European Journal of Trauma and Emergency Surgery最新文献

{"title":"Hemorrhage control in pelvic ring injuries: the role of PCCDs and other acute measures in Germany.","authors":"Felix Metzger, A Höch, S C Herath, S Buschbeck, S F Huber, U Schweigkofler","doi":"10.1007/s00068-025-02836-4","DOIUrl":"10.1007/s00068-025-02836-4","url":null,"abstract":"<p><strong>Background/purpose: </strong>Partially unstable- and unstable pelvic ring injuries (PRI) can result in massive hemorrhage. Early detection and appropriate management are of utmost importance. This retrospective study, utilizing data from the German Pelvis Registry (GPR), evaluates bleeding complications (BC), the effect of pelvic circumferential compression devices (PCCDs) on transfusion requirements and outcomes, and the role of acute measures such as pelvic clamps, external fixators, pelvic tamponade and embolization.</p><p><strong>Methods: </strong>Inclusion criteria: Adults (≥ 17 and ≤ 64 years) with partially unstable or unstable PRI (Tile type B and C), with (BC) or without bleeding complications (nBC) recorded in the GPR between July 2018 and February 2023. BC was defined as significant pelvis-related bleeding requiring blood transfusions and/or resulting in systolic blood pressure < 100 mmHg. Bleeding complications were identified by transfusions within 3 h of admission, the occurrence of bleeding during the hospital stay, or pre-hospital/ER systolic blood pressure < 100 mmHg.</p><p><strong>Exclusion criteria: </strong>Patients ≤ 17 or ≥ 64 years, Tile type A-, acetabular-, combined pelvic-acetabular injuries, and inter-hospital transfers.</p><p><strong>Results: </strong>Of 477 cases, 335 (70.2%) met inclusion criteria, with 133 (39.7%) having bleeding complications (BC) and 202 (60.3%) without (nBC). BC occurred more frequently in patients with Tile types B2-C3 injuries, who also had more concomitant injuries, higher ISS, NISS, and RISC II scores. These patients required more blood transfusions during admission and surgery, had longer ICU and hospital stays, and had worse outcomes with higher mortality rates (21.1%). Most patients with bleeding complications (BC) were stabilized with a PCCD (85%). Those with a PCCD had higher ISS but did not require more blood transfusions compared to patients without a PCCD. There were no differences in ICU or hospital stay duration, though outcomes were worse; however, mortality (23%) was not significantly higher. Pelvic tamponade was performed in 3.8% of cases, and embolization in 0.8%, both deemed 100% effective. Stabilization was done in 57.6% of cases, with pelvic clamps applied in 1.5% in the ER and 6.8% in the OR. External fixators were used in 48.9%, percutaneous osteosynthesis in 8.3%, open osteosynthesis in 2.3%, and combined measures in 12.8%. Effectiveness rates were 77.8% for pelvic clamps, 93.8% for external fixators, 100% for percutaneous osteosynthesis, and 66.7% for open osteosynthesis.</p><p><strong>Conclusion: </strong>Bleeding complications occurred in 39.7%, mostly in Tile B2-C3 injuries, with 85% receiving PCCD stabilization. Mortality and transfusion rates were similar to those without PCCD, indicating that injury severity and surgical care quality were more impactful than PCCD use. External fixators were the most commonly used measure and demonstrated high effectivenes","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"159"},"PeriodicalIF":1.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771859","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":"Imaging strategies for patients with multiple and/or severe injuries in the resuscitation room: a systematic review and clinical practice guideline update.","authors":"Stefan Huber-Wagner, Rainer Braunschweig, Daniela Kildal, Dan Bieler, Barbara Prediger, Miriam Hertwig, Charlotte Kugler, Stefan Reske, Thomas Wurmb, Gerhard Achatz, Benedikt Friemert, Carsten Schoeneberg","doi":"10.1007/s00068-025-02840-8","DOIUrl":"10.1007/s00068-025-02840-8","url":null,"abstract":"<p><strong>Purpose: </strong>Our aim was to develop new evidence-based and consensus-based recommendations for imaging strategies in patients with multiple and/or severe injuries in the resuscitation room. 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 August 2021.</p><p><strong>Inclusion criteria: </strong>patients with multiple and/or severe injuries in the resuscitation room, randomised controlled trials, prospective cohort studies, cross-sectional studies, and comparative registry studies; comparison of interventions for imaging strategies; patient-relevant clinical outcomes such as diagnostic test accuracy and mortality. Further literature reports were obtained from clinical experts. We considered patient-relevant clinical outcomes such as diagnostic test accuracy and mortality. 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>Twenty-one studies with a total of 55,227 patients were identified. There were studies with low risk (n = 2), high risk (n = 5) and unclear risk of bias (n = 14). Relevant topics were sonographic imaging of the chest and abdomen (n = 8 studies), X-ray of the chest (n = 1), indications for whole-body computed tomography (n = 6), CT scanner location (n = 1), whole-body computed tomography in haemodynamically unstable patients (n = 3), and prehospital sonography (n = 2). There were studies with low risk (n = 2), high risk (n = 5) and unclear risk of bias (n = 14). One new recommendation was developed, six were modified. All achieved strong consensus.</p><p><strong>Conclusion: </strong>While extended focused assessment with sonography for trauma should be performed for diagnostic purposes after blunt and/or penetrating thoracic and/or abdominal trauma as part of the primary survey in the resuscitation room, whole-body computed tomography (WBCT) gains highest importance as part of the diagnostic procedures for severely injured patients. WBCT with a trauma-specific protocol must be performed in a timely manner if the patient does not require an immediate intervention. Magnetic resonance imaging can be indicated as a further primary diagnostic tool for specific conditions. Two studies were judged to be of low risk of bias in all domains. The risk of selection bias was high in two studies and unclear in seven studies.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"158"},"PeriodicalIF":1.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763520","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":"Post-operative infection following ankle fracture surgery: a current concepts review.","authors":"Jasper Tausendfreund, Jens Halm, Erik Tanis, Michael Swords, Tim Schepers","doi":"10.1007/s00068-025-02837-3","DOIUrl":"10.1007/s00068-025-02837-3","url":null,"abstract":"<p><strong>Purpose: </strong>The most common early complication of operative treatment of ankle fractures is a surgical site infection (SSI) with an incidence rate varying between 1.5 and 16%, depending on various risk factors. A SSI has multiple disadvantages, including worse outcome and a socio-economic burden. The aim of this review is to provide an updated overview of the current concepts pertinent to SSI in ankle fractures.</p><p><strong>Methods: </strong>A descriptive literature review was performed to provide the overview.</p><p><strong>Results: </strong>Well known risk factors for SSI are higher age, diabetes, open fractures and fracture dislocation. Diagnostic testing for infection include laboratory results (CRP, white blood cell count, leucocyte count), radiological imaging methods (conventional imaging, CT-scan, MRI-scan, 3-phase bone scan, FDG-PET) and microbiological deep tissue sampling. Treatment options for SSI are varied and include fracture reduction, antibiotic therapy with intravenous and oral treatment, surgical debridement and irrigation, transposition flaps in case of soft tissue defects with implant exposure and arthrodesis in severe infection with septic arthritis. Multiple studies show worse outcome scores in patients who develop a SSI. Prevention is important to reduce the rate of SSI. Surgery within 24 h decreases the risk of complications, compared to surgery performed in a delayed fashion. Appropriate timing and dosing of preoperative antibiotic prophylaxis is necessary.</p><p><strong>Conclusion: </strong>This review described the most frequent risk factors, appropriate diagnostic testing methods, an oversight of treatment options, gives insight in the outcome and mentioned prevention measurements for SSI after ORIF in ankle fractures.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"157"},"PeriodicalIF":1.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742739","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":"Letter to the European Society for Trauma and Emergency Surgery (ESTES): the European white book on polytrauma management.","authors":"Hayato Kurihara, Hans-Christoph Pape","doi":"10.1007/s00068-025-02833-7","DOIUrl":"10.1007/s00068-025-02833-7","url":null,"abstract":"","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"156"},"PeriodicalIF":1.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735649","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":"Networking between hospitals.","authors":"Klaus Wendt, Frank Hildebrand","doi":"10.1007/s00068-025-02827-5","DOIUrl":"10.1007/s00068-025-02827-5","url":null,"abstract":"<p><p>Not all hospitals have the resources to manage trauma patients, which is why many countries have introduced trauma systems to connect hospitals within specific regions. When definitive care cannot be provided at a hospital, the patient should be transferred to the closest appropriate facility with the necessary resources and capabilities. Telecommunication is a critical tool for data exchange (e.g., imaging) and multidisciplinary consultations. Ideally, a unified telecommunication system should be implemented across all hospitals in a network, with the long-term goal of nationwide or even European-level standardisation. While criteria for onward transfer vary slightly between trauma systems across countries, they can be adapted to meet the needs of any healthcare system. Decisions regarding patient transfer should be based on objective, prospectively agreed criteria. In addition, a common European trauma registry is essential to evaluate quality of care.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"151"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11946965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718140","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":"The association between timing of CT and outcomes for severe trauma patients: analysis of a nationwide trauma registry.","authors":"Takeshi Nishimura, Takuya Taira, Masafumi Suga, Shota Kikuta, Shinichi Ijuin, Akihiko Inoue, Shigenari Matsuyama, Satoshi Ishihara","doi":"10.1007/s00068-025-02839-1","DOIUrl":"https://doi.org/10.1007/s00068-025-02839-1","url":null,"abstract":"<p><strong>Purpose: </strong>With advances in technology, early computed tomography (CT) scanning is advocated for trauma patients. However, the benefits of early CT scanning remain unclear. Thus, we examined whether time elapsed from hospital arrival to CT acquisition is associated with the prognoses of severe trauma patients.</p><p><strong>Methods: </strong>We utilized the Japan Trauma Data Bank, a nationwide database. Patients directly transferred from the trauma scene were included. Severe trauma patients, defined as those with Injury Severity Scores (ISS) greater than 15, were enrolled. We excluded patients with cardiac arrest on hospital arrival, ISS of 75, missing data on timing of CT, inappropriate CT time, and elapsed time from hospital arrival to CT scan longer than or equal to 60 min, as well as those who required damage control surgery and those who died within 24 h. Patients were divided into six groups based on elapsed time to CT acquisition (0-9, 10-19, 20-29, 30-39, 40-49, 50-59 min.). The primary outcome was in-hospital mortality, and the secondary outcome was amount of transfusion, including red blood cells, fresh frozen plasma, and platelets.</p><p><strong>Results: </strong>Of the registered trauma cases, 13,802 cases were included in this study. The crude proportion of in-hospital mortality in the 0-9 min. group was the highest (15.4% [138/898]) compared to other groups. Compared to the 0-9 min. group, multivariable logistic regression analysis revealed that the earlier elapsed time to CT acquisition did not contribute to the improved rate of in-hospital mortality (10-19 min.; OR 0.84, 95% CI 0.64-1.09, p = 0.19, 20-29 min.; OR 0.89, 95% CI 0.69-1.16, p = 0.39, 30-39 min.: OR 0.88, 95% CI 0.67-1.16, p = 0.36, 40-49 min.: OR 0.92, 95% CI 0.67-1.26, p = 0.60, 50-59 min.: OR 1.03, 95% CI 0.73-1.46, p = 0.85). Transfusion amounts did not differ between groups.</p><p><strong>Conclusion: </strong>Early CT scanning after hospital arrival did not contribute to improved in-hospital mortality or reduce the transfusion amount for severe trauma patients.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"150"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718158","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":"Influence of hemolysis, lipemia and bilirubin on biobank sample quality- origin and interference in the use for extracellular vesicle (EV) and MiRNA analyses.","authors":"Birte Weber, Wolfgang Welz, Inna Schaible, Jiaoyan Han, Dirk Henrich, Ingo Marzi, Liudmila Leppik","doi":"10.1007/s00068-025-02822-w","DOIUrl":"10.1007/s00068-025-02822-w","url":null,"abstract":"<p><strong>Purpose: </strong>Pre-analytic interferences can influence the laboratory downstream measurements. We recognized hemolysis, lipemia and bilirubin in some of the serum/plasma samples of the NTF-Biobank from polytraumatized patients. Aim of the present study was to detect interferences, find reasons and describe the influence on downstream analyses.</p><p><strong>Methods: </strong>The study included serum samples of n = 88 polytraumatized patients admitted to a Level 1 Trauma Center in Germany at the ER & up to 10 days after trauma. Optical absorption spectra of UV-VIS (350-660 nm) were measured to detect hemolysis, lipemia and bilirubin. To find reasons for the interferences, clinical parameters like triglycerides (TAGs), nutrition, anaesthesia or transfusions were collected from patients' record. Extracellular vesicles (EVs) were isolated by SEC from controls, lipidemic and hemolytic samples and analysed via NTA.</p><p><strong>Results: </strong>Within 10 days after trauma 31.8% of polytraumatized patients' samples showed hemolysis, 12.5% showed increased bilirubin and 15.9% lipemia. Hemolysis occurred in samples mostly at the ER (18%) and was not associated with the number of red blood cell transfusions or the ISS. Both contaminants, hemolysis and lipemia interfered with EV/EV-miRNA measurements. EV miR-16-5p was significantly increased in patients with hemolysis. The presence of lipids further influenced the EV particle size distribution and concentration.</p><p><strong>Conclusion: </strong>The optical absorption spectra measurement is an easy tool for a robust pre-analytic sample controlling for the presence of interferences. Nutrition and anaesthesia were found to be related with lipemia in samples. Hemolysis and lipemia interfered with EV/EV-miRNA analysis. Therefore, the optical absorption spectra pre-analyses should be incorporated in the EV-biobank sampling.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"153"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718120","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":"Impact of trauma on society.","authors":"Sascha Halvachizadeh, Diego Mariani, Roman Pfeifer","doi":"10.1007/s00068-025-02824-8","DOIUrl":"10.1007/s00068-025-02824-8","url":null,"abstract":"<p><p>Trauma is the leading cause of death in the working population. The World Health Organisation (WHO) reports 4.4 million deaths annually due to unintentional or violence-related injuries; one in three of these deaths results from road traffic injuries (RTIs). For individuals aged 5-29 years, three of the top five causes of death are injury-related. Major trauma is the eighth leading cause of death across all age groups and the leading cause of death among children and young adults. The highest rates of trauma-related deaths are observed in low-income countries. Globally, men face twice the risk of dying from injuries as women, with approximately 75% of injury-related deaths resulting from trauma and RTIs.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"155"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11946998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717979","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":"Prevention programs.","authors":"Luca Fattori, Roman Pfeifer","doi":"10.1007/s00068-025-02832-8","DOIUrl":"10.1007/s00068-025-02832-8","url":null,"abstract":"<p><p>With a rise in traumatic incidents across Europe, there is an escalating need for a proactive and coordinated approach to trauma prevention. This chapter outlines evidence-informed strategies and collaborative efforts aimed at reducing the incidence and impact of trauma in Europe.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"152"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718150","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":"The role of heat shock proteins in fracture healing-a narrative review.","authors":"Klemens Trieb, T Huber, S Senck, Franz Landauer","doi":"10.1007/s00068-025-02838-2","DOIUrl":"https://doi.org/10.1007/s00068-025-02838-2","url":null,"abstract":"<p><p>Fracture healing is a physiological process that is always accompanied by an immunologically mediated inflammatory reaction, resulting in primary bone healing. Heat shock proteins (HSPs) are omnipresent stress proteins produced by cells in response to exposure to stressful conditions, which function as intracellular proteins that accomplish protein folding and transport intracellularly. This narrative review aims to shed light on the underlying molecular mechanisms of HSPs with respect to the currently available Medline literature. The initial search for \"heat shock protein AND fracture\" identified 70 studies; after reviewing the texts and checking for content, 9 studies remained. The second search for \"heat shock protein AND trauma AND bone\" identified 67 studies. After manually searching through the titles and abstracts, six articles remained, three of which were already found in the first search. One study was excluded because it did not include HSPs or fractures, resulting in two additional papers being included. The third search for \"heat shock protein AND osteogenesis imperfecta AND fracture\" resulted in nine studies. After reviewing the texts, three articles that were already included from the first search remained. This review highlights the significant potential of HSPs and the established HSP investigations related to fracture healing. Our review indicates that, despite the few studies available, those that were selected are very important for identifying research approaches and areas that require further study.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"154"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718189","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}