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

{"title":"Proximal humeral fracture osteosynthesis in Belgium: a retrospective population-based epidemiologic study.","authors":"Jan Dauwe,&nbsp;Carolin Danker,&nbsp;Michiel Herteleer,&nbsp;Kris Vanhaecht,&nbsp;Stefaan Nijs","doi":"10.1007/s00068-020-01466-2","DOIUrl":"https://doi.org/10.1007/s00068-020-01466-2","url":null,"abstract":"<p><strong>Purpose: </strong>Proximal humeral fractures (PHF) comprise approximately five percent of all fractures and this percentage will continue to increase due to the aging population with accompanying osteoporosis. Most PHF can be treated conservatively; however, in displaced fractures, surgical treatment is recommended. Retrospective analyses of large groups or even populations are important as they can contribute to the needs of the community. The aim of this study was to assess the epidemiology and management of PHF fixation in Belgium based on the most recently available data from the last 5 years.</p><p><strong>Methods: </strong>The governmental organization National Institute of Health and Disability Insurance provided a population-based database with all PHF treated surgically or nonoperatively. This database was retrospectively assessed. The data included age, sex, region of residence, year and treatment strategy for every patient. Healthcare expenses were also provided.</p><p><strong>Results: </strong>A total of 62,290 PHF were identified in Belgium between 2014 and 2018. The incidence was 111 per 100,000 persons/year. The highest incidence was observed in females and people older than 80 years. The average proportion of osteosynthesis was calculated at 21%. The Belgian government spent on average more than two million euros each year on PHF treatment.</p><p><strong>Conclusion: </strong>The overall incidence of PHF increased by 12% over the last 5 years. The majority were treated nonoperatively in Belgium.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"4509-4514"},"PeriodicalIF":2.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00068-020-01466-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38290212","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":"The Beirut Port Blast: spectrum of injuries and clinical outcomes at a large tertiary care center in Beirut, Lebanon.","authors":"Tharwat El Zahran,&nbsp;Mirabelle Geha,&nbsp;Fouad Sakr,&nbsp;Rana Bachir,&nbsp;Mazen El Sayed","doi":"10.1007/s00068-022-02023-9","DOIUrl":"https://doi.org/10.1007/s00068-022-02023-9","url":null,"abstract":"<p><strong>Purpose: </strong>To describe injuries and outcomes of casualties of Beirut Port Blast treated at a large tertiary care center in Beirut, Lebanon.</p><p><strong>Methods: </strong>A retrospective observational study assessing the spectrum of injuries, treatment, and medical outcome among casualties of the Beirut Port Blast, immediately after the blast and up to 1 week from the blast to the emergency department of the American University of Beirut Medical Center (AUBMC).</p><p><strong>Results: </strong>A total of 359 patients were included. Most (n = 343, 95.6%) were adults (> 19 years), and males (56%) with a mean age of 42 ± 20 years. The most frequent mechanism of injury was a penetrating injury (45.7%), followed by other blast-related injuries (30.4%), and blunt injuries (23.4%). The most affected anatomical location were the limbs. Most (n = 217, 60.4%) patients required imaging. The most frequently administered medication was analgesics (38%), followed by anesthetics (35%), antibiotics (31%), tetanus vaccine (31%), and fluids (28%). Blood and blood products were administered in 3.8% of cases. Emergent procedures included endotracheal intubation (n = 18, 5%), surgical airway (n = 3, 0.8%), chest tube insertion (n = 4, 1.1%), thoracotomy (n = 1, 0.3%), and CPR (n = 5, 1.4%). A quarter of patients required surgical operations in the operating room (n = 85, 23.6%) and 18% required noncritical care admissions, 5.3% required critical care admissions, and 2.8% were dead on arrival.</p><p><strong>Conclusion: </strong>Casualties from this event had significant injuries requiring lifesaving interventions, surgical procedures, and admission to critical care units. High utilization of imaging modalities and of medications from existing stockpiles was also observed.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"4919-4926"},"PeriodicalIF":2.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9243705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40398297","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":"Results of emergency colectomy in nonagenarians and octogenarians previously labeled as prohibitive surgical risk.","authors":"John Alfred Carr,&nbsp;Timothy NeCamp","doi":"10.1007/s00068-022-02030-w","DOIUrl":"https://doi.org/10.1007/s00068-022-02030-w","url":null,"abstract":"<p><strong>Purpose: </strong>There are no standardized criteria for what constitutes prohibitive risk for emergency abdominal surgery.</p><p><strong>Methods: </strong>A retrospective review was performed comparing two groups of patients having emergent colectomy. One group had previously been labeled as being prohibitive surgical risk and the other was a contemporary, non-prohibitive risk group also requiring emergency colectomy. All operations were performed by a single surgeon.</p><p><strong>Results: </strong>There were 27 prohibitive risk patients and 81 non-prohibitive risk (control group) patients. The average age of the prohibitive risk group was 85 years (range 78-99) compared to the control group mean age of 52 years (18-79, p < 0.00001). Prohibitive risk was due to extremes of age combined with congestive heart failure in 44%, followed by chronic obstructive pulmonary disease combined with heart failure in 19%. The groups were closely matched by the type of colectomy performed. The total complication rate was much higher in the prohibitive risk group compared to the non-prohibitive risk patients (81% versus 48%, p 0.005). But the 30-day mortality rate was similar between groups (7% versus 4%, p 0.6).</p><p><strong>Conclusion: </strong>Patients who are labeled as prohibitive surgical risk may be inaccurately assessed in the majority of cases. Additional research will need to be performed to evaluate the presence of quantifiable high-risk physiological conditions, and not just comorbidities, that place a patient at high risk of death after abdominal surgery. Until then, elderly patients should not be denied colectomy based upon comorbidities alone.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"4927-4933"},"PeriodicalIF":2.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40399620","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":"Infrastructure, logistics and clinical practice management of acute trauma hemorrhage and coagulopathy: a survey across German trauma centers.","authors":"Vivien Karl,&nbsp;Nadine Schäfer,&nbsp;Marc Maegele","doi":"10.1007/s00068-021-01788-9","DOIUrl":"https://doi.org/10.1007/s00068-021-01788-9","url":null,"abstract":"<p><strong>Purpose: </strong>Early detection and management of acute trauma hemorrhage and coagulopathy have been associated with improved outcomes, but local infrastructure, logistics and clinical strategies may differ.</p><p><strong>Methods: </strong>To assess local differences in infrastructure, logistics and clinical management of acute trauma hemorrhage and coagulopathy we have conducted a web-based survey amongst clinicians working in DGU^®-certified supraregional, regional and local trauma centers.</p><p><strong>Results: </strong>137/1875 respondents completed the questionnaire yielding a response rate of 7.3%. The majority specified to work as head of department or senior consultant (95%) in trauma/orthopedic surgery (80%) of supraregional (38%), regional (34%) or local (27%) trauma centers. Conventional coagulation assays are most frequently used to monitor bleeding trauma patients. Only half of the respondents (53%) rely on extended coagulation tests, e.g. viscoelastic hemostatic assays. Tests to assess preinjury use of direct oral anticoagulants and platelet inhibitors are still not widely available and vary according to level of care. Conventional blood products are widely available but there remain differences between trauma centers of different level of care to access other hemostatic therapies, e.g. coagulation factor concentrates. Trauma centers of higher level of care are more likely to implement treatment protocols.</p><p><strong>Conclusion: </strong>This survey confirms still existing differences in infrastructure, logistics and clinical practice management for the detection of acute trauma hemorrhage and coagulopathy amongst DGU^®-certified supraregional, regional and local trauma centers. Further work is recommended to locally implement diagnostics, therapies and treatment algorithms compliant to current guidelines to ensure the best possible outcomes in bleeding trauma patients.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"4461-4472"},"PeriodicalIF":2.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9712372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39450215","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":"Evaluation of validity and reliability of video analysis and live observations to assess trauma team performance.","authors":"Oscar E C van Maarseveen,&nbsp;Wietske H W Ham,&nbsp;Stijn van Cruchten,&nbsp;Rauand Duhoky,&nbsp;Luke P H Leenen","doi":"10.1007/s00068-022-02004-y","DOIUrl":"https://doi.org/10.1007/s00068-022-02004-y","url":null,"abstract":"<p><strong>Introduction: </strong>A trauma resuscitation is dynamic and complex process in which failures could lead to serious adverse events. In several trauma centers, evaluation of trauma resuscitation is part of a hospital's quality assessment program. While video analysis is commonly used, some hospitals use live observations, mainly due to ethical and medicolegal concerns. The aim of this study was to compare the validity and reliability of video analysis and live observations to evaluate trauma resuscitations.</p><p><strong>Methods: </strong>In this prospective observational study, validity was assessed by comparing the observed adherence to 28 advanced trauma life support (ATLS) guideline related tasks by video analysis to life observations. Interobserver reliability was assessed by calculating the intra class coefficient of observed ATLS related tasks by live observations and video analysis.</p><p><strong>Results: </strong>Eleven simulated and thirteen real-life resuscitations were assessed. Overall, the percentage of observed ATLS related tasks performed during simulated resuscitations was 10.4% (P < 0.001) higher when the same resuscitations were analysed using video compared to live observations. During real-life resuscitations, 8.7% (p < 0.001) more ATLS related tasks were observed using video review compared to live observations. In absolute terms, a mean of 2.9 (during simulated resuscitations) respectively 2.5 (during actual resuscitations) ATLS-related tasks per resuscitation were not identified using live observers, that were observed through video analysis. The interobserver variability for observed ATLS related tasks was significantly higher using video analysis compared to live observations for both simulated (video analysis: ICC 0.97; 95% CI 0.97-0.98 vs. live observation: ICC 0.69; 95% CI 0.57-0.78) and real-life witnessed resuscitations (video analyse 0.99; 95% CI 0.99-1.00 vs live observers 0.86; 95% CI 0.83-0.89).</p><p><strong>Conclusion: </strong>Video analysis of trauma resuscitations may be more valid and reliable compared to evaluation by live observers. These outcomes may guide the debate to justify video review instead of live observations.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"4797-4803"},"PeriodicalIF":2.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9712375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40581862","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":"Fragment specific fixation with APTUS wrist system for volar rim fractures of the distal radius: a multicentric study.","authors":"Marco Biondi,&nbsp;Andrea Poggetti,&nbsp;Alessandro Fagetti,&nbsp;Agostino Di Maro,&nbsp;Prospero Bigazzi,&nbsp;Sandra Pfanner,&nbsp;Giulio Lauri","doi":"10.1007/s00068-021-01710-3","DOIUrl":"https://doi.org/10.1007/s00068-021-01710-3","url":null,"abstract":"<p><strong>Purpose: </strong>Volar rim fractures of the distal radius are a spectrum of pathology that must be well identified and treated to achieve good outcomes and avoid surgical failures. New devices of fragment specific fixation have been developed during the last decades to fix this fragment. The purpose of this retrospective study was to evaluate the ability of APTUS^® wrist distal radius system to securely fix different types of volar rim fractures.</p><p><strong>Methods: </strong>Patients with at least 1 year of follow-up and a preoperative CT-scan evaluation of the fracture pattern were included in the study. Clinical, radiological and functional outcomes were assessed.</p><p><strong>Results: </strong>Sixty-eight patients with an average follow-up of 34, 1 months (12-61) were included in the study. There were no clinical and radiological complications, including loss of reduction, device failure and tendon ruptures. No patients required hardware removal. Wrist range of motion in flexion-extension averaged 96°, while in pronation-supination 144°. At final follow-up mean visual analogue scale pain was 1,8. Questionnaires, as dissabilities of the arm, shouldder and hand (DASH) score and patient-related wrist evolution (PRWE) score were 6,6 and 3 respectively. Grip strenght measured 86% compared to the normal side.</p><p><strong>Conclusion: </strong>APTUS^® wrist presents a versatile set of fragment specific fixation plates able to easily and securely fix all types of volar rim fracture. The system can be used with other devices without any kind of interference between them. When correctly placed and used with the right indications, no late complications can be recorded.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"4577-4584"},"PeriodicalIF":2.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00068-021-01710-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38941936","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":"The influence of preoperative CT imaging on surgical delay in patients with acutely symptomatic abdominal wall hernias.","authors":"Walid Ibrahim,&nbsp;Jeremy Wilson,&nbsp;Conor Magee","doi":"10.1007/s00068-022-02025-7","DOIUrl":"https://doi.org/10.1007/s00068-022-02025-7","url":null,"abstract":"<p><strong>Purpose: </strong>Abdominal wall hernias are common in the UK and many present in an emergent fashion. The widespread introduction of computed tomography (CT) imaging has transformed surgical practice but out of hours access can be limited by hospital resources and introduce delays. We investigated the influence of preoperative CT imaging in acutely symptomatic hernia and the association with surgical delay and risks of bowel ischemia.</p><p><strong>Methods: </strong>A retrospective analysis of patients undergoing emergency hernia surgery between 2013 and 2021 in a busy UK district general hospital. We evaluated the role of preoperative CT and its influence on timing of surgery, postoperative complications, critical care admission and hospital length of stay.</p><p><strong>Results: </strong>Five hundred and five patients were studied. Of these, 191 had a preoperative CT scan. Sites of hernia included inguinal in 164 patients (33%); umbilical in 164 (33%); femoral in 69 (14%); incisional in 69 (14%); epigastric in 30 (6%) and Spigelian hernia 9 (2%). Preoperative CT imaging was associated with surgical delay (22.0 h vs 13.0 h, p < 0.001) and an increased need for bowel resection (12% vs 6%, p = 0.027). Delay in surgery was not associated with increased postoperative complications (5% vs 4%, p = 0.474) but was associated with increased critical care admission (11.0% vs 4.8%, p = 0.014).</p><p><strong>Conclusions: </strong>Preoperative CT scan for emergent hernias can delay often inevitable surgery and is associated with an increasing need for more complex, resectional surgery .</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"4903-4908"},"PeriodicalIF":2.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40121872","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":"Inflammatory response to the ischaemia-reperfusion insult in the liver after major tissue trauma.","authors":"Yang Li,&nbsp;Annette Palmer,&nbsp;Ludmila Lupu,&nbsp;Markus Huber-Lang","doi":"10.1007/s00068-022-02026-6","DOIUrl":"https://doi.org/10.1007/s00068-022-02026-6","url":null,"abstract":"<p><strong>Background: </strong>Polytrauma is often accompanied by ischaemia-reperfusion injury to tissues and organs, and the resulting series of immune inflammatory reactions are a major cause of death in patients. The liver is one of the largest organs in the body, a characteristic that makes it the most vulnerable organ after multiple injuries. In addition, the liver is an important digestive organ that secretes a variety of inflammatory mediators involved in local as well as systemic immune inflammatory responses. Therefore, this review considers the main features of post-traumatic liver injury, focusing on the immuno-pathophysiological changes, the interactions between liver organs, and the principles of treatment deduced.</p><p><strong>Methods: </strong>We focus on the local as well as systemic immune response involving the liver after multiple injuries, with emphasis on the pathophysiological mechanisms.</p><p><strong>Results: </strong>An overview of the mechanisms underlying the pathophysiology of local as well as systemic immune responses involving the liver after multiple injuries, the latest research findings, and the current mainstream therapeutic approaches.</p><p><strong>Conclusion: </strong>Cross-reactivity between various organs and cascade amplification effects are among the main causes of systemic immune inflammatory responses after multiple injuries. For the time being, the pathophysiological mechanisms underlying this interaction remain unclear. Future work will continue to focus on identifying potential signalling pathways as well as target genes and intervening at the right time points to prevent more severe immune inflammatory responses and promote better and faster recovery of the patient.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"4431-4444"},"PeriodicalIF":2.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9712415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40588027","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":"Antiplatelet therapy contributes to a higher risk of traumatic intracranial hemorrhage compared to anticoagulation therapy in ground-level falls: a single-center retrospective study.","authors":"Tomas Vedin,&nbsp;Jakob Lundager Forberg,&nbsp;Ebba Anefjäll,&nbsp;Riikka Lehtinen,&nbsp;Mohammed Faisal,&nbsp;Marcus Edelhamre","doi":"10.1007/s00068-022-02016-8","DOIUrl":"https://doi.org/10.1007/s00068-022-02016-8","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is a common injury and constitutes up to 3% of emergency department (ED) visits. Current studies show that TBI is most commonly inflicted in older patients after ground-level falls. These patients often take medications affecting coagulation such as anticoagulants or antiplatelet drugs. Guidelines for ED TBI-management assume that anticoagulation therapy (ACT) confers a higher risk of traumatic intracranial hemorrhage (TICH) than antiplatelet therapy (APT). However, recent studies have challenged this. This study aimed to evaluate if oral anticoagulation and platelet inhibitors affected rate of TICH in head-trauma patients with ground-level falls.</p><p><strong>Methods: </strong>This was a retrospective review of medical records during January 1, 2017 to December 31, 2017 and January 1 2020 to December 31, 2020 of all patients seeking ED care because of head-trauma. Patients ≥ 18 years with ground-level falls were included.</p><p><strong>Results: </strong>The study included 1938 head-trauma patients with ground-level falls. Median age of patients with TICH was 81 years. The RR for TICH in APT-patients compared to patients without medication affecting coagulation was 1.72 (p = 0.01) (95% Confidence Interval (CI) 1.13-2.60) and 1.08 (p = 0.73), (95% CI 0.70-1.67) in ACT-patients. APT was independently associated with TICH in regression analysis (OR 1.59 (95% CI 1.02-2.49), p = 0.041).</p><p><strong>Conclusion: </strong>This study adds to the growing evidence that APT-patients with ground-level falls might have as high or higher risk of TICH than ACT-patients. This is not addressed in the current guidelines which may need to be updated. We therefore recommend broad prospective studies.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"4909-4917"},"PeriodicalIF":2.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9712377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40209418","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":"Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index.","authors":"Maximilian Peter Forssten,&nbsp;Gary Alan Bass,&nbsp;Kai-Michael Scheufler,&nbsp;Ahmad Mohammad Ismail,&nbsp;Yang Cao,&nbsp;Niels Douglas Martin,&nbsp;Babak Sarani,&nbsp;Shahin Mohseni","doi":"10.1007/s00068-021-01841-7","DOIUrl":"https://doi.org/10.1007/s00068-021-01841-7","url":null,"abstract":"<p><strong>Purpose: </strong>Traumatic brain injury (TBI) continues to be a significant cause of mortality and morbidity worldwide. As cardiovascular events are among the most common extracranial causes of death after a severe TBI, the Revised Cardiac Risk Index (RCRI) could potentially aid in the risk stratification of this patient population. This investigation aimed to determine the association between the RCRI and in-hospital deaths among isolated severe TBI patients.</p><p><strong>Methods: </strong>All adult patients registered in the TQIP database between 2013 and 2017 who suffered an isolated severe TBI, defined as a head AIS ≥ 3 with an AIS ≤ 1 in all other body regions, were included. Patients were excluded if they had a head AIS of 6. The association between different RCRI scores (0, 1, 2, 3, ≥ 4) and in-hospital mortality was analyzed using a Poisson regression model with robust standard errors while adjusting for potential confounders, with RCRI 0 as the reference.</p><p><strong>Results: </strong>259,399 patients met the study's inclusion criteria. RCRI 2 was associated with a 6% increase in mortality risk [adjusted IRR (95% CI) 1.06 (1.01-1.12), p = 0.027], RCRI 3 was associated with a 17% increased risk of mortality [adjusted IRR (95% CI) 1.17 (1.05-1.31), p = 0.004], and RCRI ≥ 4 was associated with a 46% increased risk of in-hospital mortality [adjusted IRR(95% CI) 1.46 (1.11-1.90), p = 0.006], compared to RCRI 0.</p><p><strong>Conclusion: </strong>An elevated RCRI ≥ 2 is significantly associated with an increased risk of in-hospital mortality among patients with an isolated severe traumatic brain injury. The simplicity and bedside applicability of the index makes it an attractive choice for risk stratification in this patient population.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":" ","pages":"4481-4488"},"PeriodicalIF":2.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9712303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39673445","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}