Loek P H Leenen

Publications (9)25.13 Total impact

• Article: Video registration of trauma team performance in the emergency department: the results of a 2-year analysis in a Level 1 trauma center.

  Pieter H W Lubbert, Edgar G Kaasschieter, Lidewij E Hoorntje, Loek P H Leenen
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  ABSTRACT: Trauma teams responsible for the first response to patients with multiple injuries upon arrival in a hospital consist of medical specialists or resident physicians. We hypothesized that 24-hour video registration in the trauma room would allow for precise evaluation of team functioning and deviations from Advanced Trauma Life Support (ATLS) protocols. We analyzed all video registrations of trauma patients who visited the emergency room of a Level I trauma center in the Netherlands between September 1, 2000, and September 1, 2002. Analysis was performed with a score list based on ATLS protocols. From a total of 1,256 trauma room presentations, we found a total of 387 video registrations suitable for analysis. The majority of patients had an injury severity score lower than 17 (264 patients), whereas 123 patients were classified as multiple injuries (injury severity score >or=17). Errors in team organization (omission of prehospital report, no evident leadership, unorganized resuscitation, not working according to protocol, and no continued supervision of the patient) lead to significantly more deviations in the treatment than when team organization was uncomplicated. Video registration of diagnostic and therapeutic procedures by a multidisciplinary trauma team facilitates an accurate analysis of possible deviations from protocol. In addition to identifying technical errors, the role of the team leader can clearly be analyzed and related to team actions. Registration strongly depends on availability of video tapes, timely started registration, and hardware functioning. The results from this study were used to develop a training program for trauma teams in our hospital that specifically focuses on the team leader's functioning.
  The Journal of trauma 12/2009; 67(6):1412-20. · 2.48 Impact Factor
• Article: Determinants of long-term functional consequences after major trauma.

  Herman R Holtslag, Ed F van Beeck, Eline Lindeman, Loek P H Leenen
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  ABSTRACT: The purpose of this study was to describe the long-term functional consequences from major trauma and to quantify the effect of sociodemographic, injury-related, and physical determinants of its outcome. A prospective cohort study was performed at the University Medical Center Utrecht (Level I trauma center) in the Netherlands during 1999 and 2000. All severely (injury severity score [ISS] >or=16) injured adult (age >or=16) trauma survivors (n = 359) were selected for follow-up. Between 12 and 18 months after trauma, outcome was assessed by means of Glasgow Outcome Scale (GOS), EuroQol (EQ-5D), and cognitive complaints. Follow-up assessments (overall response rate 93%) were obtained of 335 patients (249 men, 86 women) with a mean age of 38 years (SD = 17) and a mean ISS of 25 (SD = 10.6). The mean visual analog scale score on the EuroQol (EQvas) was 73.5 (SD = 17.8) and the mean utility score (EQus) was 69.1 (SD = 29.9), both below the norm. Patients reported limitations of mobility (48%); self-care (18%); daily activities (55%); pain and discomfort (63%); anxiety or depression (28%); and cognitive complaints (65%). In multivariate analyses, injury localization (spinal cord injury, lower extremity injury, or brain injury) was significantly associated with EQvas, EQus, and other outcome measures. Educational level was significantly associated with EQvas, anxiety/depression, and cognitive complaints. Comorbidity was significantly associated with EQvas, EQus, all dimensions of the EQ-5D (except anxiety/depression), and cognitive complaints. In addition to the injury localization, educational level and comorbidity were identified as important independent predictors of long-term functional consequences after major trauma. These determinants need further attention in outcome research and clinical practice.
  The Journal of trauma 04/2007; 62(4):919-27. · 2.48 Impact Factor
• Source

  Available from: Cor J Kalkman

  Article: Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury.

  Olaf L Cremer, Gert W van Dijk, Erik van Wensen, Geert J F Brekelmans, Karel G M Moons, Loek P H Leenen, Cor J Kalkman
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  ABSTRACT: : Intracranial hypertension after severe head injury is associated with case fatality, but there is no sound evidence that monitoring of intracranial pressure (ICP) and targeted management of cerebral perfusion pressure (CPP) improve outcome, despite widespread recommendation by experts in the field. The purpose was to determine the effect of ICP/CPP-targeted intensive care on functional outcome and therapy intensity levels after severe head injury. : Retrospective cohort study with prospective assessment of outcome. : Two level I trauma centers in The Netherlands from 1996 to 2001. : Three hundred thirty-three patients who had survived and remained comatose for >24 hrs, from a total of 685 consecutive severely head-injured adults. : In center A (supportive intensive care), mean arterial pressure was maintained at approximately 90 mm Hg, and therapeutic interventions were based on clinical observations and computed tomography findings. In center B (ICP/CPP-targeted intensive care), management was aimed at maintaining ICP <20 mm Hg and CPP >70 mm Hg. Allocation to either trauma center was solely based on the site of the accident. : We measured extended Glasgow Outcome Scale after >/=12 months. Patient characteristics were well balanced between the centers. ICP monitoring was used in zero of 122 (0%) and 142 of 211 (67%) patients in centers A and B, respectively. In-hospital mortality rate was 41 (34%) vs. 69 (33%; p = .87). The odds ratio for a more favorable functional outcome following ICP/CPP-targeted therapy was 0.95 (95% confidence interval, 0.62-1.44). This result remained after adjustment for potential confounders. Sedatives, vasopressors, mannitol, and barbiturates were much more frequently used in center B (all p < .01). The median number of days on ventilator support in survivors was 5 (25th-75th percentile, 2-9) in center A vs. 12 (7-19) in center B (p < .001). : ICP/CPP-targeted intensive care results in prolonged mechanical ventilation and increased levels of therapy intensity, without evidence for improved outcome in patients who survive beyond 24 hrs following severe head injury.
  Critical Care Medicine 10/2005; 33(10):2207-13. · 6.33 Impact Factor
• Source

  Available from: Abid Jan

  Article: The registration of complications in surgery: a learning curve.

  Eelco J Veen, Maryska L G Janssen-Heijnen, Loek P H Leenen, Jan A Roukema
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  ABSTRACT: Registration of complications in surgery is an important method used for quality improvement. Unfortunately many different definitions and classification systems have been used, which influences the interpretation and the outcome of complication registration. Since 1986 complications have been registered on a daily basis in our surgical department. We focus in this article on the influence of changes in interpretation of the definition and registration methods used on the incidence of registered complications. Between 1986 and 1993 complications registered were strictly related to surgical procedures. In the second period, between 1993 and 2001, the interpretation of the definition changed and all adverse events were registered in a patient-centred way, not only related to the surgical procedure. The definition used in both periods did not change. In 1993 we started with the implementation of a fully automated registration system in our surgical department. In the first period 1699 (7%) complications in 24,201 surgical procedures were registered and in the second period 8335 (27%) complications were registered in 31,161 surgical procedures. A dramatic increase in the total number of registered complications was seen with the implementation of a fully automated registration system and a patient-centred way of registering complications. In the context of the evolving discussion of quality of care, a uniform definition and registration system has to be used to assure reliable outcome data in surgery and to form a basis for comparison.
  World Journal of Surgery 04/2005; 29(3):402-9. · 2.36 Impact Factor
• Article: Prevalence and determinants of disabilities and return to work after major trauma.

  Wouter J Vles, Ewout W Steyerberg, Marie-Louise Essink-Bot, Ed F van Beeck, J Dik Meeuwis, Loek P H Leenen
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  ABSTRACT: The purpose of this study was to assess the prevalence and determinants of disabilities and return to work after severe injury in a Dutch, Level I trauma center. We prospectively included 295 patients with an Injury Severity Score > or = 16 treated between January 1996 and January 1999. All survivors received a mailed questionnaire in 2000, at least 1 year after their initial hospital admission. Health status was measured by the EuroQol-5D instrument, and the Glasgow Outcome Scale. Additional questions were asked about cognitive functioning and return-to-work rates. Regression analyses was conducted to explore the associations between these functional outcome measures and patient characteristics. Of the 295 patients included, 99 (34%) died in hospital or during follow-up. From the 196 survivors, a response was obtained from 166 (85%). Of the survivors, 33% had to change their work or daily activity as a result of their injuries. Of the 127 patients of working age (18-65 years), 33 (26%) were unable to work and depended on social security. Problems with mobility, self-care, daily activities, pain/discomfort, anxiety/depression, and cognitive ability were found in 34%, 15%, 51%, 58%, 37%, and 57%, respectively. The EuroQol-5D summary score (0.76) was far below that of the general population norms. The number of body areas affected, injury severity (Injury Severity Score > or = 25), and gender (female) were significant independent predictors of worse long-term functional outcome. Severe trauma has a substantial impact on long-term functioning. Empiric quantitative data, as presented in this study, enable us to estimate the burden of injury and to evaluate the quality of trauma care programs.
  The Journal of trauma 02/2005; 58(1):126-35. · 2.48 Impact Factor
• Article: Prevalence and Determinants of Disabilities and Return to Work after Major Trauma

  Wouter J. Vles, Ewout W. Steyerberg, Marie-Louise Essink-Bot, Ed F. van Beeck, J Dik Meeuwis, Loek P.H. Leenen
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  ABSTRACT: Objective: The purpose of this study was to assess the prevalence and determinants of disabilities and return to work after severe injury in a Dutch, Level I trauma center. Methods: We prospectively included 295 patients with an Injury Severity Score ≥ 16 treated between January 1996 and January 1999. All survivors received a mailed questionnaire in 2000, at least 1 year after their initial hospital admission. Health status was measured by the EuroQol-5D instrument, and the Glasgow Outcome Scale. Additional questions were asked about cognitive functioning and return-to-work rates. Regression analyses was conducted to explore the associations between these functional outcome measures and patient characteristics. Results: Of the 295 patients included, 99 (34%) died in hospital or during follow-up. From the 196 survivors, a response was obtained from 166 (85%). Of the survivors, 33% had to change their work or daily activity as a result of their injuries. Of the 127 patients of working age (18-65 years), 33 (26%) were unable to work and depended on social security. Problems with mobility, self-care, daily activities, pain/discomfort, anxiety/depression, and cognitive ability were found in 34%, 15%, 51%, 58%, 37%, and 57%, respectively. The EuroQol-5D summary score (0.76) was far below that of the general population norms. The number of body areas affected, injury severity (Injury Severity Score ≥ 25), and gender (female) were significant independent predictors of worse long-term functional outcome. Conclusion: Severe trauma has a substantial impact on long-term functioning. Empiric quantitative data, as presented in this study, enable us to estimate the burden of injury and to evaluate the quality of trauma care programs.
  The Journal of Trauma and Acute Care Surgery. 12/2004; 58(1):126-135.
• Article: Pre-hospital trauma care: a proposal for more efficient evaluation.

  Wouter J Vles, Ewout W Steyerberg, J Dik Meeuwis, Loek P H Leenen
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  ABSTRACT: Although mortality is an important outcome parameter for pre-hospital trauma care, it is influenced by many factors other than pre-hospital trauma care alone. We therefore studied an alternative method to evaluate pre-hospital trauma care by calculating the change in probability of survival (Ps) according to the TRISS methodology, before and directly after the pre-hospital trauma care. Correlations between patient characteristics and a change in Ps were assessed. Further, required sample sizes were calculated for an 80% power to detect a hypothetical 3% reduction in mortality and the corresponding change in Ps. In 140 of 191 patients with an Injury Severity Score > or =16, the Ps did not change. In 36, the Ps increased and in 15 patients, the Ps decreased. Between these three groups, significant differences were found in Revised Trauma Score and age, but no clear differences in Injury Severity Score or mortality. A 3% difference in mortality would require 6800 patients, in contrast to 3500 when the change in Ps was the primary outcome parameter. A change in Ps is a promising outcome parameter for a more efficient evaluation of pre-hospital trauma care. A good collaboration is, however, required between ambulance services and the trauma center for reliable registration.
  Injury 09/2004; 35(8):725-33. · 1.98 Impact Factor
• Article: Transient adrenocortical insufficiency following traumatic bilateral adrenal hemorrhage.

  Maureen M J Guichelaar, Loek P H Leenen, Reinier Braams
  The Journal of trauma 06/2004; 56(5):1135-7. · 2.48 Impact Factor
• Source

  Available from: Wouter J Vles

  Article: Consequences of delayed diagnoses in trauma patients: a prospective study.

  Wouter J Vles, Eelco J Veen, Jan A Roukema, J Dik Meeuwis, Loek P H Leenen
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  ABSTRACT: The approach to trauma care has improved in recent decades but delayed diagnoses still occur. This study aimed to analyze the prevalence and consequences of delayed diagnoses in a single European trauma center. The effect of a systematic reexamination of the patient (tertiary survey) and reevaluation of x-rays and CT scans was evaluated. We prospectively registered complications among all trauma patients admitted to our hospital from January 1, 1996, to January 1, 2000. All relevant trauma and patient-related data were added by the physician to a hospital-wide trauma database with client server architecture. Complications including delay in diagnosis were subsequently added to this database. Admitted trauma patients underwent a tertiary survey and all x-rays and CT scans were reevaluated within 24 hours after admission. A total of 3,879 patients were studied and 1,016 complications were registered. Of all complications 55 concerned delayed diagnoses detected in 49 patients (1.3%). In 28 of these patients (57.1%) the tertiary survey (20 of 49; 40.8%) and reevaluation of x-rays and CT scans (8 of 49; 16.3%) resulted in detection of delayed diagnoses within 24 hours. Detection of the remaining 21 delayed diagnoses occurred after more than 24 hours. Delayed diagnoses resulted in delayed treatment in 27 of the 49 patients (55.1%) and surgery was necessary in 12 patients (24.5%). None of the delayed diagnoses resulted in death. A prospective trauma and complication registration enables evaluation of the delays in diagnosis. In our study population more than half of the delayed diagnoses could be detected by a tertiary survey and reevaluation of x-rays and CT scans. Attempts to decrease the number of delayed diagnoses should prevent delays in treatment and improve the quality of trauma care.
  Journal of the American College of Surgeons 11/2003; 197(4):596-602. · 4.55 Impact Factor