World Journal of Emergency Surgery最新文献

{"title":"Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke center.","authors":"Alexandre Nuzzo,&nbsp;Katell Peoc'h,&nbsp;Prabakar Vaittinada Ayar,&nbsp;Alexy Tran-Dinh,&nbsp;Emmanuel Weiss,&nbsp;Yves Panis,&nbsp;Maxime Ronot,&nbsp;Lorenzo Garzelli,&nbsp;Philippine Eloy,&nbsp;Iannis Ben Abdallah,&nbsp;Yves Castier,&nbsp;Olivier Corcos","doi":"10.1186/s13017-023-00505-8","DOIUrl":"https://doi.org/10.1186/s13017-023-00505-8","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis of acute mesenteric ischemia (AMI) is essential for a favorable outcome. Selection of patients requiring a dedicated multiphasic computed tomography (CT) scan remains a clinical challenge.</p><p><strong>Methods: </strong>In this cross-sectional diagnostic study conducted from 2016 to 2018, we compared the presentation of AMI patients admitted to an intestinal stroke center to patients with acute abdominal pain of another origin admitted to the emergency room (controls).</p><p><strong>Results: </strong>We included 137 patients-52 with AMI and 85 controls. Patients with AMI [median age: 65 years (interquartile range 55-74)] had arterial and venous AMI in 65% and 35% of cases, respectively. Relative to controls, AMI patients were significantly older, more likely to have risk factors or a history of cardiovascular disease, and more likely to present with sudden-onset and morphine-requiring abdominal pain, hematochezia, guarding, organ dysfunction, higher white blood cell and neutrophil counts, and higher plasma C-reactive protein (CRP) and procalcitonin concentrations. On multivariate analysis, two independent factors were associated with the diagnosis of AMI: the sudden-onset (OR = 20, 95%CI 7-60, p < 0.001) and the morphine-requiring nature of the acute abdominal pain (OR = 6, 95%CI 2-16, p = 0.002). Sudden-onset and/or morphine-requiring abdominal pain was present in 88% of AMI patients versus 28% in controls (p < 0.001). The area under the receiver operating characteristic curve for the diagnosis of AMI was 0.84 (95%CI 0.77-0.91), depending on the number of factors.</p><p><strong>Conclusions: </strong>Sudden onset and the need for morphine are suggestive of AMI in patients with acute abdominal pain and should prompt multiphasic CT scan including arterial and venous phase images for confirmation.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"37"},"PeriodicalIF":8.0,"publicationDate":"2023-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10246417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9679641","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":"Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis.","authors":"Ioannis Panagiotis Kyriazidis,&nbsp;Dominik A Jakob,&nbsp;Juliana Alexandra Hernández Vargas,&nbsp;Oscar H Franco,&nbsp;Elias Degiannis,&nbsp;Patrick Dorn,&nbsp;Sjaak Pouwels,&nbsp;Bijendra Patel,&nbsp;Ian Johnson,&nbsp;Christopher John Houdlen,&nbsp;Graham S Whiteley,&nbsp;Marion Head,&nbsp;Anil Lala,&nbsp;Haroon Mumtaz,&nbsp;J Agustin Soler,&nbsp;Katie Mellor,&nbsp;David Rawaf,&nbsp;Ahmed R Ahmed,&nbsp;Suhaib J S Ahmad,&nbsp;Aristomenis Exadaktylos","doi":"10.1186/s13017-023-00504-9","DOIUrl":"https://doi.org/10.1186/s13017-023-00504-9","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnosis of cardiac contusion, caused by blunt chest trauma, remains a challenge due to the non-specific symptoms it causes and the lack of ideal tests to diagnose myocardial damage. A cardiac contusion can be life-threatening if not diagnosed and treated promptly. Several diagnostic tests have been used to evaluate the risk of cardiac complications, but the challenge of identifying patients with contusions nevertheless remains.</p><p><strong>Aim of the study: </strong>To evaluate the accuracy of diagnostic tests for detecting blunt cardiac injury (BCI) and its complications, in patients with severe chest injuries, who are assessed in an emergency department or by any front-line emergency physician.</p><p><strong>Methods: </strong>A targeted search strategy was performed using Ovid MEDLINE and Embase databases from 1993 up to October 2022. Data on at least one of the following diagnostic tests: electrocardiogram (ECG), serum creatinine phosphokinase-MB level (CPK-MB), echocardiography (Echo), Cardiac troponin I (cTnI) or Cardiac troponin T (cTnT). Diagnostic tests for cardiac contusion were evaluated for their accuracy in meta-analysis. Heterogeneity was assessed using the I² and the QUADAS-2 tool was used to assess bias of the studies.</p><p><strong>Results: </strong>This systematic review yielded 51 studies (n = 5,359). The weighted mean incidence of myocardial injuries after sustaining a blunt force trauma stood at 18.3% of cases. Overall weighted mean mortality among patients with blunt cardiac injury was 7.6% (1.4-36.4%). Initial ECG, cTnI, cTnT and transthoracic echocardiography TTE all showed high specificity (> 80%), but lower sensitivity (< 70%). TEE had a specificity of 72.1% (range 35.8-98.2%) and sensitivity of 86.7% (range 40-99.2%) in diagnosing cardiac contusion. CK-MB had the lowest diagnostic odds ratio of 3.598 (95% CI: 1.832-7.068). Normal ECG accompanied by normal cTnI showed a high sensitivity of 85% in ruling out cardiac injuries.</p><p><strong>Conclusion: </strong>Emergency physicians face great challenges in diagnosing cardiac injuries in patients following blunt trauma. In the majority of cases, joint use of ECG and cTnI was a pragmatic and cost-effective approach to rule out cardiac injuries. In addition, TEE may be highly accurate in identifying cardiac injuries in suspected cases.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"36"},"PeriodicalIF":8.0,"publicationDate":"2023-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9678209","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":"Complex duodenal fistulae: a surgical nightmare.","authors":"Ari Leppäniemi,&nbsp;Matti Tolonen,&nbsp;Panu Mentula","doi":"10.1186/s13017-023-00503-w","DOIUrl":"https://doi.org/10.1186/s13017-023-00503-w","url":null,"abstract":"<p><strong>Introduction: </strong>A common feature of external duodenal fistulae is the devastating effect of the duodenal content rich in bile and pancreatic juice on nearby tissues with therapy-resistant local and systemic complications. This study analyzes the results of different management options with emphasis on successful fistula closure rates.</p><p><strong>Methods: </strong>A retrospective single academic center study of adult patients treated for complex duodenal fistulas over a 17-year period with descriptive and univariate analyses was performed.</p><p><strong>Results: </strong>Fifty patients were identified. First line treatment was surgical in 38 (76%) cases and consisted of resuture or resection with anastomosis combined with duodenal decompression and periduodenal drainage in 36 cases, rectus muscle patch, and surgical decompression with T-tube in one each. Fistula closure rate was 29/38 (76%). In 12 cases, the initial management was nonoperative with or without percutaneous drainage. The fistula was closed without surgery in 5/6 patients (1 patient died with persistent fistula). Among the remaining 6 patients eventually operated, fistula closure was achieved in 4 cases. There was no difference in successful fistula closure rates among initially operatively versus nonoperatively managed patients (29/38 vs. 9/12, p = 1.000). However, when considering eventually failed nonoperative management in 7/12 patients, there was a significant difference in the fistula closure rate (29/38 vs. 5/12, p = 0.036). The overall in-hospital mortality rate was 20/50 (40%).</p><p><strong>Conclusions: </strong>Surgical closure combined with duodenal decompression in complex duodenal leaks offers the best chance of successful outcome. In selected cases, nonoperative management can be tried, accepting that some patients may require surgery later.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"35"},"PeriodicalIF":8.0,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10199491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9679619","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":"WSES consensus guidelines on sigmoid volvulus management.","authors":"Brian W C A Tian,&nbsp;Gabriele Vigutto,&nbsp;Edward Tan,&nbsp;Harry van Goor,&nbsp;Cino Bendinelli,&nbsp;Fikri Abu-Zidan,&nbsp;Rao Ivatury,&nbsp;Boris Sakakushev,&nbsp;Isidoro Di Carlo,&nbsp;Gabriele Sganga,&nbsp;Ronald V Maier,&nbsp;Raul Coimbra,&nbsp;Ari Leppäniemi,&nbsp;Andrey Litvin,&nbsp;Dimitrios Damaskos,&nbsp;Richard Ten Broek,&nbsp;Walter Biffl,&nbsp;Salomone Di Saverio,&nbsp;Belinda De Simone,&nbsp;Marco Ceresoli,&nbsp;Edoardo Picetti,&nbsp;Joseph Galante,&nbsp;Giovanni D Tebala,&nbsp;Solomon Gurmu Beka,&nbsp;Luigi Bonavina,&nbsp;Yunfeng Cui,&nbsp;Jim Khan,&nbsp;Enrico Cicuttin,&nbsp;Francesco Amico,&nbsp;Inaba Kenji,&nbsp;Andreas Hecker,&nbsp;Luca Ansaloni,&nbsp;Massimo Sartelli,&nbsp;Ernest E Moore,&nbsp;Yoram Kluger,&nbsp;Mario Testini,&nbsp;Dieter Weber,&nbsp;Vanni Agnoletti,&nbsp;Nicola De' Angelis,&nbsp;Federico Coccolini,&nbsp;Ibrahima Sall,&nbsp;Fausto Catena","doi":"10.1186/s13017-023-00502-x","DOIUrl":"https://doi.org/10.1186/s13017-023-00502-x","url":null,"abstract":"<p><p>Sigmoid volvulus is a common surgical emergency, especially in elderly patients. Patients can present with a wide range of clinical states: from asymptomatic, to frank peritonitis secondary to colonic perforation. These patients generally need urgent treatment, be it endoscopic decompression of the colon or an upfront colectomy. The World Society of Emergency Surgery united a worldwide group of international experts to review the current evidence and propose a consensus guidelines on the management of sigmoid volvulus.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"34"},"PeriodicalIF":8.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10186802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9679609","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 unrestricted global effort to complete the COOL trial.","authors":"Andrew W Kirkpatrick,&nbsp;Federico Coccolini,&nbsp;Matti Tolonen,&nbsp;Samuel Minor,&nbsp;Fausto Catena,&nbsp;Emanuel Gois,&nbsp;Christopher J Doig,&nbsp;Michael D Hill,&nbsp;Luca Ansaloni,&nbsp;Massimo Chiarugi,&nbsp;Dario Tartaglia,&nbsp;Orestis Ioannidis,&nbsp;Michael Sugrue,&nbsp;Elif Colak,&nbsp;S Morad Hameed,&nbsp;Hanna Lampela,&nbsp;Vanni Agnoletti,&nbsp;Jessica L McKee,&nbsp;Naisan Garraway,&nbsp;Massimo Sartelli,&nbsp;Chad G Ball,&nbsp;Neil G Parry,&nbsp;Kelly Voght,&nbsp;Lisa Julien,&nbsp;Jenna Kroeker,&nbsp;Derek J Roberts,&nbsp;Peter Faris,&nbsp;Corina Tiruta,&nbsp;Ernest E Moore,&nbsp;Lee Anne Ammons,&nbsp;Elissavet Anestiadou,&nbsp;Cino Bendinelli,&nbsp;Konstantinos Bouliaris,&nbsp;Rosemarry Carroll,&nbsp;Marco Ceresoli,&nbsp;Francesco Favi,&nbsp;Angela Gurrado,&nbsp;Joao Rezende-Neto,&nbsp;Arda Isik,&nbsp;Camilla Cremonini,&nbsp;Silivia Strambi,&nbsp;Georgios Koukoulis,&nbsp;Mario Testini,&nbsp;Sandy Trpcic,&nbsp;Alessandro Pasculli,&nbsp;Erika Picariello,&nbsp;Fikri Abu-Zidan,&nbsp;Ademola Adeyeye,&nbsp;Goran Augustin,&nbsp;Felipe Alconchel,&nbsp;Yuksel Altinel,&nbsp;Luz Adriana Hernandez Amin,&nbsp;José Manuel Aranda-Narváez,&nbsp;Oussama Baraket,&nbsp;Walter L Biffl,&nbsp;Gian Luca Baiocchi,&nbsp;Luigi Bonavina,&nbsp;Giuseppe Brisinda,&nbsp;Luca Cardinali,&nbsp;Andrea Celotti,&nbsp;Mohamed Chaouch,&nbsp;Maria Chiarello,&nbsp;Gianluca Costa,&nbsp;Nicola de'Angelis,&nbsp;Nicolo De Manzini,&nbsp;Samir Delibegovic,&nbsp;Salomone Di Saverio,&nbsp;Belinda De Simone,&nbsp;Vincent Dubuisson,&nbsp;Pietro Fransvea,&nbsp;Gianluca Garulli,&nbsp;Alessio Giordano,&nbsp;Carlos Gomes,&nbsp;Firdaus Hayati,&nbsp;Jinjian Huang,&nbsp;Aini Fahriza Ibrahim,&nbsp;Tan Jih Huei,&nbsp;Ruhi Fadzlyana Jailani,&nbsp;Mansoor Khan,&nbsp;Alfonso Palmieri Luna,&nbsp;Manu L N G Malbrain,&nbsp;Sanjay Marwah,&nbsp;Paul McBeth,&nbsp;Andrei Mihailescu,&nbsp;Alessia Morello,&nbsp;Francesk Mulita,&nbsp;Valentina Murzi,&nbsp;Ahmad Tarmizi Mohammad,&nbsp;Simran Parmar,&nbsp;Ajay Pak,&nbsp;Michael Pak-Kai Wong,&nbsp;Desire Pantalone,&nbsp;Mauro Podda,&nbsp;Caterina Puccioni,&nbsp;Kemal Rasa,&nbsp;Jianan Ren,&nbsp;Francesco Roscio,&nbsp;Antonio Gonzalez-Sanchez,&nbsp;Gabriele Sganga,&nbsp;Maximilian Scheiterle,&nbsp;Mihail Slavchev,&nbsp;Dmitry Smirnov,&nbsp;Lorenzo Tosi,&nbsp;Anand Trivedi,&nbsp;Jaime Andres Gonzalez Vega,&nbsp;Maciej Waledziak,&nbsp;Sofia Xenaki,&nbsp;Desmond Winter,&nbsp;Xiuwen Wu,&nbsp;Andee Dzulkarnean Zakaria,&nbsp;Zaidi Zakaria","doi":"10.1186/s13017-023-00500-z","DOIUrl":"https://doi.org/10.1186/s13017-023-00500-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) ( https://clinicaltrials.gov/ct2/show/NCT03163095 ). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of \"damage control\"; however, improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL trial seeks to expand potential sites and proceed with the evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registrat","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"33"},"PeriodicalIF":8.0,"publicationDate":"2023-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10173926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9680455","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":"Trauma deaths of hospitalized patients in Abu Dhabi Emirate: a retrospective descriptive study.","authors":"David O Alao,&nbsp;Arif Alper Cevik,&nbsp;Fikri M Abu-Zidan","doi":"10.1186/s13017-023-00501-y","DOIUrl":"https://doi.org/10.1186/s13017-023-00501-y","url":null,"abstract":"<p><strong>Aim: </strong>To study the epidemiology and pattern of trauma-related deaths of hospitalized patients in Abu Dhabi Emirate, United Arab Emirates, in order to improve trauma management and injury prevention.</p><p><strong>Methods: </strong>The Abu Dhabi Trauma Registry prospectively collects data of all hospitalized trauma patients from seven major trauma centres in Abu Dhabi Emirate. We studied all patients who died on arrival or after admission to these hospitals from January 2014 to December 2019.</p><p><strong>Results: </strong>There were 453 deaths constituting 13.5% of all trauma deaths in the Abu Dhabi Emirate. The median (IQR) age of the patients was 33 (25-45) years, and 82% were males. 85% of the deaths occurred in the emergency department (ED) and the intensive care unit (ICU). Motor vehicle collision (63.8%) was the leading cause of death. 45.5% of the patients had head injury. Two of the seven hospitals admitted around 50% of all patients but accounted for only 25.8% of the total deaths (p < 0.001). Those who died in the ward (7%) were significantly older, median (IQR) age: of 65.5 (31.75-82.25) years, (p < 0.001), 34.4% of them were females (p = 0.09). The median (IQR) GCS of those who died in the ward was 15 (5.75-15) compared with 3 (3-3) for those who died in ED and ICU (P < 0.001).</p><p><strong>Conclusions: </strong>Death from trauma predominantly affects young males with motor traffic collision as the leading cause. Over 85% of in-hospital deaths occur in the ICU and ED, mainly from head injuries. Injury prevention of traffic collisions through enforcement of law and improved hospital care in the ED and ICU will reduce trauma death.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"31"},"PeriodicalIF":8.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10148441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9414720","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 new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study.","authors":"Belinda De Simone,&nbsp;Yoram Kluger,&nbsp;Ernest E Moore,&nbsp;Massimo Sartelli,&nbsp;Fikri M Abu-Zidan,&nbsp;Federico Coccolini,&nbsp;Luca Ansaloni,&nbsp;Giovanni D Tebala,&nbsp;Salomone Di Saverio,&nbsp;Isidoro Di Carlo,&nbsp;Boris E Sakakushev,&nbsp;Luigi Bonavina,&nbsp;Michael Sugrue,&nbsp;Joseph M Galante,&nbsp;Rao Ivatury,&nbsp;Edoardo Picetti,&nbsp;Mircea Chirica,&nbsp;Imtiaz Wani,&nbsp;Miklosh Bala,&nbsp;Ibrahima Sall,&nbsp;Andrew W Kirkpatrick,&nbsp;Vishal G Shelat,&nbsp;Emmanouil Pikoulis,&nbsp;Ari Leppäniemi,&nbsp;Edward Tan,&nbsp;Richard P G Ten Broek,&nbsp;Solomon Gurmu Beka,&nbsp;Andrey Litvin,&nbsp;Elie Chouillard,&nbsp;Raul Coimbra,&nbsp;Yunfeng Cui,&nbsp;Nicola De' Angelis,&nbsp;Gabriele Sganga,&nbsp;Philip F Stahel,&nbsp;Vanni Agnoletti,&nbsp;Alessia Rampini,&nbsp;Mario Testini,&nbsp;Francesca Bravi,&nbsp;Ronald V Maier,&nbsp;Walter L Biffl,&nbsp;Fausto Catena","doi":"10.1186/s13017-023-00499-3","DOIUrl":"https://doi.org/10.1186/s13017-023-00499-3","url":null,"abstract":"<p><strong>Background: </strong>Timely access to the operating room for emergency general surgery (EGS) indications remains a challenge across the globe, largely driven by operating room availability and staffing constraints. The \"timing in acute care surgery\" (TACS) classification was previously published to introduce a new tool to triage the timely and appropriate access of EGS patients to the operating room. However, the clinical and operational effectiveness of the TACS classification has not been investigated in subsequent validation studies. This study aimed to improve the TACS classification and provide further consensus around the appropriate use of the new TACS classification through a standardized Delphi approach with international experts.</p><p><strong>Methods: </strong>This is a validation study of the new TACS by a selected international panel of experts using the Delphi method. The TACS questionnaire was designed as a web-based survey. The consensus agreement level was established to be ≥ 75%. The collective consensus agreement was defined as the sum of the percentage of the highest Likert scale levels (4-5) out of all participants. Surgical emergency diseases and correlated clinical scenarios were defined for each of the proposed classes. Subsequent rounds were carried out until a definitive level of consensus was reached. Frequencies and percentages were calculated to determine the degree of agreement for each surgical disease.</p><p><strong>Results: </strong>Four polling rounds were carried out. The new TACS classification provides 6 colour-code classes correlated to a precise timing to surgery, defined scenarios and surgical condition. The WHITE colour-code class was introduced to rapidly (within a week) reschedule cancelled or postponed surgical procedures. Haemodynamic stability is the main tool to stratify patients for immediate surgery or not in the presence of sepsis/septic shock. Fifty-one surgical diseases were included in the different colour-code classes of priority.</p><p><strong>Conclusion: </strong>The new TACS classification is a comprehensive, simple, clear and reproducible triage system which can be used to assess the severity of the patient and the surgical disease, to reduce the time to access to the operating room, and to manage the emergency surgical patients within a \"safe\" timeframe. By including well-defined surgical diseases in the different colour-code classes of priority, validated through a Delphi consensus, the new TACS improves communication among surgeons, between surgeons and anaesthesiologists and decreases conflicts and waste and waiting time in accessing the operating room for emergency surgical patients.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"32"},"PeriodicalIF":8.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10147354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9418885","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":"Unlocking the potential of TIPS placement as a bridge to elective and emergency surgery in cirrhotic patients: a meta-analysis and future directions for endovascular resuscitation in acute care surgery.","authors":"Ramiro Manzano-Nunez,&nbsp;Alba Jimenez-Masip,&nbsp;Julian Chica-Yanten,&nbsp;Abdelaziz Ibn-Abdelouahab,&nbsp;Massimo Sartelli,&nbsp;Nicola de'Angelis,&nbsp;Ernest E Moore,&nbsp;Alberto F García","doi":"10.1186/s13017-023-00498-4","DOIUrl":"https://doi.org/10.1186/s13017-023-00498-4","url":null,"abstract":"<p><strong>Background: </strong>In this systematic review and meta-analysis, we examined the evidence on transjugular intrahepatic portosystemic shunt (TIPS) as a bridge to elective and emergency surgery in cirrhotic patients. We aimed to assess the perioperative characteristics, management approaches, and outcomes of this intervention, which is used to achieve portal decompression and enable the safe performance of elective and emergent surgery.</p><p><strong>Methods: </strong>MEDLINE and Scopus were searched for studies reporting the outcomes of cirrhotic patients undergoing elective and emergency surgery with preoperative TIPS. The risk of bias was evaluated using the methodological index for non-randomized studies of interventions, and the JBI critical appraisal tool for case reports. The outcomes of interest were: 1. Surgery after TIPS; 2. Mortality; 3. Perioperative transfusions; and 4. Postoperative liver-related events. A DerSimonian and Laird (random-effects) model was used to perform the meta-analyses in which the overall (combined) effect estimate was presented in the form of an odds ratio (summary statistic).</p><p><strong>Results: </strong>Of 426 patients (from 27 articles), 256 (60.1%) underwent preoperative TIPS. Random effects MA showed significantly lower odds of postoperative ascites with preoperative TIPS (OR = 0.40, 95% CI 0.22-0.72; I2 = 0%). There were no significant differences in 90-day mortality (3 studies: OR = 0.76, 95% CI 0.33-1.77; I2 = 18.2%), perioperative transfusion requirement (3 studies: OR = 0.89, 95% CI 0.28-2,84; I2 = 70.1%), postoperative hepatic encephalopathy (2 studies: OR = 0.97, 95% CI 0.35-2.69; I2 = 0%), and postoperative ACLF (3 studies: OR = 1.02, 95% CI 0.15-6.8, I2 = 78.9%).</p><p><strong>Conclusions: </strong>Preoperative TIPS appears safe in cirrhotic patients who undergo elective and emergency surgery and may have a potential role in postoperative ascites control. Future randomized clinical trials should test these preliminary results.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"30"},"PeriodicalIF":8.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10111768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9468412","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":"Correction: Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES).","authors":"Edoardo Picetti,&nbsp;Fausto Catena,&nbsp;Fikri Abu-Zidan,&nbsp;Luca Ansaloni,&nbsp;Rocco A Armonda,&nbsp;Miklosh Bala,&nbsp;Zsolt J Balogh,&nbsp;Alessandro Bertuccio,&nbsp;Walt L Biffl,&nbsp;Pierre Bouzat,&nbsp;Andras Buki,&nbsp;Davide Cerasti,&nbsp;Randall M Chesnut,&nbsp;Giuseppe Citerio,&nbsp;Federico Coccolini,&nbsp;Raul Coimbra,&nbsp;Carlo Coniglio,&nbsp;Enrico Fainardi,&nbsp;Deepak Gupta,&nbsp;Jennifer M Gurney,&nbsp;Gregory W J Hawryluk,&nbsp;Raimund Helbok,&nbsp;Peter J A Hutchinson,&nbsp;Corrado Iaccarino,&nbsp;Angelos Kolias,&nbsp;Ronald W Maier,&nbsp;Matthew J Martin,&nbsp;Geert Meyfroidt,&nbsp;David O Okonkwo,&nbsp;Frank Rasulo,&nbsp;Sandro Rizoli,&nbsp;Andres Rubiano,&nbsp;Juan Sahuquillo,&nbsp;Valerie G Sams,&nbsp;Franco Servadei,&nbsp;Deepak Sharma,&nbsp;Lori Shutter,&nbsp;Philip F Stahel,&nbsp;Fabio S Taccone,&nbsp;Andrew Udy,&nbsp;Tommaso Zoerle,&nbsp;Vanni Agnoletti,&nbsp;Francesca Bravi,&nbsp;Belinda De Simone,&nbsp;Yoram Kluger,&nbsp;Costanza Martino,&nbsp;Ernest E Moore,&nbsp;Massimo Sartelli,&nbsp;Dieter Weber,&nbsp;Chiara Robba","doi":"10.1186/s13017-023-00489-5","DOIUrl":"https://doi.org/10.1186/s13017-023-00489-5","url":null,"abstract":"","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"29"},"PeriodicalIF":8.0,"publicationDate":"2023-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10080738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9260916","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":"Risk factors for the leakage of the repair of duodenal wounds: a secondary analysis of the Panamerican Trauma Society multicenter retrospective review.","authors":"Alberto García, Alvaro I Sanchez, Paula Ferrada, Luke Wolfe, Juan Duchesne, Gustavo P Fraga, Elizabeth Benjamin, Andre Campbell, Carlos Morales, Bruno M Pereira, Marcelo Ribeiro, Martha Quiodettis, Gregory Peck, Juan C Salamea, Vitor F Kruger, Rao Ivatury, Thomas Scalea","doi":"10.1186/s13017-023-00494-8","DOIUrl":"10.1186/s13017-023-00494-8","url":null,"abstract":"","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"28"},"PeriodicalIF":6.0,"publicationDate":"2023-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10074841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9781909","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}