Pal Naess - Profile on Academia.edu (original) (raw)

Papers by Pal Naess

Cardiovascular Research, Apr 1, 1992

Traffic Injury Prevention, Jun 4, 2020

Objective: Motor vehicle collisions (MVCs) are a leading cause of death and acute disability amon... more 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 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 21 years (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). 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.

Gaarder C, Naess PA, Eken T, et al. Liver injuries—improved results with a formal protocol including angiography

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Jun 24, 2015

Tension gastrothorax in children is a life-threatening condition and presents dramatically with a... more Tension gastrothorax in children is a life-threatening condition and presents dramatically with acute and severe respiratory distress. It develops when an intra-thoracic stomach herniated through a diaphragmatic defect is massively distended by trapped air and/or fluid causing mediastinal displacement. Tension gastrothorax is often misinterpreted as tension pneumothorax and managed as such leading to increased morbidity and mortality. We present a child with tension gastrothorax and a literature review of this phenomenon. Immediate clinical and radiographic evaluation should lead to accurate diagnosis followed by emergency decompression of the stomach before laparotomy with reduction of herniated viscera and repair of the diaphragmatic defect.

Forensic Science Medicine and Pathology, Feb 20, 2021

We performed a retrospective study of the injuries and characteristics of occupant fatalities in ... more 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.

Injury-international Journal of The Care of The Injured, Sep 1, 2007

Objective: We hypothesised that a formal treatment protocol for liver injuries including angiogra... more Objective: We hypothesised that a formal treatment protocol for liver injuries including angiography would increase the non-operative management (NOM) rate and would be efficient as an adjunct to damage control surgery. Methods: During the 4-year period from 1 August 2000, a total of 138 adult patients with liver injuries were admitted to the largest trauma centre in Norway and prospectively included in the institutional trauma registry. On 1 August 2002, a protocol mandating angiography in all NOM patients with OIS grades 3-5 liver injuries and after packing of the liver was implemented. All patients admitted during the subsequent 2-year period (group 2) were compared with the previous 2 years as historic controls (group 1). Results: Fifty-five patients were included in group 1 and 59 in group 2. The groups were statistically comparable, both with a mean ISS of 31. Patients selected for NOM increased from 28 (51%) to 45 (76%) ( p < 0.05), without increasing failure rate, liverrelated complications, mortality or transfusion rate. Angiography was performed in 26 patients in group 2 (44%). Only nine patients underwent embolisation (35%), and five of these were in the NOM group. Angiography was negative in the eight NOM stable patients with OIS grade 3 injury. The implementation of a formal NOM protocol decreased total laparotomy rate and seemed to improve patient outcome without jeopardising patient

European Radiology, Dec 12, 2016

Objectives To describe the use of radiology in the emergency department (ED) in a trauma centre d... more 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. Key points • Minimum acceptable care (MAC) should replace normal routines in mass casualty incidents. • MAC implied reduced use of imaging in the emergency department (ED). • CT in ED was restricted to suspected severe head injuries during MAC. • The radiologist should cancel all non-head CTs in the ED during MAC.

Tidsskrift for Den Norske Laegeforening, May 19, 2005

. Miltskader e er stumpe buktraumer blir hos voksne i økende grad behandlet ikkeoperativt. De e s... more . Miltskader e er stumpe buktraumer blir hos voksne i økende grad behandlet ikkeoperativt. De e stiller større krav til bildediagnostisk påvisning av blant annet pseudoaneurismer, da disse kan forårsake forsinket ruptur.

European Journal of Trauma and Emergency Surgery, May 1, 2020

European Journal of Trauma and Emergency Surgery, Jul 7, 2022

There is a need for implementation and maturation of an inclusive trauma system in every country ... more There is a need for implementation and maturation of an inclusive trauma system in every country in Europe, with patient centered care by dedicated surgeons. This process should be initiated by physicians and medical societies, based on the best available evidence, and supported and subsequently funded by the government and healthcare authorities. A systematic approach to organizing all aspects of trauma will result in health gain in terms of quality of care provided, higher survival rates, better functional outcomes and quality of life. In addition, it will provide reliable data for both research, quality improvement and prevention programs. Severely injured patients need surgeons with broad technical and non-technical competencies to provide holistic, inclusive and compassionate care. Here we describe the philosophy of the surgical approach and define the necessary skills for trauma, both surgical and other, to improve outcome of severely injured patients. As surgery is an essential part of trauma care, surgeons play an important role for the optimal treatment of trauma patients throughout and after their hospital stay, including the intensive care unit (ICU). However, in most European countries, it might not be obvious to either the general public, patients or even the physicians that the surgeon must assume this responsibility in the ICU to optimize outcomes. The aim of this paper is to define key elements in terms of trauma systems, trauma-specific surgical skills and active critical care involvement, to organize and optimize trauma care in Europe.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Nov 23, 2017

Background: Non-operative management of splenic injuries has become the treatment of choice in he... more 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. 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. 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. 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.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Nov 29, 2016

Background: Although nonoperative management (NOM) has become standard care, optimal treatment of... more 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.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Jul 17, 2013

Background: Impaired haemostasis following shock and tissue trauma is frequently detected in the ... more 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.

Journal of Rehabilitation Medicine

Objective: To evaluate adherence to 3 central operational recommendations for acute rehabilitatio... more Objective: To evaluate adherence to 3 central operational recommendations for acute rehabilitation in the Norwegian trauma plan.Methods: A prospective multi-centre study of 538 adults with moderate and severe trauma with New Injury Severity Score > 9.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 in...

Forensic Science, Medicine and Pathology

Purpose We performed a multidisciplinary investigation of young adults involved in motor vehicle ... more 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 ...

European Journal of Trauma and Emergency Surgery

Correction: Rehabilitation Needs, Service Provision, and Costs in the First Year Following Traumatic Injuries: Protocol for a Prospective Cohort Study (Preprint)

UNSTRUCTURED D.N.A. Corrigendum D.N.A. Corrigendum D.N.A. Corrigendum D.N.A. Corrigendum D.N.A. C... more UNSTRUCTURED D.N.A. Corrigendum D.N.A. Corrigendum D.N.A. Corrigendum D.N.A. Corrigendum D.N.A. Corrigendum D.N.A. Corrigendum

BACKGROUND Traumatic injuries, defined as physical injuries with sudden onset, are a major public... more 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. 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. 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 perio...

Hospital Response to Mass Casualty Incidents

In mass casualty incidents, management strategies are switched from optimal treatment of the indi... more In mass casualty incidents, management strategies are switched from optimal treatment of the individual patient to do the greatest good for the greatest number of patients. An updated disaster plan must reflect these priorities, and key personnel must receive regular training.

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, 2021

BackgroundTraumatic injury accounts for 800 000 deaths in the European Union annually. The main c... more BackgroundTraumatic injury accounts for 800 000 deaths in the European Union annually. The main causes of deaths in trauma patients are exsanguination and multiple organ failure (MOF). We have studied >1000 trauma patients and identified shock‐induced endotheliopathy (SHINE), the pathophysiological mechanism responsible for MOF and high mortality. Pilot studies indicate that low‐dose iloprost (1 ng/kg/min) improves endothelial functionality in critically ill patients suggesting this intervention may improve patient outcome in traumatic SHINE.Material and MethodsThis is a multicentre, randomized, blinded clinical investigator‐initiated phase 2B trial in trauma patients with haemorrhagic shock‐induced endotheliopathy. Patients are randomized 1:1 to 72 hours infusion of iloprost 1 ng/kg/min or Placebo (equal volume of saline). A total of 220 trauma patients will be included. The primary endpoint is the number of intensive care unit (ICU)‐free days, within 28 days of admission. Secon...