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INTRODUCTION. In cases of parental opposition to emergency medical care for minors, defined as children below 15 years of age, involving the social authorities may be necessary. When medical personnel assess that an intervention is in the minor’s best interests, approval for such intervention is warranted from the local authorities in the municipality of residence. It was the primary aim of this study to assess the urgent availability of these authorities. METHODS. The urgent phone availability of social authorities at the 98 Danish local municipal offices was assessed during both regular hours and off-hours. The primary objective was to assess availability during regular hours. Urgent availability was predefined as obtained contact to a self-proclaimed accountable authority within 30 minutes. Secondary objectives were assessment of off-hour availability, time until obtained contact and number of contact links. RESULTS. Contact was obtained within 30 minutes in 59 inquiries (~ 58%) made during regular hours, with a median of three contact links and a median time until contact of eight minutes (interquartile range (IQR): 5.5-11 minutes). During off-hours, contact was obtained within 30 minutes in 91 inquiries (~ 93%), with a median of two contact links and a median time until contact of seven minutes (IQR: 5-12 minutes). CONCLUSION. During regular hours, we found that an accountable authority was urgently available for attendance to a case of parental opposition to emergency medical care of a minor within 30 minutes at the local municipal office in 58% of Danish municipalities. FUNDING. None. TRIAL REGISTRATION. Not relevant., INTRODUCTION: In cases of parental opposition to emergency medical care for minors, defined as children below 15 years of age, involving the social authorities may be necessary. When medical personnel assess that an intervention is in the minor's best interests, approval for such intervention is warranted from the local authorities in the municipality of residence. It was the primary aim of this study to assess the urgent availability of these authorities.METHODS: The urgent phone availability of social authorities at the 98 Danish local municipal offices was assessed during both regular hours and off-hours. The primary objective was to assess availability during regular hours. Urgent availability was predefined as obtained contact to a self-proclaimed accountable authority within 30 minutes. Secondary objectives were assessment of off-hour availability, time until obtained contact and number of contact links.RESULTS: Contact was obtained within 30 minutes in 59 inquiries (~ 58%) made during regular hours, with a median of three contact links and a median time until contact of eight minutes (interquartile range (IQR): 5.5-11 minutes). During off-hours, contact was obtained within 30 minutes in 91 inquiries (~ 93%), with a median of two contact links and a median time until contact of seven minutes (IQR: 5-12 minutes).CONCLUSION: During regular hours, we found that an accountable authority was urgently available for attendance to a case of parental opposition to emergency medical care of a minor within 30 minutes at the local municipal office in 58% of Danish municipalities.FUNDING: None.TRIAL REGISTRATION: Not relevant.

Background: The duration of apnoeic oxygenation with high-flow nasal oxygen is limited by hypercapnia and acidosis and monitoring of arterial carbon dioxide level is therefore essential. We have performed a study in patients undergoing prolonged apnoeic oxygenation where we monitored the progressive hypercapnia with transcutaneous carbon dioxide. In this paper, we compared the transcutaneous carbon dioxide level with arterial carbon dioxide tension. Methods: This is a secondary publication based on data from a study exploring the limits of apnoeic oxygenation. We compared transcutaneous carbon dioxide monitoring with arterial carbon dioxide tension using Bland–Altman analyses in anaesthetised and paralysed patients undergoing prolonged apnoeic oxygenation until a predefined limit of pH 7.15 or PCO2 of 12 kPa was reached. Results: We included 35 patients with a median apnoea duration of 25 min. Mean pH was 7.14 and mean arterial carbon dioxide tension was 11.2 kPa at the termination of apnoeic oxygenation. Transcutaneous carbon dioxide monitoring initially slightly underestimated the arterial tension but at carbon dioxide levels above 10 kPa it overestimated the value. Bias ranged from −0.55 to 0.81 kPa with limits of agreement between −1.25 and 2.11 kPa. Conclusion: Transcutaneous carbon dioxide monitoring provided a clinically acceptable substitute for arterial blood gases but as hypercapnia developed to considerable levels, we observed overestimation at high carbon dioxide tensions in patients undergoing apnoeic oxygenation with high-flow nasal oxygen.

Background: Many elderly patients are receiving antithrombotics, which may increase intra-operative blood loss. We aimed to assess whether chronic antithrombotic therapy was associated with intra-operative transfusion of packed red blood cells in patients at least 80 years of age undergoing elective procedures. Methods: We performed a secondary analysis of the prospective, observational European multicentre study entitled POSE (peri-interventional outcome study in the elderly) including 9497 surgical patients aged 80 years and older in 177 centres from October 2017 to December 2018. In this secondary analysis we included POSE patients who underwent elective procedures and with available data on chronic antithrombotic therapy. The primary outcome was intra-operative transfusion of packed red blood cells and results were analysed using multiple logistic regression model. We adjusted for the following predetermined explanatory variables: Age, sex, body mass index, American Society of Anaesthesiologists Physical Status Classification System, baseline haemoglobin concentration, disseminated cancer, and type and severity of surgery. Results: A total of 7174 patients were included of whom 4073 (56.8%) were on antithrombotic therapy. Among patients on antithrombotic therapy 191 (4.7%) received intra-operative blood transfusion compared with 98 (3.2%) of patients not on chronic antithrombotic therapy (crude odds ratio: 1.51, 95% CI 1.18–1.94). Following multiple logistic regression analysis, the adjusted odds ratio was 0.98; 0.73–1.32. We found that chronic antithrombotic therapy was associated with intra-operative transfusion of packed red blood cells in elderly patients undergoing elective procedures in an unadjusted analysis, but not in a multivariate adjusted model.

Importance: Immediate consequences of trauma include a rapid and immense activation of the immune system, whereas long-term outcomes include premature death, physical disability, and reduced workability. Objective: To investigate if moderate to severe trauma is associated with long-term increased risk of death or immune-mediated or cancer disease. Design, Setting, and Participants: This registry-based, matched, co-twin control cohort study linked the Danish Twin Registry and the Danish National Patient Registry to identify twin pairs in which 1 twin had been exposed to severe trauma and the other twin had not from 1994 to 2018. The co-twin control design allowed for matching on genetic and environmental factors shared within twin pairs. Exposure: Twin pairs were included if 1 twin had been exposed to moderate to severe trauma and the other twin had not (ie, co-twin). Only twin pairs where both twins were alive 6 months after the trauma event were included. Main Outcome and Measure: Twin pairs were followed up from 6 months after trauma until 1 twin experienced the primary composite outcome of death or 1 of 24 predefined immune-mediated or cancer diseases or end of follow-up. Cox proportional hazards regression was used for intrapair analyses of the association between trauma and the primary outcome. Results: A total of 3776 twin pairs were included, and 2290 (61%) were disease free prior to outcome analysis and were eligible for the analysis of the primary outcome. The median (IQR) age was 36.4 (25.7-50.2) years. The median (IQR) follow-up time was 8.6 (3.8-14.5) years. Overall, 1268 twin pairs (55%) reached the primary outcome; the twin exposed to trauma was first to experience the outcome in 724 pairs (32%), whereas the co-twin was first in 544 pairs (24%). The hazard ratio for reaching the composite outcome was 1.33 (95% CI, 1.19-1.49) for twins exposed to trauma. Analyses of death or immune-mediated or cancer disease as separate outcomes provided hazard ratio

Trine O Eskesen,1 Martin Sillesen,2,3 Lars S Rasmussen,1,3 Jacob Steinmetz1,3,4 1Department of Anesthesia, Center of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark; 2Department of Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark; 3Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; 4Danish Air Ambulance, Aarhus, DenmarkCorrespondence: Trine O Eskesen Department of Anesthesia, Center of Head and Orthopedics, Rigshospitalet, section 6011, Inge Lehmanns Vej 6, Copenhagen, DK-2100, Denmark Tel +45 35 45 82 11 Email trine.grodum.eskesen.01@regionh.dkIntroduction: Injury Severity Score (ISS) is used to describe anatomical lesions. ISS is traditionally determined through medical record review (standard ISS), which requires specific training and may be time-consuming. An alternative way to obtain ISS is by use of ICD-9/10 injury diagnoses, and several conversion tools exist. We sought to evaluate the agreement between standard ISS and ISS obtained with two tools converting ICD-10 diagnoses.Methods: Our cohort consisted of trauma patients ≥ 18 years admitted to Rigshospitalet between 1999 and 2016. The included patients had standard ISS recorded in the Trauma Audit and Research Network (TARN) database (ISS-TARN), and ICD-10 injury diagnoses for the trauma contact were recorded in the Danish National Patient Registry. We used the tools ICDPIC-R and ICD-AIS map to calculate ISS based on ICD-10 diagnoses. ICDPIC-R provided two ISSs: ISS-TQIP and ISS-NIS. The ICD-AIS map resulted in one ISS: ISS-map. The ISS-TARN was compared to the conversion tool ISSs using Bland-Altman plots. The agreement between ISS-TARN and the conversion tool ISSs for ISS above 15 was assessed using kappa statistics (κ).Results: We included 4308 trauma patients. The median age was 44 years, 70% were male, and 92% had a blunt injury mechanism. The median ISS-TARN was 16 [IQR: 9– 25], and the median conversion tool ISSs were 10 [2– 25] (ISS-TQIP)

Introduction Supplemental oxygen is commonly used in trauma patients, although it may lead to hyperoxaemia that has been associated with pulmonary complications and increased mortality. The primary objective of this trial, TRAUMOX2, is to compare a restrictive versus liberal oxygen strategy the first 8 hours following trauma. Methods and analysis TRAUMOX2 is an investigator-initiated, international, parallel-grouped, superiority, outcome assessor-blinded and analyst-blinded, randomised, controlled, clinical trial.Adult patients with suspected major trauma are randomised to eight hours of a restrictive or liberal oxygen strategy. The restrictive group receives the lowest dosage of oxygen (>= 21%) that ensures an SpO(2) of 94%. The liberal group receives 12-15 L O-2/min or FiO(2)=0.6-1.0.The primary outcome is a composite of 30-day mortality and/or development of major respiratory complications (pneumonia and/or acute respiratory distress syndrome).With 710 participants in each arm, we will be able to detect a 33% risk reduction with a restrictive oxygen strategy if the incidence of our primary outcome is 15% in the liberal group. Ethics and dissemination TRAUMOX2 is carried out in accordance with the Helsinki II Declaration. It has been approved by the Danish Committee on Health Research Ethics for the Capital Region (H-21018062) and The Danish Medicines Agency, as well as the Dutch Medical Research Ethics Committee Erasmus MS (NL79921.078.21 and MEC-2021-0932). A website () is available for updates and study results will be published in an international peer-reviewed scientific journal.