European journal of trauma and emergency surgery : official publication of the European Trauma Society最新文献

{"title":"Location of lateral tibial plateau fractures relative to the posterolateral complex predicts the need for extension of lateral approaches: A retrospective observational study.","authors":"Michael J Raschke, Elmar Herbst, Oliver Riesenbeck, Christoph Kittl, Christian Peez, J Christoph Katthagen","doi":"10.1007/s00068-025-02933-4","DOIUrl":"10.1007/s00068-025-02933-4","url":null,"abstract":"<p><strong>Purpose: </strong>Extended lateral approaches have been proposed to improve visualization and therefore reduction quality of the articular surface in lateral tibial plateau fractures. However, recommendations regarding the exact morphology of lateral tibial fractures requiring extended approaches are lacking.</p><p><strong>Methods: </strong>A retrospective observational cohort study was conducted using data from patients who underwent surgical treatment of a tibial plateau fracture involving the lateral tibial plateau (AO/OTA 41-B3 and 41-C3) at a level 1 trauma center between January 2020 and May 2024. Demographics, patient positioning, and surgical approaches were recorded. Comprehensive examinations on preoperative computed tomography (CT) scan were performed evaluating the morphology of lateral tibial plateau fractures relative to the posterolateral ligamentous structures.</p><p><strong>Results: </strong>143 patients (53.8% female, 46.2% male) with a mean age of 51.3 ± 14.3 years were included. Three distinct types of lateral tibial plateau fractures were identified. The most frequent fracture types observed were anterior to the posterolateral ligamentous structures (38.5%) and at level of the posterolateral complex (36.4%), followed by a fracture location posterior to the posterolateral ligamentous structures (25.1%). Extended lateral approaches using lateral femoral epicondyle osteotomy were performed in 17.5% of cases, with fractures posterior to the posterolateral ligamentous structures more likely to have an extended approach (80.0%, p < 0.001).</p><p><strong>Conclusions: </strong>Lateral tibial plateau fractures show three distinct fracture types, with the fracture location relative to the posterolateral ligamentous structures predicting extension of lateral approaches. For fractures extending posterior to the posterolateral complex, preoperative planning should include prone or lateral patient positioning and selection of an extended lateral approach.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"257"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability of typical radiographic features in Bosworth fracture-dislocations.","authors":"Jan Bartoníček, Stefan Rammelt, Michal Tuček, Karel Kostlivý, Jozef Malík, Caroline Stöckigt","doi":"10.1007/s00068-025-02936-1","DOIUrl":"https://doi.org/10.1007/s00068-025-02936-1","url":null,"abstract":"<p><strong>Purpose: </strong>Bosworth fracture-dislocations (BF) with entrapment of a fibular fragment behind the posterior rim of the distal tibia are rare but potentially serious injuries to the ankle.</p><p><strong>Materials and methods: </strong>We analyzed the radiographs of 23 consecutive patients with a mean age of 44 years who were treated for BF. All patients underwent routine radiological examination of the ankle and presence of a BF was confirmed intraoperatively in 22 cases and / or with CT in 15 cases.</p><p><strong>Results: </strong>Tibiofibular overlap intersecting the joint line in the anteroposterior view of the ankle was found in 20 of 23 cases (87%) and persisted in 17 of 18 cases (94%) after unsuccessful closed reduction. Posterior subluxation of the talus in the lateral view was revealed in 21 of 23 cases (91%). Tibio-fibular dissociation, i.e., posterior displacement of the distal fibula relative to the distal tibia in the lateral view was found in 22 of 23 cases (96%). This sign remained positive in all 18 cases with unsuccessful closed reduction. Closed reduction of the talus beneath the distal tibia was associated with an average increase of anterior fibular angulation of 24.5 degrees in case of inadequate closed reduction.</p><p><strong>Conclusions: </strong>Bosworth fracture represents a rare but still highly variable ankle injury that may lead to misinterpretation of the initial radiographs. Reliable radiological signs are triangular tibiofibular overlap, posterior talar subluxation and tibiofibular dissociation that should prompt CT imaging which is essential for revealing the complex pathoanatomy and planning the surgical approach.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"259"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open-source convolutional neural network to classify distal radial fractures according to the AO/OTA classification on plain radiographs.","authors":"Koen D Oude Nijhuis, Jasper Prijs, Britt Barvelink, Hans van Luit, Yang Zhao, Zhibin Liao, Ruurd L Jaarsma, Frank F A IJpma, Mathieu M E Wijffels, Job N Doornberg, Joost W Colaris","doi":"10.1007/s00068-025-02931-6","DOIUrl":"10.1007/s00068-025-02931-6","url":null,"abstract":"<p><strong>Purpose: </strong>Convolutional Neural Networks (CNNs) have shown promise in fracture detection, but their ability to improve surgeons' inconsistent fracture classification remains unstudied. Therefore, our aim was create and (externally) validate the performance of an open-source CNN algorithm to classify DRFs according to the AO/OTA classification system?</p><p><strong>Methods: </strong>Patients with postero-anterior, lateral and oblique radiographs were included. Radiographs were classified according to the AO/OTA-classification and were used to train a CNN algorithm. The algorithm was tested on an internal and external validation set (two other level 1 trauma centers), with the DRFs classified by three independent surgeons.</p><p><strong>Results: </strong>659 radiographs were used to train the algorithm. Internal- and external validation sets contained 190 and 188 patients, respectively. Upon internal validation, the CNN had an accuracy of 62% and an area under receiving operating characteristic curve (AUC) of 0.63-0.93 (type 2R3A 0.84, type 2R3B 0.63, type 2R3C 0.75, and no DRF 0.93). On the external validation, the algorithm has an accuracy of 61% and an AUC of 0.56-0.88 (type 2R3A 0.82, type 2R3B 0.56, type 2R3C 0.75, and no DRF 0.88).</p><p><strong>Conclusion: </strong>The presented algorithm has demonstrated excellent accuracy in classifying type 2R3A DRFs and excluding DRFs. However, poor to moderate accuracy is observed in classifying 2R3B and 2R3C DRFs according to the AO/OTA system, similar to limited surgeons' inter-observer agreement. These results show that despite previous excellence in fracture detection, CNN-algorithms struggle with classifying; potentially showing the inherent problems with these classification systems.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"261"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to consider fracture nonunion an orphan disease? An update into pathophysiology, epidemiology and therapeutic solutions.","authors":"Slobodan Vukicevic, Mihaela Peric, Tatjana Bordukalo-Niksic, Valentina Blazevic, Dragan Durdevic, Natalia Ivanjko, Katarina Oreskovic, Peter V Giannoudis, Reinhard Windhager","doi":"10.1007/s00068-025-02918-3","DOIUrl":"10.1007/s00068-025-02918-3","url":null,"abstract":"<p><strong>Purpose: </strong>Fracture non-union (FNU) is a rare complication of bone fractures where healing does not occur without surgical intervention. This paper aims to summarize the current knowledge on FNUs from an orphan disease perspective, and to provide an overview of existing and some emerging treatment options.</p><p><strong>Methods: </strong>Literature review.</p><p><strong>Results: </strong>Epidemiological data on FNUs are limited and vary by population and methodology. While previously an overall estimate of 5-10% of nonunion of fractures has been reported, large epidemiological studies performed in Spain, Germany, Scotland and USA, reported that the prevalence of FNUs is less than 5 cases per 10.000 inhabitants justifying the criteria for an orphan designation. There are no approved pharmacological treatments for FNUs, highlighting the need for effective therapies. Current methods rely on mechanical stabilization of FNUs using various instrumentation with or without autologous bone grafting. Combining mechanical intervention and autologous bone grafting raises healing rates from 60-70% to more than 80%, but graft harvesting causes additional injury at the donor site. Lately, a novel drug, OSTEOGROW-C combining rhBMP6 with the patient's own blood coagulum as a carrier, augmented by synthetic ceramics for biomechanical support has been developed for the treatment of FNU. Results of preclinical studies suggested that OSTEOGROW-C is superior to other OSTEOGROW formulations and commercially available products.</p><p><strong>Conclusion: </strong>Due to its low prevalence, FNU can be considered a rare disease. A novel drug, OSTEOGROW-C, represents a promising and safe therapeutic solution for inducing FNU healing.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"255"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A matched comparison of suprapatellar and infrapatellar approaches in intramedullary nailing for distal tibial fractures: a study of alignment including rotation and mid-term outcomes.","authors":"Yong-Cheol Yoon, Chang-Wug Oh, Hee-June Kim, Won-Seok Chae, Sang-Roc Han, Joon-Woo Kim","doi":"10.1007/s00068-025-02938-z","DOIUrl":"https://doi.org/10.1007/s00068-025-02938-z","url":null,"abstract":"","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"260"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the Oklahoma predictor model for discharge destination in patients with major traumatic injury: a cross-sectional study.","authors":"Aaron Alvarado, Vivian Nguyen, Bradley Cox, Ali Esparham, Michael Charles, Nasir Mushtaq, Geoffrey Chow, Zhamak Khorgami","doi":"10.1007/s00068-025-02925-4","DOIUrl":"https://doi.org/10.1007/s00068-025-02925-4","url":null,"abstract":"<p><strong>Purpose: </strong>Protracted in-patient stays affect trauma patient costs and hospital resource utilizations. Proper discharge placement stratification may help with early discharge planning in this group of patients. No standardized discharge destination prediction model exists. A scoring model has been developed after examining Oklahoma Trauma Database discharge destination predictors. This study's goal was patient data-driven model validation.</p><p><strong>Methods: </strong>Level II trauma center patient data over three months, including comorbidities, injuries, and demographics were analyzed. We compared the scoring model discharge destination prediction with actual destinations.</p><p><strong>Results: </strong>The study included 459 patients, with 108 facility discharges. The scoring model demonstrated significant facility placement prediction (Scores ≤ 7: 11.94% or Negative Predictive Value of 88.1%; Score 8-14: 47.22% as Positive Predictive Value: and Score ≥ 15: 60.00%). Scoring 8-14 showed a 6.60-fold (95%CI: 4.11, 10.61) increase compared to ≤ 7. Scoring ≥ 15 was 11.07 times (95%CI: 1.79, 68.42) more likely than ≤ 7.</p><p><strong>Conclusion: </strong>The Oklahoma Trauma Discharge Predictive Scoring Model demonstrated significant facility discharge prediction and may assist with decreasing delay of anticipated patient discharge destination.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"256"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting mortality and intensive care needs in geriatric trauma patients: A ROC analysis of frailty and trauma scoring systems.","authors":"Enes Hamdioğlu, Mehmet Altuntaş, Ali Çelik, Özcan Yavaşi","doi":"10.1007/s00068-025-02924-5","DOIUrl":"https://doi.org/10.1007/s00068-025-02924-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The global increase in the geriatric population presents significant challenges for healthcare systems. Trauma, mainly resulting from falls, constitutes a primary cause of morbidity and mortality among older people. It is imperative to evaluate mortality risk and the need for intensive care unit (ICU) admission among geriatric trauma patients to optimize clinical outcomes. This study aims to assess the efficacy of frailty and trauma scoring systems in predicting these critical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A prospective cross-sectional study was conducted at a tertiary care hospital in Türkiye from September 2023 to October 2024. The study population consisted of geriatric patients (≥ 65 years) presenting blunt trauma. Comprehensive demographic, clinical, and laboratory data were collected. Mortality risk and ICU admission requirements were assessed utilizing various scoring systems: the Frailty Index (FI), Clinical Frailty Score (CFS), Trauma-Specific Frailty Index (TSFI), Shock Index (SI), Modified Shock Index (MSI), Age Shock Index (ASI), Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), Geriatric Trauma Outcome Score (GTOS), and Glasgow Coma Scale (GCS). A Receiver Operating Characteristic (ROC) analysis was performed to determine the predictive accuracy of these scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The cohort comprised 350 patients with a median age of 74 years. The mortality rate observed was 11%, with non-survivors had significantly higher frailty and trauma scores compared to survivors (p &lt; 0.001). Admission to the intensive care unit (ICU) was necessary in 20% of the cases. A Receiver Operating Characteristic (ROC) analysis revealed the GTOS and RTS exhibited the highest and identical Area Under the Curve (AUC) values, both recorded at 0.846. Furthermore, the 95% confidence intervals (CI) for GTOS and RTS were 0.790-0.901 and 0.762-0.930, respectively, while the AUC for ICU admission requirements reached 0.830 (95% CI: 0.764-0.864) for RTS and 0.815 (95% CI: 0.755-0.876) for GTOS. Among the frailty scores, TSFI proved to be superior in predicting mortality, achieving an AUC of 0.805 (95% CI: 0.725-0.885), whereas the Frailty Index (FI) demonstrated the lowest predictive capacity for ICU needs, with an AUC of 0.666 (95% CI: 0.592-0.740).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Frailty and trauma scoring systems serve as critical tools in predicting outcomes for geriatric trauma patients. The Revised Trauma Score and the Geriatric Trauma Outcome Score have demonstrated the highest reliability in forecasting both mortality and the need for ICU admissions. While the Trauma-Specific Frailty Index has exceeded other frailty indices in terms of mortality prediction, the Frailty Index exhibits limited utility for ICU evaluations. Integrating these scoring systems into clinical practice can significantly enhance the identification of high-risk patients and improve ca","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"262"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthopedic trauma management in pediatric earthquake victims: a single-center experience from the 2023 Türkiye disaster.","authors":"Fatih Günaydın, Öner Kılınç, Bülent Sakarya, İdris Demirtaş, Mahmud Aydın, Ali Çelik","doi":"10.1007/s00068-025-02940-5","DOIUrl":"https://doi.org/10.1007/s00068-025-02940-5","url":null,"abstract":"<p><strong>Purpose: </strong>The Kahramanmaraş earthquake that occurred on February 6, 2023, caused significant destruction and resulted in a high incidence of pediatric injuries, especially musculoskeletal pathologies. This study aims to contribute to an effective health service model that will meet the special needs of children in natural disasters by identifying the frequency and variety of trauma and musculoskeletal pathologies observed in children following the Kahramanmaraş earthquake, as well as the treatment methods implemented for these injuries.</p><p><strong>Methods: </strong>In this study, 135 pediatric patients who were admitted to the hospital within the first three days after the February 6, 2023, Kahramanmaraş earthquake were analyzed retrospectively. The study examined the demographic characteristics of the patients (age, gender), types of injuries (musculoskeletal injuries, soft tissue traumas, etc.), and surgical procedures performed. Kruskal-Wallis and chi-square tests were used for data analysis. The statistical significance level was accepted as 5% (p < 0.05).</p><p><strong>Results: </strong>The median age was 12 years (IQR: 8, 15), with females constituting 62.2%. The most prevalent injuries included vertebral fractures (14.1%), lower extremity amputations (9.6%), and fasciotomies (52.6%). Age and injury type distribution significantly varied across intervention groups, with older patients more likely to undergo fasciotomy (p < 0.001). Fractures declined over the three-day period, while fasciotomies increased significantly.</p><p><strong>Conclusion: </strong>This study highlights the orthopedic trauma patterns and surgical needs of pediatric patients following the 2023 Kahramanmaraş earthquake. The findings underscore the importance of early fasciotomy, amputation preparedness, and effective fracture management in mass casualty care. These findings support the establishment of pediatric-specific triage and surgical protocolsto strengthen future disaster preparedness.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"258"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative pneumocephalus as a predictor of chronic subdural hematoma recurrence: a retrospective cohort analysis.","authors":"Haitham Alenezi, Tim Lampmann, Harun Asoglu, Mohammed Jaber, Mohammed Banat, Hartmut Vatter, Lars Eichhorn, Motaz Hamed","doi":"10.1007/s00068-025-02939-y","DOIUrl":"10.1007/s00068-025-02939-y","url":null,"abstract":"<p><strong>Background: </strong>Chronic subdural hematoma (CSDH) is a common neurosurgical condition, especially in the elderly, which is usually diagnosed by computed tomography (CT) scan and often treated surgically. After surgery patients shows favourable outcomes with improvement in symptomatology. Despite the availability of various surgical techniques, complications continue to occur frequently due to the advanced age of patients and underlying medical conditions. Burr-hole craniotomy followed by placement a closed-system drainage is widely considered the best treatment for CSDH, although technical challenges and a high recurrence rate remain. Postoperative pneumocephalus is a potential risk factor for recurrence. While the majority of patients recover well after surgery, recurrence or persistence of CSDH occurs in 0.35-33% of cases, sometimes necessitating additional surgeries.</p><p><strong>Method: </strong>This retrospective study comprehensively evaluates the clinical data of 229 patients diagnosed with chronic subdural hematoma (CSDH) who underwent surgical intervention, specifically burr-hole craniotomy with drainage between 2016 and 2021. The primary objective is to measure the prognostic significance of postoperative pneumocephalus as a predictor of recurrence of CSDH. Furthermore, the obtained univariate and multivariate regression analyses examines various patient-specific factors, including age, gender, location of CSDH (unilateral or bilateral), anticoagulation therapy status, neurosurgical follow-up outcomes, hospital readmission rates, and the incidence of repeat surgical procedures.</p><p><strong>Result: </strong>Among the analysed characteristics, postoperative pneumocephalus exceeding a specified volumetric threshold emerges as the only significant predictor of CSDH recurrence. This recurrence of CSDH is additionally associated with a substantial prolongation of the patient's hospitalization, highlighting its clinical and logistical significance.</p><p><strong>Conclusion: </strong>A postoperative pneumocephalus is nearly unavoidable; however, optimizing surgical technique to minimize its volume below 5.2 cm³ reduces significantly the recurrence rate of CSDH.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"263"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of external bleeding control training courses on lay first-person responders'knowledge, skills, and attitudes in low- and middle-income countries: a systematic review.","authors":"Husham Abdelrahman, Ahammed Mekkodathil, Ayman El-Menyar, Rafael Consunji, Sandro Rizoli, Hassan Al-Thani","doi":"10.1007/s00068-025-02917-4","DOIUrl":"10.1007/s00068-025-02917-4","url":null,"abstract":"<p><strong>Background: </strong>Exsanguinating hemorrhage is the most common cause of preventable trauma death at the injury scene, and it is often due to the inability to control bleeding immediately. Training layperson first responders (LFR) in trauma care, particularly hemorrhage control, has been recommended to address this trauma care gap. We conducted a systematic review (SR) to analyze the effect of hemorrhage control training courses for LFRs on knowledge, skill, and attitude to intervene in trauma patients.</p><p><strong>Methods: </strong>PubMed and Google Scholar databases were used to identify relevant peer-reviewed research articles describing evaluations of hemorrhage control courses for LFR between 2013 and 2024. Studies examined whether the training course was implemented in low- and middle-income countries (LMICS); trainees were LFR and had outcome measures, including knowledge, skills, attitudes (confidence gained, willingness, comfort, and likelihood to intervene) toward care utilization for trauma patients, as well as outcomes.</p><p><strong>Results: </strong>The SR included 12 articles. The quality of the selected studies was generally high. Five studies (42%) reported improved willingness, confidence, comfort, and the likelihood of responding safely to trauma. Nine studies (75%) used pre-and post-tests to document knowledge acquired, and five studies (42%) used knowledge retention evaluation at different intervals and reported substantial knowledge and skill reductions after a few months (1-3 months, 3-6 months, or both 6 and 9 months or up to 3 years). A few studies followed incident reports to document the utilization of knowledge and skills acquired during training. None reported patient outcomes.</p><p><strong>Conclusion: </strong>Bleeding control training courses for layperson first responders in LMICS significantly improve knowledge, skill, confidence, and willingness to intervene to apply bleeding control techniques to trauma patients. Evaluating clinically relevant outcomes is needed to strengthen the evidence.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"252"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}