Pub Date : 2025-02-20DOI: 10.1016/j.lanepe.2025.101244
Tom H. Karlsen , Frank Murray , Filippos T. Filippidis , Marieke Meijer , Pooja Jha , Gunhild Waldemar , Elizabeth Macintyre
{"title":"Opportunities for European medical societies within the European Global Health strategy","authors":"Tom H. Karlsen , Frank Murray , Filippos T. Filippidis , Marieke Meijer , Pooja Jha , Gunhild Waldemar , Elizabeth Macintyre","doi":"10.1016/j.lanepe.2025.101244","DOIUrl":"10.1016/j.lanepe.2025.101244","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"50 ","pages":"Article 101244"},"PeriodicalIF":13.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1016/j.lanepe.2025.101243
Miłosz Parczewski , Deniz Gökengin , Ann Sullivan , Julia de Amo , Gus Cairns , Stela Bivol , Giorgi Kuchukhidze , Marta Vasylyev , Jürgen K. Rockstroh
Despite the ambitious global goal to control HIV transmissions by 2030, more than 30% of people with HIV from the WHO European Region show persistent transmissible levels of the virus. Successful introduction of oral pre-exposure prophylaxis (PrEP) has led to significant decreases in new HIV transmissions in some areas of Europe, particularly among men who have sex with men. However, the limited PrEP access or lack of state funding in many European countries underlines the need to increase efforts to make PrEP consistently and equitably available for all individuals in need. The success of modern antiretroviral therapy (ART) is evident throughout the WHO European region, with more than 90% of treated individuals with viral suppression. Remaining barriers to control HIV include disparities in access to testing facilities such as community-based centers, persistently high levels of late diagnosis, delayed linkage to care especially for undocumented migrant populations, and inequalities in access to treatment. Retention in care and maintenance of viral suppression are additional challenges. The ongoing war in Ukraine is causing service disruption for people with HIV. Combating HIV associated stigma and discrimination, particularly in Eastern Europe and Central Asia, seems paramount in removing barriers to testing; new testing strategies, such as emergency room opt-out testing, could enable earlier diagnosis of HIV in transmission groups that have been difficult to reach. This review summarizes the barriers, opportunities, and pathways towards improvement of the HIV response in the WHO European region.
{"title":"Control of HIV across the WHO European region: progress and remaining challenges","authors":"Miłosz Parczewski , Deniz Gökengin , Ann Sullivan , Julia de Amo , Gus Cairns , Stela Bivol , Giorgi Kuchukhidze , Marta Vasylyev , Jürgen K. Rockstroh","doi":"10.1016/j.lanepe.2025.101243","DOIUrl":"10.1016/j.lanepe.2025.101243","url":null,"abstract":"<div><div>Despite the ambitious global goal to control HIV transmissions by 2030, more than 30% of people with HIV from the WHO European Region show persistent transmissible levels of the virus. Successful introduction of oral pre-exposure prophylaxis (PrEP) has led to significant decreases in new HIV transmissions in some areas of Europe, particularly among men who have sex with men. However, the limited PrEP access or lack of state funding in many European countries underlines the need to increase efforts to make PrEP consistently and equitably available for all individuals in need. The success of modern antiretroviral therapy (ART) is evident throughout the WHO European region, with more than 90% of treated individuals with viral suppression. Remaining barriers to control HIV include disparities in access to testing facilities such as community-based centers, persistently high levels of late diagnosis, delayed linkage to care especially for undocumented migrant populations, and inequalities in access to treatment. Retention in care and maintenance of viral suppression are additional challenges. The ongoing war in Ukraine is causing service disruption for people with HIV. Combating HIV associated stigma and discrimination, particularly in Eastern Europe and Central Asia, seems paramount in removing barriers to testing; new testing strategies, such as emergency room opt-out testing, could enable earlier diagnosis of HIV in transmission groups that have been difficult to reach. This review summarizes the barriers, opportunities, and pathways towards improvement of the HIV response in the WHO European region.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"52 ","pages":"Article 101243"},"PeriodicalIF":13.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1016/j.lanepe.2025.101228
Jasper P. Sijberden , Christoph Kuemmerli , Francesca Ratti , Mathieu D'Hondt , Robert P. Sutcliffe , Roberto I. Troisi , Mikhail Efanov , Robert S. Fichtinger , Rafael Díaz-Nieto , Giuseppe M. Ettorre , Aali J. Sheen , Krishna V. Menon , Marc G. Besselink , Zahir Soonawalla , Somaiah Aroori , Rebecca Marino , Celine De Meyere , Ravi Marudanayagam , Giuseppe Zimmitti , Bram Olij , Mohammed Abu Hilal
Background
An increasing number of liver resections are performed laparoscopically, while laparoscopic resection of lesions in the posterosuperior segments is technically challenging. We aimed to assess the outcomes of laparoscopic and open parenchymal preserving resection of lesions in the posterosuperior segments in a randomised controlled trial.
Methods
In this multicentre, patient-blinded, superiority randomised controlled trial, patients requiring parenchymal preserving liver resection for tumours in segment 4a, 7, or 8 were enrolled at 17 centres and randomised 1:1 to laparoscopic or open surgery using a minimisation scheme stratifying for centre and lesion size. The primary endpoint was time to functional recovery measured in postoperative days. To detect a difference in time to functional recovery of two days the sample size needed 250 patients, an interim analysis was planned with 125 patients. Patients and outcome assessors were blinded to the allocation. The study was registered on clinicaltrials.gov, NCT03270917.
Findings
Between November 2017 and November 2021, 251 patients were randomised to laparoscopic (n = 125) or open (n = 126) surgery. The majority of patients had a preoperative diagnosis of cancer (225/246 = 91.5%). Time to functional recovery was 3 days (IQR 3–5) in the laparoscopic group compared to 4 days (IQR 3–5) in the open group (difference −19.2%, 96% CI −28.8% to −8.4%; p < 0.001). Hospital stay was similarly shorter in the laparoscopic group (4 days, IQR 3–5 versus 5 days, IQR 4–7; p < 0.001). There were three deaths in the laparoscopic group (3/122 = 2.5%) and one in the open group (1/124 = 0.8%) within 90 days of resection (p = 0.336). Overall postoperative morbidity, severe morbidity, liver-specific morbidity, and readmission were not statistically significant different between the groups. The radical resection (R0) rate in patients with cancer was comparable (laparoscopic 93/106 = 87.7% versus open 97/113 = 85.8%, p = 0.539).
Interpretation
For patients with lesions in the posterosuperior segments of the liver, laparoscopic surgery, as compared to open surgery, reduces time to functional recovery. However, this reduction in time to functional recovery did not meet the hypothesized difference in time to functional recovery of two days.
Funding
This investigator-initiated trial was funded by Ethicon (Johnson & Johnson), Cancer Research United Kingdom, and Maastricht University Medical Centre+.
{"title":"Laparoscopic versus open parenchymal preserving liver resections in the posterosuperior segments (ORANGE Segments): a multicentre, single-blind, randomised controlled trial","authors":"Jasper P. Sijberden , Christoph Kuemmerli , Francesca Ratti , Mathieu D'Hondt , Robert P. Sutcliffe , Roberto I. Troisi , Mikhail Efanov , Robert S. Fichtinger , Rafael Díaz-Nieto , Giuseppe M. Ettorre , Aali J. Sheen , Krishna V. Menon , Marc G. Besselink , Zahir Soonawalla , Somaiah Aroori , Rebecca Marino , Celine De Meyere , Ravi Marudanayagam , Giuseppe Zimmitti , Bram Olij , Mohammed Abu Hilal","doi":"10.1016/j.lanepe.2025.101228","DOIUrl":"10.1016/j.lanepe.2025.101228","url":null,"abstract":"<div><h3>Background</h3><div>An increasing number of liver resections are performed laparoscopically, while laparoscopic resection of lesions in the posterosuperior segments is technically challenging. We aimed to assess the outcomes of laparoscopic and open parenchymal preserving resection of lesions in the posterosuperior segments in a randomised controlled trial.</div></div><div><h3>Methods</h3><div>In this multicentre, patient-blinded, superiority randomised controlled trial, patients requiring parenchymal preserving liver resection for tumours in segment 4a, 7, or 8 were enrolled at 17 centres and randomised 1:1 to laparoscopic or open surgery using a minimisation scheme stratifying for centre and lesion size. The primary endpoint was time to functional recovery measured in postoperative days. To detect a difference in time to functional recovery of two days the sample size needed 250 patients, an interim analysis was planned with 125 patients. Patients and outcome assessors were blinded to the allocation. The study was registered on <span><span>clinicaltrials.gov</span><svg><path></path></svg></span>, <span><span>NCT03270917</span><svg><path></path></svg></span>.</div></div><div><h3>Findings</h3><div>Between November 2017 and November 2021, 251 patients were randomised to laparoscopic (n = 125) or open (n = 126) surgery. The majority of patients had a preoperative diagnosis of cancer (225/246 = 91.5%). Time to functional recovery was 3 days (IQR 3–5) in the laparoscopic group compared to 4 days (IQR 3–5) in the open group (difference −19.2%, 96% CI −28.8% to −8.4%; p < 0.001). Hospital stay was similarly shorter in the laparoscopic group (4 days, IQR 3–5 versus 5 days, IQR 4–7; p < 0.001). There were three deaths in the laparoscopic group (3/122 = 2.5%) and one in the open group (1/124 = 0.8%) within 90 days of resection (p = 0.336). Overall postoperative morbidity, severe morbidity, liver-specific morbidity, and readmission were not statistically significant different between the groups. The radical resection (R0) rate in patients with cancer was comparable (laparoscopic 93/106 = 87.7% versus open 97/113 = 85.8%, p = 0.539).</div></div><div><h3>Interpretation</h3><div>For patients with lesions in the posterosuperior segments of the liver, laparoscopic surgery, as compared to open surgery, reduces time to functional recovery. However, this reduction in time to functional recovery did not meet the hypothesized difference in time to functional recovery of two days.</div></div><div><h3>Funding</h3><div>This investigator-initiated trial was funded by <span>Ethicon</span> (<span>Johnson & Johnson</span>), <span>Cancer Research United Kingdom</span>, and <span>Maastricht University Medical Centre+</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"51 ","pages":"Article 101228"},"PeriodicalIF":13.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the Prevention Pillar of Europe's Beating Cancer Plan (EBCP), the European Commission made a series of commitments to promote better health for all, including proposals for new legislation on food and alcohol labelling. However, the implementation of these commitments has been paralysed. In this Viewpoint, we argue that this paralysis stems, in part at least, from insufficient incorporation of the principles of transparency and openness, which promote the accountability of policy actors through citizens' participation in the legislative process. This has led to a twofold problem: 1) the misplaced belief in the contribution that self-regulation can make to the promotion of healthier environments; and 2) the failure to adopt effective legally binding measures to regulate the commercial determinants of health, as the failure to publish the suite of legislative proposals promised in the EBCP epitomises.
{"title":"Lobbying, transparency and trust: power imbalances and the failure to implement Europe’s Beating Cancer Plan","authors":"Amandine Garde , Nikhil Gokani , Juan Collado Perez-Llantada , Jaydon Souter","doi":"10.1016/j.lanepe.2025.101238","DOIUrl":"10.1016/j.lanepe.2025.101238","url":null,"abstract":"<div><div>In the Prevention Pillar of Europe's Beating Cancer Plan (EBCP), the European Commission made a series of commitments to promote better health for all, including proposals for new legislation on food and alcohol labelling. However, the implementation of these commitments has been paralysed. In this Viewpoint, we argue that this paralysis stems, in part at least, from insufficient incorporation of the principles of transparency and openness, which promote the accountability of policy actors through citizens' participation in the legislative process. This has led to a twofold problem: 1) the misplaced belief in the contribution that self-regulation can make to the promotion of healthier environments; and 2) the failure to adopt effective legally binding measures to regulate the commercial determinants of health, as the failure to publish the suite of legislative proposals promised in the EBCP epitomises.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"51 ","pages":"Article 101238"},"PeriodicalIF":13.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143438016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1016/j.lanepe.2025.101245
Yang Chen , Ziyi Zhong , Ying Gue , Maciej Banach , Garry McDowell , Dimitri P. Mikhailidis , Peter P. Toth , Peter E. Penson , Tomasz Tomasik , Adam Windak , Marek Gierlotka , Tadeusz Osadnik , Agnieszka Kuras , Marcin Miga , Jacek Jozwiak , Gregory Y.H. Lip , LIPIDOGRAM2015 Investigators
{"title":"Correction to “Impact of surrogates for insulin resistance on mortality and life expectancy in primary care: a nationwide cross-sectional study with registry linkage (LIPIDOGRAM2015)” [The Lancet Regional Health – Europe 49 (2025) 101182]","authors":"Yang Chen , Ziyi Zhong , Ying Gue , Maciej Banach , Garry McDowell , Dimitri P. Mikhailidis , Peter P. Toth , Peter E. Penson , Tomasz Tomasik , Adam Windak , Marek Gierlotka , Tadeusz Osadnik , Agnieszka Kuras , Marcin Miga , Jacek Jozwiak , Gregory Y.H. Lip , LIPIDOGRAM2015 Investigators","doi":"10.1016/j.lanepe.2025.101245","DOIUrl":"10.1016/j.lanepe.2025.101245","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"50 ","pages":"Article 101245"},"PeriodicalIF":13.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143438281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-18DOI: 10.1016/j.lanepe.2025.101242
Elizabeth Walter-Nicolet , Laetitia Marchand-Martin , Andrei S. Morgan , Monique Kaminski , Valérie Benhammou , Pierre-Yves Ancel , Pierre Tourneux , Véronique Pierrat , Xavier Durrmeyer
Background
Data on preschool neurodevelopment of preterm infants according to the duration of their neonatal exposure to opioids with/without midazolam is limited. We aimed to assess neurodevelopment outcome in children aged five years, born very preterm (24–31 weeks), according to exposure to these drugs.
Methods
Secondary analysis from the French prospective cohort study EPIPAGE-2 (Etude Epidémiologique sur les Petits Ages Gestationnels, 2011). Exposure to opioids with/without midazolam was classified as none, ≤7 or >7 days. Percentages were weighted to account for the study design. The primary outcome was moderate/severe neurodevelopmental disabilities (NDD). Analyses were conducted using logistic regression and adjusted for perinatal confounders.
Findings
Among 3117 survivors, 1165 (35.9%) were exposed (762/1165 (68.0%) ≤7 days, 403/1165 (32.0%) >7 days). Of these 49.5% received opioids only, 41.4% opioids and midazolam, and 9.1% midazolam only. Moderate/severe NDD occurred in 17.8%, 18.9%, and 31.7% in the unexposed, exposed ≤7 days, and exposed >7 days groups, respectively. After adjustment for baseline confounders, only exposure >7 days was associated with increased rates of moderate/severe NDD (adjusted odds ratio 2.07; 95% CI 1.32–3.26). After additional adjustment for severe neonatal morbidities no significant association was found between any duration of exposure and NDD.
Interpretation
Exposure to opioids with/without midazolam >7 days might be associated with a higher prevalence of moderate/severe NDD at five years in very preterm born children but severe neonatal morbidities are a major modulator of this association.
Funding
French Institute of Public Health Research, National Institute of Health and Medical Research, National Institute of Cancer, National Solidarity Fund for Autonomy, PremUp, APICIL Foundations.
{"title":"Neurodevelopmental outcomes at five years in children born very preterm (24–31 weeks) exposed to opioids with or without midazolam: results from the French nationwide EPIPAGE-2 cohort study","authors":"Elizabeth Walter-Nicolet , Laetitia Marchand-Martin , Andrei S. Morgan , Monique Kaminski , Valérie Benhammou , Pierre-Yves Ancel , Pierre Tourneux , Véronique Pierrat , Xavier Durrmeyer","doi":"10.1016/j.lanepe.2025.101242","DOIUrl":"10.1016/j.lanepe.2025.101242","url":null,"abstract":"<div><h3>Background</h3><div>Data on preschool neurodevelopment of preterm infants according to the duration of their neonatal exposure to opioids with/without midazolam is limited. We aimed to assess neurodevelopment outcome in children aged five years, born very preterm (24–31 weeks), according to exposure to these drugs.</div></div><div><h3>Methods</h3><div>Secondary analysis from the French prospective cohort study EPIPAGE-2 (Etude Epidémiologique sur les Petits Ages Gestationnels, 2011). Exposure to opioids with/without midazolam was classified as none, ≤7 or >7 days. Percentages were weighted to account for the study design. The primary outcome was moderate/severe neurodevelopmental disabilities (NDD). Analyses were conducted using logistic regression and adjusted for perinatal confounders.</div></div><div><h3>Findings</h3><div>Among 3117 survivors, 1165 (35.9%) were exposed (762/1165 (68.0%) ≤7 days, 403/1165 (32.0%) >7 days). Of these 49.5% received opioids only, 41.4% opioids and midazolam, and 9.1% midazolam only. Moderate/severe NDD occurred in 17.8%, 18.9%, and 31.7% in the unexposed, exposed ≤7 days, and exposed >7 days groups, respectively. After adjustment for baseline confounders, only exposure >7 days was associated with increased rates of moderate/severe NDD (adjusted odds ratio 2.07; 95% CI 1.32–3.26). After additional adjustment for severe neonatal morbidities no significant association was found between any duration of exposure and NDD.</div></div><div><h3>Interpretation</h3><div>Exposure to opioids with/without midazolam >7 days might be associated with a higher prevalence of moderate/severe NDD at five years in very preterm born children but severe neonatal morbidities are a major modulator of this association.</div></div><div><h3>Funding</h3><div><span>French Institute of Public Health Research</span>, <span>National Institute of Health and Medical Research</span>, <span>National Institute of Cancer</span>, <span>National Solidarity Fund</span> for Autonomy, <span>PremUp</span>, <span>APICIL Foundations</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"52 ","pages":"Article 101242"},"PeriodicalIF":13.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-13DOI: 10.1016/j.lanepe.2025.101233
Fredrik Wickbom , Rakel Bremell , Sarah Thornberg , Jorge Sotoca Fernandez , Beatrice Magnusson , Rasmus Silfver , Aqeel Chaudhry , Kristoffer Kjellröier , Hanna Farahnoosh Afsan , Marcus Bergman , Amel Jumppanen , Malin Johansson , Sascha Östberg , Christian Kamis , Mihai Ölund , Emma Jeppsson , Albert Modin , Anders Santoft , Lovisa Borg , Cathrine Gatzinsky , Johan Undén
Background
Current guidelines for initial management of traumatic brain injury (TBI) support decision making, but they are rarely validated. The Scandinavian guideline for management of children with TBI (SNC16) was developed to minimise the use of cranial computed tomography (cCT) without compromising safety, but the performance of the guideline in a real-world population is unknown. We aimed to determine the diagnostic accuracy for the SNC16 in a large, pragmatic cohort of children.
Methods
In this prospective, observational, international cohort study in 16 Swedish and Norwegian emergency departments (EDs), children (aged <18 years) with blunt head trauma, presenting within 24 h of injury and a Glasgow Coma Scale of 9–15, were prospectively enrolled. The primary outcome measure was presence of a composite variable (clinically important intracranial injury (CIII) comprised of death, neurosurgery, admission to hospital ward ≥2 days due to head injury, or intubation ≥1 day due to pathological cCT findings), all within one week from trauma. Secondary outcome measures were neurosurgery and significant trauma related findings on cCT.
Findings
A total of 3012 children were enrolled from April 2018 to May 2024. Nine patients fulfilled the primary variable CIII (0.30%; 9/3012), two patients required neurosurgery (0.07%; 2/3012), and 27 patients showed significant trauma related findings on cCT (0.90%; 27/3012). Point sensitivities to detect CIII, neurosurgery and significant cCT findings were 100% (CI 95% 70%–100% [9/9]; 34%–100% [2/2]; and 87%–100% [27/27]). Point specificity was 41.3%, 41.2%, and 41.6% (CI 95% 40%–43% [1241/3003]; 39%–43% [1241/3010]; and 40%–43% [1241/2985]). Negative predictive values were 100% for CIII, neurosurgery and significant cCT findings (CI 95% 99.7%–100.0% for all). Application of the SNC16 guidelines would have resulted in a mandatory cCT rate of 3.4% (101/3012) and immediate discharge from the ED for 41.2% (1241/3012) of children. No children with a discharge recommendation were positive for any primary or secondary outcomes.
Interpretation
Validation of the SNC16 guideline showed adequate diagnostic performance in a real-world cohort, supporting formal implementation.
Funding
Non-commercially (Swedish state) funded by Sӧdra Sjukvårdsregionen and Vetenskapliga Rådet, Hallands Hospital and Forskning och Utveckling, Halland.
{"title":"Diagnostic accuracy of the Scandinavian guidelines for minor and moderate head trauma in children: a prospective, pragmatic, validation study","authors":"Fredrik Wickbom , Rakel Bremell , Sarah Thornberg , Jorge Sotoca Fernandez , Beatrice Magnusson , Rasmus Silfver , Aqeel Chaudhry , Kristoffer Kjellröier , Hanna Farahnoosh Afsan , Marcus Bergman , Amel Jumppanen , Malin Johansson , Sascha Östberg , Christian Kamis , Mihai Ölund , Emma Jeppsson , Albert Modin , Anders Santoft , Lovisa Borg , Cathrine Gatzinsky , Johan Undén","doi":"10.1016/j.lanepe.2025.101233","DOIUrl":"10.1016/j.lanepe.2025.101233","url":null,"abstract":"<div><h3>Background</h3><div>Current guidelines for initial management of traumatic brain injury (TBI) support decision making, but they are rarely validated. The Scandinavian guideline for management of children with TBI (SNC16) was developed to minimise the use of cranial computed tomography (cCT) without compromising safety, but the performance of the guideline in a real-world population is unknown. We aimed to determine the diagnostic accuracy for the SNC16 in a large, pragmatic cohort of children.</div></div><div><h3>Methods</h3><div>In this prospective, observational, international cohort study in 16 Swedish and Norwegian emergency departments (EDs), children (aged <18 years) with blunt head trauma, presenting within 24 h of injury and a Glasgow Coma Scale of 9–15, were prospectively enrolled. The primary outcome measure was presence of a composite variable (clinically important intracranial injury (CIII) comprised of death, neurosurgery, admission to hospital ward ≥2 days due to head injury, or intubation ≥1 day due to pathological cCT findings), all within one week from trauma. Secondary outcome measures were neurosurgery and significant trauma related findings on cCT.</div></div><div><h3>Findings</h3><div>A total of 3012 children were enrolled from April 2018 to May 2024. Nine patients fulfilled the primary variable CIII (0.30%; 9/3012), two patients required neurosurgery (0.07%; 2/3012), and 27 patients showed significant trauma related findings on cCT (0.90%; 27/3012). Point sensitivities to detect CIII, neurosurgery and significant cCT findings were 100% (CI 95% 70%–100% [9/9]; 34%–100% [2/2]; and 87%–100% [27/27]). Point specificity was 41.3%, 41.2%, and 41.6% (CI 95% 40%–43% [1241/3003]; 39%–43% [1241/3010]; and 40%–43% [1241/2985]). Negative predictive values were 100% for CIII, neurosurgery and significant cCT findings (CI 95% 99.7%–100.0% for all). Application of the SNC16 guidelines would have resulted in a mandatory cCT rate of 3.4% (101/3012) and immediate discharge from the ED for 41.2% (1241/3012) of children. No children with a discharge recommendation were positive for any primary or secondary outcomes.</div></div><div><h3>Interpretation</h3><div>Validation of the SNC16 guideline showed adequate diagnostic performance in a real-world cohort, supporting formal implementation.</div></div><div><h3>Funding</h3><div>Non-commercially (Swedish state) funded by <span>Sӧdra Sjukvårdsregionen</span> and <span>Vetenskapliga Rådet</span>, Hallands Hospital and <span>Forskning och Utveckling, Halland</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"51 ","pages":"Article 101233"},"PeriodicalIF":13.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143395150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-11DOI: 10.1016/j.lanepe.2025.101219
Noah Rohner, Cascal Herrle, Luca Locher, Kerstin N. Vokinger
{"title":"Correction to “Confidential and non-confidential drug rebates in Switzerland, 2013–2023: empirical analysis of drug rebates, trends over time and re-evaluations” [The Lancet Regional Health—Europe, volume 46, November 2024, 101094]","authors":"Noah Rohner, Cascal Herrle, Luca Locher, Kerstin N. Vokinger","doi":"10.1016/j.lanepe.2025.101219","DOIUrl":"10.1016/j.lanepe.2025.101219","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"50 ","pages":"Article 101219"},"PeriodicalIF":13.6,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143378041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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