R. Hasler - Academia.edu (original) (raw)

Papers by R. Hasler

Research paper thumbnail of Risk Factors in Snowsports: A Prospective Controlled Multicenter Survey in 1088 Patients

The Journal of Emergency Medicine, 2009

Introduction: Beta-blockade is currently recommended in the early management of patients with acu... more Introduction: Beta-blockade is currently recommended in the early management of patients with acute coronary syndromes (ACS). Objective: A systematic review of the medical literature to determine if early beta-blockade improves the outcome of patients with ACS. Methods: We searched PubMed and EMBASE databases for randomized controlled trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: Patients: Adult (18ϩ years) patients presenting with clinical signs and symptoms of ACS within 24 h of onset of chest pain. Intervention: Intravenous or oral beta-blockers administered within 8 h of presentation. Comparator: Standard medical therapy with or without placebo vs. early beta-blocker administration. Outcome: The risk of in-hospital death in the intervention groups vs. the comparator groups. The methodological quality of the studies was assessed. Qualitative methods were used to summarize the study results. Data Analysis: In-hospital mortality rates were compared using a forest plot of relative risk (RR) (95% confidence interval [CI]) between beta-blockers and controls. Review Manager (RevMan computer program, Version 5.0) was utilized. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008. Pooled treatment effects were estimated using RR for mortality rate with Mantel-Haenszel risk ratio, using a fixed-effects model. Heterogeneity was assessed by chi-squared and the I2 statistic. Results: We identified 18 articles (n ϭ 72,249) that met our inclusion/ exclusion criteria. Heterogeneity: 2 ϭ 15. 7, df ϭ 16 (p ϭ 0.51); I2 ϭ 0%. In-hospital mortality: RR ϭ 0.95 (95% CI 0.90 -1.01). Only one of 18 studies (n ϭ 94) favored early beta-blocker therapy, RR ϭ 0.31 (95% CI 0.12-0.86). In the largest of these studies (n ϭ 45,852), a significantly (p Ͻ 0.0001) increased rate of cardiogenic shock was observed in the beta-blocker (5.0%) vs. control group (3.9%). Conclusions: Our systematic review failed to demonstrate a convincing mortality benefit for using beta-blockers early in the course of ACS.

Research paper thumbnail of Severe spinal injuries in alpine skiing and snowboarding: a 6-year review of a tertiary trauma centre for the Bernese Alps ski resorts, Switzerland

British Journal of Sports Medicine, 2007

To analyse the epidemiological data, injury pattern, clinical features and mechanisms of severe s... more To analyse the epidemiological data, injury pattern, clinical features and mechanisms of severe spinal injuries related to alpine skiing and snowboarding. A six-year review of all adult patients with severe spinal injuries sustained from alpine skiing or snowboarding. Tertiary trauma centre in Bern, Switzerland. All adult patients (over 16 years of age) admitted to a tertiary trauma centre from 1 July 2000, through 30 June 2006, were reviewed using a computerised database. From these records, a total of 728 patients injured from snow sports were identified. Severe spinal injuries (defined as spinal fractures, subluxations, dislocations or concomitant spinal cord injuries) were found in 73 patients (17 female, 56 male). The clinical features of these patients were reviewed with respect to epidemiological factors, mechanism of injury, fracture pattern, and neurological status. The majority of severe spinal injuries (n = 63) were related to skiing. Fatal central-nervous injuries and transient or persistent neurological symptoms occurred in 28 patients (23 skiers, 5 snowboarders). None of the snowboarders suffered from persistent neurological sequelae. Snowboarders with severe spinal injuries (n = 10) were all male (p<0.05), and were significantly younger than skiers (p<0.001). The most commonly affected site was the lumbar spine. However, 39 patients (53.4%) suffered from injury pattern at two or more levels. With advances in technology and slope maintenance, skiers and snowboarders progress to higher skill levels and faster speeds more rapidly than ever before. Great efforts have been focused on reducing extremity injuries in snow sports, but until recently very little attention has been given to spinal injury prevention on the slopes. Suggestions for injury prevention include the use of spine protectors, participation on appropriate runs for ability level, proper fit and adjustment of equipment, and taking lessons with the goal of increasing ability and learning hill etiquette.

Research paper thumbnail of Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study

European Spine Journal, 2011

This is a European cohort study on predictors of spinal injury in adult (C16 years) major trauma ... more This is a European cohort study on predictors of spinal injury in adult (C16 years) major trauma patients, using prospectively collected data of the Trauma Audit and Research Network from 1988 to 2009. Predictors for spinal fractures/dislocations or spinal cord injury were determined using univariate and multivariate logistic regression analysis. 250,584 patients were analysed. 24,000 patients (9.6%) sustained spinal fractures/dislocations alone and 4,489 (1.8%) sustained spinal cord injury with or without fractures/dislocations. Spinal injury patients had a median age of 44.5 years (IQR = 28.8-64.0) and Injury Severity Score of 9 (IQR = 4-17). 64.9% were male. 45% of patients suffered associated injuries to other body regions. Age \45 years (C45 years OR 0.83-0.94), Glasgow Coma Score (GCS) 3-8 (OR 1.10, 95% CI 1.02-1.19), falls[2 m (OR 4.17, 95% CI 3.98-4.37), sports injuries (OR 2.79, 95% CI 2.41-3.23) and road traffic collisions (RTCs) (OR 1.91, 95% CI 1.83-2.00) were predictors for spinal fractures/dislocations. Age \45 years (C45 years OR 0.78-0.90), male gender (female OR 0.78, 95% CI 0.72-0.85), GCS \15 (OR 1.36-1.93), associated chest injury (OR 1.10, 95% CI 1.01-1.20), sports injuries (OR 3.98, 95% CI 3.04-5.21), falls [2 m (OR 3.60, 95% CI 3.21-4.04), RTCs (OR 2.20, 95% CI 1.96-2.46) and shooting (OR 1.91, 95% CI 1.21-3.00) were predictors for spinal cord injury. Multilevel injury was found in 10.4% of fractures/ dislocations and in 1.3% of cord injury patients. As spinal trauma occurred in [10% of major trauma patients, aggressive evaluation of the spine is warranted, especially, in males, patients\45 years, with a GCS\15, concomitant chest injury and/or dangerous injury mechanisms (falls [2 m, sports injuries, RTCs and shooting). Diagnostic imaging of the whole spine and a diligent search for associated injuries are substantial.

Research paper thumbnail of Risk Factors in Snowsports: A Prospective Controlled Multicenter Survey in 1088 Patients

The Journal of Emergency Medicine, 2009

Introduction: Beta-blockade is currently recommended in the early management of patients with acu... more Introduction: Beta-blockade is currently recommended in the early management of patients with acute coronary syndromes (ACS). Objective: A systematic review of the medical literature to determine if early beta-blockade improves the outcome of patients with ACS. Methods: We searched PubMed and EMBASE databases for randomized controlled trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: Patients: Adult (18ϩ years) patients presenting with clinical signs and symptoms of ACS within 24 h of onset of chest pain. Intervention: Intravenous or oral beta-blockers administered within 8 h of presentation. Comparator: Standard medical therapy with or without placebo vs. early beta-blocker administration. Outcome: The risk of in-hospital death in the intervention groups vs. the comparator groups. The methodological quality of the studies was assessed. Qualitative methods were used to summarize the study results. Data Analysis: In-hospital mortality rates were compared using a forest plot of relative risk (RR) (95% confidence interval [CI]) between beta-blockers and controls. Review Manager (RevMan computer program, Version 5.0) was utilized. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008. Pooled treatment effects were estimated using RR for mortality rate with Mantel-Haenszel risk ratio, using a fixed-effects model. Heterogeneity was assessed by chi-squared and the I2 statistic. Results: We identified 18 articles (n ϭ 72,249) that met our inclusion/ exclusion criteria. Heterogeneity: 2 ϭ 15. 7, df ϭ 16 (p ϭ 0.51); I2 ϭ 0%. In-hospital mortality: RR ϭ 0.95 (95% CI 0.90 -1.01). Only one of 18 studies (n ϭ 94) favored early beta-blocker therapy, RR ϭ 0.31 (95% CI 0.12-0.86). In the largest of these studies (n ϭ 45,852), a significantly (p Ͻ 0.0001) increased rate of cardiogenic shock was observed in the beta-blocker (5.0%) vs. control group (3.9%). Conclusions: Our systematic review failed to demonstrate a convincing mortality benefit for using beta-blockers early in the course of ACS.

Research paper thumbnail of Severe spinal injuries in alpine skiing and snowboarding: a 6-year review of a tertiary trauma centre for the Bernese Alps ski resorts, Switzerland

British Journal of Sports Medicine, 2007

To analyse the epidemiological data, injury pattern, clinical features and mechanisms of severe s... more To analyse the epidemiological data, injury pattern, clinical features and mechanisms of severe spinal injuries related to alpine skiing and snowboarding. A six-year review of all adult patients with severe spinal injuries sustained from alpine skiing or snowboarding. Tertiary trauma centre in Bern, Switzerland. All adult patients (over 16 years of age) admitted to a tertiary trauma centre from 1 July 2000, through 30 June 2006, were reviewed using a computerised database. From these records, a total of 728 patients injured from snow sports were identified. Severe spinal injuries (defined as spinal fractures, subluxations, dislocations or concomitant spinal cord injuries) were found in 73 patients (17 female, 56 male). The clinical features of these patients were reviewed with respect to epidemiological factors, mechanism of injury, fracture pattern, and neurological status. The majority of severe spinal injuries (n = 63) were related to skiing. Fatal central-nervous injuries and transient or persistent neurological symptoms occurred in 28 patients (23 skiers, 5 snowboarders). None of the snowboarders suffered from persistent neurological sequelae. Snowboarders with severe spinal injuries (n = 10) were all male (p<0.05), and were significantly younger than skiers (p<0.001). The most commonly affected site was the lumbar spine. However, 39 patients (53.4%) suffered from injury pattern at two or more levels. With advances in technology and slope maintenance, skiers and snowboarders progress to higher skill levels and faster speeds more rapidly than ever before. Great efforts have been focused on reducing extremity injuries in snow sports, but until recently very little attention has been given to spinal injury prevention on the slopes. Suggestions for injury prevention include the use of spine protectors, participation on appropriate runs for ability level, proper fit and adjustment of equipment, and taking lessons with the goal of increasing ability and learning hill etiquette.

Research paper thumbnail of Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study

European Spine Journal, 2011

This is a European cohort study on predictors of spinal injury in adult (C16 years) major trauma ... more This is a European cohort study on predictors of spinal injury in adult (C16 years) major trauma patients, using prospectively collected data of the Trauma Audit and Research Network from 1988 to 2009. Predictors for spinal fractures/dislocations or spinal cord injury were determined using univariate and multivariate logistic regression analysis. 250,584 patients were analysed. 24,000 patients (9.6%) sustained spinal fractures/dislocations alone and 4,489 (1.8%) sustained spinal cord injury with or without fractures/dislocations. Spinal injury patients had a median age of 44.5 years (IQR = 28.8-64.0) and Injury Severity Score of 9 (IQR = 4-17). 64.9% were male. 45% of patients suffered associated injuries to other body regions. Age \45 years (C45 years OR 0.83-0.94), Glasgow Coma Score (GCS) 3-8 (OR 1.10, 95% CI 1.02-1.19), falls[2 m (OR 4.17, 95% CI 3.98-4.37), sports injuries (OR 2.79, 95% CI 2.41-3.23) and road traffic collisions (RTCs) (OR 1.91, 95% CI 1.83-2.00) were predictors for spinal fractures/dislocations. Age \45 years (C45 years OR 0.78-0.90), male gender (female OR 0.78, 95% CI 0.72-0.85), GCS \15 (OR 1.36-1.93), associated chest injury (OR 1.10, 95% CI 1.01-1.20), sports injuries (OR 3.98, 95% CI 3.04-5.21), falls [2 m (OR 3.60, 95% CI 3.21-4.04), RTCs (OR 2.20, 95% CI 1.96-2.46) and shooting (OR 1.91, 95% CI 1.21-3.00) were predictors for spinal cord injury. Multilevel injury was found in 10.4% of fractures/ dislocations and in 1.3% of cord injury patients. As spinal trauma occurred in [10% of major trauma patients, aggressive evaluation of the spine is warranted, especially, in males, patients\45 years, with a GCS\15, concomitant chest injury and/or dangerous injury mechanisms (falls [2 m, sports injuries, RTCs and shooting). Diagnostic imaging of the whole spine and a diligent search for associated injuries are substantial.