European Journal of Trauma and Emergency Surgery最新文献

{"title":"Efficiency of a virtual fracture clinic review protocol in adult patients with distal radial fractures requiring semi-acute surgical treatment.","authors":"Dorien A Salentijn, Gijs J A Willinge, Ruben N van Veen, Marcel G W Dijkgraaf","doi":"10.1007/s00068-025-02764-3","DOIUrl":"10.1007/s00068-025-02764-3","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to evaluate the effect of implementation of a Virtual Fracture Clinic (VFC) review protocol on the time between injury and surgery, and on secondary healthcare utilization, in patients with Distal Radius Fractures (DRFs) requiring semi-acute surgery.</p><p><strong>Methods: </strong>Data for this retrospective before-after study were gathered between April 2017 and March 2019 (Pre-VFC n = 269), and between April 2021 and March 2023 (VFC n = 440) in a large level 2 urban trauma center. The primary outcome was the number of days between injury and operation. Furthermore secondary healthcare utilization was assessed.</p><p><strong>Results: </strong>The average time between injury and surgery was 11.0 days (95% CI: 10.6-11.5) before and 9.2 days (95% CI: 8.9-9.6) after VFC-implementation ( p < 0.001). Following VFC-implementation, 33% (was 17%) of patients underwent surgery within 7 days, 92% (was 84%) within 2 weeks, and 99% (was 96%) within 3 weeks (p < 0.001). This included patients with delays of up to 15 days between injury and their initial hospital presentation. Hospital contacts decreased from 5 (IQR: 4-6) to 4 (IQR: 3-5) whereof physical consults decreased from 4 (IQR: 3-5) to 1 and telephone contacts increased from negligible to 1 (IQR: 1-2). Radiographs reduced from 6 (IQR: 5-7) to 4 (IQR: 3-5).</p><p><strong>Conclusions: </strong>Implementation of a VFC-review protocol is associated with a reduced time between injury and semi-acute surgery for DRFs and reflects an improvement in quality of timely planning. Secondary healthcare utilization is reduced and a shift to remote delivery of care is observed.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"96"},"PeriodicalIF":1.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364130","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":"A single-centre, retrospective study on the impact of omitting preoperative antibiotic prophylaxis on wound infections in minor orthopedic implant removals.","authors":"Cyrill Pfammatter, Jan Hambrecht, Yannik Kalbas, Valentin Neuhaus, Christian Hierholzer, Claudio Canal","doi":"10.1007/s00068-025-02769-y","DOIUrl":"10.1007/s00068-025-02769-y","url":null,"abstract":"<p><strong>Background: </strong>The use of preoperative antibiotic prophylaxis (POAP) in elective implant removal (IR) is controversial due to a lack of evidence-based recommendations. First-generation cephalosporins, which are commonly used in orthopedic IR, are believed to reduce wound infection risks. However, the potential for serious side effects had raised concerns about their necessity. This study was intended to evaluate whether omitting POAP in small IR increases the risk of wound infections.</p><p><strong>Methods: </strong>This retrospective, single-centre cohort study was conducted at a level I trauma centre in Switzerland, including patients who underwent IR between January 1, 2016, and December 31, 2021. The IR procedures involved the upper extremities (UEs), such as the clavicle, olecranon, radius and ulna, as well as the lower extremities (LEs), such as the patella, tibia, fibula, (bi)malleolar and foot. Postoperative follow-up included clinical and radiological evaluations 6 weeks after surgery. The outcomes assessed were deep wound infections, wound healing complications, refractures, persistent pain, bleeding, neurovascular injuries and muscle hernias.</p><p><strong>Results: </strong>Of the 273 patients (mean age: 42.1 ± 14.5; 44% female), 117 (42.9%) received POAP. In the LE group (n = 141), 51.1% received POAP; in the UE group (n = 132), 34.1% received POAP. Eleven (4.0%) wound-healing disorders were documented, with five (4.3%) in the POAP group and six (3.8%) in the non-POAP group (p = 1). No deep wound infections were observed.</p><p><strong>Conclusion: </strong>Withholding POAP in elective IR procedures does not significantly increase wound infection rates, suggesting it may be unnecessary in uncomplicated cases.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"94"},"PeriodicalIF":1.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363922","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":"Cannabidiol protects lung against inflammation and apoptosis in a rat model of blunt chest trauma via Bax/Bcl-2/Cas-9 signaling pathway.","authors":"Akın Süleyman Emre, Savran Mehtap, Doğan Cem, İlhan İlter, Arlıoğlu Melih, Özmen Özlem, Sezer Serdar, Çamaş Hasan Ekrem, Yazkan Rasih","doi":"10.1007/s00068-025-02767-0","DOIUrl":"10.1007/s00068-025-02767-0","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the hypothesis that cannabidiol (CBD), with known anti-inflammatory and anti-apoptotic effects, would reduce the severity of acute lung injury in pulmonary contusion following blunt chest trauma.</p><p><strong>Methods: </strong>Forty male Wistar Albino rats were randomly divided into four groups, each consisting of 10 rats: Sham, Trauma, Trauma + CBD, and CBD. The rats were treated with a single dose of 5 mg/kg CBD intraperitoneally 30 min before trauma. Then, the trauma were exposed to a weight of 200 g and a height of 1 m. After sacrifice, the lung tissues were removed for histopathological, immunohistochemical, biochemical, and genetic analyses.</p><p><strong>Results: </strong>Pulmonary injury of trauma group led to increases in tumor necrosis factor α, caspase-3, caspase-9, Bcl-2-associated X protein expressions, total oxidant status, oxidative stress index levels, and decreases in B-cell lymphoma expression and total antioxidant levels. Additionally, inflammatory cell infiltration, damage-related emphysema, pronounced hyperemia, and increased septal tissue thickness were observed histopathologically. CBD treatment ameliorated all these findings.</p><p><strong>Conclusion: </strong>CBD reduces lung damage in lung contusions caused by blunt chest trauma through its anti-inflammatory and antiapoptotic effects. More detailed studies investigating other important intracellular pathways are needed.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"95"},"PeriodicalIF":1.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364118","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":"Stop the bleed \" - Prehospital bleeding control in patients with multiple and/or severe injuries - A systematic review and clinical practice guideline - A systematic review and clinical practice guideline.","authors":"H Trentzsch, K Goossen, B Prediger, U Schweigkofler, P Hilbert-Carius, H Hanken, D Gümbel, B Hossfeld, H Lier, D Hinck, A J Suda, G Achatz, D Bieler","doi":"10.1007/s00068-024-02726-1","DOIUrl":"10.1007/s00068-024-02726-1","url":null,"abstract":"<p><strong>Purpose: </strong>Our aim was to develop new evidence-based and consensus-based recommendations for bleeding control in patients with multiple and/or severe injuries in the prehospital setting. 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 until June 2021. Further literature reports were obtained from clinical experts. Randomised controlled trials, prospective cohort studies, and comparative registry studies were included if they compared interventions for bleeding control in the prehospital setting using manual pressure, haemostatic agents, tourniquets, pelvic stabilisation, or traction splints in patients with multiple and/or severe injuries. We considered patient-relevant clinical outcomes such as mortality and bleeding control. Transfusion requirements and haemodynamic stability were 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>Fifteen studies were identified. Interventions covered were pelvic binders (n = 4 studies), pressure dressings (n = 1), tourniquets (n = 6), traction splints (n = 1), haemostatic agents (n = 3), and nasal balloon catheters (n = 1). Fourteen new recommendations were developed. All achieved strong consensus.</p><p><strong>Conclusion: </strong>Bleeding control is the basic objective of treatment. This can be easily justified based on empirical evidence. There is, however, a lack of reliable and high-quality studies that assess and compare methods for bleeding control in patients with multiple and/or severe injuries. The guideline provides reasonable and practical recommendations (although mostly with a low grade of recommendation) and also reveals several open research questions that can hopefully be answered when the guideline is revised again.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"92"},"PeriodicalIF":2.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188678","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":"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":"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":"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":"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":"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":"Dynamic pathophysiological features of early primary blast lung injury: a novel functional incapacity pig model.","authors":"Shifeng Shao, Shasha Wu, Jun Liu, Zhikang Liao, Pengfei Wu, Yuan Yao, Zhen Wang, Liang Zhang, Yaoli Wang, Hui Zhao","doi":"10.1007/s00068-024-02672-y","DOIUrl":"10.1007/s00068-024-02672-y","url":null,"abstract":"<p><strong>Introduction: </strong>While there is evidence supporting the use of ultrasound for real-time monitoring of primary blast lung injury (PBLI), uncertainties remain regarding the timely detection of early PBLI and the limited data correlating it with commonly used clinical parameters. Our objective is to develop a functional incapacity model for PBLI that better addresses practical needs and to verify the early diagnostic effectiveness of lung ultrasound in identifying PBLI.</p><p><strong>Methods: </strong>We selected six healthy male pigs to develop an animal model using a bio-shock tube (BST-I). The injuries were induced at a pressure of 4.8 MPa. We monitored the animals before and after the injury using various methods to detect changes in vital signs, lung function, and hemodynamics.</p><p><strong>Results: </strong>The experimental peak overpressure was measured at 405.89 ± 4.14KPa, with the duration of the first positive peak pressure being 50.01ms. The mortality rate six hours after injury was 50%. The average Military Combat Injury Scale was higher than 3. Significant increases were observed in heart rate (HR), shock index (SI), alveolar-arterial oxygen gradient (AaDO₂), lung ultrasound scores(LUS), and pulmonary vascular permeability index (PVPI) at 0.5 h, 3 h, and 6 h after-injury (p < 0.05). Conversely, there were notable decreases in average arterial pressure(MAP), oxygenation index (OI), stroke volume per heartbeat(SV), cardiac output power index(CPI), global end-diastolic index (GEDI), and intrathoracic blood volume index (ITBI) during the same time periods (p < 0.05). Meanwhile, the extrapulmonary water index (ELWI) showed a significant increase at 0.5 h and 6 h after injury (p < 0.05). At 6 h after injury, pulmonary ultrasound scores were positively correlated with HR (R = 0.731, p < 0.001), AaDO₂ (R = 0.612, p = 0.012), SI (R = 0.661, p = 0.004), ELWI (R = 0.811, p < 0.001), PVPI (R = 0.705, p = 0.002). In contrast, these scores were negatively correlated with SpO₂ (R = -0.583, p = 0.007),OI (R = -0.772, p < 0.001), ITBI (R = -0.637, p = 0.006).</p><p><strong>Conclusion: </strong>We have successfully developed a novel, and highly reproducible animal model for assessing serious PBLI functional incapacity. This model displays immediate symptoms of hypoxia, decreased cardiac output, decreased blood volume, and abnormal lung ultrasound findings within 0.5 h of injury, with syptoms lasting for up to 6 h. Lung ultrasound evaluation is crucial for the early assessment of injuries, and is comparable to commonly used clinical parameters.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"60"},"PeriodicalIF":1.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037693","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":"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}