European Journal of Trauma and Emergency Surgery最新文献

{"title":"Publisher Correction: How does damage control strategy influence organ's suitability for donation after major trauma? A multi-institutional study.","authors":"Michele Altomare,Shir Sara Bekhor,Marco Sacchi,Federico Ambrogi,Gabriele Infante,Arturo Chieregato,Federico Pozzi,Tullia Maria De Feo,Lorenza Nava,Elisabetta Masturzo,Luca Del Prete,Carolina Perali,Elena Manzo,Paolo Bertoli,Francesco Virdis,Andrea Spota,Stefano Piero Bernardo Cioffi,Laura Benuzzi,Giuliano Santolamazza,Mauro Podda,Andrea Mingoli,Osvaldo Chiara,Stefania Cimbanassi","doi":"10.1007/s00068-024-02593-w","DOIUrl":"https://doi.org/10.1007/s00068-024-02593-w","url":null,"abstract":"","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"18 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256571","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":"TBI related death has become the new epidemic in polytrauma: a 10-year prospective cohort analysis in severely injured patients","authors":"Karlijn J. P. van Wessem, Kim E. M. Benders, Luke P. H. Leenen, Falco Hietbrink","doi":"10.1007/s00068-024-02653-1","DOIUrl":"https://doi.org/10.1007/s00068-024-02653-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Advances in trauma care have attributed to a decrease in mortality and change in cause of death. Consequently, exsanguination and traumatic brain injury (TBI) have become the most common causes of death. Exsanguination decreased by early hemorrhage control strategies, whereas TBI has become a global health problem. The aim of this study was to investigate trends in injury severity,physiology, treatment and mortality in the last decade.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In 2014, a prospective cohort study was started including consecutive severely injured trauma patients &gt; 15 years admitted to a Level-1 Trauma Center ICU. Demographics, physiology, resuscitation, and outcome parameters were prospectively collected.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Five hundred and seventy-eight severely injured patients with predominantly blunt injuries (94%) were included. Seventy-two percent were male with a median age of 46 (28–61) years, and ISS of 29 (22–38). Overall mortality rate was 18% (106/578) with TBI (66%, 70/106) being the largest cause of death. Less than 1% (5/578) died of exsanguination. Trend analysis of the 10-year period revealed similar mortality rates despite an ISS increase in the last 2 years. No significant differences in demographics,and physiology in ED were noted. Resuscitation strategy changed to less crystalloids and more FFP. Risk factors for mortality were age, brain injury severity, base deficit, hypoxia, and crystalloid resuscitation.</p><h3 data-test=\"abstract-sub-heading\">Discussion</h3><p>TBI was the single largest cause of death in severely injured patients in the last decade. With an aging population TBI will increase and become the next epidemic in trauma. Future research should focus on brain injury prevention and decreasing the inflammatory response in brain tissue causing secondary damage, as was previously done in other parts of the body.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"44 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256598","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":"Angioembolization in patients with blunt splenic trauma in Germany –guidelines vs. Reality a retrospective registry-based cohort study of the TraumaRegister DGU®","authors":"Benny Kölbel, Sebastian Imach, Michael Engelhardt, Arasch Wafaisade, Rolf Lefering, Christian Beltzer","doi":"10.1007/s00068-024-02640-6","DOIUrl":"https://doi.org/10.1007/s00068-024-02640-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Nonoperative management (NOM) for blunt splenic injuries (BSIs) is supported by both international and national guidelines in Germany, with high success rates even for severe organ injuries. Angioembolization (ANGIO) has been recommended for stabilizable patients with BSI requiring intervention since the 2016 German National Trauma Guideline. The objectives were to study treatment modalities in the adult BSI population according to different severity parameters including NOM, ANGIO and splenectomy in Germany.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Between 2015 and 2020, a retrospective registry-based cohort study was performed on patients with BSIs with an Abbreviated Injury Score ≥ 2 in Germany using registry data from the TraumaRegister DGU® (TR DGU). This registry includes patients which were treated in a resuscitation room and spend more than 24-h in an intensive care unit or died in the resuscitation room.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 2,782 patients with BSIs were included in the analysis. ANGIO was used in 28 patients (1.0%). NOM was performed in 57.5% of all patients, predominantly those with less severe organ injuries measured by the American Association for the Surgery of Trauma Organ Injury Scale (AAST) ≤ 2. The splenectomy rate for patients with an AAST ≥ 3 was 58.5%, and the overall mortality associated with BSI was 15%.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>In this cohort splenic injuries AAST ≥ 3 were predominantly managed surgically and ANGIO was rarely used to augment NOM. Therefore, clinical reality deviates from guideline recommendations regarding the use of ANGIO and NOM. Local interdisciplinary treatment protocols might close that gap in the future.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"38 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256569","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":"Operative versus non-operative treatment of ulnar styloid process base fractures: a systematic review and meta-analysis","authors":"L. X. van Rossenberg, F. J. P. Beeres, M. van Heijl, U. Hug, R. H. H. Groenwold, R. M. Houwert, B. J. M. van de Wall","doi":"10.1007/s00068-024-02660-2","DOIUrl":"https://doi.org/10.1007/s00068-024-02660-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Ulnar styloid process (USP) fractures are present in 40–65% of all distal radius fractures (DRFs). USP base fractures can be associated with distal radioulnar joint (DRUJ) instability and ulnar sided wrist pain and are treated by conservative management and surgical fixation, without consensus. This systematic review and meta-analysis compares operative to non-operative treatment of concomitant ulnar styloid base fractures in patients with distal radius fractures.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>PubMed/Medline/Embase/CENTRAL databases were searched identifying RCTs and comparative observational studies. Effect estimates were extracted and pooled using random effect models to account for heterogeneity across studies. Results were presented as (standardized) mean differences (SMD or MD) or odds ratios (OR) and corresponding 95% confidence intervals (95%CI).</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Two RCTs (161 patients) and three observational studies (175 patients) were included. Tension band wiring was used for surgically treated USP fractures. Results were comparable across the different study designs and hence pooled across studies. Non-surgically treated patients had better wrist function at 6 months (SMD 0.57, 95%CI 0.30; 0.90, I² = 0%). After 12 months there was no observed difference (MD 2.31, 95%CI −2.57; 7.19, I² = 91%). Fewer patients had USP non-unions in the operative group (OR 0.08, 95%CI 0.04; 0.18, I² = 0%). More patients suffered complications in the operative group (OR 14.3; 95%CI 1.08; 188, I² = 89%).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Routinely fixating USP base fractures as standard of care is not indicated. Surgery may be considered in selective cases (e.g. persistent DRUJ instability during ballottement test after fixation of the radius).</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"400 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201267","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":"Epidemiology of postinjury multiple organ failure: a prospective multicenter observational study","authors":"Ryan S. Ting, Natasha A. Weaver, Kate L. King, Teagan L. Way, Pooria Sarrami, Lovana Daniel, Michael Dinh, Priya Nair, Jeremy Hsu, Scott K. D’Amours, Zsolt J. Balogh","doi":"10.1007/s00068-024-02630-8","DOIUrl":"https://doi.org/10.1007/s00068-024-02630-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Postinjury multiple organ failure (MOF) is the sequela to the disease of polytrauma. We aimed to describe the contemporary population-based epidemiology of MOF within a mature trauma system, to analyse the time taken for MOF to develop, and to evaluate the temporal patterns and contributions of the individual constituent organ failures.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Prospective observational study conducted across five Level-1 trauma centers in New South Wales, Australia. Trauma patients at-risk of MOF (Denver &gt; 3 from 48 h post-admission), aged &gt; 16 years, ISS &gt; 15, and who stayed in ICU for ≥ 48 h were eligible for inclusion.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>From May 2018–February 2021, 600 at-risk polytrauma patients were prospectively enrolled (mean(SD)age = 49(21)years, males = 453/600(76%),median(IQR)ISS = 26(20,34)). MOF incidence was 136/600(23%) among at-risk patients, 142/6248(2%) among major trauma patients (ISS &gt; 12 per Australian definition), and 0.8/100,000 in the general population. The mortality rate was 55/600(11%) in the overall study population, and 34/136(25%) in MOF patients. 82/136(60%) of MOF patients developed MOF on day-3. No patients developed MOF after day-13. Among MOF patients, 60/136(44%) had cardiac failures (mortality = 37%), 39/136(29%) had respiratory failures (mortality = 23%), 24/136(18%) had renal failures (mortality = 63%), and 12/136(9%) had hepatic failures (mortality = 50%).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Although a rare syndrome in the general population, MOF occurred in 23% of the most severely injured polytrauma patients. When compared to previous risk-matched cohorts, MOF become more common, but not more lethal, despite a decade older cohort. The heart has superseded the lungs as the most common organ to fail. Cardiac and respiratory failures occurred earlier and were associated with lower mortality than renal and hepatic failures.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"41 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201250","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":"Classification methods of pulmonary contusion based on chest CT and the association with in-hospital outcomes: a systematic review of literature","authors":"Max R. Van Diepen, Mathieu M. E. Wijffels, Michael H. J. Verhofstad, Esther M. M. Van Lieshout","doi":"10.1007/s00068-024-02666-w","DOIUrl":"https://doi.org/10.1007/s00068-024-02666-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Patients sustaining pulmonary contusion (PC) have a higher risk of complications and long-term respiratory difficulty. Computed tomography (CT) scans have a high sensitivity for PC. However, since PC develops over time, CT scans made directly post-trauma may underestimate the full extent of PC. This creates a need to better define in which PC-patients complications are more likely. The aim of this systematic review was to identify different classification systems of PC, and investigate the association between amount of PC and in-hospital outcomes.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A systematic review was conducted in accordance with PRISMA guidelines. Studies reporting a classification system for PC after blunt thoracic trauma based on a CT scan were included. Outcomes were classification method of PC and the relation between classification and pulmonary complications and in-hospital outcomes.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Twenty studies were included. Total number of patients ranged from 49 to 148,140 patients. The most common classification system used was calculating the percentage of contused lung volume. Other classification methods were based on Blunt Pulmonary Contusion score-6 and -18, Abbreviated Injury Score and Thoracic Trauma Severity scores. Worse outcomes were generally associated with between &gt; 18 to &gt; 24% contusion volume.</p><h3 data-test=\"abstract-sub-heading\">Discussion</h3><p>The heterogeneity of currently available literature makes comparing classification methods challenging. The most common classification of PC was based on volumetric analysis. Calculating a percentage of PC as part of the total volume allows for the highest level of segmentation of lung parenchyma as compared to using BPC-6, BPC-18, or AIS. Contusion volume exceeding 18–24% was generally associated with worse outcomes.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"45 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201268","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":"Venous thromboembolism chemoprophylaxis after severe polytrauma: timing and type of prophylaxis matter","authors":"James P. Byrne, Morgan Schellenberg","doi":"10.1007/s00068-024-02651-3","DOIUrl":"https://doi.org/10.1007/s00068-024-02651-3","url":null,"abstract":"<p>In this review, we provide recommendations as well as summarize available data on the optimal time to initiate venous thromboembolism chemoprophylaxis after severe trauma. A general approach to the severe polytrauma patient is provided as well as in-depth reviews of three high-risk injury subgroups: patients with traumatic brain injury, solid organ injury, and pelvic fractures.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"29 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201269","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":"Fractures of the thoracolumbar spine in osteoporosis","authors":"Radko Komadina, Frank W. Bloemers, Marko Jug, Klaus W. Wendt, Christoph Nau, Hans-Christoph Pape","doi":"10.1007/s00068-024-02625-5","DOIUrl":"https://doi.org/10.1007/s00068-024-02625-5","url":null,"abstract":"<p>Due to increasing life expectancy, the prevalence of fractures caused by osteoporosis is raising. These fractures significantly reduce the quality of life in the elderly population. They represent both a disease and an injury simultaneously. While they were once treated solely with conservative methods, new techniques and implants are expanding the indications for surgical treatment. This article presents the current treatment options.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"4 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201251","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":"Contrast-enhanced CT scan (CECT) for the detection of hollow viscus and mesenteric injuries in blunt trauma - an updated systematic review of the literature and meta-analysis of diagnostic test accuracy.","authors":"Stefano Granieri, Michele Altomare, Alessandro Bonomi, Giada Panagini, Simone Frassini, Stefano Piero Bernardo Cioffi, Giorgio Basta, Andrea Spota, Fabrizio Sammartano, Roberto Bini, Federica Renzi, Elisa Reitano, Osvaldo Chiara, Stefania Cimbanassi","doi":"10.1007/s00068-024-02667-9","DOIUrl":"https://doi.org/10.1007/s00068-024-02667-9","url":null,"abstract":"<p><strong>Background: </strong>Despite improved awareness of blunt traumatic hollow viscus and mesenteric injuries (THVMI), the accuracy of contrast-enhanced CT (CECT) varies considerably among studies. This systematic review and meta-analysis of test accuracy aims to explore the diagnostic performance of CECT in detecting THVMI in blunt trauma.</p><p><strong>Methods: </strong>The study was conducted according to the Cochrane recommendations searching the PubMed, Scopus, and Cochrane Library datasets from 2000 to 8 September 2023 (PROSPERO ID: CRD42023473041). Surgical exploration, autopsy, and discharge from the hospital after monitoring were set as reference standard. To explore the diagnostic accuracy of CECT in detecting THVMI hierarchical models were developed. The risk of bias in individual studies was assessed with the QUADAS-2 tool. Sensitivity analysis was conducted to detect sources of heterogeneity.</p><p><strong>Results: </strong>Twelve studies, for a total of 4537 patients, were deemed eligible. After identification of outliers and sensitivity analysis, the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.85 (95% CI: 0.69-0.93), 0.94 (95% CI: 0.8-0.98), 14.65 (95% CI: 4.22-50.85), 0.16 (95% CI: 0.07-0.34), 92.3 (95% CI: 29.75-286.34), respectively. The Area under the HSROC curve was 0.95 (95% CI: 0.92-0.96). Meta-regression analysis identified the year of publication as a covariate significantly associated with heterogeneity. A high risk of bias was detected in the \"patient selection\" domains.</p><p><strong>Conclusion: </strong>CECT has a fundamental role in identifying THVMI with high specificity but suboptimal sensitivity. Clinical criteria are still of paramount importance, especially in cases of ambiguous initial CECT images.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153493","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":"REBOA in trauma: a life-saving intervention or a spectacular failure?","authors":"Bellal Joseph, Demetrios Demetriades","doi":"10.1007/s00068-024-02657-x","DOIUrl":"https://doi.org/10.1007/s00068-024-02657-x","url":null,"abstract":"<p><strong>Purpose: </strong>Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a controversial haemorrhage control intervention often touted as the bridge to definitive haemorrhage control. This review summarizes the evolution of REBOA from its inception to the latest applications with an emphasis on clinical outcomes.</p><p><strong>Methods: </strong>This is a narrative review based on a selective review of the literature.</p><p><strong>Results: </strong>REBOA remains a rarely utilized intervention in trauma patients. Complications have remained consistent over time despite purported improvements in catheter technology. Ischemia-reperfusion injuries, end-organ dysfunction, limb ischemia, and amputations have all been reported. Evidence-based guidelines are lacking, and appropriate indications and the ideal patient population for this intervention are yet to be defined.</p><p><strong>Conclusion: </strong>Despite the hype, purported technological advancements, and the mirage of high-quality studies over the last decade, REBOA has failed to keep up to its expectations. The quest to find the solution for uncontrolled NCTH remains unsolved.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153494","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}