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Andersson Hagiwara, M., Wireklint Sundström, B., Brink, P., Herlitz, J. & Hansson, P.-O. (2018). A shorter system delay for haemorrhagic stroke than ischaemic stroke among patients who use emergency medical service.. Acta Neurologica Scandinavica
Open this publication in new window or tab >>A shorter system delay for haemorrhagic stroke than ischaemic stroke among patients who use emergency medical service.
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2018 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: We compare various aspects in the early chain of care among patients with haemorrhagic stroke and ischaemic stroke.

MATERIALS & METHODS: The Emergency Medical Services (EMS) and nine emergency hospitals, each with a stroke unit, were included. All patients hospitalised with a first and a final diagnosis of stroke between 15 December 2010 and 15 April 2011 were included. The primary endpoint was the system delay (from call to the EMS until diagnosis). Secondary endpoints were: (i) use of the EMS, (ii) delay from symptom onset until call to the EMS; (iii) priority at the dispatch centre; (iv) priority by the EMS; and (v) suspicion of stroke by the EMS nurse and physician on admission to hospital.

RESULTS: Of 1336 patients, 172 (13%) had a haemorrhagic stroke. The delay from call to the EMS until diagnosis was significantly shorter in haemorrhagic stroke. The patient's decision time was significantly shorter in haemorrhagic stroke. The priority level at the dispatch centre did not differ between the two groups, whereas the EMS nurse gave a significantly higher priority to patients with haemorrhage. There was no significant difference between groups with regard to the suspicion of stroke either by the EMS nurse or by the physician on admission to hospital.

CONCLUSIONS: Patients with a haemorrhagic stroke differed from other stroke patients with a more frequent and rapid activation of EMS.

Keywords
EMS, prehospital, stroke, system delay
National Category
Clinical Medicine
Identifiers
urn:nbn:se:hb:diva-13521 (URN)10.1111/ane.12895 (DOI)29315463 (PubMedID)
Available from: 2018-01-17 Created: 2018-01-17 Last updated: 2018-01-17Bibliographically approved
Andersson, E., Bohlin, L., Herlitz, J., Sundler, A. J., Fekete, Z. & Andersson Hagiwara, M. (2018). Prehospital Identification of Patients with a Final Hospital Diagnosis of Stroke.. Prehospital and Disaster Medicine, 1-8
Open this publication in new window or tab >>Prehospital Identification of Patients with a Final Hospital Diagnosis of Stroke.
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2018 (English)In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, p. 1-8Article in journal (Refereed) Epub ahead of print
Abstract [en]

Introduction the early phase of stroke, minutes are critical. Since the majority of patients with stroke are transported by the Emergency Medical Service (EMS), the early handling and decision making by the EMS clinician is important. Problem The study aim was to evaluate the frequency of a documented suspicion of stroke by the EMS nurse, and to investigate differences in the clinical signs of stroke and clinical assessment in the prehospital setting among patients with regard to if there was a documented suspicion of stroke on EMS arrival or not, in patients with a final hospital diagnosis of stroke.

METHODS: The study had a retrospective observational design. Data were collected from reports on patients who were transported by the EMS and had a final diagnosis of stroke at a single hospital in western Sweden (630 beds) in 2015. The data sources were hospital and prehospital medical journals.

RESULTS: In total, 454 patients were included. Among them, the EMS clinician suspected stroke in 52%. The findings and documentation on patients with a suspected stroke differed from the remaining patients as follows: a) More frequently documented symptoms from the face, legs/arms, and speech; b) More frequently assessments of neurology, face, arms/legs, speech, and eyes; c) More frequently addressed the major complaint with regard to time and place of onset, duration, localization, and radiation; d) Less frequently documented symptoms of headache, vertigo, and nausea; and e) More frequently had an electrocardiogram (ECG) recorded and plasma glucose sampled. In addition to the 52% of patients who had a documented initial suspicion of stroke, seven percent of the patients had an initial suspicion of transitory ischemic attack (TIA) by the EMS clinician, and a neurologist was approached in another 10%.

CONCLUSION: Among 454 patients with a final diagnosis of stroke who were transported by the EMS, an initial suspicion of stroke was not documented in one-half of the cases. These patients differed from those in whom a suspicion of stroke was documented in terms of limited clinical signs of stroke, a less extensive clinical assessment, and fewer clinical investigations. Andersson E , Bohlin L , Herlitz J , Sundler AJ , Fekete Z , Andersson Hagiwara M . Prehospital identification of patients with a final hospital diagnosis of stroke.

Keywords
CT computer tomography, ECG electrocardiogram, EMS Emergency Medical Service, ESS emergency signs and symptoms, TIA transitory ischemic attack, rt-PA recombinant tissue plasminogen activator, EMS, assessment, prehospital, stroke
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13413 (URN)10.1017/S1049023X17007178 (DOI)29317012 (PubMedID)
Available from: 2018-01-12 Created: 2018-01-12 Last updated: 2018-01-17Bibliographically approved
Andersson, H., Axelsson, C., Larsson, A., Bremer, A., Gellerstedt, M., Bång, A., . . . Ljungström, L. (2018). The early chain of care in bacteraemia patients: Early suspicion, treatment and survivalin prehospital emergency care. American Journal of Emergency Medicine
Open this publication in new window or tab >>The early chain of care in bacteraemia patients: Early suspicion, treatment and survivalin prehospital emergency care
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2018 (English)In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171Article in journal (Refereed) Epub ahead of print
Abstract [en]

Introduction: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim ofthis study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chanceof survival during the subsequent 28 days after admission to hospital. Furthermore, the long-term outcome wasassessed.

Methods: This study has a quantitative design based on data fromEmergencyMedical Services (EMS) and hospitalrecords.

Results: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28 days. TheEMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis alreadyon scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code “fever, infection”more frequently for survivors upon arriving on scene. The delay time fromcall to the EMS and admission to hospitaluntil start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%.Five-year mortalitywas 62.6% among those who used the EMS and 29.5% among those who did not (p b 0.0001).

Conclusion: This study shows that among patientswith bacteraemiawho used the EMS, an early suspicion of sepsisor fever/infection was associated with improved early survival whereas the delay time from call to the EMSand admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were deadafter five years.

Keywords
Bacteraemia, Prehospital emergency care
National Category
Infectious Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13974 (URN)10.1016/j.ajem.2018.04.004 (DOI)
Available from: 2018-04-13 Created: 2018-04-13 Last updated: 2018-04-27Bibliographically approved
Rawshani, N., Rawshani, A., Gelang, C., Herlitz, J., Bång, A., Andersson, J.-O. & Gellerstedt, M. (2017). Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain.. International Journal of Cardiology, 248, 77-81, Article ID S0167-5273(17)30115-8.
Open this publication in new window or tab >>Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain.
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2017 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 248, p. 77-81, article id S0167-5273(17)30115-8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In the assessment of patients with chest pain, there is support for the use of pre-hospital ECG in the literature and in the care guidelines. Using propensity score methods, we aim to examine whether the mere acquisition of a pre-hospital ECG among patients with chest pain affects the outcome (30-day mortality).

METHODS: The association between pre-hospital ECG and 30-day mortality was studied in the overall cohort (n=13151), as well as in the one-to-one matched cohort with 2524 patients not examined with pre-hospital ECG and 2524 patients examined with pre-hospital ECG.

RESULTS: In the overall cohort, 21% (n=2809) did not undergo an ECG tracing in the pre-hospital setting. Among those who had pain during transport, 14% (n=1159) did not undergo a pre-hospital ECG while 32% (n=1135) of those who did not have pain underwent an ECG tracing. In the overall cohort, the OR for 30-day mortality in patients who had a pre-hospital ECG, as compared with those who did not, was 0.63 (95% CI 0.05-0.79; p<0.001). In the matched cohort, the OR was 0.65 (95% CI 0.49-0.85; p<0.001). Using the propensity score, in the overall cohort, the corresponding HR was 0.65 (95% CI 0.58-0.74).

CONCLUSION: Using propensity score methods, we provide real-world data demonstrating that the adjusted risk of death was considerably lower among the cases in whoma pre-hospital ECG was used. The PH-ECG is underused among patients with chest discomfort and the mere acquisition of a pre-hospital ECG may reduce mortality.

Keywords
Chest pain, Electrocardiography (ECG), Mortality, Pre-hospital
National Category
Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13325 (URN)10.1016/j.ijcard.2017.06.032 (DOI)000411439900014 ()28864133 (PubMedID)2-s2.0-85028456569 (Scopus ID)
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-01-04Bibliographically approved
Al-Dury, N., Rawshani, A., Israelsson, J., Strömsöe, A., Aune, S., Agerström, J., . . . Herlitz, J. (2017). Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age.. American Journal of Emergency Medicine, 35(12), 1839-1844, Article ID S0735-6757(17)30451-5.
Open this publication in new window or tab >>Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age.
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2017 (English)In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, no 12, p. 1839-1844, article id S0735-6757(17)30451-5Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate characteristics and outcome among patients suffering in-hospital cardiac arrest (IHCA) with the emphasis on gender and age.

METHODS: Using the Swedish Register of Cardiopulmonary Resuscitation, we analyzed associations between gender, age and co-morbidities, etiology, management, 30-day survival and cerebral function among survivors in 14,933 cases of IHCA. Age was divided into three ordered categories: young (18-49years), middle-aged (50-64years) and older (65years and above). Comparisons between men and women were age adjusted.

RESULTS: The mean age was 72.7years and women were significantly older than men. Renal dysfunction was the most prevalent co-morbidity. Myocardial infarction/ischemia was the most common condition preceding IHCA, with men having 27% higher odds of having MI as the underlying etiology. A shockable rhythm was found in 31.8% of patients, with men having 52% higher odds of being found in VT/VF. After adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days. Older individuals were managed less aggressively than younger patients. Increasing age was associated with lower 30-day survival but not with poorer cerebral function among survivors.

CONCLUSION: When adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days after in-hospital cardiac arrest. Older individuals were managed less aggressively than younger patients, despite a lower chance of survival. Higher age was, however, not associated with poorer cerebral function among survivors.

Keywords
Cardiac arrest, Cardiopulmonary resuscitation
National Category
Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13331 (URN)10.1016/j.ajem.2017.06.012 (DOI)000417337100009 ()28624147 (PubMedID)2-s2.0-85020765621 (Scopus ID)
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-01-04Bibliographically approved
Claesson, A., Herlitz, J., Svensson, L., Ottosson, L., Bergfeldt, L., Engdahl, J., . . . Bremer, A. (2017). Defibrillation before EMS arrival in western Sweden.. American Journal of Emergency Medicine, 35(8), 1043-1048, Article ID S0735-6757(17)30117-1.
Open this publication in new window or tab >>Defibrillation before EMS arrival in western Sweden.
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2017 (English)In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, no 8, p. 1043-1048, article id S0735-6757(17)30117-1Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Bystanders play a vital role in public access defibrillation (PAD) in out-of-hospital cardiac arrest (OHCA). Dual dispatch of first responders (FR) alongside emergency medical services (EMS) can reduce time to first defibrillation. The aim of this study was to describe the use of automated external defibrillators (AEDs) in OHCAs before EMS arrival.

METHODS: All OHCA cases with a shockable rhythm in which an AED was used prior to the arrival of EMS between 2008 and 2015 in western Sweden were eligible for inclusion. Data from the Swedish Register for Cardiopulmonary Resuscitation (SRCR) were used for analysis, on-site bystander and FR defibrillation were compared with EMS defibrillation in the final analysis.

RESULTS: Of the reported 6675 cases, 24% suffered ventricular fibrillation (VF), 162 patients (15%) of all VF cases were defibrillated before EMS arrival, 46% with a public AED on site. The proportion of cases defibrillated before EMS arrival increased from 5% in 2008 to 20% in 2015 (p<0.001). During this period, 30-day survival increased in patients with VF from 22% to 28% (p=0.04) and was highest when an AED was used on site (68%), with a median delay of 6.5min from collapse to defibrillation. Adjusted odds ratio for on-site defibrillation versus dispatched defibrillation for 30-day survival was 2.45 (95% CI: 1.02-5.95).

CONCLUSIONS: The use of AEDs before the arrival of EMS increased over time. This was associated with an increased 30-day survival among patients with VF. Thirty-day survival was highest when an AED was used on site before EMS arrival.

Keywords
Automated external defibrillator, Emergency medical services, First responder, Out-of-hospital cardiac arrest
National Category
Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13342 (URN)10.1016/j.ajem.2017.02.030 (DOI)000407941000001 ()28238537 (PubMedID)2-s2.0-85013677603 (Scopus ID)
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-01-04Bibliographically approved
Hasselqvist-Ax, I., Nordberg, P., Herlitz, J., Svensson, L., Jonsson, M., Lindqvist, J., . . . Hollenberg, J. (2017). Dispatch of Firefighters and Police Officers in Out-of-Hospital Cardiac Arrest: A Nationwide Prospective Cohort Trial Using Propensity Score Analysis.. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 6(10), Article ID e005873.
Open this publication in new window or tab >>Dispatch of Firefighters and Police Officers in Out-of-Hospital Cardiac Arrest: A Nationwide Prospective Cohort Trial Using Propensity Score Analysis.
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2017 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 6, no 10, article id e005873Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Dispatch of basic life support-trained first responders equipped with automated external defibrillators in addition to advanced life support-trained emergency medical services personnel in out-of-hospital cardiac arrest (OHCA) has, in some minor cohort studies, been associated with improved survival. The aim of this study was to evaluate the association between basic life support plus advanced life support response and survival in OHCA at a national level.

METHODS AND RESULTS: This prospective cohort study was conducted from January 1, 2012, to December 31, 2014. People who experienced OHCA in 9 Swedish counties covered by basic life support plus advanced life support response were compared with a propensity-matched contemporary control group of people who experienced OHCA in 12 counties where only emergency medical services was dispatched, providing advanced life support. Primary outcome was survival to 30 days. The analytic sample consisted of 2786 pairs (n=5572) derived from the total cohort of 7308 complete cases. The median time from emergency call to arrival of emergency medical services or first responder was 9 minutes in the intervention group versus 10 minutes in the controls (P<0.001). The proportion of patients admitted alive to the hospital after resuscitation was 31.4% (875/2786) in the intervention group versus 24.9% (694/2786) in the controls (conditional odds ratio, 1.40; 95% confidence interval, 1.24-1.57). Thirty-day survival was 9.5% (266/2786) in the intervention group versus 7.7% (214/2786) in the controls (conditional odds ratio, 1.27; 95% confidence interval, 1.05-1.54).

CONCLUSIONS: In this nationwide interventional trial, using propensity score matching, dispatch of first responders in addition to emergency medical services in OHCA was associated with a moderate, but significant, increase in 30-day survival.

CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02184468.

Keywords
automated external defibrillator, cardiac arrest, cardiopulmonary resuscitation, defibrillation, dispatch center, emergency medical services, firefighters, first responders, out‐of‐hospital cardiac arrest, survival
National Category
Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13319 (URN)10.1161/JAHA.117.005873 (DOI)28978527 (PubMedID)
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-01-04Bibliographically approved
Martinell, L., Nielsen, N., Herlitz, J., Karlsson, T., Horn, J., Wise, M. P., . . . Rylander, C. (2017). Early predictors of poor outcome after out-of-hospital cardiac arrest.. Critical Care, 21(1), Article ID 96.
Open this publication in new window or tab >>Early predictors of poor outcome after out-of-hospital cardiac arrest.
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2017 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 21, no 1, article id 96Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Early identification of predictors for a poor long-term outcome in patients who survive the initial phase of out-of-hospital cardiac arrest (OHCA) may facilitate future clinical research, the process of care and information provided to relatives. The aim of this study was to determine the association between variables available from the patient's history and status at intensive care admission with outcome in unconscious survivors of OHCA.

METHODS: Using the cohort of the Target Temperature Management trial, we performed a post hoc analysis of 933 unconscious patients with OHCA of presumed cardiac cause who had a complete 6-month follow-up. Outcomes were survival and neurological function as defined by the Cerebral Performance Category (CPC) scale at 6 months after OHCA. After multiple imputations to compensate for missing data, backward stepwise multivariable logistic regression was applied to identify factors independently predictive of a poor outcome (CPC 3-5). On the basis of these factors, a risk score for poor outcome was constructed.

RESULTS: We identified ten independent predictors of a poor outcome: older age, cardiac arrest occurring at home, initial rhythm other than ventricular fibrillation/tachycardia, longer duration of no flow, longer duration of low flow, administration of adrenaline, bilateral absence of corneal and pupillary reflexes, Glasgow Coma Scale motor response 1, lower pH and a partial pressure of carbon dioxide in arterial blood value lower than 4.5 kPa at hospital admission. A risk score based on the impact of each of these variables in the model yielded a median (range) AUC of 0.842 (0.840-0.845) and good calibration. Internal validation of the score using bootstrapping yielded a median (range) AUC corrected for optimism of 0.818 (0.816-0.821).

CONCLUSIONS: Among variables available at admission to intensive care, we identified ten independent predictors of a poor outcome at 6 months for initial survivors of OHCA. They reflected pre-hospital circumstances (six variables) and patient status on hospital admission (four variables). By using a simple and easy-to-use risk scoring system based on these variables, patients at high risk for a poor outcome after OHCA may be identified early.

Keywords
Intensive care, Out-of-hospital cardiac arrest, Prognosis, Risk score
National Category
Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13338 (URN)10.1186/s13054-017-1677-2 (DOI)000399361900001 ()28410590 (PubMedID)2-s2.0-85018367739 (Scopus ID)
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-01-04Bibliographically approved
Glantz, H., Johansson, M. C., Thunström, E., Guron, C. W., Uzel, H., Saygin, M., . . . Peker, Y. (2017). Effect of CPAP on diastolic function in coronary artery disease patients with nonsleepy obstructive sleep apnea: A randomized controlled trial.. International Journal of Cardiology, 241, 12-18, Article ID S0167-5273(16)34469-2.
Open this publication in new window or tab >>Effect of CPAP on diastolic function in coronary artery disease patients with nonsleepy obstructive sleep apnea: A randomized controlled trial.
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2017 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 241, p. 12-18, article id S0167-5273(16)34469-2Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Obstructive sleep apnea (OSA) has been associated with worse diastolic function in patients with coronary artery disease (CAD). This analysis determined whether continuous positive airway pressure (CPAP) treatment would improve diastolic function in CAD patients with nonsleepy OSA.

METHODS: Between December 2005 and November 2010, 244 revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index (AHI) ≥15/h, Epworth Sleepiness Scale [ESS] score<10) were randomly assigned to CPAP or no-CPAP. Echocardiographic measurements were obtained at baseline, and after 3 and 12months.

RESULTS: A total of 171 patients with preserved left ventricular ejection fraction (≥50%), no atrial fibrillation or severe valve abnormalities, and technically adequate echocardiograms at baseline and follow-up visits were included (CPAP, n=87; no-CPAP, n=84). In the intention-to-treat analysis, CPAP had no significant effect on echocardiographic parameters of mild (enlarged left atrium or decreased diastolic relaxation velocity) or worse (increased E/é filling index [presumed elevated left ventricular filling pressure]) diastolic function. Post-hoc analysis revealed a significant association between CPAP usage for ≥4h/night and an increase in diastolic relaxation velocity at 12months' follow-up (odds ratio 2.3, 95% confidence interval 1.0-4.9; p=0.039) after adjustment for age, sex, body mass index, and left atrium diameter at baseline.

CONCLUSIONS: CPAP did not improve diastolic dysfunction in CAD patients with nonsleepy OSA. However, good CPAP adherence was significantly associated with an increase in diastolic relaxation velocity after one year.

Keywords
Continuous positive airway pressure, Coronary artery disease, Diastolic function, Echocardiography, Doppler, Obstructive sleep apnea
National Category
Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13340 (URN)10.1016/j.ijcard.2017.03.100 (DOI)000405455200003 ()28408103 (PubMedID)2-s2.0-85017335985 (Scopus ID)
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-01-04Bibliographically approved
Nord, A., Hult, H., Kreitz-Sandberg, S., Herlitz, J., Svensson, L. & Nilsson, L. (2017). Effect of two additional interventions, test and reflection, added to standard cardiopulmonary resuscitation training on seventh grade students' practical skills and willingness to act: a cluster randomised trial.. BMJ Open, 7(6), Article ID e014230.
Open this publication in new window or tab >>Effect of two additional interventions, test and reflection, added to standard cardiopulmonary resuscitation training on seventh grade students' practical skills and willingness to act: a cluster randomised trial.
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 6, article id e014230Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aim of this research is to investigate if two additional interventions, test and reflection, after standard cardiopulmonary resuscitation (CPR) training facilitate learning by comparing 13-year-old students' practical skills and willingness to act.

SETTINGS: Seventh grade students in council schools of two municipalities in south-east Sweden.

DESIGN: School classes were randomised to CPR training only (O), CPR training with a practical test including feedback (T) or CPR training with reflection and a practical test including feedback (RT). Measures of practical skills and willingness to act in a potential life-threatening situation were studied directly after training and at 6 months using a digital reporting system and a survey. A modified Cardiff test was used to register the practical skills, where scores in each of 12 items resulted in a total score of 12-48 points. The study was conducted in accordance with current European Resuscitation Council guidelines during December 2013 to October 2014.

PARTICIPANTS: 29 classes for a total of 587 seventh grade students were included in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES: The total score of the modified Cardiff test at 6 months was the primary outcome. Secondary outcomes were the total score directly after training, the 12 individual items of the modified Cardiff test and willingness to act.

RESULTS: At 6 months, the T and O groups scored 32 (3.9) and 30 (4.0) points, respectively (p<0.001), while the RT group scored 32 (4.2) points (not significant when compared with T). There were no significant differences in willingness to act between the groups after 6 months.

CONCLUSIONS: A practical test including feedback directly after training improved the students' acquisition of practical CPR skills. Reflection did not increase further CPR skills. At 6-month follow-up, no intervention effect was found regarding willingness to make a life-saving effort.

Keywords
cpr training, feedback, reflection, skill test, students, willingness
National Category
Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13330 (URN)10.1136/bmjopen-2016-014230 (DOI)000406391200048 ()28645953 (PubMedID)2-s2.0-85021624804 (Scopus ID)
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-01-04Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4139-6235

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