FFR-Guided Complete or Culprit-Only PCI in Patients with Myocardial Infarction.

BACKGROUND: The benefit of fractional flow reserve (FFR)-guided complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease remains unclear. METHODS: In this multinational, registry-based, randomized trial, we assigned patients with STEMI or very-high-risk non-STEMI (NSTEMI) and multivessel disease who were undergoing primary percutaneous coronary intervention (PCI) of the culprit lesion to receive either FFR-guided complete revascularization of nonculprit lesions or no further revascularization. The primary outcome was a composite of death from any cause, myocardial infarction, or unplanned revascularization. The two key secondary outcomes were a composite of death from any cause or myocardial infarction and unplanned revascularization. RESULTS: A total of 1542 patients underwent randomization, with 764 assigned to receive FFR-guided complete revascularization and 778 assigned to receive culprit-lesion-only PCI. At a median follow-up of 4.8 years (interquartile range, 4.3 to 5.2), a primary-outcome event had occurred in 145 patients (19.0%) in the complete-revascularization group and in 159 patients (20.4%) in the culprit-lesion-only group (hazard ratio, 0.93; 95% confidence interval [CI], 0.74 to 1.17; P = 0.53). With respect to the secondary outcomes, no apparent between-group differences were observed in the composite of death from any cause or myocardial infarction (hazard ratio, 1.12; 95% CI, 0.87 to 1.44) or unplanned revascularization (hazard ratio, 0.76; 95% CI, 0.56 to 1.04). There were no apparent between-group differences in safety outcomes. CONCLUSIONS: Among patients with STEMI or very-high-risk NSTEMI and multivessel coronary artery disease, FFR-guided complete revascularization was not shown to result in a lower risk of a composite of death from any cause, myocardial infarction, or unplanned revascularization than culprit-lesion-only PCI at 4.8 years. (Funded by the Swedish Research Council and others; FULL REVASC ClinicalTrials.gov number, NCT02862119.).

[Management of patients with left main stem stenosis in Iceland 2010-2020: PCI or CABG].

INTRODUCTION: Coronary artery bypass surgery (CABG) has been standard treatment for patients with left main coronary artery disease (LMCAD) but percutaneous coronary intervention (PCI) can be a good alternative. Our aim was to evaluate revascularization of LMCAD-patients in Iceland and treatment changes in recent years. We also assessed the impact of patient background factors on treatment choice and long-term survival. METHODS: This retrospective, population-based registry-study analyzed data from the SCAAR-SWEDEHEART database. Patients with significant LMCAD on coronary angiography in Iceland 2010-2020, without previous history of CABG or contraindication for surgery were enrolled. The Kaplan-Meier method was used to study long-term survival and COX-regression analysis to adjust for predictor variables. FINDINGS: Of 702 LMCAD patients, 195 were treated with PCI, 460 with CABG and 47 with medical therapy. The widest age-range was in the PCI group and the mean age was highest in the medical therapy group. Patients with LMCAD and concomitant three vessel disease or heart valve disese were mostly treated with CABG (76.1% and 84.4%). The majority of patients with LMCAD only were treated with PCI, as well as patients presenting with STEMI or in cardiogenic shock (67.1% and 70.0%). The proportion of patients treated with PCI increased from 19.8% in 2010-2015 to 42.7% in 2016-2020. There was no significant difference in survival between the PCI and CABG-groups (p=0.41). CONCLUSIONS: In patients with LMCAD the main factors determining treatment choice are age, anatomical complexity and acuteness. There has been a significant increase in LMCAD patients treated with PCI.

[Management and revascularization of diabetics with coronary artery disease in Iceland].

BACKGROUND: The incidence of diabetes is growing, and diabetics have increased risk of atherosclerosis and diffuse coronary artery disease (CAD). Our aim was to assess the revascularization treatment of diabetics with CAD in Iceland from 2010-2020, changes in management and long-term survival of patients. METHODS: All patients in Iceland with diabetes and CAD on cardiac catheterization 2010-2020 were included in this retrospective, population-based study. We analyzed data from the SCAAR/SWEDEHEART database: patients' background information, findings of cardiac catheterization, planned treatment and results. The Kaplan-Meier method was used to estimate long-term survival and Cox-regression-analysis to adjust for predictor variables. RESULTS: Of 1905 cases (1485 patients), 1230 (65%) underwent PCI, 274 (14%) CABG and 401 (21%) had medical therapy only. The age distribution differed: The PCI group had the widest age bracket, the CABG group the narrowest, and the medical therapy group had the highest mean age. Most patients with STEMI or cardiogenic shock underwent PCI, while most patients with concomitant heart-valve disease underwent CABG. The proportion of patients undergoing CABG increased with more diffuse CAD. 41% of patients with left main- and three-vessel disease underwent CABG while only 2% of those with single-vessel disease. From 2010-2020 the proportion of patients that underwent PCI increased from 49% to 72%. There was no difference in survival between the PCI and CABG groups (p=1.00). CONCLUSION: Three quarters of patients with diabetes and obstructive CAD are now treated with PCI. The PCI and CABG groups had overall equal survival but the groups had different characteristics.

Women's intimate partner violence versus community violence: Comparing injuries as presented in Iceland's largest emergency department.

BACKGROUND: Intimate partner violence (IPV) is a widespread, often unidentified and hidden public health problem, which has serious consequences. The purpose of this study was to describe and compare the clinical characteristics of women's violence inflicted physical injuries, as presented at Iceland's largest Emergency Department (ED). Three groups were created based on registered reason of injury: (1) IPV, (2) community violence (CV) with a history of IPV (HIPV), and (3) CV with no history of IPV. METHODS: Data was collected retrospectively by using the Nomesco classification system of external causes of injuries. Participants were adult women, residing in the capital area, visiting the ED during 2005-2019. RESULTS: IPV inflicted ED visits declined by 45% during the research period and CV visits declined by 61%. Women in the IPV group had the highest prevalence of repeated new ED visits per 1000 women in the capital area. The majority of IPV occurred in residential areas (86.4%), inflicted by a current partner (54.7%), and included only one perpetrator (95.3%). Women involved in CV were most likely to visit the ED on weekends (p = 0.003) and IPV women were most likely to visit between 08:00 and 16:00 (p < 0.001). Superficial injuries were the most common type of injury among all groups and IPV women were twice as likely (7.1%) to have injuries on their neck than CV women (3.5%). IPV women were most likely to be admitted (3.0%). CONCLUSION: Time of ED visit, number of perpetrators and location of assault can be indicators of IPV inflicted injuries, as opposed to otherwise inflicted injuries. Repeated visits, superficial injuries and neck injuries might also be an indicator of IPV, however wounds and sprains and injuries on head and upper limbs are more likely to be non-IPV inflicted.

Epidemiology of trauma in the subarctic regions of the Nordic countries.

BACKGROUND: The northern regions of the Nordic countries have common challenges of sparsely populated areas, long distances, and an arctic climate. The aim of this study was to compare the cause and rate of fatal injuries in the northernmost area of the Nordic countries over a 5-year period. METHODS: In this retrospective cohort, we used the Cause of Death Registries to collate all deaths from 2007 to 2011 due to an external cause of death. The study area was the three northernmost counties in Norway, the four northernmost counties in Finland and Sweden, and the whole of Iceland. RESULTS: A total of 4308 deaths were included in the analysis. Low energy trauma comprised 24% of deaths and high energy trauma 76% of deaths. Northern Finland had the highest incidence of both high and low energy trauma deaths. Iceland had the lowest incidence of high and low energy trauma deaths. Iceland had the lowest prehospital share of deaths (74%) and the lowest incidence of injuries leading to death in a rural location. The incidence rates for high energy trauma death were 36.1/100000/year in Northern Finland, 15.6/100000/year in Iceland, 27.0/100000/year in Northern Norway, and 23.0/100000/year in Northern Sweden. CONCLUSION: We found unexpected differences in the epidemiology of trauma death between the countries. The differences suggest that a comparison of the trauma care systems and preventive strategies in the four countries is required.

The Full Revasc (Ffr-gUidance for compLete non-cuLprit REVASCularization) Registry-based randomized clinical trial.

BACKGROUND: Complete revascularization in ST elevation myocardial infarction (STEMI) patients with multivessel disease has resulted in reduction in composite clinical endpoints in medium sized trials. Only one trial showed an effect on hard clinical endpoints, but the revascularization procedure was guided by angiographic evaluation of stenosis severity. Consequently, it is not clear how Fractional Flow Reserve (FFR)-guided percutaneous coronary intervention (PCI) affects hard clinical endpoints in STEMI. METHODS AND RESULTS: The Ffr-gUidance for compLete non-cuLprit REVASCularization (FULL REVASC) - is a pragmatic, multicenter, international, registry-based randomized clinical trial designed to evaluate whether a strategy of FFR-guided complete revascularization of non-culprit lesions, reduces the combined primary endpoint of total mortality, non-fatal MI and unplanned revascularization. 1,545 patients were randomized to receive FFR-guided PCI during the index hospitalization or initial conservative management of non-culprit lesions. We found that in angiographically severe non-culprit lesions of 90-99% severity, 1 in 5 of these lesions were re-classified as non-flow limiting by FFR. Considering lesions of intermediate severity (70%-89%), half were re-classified as non-flow limiting by FFR. The study is event driven for an estimated follow-up of at least 2.75 years to detect a 9.9%/year>7.425%/year difference (HR = 0.74 at 80% power (α = .05)) for the combined primary endpoint. CONCLUSION: This large randomized clinical trial is designed and powered to evaluate the effect of complete revascularization with FFR-guided PCI during index hospitalization on total mortality, non-fatal MI and unplanned revascularization following primary PCI in STEMI patients with multivessel disease. Enrollment completed in September 2019 and follow-up is ongoing.

Effect of replacing ambulance physicians with paramedics on outcome of resuscitation for prehospital cardiac arrest.

INTRODUCTION: Limited evidence suggests that the presence of a prehospital physician improves survival from cardiac arrest. A retrospective study is undertaken to examine this question. In Reykjavik, Iceland, prehospital physicians on ambulances were replaced by emergency medical technicians (EMTs) in 2007. The aim of this study is to compare the outcome of prehospital resuscitation from cardiac arrest during periods of time with and without prehospital physician involvement. METHODS: All cardiac arrests that underwent prehospital resuscitation by emergency medical systems between 2004 and 2014 were included. The primary outcome was survival to hospital discharge, and the secondary outcome was return of spontaneous circulation (ROSC). Subgroup analyses were performed according to the type of cardiac arrest. RESULTS: A total of 471 cardiac arrests were included for analysis, 200 treated by prehospital physicians from 2004 to 2007 and 271 treated by EMTs from 2008 to 2014. The overall rate of survival to hospital discharge and ROSC was 23 and 50% during the study period. No significant difference was observed in the rate of survival to hospital discharge [25 vs 22%, difference 3% (95% confidence interval (CI): 11-5%)] or ROSC [53 vs 47%, difference -6% (95% CI: 15-3%)] between these two time periods. In the subgroup of patients with pulseless electrical activity, survival to hospital discharge did not differ between the two periods, but the rate of ROSC was higher in the 'physician period' [50 vs 30%, difference -20% (95% CI: -40 to -1%)]. CONCLUSIONS: The presence of a prehospital physician on the ambulance was not found to result in a significant improvement in survival or ROSC after cardiac arrest compared to care by EMTs. Patients with pulseless electrical activity experienced an increase in ROSC when a physician was present but without improvement in survival to hospital discharge.

Women and intimate partner violence: Prevalence of hospital visits and nature of injuries in the Icelandic population.

Aims: The purpose of this study was to analyse the prevalence of hospital visits and nature of injuries caused by intimate partner violence (IPV) against women and associated costs. Methods: All visits to Landspitali National University Hospital by women 18 years or older subjected to IPV, inflicted by a current or former male partner during 2005-2014, were observed and analysed. Information was obtained on number, date and time of visits and admissions, place of occurrence, patients' and perpetrators' age and relationship, number of perpetrators, medical diagnosis, aetiology, injury severity and cost. Results: The number of new hospital visits due to IPV was 1454, of which 92.6% were to the Emergency Department. The average age of the women was 34 years and 3.2% were admitted. According to the Injury Severity Score, physical injuries were mostly minor (92.4%) and mainly located on the upper body (64.3%) - namely, face, head and neck (37.1%) and upper limbs (27.2%). The majority of injuries were superficial (76.2%) and punching (29.7%), shoving (17.8%), kicking (10.5%) and attempted strangulation (9.8%) were the most common types of aetiology. Repeated new visits were 37.8%. The total cost for the hospital relating to IPV was €783,330. Conclusions: The total number of new visits resulting from IPV was 1454, and prevalence was 1.69 per 1000 women in the capital area over the research period. The majority of women were shown to have minor physical injuries of a superficial nature, located on the upper body. Although a low percentage of women were admitted, the associated cost for visits and admissions was substantial.

Multi-sensory training and wrist fractures: a randomized, controlled trial.

BACKGROUND: Asymmetric vestibular function, decreased plantar sensation, postural control and functional ability have been associated with fall-related wrist fractures. OBJECTIVE: To investigate whether multi-sensory training (MST) improves postural control, vestibular function, foot sensation and functional ability among people with fall-related wrist fractures compared to wrist stabilization training (WT). METHODS: This was an assessor-blinded, randomized controlled trial. Ninety-eight participants, age 50-75 years, were randomized to MST or WT. Pre- and post-training measurements: Head Shake Test (HST), Video-Head Impulse Test (vHIT), Semmes-Weinstein Monofilaments (SWF), Biothesiometer (BT), Sensory Organization Test (SOT), 10-m Walk Test (10MWT), Five Times Sit to Stand Test (FTSTS), Activities-Specific Balance Confidence (ABC) and Dizziness Handicap Inventory Scales (DHI). The training period was 12 weeks, with six supervised sessions by a physical therapist and daily home exercises for both groups. RESULTS: There were significant endpoint differences in SOT (p = 0.01) between the two groups, in favor of the MST group, but no changes were seen in other outcome variables. Subgroup analysis with participants below normal baseline SOT composite scores indicated that the MST was more effective in improving 10MWT fast (p = 0.04), FTSTS (p = 0.04), SWF (p = 0.04) and SOT scores (p = 0.04) than the WT. CONCLUSIONS: MST improves postural control among people with a fall-related wrist fracture. The results further suggest that the program is more effective for those with SOT balance scores below age-related norms.

Publisher Correction: GWAS of bone size yields twelve loci that also affect height, BMD, osteoarthritis or fractures.

The original HTML version of this Article was updated shortly after publication to add links to the Peer Review file.In addition, affiliations 16 and 17 incorrectly read 'School of Medicine Sydney, University of Notre Dame Australia, Sydney, WA, 6160, Australia' and 'St Vincent's Clinical School, University of New South Wales Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.' This has now been corrected in both the PDF and HTML versions of the Article.

GWAS of bone size yields twelve loci that also affect height, BMD, osteoarthritis or fractures.

Bone area is one measure of bone size that is easily derived from dual-energy X-ray absorptiometry (DXA) scans. In a GWA study of DXA bone area of the hip and lumbar spine (N ≥ 28,954), we find thirteen independent association signals at twelve loci that replicate in samples of European and East Asian descent (N = 13,608 - 21,277). Eight DXA area loci associate with osteoarthritis, including rs143384 in GDF5 and a missense variant in COL11A1 (rs3753841). The strongest DXA area association is with rs11614913[T] in the microRNA MIR196A2 gene that associates with lumbar spine area (P = 2.3 × 10-42, ß = -0.090) and confers risk of hip fracture (P = 1.0 × 10-8, OR = 1.11). We demonstrate that the risk allele is less efficient in repressing miR-196a-5p target genes. We also show that the DXA area measure contributes to the risk of hip fracture independent of bone density.

Penetrating stab injuries in Iceland: a whole-nation study on incidence and outcome in patients hospitalized for penetrating stab injuries.

BACKGROUND: Studies on penetrating injuries in Europe are scarce and often represent data from single institutions. The aim of this study was to describe the incidence and demographic features of patients hospitalized for stab injury in a whole nation. MATERIALS AND METHODS: This was a retrospective nationwide population-based study on all consecutive adult patients who were hospitalized in Iceland following knife and machete-related injuries, 2000-2015. Age-standardized incidence was calculated and Injury Severity Score (ISS) was used to assess severity of injury. RESULTS: Altogether, 73 patients (mean age 32.6 years, 90.4% males) were admitted during the 16-year study period, giving an age-standardized incidence of 1.54/100,000 inhabitants. The incidence did not vary significantly during the study period (P = 0.826). Most cases were assaults (95.9%) occurring at home or in public streets, and involved the chest (n = 32), abdomen (n = 26), upper limbs (n = 26), head/neck/face (n = 21), lower limbs (n = 10), and the back (n = 6). Median ISS was 9, with 14 patients (19.2%) having severe injuries (defined as ISS > 15). The median length of hospital stay was 2 days (range 0-53). Forty-seven patients (64.4%) underwent surgery and 26 of them (35.6%) required admission to an intensive care unit (ICU), all with ISS scores above 15. Three patients did not survive for 30 days (4.1%); all of them had severe injuries (ISS 17, 25, and 75). CONCLUSION: Stab injuries that require hospital admission are rare in Iceland, and their incidence has remained relatively stable. One in every five patients sustained severe injuries, two-thirds of whom were treated with surgical interventions, and roughly one-third required ICU care. Although some patients were severely injured with high injury scores, their 30-day mortality was still low in comparison to other studies.

Hip fractures among older people in Iceland between 2008 and 2012.

INTRODUCTION: Hip fractures are a serious injury especially among older people, mainly caused by falls and women have a higher risk. The authors studied gender differences in hip fractures, marital status, waiting times for surgery and mortality in an older population. METHODS: Data was obtained for all 67 years and older admitted with hip fractures to an Emergency Department (ED) in Iceland 2008-2012. The associations of covariates with mortality were analyzed using multivariable logistic regression. RESULTS: The study included 1053 patients; covering 80% of hip fractures in Iceland during the study period, 72% were women. Men were more often married (51% vs. 23%) (P < 0.001). Average waiting time was men vs. women 21.5 h/18.9 h (p = 0.003). Mortality within 12 months was men 36% vs. women 21% (Odds Ratio (OR); 2.30, 95% Confidence Interval (CI); 1.66-3.18). Higher mortality rates were observed in older age-groups compared to 67-79 years old, i.e.80-89 years: OR 1.80 (95% CI 1.25-2.60) and 90-109 years: OR 4.52 (95% CI 2.91-7.01). Waiting time was not associated with 12-months mortality risk after adjustment. CONCLUSION: Although women constitute the majority of elderly with hip fractures, men had higher mortality in our study. Further reserach that examine factors affecting gender difference will likey be of benefit and associated changes to the care already dleivered in the ED may improve mortality.

Accidental injuries among older adults: An incidence study.

BACKGROUND: To date, the majority of studies assessing accidental injuries among the elderly have focused on fall injuries, while studies of other mechanisms of injuries have been lacking. Therefore, the main objective of this study was to investigate all injury-related visits among older adults to an emergency department and risk factors for injuries. METHODS: Data were collected on all registered visits of adults, ≥67 years old, living in the capital of Iceland, to the emergency department of Landspitali, the National University Hospital, in 2011 and 2012. RESULTS: The yearly incidence rate for injuries was 106 per 1000 adults, ≥67 years old. Of all injuries (n = 4,469), falls were the most common mechanism of injury (78 per 1000), followed by being struck or hit (12 per 1000) and being crushed, cut or pierced (8 per 1000). Other mechanisms of injury, such as acute overexertion, foreign body in natural orifice, injuries caused by thermal and chemical effect and other and unspecified mechanism were less common (8 per 1000). Fractures were the most common consequences of injuries (36 per 1000). The most frequent place of injury was in or around homes (77 per 1000), with men being more likely than women to be injured outside of the home (60 per 1000 vs. 36 per 1000). CONCLUSION: Results indicate that falls are the main cause of accidental injuries, followed by being struck and hit injuries but other causes contributed to the rest. Falls constitute a major public health problem and fall-related injuries can have a substantial impact on the lives of older adults. As life expectancy continues to increase, fall risk is expected to increase. Since falls constitute a major impact on the lives of older adults and can lead to not only declines in physical activity and functional status, but to considerable health care costs, the health care system needs to intervene.

Sensory impairments and wrist fractures: A case-control study.

OBJECTIVES: To investigate vestibular function, foot sensation, postural control and functional abilities, and to evaluate whether these variables are associated with fall-related wrist fracture. METHODS: A case-control study was conducted with 98 subjects, age range 50-75 years, who had sustained a fall-related wrist fracture. Forty-eight sex-, age- and physical activity-matched individuals, with no previous history of wrist fracture, served as controls. Measurements included: head-shake test (HST), tuning fork, biothesiometer, Semmes-Weinstein monofilaments (MF), Sensory Organization Test (SOT), Five-Times-Sit-to-Stand Test (FTSTS), 10-m walk test (10MWT), Activities-specific Balance Confidence (ABC), and the Dizziness Handicap Inventory (DHI) scales. Logistic regression models were used to determine associations of variables with a fall-related wrist fracture. RESULTS: Vestibular asymmetry was apparent in 82% of wrist fracture subjects and 63% of controls (p = 0.012). Plantar pressure sensation (p <0.001), SOT composite scores (p< 0.001), 10MWT (p <0.001), FTSTS (p <0.001), ABC (p <0.001) and DHI (p <0.005) were significantly poorer among cases than controls. A positive HST (odds ratio (OR) 5.424; p = 0.008) and monofilament sensation (OR 3.886; p = 0.014) showed the strongest associations with having a fall-related wrist fracture. CONCLUSION: Asymmetrical vestibular function and reduced plantar pressure sensation are associated with fall-related wrist fractures among the ageing population. These factors are potential targets for future interventions.

Very low pacemaker rate following ACURATE neo transcatheter heart valve implantation.

AIMS: The aim of this study was to investigate whether minimising trauma to the aortic annulus and left ventricular outflow tract reduces the occurrence of new conduction disorders and the need for permanent pacemakers. METHODS AND RESULTS: A total of 175 patients (58% female, mean age 83±6 years) underwent transfemoral TAVI with the Boston Scientific ACURATE neo at three centres in Europe. Prosthesis size selection was based on perimeter-derived annular diameter. Predilatation was performed in all with a balloon 1.9±0.9 mm smaller than the perimeter-derived annular diameter. Post-dilatation was performed in 46 (26.3%) with a balloon 1.2±0.9 mm smaller than the perimeter-derived annular diameter. Eighteen patients (10.3%) developed a new left bundle branch block, 13 (7%) a new first-degree AV block, and four (2.3%) received a new permanent pacemaker. Paravalvular regurgitation was none/trace in 66 (37.7%), mild in 101 (57.7%) and moderate in eight (4.6%). At 30 days, the rate of any stroke was 1.7% (3/175), and one patient (0.6%) had died. CONCLUSIONS: With careful selection of the balloon and the ACURATE neo prosthesis size, very low rates of new conduction disorders and permanent pacemaker implantation may be achieved without increasing the amount of paravalvular regurgitation.

Suicide attempts and self-harm during a dramatic national economic transition: a population-based study in Iceland.

Background: Macroeconomic downturns have been associated with increased suicide rates. This study examined potential changes in suicide attempts and self-harm in Iceland during a period of major economic transition (2003-12). Methods: Data were retrieved from the National University Hospital in Reykjavik (population size: 204.725), containing all ICD-10 diagnoses connected to potential suicidal behaviour. Poisson regression models were used to compare attendance rates before and after the 2008 economic collapse. Results: During the study period, a total of 4537 attendances of 2816 individuals were recorded due to suicide attempts or self-harm. We noted a significant change in total attendance rates among men, characterized by an annual increase in attendance rate pre-collapse of 1.83 per 100.000 inhabitants and a decrease of 3.06 per 100.000 inhabitants post-collapse ( P = 0.0067). Such pattern was not observed among women. When restricting to first attendances only, we found a reduced incidence post-crisis among both men (RR: 0.85; 0.76-0.96) and women (RR: 0.86; 0.79-0.92). We further found 1% increase in unemployment rate and balance of trade to be associated with reduced attendance rates among men (RR: 0.84; 0.76-0.93 and RR: 0.81; 0.75-0.88, respectively) but not among women. Conclusion: These data suggest no overall increase in attendance rates due to suicide attempts or self-harm following the 2008 Icelandic economic collapse. In fact, a high-point in self-harm and suicide attempts was observed among men at the height of the economic boom and a decrease in new attendances among both men and women after the economic collapse.

[Visits of patients with exertional rhabdomyolysis to the Emergency Department at Landspítali, The National University Hospital of Iceland in the years 2008-2012]. / Komur á bráðamóttöku Landspítala vegna áreynslurákvöðvarofs árin 2008-2012

INTRODUCTION: Overexertion and too much training are among the -multiple etiologies of rhabdomyolysis. Creatine kinase (CK) and myo-globine, released from skeletal muscle cells, are useful for diagnosis and follow-up. Acute kidney injury is a serious complication of myoglobinemia. Literature on exertional rhabdomyolysis in the general population is scarce. The aim of this study was to investigate the epidemiology of exertional rhabdomyolysis among patients diagnosed at Landspítali The National University Hospital of Iceland in 2008-2012. MATERIALS AND METHODS: The study was retrospective and observational. All patients presenting with muscle pain after exertion and elevated creatine kinase >1000 IU/L, during the period from 1 January 2008 to 31 December 2012, were included. Patients with CK elevations secondary to causes other than exertion were excluded. Variables included: patient number and gender, CK-levels, date of hospital admission, cause of rhabdomyolysis, location of injured muscle groups, length of hospital stay, complications and means of fluid replacement. Population figures of the capital region were gathered from Statistics Iceland and information on sport practice in the capital region from The National Olympic and Sports Association of Iceland. RESULTS: Exertional rhabdomyolysis was diagnosed in 54 patients, 18 females (33,3%) and 36 males (66,7%), or 8,3% of rhabdomyolysis cases from all causes in the study period (648 cases). Incidence in the capital region was 5,0/100.000 inhabitants per year in the study period. Median age was 28 years and median CK-level was 24.132 IU/L. CK-levels were higher among females but the difference between genders was not significant. Muscle groups of the upper and lower extremities were most frequently affected (89%). Thirty patients received intravenous fluids. They had significantly higher CK values than other patients. One patient developed acute kidney injury. Information on sport practice and physical training in the capital region was not available. CONCLUSION: Exertional rhabdomyolysis is uncommon but mostly affects younger people. Information on the practice of exertion among males and females is not available but CK-levels were not significantly different between genders, age groups or different muscle groups. CK-levels were high but complications uncommon. Studies of exertional rhabdomyolysis in the general population are lacking. KEY WORDS: Rhabdomyolysis, exertion, sports, physical training, CK elevation. Correspondence: Brynjolfur Mogensen, brynmog@landspitali.is.

[Treatment and outcome of patients with hip fracture].

INTRODUCTION: Hip fractures are common amongst the elderly, often with serious consequences and increased mortality. The aim of this study was to describe treatment and outcome of patients with hip fractures. MATERIAL AND METHODS: Retrospective study on all hip fracture patients ≥60 years of age operated at Landspitali University Hospital in the year 2011. RESULTS: The study group was made up of 255 patients (mean age 82 ± 8 years, women 65%). Mean delay to operation was 22 ± 14 hours. Mean length of hospital stay for those living at a nursing home before hip fracture was 4 ± 2 days but if they had lived at home 14 ± 10 days (p<0.001). Before the fracture 68% of the patients lived at home but 54% at the end of follow-up (p<0.001). Mortality one year after hip fracture was 27% and on average eightfold compared to the general population ≥60 years. A multivariate analysis showed that age, time from fracture to arrival at hospital, ASA-classification and living in a nursing home before fracture were linked to an increased risk of death. CONCLUSION: The mean delay to surgery was within recommended guidelines, but one- third waited longer than 24 hours. Resources outside hospital seemed to decide hospital length of stay. Mortality of hip fracture patients was manifold compared to the general population of the same age and within higher range compared to other countries. Significantly fewer lived in their own home after the fracture. Hip fractures cause serious debilitation and are demanding for society.

[Incidence of Bicycle injuries presenting to the Emergency Department in Reykjavik 2005-2010].

INTRODUCTION: Bicycling has become increasingly popular in Iceland. Official registration of bicycle accidents is based on police reports. As minor accidents are often not reported to the police, these accidents may be underreported in police records. The aim of this study was to examine the epidemiology of bicycle related accidents in patients seeking medical assistance at the Emergency Department (ED) at Landspitali-University Hospital, Reykjavik (LUH), Iceland. MATERIALS AND METHODS: This retrospective cohort study was conducted at the ED at LUH, Iceland from January 2005 to December 2010. All medical files were reviewed and sex, age, year and month of accident/injury, helmet wearing, ICD-10 diagnosis, severity of injury according to the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) recorded. The rate of hospital admission was examined with length of stay, Intensive Care Unit admission, use of medical imaging and operative treatment. RESULTS: A total of 3472 patients presented to the ED with bicycle related accidents , 68.3% men and 31.7% female. The average age of patients was 22,6 years (1-95 years). Most are injured during recreational activities (72.4%) and in residence areas (45,7%). Most injuries occurred during May-September (71.4%). Data on counterparty was missing in 74.9% of cases. The cause of accident was in 44.0% a low fall or jump. The upper extremity was injured in 47.1% cases. A majority of the patients (65.6%) had a mild injury (ISS≤3points) and 29.3% had a moderate injury (4-8 points). No fatalities were found during the study period. Use of helmets was only recorded in 14.2% of cases. In total 124 patients were admitted during the period where the mean time of admission was 5 days. CONCLUSION: The incidence of bicycle injuries increased during the study period but appears to have increased less than the number of bicyclists. Injuries are more frequent among males and the majority are of a young age. The accidents usually occur during the spring and summer. Most injuries are minor but 3.6% required admission. Department of Emergency Medicine, The National University Hospital of Iceland1, Icelandic Transportation Safety Board2, Faculty of Medicine, University of Iceland3 KEY WORDS: bicycle accident, emergency department, helmet, injury. Correspondence: Hjalti Mar Bjornsson, hjaltimb@landspitali.is.