; Løkke, Ruth J.; Hestnes, Morten; Dormage, Johnn Baptist & Næss, Pål Aksel (2009). Ultrasound Performed by Radiologists-Confirming the Truth About FAST in Trauma. Journal of Trauma. ISSN 0022-5282. 67(2), p. 323–327. doi: 10.1097/TA.0b013e3181a4cd27. Full text in Research Archive

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• Netteland, Dag Ferner; Næss, Pål Aksel; Gaarder, Aslaug Christine & Helseth, Eirik (2024). Letter to the editor. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 32(1). doi: 10.1186/s13049-024-01199-w. Full text in Research Archive
• Rasmussen, Mari Storli; Andelic, Nada; Selj, Joanna Nordhagen; Danielsen, Vilde Marie; Løvstad, Marianne & Howe, Emilie Isager [Show all 30 contributors for this article] (2024). Self-management support program delivered in the sub-acute phase after traumatic injury-study protocol for a pragmatic randomized controlled trial. Trials. 25(1), p. 639–639. doi: 10.1186/s13063-024-08492-0. Full text in Research Archive Show summary

  Background Traumatic injuries, defined as physical injuries with sudden onset, are a major cause of distress and disability, with far-reaching societal consequences. A significant proportion of trauma survivors report persistent symptoms and difficulties after the injury, and studies show unmet health care needs. Self-management programs delivered in the sub-acute phase after traumatic injuries are scarcely evaluated. The aim of the present study is to evaluate the effectiveness of a self-management program (SEMPO), delivered 3–4 months after moderate-to-severe traumatic injury. Methods This study protocol describes a pragmatic randomized controlled trial (RCT) with two classical RCT arms (intervention and control) and an explorative self-selection arm. 220 patients will be recruited from Oslo University Hospital, the largest Trauma Referral Centre in Norway. Patients aged 18–72 years residing in the south-east region of Norway, admitted to the Trauma Centre directly or within 72 h after having sustained a moderate to severe traumatic injury, defined as a New Injury Severity Score > 9, having at least 2 days hospital stay, and reporting injury-related symptoms and impairment at discharge from the acute hospital will be included. Patients will be randomly assigned to either a classical RCT randomization arm (intervention or control arm) or to a self-selection arm. In the randomization arm, participants are further randomized into intervention or control group. Participants allocated to the self-selection arm will choose to partake either in the intervention or control arm. The primary outcome is the level of self-efficacy in trauma coping assessed 6 months after completion of the intervention, with a similar time point for the control group. Secondary outcomes include symptom burden, physical functioning and disability, return to work and health care utilization, health-related quality of life, and communication competency. In addition, patients will be asked to nominate one domain-related measurement as their preferred outcome measure. Discussion This RCT will determine the effect of a self-management program tailored to patients with moderate to severe physical trauma, and the self-selection arm incorporates the potential influence of patient treatment preferences on intervention results. If the intervention proves effective, cost-effectiveness and cost-utility analyses will be performed and thereby provide important information for clinicians and policy makers. Trial registration The study is registered in Clinical Trials with the identifier: NCT06305819. Registered on March 05, 2004.

• Næss, Pål Aksel & Gaarder, Aslaug Christine (2024). Invited commentary to strengths and opportunities for improvement in surgical education in Ukraine: A qualitative study. World Journal of Surgery. ISSN 0364-2313. doi: 10.1002/wjs.12295. Full text in Research Archive
• Søberg, Helene L.; Moksnes, Håkon Øgreid; Anke, Audny Gabriele Wagner; Røise, Olav; Røe, Cecilie & Aas, Eline [Show all 20 contributors for this article] (2022). Erratum: Rehabilitation Needs, Service Provision, and Costs in the First Year following Traumatic Injuries: Protocol for a Prospective Cohort Study ((JMIR Res Protoc (2021) 10: 4 (e25980) DOI: 10.2196/25980). JMIR Research Protocols. 11(3). doi: 10.2196/37723. Full text in Research Archive
• Næss, Pål Aksel (2021). Verdt å ha med i lommen? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(3), p. 1–2. doi: 10.4045/tidsskr.20.0868. Full text in Research Archive
• Johansson, Pär I.; Eriksen, Christian Fenger; Schmal, Hagen; Gaarder, Christine; Pall, Marlene & Henriksen, Hanne Hee [Show all 12 contributors for this article] (2021). Efficacy and safety of iloprost in trauma patients with haemorrhagic shock-induced endotheliopathy—Protocol for the multicentre randomized, placebo-controlled, blinded, investigator-initiated shine-trauma trial. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 65(4), p. 551–557. doi: 10.1111/aas.13776. Full text in Research Archive
• Gaarder, Aslaug Christine; Næss, Pål Aksel & Mesquita, Carlos (2020). Editorial ECTES Abstracts 2020. European Journal of Trauma and Emergency Surgery. ISSN 1863-9933. 46. doi: 10.1007/s00068-020-01384-3. Full text in Research Archive
• Breen, Jan Mario; Næss, Pål Aksel; Gjerde, Hallvard; Gaarder, Christine & Stray-Pedersen, Arne (2018). Drivers and passengers in fatal motor vehicle collisions: The significance of alcohol/drugs, pre-existing medical conditions and seat belt use. Full text in Research Archive Show summary

  Background: Drivers and passengers represent the largest number of fatalities on the road. To “learn from the dead” aiming to prevent future fatalities, we analyzed the significance of pathology, injuries and toxicological findings in fatal occupants motor vehicle collisions (MVCs). Methods: Forensic autopsy records of MVC occupants in southeast Norway from 2000 through 2014 were studied retrospectively. Data from individual police and collision investigation reports were also collected and analyzed. Results: In total, 406 drivers and 150 passengers had undergone forensic autopsy in the study period, suggesting an autopsy rate of approximately 45%. Eighty-four percent of the drivers were males and 50% had worn seatbelts. Totally 9% of the drivers died from natural causes, 9% were suicides, 65% were culpable accidental deaths, 14% were nonculpable deaths, and 3% were undetermined deaths. Alcohol and/or drugs that indicated impairment at the time of the collision were detected in 50% of culpable drivers aged 35 years and younger. Medical conditions, mostly cardiovascular pathology suggestive of sudden incapacitation prior to the accident were present in 70% of culpable drivers older than 55 years. The 37 natural deaths were all males and died of cardiovascular disease. In 117 passenger fatalities the occupant’s position in the vehicle could be established. Fifty-three percent were males and 62% had used seatbelts. Female passengers used seat belt more frequently than males (p < 0.05). Alcohol above 0.5 g/kg was detected in 30% of front seat passengers of which most were younger than 35 years of age and the fatal accident had occurred during night-time. Multiple injuries involving several body regions and isolated head injuries were the most common causes of death in all occupant groups. With regard to injury patterns no significant differences between drivers, front seat and rear seat passengers were observed. Conclusions: Suicides and natural deaths constitute both significant proportions of MVC fatalities and may be misclassified unless a full inquest including an autopsy is performed. A substantial proportion of young drivers are killed in accidental collisions that may have occurred as a result of either alcohol/drug impairment. Pre-existing medical conditions, most commonly cardiovascular disease, may play a role in fatal crashes involving drivers of older age. The high proportion of alcohol detection and relatively low frequency of belt use among both driver and passenger fatalities highlight the need to continue preventive campaigns and targeted legal action against unsafe driving.

• Glambek, Inge; Wisborg, Torben; Wahba, Alexander; Gaarder, Christine; Haaverstad, Rune & Aamodt, Henrik [Show all 8 contributors for this article] (2017). Re: Prehospital torakotomi ved traumatisk hjertestans. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(3), p. 168–168. doi: 10.4045/tidsskr.17.0053. Full text in Research Archive
• Breen, Jan Mario; Næss, Pål Aksel; Hansen, Trond Boye; Gaarder, Christine & Stray-Pedersen, Arne (2015). A prospective in-depth study of real-world car collisions involving youth and young adults. Full text in Research Archive
• Breen, Jan Mario; Næss, Pål Aksel; Gaarder, Christine & Stray-Pedersen, Arne (2015). Case characteristics and injury mechanisms in motor vehicle accidents in South East Norway from 2000 to 2014: An autopsy study. Journal of local and global health science. ISSN 2306-0441. 2(2). doi: 10.5339/jlghs.2015.itma.12. Full text in Research Archive
• Hagemo, Jostein Skjalg; Gaarder, Christine; Næss, Pål Aksel; Viksmoen, Yvonne & Heier, Hans Erik (2010). COMPARING TEG (R) AND ROTEM (R) AS POINT-OF-CARE DEVICES IN TRAUMA PATIENTS. Vox Sanguinis. ISSN 0042-9007. 99, p. 437–437. Full text in Research Archive
• Kristiansen, Thomas; Rehn, Marius; Braarud, Anne-Cathrine; Holtan, Anders; Skaga, Nls Oddvar & Strand, Terje [Show all 9 contributors for this article] (2010). NYE TRIAGEKRITERIER: OSLO–AKERSHUS TRIAGE STUDIE (OATS). Full text in Research Archive
• Rehn, Marius; Kristiansen, Thomas; Braarud, Anne-Cathrine; Holtan, Anders; Skaga, Nls Oddvar & Strand, Terje [Show all 9 contributors for this article] (2010). Nye triagekriterier: Oslo–Akershus Triage Studie (OATS). Full text in Research Archive
• Skjerven-Martinsen, Marianne; Stray-Pedersen, Arne & Næss, Pål Aksel (2014). Child occupants in motor vehicle collisions. Universitetet i Oslo. ISSN 9788282648523. Full text in Research Archive

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