European Journal of Trauma and Emergency Surgery最新文献

{"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":null,"pages":null},"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":null,"pages":null},"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}

{"title":"Analysis of ballistic trajectories and its association with clinical outcomes in civilian penetrating brain injury.","authors":"Sebastián Ordoñez, Mauricio A Ledesma, Lina María Villegas-Trujillo, Miguel Velásquez, María Trujillo, Andrés M Rubiano","doi":"10.1007/s00068-024-02643-3","DOIUrl":"https://doi.org/10.1007/s00068-024-02643-3","url":null,"abstract":"<p><strong>Purpose: </strong>Civilian penetrating brain injuries (PBI) caused by firearms are a medical emergency with high rates of morbidity and mortality. The aim of this study was to evaluate the association between trajectory vectors in CT brain angiography and clinical outcomes in patients with civilian gunshots.</p><p><strong>Methods: </strong>This is a retrospective analytical cross-sectional study that includes patients over 15 years of age with PBI due to firearms, admitted from January 2019 to December 2021 at a University Hospital in Cali, Colombia. A brain CT with angio-CT was performed the first day of admission. An XYZ coordinate system centered on the Turk's saddle was developed. Trajectories of projectiles were plotted and compared to a patient 0 in a 3D-Slicer software. A bivariate analysis of the clinical and geometric characteristics of the trajectory was performed. Primary outcomes include mortality and disability at 6 months.</p><p><strong>Results: </strong>Twenty-eight patients with a mean age of 27.39 ± 11.66 years were included. The vectors of non-survivors show a trend, crossing at a specific area. This area was designated as a \"potential lethal zone\" and inside this area, injuries around 25.3 mm from the circle of Willis, were associated with greater mortality (p < 0.005).</p><p><strong>Conclusions: </strong>In our study PBI avoiding the ventricular system, brain stem, dorsum sellae and the circle of Willis were associated with more survivability. A \"potential lethal zone\" was detected and associated with poor outcome after civilian PBI due to firearms. A better evaluation of the performance of this \"potential lethal zone\" in larger studies will be required.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153492","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":"International publication activity in orthopaedic surgery over a ten-year interval.","authors":"C Michels, K-H Frosch, F T Beil, E S Debus, R T Grundmann","doi":"10.1007/s00068-024-02665-x","DOIUrl":"https://doi.org/10.1007/s00068-024-02665-x","url":null,"abstract":"<p><strong>Purpose: </strong>International English language publication activities in orthopaedic surgery comparing the years 2008/09 to 2018/19 were analyzed.</p><p><strong>Methods: </strong>20 international journals listed on PubMed were examined. The impact factor (IF) for each journal was determined using the InCites Journal Citation Report.</p><p><strong>Results: </strong>9,205 publications in 2008/09 and 15,549 in 2018/19 with 21,435 cumulative IF (CIF) in 2008/09 and 50,552 in 2018/19 were registered. Most publications consisted of narrative reviews (42.0%), followed by clinical studies (22.0%), experimental investigations (16.9%), randomized controlled trials (6.0%), and meta-analyses (5.6%). The highest increase in publications was observed for narrative reviews from 33.5% in 2008/09 to 41.1% in 2018/19. The USA had the highest number of publications (2,981 and 4,796), followed by UK (806 and 879) and Germany (606 and 922) in 2008/09 and 2018/19, resp. Per 1 Mio inhabitants, Switzerland (13.6 and 28.4), Sweden (10.9 and 18.1), the Netherlands (9.6 and 15.4), and Denmark (9.0 and 21.8) were the most productive countries in 2008/09 and 2018/19, resp.</p><p><strong>Conclusions: </strong>International publishing activity in orthopaedic surgery has increased substantially over the last 10 years. The quality of the published articles has not increased in the same way, as evidenced by the disproportionate rise in narrative reviews. Over the entire period, the US were the leader with respect to number of publications and CIF. In terms of population, however, smaller countries such as Switzerland and Sweden were much more active.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132247","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":"Publisher Correction: Abstracts from the 7th European Society of Tissue Regeneration in Orthopaedics and Traumatology (ESTROT).","authors":"","doi":"10.1007/s00068-024-02614-8","DOIUrl":"10.1007/s00068-024-02614-8","url":null,"abstract":"","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132248","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":"The non-haemorrhagic vagal response to trauma: a review of hypotensive and bradycardic responses to injury in the absence of bleeding.","authors":"Jonathan Woods, Jake Turner, Amy Hughes, Gareth Davies, Gareth Grier","doi":"10.1007/s00068-024-02648-y","DOIUrl":"https://doi.org/10.1007/s00068-024-02648-y","url":null,"abstract":"<p><strong>Purpose: </strong>Trauma has the potential to cause haemorrhage, tissue damage, pain, visceral manipulation and psychological distress. Each of these consequences of trauma can cause changes in autonomic outflow, which dictates a patient's vital signs. Patients who are hypotensive and bradycardic due to a vagally mediated parasympathetic response to pain, psychological distress and visceral manipulation may be confused with those who exhibit bradycardia and hypotension following significant blood volume loss.</p><p><strong>Methods: </strong>This review summarises literature that describes specific stimuli, patterns of injury and patient characteristics that are associated with a non-haemorrhagic vagal response to trauma.</p><p><strong>Results: </strong>Twenty-six records described predominantly parasympathetic responses to trauma (both blunt and penetrating) and surgery (\"iatrogenic trauma\"). Such a non-haemorrhagic vagal response occurs following a wide variety of injury patterns. Patient age and sex are poor predictors of the likelihood of a non-haemorrhagic vagal response. The development and resolution of a non-haemorrhagic vagal response occurs over a heterogenous time period. It is unclear whether speed of onset and resolution is linked to the pattern of injury or other factors causing a predominantly parasympathetic response following non-haemorrhagic trauma.</p><p><strong>Conclusion: </strong>The pattern of injury, patient demographic and speed of onset / resolution associated with the non-haemorrhagic vagal response to trauma may is heterogenous. It is therefore challenging to clinically distinguish between the hypotensive bradycardia due to hypovolaemia secondary to haemorrhage, or a parasympathetic response to trauma in the absence of bleeding.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125220","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":"Role of laparoscopic surgery in managing hemodynamically stable abdominal trauma patients: a single level I trauma center, propensity score matching study.","authors":"Doo-Hun Kim, Maru Kim, Dae-Sang Lee, Tae Hwa Hong, Hoonsung Park, Hangjoo Cho","doi":"10.1007/s00068-024-02642-4","DOIUrl":"https://doi.org/10.1007/s00068-024-02642-4","url":null,"abstract":"<p><strong>Background: </strong>The role of laparoscopy in the treatment and diagnosis of penetrating thoraco-abdominal injury has been established. However, there is no clear consensus on the role of laparoscopy in blunt injury due to numerous reasons, such as concerns of missed injury and technical problems in treating various abdominal organs. This study aimed to determine the feasibility of laparoscopy and evaluate its safety in managing blunt and penetrating abdominal trauma.</p><p><strong>Methods: </strong>The medical records and Korean Trauma Data Base (KTDB) of patients who underwent abdominal surgery from January 2018 to December 2022 at a single level I center were collected. Patients were classified into a laparoscopy group and a laparotomy group. The laparoscopy groups were matched 1:1 with the laparotomy group by using propensity score matching (PSM). Patient demographics, injured organ and its grade, operative procedure, and postoperative outcomes were evaluated and compared between the two groups.</p><p><strong>Results: </strong>After propensity score matching, 128 patients were included. There was no significant imbalance in demographics between the two groups except sex. Injured organ and its grade showed no significant differences between the two groups except for the incidence of omentum. Small bowel and mesenteric repair were performed most often in both groups. Splenectomy, pancreatic surgery, duodenectomy, and liver resection were performed exclusively in the laparotomy group. Severe postoperative complication rate (3% vs. 20%: p = 0.004), length of stay in ICU (3.3 ± 3.2 days vs. 4.6 ± 3.7; p = 0.046), and operation time (93.9 ± 47.7 min vs. 112.8 ± 57.7; p = 0.046) were significantly lower in the laparoscopy group. The conversion rate was about 16%. There was no missed injury.</p><p><strong>Conclusions: </strong>In hemodynamically stable abdominal trauma patients who sustained penetrating or blunt injury, laparoscopy is feasible and safe as a diagnostic and therapeutic modality in selected cohort of abdominal trauma.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119335","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 and functional outcomes of locked plating vs. cerclage compression wiring for AO type C patellar fractures– a retrospective single-center cohort study","authors":"Steven Bickel, Kai Oliver Jensen, Felix Karl-Ludwig Klingebiel, Michel Paul Johan Teuben, Roman Pfeifer, Hans-Christoph Pape, Christian Hierholzer, Yannik Kalbas","doi":"10.1007/s00068-024-02633-5","DOIUrl":"https://doi.org/10.1007/s00068-024-02633-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Although “tension-band wiring” is still commonly used to stabilize patellar fractures, the technique has recently been scrutinized due to biomechanical insufficiency. Consequently, the AO Foundation renamed the principle to compression cerclage wiring (CCW). Several studies propose favorable outcomes when utilizing locked plating (LP). This study aims to compare outcome of CCW and LP for complex patellar fractures.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A retrospective, single-center cohort study was performed on patients who underwent operative treatment for (AO 34 C-Type) patellar fractures between April 2013 and March 2023. Patients with a 12 month follow up were included. We grouped and compared patients based on the applied treatment strategy: group LP vs. group CCW. Primary outcome parameters included implant-related complications and revision surgeries. Secondary outcomes were length of stay, return to work and 12 months functional outcome (Lysholm score). Odd ratios for complications and revisions were calculated using the conditional Maximum Likelihood Estimate. The threshold for statistical significance was set at <i>p</i> &lt; 0.05.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Of 145 patients, 63 could be included (group LP: <i>n</i> = 23 and group CCW: <i>n</i> = 40). Fractures in group LP were significantly more complex in regard to AO Classification (<i>p</i> &lt; 0.001), number of fragments (<i>p</i> &lt; 0.001) and degree of comminution (<i>p</i> &lt; 0.001), yet odds of complications were significantly lower in group LP (OR: 0.147; 95%CI: 0.015–0.742; <i>p</i> = 0.009). K-wire migration was the most common complication in group CCW (20%). Odds of revision surgery were significantly lower in group LP (OR: 0.000; 95%CI: 0.000-1.120; <i>p</i> = 0.041). The average Lysholm score at one year was favorable in both groups (89.8; SD: 11.9 in group LP and 90.6; SD: 9.3 in group CCW; n.s.).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>In our study cohort, LP was routinely chosen for more complex fracture morphologies; nevertheless the data implies that LP may be considered as the superior fixation technique in regard to complications and revision operations. Especially, K-wire migration occurs frequently after CCW. The one year functional outcome was comparable between the groups, with both demonstrating good results. Prospective randomized studies are indicated to validate our findings.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201271","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":"Bringing the operating room to the field: lessons learned from on-scene field amputations","authors":"Jennie S. Kim, Elizabeth R. Benjamin, Saman Kashani, Marc Eckstein, Demetrios Demetriades","doi":"10.1007/s00068-024-02668-8","DOIUrl":"https://doi.org/10.1007/s00068-024-02668-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Complicated field extrication may require the assistance of a surgical team to perform an on-scene limb amputation. Although a rare event, when needed, an organized and efficient response is critical to successful outcomes.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>The Los Angeles County Hospital Emergency Response Team (HERT) program and the organization of the team is described, and a multidisciplinary quality improvement process reviewed and analyzed two cases and identified areas for performance improvement.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Experience shapes policy and procedures within the HERT program. The timeliness of HERT activation has a major influence on the success of extrication, and regular drills of the multidisciplinary team consisting of trauma surgeons, emergency physicians, nurses, paramedics, and fire department allow for rapid, effective activation. Post-event quality improvement process reviews the timeline of events, provider activation, communication across field and hospital providers, in-hospital events, and medical decision making throughout. Critical analysis of every step helps prepare for any subsequent encounter.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>A well-organized and rehearsed protocol to streamline activation and transportation of a well-trained, designated team, in addition to pre-packaged surgical supplies and an effective communication tree are essential elements of a HERT program.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201276","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":"Correction: The utility of the prehospital shock index, age shock index, and modified shock index for predicting hypofibrinogenaemia in trauma patients: an observational retrospective study.","authors":"Jihwan Moon, Sungwook Park","doi":"10.1007/s00068-024-02656-y","DOIUrl":"10.1007/s00068-024-02656-y","url":null,"abstract":"","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119334","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}