World Journal of Emergency Surgery最新文献

{"title":"Incidence of intra-abdominal injury after blunt abdominal trauma with negative CT scan: a systematic review and meta-analysis.","authors":"Virginia Zarama, María Camila García, Juan Pablo Arango-Ibanez, Laura J Osorio-González","doi":"10.1186/s13017-026-00680-4","DOIUrl":"10.1186/s13017-026-00680-4","url":null,"abstract":"<p><strong>Background: </strong>Missed intra-abdominal injuries (IAI) after blunt abdominal trauma (BAT) with a negative CT scan are rare, but incidence estimates vary across populations and over time, leading to heterogeneous practices regarding observation and discharge. The aim of this study is to synthesize available evidence to estimate the incidence of IAI among patients with BAT and a negative CT scan and to examine how different characteristics influence this risk.</p><p><strong>Methods: </strong>Systematic searches were conducted in MEDLINE, EMBASE, CENTRAL, and LILACS from inception to May 12, 2025, without language restrictions, and supplemented with WoS, trial registries and grey literature sources. Eligible studies included cohort, cross-sectional, case-control studies, or randomized trials evaluating patients of any age with BAT who underwent CT with negative findings for IAI. Emergent procedures and hemodynamic instability were exclusion criteria. Screening and study selection were performed independently by two reviewers. Duplicate and independent data extraction was conducted. Reporting followed PRISMA guidelines and quality was assessed using the Joanna Briggs Institute tool. Pooled incidences were estimated using random-effects meta-analysis. The primary outcome was the incidence of IAI in patients with negative CT scans, and subgroup and sensitivity analyses were performed to assess heterogeneity and robustness.</p><p><strong>Results: </strong>Thirty-one studies comprising 27,342 patients were included. The pooled incidence of IAI after a negative CT was 0.34% (95% CI, 0.21-0.51%). Heterogeneity was substantial (I² = 62.8%) and largely explained by patient characteristics and CT technology. Subgroups with high-risk clinical features had a higher incidence (1.03%; 95% CI, 0.31-2.12%) than unselected trauma cohorts (0.22%; 95% CI, 0.12-0.35%, p = 0.01). Older CT technology showed a higher incidence (0.69%; 95% CI, 0.25-1.33%, compared with MDCT (0.26%; 95% CI 0.14-0.42%, p = 0.05). Sensitivity analyses with GLMM confirmed the robustness of our findings.</p><p><strong>Conclusions: </strong>In patients with blunt abdominal trauma and a negative CT scan, the incidence of intra-abdominal injury is exceedingly low (0.34%). These findings provide robust, contemporary evidence to inform clinical decisions regarding the need for in-hospital observation and support consideration of early discharge in most patients, while recognizing that individuals with high-risk clinical features may warrant closer monitoring.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closed incision negative pressure wound therapy after emergency laparotomy: a systematic review and Meta-analysis of randomized controlled trials.","authors":"Jamal Ahmad, Mahmoud Diaa Hindawi, Ahmed Mohamed Hamdy, Alaa R Al-Ihribat, Omar Hammam Salloum, Mohammad Marrawani, Nada S Jibril, Mariam Elewidi, Hamdi Elbelkasi, Abd-Elfattah Kalmoush, Andrew W Kirkpatrick, Edward C T H Tan","doi":"10.1186/s13017-026-00679-x","DOIUrl":"10.1186/s13017-026-00679-x","url":null,"abstract":"<p><strong>Purpose: </strong>Emergency laparotomy is associated with high rates of postoperative wound complications, contributing substantially to patient morbidity and healthcare burden. Closed incision negative pressure wound therapy (ciNPWT) has been proposed as a prophylactic strategy to reduce wound-related complications; however, its effectiveness in the emergency laparotomy setting remains uncertain. We evaluated whether ciNPWT reduces wound complications after emergency laparotomy compared with standard dressings.</p><p><strong>Methods: </strong>This study is a systematic review and meta-analysis of randomized controlled trials (RCTs). Six databases and trial registries were systematically searched for RCTs from inception to October 10, 2025, with the search subsequently updated using automated database alerts (RSS) up to the time of manuscript submission.</p><p><strong>Results: </strong>Six randomized controlled trials (1208 patients) were included. Compared with standard dressings, ciNPWT reduced overall wound morbidity (RR 0.49, 95% CI 0.38-0.62; I² = 0%) and overall SSI (RR 0.40, 95% CI 0.26-0.61; I² = 0%). ciNPWT also reduced superficial SSI (RR 0.46, 95% CI 0.24-0.85) and wound dehiscence (RR 0.40, 95% CI 0.20-0.80). No significant differences were observed for seroma (RR 0.59, 95% CI 0.34-1.01), length of hospital stay (MD - 0.43 days, 95% CI- 1.14 to 0.29), mortality (RR 1.18, 95% CI 0.64-2.15), or 30-day complications (RR 0.98, 95% CI 0.85-1.15).</p><p><strong>Conclusion: </strong>In adult patients undergoing emergency laparotomy with primary abdominal closure, ciNPWT significantly reduces key incision-related complications, particularly superficial SSI and wound dehiscence. Its clinical benefit appears confined to incision-level outcomes, with no effect on systemic or multifactorial postoperative endpoints. These findings support the selective use of ciNPWT in high-risk emergency laparotomy patients and highlight the need for standardized application protocols and longer-term outcome assessment.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13014843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of nutritional status in prognosis of Fournier gangrene: a single-center experience.","authors":"Muhammed Salih Süer, Serkan Demir, Eda Gül Doğan, Ramazan Onuş, Batuhan Alp Akpolat, Betül Alçelik, Ender Ergüder, Şener Balas, Melih Akıncı","doi":"10.1186/s13017-026-00675-1","DOIUrl":"10.1186/s13017-026-00675-1","url":null,"abstract":"<p><strong>Background and aims: </strong>Fournier's gangrene (FG) is a severe and life-threatening necrotizing soft-tissue infection with high mortality. Traditional severity indices may not adequately reflect nutritional and inflammatory status, which are increasingly recognized as important prognostic factors. This study aimed to evaluate the impact of nutritional and inflammatory markers on outcomes in FG.</p><p><strong>Methods: </strong>We retrospectively analyzed 45 patients with FG treated between October 2022 and May 2025 at a tertiary hospital. Demographic, clinical, nutritional [body mass index (BMI), serum albumin, psoas muscle index (PMI), Nutritional Risk Screening-2002 (NRS-2002)], and inflammatory parameters [neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), hemoglobin-albumin-lymphocyte-platelet (HALP) score] were recorded. Sarcopenia was defined using population-specific PMI cut-offs. Outcomes included in-hospital mortality, length of stay, and surgical interventions. Prognostic performance was assessed with ROC curves and logistic regression.</p><p><strong>Results: </strong>Overall mortality was 24.4%. Non-survivors had lower serum albumin (22.9 vs. 27.4 g/L, p = 0.035), lower PMI (4.1 vs. 5.7 cm²/m², p = 0.033), and higher NRS-2002 scores (3.0 vs. 0.7, p < 0.001). Sarcopenia was frequent (58.1%) and present across all BMI categories, indicating sarcopenic obesity. NRS-2002 showed the strongest predictive ability for mortality (AUC 0.849).</p><p><strong>Conclusion: </strong>Nutritional impairment and sarcopenia are common in FG and strongly associated with adverse outcomes. Incorporating nutritional markers into severity assessment may enhance prognostic accuracy and support early nutrition-focused interventions.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13011676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Independent risk of death from hemorrhage and traumatic brain injury in polytrauma: findings from a prospective, multi-center study in the Western Cape of South Africa.","authors":"Jessica L Wild, Julia M Dixon, Mengli Xiao, Hendrick J Lategan, George Oosthuizen, Steven G Schauer, Elmin Steyn, Janette Verster, Craig Wylie, Shaheem de Vries, Adriaan Vlok, Willem Stassen, Maria Kohlbrenner, Nee-Kofi Mould-Millman","doi":"10.1186/s13017-026-00677-z","DOIUrl":"10.1186/s13017-026-00677-z","url":null,"abstract":"<p><strong>Background: </strong>Injury is one of the leading causes of death globally, with the largest burden in low- and middle-income countries. Injuries resulting in both hemorrhage and traumatic brain injury (TBI) are associated with high mortality. We seek to quantify the contribution of each injury process, hemorrhage and TBI, and their severity on mortality among patients with concurrent hemorrhage + TBI.</p><p><strong>Methods: </strong>This is a secondary analysis from the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study conducted in the Western Cape, South Africa. Adult patients experiencing both hemorrhage + TBI were included. Hemorrhage and TBI severity (mild, moderate, or severe) were assigned according to physiology, injury severity, laboratory and imaging data, and clinical interventions. The independent association of hemorrhage and TBI severity on 7-day mortality was assessed by an adjusted Cox proportional hazards model. Adjustment covariates included age, sex, primary EMS transport, TEWS, and NISS. Secondary endpoints included 48-h and 30-day mortality.</p><p><strong>Results: </strong>A total of 877 patients were included in the final analysis. Patients were 86% (n = 758) male with a median age of 32 years. 66% (n = 581) of patients were injured by a non-penetrating force. The adjusted rate of death was significantly higher with increasing severity of both hemorrhage and TBI. For the primary outcome of 7-day mortality, severe TBI compared to mild had a 5.11 times higher rate of mortality (aHR 5.11, 95% CI 3.29-7.93) and severe versus moderate TBI had a 5.02 times higher rate (aHR 5.02, 95% CI 4.22-5.96). When assessing across hemorrhage severity, the rate of 7-day mortality was 4.5 times higher (aHR 4.5, 95% CI 3.70-5.47) comparing severe to mild and 3.2 times higher (aHR 3.2, 95% CI 2.53-4.12) comparing severe to moderate. The largest increased rate of death was found in the 48-h mortality analysis comparing severe to mild hemorrhage, with an 18.4 times higher mortality rate (aHR 18.4, 95% CI 12.02-28.21).</p><p><strong>Conclusions: </strong>Increasing severity of hemorrhage and TBI are both independently associated with a three to five times higher rate of 7-day mortality. These findings highlight the importance of timely hemorrhage control and resuscitation to reduce mortality and the risk of progression to severe disease.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13011325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-assisted training for rib fracture interpretation: a prospective study in undergraduate medical students.","authors":"Yu-San Tee, Chien-An Liao, Ling-Wei Kuo, Chih-Po Hsu, Chia-Cheng Wang, Chih-Yuan Fu, Chien-Hung Liao, Chi-Tung Cheng","doi":"10.1186/s13017-026-00678-y","DOIUrl":"10.1186/s13017-026-00678-y","url":null,"abstract":"<p><strong>Purpose: </strong>Chest X-rays (CXRs) are essential in trauma care but have limited sensitivity for rib fracture detection, leading to frequent missed diagnoses. Artificial intelligence (AI) has shown potential to improve diagnostic accuracy, yet its role in radiology education remains underexplored. This study evaluated the impact of AI-assisted training on early diagnostic performance and confidence in rib fracture detection on trauma CXRs.</p><p><strong>Methods: </strong>In this prospective observational study, 26 undergraduate medical students (UGY) completed three sequential sessions: baseline unassisted interpretation of 50 CXRs (Session 1, S1), AI-assisted interpretation of the same cases (Session 2, S2), and interpretation of 50 new CXRs without AI assistance (Session 3, S3). Diagnostic performances and confidence levels were compared across sessions.</p><p><strong>Results: </strong>AI-assistance (S2) significantly improved all performance metrics, with increases of 26.7% in accuracy, 41.0% in sensitivity, 25.1% in specificity, 35.6% in F1 score, and 31.4% in precision (all p < 0.01). Performance in S3 declined compared to S2 but remained higher than baseline for accuracy (+ 13.3%, p = 0.010) and precision (+ 13.7%, p = 0.010) compared to baseline. Confidence levels showed sustained improvement across all sessions (p < 0.001). Agreement analysis in AI-misclassified cases suggested possible automation bias in S2 and carryover effects in S3.</p><p><strong>Conclusions: </strong>AI-assisted training significantly enhances early diagnostic performance and confidence in rib fracture detection on chest radiographs, a key competency in trauma and emergency care, with partial skill retention after AI withdrawal. Integrating AI into early trauma imaging training may strengthen radiology training but requires strategies to mitigate automation bias and foster independent judgment.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13011741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146198272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous vs. surgical management in acute cholecystitis: addressing selection bias in meta-analyses.","authors":"Ling Chen","doi":"10.1186/s13017-026-00671-5","DOIUrl":"10.1186/s13017-026-00671-5","url":null,"abstract":"<p><p>This commentary addresses the recent research titled \"Comparing percutaneous treatment and cholecystectomy outcomes in acute cholecystitis patients: a systematic review and meta-analysis\" published in the World Journal of Emergency Surgery. The review confirms that cholecystectomy (CC), particularly laparoscopic, is associated with lower mortality and readmission rates compared to percutaneous cholecystostomy (PC). However, this commentary emphasizes that the interpretation of these findings must account for inherent selection bias: in clinical practice, PC is typically reserved for higher-risk patients who are unfit for immediate surgery. Thus, the observed outcome differences partially reflect disparities in baseline risk rather than therapeutic efficacy alone. The review's true value lies in reinforcing early CC as the standard of care for suitable patients and clarifying the role of PC as a \"bridge therapy\" to stabilize patients for subsequent definitive surgery. Future research should focus on optimizing risk stratification and timing of delayed CC after PC.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"21 1","pages":"9"},"PeriodicalIF":5.8,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12903393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146195868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in emergency surgery: a scoping review within the artificial intelligence in emergency and trauma surgery (ARIES) project.","authors":"Belinda De Simone, Lucienne Kasongo, Andrew A Gumbs, Fabrizio Vecchio, Alberto De Franceschi, Nicola DèAngelis, Andrew W Kirkpatrick, Juan P Wachs, Tyler J Loftus, Fikri M Abu-Zidan, Rifat Latifi, Genevieve Deeken, Elie Chouillard, Andrey Litvin, Massimo Sartelli, Desiree Pantalone, Ari Leppäniemi, Mehmet Eryilmaz, Kemal Rasa, Arda Isik, Haytham M Kaafarani, Gustavo Fraga, Raul Coimbra, Ernest E Moore, Walter L Biffl, Fausto Catena","doi":"10.1186/s13017-026-00674-2","DOIUrl":"10.1186/s13017-026-00674-2","url":null,"abstract":"<p><strong>Aim: </strong>To map and critically appraise the current literature on Artificial Intelligence (AI) applications in emergency general surgery, with a focus on clinical decision-support tools for preoperative risk stratification and intraoperative assistance, and to identify ethical, structural, and regulatory barriers to implementation.</p><p><strong>Methods: </strong>A scoping review was conducted within the ARIES project, following established methodological frameworks. Relevant studies evaluating AI-based tools in emergency surgical settings were systematically identified and analyzed.</p><p><strong>Results: </strong>The literature describes AI applications mainly in two domains: preoperative decision support, including risk prediction and diagnostic or triage models for acute abdominal and traumatic conditions, and intraoperative assistance, largely focused on computer vision-based systems for anatomical recognition, safety guidance, and navigation in minimally invasive emergency procedures. Additional contributions address training and telementoring platforms, as well as cross-cutting ethical, legal, and regulatory considerations relevant to AI adoption in emergency surgical care.</p><p><strong>Conclusions: </strong>AI has the potential to complement emergency surgeons' clinical judgment, but its routine adoption in emergency surgical practice remains limited. Addressing methodological, ethical, and regulatory challenges, together with the development of robust data infrastructures and targeted training pathways, is essential to support safe, effective, and equitable implementation in acute care settings. In addition, the lack of dedicated investment and sustainable funding models for large-scale clinical implementation and prospective evaluation represents a critical barrier to the translation of AI from research into routine emergency surgical practice.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12977898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumoperitoneum without significant bowel perforation in patients with blunt trauma: a systematic review and meta-analysis.","authors":"Emad Masuadi, Yasir Ahmed Mohammed Elhadi, Osman S Abdelhamed, Zainab M Alkharas, Linda Östlundh, Gamila Ahmed, Ashraf F Hefny","doi":"10.1186/s13017-026-00673-3","DOIUrl":"10.1186/s13017-026-00673-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Free intraperitoneal air (FIA) after blunt trauma is traditionally considered a radiological marker of hollow viscus perforation requiring urgent laparotomy. However, emerging reports have described pneumoperitoneum without surgically meaningful bowel injury, raising concerns about unnecessary operations. This systematic review and meta-analysis aimed to quantify the proportion of patients with blunt trauma with computed tomography (CT)-detected FIA who had no significant bowel perforation, defined as either (1) non-therapeutic laparotomy with no identified macroscopic perforation or (2) successful nonoperative management without subsequent clinical deterioration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was prospectively registered in the International Prospective Register of Systematic Reviews (CRD42020202174). PubMed, Embase, Scopus, and Web of Science were searched through November 13, 2025, for observational studies reporting the outcomes of patients with blunt trauma with CT-detected FIA. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed to estimate the pooled proportion of FIA cases without significant perforation. Heterogeneity was assessed using I-squared statistic (measure of heterogeneity) and τ&lt;sup&gt;2&lt;/sup&gt;; small-study effects were examined using contour-enhanced funnel plots and Egger's regression. Case reports meeting eligibility criteria were narratively summarized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fourteen studies comprising 8,972 patients with blunt trauma were included. Among them, 239 (2.7%) had CT-detected FIA. In the FIA subgroup, 117 patients (49.0%) had surgically confirmed bowel perforation, whereas 122 (51.0%) had no significant perforation, defined as a non-therapeutic laparotomy or a stable nonoperative clinical course. Among patients without FIA on CT, 56 of 8,733 (0.6%) had bowel perforation identified during surgery. The pooled analysis showed that 34% (95% CI 14-63%) of patients with FIA had no significant perforation. Substantial heterogeneity was observed (I-squared statistic = 80.3%, τ&lt;sup&gt;2&lt;/sup&gt; = 3.26, p &lt; 0.001), reflecting variations in CT acquisition, diagnostic criteria, and operative thresholds. Funnel plot asymmetry suggested potential small-study effects. Additionally, 19 case reports (20 patients) published between 1999 and 2025 illustrated that benign pneumoperitoneum most often occurred in young men following high-energy trauma, commonly associated with pneumothorax or pneumomediastinum; most underwent nontherapeutic laparotomy, whereas several were successfully managed nonoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;A noteworthy subgroup of patients with blunt trauma with CT-detected FIA did not exhibit clinically significant bowel perforation","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12952182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the initial impact: troponin patterns frequently reveal delayed cardiac injury in polytrauma patients.","authors":"Larissa Sztulman,Victoria Pfeiffer,Miriam Saenger,Ruth Brenner,Lea Usov,Ingo Marzi,Birte Weber","doi":"10.1186/s13017-026-00672-4","DOIUrl":"https://doi.org/10.1186/s13017-026-00672-4","url":null,"abstract":"BACKGROUNDCardiac troponin serves as a biomarker for diagnosing myocardial contusion following blunt chest trauma and for differentiating between types of myocardial infarction. However, its interpretation in polytrauma remains challenging due to overlapping pathophysiological mechanisms. This study aims to improve troponin-based cardiac risk stratification to more accurately identify high-risk patients and enhance prognostic assessment.METHODSThis prospectively performed study included polytraumatized patients (ISS ≥ 16) admitted to a German Level 1 trauma center between January 2024 and July 2025. For each patient, six blood samples collected over ten days were analyzed for Troponin T (TnT) and NT-proBNP; and two transthoracic echocardiograms (24 h and 48 h) and ECGs were evaluated by a cardiologist. Data were correlated with clinical records, trauma-dependent and -independent cardiac risk factors, including the cardiovascular risk score (SCORE2).RESULTSSeventy-seven patients were included (mean age 52 years; 73% male; mean ISS 29). TnT was elevated in 44% at admission and in 73% after 24 h. 13% of the patients were diagnosed with a cardiac contusion. TnT elevation was associated with age ≥ 40 years, higher SCORE2, thoracic injuries, ISS ≥ 25, preclinical arrhythmias, catecholamine therapy, and surgery at admission. Two distinct TnT patterns were found: Group 1 (44%)-elevation already at admission, mirrored the overall risk profile but showed more persistent elevation in patients ≥ 60 years, with very high SCORE2 or catecholamine therapy and was especially linked to sternal fractures. Group 2 (26%)-delayed TnT rise after 24 h, associated with thoracic trauma, ISS ≥ 25, surgery and catecholamine therapy. Complications, including new-onset arrhythmias and higher mortality, occurred in both groups.CONCLUSIONCardiac involvement in polytrauma is multifactorial and often underrecognized. TnT elevation was associated with higher age, high SCORE2, severe injury, thoracic trauma, arrhythmias, and resuscitation, with a distinct subgroup showing delayed elevation after 24 h. This delayed phenotype is clinically relevant, as most of these patients had thoracic trauma and underwent early surgery, aligning with recommendations for perioperative screening for myocardial infarction. Our findings emphasize routine peri-traumatic and peri-operative troponin measurement and highlight the value of TTE and continuous ECG for detecting evolving cardiac dysfunction. Systematic follow-up is needed to assess long-term outcomes and refine cardiac risk stratification in this vulnerable population.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"143 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146089065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of blunt adrenal gland injury (BAGI) in major trauma: a systematic review and meta-analysis.","authors":"Laura Benuzzi,Stefano P B Cioffi,Stefano Granieri,Giada Panagini,Michele Altomare,Andrea Spota,Francesco Virdis,Roberto Bini,Andrea Mingoli,Osvaldo Chiara,Stefania Cimbanassi","doi":"10.1186/s13017-025-00654-y","DOIUrl":"https://doi.org/10.1186/s13017-025-00654-y","url":null,"abstract":"BACKGROUNDBlunt adrenal gland injuries (BAGI) are rare and typically reflect high-energy trauma. Despite suggestions that BAGI may be a marker of increased injury severity and mortality, evidence remains conflicting. We conducted a systematic review and meta-analysis to assess the impact of BAGI on trauma severity, in-hospital mortality, and hospital length of stay (LOS).METHODSA systematic search of PubMed, Scopus, and Embase was performed up to August 31, 2024. Studies comparing adult blunt trauma patients with and without BAGI were included. Data on Injury Severity Score (ISS), in-hospital mortality, and LOS were extracted. The risk of bias was assessed using ROBINS-E; certainty of evidence was evaluated via GRADE. Random and fixed effects models were applied based on heterogeneity levels.RESULTSEight retrospective studies involving 379,070 patients, including 15,990 with BAGI, met inclusion criteria. BAGI patients had significantly higher ISS (mean difference [MD]: 7.18; 95 % CI 2.59-11.76; p = 0.012). In-hospital mortality was not initially different (OR 1.10; 95 % CI 0.69-1.73), but sensitivity analysis excluding heterogeneity-influencing studies showed increased mortality in BAGI patients (OR 1.51; 95 % CI 1.2-1.91; p = 0.007). No significant difference in LOS was observed (MD: 3.26 days; 95 % CI - 1.56-8.10; p = 0.13). Evidence certainty was moderate for ISS and mortality, and low for LOS.CONCLUSIONSBAGI is associated with higher trauma severity and, potentially, increased mortality. While not independently predictive, its presence should prompt awareness of severe polytrauma. Standardized injury grading and prospective data are needed to clarify BAGI's prognostic role.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"30 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}