European Journal of Trauma and Emergency Surgery最新文献

{"title":"Masquelet technique including a multiperforated non-vascularized fibula graft for the reconstruction of massive post-traumatic bone defects in military practice.","authors":"Laurent Mathieu, Ammar Ghabi, Thibault Druel, René Ayaovi Gayito Adagba, Antoine Grosset, Marjorie Durand, Jean-Marc Collombet, Christophe Andro","doi":"10.1007/s00068-024-02722-5","DOIUrl":"https://doi.org/10.1007/s00068-024-02722-5","url":null,"abstract":"<p><strong>Background: </strong>The management of extensive bone defects presents a significant challenge for military orthopedic surgeons, especially in the context of a high intensity conflict or when patients are fully treated in the field. The objective was to evaluate the induced membrane technique (IMT) including a multiperforated non-vascularized fibular graft (NVFG) for the reconstruction of massive bone defects performed in both the ideal conditions of military trauma centers and the austere environment of forward surgical units.</p><p><strong>Methods: </strong>A retrospective case study was conducted on patients who underwent the above procedure in various care settings between January 2019 and June 2023. Outcomes measured included the achievement of bone union, time to bone union, and the healing index (time to bone healing/length of reconstructed bone). Functional assessment was based on the Quick-DASH score and the lower extremity functional scale (LEFS).</p><p><strong>Results: </strong>Nine patients with a mean age of 37 years were included: five were managed in a role 4 medical treatment facility (MTF) and four in a role 2 MTF. Five patients had an infected bone defect before IMT application. After debridement, the mean bone defect length was 14 cm, and the mean bone defect volume was 190 cm³. The mean interval between stages was 15 weeks. The mean follow-up was 20 months. Bone union was achieved in 8/9 cases with a mean time of 8.1 months and a mean healing index of 0.58 month/cm. Only the patient with persistent humeral nonunion had a poor DASH-score. The mean LEFS was 68%.</p><p><strong>Conclusions: </strong>In this small cohort, IMT including a multiperforated NVFG enabled successful reconstruction of massive bone defects in the femur, tibia, and humerus, even in the austere environment of forward surgical units, provided that prior infection control had been achieved.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"90"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074363","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":"Pelvic ring fracture and erectile dysfunction (PERFECD) - 3 year follow-up cross sectional study.","authors":"Gioia Rizzoli, Florian A Schmid, Franziska Kessler, Yannik Kalbas, Felix Karl-Ludwig Klingebiel, Till Berk, Roman Pfeifer, Daniel Eberli, Hans-Christoph Pape, Sascha Halvachizadeh","doi":"10.1007/s00068-024-02761-y","DOIUrl":"10.1007/s00068-024-02761-y","url":null,"abstract":"<p><strong>Introduction: </strong>Pelvic ring fractures are known to be associated with complications associated with adjacent organ injuries, such as the urogenital tract (e.g. erectile dysfunction (ED), which are sometimes diagnosed in a delayed fashion. Therefore, we assessed the quality of life (QoL) and the rate of erectile dysfunction (ED) following pelvic ring fractures at a minimum of 3 years after pelvic ring injury.</p><p><strong>Methods: </strong>Between January 1, 2016, and December 31, 2020, adult male patients (≥ 18 years) with pelvic ring injuries were included in the study. Fractures were classified according to the Young & Burgess (Y&B) classification system, while pelvic contusions were categorized as the control group. Data were collected using a written questionnaire that assessed Quality of Life (QoL) by Short Form 12 (SF-12) and erectile dysfunction (ED) with the International Index of Erectile Function 5 (IIEF-5). ED was stratified as follows: no ED (21-25 points), mild ED (16-21 points), moderate ED (9-15 points), and severe ED (5-7 points). Comorbidities and risk factors for ED were also assessed, including vasculopathy, peripheral artery disease, hypercholesterolemia, coronary artery disease, diabetes, and smoking.</p><p><strong>Results: </strong>A total of 182 patients were included, with a mean age at injury of 53.5 years (SD 17.1) and a mean age at the time of the questionnaire of 57.8 years (SD 17.4). The distribution of patients was as follows: APC Group (n = 20, 11.1%), LC Group (n = 94, 52.2%), CMVS Group (n = 6, 3.3%), and Control Group (n = 60, 33.3%). The mean Injury Severity Score (ISS) was 24.6 points (SD 16.4). Regarding erectile dysfunction, 8 patients (17.4%) had no ED, 10 (21.7%) had mild ED, 6 (13.0%) had moderate ED, and 22 (47.8%) had severe ED. Quality of Life (QoL) was significantly reduced in patients with CMVS pelvic fractures, particularly in physical role function, which scored 62.5 points (SD 29.6, p < 0.001). All patients in the APC Group reported at least a mild form of ED. APC injuries were identified as an independent risk factor for lower IIEF-5 scores (OR -4.5, 95% CI -8.3 to -0.7, p = 0.02), comparable to other risk factors such as hypertension (OR -9.2, 95% CI -12.8 to -5.6, p < 0.001), diabetes (OR -5.3, 95% CI -9.4 to -1.2, p = 0.012), and smoking (OR -2.6, 95% CI -5.2 to -0.04, p = 0.05).</p><p><strong>Conclusion: </strong>Vertical shear fractures are associated with significantly lower quality of life compared to APC or LC fractures three years post-injury. The APC type of pelvic ring injury was identified as an independent risk factor for the development of erectile dysfunction (ED). Early screening and appropriate management should be initiated for patients with APC injuries to address and mitigate the risk of ED.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"89"},"PeriodicalIF":1.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052100","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":"Alcohol drinking leads to sex-dependent differentiation of T cells.","authors":"Ramona Sturm, Florian Haag, Christian B Bergmann, Ingo Marzi, Borna Relja","doi":"10.1007/s00068-024-02732-3","DOIUrl":"10.1007/s00068-024-02732-3","url":null,"abstract":"<p><strong>Objective: </strong>Global per capita alcohol consumption is increasing, posing significant socioeconomic and medical challenges also due to alcohol-related traumatic injuries but also its biological effects. Trauma as a leading cause of death in young adults, is often associated with an increased risk of complications, such as sepsis and multiple organ failure, due to immunological imbalances. Regulatory T cells play a crucial role in maintaining immune homeostasis by regulating the inflammatory response. Since it is crucial to understand the effects of alcohol in healthy volunteers, in order to refer findings from trauma cohorts, this study investigates the time- and dose-dependent modulation of CD4⁺ lymphocytes and their subsets following acute alcohol consumption, considering both general and sex-specific variations.</p><p><strong>Methods: </strong>Twelve female and ten male healthy volunteers consumed twelve alcohol mixed drinks over four hours to achieve a blood alcohol level of 1.0‰. Blood samples were collected before and at various time points (2, 4, 6, 24 and 48 h) post-consumption for flow cytometric analyses of the phenotype and activation makers CD4/CD25/CD127 of CD4⁺ T cells and their subtypes.</p><p><strong>Results: </strong>CD4⁺ lymphocytes significantly decreased at 4 h and increased at 6 h post-alcohol consumption. Naïve CD25^-CD127⁺ T cells significantly decreased from 2 to 24 h in women and 2 to 48 h in men, while CD25⁺CD127⁺ effector T cells significantly increased during the same period. Natural CD25⁺CD127^- regulatory T cells increased significantly at 4 and 6 h, with a higher increase in men. Induced regulatory T cells (CD4⁺CD25^highCD127^-) significantly increased at 2 h for all volunteers, with lower proportions of natural and induced regulatory T cells in women.</p><p><strong>Conclusions: </strong>Acute alcohol consumption induces immune modulation persisting for days, impacting T cell subsets differently in men and women. The prolonged modulation in men may contribute to slightly poorer clinical outcomes, emphasizing the need to consider these effects in trauma patients with acute alcohol intoxication.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"87"},"PeriodicalIF":1.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052119","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":"Outcomes of electrical injuries in the emergency department: epidemiology, severity predictors, and chronic sequelae.","authors":"Rym Karray, Olfa Chakroun-Walha, Folla Mechri, Imen Salem, Hanen Drira, Abdennour Nasri, Ayman Damak, Noureddine Rekik","doi":"10.1007/s00068-025-02766-1","DOIUrl":"https://doi.org/10.1007/s00068-025-02766-1","url":null,"abstract":"<p><strong>Introduction: </strong>Electrical injuries (EIs) represent a significant clinical challenge due to their complex pathophysiology and variable presentation, ranging from minor burns to severe internal organ damage. Despite their prevalence in both; domestic and occupational settings, there remains a rareness of systematic guidelines and comprehensive literature to aid clinicians in effectively managing these injuries. Understanding these factors is crucial for developing protocols that can mitigate the risk of delayed complications, such as cardiac arrhythmias, in patients who initially appear stable.</p><p><strong>Objectives: </strong>This study aims to elucidate the epidemiology, clinical outcomes, and predictors of severe presentation in EIs, providing insights to improve patient assessment and management strategies.</p><p><strong>Methods: </strong>A retrospective study was conducted over 4 years. Data were collected from standardized medical records. The group of patients with severe complications included those who presented a life-threatening cardiac, respiratory, neurological, or biological impairment or died within the first 48 h of the EI.</p><p><strong>Results: </strong>We enrolled 118 cases of electrical injury (EI). Ages ranged from 4 to 82 years, with 31.3% under 15. EI incidence peaked in summer, with 63.5% being home accidents. High-voltage injuries occurred in 13.6%. The most common ED complaints were burns in children (59.5%) and trauma in adults (48.1%). ECG abnormalities correlated with tetany (p = 0.016), and palpitations (p = 0.014). Complications included cardiac arrest (n = 8), rhabdomyolysis (n = 23), and acute renal injury (n = 9). Severe EI was linked to respiratory distress and creatine kinase levels higher than ≥ 253 UI/l. A normal ECG within 1 h post-injury was correlated to a low risk of severe EI. At 2-year follow-up, 43.9% of survivors reported aesthetic sequelae, 25.3% had psychological disorders, and 7% of adults could not return to their previous occupations.</p><p><strong>Conclusion: </strong>EIs are frequent, with diverse clinical presentations requiring multidisciplinary care. Awareness of potential delayed complications is essential, and prevention is crucial.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"85"},"PeriodicalIF":1.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046094","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":"Does a gentamicin-coated intramedullary nail prevent postoperative infection in Gustilo type I and II tibial open fractures? A comparative study and retrospective analysis.","authors":"S K Rai, T P Gupta, Manoj Kashid, Bhavya Sirohi, Amit Kale, Ritesh Sharma, Arjun Gandotra","doi":"10.1007/s00068-025-02763-4","DOIUrl":"https://doi.org/10.1007/s00068-025-02763-4","url":null,"abstract":"<p><strong>Purpose: </strong>Tibial open shaft fractures are very common and susceptible to infection, which can lead to significant morbidity especially infection and non-union. Antibiotic coated nail is one option for fixing open shaft tibial fractures to minimise infection. This study aimed to compare the clinical outcome of Gentamicin-coated tibial nails versus regular unreamed interlocking tibial nails in the treatment of type I and II tibial open fractures.</p><p><strong>Methods: </strong>Between 2013 and 2020, in a retrospective study of 124 patients with Gustilo type I and II tibial fractures compared non-antibiotic-coated nails (62 patients) with gentamicin-coated nails (62 patients) over 12 months. This study assessed infection rates, duration of hospital stays, fracture union time, and complications.</p><p><strong>Results: </strong>The antibiotic nail group had significantly lower postoperative infection rates (3.2%) than the regular nail group (17.7%), (χ2 = 4.64, p = 0.031). At the 6-month follow-up, significant differences were observed in ESR (p = 0.031), CRP (p = 0.019), leukocyte count (p = 0.0241), and blood culture (p = 0.018), but not in hemoglobin levels (p = 0.067). The Gentamicin-coated nail group demonstrated better fracture union rates at 6 and 12 months, (p = 0.0267) and lower overall complication rates.</p><p><strong>Conclusion: </strong>A tibial nail coated with Gentamicin is an effective method for preventing infection in type I and II open fracture shafts of the tibia. It allows, shortens hospital stay and healing time, prevents infection, and thus reduces the chance of a second surgery.</p><p><strong>Level of evidence: </strong>Level III, a retrospective study.</p><p><strong>Design: </strong>Retrospective analytical study.</p><p><strong>Hypothesis: </strong>We hypothesized that Gentamicin-coated nail is effective in preventing infection in Gustilo type I and II open fractures compared to non-antibiotic-coated regular nails.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"86"},"PeriodicalIF":1.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052122","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":"Extracorporeal membrane oxygenation in trauma: a single-center retrospective observational study.","authors":"Mathias Ahlqvist, Pär Forsman, Pål Morberg, Magnus Larsson, Lars Mikael Broman, Shahzad Akram","doi":"10.1007/s00068-024-02734-1","DOIUrl":"10.1007/s00068-024-02734-1","url":null,"abstract":"<p><strong>Purpose: </strong>Globally, trauma is a leading cause of death in young adults. The use of extracorporeal membrane oxygenation (ECMO) in the trauma population remains controversial due to the limited published research. This study aimed to analyze 30-day survival of all the trauma ECMO patients at our center, with respect to injury severity score (ISS) and new injury severity score (NISS).</p><p><strong>Methods: </strong>We performed a retrospective analysis of all trauma patients receiving ECMO support at a Level 1 trauma center in Sweden between 1997 and 2019.</p><p><strong>Results: </strong>A total of 53 trauma patients received ECMO support. 85% were male; the median age was 24, with interquartile range (IQR) 17-44 years. More than 70% were multi-trauma patients. The mean NISS and ISS were 50 (IQR:34-57) and 42 (IQR:33-57), respectively. 62% were supported on veno-arterial ECMO with a survival benefit for veno-venous ECMO (75% vs. 36%, respectively (p = 0.01)). There was no association between severity in terms of trauma-score and survival. Sixteen patients (30%) were cannulated at referring hospitals and transported to our unit on ECMO with a survival of 69%, similar to those cannulated in-house. 60% of patients survived ECMO, and 51% survived to hospital discharge.</p><p><strong>Conclusions: </strong>This study indicates that trauma patients may benefit from ECMO, independent of severity. Furthermore, our results support ECMO transport as feasible in trauma patients. We recommend larger multi-center studies to determine which trauma patients would have the greatest benefit of ECMO.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"88"},"PeriodicalIF":1.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052124","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":"Assessing the role of chest CT in minor blunt trauma: evaluation of the NEXUS decision instrument across an expanded population.","authors":"Ziv Lahav, Shachar Shimonovich, Fahim Kanani, Shira Haberman, Sivan Ebril, Eyal Hashavia, Noaa Shopen, Neta Cohen","doi":"10.1007/s00068-024-02692-8","DOIUrl":"https://doi.org/10.1007/s00068-024-02692-8","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the NEXUS Chest CT ALL decision instrument (DI) in reducing unnecessary chest CT imaging in minor blunt trauma patients while preserving high sensitivity for detecting clinically meaningful injuries. Additionally, we examined the impact of delayed presentation, chronic disease, and anticoagulation/anti-aggregation medications on trauma outcomes.</p><p><strong>Methods: </strong>This retrospective study included 853 adult minor blunt trauma patients who underwent chest CT in the emergency department (ED) of Tel-Aviv Sourasky Medical Center between 2018 and 2022. Clinically meaningful outcomes were defined as trauma-related interventions or hospital admissions. The NEXUS Chest CT DI criteria, along with three additional criteria, were analyzed using logistic regression to identify independent predictors for the primary outcome. These predictors formed a modified DI, and its performance was compared to the original NEXUS DI.</p><p><strong>Results: </strong>Among 853 patients (median age 44.5 years, 64.2% male), 230 (27.0%) had trauma-related chest CT findings, and 64 (7.5%) experienced clinically meaningful outcomes. Independent predictors included abnormal chest X-ray (aOR 6.5, p < 0.001), chronic disease (aOR 5.2, p < 0.001), sternal tenderness (aOR 4.7, p = 0.007), rapid deceleration (aOR 3.7, p < 0.001), and chest wall tenderness (aOR 3.1, p < 0.001). The NEXUS DI achieved 92.1% sensitivity, reducing imaging by 41.3%, while the modified DI increased sensitivity to 98.4% with a 34.3% imaging reduction.</p><p><strong>Conclusions: </strong>The NEXUS Chest CT ALL DI significantly reduces unnecessary imaging while maintaining high diagnostic precision. A modified version enhances sensitivity, refining decision-making in emergency care. Integrating such decision tools, particularly in cases of minor trauma, is highly recommended to optimize resource use and improve patient outcomes.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"84"},"PeriodicalIF":1.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046088","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":"Accuracy of GFAP and UCH-L1 in predicting brain abnormalities on CT scans after mild traumatic brain injury: a systematic review and meta-analysis.","authors":"Armin Karamian, Hana Farzaneh, Masoud Khoshnoodi, Nazanin Maleki, Saurabh Rohatgi, Jeremy N Ford, Javier M Romero","doi":"10.1007/s00068-024-02697-3","DOIUrl":"https://doi.org/10.1007/s00068-024-02697-3","url":null,"abstract":"<p><strong>Purpose: </strong>Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. In recent years, blood biomarkers including glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) have shown a promising ability to detect head CT abnormalities following TBI. This review aims to combine the existing research on GFAP and UCH-L1 biomarkers and examine how well they can predict abnormal CT results after mild TBI.</p><p><strong>Methods: </strong>Our study protocol was registered in PROSPERO (CRD42024556264). PubMed, Google Scholar, and Cochrane electronic databases were searched. We reviewed 37 full-text articles for eligibility and included 14 in our systematic review and meta-analysis.</p><p><strong>Results: </strong>Thirteen studies reported data for GFAP. The optimal cutoff of GFAP was 65.1 pg/mL with a sensitivity of 76% (95% CI 37 ̶ 95) and a specificity of 74% (95% CI 39 ̶ 93). In patients with GCS 13 ̶ 15 the optimal cutoff was 68.5 pg/mL, showing a sensitivity of 75% (95% CI 17 ̶ 98), and a specificity of 73% (95% CI 20 ̶ 97). Seven studies provided data on UCH-L1. The optimal cutoff was 225 pg/mL, with a sensitivity of 86% (95% CI 50 ̶ 97) and a specificity of 51% (95% CI 19 ̶ 83). In patients with GCS 13 ̶ 15, the optimal cutoff was 237.7 pg/mL, with a sensitivity of 89% (95% CI 74 ̶ 96), and a specificity of 36% (95% CI 29 ̶ 44). Modeling the diagnostic performance of GFAP showed that in adult patients with GCS 13-15 for ruling out CT abnormalities, at the threshold of 4 pg/mL, the optimal diagnostic accuracy was achieved with a sensitivity of 98% (95% CI 94-99) and (negative predictive value) NPV of 97%. For UCH-L1, the optimal diagnostic accuracy for ruling out intracranial abnormalities in adults with GCS 13-15 was achieved at the threshold of 64 pg/mL, with a sensitivity of 99% (95% CI 92-100) and NPV of 99%.</p><p><strong>Conclusion: </strong>Present results suggest that GFAP and UCH-L1 have the clinical potential for screening mild TBI patients for intracranial abnormalities on head CT scans.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"68"},"PeriodicalIF":1.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037688","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":"Analyse of patient characteristics and aetiological causes of enterocutaneous fistulas and their impacts on in-hospital mortality: a ten-year retrospective cohort study.","authors":"Vahit Onur Gul, Sabahattin Destek, Mutlu Sahin","doi":"10.1007/s00068-024-02733-2","DOIUrl":"https://doi.org/10.1007/s00068-024-02733-2","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to compare patient characteristics according to the primary aetiology including gunshot wounds in inpatient individuals diagnosed with enterocutaneous fistula (ECF) or enteroatmospheric fistula (EAF) and to evaluate the impacts of these characteristics on all-cause in-hospital mortality.</p><p><strong>Methods: </strong>This is a single-centre hospital-based retrospective cohort study conducted with adult patients who were hospitalised for treatment of ECF or EAF. The patients were allocated to three study groups according to their primary aetiology (surgery-related group, gunshot-related group and other-cause group). The demographics and clinical features of the patients were compared between the study groups, furthermore, the impacts of these characteristics on in-hospital mortality were evaluated using Cox Regression Analysis.</p><p><strong>Results: </strong>Gunshot-related fistulas were more likely to originate from small intestines, whereas surgery-related fistulas originated from all anatomic sites and those related to other aetiologies often originated from large intestines (p = 0.006). Severe malnutrition was more prevalent in the other-cause group (26.1%) (p < 0.001). Sepsis occurred in 24.3%, 68.8% and 47.8% of the patients (p = 0.008); and the median length of stay was 18.0, 45.0 and 32.0 days (p = 0.025) in the surgery-related group, the gunshot-related group, and the other-cause group, respectively. While the surgery-related and gunshot-related groups had similar and low mortality rates (2.7% and 6.7%, respectively), patients with other reasons had the highest mortality (30.4%). The increase in the duration of output (DOO) was associated with decreased mortality [HR (95%CI): 0.55 (0.39-0.79) p = 0.001], whereas being severely malnourished and having an aetiology of other causes were associated with increased mortality [HR (95%CI): 25.29 (5.20-123.09) and p < 0.001, and HR (95%CI): 9.06 (1.11-73.86) and p = 0.040, respectively].</p><p><strong>Conclusions: </strong>Patient characteristics, clinical manifestations and treatment approach may differ according to primary aetiology in patients with ECF or EAF. Primary aetiology, the decrease in DOO and severe malnourishment have negative impacts on in-hospital mortality.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"58"},"PeriodicalIF":1.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037689","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":"Increasing prehospital tourniquet use attributed to non-indicated use: an 11-year retrospective study.","authors":"Daniel J Hedger, Mitchell Smith, Natasha Weaver, Jason Bendall, Zsolt J Balogh","doi":"10.1007/s00068-024-02716-3","DOIUrl":"10.1007/s00068-024-02716-3","url":null,"abstract":"<p><strong>Purpose: </strong>The use of prehospital tourniquets (PHTQ) for haemorrhage control in the civilian trauma population has increased over the past decade with some reports documenting the overuse of the device. The aim of this study was to identify the proportion of PHTQ use that is non-indicated and determine how this proportion is changing over time.</p><p><strong>Methods: </strong>An 11-year retrospective study was performed at a Level-1 Trauma Centre on all trauma patients admitted with a PHTQ. Local PHTQ guidelines were used to define non-indicated use. Collected variables included patient demographics, injury characteristics, tourniquet application characteristics, prehospital data, emergency department data, and clinical outcomes. The primary outcome was non-indicated PHTQ use. The secondary outcome was complications attributed to PHTQ use.</p><p><strong>Results: </strong>There were 88 PHTQ applications to 88 extremity injuries in 86 patients (n = 86, median (IQR) age 43 (28-57) years, 85% male). PHTQ use was deemed non-indicated in 68 cases (68/88, 77% [95%CI 67-86%]). The proportion of non-indicated PHTQ use increased over the period of the study period (p = 0.03). At least one complication potentially from PHTQ use was seen in 33 patients (33/86, 38%). In patients with prolonged tourniquet time (n = 13), at least one complication from PHTQ use was seen in 11 patients (11/13, 85%).</p><p><strong>Conclusion: </strong>Over this 11-year period, we identified that the increase in PHTQ use in civilian trauma is from increasing non-indicated use. Given that complications are associated with unnecessary PHTQ use, the adherence to the guidelines needs to be urgently reinforced.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"71"},"PeriodicalIF":1.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036922","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}