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D Stålhammar

Publications and source records attributed to D Stålhammar.

At least 19 recordsLinked to original sources
PubMed2003

Epidemiology of traumatic brain injury: a population based study in western Sweden.

BACKGROUND: This study on traumatic brain injury (TBI) is based on prospective and retrospective population based data from a head injury register in Borås. METHODS: Data was collected from the hospital emergency unit, the discharge register, the regional neurosurgical clinic and the coroner's records during 1 year. This district is mixed urban and rural with a population of 138 000. RESULTS: The 753 cases identified represent an incidence of 546 per 100 000 which includes deaths (0.7%), hospital admissions (67%) and attendance at the emergency department in patients not admitted (32%). Males (644 per 100 000), had 1.46 higher overall rate than females (442 per 100 000). The external causes were dominated by fall from same level (31%) and fall from different level (27%) followed by traffic accidents (16%) and persons hit by objects (15%). CONCLUSIONS: The incidence of TBI found in this study is high but well in accordance with earlier published Swedish studies.

Adolescent↗
PubMed2003

Quality of life and post-concussion symptoms in adults after mild traumatic brain injury: a population-based study in western Sweden.

OBJECTIVES: To study quality of life and subjective post-concussion symptoms in adults (16-60 years) with a mild traumatic brain injury (MTBI) 3 months and 1 year after injury. METHODS: Of a total of 489 patients 173 responded to questionnaires at 3 months and at 1 year, including the SF-36 health-related quality of life survey, which is a standardized measure validated for Swedish conditions. Post-concussion symptoms were rated as either existing or non-existing in a 21-item checklist [a modified version of Comprehensive Psychopathological Rating Scale (CPRS)]. RESULTS: SF-36 showed impaired scores in all dimensions. Existing post-concussion symptoms were reported by 1545%. Significantly, more symptoms were present at 3 months than at 3 weeks after injury. Furthermore, a significant correlation between higher rates of post-concussion symptoms and lower SF-36 scores was found. CONCLUSIONS: The SF-36 results were significantly impaired compared with an age- and gender-matched normative control group and the rate of post-concussion symptoms was significantly higher at 3 months than at 3 weeks after injury. As a significant correlation between higher rates of symptoms and low SF-36 scores was also found we assume SF-36 to be a sensitive enough measure of MTBI-related effects.

Adolescent↗
PubMed1990

[A new reaction level scale is recommended in Sweden].

Assessment of the reaction level is the single most important investigation in patients with acute cerebral disorders. The Reaction Level Scale, RLS-85, a recently developed and scientifically based method, is recommended for introduction in Sweden.

Glasgow Coma Scale↗
PubMed1988

The Reaction Level Scale (RLS85). Manual and guidelines.

The Reaction Level Scale (RLS85) is a "coma scale" for the direct assessment of overall reaction level in patients with acute brain disorders. It is devised for reliable use even in the management of patients who are difficult to assess, such as intubated patients and patients with swollen eyelids. We here present the manual of the RLS85 and the guidelines for its use. The underlying concepts as well as limitations are outlined. Condensed information of known reliability and validity is presented. A training scheme for presumed observers (doctors, nurses and assistant nurses) is outlined. It is suggested that users of the RLS85 refer to these guidelines and in scientific reports clearly state any deviations from this present manual in order to facilitate valid comparisons between different studies and different groups of patients.

Acute Disease↗
PubMed1988

Assessment of responsiveness in acute cerebral disorders. A multicentre study on the reaction level scale (RLS 85).

A new scale for assessment of overall responsiveness, the Reaction Level Scale (RLS 85), which has been shown to have better reliability than the Glasgow Coma Scale (GCS), has been tested in four neurosurgical departments regarding inter-observer agreement and coverage i.e. the proportion of patients that could be assessed by the scale. In a carefully designed study 51 observers pairwise performed 164 tests on 88 patients. Reliability was studied by the Kappa method, which is defined as inter-observer agreement corrected for agreement by chance. The inter-observer agreement measured as overall Kappa was good (K = 0.69 +/- 0.05) and there were no significant differences between the departments, professional categories or aetiologies. Regarding the separate RLS 85 levels the Kappa values were above 0.65, except for withdrawing (K = 0.51) and flexor responses (K = 0.55). There was good inter-observer agreement on coma (K = 0.71). In conclusion, the RLS 85 proved to be easily learnt, it showed full coverage without pseudoscoring, and it was used in a consistent way by doctors, nurses and assistant nurses of four different neurosurgical departments in two Scandinavian countries.

Adolescent↗
PubMed1988

Current reporting of responsiveness in acute cerebral disorders. A survey of the neurosurgical literature.

One hundred sixty-six papers published in seven neurosurgical journals from 1983 through 1985 have been surveyed to determine the methods used for assessment of overall patient responsiveness in acute cerebral disorders (coma grading). Fifty-one different coma scales or modifications were found. The Glasgow Coma Scale (GCS) sum score (that is, the sum of the scores of the individual eye, verbal, and motor scales) dominated (54%), and was used in 73 (76%) of 96 of the head-injury studies; in 56 (77%) of these 73 studies it was the single method of grading neurological status. The GCS sum score was used in 16 (23%) of 70 studies in patients with other etiologies. The Hunt and Hess scale was used in 26 (57%) of 46 reports of patients with subarachnoid hemorrhage. In 31 (55%) of the 56 studies of head injuries using the GCS alone, it was not obvious if the 12- or 13-grade scale was used. In 13 studies (23%) no reference to methodological investigations was made. In 44 papers (79%) the handling of untestable features, such as intubation or swollen eyes, was not reported. In the 56 studies using the GCS alone, coma was defined in many different ways and in 22 studies the definition of coma was not specified. In 63% of reports, the GCS sum score scale was combined in one to five groups of scores and this was done in 32 different ways. No information was available to describe the procedure of data aggregation or the reliability of the 13-grade GCS sum score. The lack of standardization makes it unnecessarily difficult to perform valid comparisons between different series of patients. Since the GCS sum score is the most widely used scale, it is suggested that the reporting of the GCS sum score should be standardized regarding pseudoscoring, coma definition, and use of combined scores. Further studies on the reliability of the GCS sum score are needed.

Acute Disease↗
PubMed1988

A comparison of the Glasgow Coma Scale and the Reaction Level Scale (RLS85).

The Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS85) were compared for rating neurosurgical patients in regard to ranking order of deficit severity, interobserver variability, and coverage for relevant factors. Four physicians, four registered nurses, and four assistant nurses performed 72 pairwise ratings on 47 neurosurgical patients. The rank correlation between the GCS sum score and the RLS85 was -0.94, suggesting the same ranking order of severity and indicating that the underlying concepts of somnolence, delirium, and motor responses in coma are evaluated in the same way. By the sign test, the RLS85 was shown to have better interobserver agreement than the GCS sum score and the eye-motor-verbal (EMV) profile. The interobserver grading disagreements in both scales were distributed over the entire range of responsiveness, and for the GCS sum score they were slanted to combined segments 9 to 15. The RLS85 showed full coverage of relevant factors, while 43 (60%) of the 72 test occasions in the GCS sum score and the EMV profiles showed untestable features, most often because of patient intubation. The pseudoscore (that is, the choice of value given to untestable features) affects interobserver agreement as well as the estimated overall patient responsiveness in the GCS sum score. Assessment by the order of applying the scales showed a significant effect on the GCS eye-opening scale (p = 0.01) and the GCS sum score (p = 0.03), indicating a sensitivity to environmental stimuli unrelated to the patient's status. This study demonstrates that basically the same information as that found in the separate eye, motor, and verbal scales of the GCS can be combined directly into the RLS85, which has better interobserver agreement and better coverage than the GCS sum score.

Coma↗
PubMed1986

Experimental models of head injury.

Experimental research in studies of head injury may be directed along theoretical, mechanical and experimental animal and clinical lines. The parameter of the results compared may thus be the mechanics of skull or the skull contents, pathophysiological changes or pathomorphological lesions. Due to the variation of the daily accidents and resulting injuries each series of problems must be studied with suitable technique. Often the various types of studies determine the possibility of interpreting the results for clinical analysis and prevention. However, this is often possible if all experimental conditions and parameters studied are precisely defined. Movements, deformations of skull and the intracranial contents, results from rotational and angular acceleration and velocities as well as the direction and the site of impact in the human being must always be considered.

Animals↗
PubMed1986

Resources, distribution and management levels of head injury patients; place of CT-scanning.

The task for the medical profession is to diagnose, to treat, to evaluate results of the management and to deliver information about the management to those who are responsible for the regional planning of head injury care and preventive work. The impact of CT scanning on diagnoses and distribution on different levels of managements is discussed. These considerations are related to the degree of severity of the patient's symptoms early after the accident. The strategy of priority with more restrained economical resources will make the above mentioned considerations even more important.

Costs and Cost Analysis↗
PubMed1986

Assessment of responsiveness in head injury patients. The Glasgow Coma Scale and some comments on alternative methods.

The last twelve years history of coma scaling, i.e. reaction level scaling is reviewed. Examples are given of different Glasgow Coma Scale sum scores. The common use of these "sum scores", aggregations of various features, may give an impression of corresponding conscious levels with different functions tested. A more direct approach with mention of varied responses in a reaction level scale may be more reliable and this is also possible to use in a neurological observation chart at bedside.

Coma↗
PubMed1975

Experimental brain damage from fluid pressures due to impact acceleration. 1. Design of experimental procedure.

The significance of the intracranial acceleration pressure pattern at impact to the intact skull in production of brain damage is discussed particularly as regards the contre-coup pressures. Sudden pressure changes within the cranial cavity of the rabbit were studied by means of a new impact acceleration model. The rabbit skull was connected with a cylinder. Impact acceleration was applied to the model with the skull contents serving as a "contre-coup end". Skull deformation was minimized by reinforcement of the skull vault. Acceleration, velocity and displacement of the system were recorded at various sites and could be predicted within wide ranges. Simultaneous recordings were also made of the pressure changes in the skull cavity and cylinder contents. By adjusting the acceleration course and by introducing a quantified air bubble 050, 100, 150 mm3) at the impact of the cylinder, it was possible to produce and vary an intracranial pressure pattern of "contre-coup type", including predictable subatmospheric transients. The mechanics of the intracranial pressure changes and displacements are discussed. The method seems to be suitable for studying the relations between brief negative-positive pressure variations (about 5 ms) of "contre-coup type" and pathological alterations similar to those reported in other head injury models and in human head trauma.

Acceleration↗
PubMed1975

Experimental brain damage from fluid pressures due to impact acceleration. 2. Pathophysiological observations.

The significance of the intracranial acceleration pressure pattern at impact to the intact skull in production of brain damage is discussed, particularly as regards the contre-coup pressures. A rigid fluid-filled cylinder was connected to the skull cavity of rabbits; the cylinder was impacted and the intracranial contents acted as a contre-coup end. The pressure pattern was also modified by injection of small quantified air volumes. The pathophysiological effects of "experimental brain concussion" with vasomotor and respiratory disturbances which occurred were related to the contre-coup pressures produced, particularly the magnitude of subatmospheric pressures and the duration of late positive pressures. Some implications on their significance for brain tissue flow are discussed.

Acceleration↗
PubMed1975

Experimental brain damage from fluid pressures due to impact acceleration. 3. Morphological observations.

"Contre-coup" lesions occurring particularly in the frontal and temporal lobes following head injury have been claimed to be caused by sudden negative pressure transients, as part of the "contre-coup" end pressures occurring in the brain tissue at an occipital impact. With a new experimental model such impact acceleration pressure (near-1 atm) could be generated in the rabbit brain through a parietal opening. Resulting morphological changes were evaluated with various microscopical methods, including Evan's blue-albumin technique for observations on vascular permeability changes. Regardless of the magnitude of the negative pressure transients no changes characteristic of "contre-coup" lesions were seen in temporal lobes, i.e. in areas where preparative artefacts are absent in control animals. Therefore such negative pressure transients per se do not appear to be of major importance for the development of contre-coup lesions. However, vascular permeability changes were frequently observed in the brain stem and upper cervical cord and are presumably related to the flow of tissue in the cranio-spinal junction.

Acceleration↗