Torsten Eken

Oslo University Hospital · Division of Emergencies and Critical Care

Purpose This study explores the protective capabilities of bicycle helmets on serious head injury among bicyclists hospitalized in a Norwegian level 1 trauma centre. Method Information on helmet use, demographic variables, Abbreviated Injury Scale (AIS) and surgical procedure codes was retrieved from the Oslo University Hospital Trauma Registry fo...

This study investigates the impact of helmet use on the incidence of facial fractures in bicycle accidents. Analyzing data from hospitalized bicyclists between 2005 and 2016, the research focused on the correlation between helmet usage and various facial fractures. The study included 1256 bicyclists with known helmet use, among whom 277 individuals...

Purpose To compare the types of facial fractures and their treatment in bicyclists admitted to a level 1 trauma centre with major and minor-moderate head injury. Methods Retrospective analysis of data from bicycle-related injuries in the period 2005–2016 extracted from the Oslo University Hospital trauma registry. Results A total of 967 bicyclist...

Background: National quality data for trauma care in Norway have not previously been reported. We have therefore assessed crude and risk-adjusted 30-day mortality in trauma cases after primary hospital admission on national and regional levels for 36 acute care hospitals and four regional trauma centres. Methods: All patients in the Norwegian Tr...

Bicyclists are vulnerable road users. The authors aimed to characterise facial fractures and their association with head and neck injuries in bicyclists admitted to a Scandinavian Level 1 trauma center with a catchment area of ~3 million inhabitants. Data from bicycle-related injuries in the period 2005 to 2016 were extracted from the Oslo Universi...

Objectives Describe patient transfer patterns within a large Norwegian hospital. Identify risk factors associated with a high number of transfers. Develop methods to monitor intrahospital patient flows to support capacity management and infection control. Design Retrospective observational study of linked clinical data from electronic health recor...

Background Alarmins are considered proximal mediators of the immune response after tissue injury. Understanding their biology could pave the way for development of new therapeutic targets and biomarkers in human disease, including multiple trauma. In this study we explored high-resolution concentration kinetics of the alarmin interleukin-33 (IL-33)...

Background Complement activation is a central mechanism in systemic inflammation and remote organ dysfunction following major trauma. Data on temporal changes of complement activation early after injury is largely missing. We aimed to describe in detail the kinetics of complement activation in individual trauma patients from admission to 10 days af...

Background: Trauma patients have high concentrations of circulating extracellular vesicles (EVs) following injury, but the functional role of EVs in this setting is only partly deciphered. We aimed to describe in detail EV-associated procoagulant activity in individual trauma patients during the first 12 hours after injury in order to explore thei...

Introduction Traumatic injuries constitute a major cause of mortality and morbidity. Still, the public health burden of trauma in Norway has not been characterised using nationwide registry data. More knowledge is warranted on trauma risk factors and the long-term outcomes following trauma. The Injury Prevention and long-term Outcomes following Tra...

Background: HMGB1 is a mediator of systemic inflammation in sepsis and trauma, and a promising biomarker in many diseases. There is currently no standard operating procedure for pre-analytical handling of HMGB1 samples, despite that pre-analytical conditions account for a substantial part of the overall error rate in laboratory testing. We hypothe...

Introduction Norwegian authorities encourage people to commute by bicycle to improve public health, decrease rush-hour traffic jams and reduce pollution. However, increasing the number of bicyclists, especially in the rush-hour traffic, may increase the number of serious bicycle injuries. Objective To explore trends in hospitalized bicycle injurie...

Background/Aim Despite its many benefits, bicycling carries the risk of accidents. Although numerous studies have reported the effect of helmet use on traumatic brain injury, it remains unclear if, and to what extent, helmet use reduces the risk of facial injuries. This is particularly true in regard to injuries of the lower face. In addition, ther...

PurposeTo evaluate whether an arterial phase scan improves the diagnostic performance of computed tomography to identify pelvic trauma patients who received angiographic intervention on demand of the trauma surgeon.Methods This retrospective single-center study was performed at an academic Scandinavian trauma center with approximately 2000 trauma a...

Background: Trauma survival prediction models can be used for quality assessment in trauma populations. The Norwegian survival prediction model in trauma (NORMIT) has been updated recently and validated internally (NORMIT 2). The aim of this observational study was to compare the accuracy of NORMIT 1 and 2 in two Swedish trauma populations. Metho...

Acute low back pain (ALBP) causes rapid deterioration of paraspinal muscle function. The underlying neurophysiology is poorly understood. We therefore carried out this observational study in ALBP patients to characterize motor unit (MU) activity in deep lumbar multifidus (LM) muscle and compare to our previous findings from pain free subjects. Nine...

Aim: To explore the role of tonic motor unit activity in body temperature control. Methods: Motor unit activity in soleus and several other skeletal muscles were recorded electromyographically from adult rats placed in a climate chamber on a load sensitive floor, which, together with video monitoring, allowed detection of every successive period...

Objectives: The causal role of the prototype alarmin high mobility group box 1 protein in systemic inflammation and remote organ injury after trauma and shock is established in animal models but not in humans. Our aim was therefore to determine high mobility group box 1 protein concentration kinetics with high time resolution during the first hour...

Purpose To perform a systematic review and meta-analysis of acute kidney injury (AKI) in trauma patients admitted to the intensive care unit (ICU). Methods We conducted a systematic literature search of studies on AKI according to RIFLE, AKIN, or KDIGO criteria in trauma patients admitted to the ICU (PROSPERO CRD42017060420). We searched PubMed, C...

Background Although non-operative management (NOM) has become the treatment of choice in hemodynamically normal patients with liver injuries, the optimal management of Organ Injury Scale (OIS) grades 4 and 5 injuries is still controversial. Oslo University Hospital Ulleval (OUHU) has since 2008 performed angiography only with signs of bleeding. Sim...

Precise electrode placement is essential for obtaining useful electromyographic (EMG) recordings. Our aim was to develop a protocol for computerized-tomography (CT) guided fine-wire (FW) electrode placement that permits confirmation of the final electrode position in the deep posterior cervical multifidus (CM). FW-EMG electrodes were custom-made fr...

Background Trauma is a leading global cause of death, and predicting the burden of trauma admissions is vital for good planning of trauma care. Seasonality in trauma admissions has been found in several studies. Seasonal fluctuations in daylight hours, temperature and weather affect social and cultural practices but also individual neuroendocrine r...

Background Split-bolus computed tomography (CT) is a recent development in trauma imaging. Instead of multiple scans in different contrast phases after a single contrast bolus, split-bolus protocols consist of one single scan of the thorax and abdomen after two or three contrast injections at different points of time. Purpose To evaluate and compa...

Introduction: Anatomic injury, physiological derangement, age, injury mechanism and pre-injury comorbidity are well-founded predictors of trauma outcome. Statistical prediction models may have poorer discrimination, calibration and accuracy when applied in new locations. We aimed to compare the TRISS, TARN and NORMIT survival prediction models in...

Background Assessment of trauma-system performance is important for improving the care of injured patients. The aim of the study was to compare risk-adjusted survival in two Scandinavian Level-I trauma centres. Methods This was an observational, retrospective study of prospectively-collected trauma registry data for patients >14 years from Karolin...

Background Although nonoperative management (NOM) has become standard care, optimal treatment of liver injuries in children is still challenging since many of these patients have multiple injuries. Moreover, the role of angiography remains poorly defined, and a high index of suspicion of complications is warranted. This study reviews treatment and...

The underlying neurophysiology of postural control of the lower back in humans is poorly understood. We have characterized motor unit (MU) discharge activity in the deep lumbar multifidus (LM) muscle in 9 healthy subjects (20-40 years, 3 females). Bilateral fine wire electrodes were implanted at L4 spinal level using ultrasound guidance. EMG was re...

To compare benefits and harms of low molecular weight heparin (LMWH) versus unfractionated heparin (UFH) as thromboprophylaxis in intensive care unit (ICU) patients. We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomised controlled trials (RCTs) comparing LMWH with UFH as thromboprophylaxis in adult IC...

Background: Outcome after trauma depends on patient characteristics, quality of care, and random events. The TRISS model predicts probability of survival (Ps) adjusted for Injury Severity Score (ISS), Revised Trauma Score (RTS), mechanism of injury, and age. Quality of care is often evaluated by calculating the number of "excess" survivors, year b...

Introduction Damage control surgery and damage control resuscitation have reduced mortality in patients with severe abdominal injuries. The shift towards non-operative management in haemodynamically stable patients suffering blunt abdominal trauma has further contributed to the improved results. However, in many countries, low volume of trauma case...

Exsanguination due to trauma-induced coagulopathy is a continuing challenge in emergency trauma care. Fibrinogen is a crucial factor for haemostatic competence, and may be the factor that reaches critically low levels first. Early fibrinogen substitution is advocated by a number of authors. Little evidence exists regarding the indications for fibri...

Anatomic injury, physiological derangement, age, and injury mechanism are well-founded predictors of trauma outcome. We aimed to develop and validate the first Scandinavian survival prediction model for trauma. Eligible were patients admitted to Oslo University Hospital Ullevål within 24 h after injury with Injury Severity Score ≥ 10, proximal pene...

The justification and safety of splenic angiographic embolization (SAE) as an adjunct to nonoperative management (NOM) in high-grade splenic injuries are matters of controversy. At Oslo University Hospital-Ulleval, mandatory SAE was introduced in hemodynamically stable Organ Injury Scale (OIS) Grades 3 to 5 injuries in 2002. From October 2008, mand...

Triage is the process of classifying patients according to injury severity and determining the priority for further treatment. Although the term "major trauma" represents the reference against which over- and undertriage rates are calculated, its definition is inconsistent in the current literature. This study aimed to investigate the effects of di...

Background The European UN ECE17 regulation states that car backseats should sustain hits from 36 kg luggage in 20 to 28 g. This weight seems unrealistically low; still dur- ing crash tests such loads wrecked seatbacks and injured rear seat test dummies. Methods In car crashes with suspected severe person injury, dedi- cated paramedics documented l...

Moving objects may pose an added threat to car occupants in motor vehicle accidents (MVAs). However, to our knowledge, there have only been two case studies published on the subject. For the present study, accident reports and photo documentation from MVAs were collected on-scene by dedicated paramedics. Emergency medical service personnel on-scene...

A registry-based analysis revealed imprecise informal one-tiered trauma team activation (TTA) in a primary trauma centre. A two-tiered TTA protocol was introduced and analysed to examine its impact on triage precision and resource utilization. Interhospital transfers and patients admitted by non-healthcare personnel were excluded. Undertriage was d...

We present a detailed comparison of the behavioral and electrophysiological development of seizure activity in mice genetically depleted of synapsin I and synapsin II (SynDKO mice), based on combined video and surface EEG recordings. SynDKO mice develop handling-induced epileptic seizures at the age of 2months. The seizures show a very regular beha...

Few studies have evaluated intrainstitutional improvement of trauma care. We hypothesized that the formalization of a dedicated multidisciplinary trauma service in a major Scandinavian trauma center in 2005 would result in improved outcome. Institutional trauma registry data for 7,243 consecutive patients from the years 2002-2008 were retrospective...

Objectives: To investigate motor unit firing patterns responsible for prolonged psychogenic muscle activation. Methods: Integrated surface electromyography [EMG] and single motor unit EMG were recorded from the upper left trapezius muscle of a physically inactive healthy subject solving a reaction time task of 10 min. duration. Results: A stable ps...

Field triage is important for regional trauma systems providing high sensitivity to avoid that severely injured are deprived access to trauma team resuscitation (undertriage), yet high specificity to avoid resource over-utilization (overtriage). Previous informal trauma team activation (TTA) at Ulleval University Hospital (UUH) caused imprecise tri...

Background: Death during acute care hospitalisation is commonly used as a principal outcome indicator in injury research. This endpoint excludes post-hospital trauma-related deaths, which are substantial according to recent US studies. Two additional ways of defining outcome in trauma victims are also used; by end of somatic care, and at 30 days a...

Tonic firing behavior in soleus muscle of unrestrained rats aged 7 to >or=100 days was studied by chronic single-motor-unit and gross-electromyographic (EMG) recordings. Median motor-unit firing frequency at 10 days was 19-26 Hz and did not change appreciably after this time, whereas interval-to-interval firing variability was reduced with age. Two...

The ability of an organism to withstand trauma is determined by the injury per se and inherent properties of the organism at the time of injury. We analyzed whether pre-injury morbidity scored on a four-level ordinal scale according to the American Society of Anesthesiologists Physical Status (ASA-PS) classification system predicts mortality after...

We hypothesised that a formal treatment protocol for liver injuries including angiography would increase the non-operative management (NOM) rate and would be efficient as an adjunct to damage control surgery. During the 4-year period from 1 August 2000, a total of 138 adult patients with liver injuries were admitted to the largest trauma centre in...

Although several changes were implemented in the 1998 update of the abbreviated injury scale (AIS 98) versus the previous AIS 90, both are still used worldwide for coding of anatomic injury in trauma. This could possibly invalidate comparisons between systems using different AIS versions. Our aim was to evaluate whether the use of different coding...

Nonoperative management (NOM) of patients with severe splenic injuries carries a significant risk of failure. We hypothesized that adding angiographic embolization (AE) to the NOM protocol would decrease the laparotomy rate, and increase the success rate of NOM and splenic salvage rate. A protocol introducing AE in the treatment of splenic injuries...

Using prospectively collected data from Ulleval University Hospital in Norway, standard TRISS-based methods with case mix correction were compared with analysis based on ISS stratified data. Reference data were The Major Trauma Outcome Study (MTOS) controlled sites, used for calculation of AIS 90 based TRISS coefficients. Present TRISS convention r...

Some of the problems faced in trauma surgery are increasing non-operative management of abdominal injuries, decreasing work hours and increasing sub-specialisation. We wanted to document the experience of trauma team leaders at the largest trauma centre in Norway, hypothesising that the patient volume would be inadequate to secure optimal trauma ca...

This paper compares the activity of hindlimb motor units from muscles mainly composed of fast-twitch muscle fibers (medial and lateral gastrocnemius: MG/LG, tibialis anterior: TA) to motor units from a muscle mainly composed of slow-twitch muscle fibers (soleus: SOL) during unrestrained walking in the conscious rat. Several differences in the activ...

To measure and compare the size of the sphenoid sinuses in patients with cystic fibrosis (CF) to patients with inflammatory sinonasal disease, and to correlate the size with number of CF mutations in each patient. Ninety-six CF patients aged 5-47 years (median 19 years) and 130 control patients aged 7-51 years (median 32 years) were examined using...

The activity of hindlimb motor units from the lateral gastrocnemius and tibialis anterior muscles in the awake rat was compared during locomotion and during slow, sinusoidal muscle stretch. The majority of units were activated with high initial frequencies and often commenced firing with an initial doublet or triplet, even when activated by slow mu...

The expression of plateau potentials in spinal motor neurons is regulated by neuromodulatory substances. Recent experiments have shed new light on this regulation at the cellular level. It is now possible to evaluate the existence of plateau potentials in intact organisms, including humans, and to address the functional role of plateau potentials i...

Single-motor-unit and gross electromyograms (EMG) were recorded from the soleus muscle in six unrestrained rats. The median firing frequencies of nine motor units were in the 16-25 Hz range, in agreement with previous studies. One additional motor unit had a median firing frequency of 47 Hz. This unit and one of the lower-frequency units regularly...

Serotonin (5-HT) and norepinephrine-dependent plateau potentials are found in spinal motoneurons in reduced turtle and cat preparations. Triggering the plateau potential by short-lasting synaptic excitation causes a prolonged self-sustained firing, which can be terminated by short-lasting synaptic inhibition. The presence of plateau potentials can...

Activity of single motor units in relation to surface electromyography (EMG) was studied in 11 subjects in attention-demanding work tasks with minimal requirement of movement. In 53 verified firing periods, single motor units fired continuously from 30 s to 10 min (duration of the experiment work task) with a stable median firing rate in the range...

1. To assess the role of descending monoaminergic pathways for motor activity long-lasting EMG recordings were performed from the adult soleus muscle before and after selective depletion of spinal monoamines. 2. Rats were chronically implanted with an intrathecal catheter placed in the lumbar subarachnoid space and gross-EMG recording electrodes in...

Objectives: To investigate motor unit firing patterns responsible for prolonged psychogenic muscle activation. Methods: Integrated surface electromyography [EMG] and single motor unit EMG were recorded from the upper left trapezius muscle of a physically inactive healthy subject solving a reaction time task of 10 min. duration. Results: A stable ps...

Soleus (SOL) and extensor digitorum longus (EDL) muscles were denervated and directly stimulated for 23-69 days through implanted electrodes employing three different patterns. The stimulation was delivered in impulse trains where the pulse frequency differed (20, 75, and 150 Hz), while the train duration (0.3 s) and train repetition rate (1 min-1)...

EMG recordings from single motor units in the soleus muscle were performed in alert unrestrained rats. A cuff electrode around the tibial nerve and subcutaneously placed electrodes in the foot permitted stimulation of afferent fibres. The movements of the rat and the simultaneous EMG activity were displayed together on a video monitor. Most motor u...

An increasing number of vertebrate central neurones has been shown to possess complex membrane properties. However, the functional significance of such properties is unclear. The aim of the present paper is to review some old and new findings in this field from this laboratory. First, a bistability in alpha motoneurones in reduced preparations is d...

1. The slow-twitch soleus muscle and the fast-twitch extensor digitorum longus muscle (EDL) were denervated and stimulated directly with implanted electrodes for 33-82 days. Four different stimulation patterns were used in order to mimic important characteristics of the natural motor-unit activity in these muscles. In addition, to compare the effec...