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Koskinen, Lars-Owe D.
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Publications (10 of 79) Show all publications
Lindgren, C., Koskinen, L.-O., Ssozi, R. & Naredi, S. (2019). Cerebrospinal fluid lactate and neurological outcome after subarachnoid haemorrhage. Journal of clinical neuroscience, 60, 63-67
Open this publication in new window or tab >>Cerebrospinal fluid lactate and neurological outcome after subarachnoid haemorrhage
2019 (English)In: Journal of clinical neuroscience, ISSN 0967-5868, E-ISSN 1532-2653, Vol. 60, p. 63-67Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Increased lactate in cerebrospinal fluid (CSF) has been regarded as a marker for cerebral ischemia and damage in the central nervous system. The aim of this study was to evaluate if CSF-lactate was associated with; impaired cerebral circulation, outcome, sex, age, clinical condition or treatment after subarachnoid haemorrhage (SAH).

METHODS: This study consists of 33 patients (22 females, 11 males) with aneurysmal SAH treated at Umeå university hospital 2008-2009. Samples were obtained from external ventricular catheters 0-240 h after SAH. Normal CFS-lactate was defined as 1.2-2-1 mmol/L. Hunt & Hess scale assessed clinical condition. Impaired cerebral circulation was evaluated by clinical examination, transcranial doppler, CT-scan, and cerebral angiography. Glasgow outcome scale (GOS) evaluated outcome.

RESULTS: Seventy-nine CSF-lactate samples were analysed. CSF-lactate >2.1 mmol/L was found in 25/33 (76%) patients and in 50/79 (63%) samples. No difference in CSF-lactate levels was found over time. No association was found between patients with CSF-lactate >2.1 mmol/L and; sex, severity of clinical condition, impaired cerebral circulation or outcome. CSF-lactate >2.1 mmol/L was more common in patients ≥61 years of age (p = 0.04) and in patients treated with endovascular coiling compared to surgical clipping (p = 0.0001).

CONCLUSION: In patients with SAH, no association was found between increased CSF-lactate (>2.1 mmol/L) and severe clinical condition, impaired cerebral circulation or unfavourable outcome. Endovascular coiling and age ≥61 years was associated with CSF-lactate above >2.1 mmol/L.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Cerebral aneurysms, Cerebrospinal fluid, Cerebrovascular circulation, Critical care outcomes, Endovascular procedures, Lactic acid
National Category
Anesthesiology and Intensive Care Surgery
Identifiers
urn:nbn:se:umu:diva-152935 (URN)10.1016/j.jocn.2018.10.025 (DOI)000456753600011 ()30361053 (PubMedID)
Funder
The Kempe Foundations
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2019-02-26Bibliographically approved
Huijben, J. A., Wiegers, E. J. A., de Keizer, N. F., Maas, A. I. R., Menon, D., Ercole, A., . . . Vos, P. E. (2019). Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury. Critical Care, 23, Article ID 95.
Open this publication in new window or tab >>Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury
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2019 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 23, article id 95Article in journal (Refereed) Published
Abstract [en]

Background: We aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators.

Methods: A preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool.

Results. The expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N=24, 48%) and neurosurgeons (N=7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N=49, 98%) and indicated routine measurement in registries (N=41, 82%), benchmarking (N=42, 84%), and quality improvement programs (N=41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N=48, 98%).

Conclusions: This Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Quality indicators, Benchmarking, Traumatic brain injury, Intensive care unit, Trauma registry, Quality care
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-157950 (URN)10.1186/s13054-019-2377-x (DOI)000462208200002 ()30902117 (PubMedID)
Available from: 2019-04-17 Created: 2019-04-17 Last updated: 2019-04-17Bibliographically approved
Sandvig, A., Arnell, K., Malm, J., Eklund, A. & Koskinen, L.-O. D. (2018). Analysis of Codman microcerebrospinal fluid shunt. Brain and Behavior, 8(10), Article ID e01002.
Open this publication in new window or tab >>Analysis of Codman microcerebrospinal fluid shunt
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2018 (English)In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 8, no 10, article id e01002Article in journal (Refereed) Published
Abstract [en]

Introduction: Ventriculo-peritoneal cerebrospinal fluid (CSF) shunt is the most common method of treating pediatric hydrocephalus. The Codman microadjustable valve (CMAV) is a CSF shunt constructed for children. The objective of the study was (a) to analyze complications after insertion of a CMAV shunt in hydrocephalic children, (b)to analyze complications after replacing a CMAV by an adult-type Codman Hakim adjustable valve shunt (CHAV), and to (c) analyze the in vitro characteristics of the CMAV shunt and correlate the findings with the clinical performance of the shunt.

Methods: A retrospective study analyzed a cohort of hydrocephalic children who had received a CMAV shunt and later replaced by a CHAV shunt. We report on the complications that resulted from replacing the CMAV with the CHAV. We tested six CMAV shunts with or without an antisiphon device (ASD) in which opening pressure, resistance, sensitivity to abdominal pressure, ASD position dependency, and function were determined. The test results were correlated with the clinical performance of the shunt in the retrospective study.

Results: Thirty-seven children (19 boys, 18 girls) were identified. Within the first month after shunt placement, a total of 10 patients (27%) developed complications including infections, hygromas, and shunt dysfunction. Shunt survival varied from 1week to 145 months. Over the 10-year follow-up period, 13 children had their shunts replaced, six of them with a CHAV without any further complications. A bench test of the CMAV was done to test whether the opening pressure was in agreement with the manufacturer's specifications. Our results were generally in agreement with specifications stated by the manufacturer.

Conclusion: Replacing a CMAV with a CHAV was well tolerated by the patients. Bench test results were generally in agreement with manufacturers specifications. Replacing a CMAV with a CHAV in pediatric hydrocephalus patients can be accomplished safely.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
cerebrospinal fluid, clinical retrospective study
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-153130 (URN)10.1002/brb3.1002 (DOI)000447544700001 ()30207083 (PubMedID)2-s2.0-85053399281 (Scopus ID)
Available from: 2018-11-09 Created: 2018-11-09 Last updated: 2018-11-09Bibliographically approved
Sundström, N., Lagebrant, M., Eklund, A., Koskinen, L.-O. D. & Malm, J. (2018). Subdural hematomas in 1846 patients with shunted idiopathic normal pressure hydrocephalus: treatment and long-term survival. Journal of Neurosurgery, 129(3), 797-804
Open this publication in new window or tab >>Subdural hematomas in 1846 patients with shunted idiopathic normal pressure hydrocephalus: treatment and long-term survival
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2018 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 129, no 3, p. 797-804Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE Subdural hematoma (SDH) is the most common serious adverse event in patients with shunts. Adjustable shunts are used with increasing frequency and make it possible to noninvasively treat postoperative SDH. The objective of this study was to describe the prevalence and treatment preferences of SDHs, based on fixed or adjustable shunt valves, in a national cohort of patients with shunted idiopathic normal pressure hydrocephalus (iNPH), as well as to evaluate the effect of SDH and treatment on long-term survival.

METHODS Patients with iNPH who received a CSF shunt in Sweden from 2004 to 2015 were included in a prospective quality registry (n = 1846) and followed regarding SDH, its treatment, and mortality. The treatment of SDH was categorized into surgery, opening pressure adjustments, or no treatment.

RESULTS During the study period, the proportion of adjustable shunts increased from 75% to 95%. Ten percent (n = 184) of the patients developed an SDH. In 103 patients, treatment was solely opening pressure adjustment. Surgical treatment was used in 66 cases (36%), and 15 (8%) received no treatment. In patients with fixed shunt valves, 90% (n = 17) of SDHs were treated surgically compared with 30% (n = 49) in patients with adjustable shunts (p < 0.001). There was no difference in long-term patient survival between the SDH and non-SDH groups or between different treatments.

CONCLUSIONS SDH remains a common complication after shunt surgery, but adjustable shunts reduced the need for surgical interventions. SDH and treatment did not significantly affect survival in this patient group, thus the noninvasive treatment offered by adjustable shunts considerably reduces the level of severity for this common adverse event.

Place, publisher, year, edition, pages
American Association of Neurological Surgeons, 2018
Keywords
NPR = National Population Registry, SDH = subdural hematoma, SHDR = Swedish Hospital Discharge Registry, SHQR = Swedish Hydrocephalus Quality Register, cerebrospinal fluid shunt, complications, hydrocephalus, iNPH = idiopathic normal pressure hydrocephalus, normal pressure, subdural hematoma, survival, treatment
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-142422 (URN)10.3171/2017.5.JNS17481 (DOI)000443287000026 ()29076787 (PubMedID)
Available from: 2017-11-30 Created: 2017-11-30 Last updated: 2018-09-14Bibliographically approved
Koskinen, L.-O. D., Sundström, N., Hägglund, L., Eklund, A. & Olivecrona, M. (2018). The relation between brain interstitial clycerol and pressure reactivity in TBI is prostacyclin dependent. Paper presented at 3rd Joint Symposium of the International-and-National-Neurotrauma-Societies-and-AANS/CNS-Section on Neurotrauma and Critical Care, AUG 11-16, 2018, Toronto, CANADA. Journal of Neurotrauma, 35(16), A185-A185
Open this publication in new window or tab >>The relation between brain interstitial clycerol and pressure reactivity in TBI is prostacyclin dependent
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2018 (English)In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 35, no 16, p. A185-A185Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Mary Ann Liebert, 2018
Keywords
biomarker, intracranial pressure, neurocritical care
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-151558 (URN)000441527400497 ()
Conference
3rd Joint Symposium of the International-and-National-Neurotrauma-Societies-and-AANS/CNS-Section on Neurotrauma and Critical Care, AUG 11-16, 2018, Toronto, CANADA
Note

Meeting Abstract: PS2.04.10

Available from: 2018-09-10 Created: 2018-09-10 Last updated: 2018-09-10Bibliographically approved
Holmlund, P., Eklund, A., Koskinen, L.-O. D., Johansson, E., Sundström, N., Malm, J. & Qvarlander, S. (2018). Venous collapse regulates intracranial pressure in upright body positions. American Journal of Physiology. Regulatory Integrative and Comparative Physiology, 314(3), R377-R385
Open this publication in new window or tab >>Venous collapse regulates intracranial pressure in upright body positions
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2018 (English)In: American Journal of Physiology. Regulatory Integrative and Comparative Physiology, ISSN 0363-6119, E-ISSN 1522-1490, Vol. 314, no 3, p. R377-R385Article in journal (Refereed) Published
Abstract [en]

Recent interest in intracranial pressure (ICP) in the upright posture has revealed that the mechanisms regulating postural changes in ICP are not fully understood. We have suggested an explanatory model where the postural changes in ICP depend on well-established hydrostatic effects in the venous system and where these effects are interrupted by collapse of the internal jugular veins (IJVs) in more upright positions. The aim of this study was to investigate this relationship by simultaneous invasive measurements of ICP, venous pressure and IJV collapse in healthy volunteers. ICP (monitored via the lumbar route), central venous pressure (PICC-line) and IJV cross-sectional area (ultrasound) were measured in 11 healthy volunteers (47±10 years) in seven positions, from supine to sitting (0°-69°). Venous pressure and anatomical distances were used to predict ICP in accordance with the explanatory model, and IJV area was used to assess IJV collapse. The hypothesis was tested by comparing measured ICP to predicted ICP. Our model accurately described the general behavior of the observed postural ICP changes (mean difference: -0.03±2.7 mmHg). No difference was found between predicted and measured ICP for any tilt-angle (p-values: 0.65 - 0.94). The results support the hypothesis that postural ICP changes are governed by hydrostatic effects in the venous system and IJV collapse. This improved understanding of the postural ICP regulation may have important implications for the development of better treatments for neurological and neurosurgical conditions affecting ICP.

Place, publisher, year, edition, pages
American Physiological Society, 2018
Keywords
Intracranial pressure, healthy volunteers, hydrocephalus, posture, venous pressure
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-142424 (URN)10.1152/ajpregu.00291.2017 (DOI)000426326500006 ()29118021 (PubMedID)
Available from: 2017-11-30 Created: 2017-11-30 Last updated: 2019-03-06Bibliographically approved
Olivecrona, Z. & Koskinen, L.-O. D. (2017). APOE epsilon 4 positive patients suffering severe traumatic head injury are more prone to undergo decompressive hemicraniectomy. Journal of clinical neuroscience, 42, 139-142
Open this publication in new window or tab >>APOE epsilon 4 positive patients suffering severe traumatic head injury are more prone to undergo decompressive hemicraniectomy
2017 (English)In: Journal of clinical neuroscience, ISSN 0967-5868, E-ISSN 1532-2653, Vol. 42, p. 139-142Article in journal (Refereed) Published
Abstract [en]

Object: In this paper we tested the hypothesis if patients with severe traumatic brain injury and presence of the apolipoprotein E (APOE) epsilon 4 allele are more prone to undergo the surgical procedure decompressive hemicraniectomy (DC) in order to bring the intracranial pressure (ICP) under control. Methods: In this prospective consecutive study patients with sTBI were enrolled (n = 48). Inclusion criteria were arrival to our level one trauma university hospital within 24 h after trauma, patient age between 15 and 70 years, Glasgow Coma Scale (GCS) score <= 8 at the time of intubation and sedation, an initial cerebral perfusion pressure >10 mm Hg. Venous blood was sampled for APOE genotype determination. Clinical outcome at 6 months after injury was assessed with the Extended Glasgow Outcome Scale (GOSE). All surgical procedures needed for each patient were registered. Results: Patients with the APOE epsilon 4 allele were significantly overrepresented in the DC group. In the APOE epsilon 4 + DC group, ICPmax and ICPmean mean during the first 36 h were significantly higher and GOSE was significantly worse at 6 months. Conclusion: Our data suggest that patients with the APOE epsilon 4 allele are predisposed for the need of DC more often than patients without the APOE epsilon 4 allele. Thus, it seems to be of importance to consider the APOE genotype in patients suffering severe traumatic brain injury in order to forecast the need for a more exquisite intensive care. (C) 2017 Published by Elsevier Ltd.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2017
Keywords
Severe traumatic brain injury, APOE epsilon 4, Hemicraniectomy
National Category
Neurosciences
Identifiers
urn:nbn:se:umu:diva-138417 (URN)10.1016/j.jocn.2017.03.024 (DOI)000405535800030 ()28372905 (PubMedID)
Available from: 2017-08-23 Created: 2017-08-23 Last updated: 2018-06-09Bibliographically approved
Nordström, C.-H., Koskinen, L.-O. & Olivecrona, M. (2017). Aspects on the Physiological and Biochemical Foundations of Neurocritical Care. Frontiers in Neurology, 8, Article ID 274.
Open this publication in new window or tab >>Aspects on the Physiological and Biochemical Foundations of Neurocritical Care
2017 (English)In: Frontiers in Neurology, ISSN 1664-2295, E-ISSN 1664-2295, Vol. 8, article id 274Article, review/survey (Refereed) Published
Abstract [en]

Neurocritical care (NCC) is a branch of intensive care medicine characterized by specific physiological and biochemical monitoring techniques necessary for identifying cerebral adverse events and for evaluating specific therapies. Information is primarily obtained from physiological variables related to intracranial pressure (ICP) and cerebral blood flow (CBF) and from physiological and biochemical variables related to cerebral energy metabolism. Non-surgical therapies developed for treating increased ICP are based on knowledge regarding transport of water across the intact and injured blood-brain barrier (BBB) and the regulation of CBF. Brain volume is strictly controlled as the BBB permeability to crystalloids is very low restricting net transport of water across the capillary wall. Cerebral pressure autoregulation prevents changes in intracranial blood volume and intracapillary hydrostatic pressure at variations in arterial blood pressure. Information regarding cerebral oxidative metabolism is obtained from measurements of brain tissue oxygen tension (PbtO2) and biochemical data obtained from intracerebral microdialysis. As interstitial lactate/pyruvate (LP) ratio instantaneously reflects shifts in intracellular cytoplasmatic redox state, it is an important indicator of compromised cerebral oxidative metabolism. The combined information obtained from PbtO2, LP ratio, and the pattern of biochemical variables reveals whether impaired oxidative metabolism is due to insufficient perfusion (ischemia) or mitochondrial dysfunction. Intracerebral microdialysis and PbtO2 give information from a very small volume of tissue. Accordingly, clinical interpretation of the data must be based on information of the probe location in relation to focal brain damage. Attempts to evaluate global cerebral energy state from microdialysis of intraventricular fluid and from the LP ratio of the draining venous blood have recently been presented. To be of clinical relevance, the information from all monitoring techniques should be presented bedside online. Accordingly, in the future, the chemical variables obtained from microdialysis will probably be analyzed by biochemical sensors.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2017
Keywords
neurocritical care, intracranial pressure, cerebral blood flow, cerebral energy metabolism, microdialysis
National Category
Neurology Neurosciences
Identifiers
urn:nbn:se:umu:diva-137631 (URN)10.3389/fneur.2017.00274 (DOI)000403714300001 ()
Available from: 2017-07-19 Created: 2017-07-19 Last updated: 2018-06-09Bibliographically approved
Koskinen, L.-O. D., Malm, J., Zakelis, R., Bartusis, L., Ragauskas, A. & Eklund, A. (2017). Can intracranial pressure be measured non-invasively bedside using a two-depth Doppler-technique?. Journal of clinical monitoring and computing, 31(2), 459-467
Open this publication in new window or tab >>Can intracranial pressure be measured non-invasively bedside using a two-depth Doppler-technique?
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2017 (English)In: Journal of clinical monitoring and computing, ISSN 1387-1307, E-ISSN 1573-2614, Vol. 31, no 2, p. 459-467Article in journal (Refereed) Published
Abstract [en]

Measurement of intracranial pressure (ICP) is necessary in many neurological and neurosurgical diseases. To avoid lumbar puncture or intracranial ICP probes, non-invasive ICP techniques are becoming popular. A recently developed technology uses two-depth Doppler to compare arterial pulsations in the intra- and extra-cranial segments of the ophthalmic artery for non-invasive estimation of ICP. The aim of this study was to investigate how well non-invasively-measured ICP and invasively-measured cerebrospinal fluid (CSF) pressure correlate. We performed multiple measurements over a wide ICP span in eighteen elderly patients with communicating hydrocephalus. As a reference, an automatic CSF infusion apparatus was connected to the lumbar space. Ringer's solution was used to create elevation to pre-defined ICP levels. Bench tests of the infusion apparatus showed a random error (95 % CI) of less than ±0.9 mmHg and a systematic error of less than ±0.5 mmHg. Reliable Doppler signals were obtained in 13 (72 %) patients. An infusion test could not be performed in one patient. Thus, twelve patients and a total of 61 paired data points were studied. The correlation between invasive and non-invasive ICP measurements was good (R = 0.74), and the 95 % limits of agreements were -1.4 ± 8.8 mmHg. The within-patient correlation varied between 0.47 and 1.00. This non-invasive technique is promising, and these results encourage further development and evaluation before the method can be recommended for use in clinical practice.

Keywords
Non-invasive ICP, Transcranial-Doppler, Intracranial pressure, Ophthalmic artery, Infusion test
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-131142 (URN)10.1007/s10877-016-9862-4 (DOI)000396348800027 ()26971794 (PubMedID)
Available from: 2017-02-06 Created: 2017-02-06 Last updated: 2018-06-09Bibliographically approved
Stenberg, M., Koskinen, L.-O. D., Jonasson, P., Levi, R. & Stålnacke, B.-M. (2017). Computed tomography and clinical outcome in patients with severe traumatic brain injury. Brain Injury, 31(3), 351-358
Open this publication in new window or tab >>Computed tomography and clinical outcome in patients with severe traumatic brain injury
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2017 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 31, no 3, p. 351-358Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To study: (i) acute computed tomography (CT) characteristics and clinical outcome; (ii) clinical course and (iii) Corticosteroid Randomisation after Significant Head Injury acute calculator protocol (CRASH) model and clinical outcome in patients with severe traumatic brain injury (sTBI).

METHODS: Initial CT (CTi) and CT 24 hours post-trauma (CT24) were evaluated according to Marshall and Rotterdam classifications. Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE) were assessed at three months and one year post-trauma. The prognostic value of the CRASH model was evaluated.

RESULTS: Thirty-seven patients were included. Marshall CTi and CT24 were significantly correlated with RLAS-R at three months. Rotterdam CT24 was significantly correlated with GOSE at three months. RLAS-R and the GOSE improved significantly from three months to one year. CRASH predicted unfavourable outcome at six months for 81% of patients with bad outcome and for 85% of patients with favourable outcome according to GOSE at one year.

CONCLUSION: Neither CT nor CRASH yielded clinically useful predictions of outcome at one year post-injury. The study showed encouragingly many instances of significant recovery in this population of sTBI. The combination of lack of reliable prognostic indicators and favourable outcomes supports the case for intensive acute management and rehabilitation as the default protocol in the cases of sTBI.

Keywords
Computed tomography, outcome, severe traumatic brain injury
National Category
Other Medical Sciences not elsewhere specified Neurology
Identifiers
urn:nbn:se:umu:diva-132533 (URN)10.1080/02699052.2016.1261303 (DOI)000398005900010 ()28296529 (PubMedID)
Available from: 2017-03-16 Created: 2017-03-16 Last updated: 2018-06-09Bibliographically approved
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