European Journal of Trauma and Emergency Surgery最新文献

{"title":"Initial surgical management of injuries to the lower extremities in patients with multiple and/or severe injuries - A systematic review and clinical practice guideline update.","authors":"Kai Oliver Jensen, Barbara Prediger, Nadja Könsgen, Michel Paul Johan Teuben","doi":"10.1007/s00068-024-02662-0","DOIUrl":"https://doi.org/10.1007/s00068-024-02662-0","url":null,"abstract":"<p><strong>Purpose: </strong>Our aim was to develop new evidence-based and consensus-based recommendations for the initial inhospital management of lower-extremity injuries in patients with multiple and/or severe trauma. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with multiple and/or severe Injuries.</p><p><strong>Methods: </strong>MEDLINE and Embase were systematically searched to May 2021. Randomised controlled trials, prospective cohort studies, and comparative registry studies were included if they compared interventions for the initial surgical and non-surgical management of fractures, dislocations or vascular injuries of the lower extremities in patients with multiple and/or severe trauma. We considered patient-relevant clinical outcomes such as mortality, complication rates, length of stay, and function. Risk of bias was assessed using NICE 2012 checklists. The evidence was synthesised narratively, and expert consensus was used to develop recommendations and determine their strength.</p><p><strong>Results: </strong>Eleven studies were identified. They addressed time to definitive fixation (n = 10 studies) and amputation (n = 1). Two new recommendations were developed, one was modified. All recommendations achieved strong consensus.</p><p><strong>Conclusion: </strong>This systematic literature review and subsequent expert consensus process resulted in the following new key recommendations. It is recommended that isolated and multiple lower-extremity fractures are managed with primary definitive fixation in patients whose condition is stable. Patients condition is not considered stable should be managed with primary temporary fixation. In addition, it is recommended that dislocations of the lower extremities are reduced and immobilised as early as possible.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"23rd European Congress of Trauma and Emergency Surgery.","authors":"","doi":"10.1007/s00068-024-02599-4","DOIUrl":"https://doi.org/10.1007/s00068-024-02599-4","url":null,"abstract":"","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral haemodynamics and intracranial pressure during haemorrhagic shock and resuscitation with total endovascular balloon occlusion of the aorta in an animal model.","authors":"Sam Er Bader, C Brorsson, N Löfgren, F Löfgren, P-J Blind, N Sundström, M Öman, M Olivecrona","doi":"10.1007/s00068-024-02646-0","DOIUrl":"https://doi.org/10.1007/s00068-024-02646-0","url":null,"abstract":"<p><strong>Purpose: </strong>To assess changes of cerebral haemodynamic and intracranial pressure (ICP) in animals, with or without elevated ICP, during controlled haemorrhagic shock and resuscitation with Total REBOA (tREBOA).</p><p><strong>Method: </strong>In 22 anaesthetized and normoventilated pigs, after placement of catheters for monitoring invasive proximal blood pressure (pMAP), ICP, and vital parameters, and 60 min stabilisation phase, a controlled haemorrhagic shock (HS), was conducted. In 11 pigs (EICPG), an elevated ICP of 25-30 mmHg at the end HS was achieved by simulating an epidural mass. In 11 pigs (NICPG), the ICP was normal. tREBOA was then applied for 120 min. The changes of pMAP and ICP were followed, and cerebral perfusion pressure (CPP) calculated. The integrity of the autoregulation was estimated using a calculated Modified-Long Pressure Reactivity Index (mL-PRx).</p><p><strong>Results: </strong>After stabilisation, hemodynamics and physiological parameters were similar and normal in both groups. At the end of the HS, ICP was 16 mmHg in NICPG vs. 32 in EICPG (p = 0.0010). CPP was 30 mmHg in NICPG vs. 6 mmHg in EICPG (p = 0.0254). After aorta occlusion CPP increased immediately in both groups reaching after 15 min up to104 mmHg in NICPG vs. 126 mmHg in EICPG. Cerebrovascular reactivity seems to be altered during bleeding and occlusion phases in both groups with positive mL-PRx. The alteration was more pronounced in EICPG, but reversible in both groups.</p><p><strong>Conclusion: </strong>tREBOA is lifesaving by restoration the cerebral circulation defined as CPP in animals with HS with normal or elevated ICP. Despite the observation of short episodes of cerebral autoregulation impairment during the occlusion, mainly in EICPG, tREBOA seems to be an effective tool for improving cerebral perfusion in HS that extends the crucial early window sometimes known as the \"golden hour\" for resuscitation even after a traumatic brain injury.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focus on thoracolumbar spine injuries.","authors":"Klaus Wendt","doi":"10.1007/s00068-024-02669-7","DOIUrl":"https://doi.org/10.1007/s00068-024-02669-7","url":null,"abstract":"","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating predictors of mortality in octogenarians undergoing urgent or emergent trauma laparotomy.","authors":"Jordan G Shin, Jeffry Nahmias, Elliot Silver, Robert Painter, Shaina Sedighim, Flora Park, Areg Grigorian","doi":"10.1007/s00068-024-02635-3","DOIUrl":"https://doi.org/10.1007/s00068-024-02635-3","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to identify associated risk factors for mortality in octogenarian trauma patients undergoing urgent or emergent laparotomy (UEL).</p><p><strong>Methods: </strong>Trauma patients ages 80-89 years-old undergoing UEL within 6-hours of arrival were included. A multivariable logistic regression analysis was performed to determine associated risk of mortality.</p><p><strong>Results: </strong>From 701 octogenarians undergoing UEL, 324 (46.2%) died. Compared to survivors, UEL octogenarians who died had higher rates of cirrhosis (3.5% vs. 1.1%, p = 0.028), injuries to the brain (17.3% vs. 5.6%, p < 0.001), heart (8.6% vs. 1.6%, p < 0.001), and lung (57.4% vs. 23.9%, p < 0.001) and lower rates of functional independence (6.4% vs. 12.6%, p = 0.007). The strongest independent associated patient-related risk factor for death was cirrhosis (OR 8.28, CI 2.25-30.46, p = 0.001). However, undergoing concurrent thoracotomy increased risk of death significantly (OR 16.59, CI 2.07-132.76, p = 0.008). Functional independence was not associated with mortality (p > 0.05).</p><p><strong>Conclusion: </strong>This national analysis emphasizes the need to identify and manage pre-existing conditions like cirrhosis and not determine futility based on pre-trauma functional status alone. Concurrent thoracotomy for hemorrhage control increases risk of death over 16-fold.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Hartmann's procedure for complicated diverticulitis is associated with lower superficial surgical site infections compared to open surgery with similar other outcomes: a NSQIP-based, propensity score matched analysis.","authors":"Leo I Amodu, Hazim Hakmi, Amir H Sohail, Meredith Akerman, Patrizio Petrone, David K Halpern, Toyooki Sonoda","doi":"10.1007/s00068-024-02661-1","DOIUrl":"https://doi.org/10.1007/s00068-024-02661-1","url":null,"abstract":"<p><strong>Background: </strong>Open Hartmann's procedure has traditionally been the procedure of choice to treat complicated diverticulitis. We analyzed the ACS-NSQIP database to compare outcomes in patients who underwent emergent laparoscopic Hartmann's procedure (LHP) to those who had an open Hartmann's procedure (OHP).</p><p><strong>Study design: </strong>Data analyzed from 2015 to 2019 using ICD-10 codes. Patients were matched on several important covariates using a propensity score matching method (PSM). Patients were matched in a 4:1 ratio of controls to cases based on the propensity score.</p><p><strong>Results: </strong>We identified 5026, of which 456 had LHP and 4570 had OHP. PSM analysis yielded 369 LHP and 1476 OHP patients. LHP had lower rates of superficial surgical site infection (SSSI) compared to OHP (2.44% vs. 5.89%, p = 0.007). LHP had similar post-operative outcomes compared to OHP, including 30-day mortality (5.15% vs. 2.98%, p = 0.060), organ space surgical site infection (OSSSI) (14.36% vs. 12.60%, p = 0.161), wound disruption (1.36% vs. 2.44%, p = 0.349), median LOS (8 vs. 9 days, p = 0.252), readmission within 30 days (11.92% vs. 8.67%, p = 0.176), rate of reoperation (6.0 vs. 6.5%, p = 0.897), and discharge to home (76% vs. 77%, p = 0.992). LHP had longer operative times compared to OHP (median 129 vs. 118 min, p < 0.0001).</p><p><strong>Conclusion: </strong>The LHP is associated with lower rates of SSSI. However, it is not associated with lower rates of mortality, OSSSI, readmissions and reoperations within 30 days. Surgical times are longer in LHP. More studies are needed to determine whether LHP offers advantages in the long-term, particularly in rates of incisional hernia and colostomy closure.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracolumbar injuries: prehospital and emergency management, imaging, classifications and clinical implications.","authors":"Guido A Wanner, Frank Bloemers, Christoph Nau, Klaus Wendt, Marko Jug, Radko Komadina, Hans Christoph Pape","doi":"10.1007/s00068-024-02658-w","DOIUrl":"https://doi.org/10.1007/s00068-024-02658-w","url":null,"abstract":"<p><p>Thoracolumbar fractures are common injuries that usually result from high energy trauma. They can lead to significant morbidity due to neurologic impair - or mortality - if not managed according to strict and rapid intervention rules in terms of decompression of the spinal cord, and rigid fixation of the fracture. This manuscript reviews emergency treatment protocols, imaging modalities, and classification systems used for thoracolumbar fractures. The emergency treatment is discussed, specific classifications are compared and indications for surgeries are compared.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracolumbar injuries: non operative treatment: indications, management.","authors":"Christoph Nau, Hans Christoph Pape, Marko Jug, Klaus Wendt, Radko Komadina, Frank Bloemers","doi":"10.1007/s00068-024-02619-3","DOIUrl":"https://doi.org/10.1007/s00068-024-02619-3","url":null,"abstract":"<p><strong>Introduction: </strong>Thoracolumbar spine injuries can result from various traumatic events such as falls, motor vehicle accidents, and sports injuries. While surgical intervention is often indicated for complex fractures and in case of neurological deficits, non-operative treatment remains a viable option for certain types of injuries.</p><p><strong>Aims: </strong>This manuscript aims to provide a comprehensive overview of the specific indications and treatment options of non-operative thoracolumbar spine injuries. It seeks to provide evidence-based recommendations for selecting patients suitable for conservative management based on fracture type and stability, absence of neurological deficits, spine deformity, integrity of the posterior ligament complex and patient specific factors.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-operative treatment of metacarpal fractures and patient-reported outcomes: a multicentre snapshot study.","authors":"L E M de Haas, P A Jawahier, T C C Hendriks, D A Salentijn, B T van Hoorn, R H H Groenwold, N W L Schep, M van Heijl","doi":"10.1007/s00068-024-02659-9","DOIUrl":"https://doi.org/10.1007/s00068-024-02659-9","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate practice variation in non-operative treatment methods and immobilisation duration for metacarpal fractures, and to evaluate patient-reported outcomes.</p><p><strong>Methods: </strong>Conducted in 12 Dutch hospitals over three months in 2020, this study included adult patients with non-operatively treated solitary metacarpal fractures. Fractures were classified into intra-articular base, extra-articular base, shaft, neck, and intra-articular head fractures. The treatment methods (functional treatment allowing digit mobilisation or immobilisation) and immobilisation duration were assessed. Patient-reported outcomes were evaluated using the Michigan Hand Outcomes Questionnaire (MHQ) at three months post-trauma.</p><p><strong>Results: </strong>Of 389 included patients, shaft fractures were most common (n = 150, 39%), with 93% immobilised, followed by fifth metacarpal neck fractures (n = 93, 24%), with 75% immobilised. Immobilisation rates for fifth metacarpal neck fractures varied between hospitals, ranging from 29% (95% CI 0.10-0.58) to 100% (95% CI 0.78-1.00). The median immobilisation duration for all fractures was 23 days (IQR: 20-28), and hospital setting was independently associated with this duration. Patients with metacarpal shaft fractures immobilised for less than 21 days had higher MHQ scores compared to those immobilised for 21 days or more (median (IQR) 83 (76-100) versus 71 (57-89), p = 0.026).</p><p><strong>Conclusions: </strong>The results showed practice variation in the treatment of metacarpal fractures, especially in the treatment of fifth MC neck fractures, with some hospitals following the Dutch guideline that advocates functional treatment while others did not. There are suggestions that prolonged immobilisation of metacarpal shaft fractures may lead to a worse MHQ score. These findings underscore the need for adherence to treatment protocols and emphasize functional treatment to potentially improve patient outcomes and cost-effectiveness.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focus on challenges and advances in the treatment of traumatic brain injury.","authors":"Cora Schindler,Thomas Lustenberger","doi":"10.1007/s00068-024-02623-7","DOIUrl":"https://doi.org/10.1007/s00068-024-02623-7","url":null,"abstract":"","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"100 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}