European Journal of Trauma and Emergency Surgery最新文献

{"title":"Initial surgical management of injuries to the urogenital tract in patients with polytrauma and/or severe injuries: a systematic review and clinical practice guideline update.","authors":"Christian Ruf, Luis Kluth, Sarah Wahlen, Jessica Breuing, Tim Nestler","doi":"10.1007/s00068-025-02847-1","DOIUrl":"10.1007/s00068-025-02847-1","url":null,"abstract":"<p><strong>Purpose: </strong>Our aim was to update evidence-based and consensus-based recommendations for the initial surgical management of urogenital injuries in patients with polytrauma 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 Polytrauma and/or Severe Injuries.</p><p><strong>Methods: </strong>MEDLINE and Embase were systematically searched to June 2021. Randomised controlled trials, prospective cohort studies, and comparative registry studies were included if they compared surgical and/or therapeutic interventions for urogenital injuries in the hospital setting. We considered patient-relevant clinical outcomes such as mortality and bleeding control, or coagulation parameters as surrogate outcomes. 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>Two new studies were identified. The topics covered were the comparison of outcomes after surgical and nonsurgical management as well as the use of surgical repair versus catheter drainage in patients with extraperitoneal bladder injuries. Three recommendations were modified, one of which for editorial reasons. All achieved strong consensus.</p><p><strong>Conclusion: </strong>The following key recommendations are made. 1. Renal artery injuries can be managed using an endovascular approach. 2. Depending on the type and severity of the injury and concomitant injuries, renal injuries should be managed with the intent to preserve the organ. 3. Extraperitoneal bladder ruptures without involvement of the bladder neck should be conservatively treated with catheterisation.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"182"},"PeriodicalIF":2.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986061","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 treatment approaches on renal function in renal trauma patients.","authors":"Serhat Yentur, Ibrahim Ogulcan Canitez, Adem Gokce, Ali Rojhat Kaya, Hakan Polat, Alper Bitkin, Ismail Engin Kandirali","doi":"10.1007/s00068-025-02863-1","DOIUrl":"https://doi.org/10.1007/s00068-025-02863-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Renal injuries account for 5% of all traumatic injuries, with blunt trauma being the most common cause (82-95%) [Meng, M.V., S.B. Brandes, and J.W. McAninch,, Renal trauma: indications and techniques for surgical exploration (17) 1999, Wessells, H., et al., Renal injury and operative management in the United States: results of a population-based study, 54(3) 2003]. Motor vehicle collisions (MVCs), pedestrian-vehicle accidents (PVAs), and falls often cause blunt renal injuries, frequently associated with intra-abdominal or thoracic trauma [Santucci, R., et al., Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee, 93(7) 2004]. Penetrating injuries, more common in urban areas, are typically severe and linked to firearm or sharp object incidents [Najibi, S., M. Tannast, and J.M. Latini, Civilian gunshot wounds to the genitourinary tract: incidence, anatomic distribution, associated injuries, and outcomes, 76(4) 2010]. Conservative management is generally recommended for grades 1-4 injuries [DiGiacomo, J.C., et al., The role of nephrectomy in the acutely injured 2001 136(9), Sujenthiran, A., et al., Is nonoperative management the best first-line option for high-grade renal trauma? A systematic review 2019 5(2)], and there is an increasing trend toward nonoperative management even for grade 5 injuries, though this remains a topic of debate [Keihani, S., et al., Contemporary management of high-grade renal trauma: results from the American Association for the Surgery of Trauma Genitourinary Trauma study 2018. 84(3), Moudouni, S., et al., Management of major blunt renal lacerations: is a nonoperative approach indicated? 2001 40(4)]. Our study aims to evaluate the impact of different treatment strategies on renal function outcomes in renal trauma patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This multicenter, retrospective study reviewed data from 65 renal trauma patients, including clinical notes, radiology, and pathology reports. We analyzed demographics, trauma mechanisms, injury grades, associated injuries, transfusion needs, and long-term renal function assessed via DMSA scintigraphy. Angioembolization's impact on clinical stability, transfusion needs, and renal function preservation was specifically evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Blunt trauma was the predominant mechanism (67.7% of cases). Angioembolization was performed in 10 patients, significantly reducing transfusion needs and preserving renal function (40% vs. 25% without; p = 0.009). Grade 5 injuries showed significant renal function decline, and conservative management increased the risk of severe complications. Urinoma developed in five cases, predominantly in high-grade injuries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Angioembolization improves outcomes in severe renal trauma by stabilizing clinical conditions, reducing blood transfusion needs, and preserving renal function better than conserva","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"185"},"PeriodicalIF":1.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988179","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":"Cardiopulmonary collapse in frail patients treated with cemented and uncemented hemiarthroplasty.","authors":"Thomas P Bosch, Max P L van der Sijp, Pieta Krijnen, Arthur H P Niggebrugge, Rachid Mahdad, Inger B Schipper","doi":"10.1007/s00068-025-02856-0","DOIUrl":"https://doi.org/10.1007/s00068-025-02856-0","url":null,"abstract":"<p><strong>Background: </strong>Peri-operative cardiopulmonary collapse (CPC) poses an increased risk of in-hospital mortality, especially in frail patients. Bone Cement Implantation Syndrome (BCIS) is CPC following, cemented, arthroplasty, characterized by hypoxia and/or hypotension. The main objective of this study was to evaluate the association between cemented hemiarthroplasty and CPC, in patients with a femoral neck fracture (FNF) and increased pre-operative risk, and identify other risk factors for cardiopulmonary collapse.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with a FNF treated with a cemented or uncemented hemiarthroplasty, aged ≥ 80 years, with ASA score ≥ 3 and ≥ 1 cardiac or pulmonal comorbidity. CPC was defined as hypoxia/hypotension grade ≥ 2 according to Donaldson's criteria. Multivariable logistic regression analysis was used to adjust for confounding in the relation between cemented hemiarthroplasty and CPC, and to identify other risk factors for CPC in patients with a cemented hemiarthroplasty.</p><p><strong>Results: </strong>The incidence of CPC was 51.1% in 221 cemented hemiarthroplasty patients compared to 23.3% in 73 uncemented hemiarthroplasty patients (p < 0.001). The use of cement increased the risk for CPC almost threefold (adjusted odds ratio [aOR] 2.87, 95% confidence interval [CI] 1.46-5.64). Preoperative reduced left ventricle ejection fraction (aOR 3.03, 95% CI 1.50-6.14) was another independent risk factor for CPC.</p><p><strong>Conclusion: </strong>Cementation increases the risk of CPC in frail FNF patients treated with hemiarthroplasty. Emphasis on euvolemia and avoidance of excessive pressurization, and careful consideration of an indicated cemented hemiarthroplasty in frail hip fracture patients may be advised for patients with an increased preoperative risk for BCIS.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"181"},"PeriodicalIF":1.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12018635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973506","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":"Insights into orthopedic and trauma emergency care and current challenges in Germany.","authors":"Jonas Roos, Sophia Helm, Amadeo Touet, Davide Cucchi, Kristian Welle, Leonie Weinhold, Ingo Graeff, Martin Gathen","doi":"10.1007/s00068-025-02829-3","DOIUrl":"https://doi.org/10.1007/s00068-025-02829-3","url":null,"abstract":"<p><strong>Background: </strong>The reform of emergency and acute care in Germany focuses on efficiently managing patient flows to reduce overcrowding in emergency departments, primarily caused by a rise in patients with low urgency and a lack of alternative care options. The aim of this work was to analyze the emergency care of orthopedic and trauma surgery patients in a Level I trauma center in order to improve patient care and manage resources more effectively.</p><p><strong>Material and methods: </strong>In this retrospective study, the data of orthopaedic and trauma surgery patients from the emergency department of a university in 2022 were analyzed. Data included demographics, triage levels, transport modes, diagnoses, and treatment outcomes. Process metrics like length of stay and time to medical contact were also evaluated. Descriptive and statistical analyses were conducted to examine patient distribution and resource use.</p><p><strong>Results: </strong>A total of 9414 patients (47.5% females; mean age 42.4 ± 24.1 years) were included, with 7500 treated for trauma and 1914 for orthopedic diagnoses. Most patients (79.6%) received outpatient care, while 21.3% were admitted as inpatients. Manchester Triage System distribution revealed 48.5% green, 31.0% yellow, 14.8% orange, and 0.8% red. The most common MTS flowcharts were limb problems (38.3%), falls (19.7%), and back pain (11.1%). Ambulance transport accounted for 33.7% of arrivals, while 65.1% presented independently. The average length of stay in the ED was 213 min, varying significantly across triage categories and working hours.</p><p><strong>Conclusion: </strong>This study highlights key challenges in orthopedic and trauma emergency care, emphasizing the prevalence of low-urgency cases contributing to overcrowding. Enhancing outpatient care capacity and implementing reforms like integrated emergency centers and optimized triage systems are crucial to improving efficiency and aligning resources with patient needs.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"180"},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997810","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":"Immunomodulatory and cardio-protective effects of differentially originated multipotent mesenchymal stroma cells during polymicrobial sepsis in mice.","authors":"Anna Kanewska, Ina Lackner, Anne Friedrich, Martina Winkelmann, Markus Rojewski, Birte Weber, Jochen Preßmar, Mario Perl, Hubert Schrezenmeier, Miriam Kalbitz","doi":"10.1007/s00068-025-02862-2","DOIUrl":"https://doi.org/10.1007/s00068-025-02862-2","url":null,"abstract":"<p><strong>Purpose: </strong>Sepsis is a life-threatening condition with cardiac complications being an independent predictor of poor outcome. Although their mechanisms have been widely investigated, therapeutic options remain limited. One promising therapeutic tool are mesenchymal stromal cells (MSCs). The aim of this study is to investigate the immunomodulatory effects of human MSCs from two different sources (bone marrow/BMMSC and adipose tissue/ASC) and to evaluate their cardioprotective potential.</p><p><strong>Methods: </strong>60 adult male C57BL/6 mice were divided into sham, sepsis (cecal ligation puncture (CLP)) and two i.v. treatment groups CLP + human BMMSC and CLP + human ASC with 5 animals in each group. The observation periods were 8, 24 and 72 h. Left ventricular tissue was analyzed histologically, by qPCR (C3ar, C5ar1, Il-1b, Il-6, Il-10, Tlr2, Tlr4, Tnfa, and Nlrp3) and western blot. Cardiac damage markers troponin I and heart fatty acid binding protein (HFABP) were detected in serum by ELISA.</p><p><strong>Results: </strong>Troponin I and HFABP were significantly increased in CLP group after 8 h compared to sham. In cardiac tissue the expression of C3ar, C5ar1, Il-1b, Il-6, Il-10, Tlr2, Tlr4, Tnfa and Nlrp3 inflammasome was upregulated up to 24h after CLP compared to sham. After BMMSC treatment, C3ar as well as C5ar, Tlr2 and Il-10 mRNA expression in left ventricle was downregulated compared to CLP, whereas ASC treatment was associated with the downregulation of Il-6 and Nlrp3.</p><p><strong>Conclusions: </strong>CLP-induced polymicrobial sepsis in mice was associated with cardiac damage and increased inflammation in left ventricular tissue. Therapeutic systemic application of human BMMSC and ASC ameliorated damage and inflammation in the heart.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"178"},"PeriodicalIF":1.9,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987722","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":"Surgical management of injuries to the abdomen in patients with multiple and/or severe trauma- a systematic review and clinical practice guideline update.","authors":"Christoph Güsgen, Jessica Breuing, Barbara Prediger, Dan Bieler, Robert Schwab","doi":"10.1007/s00068-025-02841-7","DOIUrl":"https://doi.org/10.1007/s00068-025-02841-7","url":null,"abstract":"<p><strong>Purpose: </strong>Our aim was to update evidence-based and consensus-based recommendations for the surgical management of abdominal injuries 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 May 2021. Further literature reports were obtained from clinical experts. Randomised controlled trials, prospective cohort studies, cross-sectional studies and comparative registry studies were included if they compared interventions for the surgical management of abdominal injuries in patients with multiple and/or severe injuries. We considered patient-relevant clinical outcomes such as mortality, length of stay, 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>Three studies were identified. The topics of these studies were nonoperative management in haemodynamically stable patients with isolated blunt hepatic (n = 1) or splenic injuries (n = 1) and selective angioembolisation (n = 1). None of the recommendations were modified, one new recommendation was developed, and one was deleted based on the updated evidence and expert consensus. All recommendations achieved strong consensus.</p><p><strong>Conclusion: </strong>The following recommendations are made. All but one of the previous guideline recommendations were confirmed. The recommendation to perform diagnostic peritoneal lavage in exceptional cases was completely deleted. An additional recommendation was made and states that the performance of a diagnostic laparoscopy can be considered in haemodynamically stable patients with penetrating trauma when there is therapeutic uncertainty.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"177"},"PeriodicalIF":1.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985724","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":"Investigating the effect of phase change materials on the viability of damaged tissue in disarticulated limbs.","authors":"Jiahua Xing, Muzi Chen, Ran Tao","doi":"10.1007/s00068-025-02806-w","DOIUrl":"https://doi.org/10.1007/s00068-025-02806-w","url":null,"abstract":"<p><strong>Background: </strong>This study developed a temperature-controlled transport preservation box for severed limb tissues using phase change material (PCM) as the main source to solve the problem of inconvenient preservation of trauma and severed tissues under emergency conditions. The goal of this study is to extend the time window for treatment of severed limb casualties and reduce the rate of disability and teratogenicity.</p><p><strong>Methods: </strong>In this study, after successfully establishing an animal model of severed limb injury in rats, the rats were divided into experimental and control groups. The rats in the control group were given emergency bandaging of the severed limbs and then reimplanted, while the rats in the experimental group were placed in the PCM preservation box at 4℃, 8℃, 12℃, and 16℃, and then the limbs were reimplanted. The PCM was subjected to temperature control test, thermal conductivity test, and DSC test at the four test temperatures. The biochemical indices, histological HE and PTAH staining, and ultrastructural observation by transmission electron microscopy were performed at the four test temperatures to evaluate the damage and degeneration of the severed limb tissues.</p><p><strong>Results and conclusions: </strong>The PCM had good material and thermal properties at the four test temperatures. The control group was more damaged than the test group in terms of biochemical factor expression, histologic degeneration, and ultrastructural changes. Considering the material and thermal properties, cell structure changes, and cell physiological status, the 8℃ test group shows excellent potential for clinical application and lays a solid foundation for further clinical application in the future.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"176"},"PeriodicalIF":1.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990237","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":"Pragmatic O-Positive Whole-blood RandoMizaTion in male trauma Patients (POWeR-MTP).","authors":"Anthony M Strada, Gus Suarez, Xian Luo-Owen, Maryam B Tabrizi, Martin G Rosenthal, Wesley T Stevens, Sharon S Lum, Kaushik Mukherjee","doi":"10.1007/s00068-025-02848-0","DOIUrl":"https://doi.org/10.1007/s00068-025-02848-0","url":null,"abstract":"<p><strong>Purpose: </strong>Hemorrhage is a significant cause of trauma-related death. Low-titer O-positive whole blood (LTOWB) is an alternative to component therapy (CT) [packed red blood cells (PRBC) and fresh frozen plasma (FFP)]. We evaluated if LTOWB reduces transfusion requirement or mortality.</p><p><strong>Methods: </strong>Adult male trauma activations requiring uncrossmatched transfusion in the emergency department underwent nonblinded 24-hour block randomization to receive uncrossmatched LTOWB or CT in the emergency department (ED). Female patients, children, and known prisoners were excluded. If LTOWB was not available, CT was used. Primary outcome was transfusion requirement in patients surviving ≥ 24 h, with a subset analysis for patients undergoing hemorrhage control interventions (HCI). Dichotomous variables were evaluated with Chi-Square testing and continuous outcomes with Student's T-test.</p><p><strong>Results: </strong>Overall, 199 patients were randomized (52 LTOWB, 147 CT); 36 patients (12 LTOWB, 24 CT) were excluded post-randomization for mortality within 24 h. The remaining 40 LTOWB and 123 CT patient cohorts had similar age, Glasgow Coma Scale, Injury Severity Score, heart rate, systolic blood pressure, and temperature. LTOWB patients received 1.4 ± 0.75 LTOWB units. LTOWB patients trended toward less transfusion (PRBC [3.8 ± 5.6 vs. 5.7 ± 6.2 units, p = 0.077], FFP [2.3 ± 3.8 vs. 3.5 ± 4.3 units, p = 0.088], and CRYO [0.13 ± 0.34 vs. 0.28 ± 0.68 units, p = 0.061]). Mortality was similar (LTOWB:10.2% [4/39] vs. CT:10.5% [13/123], p = 0.956). LTOWB patients undergoing HCI had less transfusion than CT patients (PRBC [3.9 ± 5.1 vs. 7.4 ± 7.2 units, p = 0.013]; in the HCI cohort the differences were even more pronounced when severe traumatic brain injury (TBI) deaths were excluded (PRBC [3.0 ± 3.6 vs. 7.4 ± 7.2 units, p < 0.001], FFP [2.1 ± 2.3 vs. 4.5 ± 5.2 units, p = 0.005]).</p><p><strong>Conclusion: </strong>LTOWB is associated with reduced PRBC transfusion in patients undergoing HCI, and a trend toward decreased PRBC, FFP, and CRYO transfusion in all patients.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT05081063), posted 10/18/2021.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"175"},"PeriodicalIF":1.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063006","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":"Thoracostomy for removal of excess fluid in surgical stabilization of rib fractures: the T-REX trial.","authors":"Sarah Majercik, Scott Gardner, Evert A Eriksson, Joseph D Forrester, Joshua A Villarreal, Zachary M Bauman, Lindsey Cavlovic, Andrew R Doben, Gregory R Semon, Fredric M Pieracci, Theresa Morin, Kelley Mancine, Zachary D Warriner, Caroline Neff, SarahAnn S Whitbeck, Thomas W White","doi":"10.1007/s00068-025-02845-3","DOIUrl":"https://doi.org/10.1007/s00068-025-02845-3","url":null,"abstract":"<p><strong>Background: </strong>Management of the pleural space during and after SSRF is a matter of debate. Tube thoracostomy (TT), intra-operative pleural lavage (PL) and video assisted thoracoscopic surgery (VATS) use varies between surgeons. The purpose of this study is to describe differences in practice patterns of pleural space management (TT, PL, VATS) after SSRF at institutions with extensive experience in chest wall reconstruction.</p><p><strong>Methods: </strong>Prospective data from adult SSRF patients at eight U.S. trauma centers between January 1, 2020 and September 1, 2022 was collected. Patients were managed according to institutional protocols. Outcome measures included hospital and ICU length of stay, 30-day readmission rate, infectious complications, and incidence of procedural re-intervention. Discrete variables are reported as median (IQR). P-values for continuous variables were obtained using Kruskal-Wallis, and for categorical variables using Chi-square.</p><p><strong>Results: </strong>273 patients from 8 centers were included. Median age was 60 (46-68), 70% were male, and 99% suffered blunt trauma. ISS was 17 (13-26), ranging from a low of 14 (10-19) to 26 (18-35) (p = 0.002). Median operative time was 2.5 (1.9-3.3) hours, with 5 (4-6) plates placed. VATS ranged from 2 to 78% at each center and PL ranged from 25 to 100% (p < 0.001). Almost all patients received TT. TT remained in place for 3 (2-4) days, few (2%) had any complication related to the TT, nor did they require drain replacement (7%) or reoperation (2%). ICU and hospital lengths of stay were 3 (2-6) and 8 (6-13) days (P < 0.001). Readmission rates were low (4%), and did not differ between centers.</p><p><strong>Conclusion: </strong>At centers experienced in SSRF, there is variation in management of the pleural space. While ICU and hospital lengths of stay are different between centers, rates of reoperation and readmission are similar. Further study is needed to delineate optimal management of the pleural space after SSRF.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"174"},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984781","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":"Management of upper limb vascular injuries and their outcomes-our experience from a level I trauma centre.","authors":"Mishal Shan Siddiqui, Huda Raja, Fahad Tariq Berlas, Abdullah Nadeem, Khalil Ur Rehman, Waryam Saleh, Najamuddin Rajper","doi":"10.1007/s00068-025-02843-5","DOIUrl":"https://doi.org/10.1007/s00068-025-02843-5","url":null,"abstract":"<p><strong>Introduction: </strong>Upper limb arterial trauma is associated with significant morbidity and functional impairment. Despite the critical role of timely intervention, we often encounter delayed presentations due to poor access to vascular surgery services and long travel times to the hospital. We analyzed the patterns of vascular injury encountered in our experience and gauged the impact of time delay and the nature of injury on our post-surgical outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of patients undergoing intervention for upper extremity arterial injuries at our vascular surgery department from 2020-2021. Patients presenting with a primary traumatic amputation or a non-salvageable ischemic hand defined according to the Rutherford classification of acute limb ischemia Grade III were excluded. Data regarding their demography, presentation, surgical interventions, and outcomes were gathered.</p><p><strong>Results: </strong>69 cases of upper extremity vascular trauma were included. The limb salvage rate was 94%, and the mortality rate was 0%. Higher Rutherford ischemia classes and more excellent MESS scores are associated with more excellent limb loss rates. Associated soft tissue injury also led to a higher rate of limb loss; while coexisting fractures or neurological injuries had no significant impact on salvage rates. Limb salvage was comparable to ligation and revascularization in brachial and radial injuries.</p><p><strong>Conclusion: </strong>Upper-limb arterial injuries have a good prognosis if presented early to a vascular surgery centre. Our experience has yielded promising results with repair via native venous graft. Ligation of distal arteries is also possible owing to good collateral circulation.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"173"},"PeriodicalIF":1.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988181","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}