European Journal of Trauma and Emergency Surgery最新文献

{"title":"Open lower limb fracture reconstruction in the elderly population: the experience of a major trauma centre.","authors":"Manuela Roman, Metin Ali Nizamoglu, Garance Biosse-Duplan, Dan Gearon, Ahid Abood, Keith Anderson","doi":"10.1007/s00068-024-02688-4","DOIUrl":"https://doi.org/10.1007/s00068-024-02688-4","url":null,"abstract":"<p><strong>Purpose: </strong>Management of the elderly patients presenting with open lower limb fractures is challenging due to physiological changes and pre-existing co-morbidities. The aim of this study was to assess the compliance with the British Orthopaedic Association's Standards for Trauma Number 4 (BOAST 4) guidelines in this patient group.</p><p><strong>Methods: </strong>The study included a retrospective analysis of all the patients aged > 65 years old admitted with open lower limb fracture between 2017 and 2019 to a major trauma centre (MTC) in East of England.</p><p><strong>Results: </strong>Our study included 91 patients presenting with lower limb trauma. The most common injury was a Gustilo and Anderson grade IIIB (39.6%). 30.8% of the study population received antibiotics within 1 h, 89% had debridement and bone stabilization within 24 h. Mean time to definitive soft tissue coverage was 3 days, with 66% of the study group having their fracture fixed and soft tissue coverage within 72 h. 52% had direct wound closure, with 9% having an incisional topical negative pressure wound therapy, 17% had a local flap and 5% patients had a free flap. The most common complication was wound dehiscence. The wounds closed without an incisional topical negative pressure wound therapy have shown a dehiscence rate of 15.4%, compared to 0% in the patients who had one.</p><p><strong>Conclusion: </strong>Our study suggests that BOAST 4 compliance in the population > 65 years is comparable to the younger population. It is likely that the lower energy injury profile enables early definitive management even in the presence of age related co-morbidities.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"20"},"PeriodicalIF":1.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002760","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":"Clinical presentation, acute care management and discharge information of patients with thoracic trauma in South Africa and Sweden: a prospective multicenter observational study.","authors":"Heleen van Aswegen, Ronel Roos, Anna Svensson-Raskh, Annie Svensson, Maria Sehlin, Eva-Corina Caragounis, Frank Plani, Monika Fagevik-Olsén","doi":"10.1007/s00068-024-02753-y","DOIUrl":"https://doi.org/10.1007/s00068-024-02753-y","url":null,"abstract":"<p><strong>Purpose: </strong>Thoracic trauma causes pain and hospitalisation. Middle- and high-income countries have different trauma contexts and populations. To report patients' clinical presentation (pain and shortness of breath) and its influence on hospital length of stay (LOS), acute care management, and discharge destinations in South Africa (SA) and Sweden.</p><p><strong>Methods: </strong>Prospective observational multicenter study by means of clinical record review. Two centers in SA and four centers in Sweden participated. One thousand nine hundred and eighteen adults with thoracic trauma were screened over the 20 months period. Study objectives guided information retrieved from clinical records. Statistical analysis was done with significance at p-value < 0.05.</p><p><strong>Results: </strong>Three-hundred-sixty-four participants were recruited with most being male (n = 170/179 (95%) SA; n = 125/185 (68%) Sweden). Type and mechanism of injury differed (SA penetrating (82%) versus Sweden blunt (95%); SA assaults (90%) versus Sweden falls (44%)). Unilateral haemopneumothorax was common (SA 68%, Sweden 35%) and managed with intercostal drainage. Rib cage injuries were common in the Swedish cohort with rib fixation surgery for 17%. Physiotherapy treatment frequency was mostly daily. Blunt injury resulted in higher pain levels during deep breathing (day 1: p = 0.014; day 2: p < 0.001; day 3: p < 0.001) and shortness of breath during activity (day 1: p = 0.036; day 2: p = 0.003; day 3: p < 0.001). LOS was shorter for SA cohort (5 (± 4) versus 7 (± 5) days; p = 0.024). Age influenced LOS in the blunt injury group. Discharge destination was mostly home (99% SA, 56% Sweden).</p><p><strong>Conclusion: </strong>Priority care is indicated for those who are older and have blunt thoracic injury to prevent pulmonary complications and prolonged hospitalisation.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"21"},"PeriodicalIF":1.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular management of haemorrhage and vascular lesions in patients with multiple and/or severe injuries: a systematic review and clinical practice guideline update.","authors":"Hans-Joachim Wagner, Käthe Goossen, Peter Hilbert-Carius, Rainer Braunschweig, Daniela Kildal, Daniel Hinck, Thomas Albrecht, Nadja Könsgen","doi":"10.1007/s00068-024-02719-0","DOIUrl":"10.1007/s00068-024-02719-0","url":null,"abstract":"<p><strong>Purpose: </strong>Our aim was to update evidence-based and consensus-based recommendations for the inhospital endovascular management of haemorrhage and vascular lesions in patients with multiple and/or severe injuries based on current evidence. 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 June 2021. Further literature reports were obtained from clinical experts. Randomised controlled trials, prospective cohort studies, and comparative registry studies were included if they compared endovascular interventions for bleeding control such as embolisation, stent or stent-graft placement, or balloon occlusion against control interventions in patients with polytrauma and/or severe injuries in the hospital setting. The diagnosis of pelvic haemorrhage was added post-hoc as an additional clinical question. We considered patient-relevant clinical outcomes such as mortality, bleeding control, haemodynamic stability, transfusion requirements, complications, and diagnostic test accuracy. 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>Forty-three new studies were identified. Interventions covered were resuscitative endovascular balloon occlusion of the aorta (REBOA) (n = 20), thoracic endovascular aortic repair (TEVAR) (n = 9 studies), pelvic trauma (n = 6), endovascular aortic repair (EVAR) of abdominal aortic injuries (n = 3), maxillofacial and carotid artery injuries (n = 2), embolisation for abdominal organ injuries (n = 2), and diagnosis of pelvic haemorrhage (n = 1). Five recommendations were modified, and one additional recommendation was developed. All achieved strong consensus.</p><p><strong>Conclusion: </strong>The following key recommendations are made. Whole-body contrast-enhanced computed tomography should be used to detect bleeding and vascular injuries. Blunt thoracic and abdominal aortic injuries should be managed using TEVAR/EVAR. If possible, endovascular treatment should be delayed beyond 24 h after injury. Bleeding from parenchymatous abdominal organs should be controlled using transarterial catheter embolisation. Splenic injuries that require no immediate intervention can be managed with observation.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"22"},"PeriodicalIF":1.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical consequence of the 4-week X-ray control after ESIN osteosynthesis of forearm fractures in children.","authors":"Erik Wegner, Nora Laubach, Phillip Schippers, Lotte Schierjott, Rujuta Shrotriya, Erol Gercek, Philipp Drees, Sven-Oliver Dietz","doi":"10.1007/s00068-024-02721-6","DOIUrl":"10.1007/s00068-024-02721-6","url":null,"abstract":"<p><strong>Purpose: </strong>The absence of evidence based general guidelines for radiographic follow-ups of pediatric diaphyseal forearm fractures treated with ESIN results in an arbitrary array of X-ray examinations. In most pediatric traumatology departments, an X-ray check is carried out 4 weeks after ESIN osteosynthesis of forearm shaft fractures to detect incipient consolidation of the fracture. However, the elevated sensitivity to ionizing radiation requires special precautions in the pediatric populations. To prevent the indiscriminate use of this diagnostic tool it is necessary to assess the consequence of routinely taken X-rays at the 4-week follow-up.</p><p><strong>Methods: </strong>This retrospective analysis included 219 pediatric patients who underwent ESIN treatment for a diaphyseal forearm fracture between 2010 and 2018 at the same pediatric trauma center. The primary outcome was defined as the prevalence of aberrant radiographic findings (ARF) during the 4-week follow-up with an otherwise normal clinical course and examination. Pathologies in the physical exam and irregularities in the medical history were summarized as non-radiological abnormalities (nRD). Binary logistic regression was calculated to identify risk factors associated with an increased likelihood of an ARF.</p><p><strong>Results: </strong>Of the 219 pediatric patients included, 123 patients had no nRDs at the 4-week follow-up. Only one patient was found to have an ARF (absolute risk = 0.008). Regression showed that the odds of receiving an ARF increased significantly as other nRDs were detected (p = 0.012, OR 14.554). A positive correlation was found especially for irregularities in the medical history (n = 59, p = 0.003, OR = 8.134).</p><p><strong>Conclusion: </strong>This study provides evidence that standardized radiographic follow-up 4 weeks after surgical treatment has no clinical consequences if the course of the fracture is otherwise uneventful. It should be strictly reserved for pediatric patients with a complicated course.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"19"},"PeriodicalIF":1.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A national study of in-hospital preparedness for Mass Casualty Incidents and disasters.","authors":"Kristina Stølen Ugelvik, Øyvind Thomassen, Geir Sverre Braut, Thomas Geisner, Janecke Engeberg Sjøvold, Carl Montán","doi":"10.1007/s00068-024-02685-7","DOIUrl":"10.1007/s00068-024-02685-7","url":null,"abstract":"<p><strong>Purpose: </strong>The current geopolitical situation and climate changes accentuate the importance of health preparedness. The aim was to examine the in-hospital preparedness for Mass Casualty Incidents (MCI) and Major Incidents (MI) on a national level.</p><p><strong>Method: </strong>A web-based, cross-sectional study of in-hospital preparedness for MCI/MI in Norway. All hospitals with trauma function were included with 3 defined representatives, excluding hospitals without trauma function. The survey consisted of 63 questions covering: MCI/MI organisation, education, plans, Surge Capacity, triage and supply management.</p><p><strong>Results: </strong>The study had a response rate of 97/112 (87%), representing 35/38 (92%) of the included hospitals. Contingency responsible respondents (CRR) reported that 27/34 (80%) of the hospitals had a contingency responsible function/role and 29/34 (85%) had a Disaster Preparedness Committee. Among CRR, formal MCI/MI education 5/34 (15%) and MCI/MI training 9/34 (26%) was completed. Further, 87/97 (90%) had an all-hazard contingency plan. MCI/MI exercise within the last 2 years was reported by 63/97 (65%). Surge Capacity was assessed within the last 5 years at 6/35 (17%) of the hospitals. MCI/MI material storage was reported by 56/97 (58%).</p><p><strong>Conclusion: </strong>Many key aspects of contingency work were found to be well-established. MCI/MI education and training for roles/functions was missing in most hospitals. Areas of improvement detected included Surge Capacity and emergency storage. The results suggest a need for national minimum standards and requirements. National in-hospital MCI/MI preparedness could be monitored by a web-based survey, providing information of pan-European relevance.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"18"},"PeriodicalIF":1.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to work of major trauma survivors from a private level 1 trauma centre in South Africa.","authors":"Francesca Bharath, Susan Hanekom, Tonya Estherhuizen, Alison Lupton-Smith","doi":"10.1007/s00068-024-02712-7","DOIUrl":"10.1007/s00068-024-02712-7","url":null,"abstract":"<p><strong>Purpose: </strong>Trauma is known as a leading cause of mortality and injury related disability globally. In South Africa (SA) the socioeconomic burden of trauma is magnified as the working age is most affected. The aim of this study was to describe the proportion of major trauma survivors who returned to work (RTW) during a 6-month period post hospital discharge and to identify the factors associated with the RTW outcome.</p><p><strong>Methods: </strong>This was a prospective observational cohort study involving major trauma survivors from a private level 1 trauma centre intensive care unit in SA between January and September 2022. RTW status was assessed using the Employment Questionnaire. Univariate and multivariable Cox proportional hazards regression was used in analysis.</p><p><strong>Results: </strong>Sixty-four of the 86 participants (74.4%) RTW at six months post hospital discharge. RTW had a median time of 16 weeks. After adjusting and backwards analysis, Chelsea Critical Care Physical assessment tool scores (adjusted hazard ratio (AHR), 1.06, 95% CI 1.01-1.10, p = 0.007), and not having applied/received any form of grants (AHR 2.26, 95% CI 1.35-3.77, p = 0.002) were the only factors that were associated with the RTW outcome.</p><p><strong>Conclusion: </strong>The cumulative probability of no RTW was 25.6% among participants after 24 weeks. Higher physical function at ICU discharge and not seeking any form of compensation was associated with a higher probability of RTW. This study has highlighted the complexities of RTW and the socioeconomic burden following major trauma. There is therefore a need for further studies on RTW following major trauma in SA.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"17"},"PeriodicalIF":1.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ionised calcium levels during trauma resuscitation in predicting outcomes-a prospective cohort study.","authors":"Ramesh Vaidyanathan, Preksha Rani, Shrikanth Manwatkar, J K Singh, Dinesh Gora, Pranabh Kushwaha, Pratyusha Priyadarshini, Dinesh Bagaria, Narendra Choudhary, Junaid Alam, Arul Selvi, Anand Kumar, Kapil Dev Soni, Sushma Sagar, Subodh Kumar, Amit Gupta, Biplab Mishra, Abhinav Kumar, Mahroof Khan","doi":"10.1007/s00068-024-02713-6","DOIUrl":"https://doi.org/10.1007/s00068-024-02713-6","url":null,"abstract":"<p><strong>Background: </strong>Haemorrhage remains the leading cause of preventable mortality following trauma, often aggravated by the acidosis, hypothermia and coagulopathy-the lethal triad of trauma. However, the impact of trauma-induced hypocalcemia on the haemorrhage remains unclear. It is intuitive to consider perturbations of ionised calcium early during trauma resuscitation in acutely injured patients given its pathophysiological significance for an improved outcome. Thus, we conducted a prospective study to analyse the role of ionized calcium ion levels during trauma resuscitation and its association with the need for blood transfusion(s) requirement and mortality.</p><p><strong>Methods: </strong>A prospective study was conducted on acutely injured patients with haemorrhage getting admitted to a Level 1 trauma center in India between September 2020 and June 2022. Ionised calcium was measured on arrival, after 6 h, and on day two of the injury to assess the prevalence. The amount of blood transfusion received by the patient was noted along with other demographic and in-hospital details. The association of hypocalcemia with blood transfusion and mortality was also evaluated.</p><p><strong>Results: </strong>Of the 1961 patients screened for eligibility, 200 patients were recruited and analysed. 72.5% of patients were hypocalcaemic on emergency department (ED) admission. Ionized hypocalcaemia was significantly associated with the need for blood transfusion(s) (p-value < 0.01). A significant association was also noted between ionized hypocalcaemia and mortality (p-value: 0.0085). On the univariate and multivariable analysis, ionized hypocalcaemia was a significant predictor of mortality.</p><p><strong>Conclusions: </strong>Ionized hypocalcaemia is widely prevalent among acutely injured. Trauma-induced hypocalcaemia at admission is associated with increased need for blood transfusions and increased mortality.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"16"},"PeriodicalIF":1.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982997","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":"Temporal comparison of radiological and functional outcomes in calcaneal fracture surgery with and without iliac crest graft application: Mid- to long-term results.","authors":"Enes Polat, Muhammed Yusuf Afacan, Bedri Karaismailoglu, Huseyin Botanlioglu, Ali Seker","doi":"10.1007/s00068-024-02687-5","DOIUrl":"10.1007/s00068-024-02687-5","url":null,"abstract":"<p><strong>Background: </strong>The standard approach for addressing intra-articular calcaneal fractures involves open reduction with plate and screw fixation, with ongoing discourse regarding the application of grafts to address bone gaps. The aim of this study is the temporal comparison of the radiological and functional outcomes in patients undergoing surgery for intra-articular calcaneal fractures, with a specific focus on the use of bone grafts.</p><p><strong>Methods: </strong>Thirty patients, comprising 13 with iliac grafts and 17 without, were enrolled in the study. Preoperative and postoperative assessments included Gissane and Böhler angles, Visual Analog Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scale, and Kellgreen-Lawrance subtalar arthrosis stages. The average follow-up period was 6.7 years, ranging from a minimum of 3.5 to a maximum of 10 years.</p><p><strong>Results: </strong>The Böhler angle exhibited a significant increase (p < 0.001), while the Gissane angle did not show significant changes in the early postoperative period across the entire study group (p = 0.1). Graft-treated patients demonstrated a significantly higher Böhler angle in the early and late postoperative periods compared to preoperative values (p = 0.04, p = 0.05). Similarly, patients without grafts exhibited a significantly higher Böhler angle in the early and late postoperative periods compared to preoperative values (p = 0.004, p = 0.002). No significant differences were observed between periods in Gissane measurements (p = 0.3), VAS scores, AOFAS scores, and the development of subtalar arthrosis in both grafted and non-grafted patients.</p><p><strong>Conclusions: </strong>Evaluation of patients with calcaneal fractures, both with and without grafts, was conducted using Böhler and Gissane angles, VAS scores, AOFAS scores, and the development of fracture union and subtalar arthrosis, assessing preoperative, early, and late postoperative periods. No significant differences were found between the two groups in terms of clinical and radiological outcomes during mid-to long-term follow-up.</p><p><strong>Level of evidence: </strong>A retrospective cohort study.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"15"},"PeriodicalIF":1.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors against discharge to home in geriatric emergency general surgery patients.","authors":"Vahe S Panossian, May Abiad, Jefferson Proaño, Emanuele Lagazzi, Ikemsinachi C Nzenwa, Wardah Rafaqat, Suzanne Arnold, Veerle P C van Zon, Casey Luckhurst, Jonathan J Parks, Michael P DeWane, George C Velmahos, John O Hwabejire","doi":"10.1007/s00068-024-02750-1","DOIUrl":"https://doi.org/10.1007/s00068-024-02750-1","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to identify predictors of discharge to post-acute care in geriatric emergency general surgery (EGS) patients.</p><p><strong>Methods: </strong>This is a retrospective study of geriatric emergency general surgery (EGS) patients at a tertiary care facility between 2017 and 2018. Inclusion criteria were ≥ 65 years old and presented directly from home. Non-survivors or those admitted from a healthcare facility were excluded. The primary outcome was discharge to home versus post-acute care.</p><p><strong>Results: </strong>Out of 577 patients, the median age was 74, and 36.9% were discharged to a post-acute care facility. Factors predicting discharge to post-acute care were: mobility aid use (1.92, [1.19-3.11], p = 0.008), cerebrovascular accident (4.67, [1.99-10.94], p < 0.001), delirium (11.06, [2.29-53.43], p = 0.003), pre-operative transfusion (2.39, [1.13-5.08], p = 0.023), fall history (3.74, [1.90-7.36], p < 0.001), AKI (5.42, [2.61-11.25], p < 0.001), and lack of capacity to consent (4.11, [2.10-8.02], p < 0.001). Non-operative management was protective against discharge to post-acute care (0.38, [0.24-0.60], p < 0.001).</p><p><strong>Conclusion: </strong>Early recognition of the role of these factors in influencing discharge disposition may help with clinical decision-making and discharge planning.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"14"},"PeriodicalIF":1.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978091","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":"Effect of isotonic sodium bicarbonate infusion on perioperative acid-base status among patients undergoing emergency laparotomy for perforation peritonitis (ISABEL trial): a randomized controlled trial.","authors":"Rahul Kumar Chaudhary, Ankita Dhir, Venkata Ganesh, Ajay Singh, Naveen B Naik, Priyankar Kumar Datta, Shiv Lal Soni, Narender Kaloria, Yashwant Raj Sakaray","doi":"10.1007/s00068-024-02751-0","DOIUrl":"https://doi.org/10.1007/s00068-024-02751-0","url":null,"abstract":"<p><strong>Purpose: </strong>Perioperative metabolic acidosis negatively affects patient outcomes. Perioperative fluid therapy has a clinically significant effect on acid-base balance. This study was conducted to evaluate the effects of isotonic sodium bicarbonate infusion (ISB) versus balanced crystalloid solution (BCS) on perioperative acid-base balance, in terms of postoperative base excess, among patients undergoing emergency laparotomy for perforation peritonitis.</p><p><strong>Methods: </strong>This prospective, randomized, single-center, double-blinded study was conducted in a tertiary hospital from October 2021 to November 2022. A total of 90 patients undergoing emergency laparotomy for perforation peritonitis were randomly assigned to receive either isotonic sodium bicarbonate (ISB) or Ringer's Lactate as a balanced crystalloid solution (BCS) for perioperative maintenance fluid therapy. The primary outcome was to compare the base excess (BE) at the end of surgery. The secondary outcomes were to compare the postoperative clinical outcomes, including the requirement of vasopressors, duration of mechanical ventilation, HDU/ICU stay, the incidence of AKI within seven days, the incidence of re-exploration, and in-hospital mortality. Additionally, pH, PaCO2, HCO3, BE, and lactates intraoperatively and up to 24 h postoperatively were also compared.</p><p><strong>Results: </strong>The median base excess (BE) values at the end of surgery were significantly better in the ISB group - 4.80 [- 6.80, - 4.10] as compared to the BCS group - 7.30 [- 8.50, - 6.30]. The ISB group had a lower incidence of postoperative AKI (9% ISB versus 24% BCS) and requirement of vasopressors (18% ISB versus 44% BCS). However, there was no major difference between the incidence of re-exploration, length of ICU/HDU stay, and in-hospital mortality.</p><p><strong>Conclusion: </strong>Infusing isotonic sodium bicarbonate (ISB) for intraoperative maintenance fluid therapy in patients undergoing emergency laparotomy for perforation peritonitis significantly improves perioperative acid-base balance with better postoperative clinical outcomes compared to a balanced crystalloid solution (BCS).</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"10"},"PeriodicalIF":1.9,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142968963","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}