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Störmann P, Verboket R, Marzi I. Clinical and healthcare research. Eur J Trauma Emerg Surg 2025; 51:195. [PMID: 40327123 PMCID: PMC12055636 DOI: 10.1007/s00068-025-02859-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2025] [Accepted: 04/03/2025] [Indexed: 05/07/2025]
Abstract
Research in trauma care is indispensable for advancing the field of trauma surgery and healthcare delivery. The outcomes of such research have the potential to save lives, reduce disability, and optimise healthcare resource allocation. This chapters summarises key types of research in trauma care, highlights funding opportunities, and outlines future research priorities in Europe.
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Affiliation(s)
- Philipp Störmann
- Department of Trauma Surgery and Orthopedics, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - René Verboket
- Department of Trauma Surgery and Orthopedics, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma Surgery and Orthopedics, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany.
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Willing M, Ebbers S, Dresen C, Czolbe M, Saatjohann C, Schinzel S. Simulating the overload of medical processes due to system failures during a cyberattack. BMC Med Inform Decis Mak 2025; 25:174. [PMID: 40269938 PMCID: PMC12016121 DOI: 10.1186/s12911-025-02988-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/26/2025] [Indexed: 04/25/2025] Open
Abstract
Today's medical IT is more and more connected and network or IT system outages may impact the quality of patient treatment. IT outages from cyberattacks are particularly worrisome if attackers focus on those medical IT devices that are critical for medical processes. However, medical processes are primarily documented for the hospital employees and not for analyzing the criticality of any given human or medical IT resource. This paper presents a generic model for realistic, patient-focused simulation of medical processes. The model allows the simulation of cyber incidents, focusing on device outages or overload situations like mass casualty incidents. Furthermore, we present a proof-of-concept tool that implements the described model, enabling end-users to simulate their processes. The tool offers the ability to run with low detailed data for overview purposes and highly detailed data for fine-grained simulation results. We perform different scenario simulations for a sample hospital, including the acute phase of a ransomware attack, negative performance impacts due to the implementation of cybersecurity measures, and emergency plans for mass casualty incidents. In each scenario, the respective simulation resulted in a quantitative statement of how these scenarios affect overall process performance and show possible key factors supporting decision-making. We use real-world data from a German trauma room to optimize and evaluate the process simulation.
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Affiliation(s)
- Markus Willing
- Fraunhofer SIT, Fraunhofer Institute for Secure Information Technology SIT| ATHENE National Research Center for Applied Cybersecurity, Steinfurt, Germany.
- University Medical Center East Westphalia-Lippe, Bielefeld, Germany.
| | - Simon Ebbers
- University of Applied Sciences Muenster, Muenster, Germany
| | | | - Marc Czolbe
- University of Applied Sciences Muenster, Muenster, Germany
| | | | - Sebastian Schinzel
- Fraunhofer SIT, Fraunhofer Institute for Secure Information Technology SIT| ATHENE National Research Center for Applied Cybersecurity, Steinfurt, Germany
- University of Applied Sciences Muenster, Muenster, Germany
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Ding C, Jia M, Han X, Zhang J, Zhao X, Sang X. A China-Based exploration of surgical timing for polytrauma with a focus on fracture reconstruction. World J Emerg Surg 2025; 20:33. [PMID: 40240895 PMCID: PMC12001529 DOI: 10.1186/s13017-025-00607-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 04/07/2025] [Indexed: 04/18/2025] Open
Abstract
BACKGROUND For patients with severe polytrauma and fractures, early fracture reconstruction surgery under stable conditions can significantly reduce pulmonary and other complications. However, premature surgical intervention may heighten infection risk, adversely affecting the patient's prognosis. Consequently, determining the optimal timing of surgery is crucial for patients with multiple traumatic injuries. Given China's healthcare context, this study will assess injury severity and perform definitive fracture reconstruction at specified post-trauma intervals. Postoperative infection rates, including wound infections, other complication incidences, hospital stay duration, treatment costs, and long-term outcomes will be observed and compared to identify the optimal timing for surgical intervention. This study also aims to develop effective polytrauma management models. By applying accessible criteria and choosing suitable timing for fracture reconstruction, we can better assess patient conditions, reduce complications, and minimize the surgery's "second hit" effect, addressing an important research gap regarding optimal surgical timing for polytrauma in China. METHODS This study collected data on 200 patients treated at our hospital between March 2023 and March 2024, with an average age of 47.24 ± 16.56 years and an average Injury Severity Score (ISS) of 25.85 ± 13.35. A total of 250 fractures received definitive fixation in the initial surgery, including femoral fractures (n = 75), spinal fractures (n = 46), pelvic ring fractures (n = 49), tibial fractures (n = 25), acetabular fractures (n = 12), humeral fractures (n = 12), and other fractures (n = 5) (including clavicle, radius and ulna, calcaneus, and patella). Among these patients, 151 underwent single-fracture reconstruction, 42 had two fractures reconstructed, and 5 had three fractures treated during the first surgery. The study protocol excluded patients with absolute contraindications, including bacteremia and infections near the surgical site. Additional inclusion criteria required stable vital signs (temperature < 38.5 °C with a downward trend, systolic blood pressure > 100 mmHg, stable traumatic brain injury status) and blood routine (white blood cell count < 22.0 × 10⁹/L with a neutrophil percentage < 90%, both trending downward; platelet count > 50 × 10⁹/L; hemoglobin > 90 g/L). Based on these criteria, historical cohorts were identified and assigned to either an experimental group or a control group. Observed outcomes included postoperative complications, wound healing grades, inflammatory markers, changes in vital signs, length of hospital stay, costs, and long-term follow-up results. RESULTS Among the patients, 97 underwent surgery after meeting the specified criteria for fracture reconstruction, while 103 received surgery without meeting these criteria. Patients who met the surgical criteria demonstrated superior outcomes, with lower complication rates (including pneumonia and respiratory distress syndrome), improved surgical incision healing, faster postoperative consciousness recovery, shorter overall and ICU stays, reduced hospitalization costs, greater joint mobility at the 9-month follow-up, and higher quality of life assessments compared to those who did not meet the criteria. Among patients who met the criteria, those with spinal fractures experienced better quality of life outcomes, and those with femoral fractures showed improved fracture healing. CONCLUSIONS For polytrauma patients with fractures, performing surgery once surgical requirements are met results in fewer early postoperative pulmonary complications, quicker recovery of consciousness, lower wound infection rates, shorter hospital and ICU stays, reduced costs, and improved postoperative outcomes. This protocol is safe and effective for most polytrauma patients requiring fixation, particularly those with mechanically unstable femoral, pelvic, acetabular, or spinal fractures.
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Affiliation(s)
- Chenning Ding
- Acute care surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Mingwang Jia
- Acute care surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xing Han
- Acute care surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jiahui Zhang
- Acute care surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xin Zhao
- Acute care surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiguang Sang
- Acute care surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
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Valcarcel CR, Bieler D, Bass GA, Gaarder C, Hildebrand F. ESTES recommendations for the treatment of polytrauma-a European consensus based on the German S3 guidelines for the treatment of patients with severe/multiple injuries. Eur J Trauma Emerg Surg 2025; 51:171. [PMID: 40214785 PMCID: PMC11991986 DOI: 10.1007/s00068-025-02852-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Accepted: 03/25/2025] [Indexed: 04/14/2025]
Abstract
INTRODUCTION Considerable heterogeneity exists in the configuration and implementation maturity of trauma systems across European healthcare settings, and the opportunities for guideline-informed high-quality care varies considerably. Therefore, the European Society of Trauma and Emergency Surgery (ESTES), with its constituent national societies, has developed comprehensive consensus recommendations for care-context appropriate treatment of polytrauma patients in Europe, from the pre-hospital setting to the first surgical phase. METHODS Adhering to the RAND/UCLA Appropriateness Method (RAM), ESTES conducted a three-round modified Delphi consensus. National society expert delegates assessed Grade of Recommendation (GoR) A and Good Clinical Practice Points (GPP) elements of the German Society of Trauma Surgery (DGU) "S3 guidelines for polytrauma/severe injury management" for appropriateness and implementability within their respective healthcare systems. RESULTS In the first consensus round, 82 GoR A and 57 GPP recommendations were analysed. Of these, seven GPP were rephrased for clarity and four were removed due to redundancy or conflicting content. Consequently, 135 recommendations (82 GoR A and 53 GPP) remained, with 128 (77 GoR A and 51 GPP) deemed appropriate and necessary, and seven as uncertain due to expert disagreement. CONCLUSION These ESTES recommendations constitute the first cohesive Europe-wide framework for managing the polytrauma patient from the prehospital setting to the end of the first surgical phase. They serve as a foundational tool for the development of national guidelines, particularly in regions with evolving trauma systems, and promote alignment towards a uniform standard-of-care across Europe.
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Affiliation(s)
- Cristina Rey Valcarcel
- Unit of Trauma and Emergency Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Dan Bieler
- Department for Trauma Surgery and Orthopaedics, Reconstructive and Hand Surgery, Burn Medicine, Germany Armed Forces Central Hospital Koblenz, Rübenacher Strasse, 56072, Koblenz, Germany
| | - Gary A Bass
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany.
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Voelckel WG. Vasopressin in traumatic hemorrhagic shock. Curr Opin Anaesthesiol 2025; 38:81-92. [PMID: 39936940 DOI: 10.1097/aco.0000000000001456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2025]
Abstract
PURPOSE OF REVIEW Hemorrhage and subsequent development of therapy refractory shock are the major cause of death in potentially salvageable trauma victims. Recent scientific work recognizes that there is an urgent need to develop new life-support strategies. From a variety of interventions and drugs with the potential to prolong the compensation phase or to reverse the decompensation phase of shock, arginine vasopressin (AVP) is one of the most promising and best evaluated drugs. Nonetheless, the efficacy of AVP administration in hemorrhagic shock is still to be proven. Thus, this umbrella review summarizes the current evidence of AVP in hemorrhagic shock. RECENT FINDINGS Fifteen short reviews, narrative reviews, systematic reviews and meta-analysis addressing AVP in traumatic hemorrhagic shock were identified and included in this umbrella review. There is robust evidence deriving form 23 animal studies that AVP administration is effective in hemorrhagic shock, resulting in hemodynamic stabilization and improved survival. This observation is supported by six case reports but not confirmed by two retrospective observational studies and two randomized control trials. SUMMARY In uncontrolled hemorrhagic shock, arginine vasopressin might be considered as a therapy of last resort in shock patients not responding to conventional therapy. Further research is needed to determine the potential benefits and optimal dosage/timing of vasopressin use in hemorrhagic shock.
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Affiliation(s)
- Wolfgang G Voelckel
- Department of Anesthesiology and Critical Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
- University of Stavanger, Faculty of Health Sciences, Department of Quality and Health Technology, Stavanger, Norway
- OEAMTC Air Rescue, Vienna, Austria
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Spering C, Lefering R, Bieler D, Hackenberg L, Dobroniak CC, Müller G, Lehmann W, H R. Preventing the disaster: severe abdominal injury in child passengers of motor vehicle accidents often indicate even more serious trauma. Eur J Trauma Emerg Surg 2025; 51:145. [PMID: 40111514 PMCID: PMC11925968 DOI: 10.1007/s00068-025-02811-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Accepted: 03/01/2025] [Indexed: 03/22/2025]
Abstract
PURPOSE The purpose of this study was to assess severe abdominal injury in child passengers of different ages of motor vehicle accidents and analyze the concomitant pattern of injury regarding injury severity, trauma management and outcome. METHOD Data acquisition from Trauma Register DGU® (TR-DGU) in a 10-years period (2010-2020) of seriously injured children (max. AIS 2+ / intensive care) 0-15 years of age, as motor vehicle passengers (cMVP) (n = 1,035). Primarily treated in or transferred to a German Trauma Center. Matched pairs analysis with adult severely injured motor vehicle passengers (aMVP) (age 20-50 years, n = 26,218), matching 1:4 (child: adult), was performed to identify causes of mortality. RESULTS The study group (cMVP) included 1,035 children. The mean age was 9.5 years, 50.5% were male and the mean Injury Severity Score (ISS) was 18.7 points. 93.0% were transported from scene directly to the final trauma center. Transferred patients showed a higher ISS (26 vs. 18 points), higher rate of severe traumatic brain injury (TBI), a higher rate of serious abdominal injury and a higher mortality rate (12.5% vs. 7.4%). Most of the severe abdominal injuries occurred after the third year of age (first peak between 8 and 9 years; second peak 14-15 years). Serious injuries to the pelvis show a similar distribution but less often, the same applies to thoracical injuries. Severe brain and head injuries show an antiproportional distribution to the age groups with the highest rate in the 0-1 year old (78%) and the lowest in the 14-15 year old (40%). The highest mortality rate was shown in the youngest age groups, related to TBI (AISTBI ≥ 3; 62% in 0-1 years). The matched pairs analysis shows a higher mortality rate of cMVP compared to aMVP within the first 24 h after hospital admission and a significantly higher rate of shock and unconsciousness, while the intubation rate is significantly lower. CONCLUSION Child passengers of motor vehicle accidents are in need of a specific and age-related attention towards security systems. Severe injuries in children are rare, yet life threatening. The highest mortality rate is related to severe TBI, especially in the youngest children. But also severe abdominal as well as thoracic injuries their concomitant trauma need to be prevented and are indicators for even more severe injuries. It seems to be favorable for cMVP to be directly transported to designated special centers with sufficient capacity and competency to treat and manage severely injured children.
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Affiliation(s)
- Christopher Spering
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, Göttingen University Medical Center, Göttingen, Germany.
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten / Herdecke, Cologne, Germany
| | - D Bieler
- Department of Orthopaedics and Trauma Surgery, Heinrich Heine University Medical School, Düsseldorf, Germany
- Department for Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery, Burn Medicine, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - L Hackenberg
- Department for Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery, Burn Medicine, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - C C Dobroniak
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, Göttingen University Medical Center, Göttingen, Germany
| | - G Müller
- Chair of Automotive Engineering, Technische Universität Berlin, Berlin, Germany
| | - W Lehmann
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, Göttingen University Medical Center, Göttingen, Germany
| | - Rüther H
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, Göttingen University Medical Center, Göttingen, Germany
- Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of The German Trauma Society (DGU), Berlin, Germany
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Luckscheiter A, Thiel M, Zink W, Eisenberger J, Viergutz T, Schneider-Lindner V. Utilization of non-invasive ventilation before prehospital emergency anesthesia in trauma - a cohort analysis with machine learning. Scand J Trauma Resusc Emerg Med 2025; 33:35. [PMID: 40033329 PMCID: PMC11877787 DOI: 10.1186/s13049-025-01350-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 02/22/2025] [Indexed: 03/05/2025] Open
Abstract
BACKGROUND For preoxygenation, German guidelines consider non-invasive ventilation (NIV) as a possible method in prehospital trauma care in the absence of aspiration, severe head or face injuries, unconsciousness, or patient non-compliance. As data on the utilization and characteristics of patients receiving NIV are lacking, this study aims to identify predictors of NIV usage in trauma patients using machine learning and compare these findings with the current national guideline. METHODS A cross-regional registry of prehospital emergency services in southwestern Germany was searched for cases of emergency anesthesia in multiply injured patients in the period from 2018 to 2020. Initial vital signs, oxygen saturation, respiratory rate, heart rate, systolic blood pressure, Glasgow Coma Scale (GCS), injury pattern, shock index and age were examined using logistic regression. A decision tree algorithm was then applied in parallel to reduce the number of attributes, which were subsequently tested in several machine learning algorithms to predict the usage of NIV before the induction of anesthesia. RESULTS Of 992 patients with emergency anesthesia, 333 received NIV (34%). Attributes with a statistically significant influence (p < 0.05) in favour of NIV were bronchial spasm (odds ratio (OR) 119.75), dyspnea/cyanosis (OR 2.28), moderate and severe head injury (both OR 3.37) and the respiratory rate (OR 1.07). Main splitting points in the initial decision tree included auscultation (rhonchus and bronchial spasm), respiratory rate, heart rate, age, oxygen saturation and head injury with moderate head injury being more frequent in the NIV group (23% vs. 12%, p < 0.01). The rates of aspiration and the level of consciousness were equal in both groups (0.01% and median GCS 15, both p > 0.05). The prediction accuracy for NIV usage was high for all algorithms, except for multilayer perceptron and logistic regression. For instance, a Bayes Network yielded an AUC-ROC of 0.96 (95% CI, 0.95-0.96) and PRC-areas of 0.96 [0.96-0.96] for predicting and 0.95 [0.95-0.96] for excluding NIV usage. CONCLUSIONS Machine learning demonstrated an excellent categorizability of the cohort using only a few selected attributes. Injured patients without severe head injury who presented with dyspnea, cyanosis, or bronchial spasm were regularly preoxygenated with NIV, indicating a common prehospital practice. This usage appears to be in accordance with current German clinical guidelines. Further research should focus on other aspects of the decision making like airway anatomy and investigate the impact of preoxygenation with NIV in prehospital trauma care on relevant outcome parameters, as the current evidence level is limited.
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Affiliation(s)
- André Luckscheiter
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Department of Anesthesiology, Operative Intensive Care Medicine and Emergency Medicine, Ludwigshafen City Hospital, Bremserstrasse 79, 67063, Ludwigshafen, Germany.
| | - Manfred Thiel
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Anesthesiology and Surgical Intensive Care Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Wolfgang Zink
- Department of Anesthesiology, Operative Intensive Care Medicine and Emergency Medicine, Ludwigshafen City Hospital, Bremserstrasse 79, 67063, Ludwigshafen, Germany
| | - Johanna Eisenberger
- Centre for Quality Management in Emergency Medical Service Baden-Wuerttemberg (SQR-BW), Stuttgart, Germany
| | - Tim Viergutz
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Anesthesiology, Intensive Care and Pain Therapy, BG Trauma Centre Tuebingen, Tuebingen, Germany
| | - Verena Schneider-Lindner
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Anesthesiology and Surgical Intensive Care Medicine, University Medical Centre Mannheim, Mannheim, Germany
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Groven RVM, Mert Ü, Greven J, Horst K, Joris V, Bini L, Poeze M, Blokhuis TJ, Huber-Lang M, Hildebrand F, van Griensven M. Early total care and damage control orthopaedics result in partially contrasting patterns of microRNA expression at the fracture site and in the systemic circulation : an animal study. Bone Joint J 2025; 107-B:193-203. [PMID: 39889739 DOI: 10.1302/0301-620x.107b2.bjj-2024-0160.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2025]
Abstract
Aims The aims of this study, using a porcine model of multiple trauma, were to investigate the expression of microRNAs at the fracture site, in the fracture haematoma (fxH) and in the fractured bone, compared with a remote unfractured long bone, to characterize the patterns of expression of circulating microRNAs in plasma, and identify and validate messenger RNA (mRNA) targets of the microRNAs. Methods Two multiple trauma treatment strategies were compared: early total care (ETC) and damage control orthopaedics (DCO). For this study, fxH, fractured bone, unfractured control bone, plasma, lung, and liver samples were harvested. MicroRNAs were analyzed using quantitative real-time polymerase chain reaction arrays, and the identified mRNA targets were validated in vivo in the bone, fxH, lung, and liver tissue. Results MicroRNA expression was associated with the trauma treatment strategy and differed depending on the type of sample. In the ETC group, a more advanced fracture healing response, as reflected by the expression of osteogenic microRNAs, was seen compared with the DCO group. DCO treatment resulted in a more balanced immune response in the systemic circulation as represented by significant upregulations of several anti-inflammatory microRNAs. The in vivo validation of the abundance of putative mRNA targets reflected the levels of microRNAs which were identified. Conclusion Local and systemic microRNA patterns of expression were identified, specific for the treatment strategy in multiple trauma, which corresponded with the expression of mRNA at the fracture site and in target organs. These findings match clinical observations and offer insights into the cellular communication which may underlie the effects of using different surgical strategies in patients with multiple trauma, both locally and systemically. We also identified a systemic involvement of microRNAs in multiple trauma which may include distant cellular communication between injured tissues. Further research may further describe the temporospatial role of circulating microRNAs after multiple trauma, their potential role in communication between organs, and prospective therapeutic applications.
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Affiliation(s)
- Rald V M Groven
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands
- Division of Trauma Surgery, Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Ümit Mert
- Department of Orthopaedic, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Johannes Greven
- Experimental Orthopaedics and Trauma Surgery, Department of Orthopaedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Klemens Horst
- Department of Orthopaedic, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Virginie Joris
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands
| | - Lara Bini
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands
| | - Martijn Poeze
- Division of Trauma Surgery, Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Taco J Blokhuis
- Division of Trauma Surgery, Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, Ulm, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Martijn van Griensven
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands
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Hilbert-Carius P, Lefering R, Wrigge H, Hofmann GO, Davis J, Koch R. Does a Simple Blood Gas Analysis and the Clinical Impression Predict Trauma-Induced Coagulopathy? Hamostaseologie 2025. [PMID: 39832780 DOI: 10.1055/a-2445-7163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2025] Open
Abstract
OBJECTIVES Trauma-induced coagulopathy (TIC) is common in severely injured patients and is associated with significant morbidity and mortality. METHOD The association of two parameters of blood gas analysis (hemoglobin [Hb], base excess [BE]) with standard coagulation tests (SCTs) and rotational thrombelastometry (ROTEM) using the database of the TraumaRegister DGU between 2015 and 2022 was studied. In a stepwise approach, the occurrence of a TIC, the correlations between Hb/BE levels and SCT, as well as ROTEM were calculated respectively. Then we aimed to detect relations between different Hb/BE levels and the occurrence of TIC, using standard clotting studies and/or ROTEM respectively. RESULTS TIC occurred in 17.2% of the 68,996 primarily admitted adult patients with Injury Severity Score ≥9. A high correlation was found between Hb/BE and SCT. With a decrease in Hb and BE, the frequency of TIC increased and at an admission Hb <8 g/dL and BE < -6 mmol/L, >60% of patients presented with TIC. Clinical conditions associated with TIC were Glasgow Coma Scale ≤8, blood pressure ≤90 mmHg on the scene or at hospital admission, prehospital volume >1,000 mL, serious injuries to the head and/or the thorax and/or the abdomen and/or the extremities. CONCLUSION Almost one-sixth of patients present with a TIC at hospital admission. Blood gas analysis samples showed relevant correlations between Hb/BE levels and SCT. The combined closer inspection of Hb/BE and the clinical presentation of the patient is able to predict TIC in the majority of patients.
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Affiliation(s)
- Peter Hilbert-Carius
- Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bergmannstrost BG-Klinikum Halle, Saxonia-Anhalt, Germany
| | - Rolf Lefering
- IFOM, Witten/Herdecke University, Köln, Nordrhein-Westfalen, Germany
| | - Hermann Wrigge
- Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bergmannstrost BG-Klinikum Halle, Saxonia-Anhalt, Germany
- Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Gunther O Hofmann
- Department of Trauma Surgery, Jena University Hospital, Jena, Thueringen, Germany
| | - Jesse Davis
- Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bergmannstrost BG-Klinikum Halle, Saxonia-Anhalt, Germany
| | - Renè Koch
- Department of Anaesthesiology and Intensive Care Medicine, Husum Hospital, Husum, Schleswig-Holstein, Germany
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Hörauf JA, Singh A, Voth M, Moheimani H, Schindler CR, Relja B, Leppik L, Marzi I, Henrich D. Limited Diagnostic Value of miRNAs in Early Trauma-Induced Liver Injury: Only miRNA-122 Emerges as a Late-Phase Marker. Diagnostics (Basel) 2025; 15:179. [PMID: 39857063 PMCID: PMC11764008 DOI: 10.3390/diagnostics15020179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Revised: 01/09/2025] [Accepted: 01/12/2025] [Indexed: 01/27/2025] Open
Abstract
Background/Objectives: Liver injury is common after abdominal trauma. However, the established biomarkers of liver injury, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), lack accuracy. This study investigates whether specific liver-related microRNAs (miRNAs) are released into the circulation in trauma patients with liver injury and whether they can indicate liver damage in the early phase after major trauma. Methods: A retrospective analysis of prospectively collected data and blood samples from 26 trauma patients was conducted. The levels of miRNA-21-5p, -122-5p, -191-5p, -192-3p, and -212-3p were measured in patients with computed tomography-confirmed liver trauma (LT group, n = 12) and polytrauma patients without liver trauma (PT group, n = 14) upon emergency room (ER) admission, and 24 and 48 h after trauma. Additionally, liver-type fatty acid binding protein (L-FABP) was measured, as it has recently been discussed in the context of abdominal trauma. Results: Only miRNA-122-5p showed a significant increase in the LT group compared to the PT group, but only at the 48 h time point (p = 0.032). Conversely, L-FABP (p = 0.018) and ALT (p = 0.05) were significantly elevated in the LT group compared to the PT group at the time of ER admission. There was a moderate correlation between miRNA-122-5p and AISAbdomen (p = 0.056) and transfused red blood cell concentrates (p = 0.055). L-FABP correlated strongly with the ALT levels (p = 0.0009) and the length of stay in the ICU (p = 0.0086). Conclusions: In this study, the liver-specific miRNA-122-5p did not effectively indicate liver injury in the early acute post-traumatic phase. Future research with a large sample size should investigate whether other miRNAs can more accurately predict liver injury and the extent of hepatocellular injury, particularly in the acute post-traumatic phase.
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Affiliation(s)
- Jason-Alexander Hörauf
- Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Amit Singh
- Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Maika Voth
- Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Hamed Moheimani
- Pittsburgh Trauma Research Center, Division of Trauma and Acute Care Surgery, Pittsburgh, PA 15213, USA
| | - Cora Rebecca Schindler
- Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Borna Relja
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Translational and Experimental Trauma Research, University Hospital Ulm, Ulm University, 89081 Ulm, Germany
| | - Liudmila Leppik
- Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Dirk Henrich
- Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
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Lakomek F, Hilsmann F, Schiffner E, Gehrmann S, Schöps D, Prost M, Windolf J, Latz D. [Doctor, when can I drive? Characterization of driving behavior of orthopedic and trauma surgery patients using a prospective questionnaire study]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2025; 128:38-46. [PMID: 39586920 PMCID: PMC11735540 DOI: 10.1007/s00113-024-01502-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2024] [Indexed: 11/27/2024]
Abstract
BACKGROUND Individual mobility in road traffic is of high importance in Germany, both individually and socioeconomically; however, diseases and injuries of the musculoskeletal system in particular can lead to temporary impairments. The aim of this prospective patient survey was to record how patients assessed their driving capability during an injury and the associated immobilization and on what basis the decision on driving capability was made on the part of the patients. MATERIAL AND METHODS A systematic questionnaire was used to analyze a total of 100 patients with a diagnosis in orthopedics/trauma surgery and associated joint immobilization. In addition to personal data and the injuries/illnesses, an analysis on risk tolerance was performed and patients were asked about their knowledge regarding driving capability. Finally, it was recorded which patients drove a motor vehicle and for what reasons despite immobilization. RESULTS Overall, 40.2% reported knowledge of the applicable laws regarding driving capability and 55.6% considered the treating physician to be responsible regarding the decision on driving capability. The patients who drove a motor vehicle reported higher personal and professional dependence on the motor vehicle (personal: 60.6% vs. 45.7%; professional: 48.5% vs. 36.1%). In the group of patients who drove a motor vehicle during immobilization, overall a fracture was less likely to be the reason for immobilization (33.3% vs. 51.0%). CONCLUSION Overall, the patient population rated their knowledge of the law as low and viewed the treating physician as having the majority of the decision-making responsibility regarding driving capability. The patients who drove a motor vehicle during immobilization reported a higher personal as well as professional dependence on driving a motor vehicle. At the same time the injury severity had an influence on the decision, so that patients with fractures were more likely to avoid driving a motor vehicle. Further studies, particularly at the biomechanical level, are needed to ensure a better basis for the physician in making decisions with respect to the driving capability of orthopedic and trauma surgery patients.
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Affiliation(s)
- Felix Lakomek
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Falk Hilsmann
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - Erik Schiffner
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Sebastian Gehrmann
- Klinik für Orthopädie und Unfallchirurgie, Karl-Leisner-Klinikum Kleve, Albersallee 5, 47533, Kleve, Deutschland
| | - Dominique Schöps
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Max Prost
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Joachim Windolf
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - David Latz
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
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12
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Nakao S, Katsura M, Yagi M, Ogura H, Oda J. Assessing associated factors for failure of nonoperative management in pediatric blunt liver and spleen injuries: a secondary analysis of the SHIPPs study. Eur J Trauma Emerg Surg 2024; 50:2249-2257. [PMID: 38886237 PMCID: PMC11599619 DOI: 10.1007/s00068-024-02575-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE The purpose of this study was to describe the characteristics of pediatric patients who underwent nonoperative management (NOM) for blunt splenic and hepatic injuries and to explore factors associated with NOM failure. METHODS This was a secondary analysis of a multicenter cohort study of pediatric patients with blunt liver and spleen injuries in Japan. Participants included pediatric trauma patients aged 16 years or younger between 2008 and 2019 with NOM, which was defined as no surgery provided within 6 h of hospital arrival. NOM failure, defined as abdominal surgery performed after 6 h of hospital arrival, was the primary outcome. Descriptive statistics were provided and exploratory analysis to assess the associations with outcome using logistic regression. RESULTS During the study period, 1339 met our eligibility criteria. The median age was 9 years, with a majority being male. The median Injury Severity Score (ISS) was 10. About 14.0% required transfusion within 24 h, and 22.3% underwent interventional radiology procedures. NOM failure occurred in 1.0% of patients and the in-hospital mortality was 0.7%. Factors associated with NOM failure included age, positive focused assessment with sonography for trauma (FAST), contrast extravasation on computed tomography (CT), severe liver injury, concomitant pancreas injury, concomitant gastrointestinal injury, concomitant mesenteric injury, and ISS. CONCLUSIONS In our study, NOM failure were rare. Older age, positive FAST, contrast extravasation on CT, severe liver injury, concomitant pancreas injury, concomitant gastrointestinal injury, concomitant mesenteric injury, and higher ISS were suggested as possible risk factors for NOM failure.
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Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Morihiro Katsura
- Department of Surgery, Okinawa Chubu Hospital, Uruma, Okinawa, Japan
| | - Masayuki Yagi
- Emergency Medicine and Acute Care Surgery, Matsudo City General Hospital, Matsudo, Chiba, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Helsloot D, Fitzgerald M, Lefering R, Groombridge C, Becaus N, Verelst S, Missant C. Calcium supplementation during trauma resuscitation: a propensity score-matched analysis from the TraumaRegister DGU ®. Crit Care 2024; 28:222. [PMID: 38970063 PMCID: PMC11227138 DOI: 10.1186/s13054-024-05002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/24/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND In major trauma patients, hypocalcemia is associated with increased mortality. Despite the absence of strong evidence on causality, early calcium supplementation has been recommended. This study investigates whether calcium supplementation during trauma resuscitation provides a survival benefit. METHODS We conducted a retrospective analysis using data from the TraumaRegister DGU® (2015-2019), applying propensity score matching to balance demographics, injury severity, and management between major trauma patients with and without calcium supplementation. 6 h mortality, 24 h mortality, and in-hospital mortality were considered as primary outcome parameters. RESULTS Within a cohort of 28,323 directly admitted adult major trauma patients at a European trauma center, 1593 (5.6%) received calcium supplementation. Using multivariable logistic regression to generate propensity scores, two comparable groups of 1447 patients could be matched. No significant difference in early mortality (6 h and 24 h) was observed, while in-hospital mortality appeared higher in those with calcium supplementation (28.3% vs. 24.5%, P = 0.020), although this was not significant when adjusted for predicted mortality (P = 0.244). CONCLUSION In this matched cohort, no evidence was found for or against a survival benefit from calcium supplementation during trauma resuscitation. Further research should focus on understanding the dynamics and kinetics of ionized calcium levels in major trauma patients and identify if specific conditions or subgroups could benefit from calcium supplementation.
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Affiliation(s)
- Dries Helsloot
- Department of Anesthesia and Emergency Medicine, AZ Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
- Department of Cardiovascular Sciences, Kulak University Kortrijk Campus, Etienne Sabbelaan 53, Box 7700, 8500, Kortrijk, Belgium.
- National Trauma Research Institute, Alfred Health and Monash University, Level 4, 89 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Mark Fitzgerald
- National Trauma Research Institute, Alfred Health and Monash University, Level 4, 89 Commercial Road, Melbourne, VIC, 3004, Australia
- Trauma Service, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Universität Witten/Herdecke, Ostmerheimer Str.200, Haus 38, 51109, Cologne, Germany
| | - Christopher Groombridge
- National Trauma Research Institute, Alfred Health and Monash University, Level 4, 89 Commercial Road, Melbourne, VIC, 3004, Australia
- Trauma Service, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Nathalie Becaus
- Department of Anesthesia and Emergency Medicine, AZ Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - Sandra Verelst
- Heilig Hart Hospital, Naamsestraat 105, 3000, Leuven, Belgium
| | - Carlo Missant
- Department of Anesthesia and Emergency Medicine, AZ Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
- Department of Cardiovascular Sciences, Kulak University Kortrijk Campus, Etienne Sabbelaan 53, Box 7700, 8500, Kortrijk, Belgium
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Hörauf JA, Woschek M, Schindler CR, Verboket RD, Lustenberger T, Marzi I, Störmann P. Settlement Is at the End-Common Trauma Scores Require a Critical Reassessment Due to the Possible Dynamics of Traumatic Brain Injuries in Patients' Clinical Course. J Clin Med 2024; 13:3333. [PMID: 38893044 PMCID: PMC11173217 DOI: 10.3390/jcm13113333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Scientific studies on severely injured patients commonly utilize the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) for injury assessment and to characterize trauma cohorts. However, due to potential deterioration (e.g., in the case of an increasing hemorrhage) during the clinical course, the assessment of injury severity in traumatic brain injury (TBI) can be challenging. Therefore, the aim of this study was to investigate whether and to what extent the worsening of TBI affects the AIS and ISS. Methods: We retrospectively evaluated 80 polytrauma patients admitted to the trauma room of our level I trauma center with computed-tomography-confirmed TBI. The initial AIS, ISS, and Trauma and Injury Severity Score (TRISS) values were reevaluated after follow-up imaging. Results: A total of 37.5% of the patients showed a significant increase in AIShead (3.7 vs. 4.1; p = 0.002) and the ISS (22.9 vs. 26.7, p = 0.0497). These changes resulted in an eight percent reduction in their TRISS-predicted survival probability (74.82% vs. 66.25%, p = 0.1835). Conclusions: The dynamic nature of intracranial hemorrhage complicates accurate injury severity assessment using the AIS and ISS, necessitating consideration in clinical studies and registries to prevent systematic bias in patient selection and subsequent data analysis.
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Affiliation(s)
- Jason-Alexander Hörauf
- Department of Trauma Surgery and Orthopedics, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Mathias Woschek
- Department of Trauma Surgery and Orthopedics, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Cora Rebecca Schindler
- Department of Trauma Surgery and Orthopedics, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Rene Danilo Verboket
- Department of Trauma Surgery and Orthopedics, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Thomas Lustenberger
- Department of Orthopedic Surgery and Traumatology, Inselspital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Ingo Marzi
- Department of Trauma Surgery and Orthopedics, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Philipp Störmann
- Department of Trauma Surgery and Orthopedics, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Zhang S, Liu F, Li X, Zhang X, Han X. Effect of access to the integrated treatment model for patients with multiple severe injuries in the Chinese population. Int Emerg Nurs 2024; 74:101423. [PMID: 38432044 DOI: 10.1016/j.ienj.2024.101423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 03/05/2024]
Abstract
AIMS The aim of this study was to enhance the effectiveness of an integrated treatment model for patients with severe multiple injuries in China. METHODS In this study, we conducted a retrospective analysis of data from 110 patients with multiple severe injuries. These patients were divided into two groups based on the treatment model they received. The first group, called the MDTM group, received the integrated treatment model, which involved a multidisciplinary team-based approach. The second group, designated the TSM group, received the traditional specialist-based treatment model. The primary outcome measure was the survival rate of patients after treatment. Secondary outcomes included the time spent on hospital emergency treatment, the length of hospital stay, the mortality rate, and family satisfaction. RESULTS The survival rate of patients after treatment in the MDTM group (83.93%) was significantly greater than that in the TSM group (70.37%). Consequently, the mortality of patients after treatment in the MDTM group (16.07%) was significantly lower than that in the TSM group (29.63%). Furthermore, the MDTM group demonstrated significantly shorter durations of rescue efforts and shorter hospital stays. Additionally, family satisfaction was significantly greater in the MDTM group. CONCLUSION The integrated treatment model shows potential for optimizing outcomes for patients with multiple severe injuries and generating higher levels of family satisfaction. This model holds practical applicability in the context of China and may help alleviate the strained relationship between physicians and patients.
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Affiliation(s)
- Shuai Zhang
- Department of Emergency Medicine, Clinical Research Center For Emergency and Critical Care In Hunan Province, Hunan Provincial Institute of Emergency Medicine, Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410005, Hunan, China
| | - Fang Liu
- Department of Radiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410005, Hunan, China
| | - Xiang Li
- Department of Emergency Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410005, Hunan, China
| | - Xingwen Zhang
- Department of Emergency Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410005, Hunan, China
| | - Xiaotong Han
- Department of Emergency Medicine, Clinical Research Center For Emergency and Critical Care In Hunan Province, Hunan Provincial Institute of Emergency Medicine, Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410005, Hunan, China.
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16
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Spering C, Lehmann W, Möller S, Bieler D, Schweigkofler U, Hackenberg L, Sehmisch S, Lefering R. The pelvic vascular injury score (P-VIS): a prehospital instrument to detect significant vascular injury in pelvic fractures. Eur J Trauma Emerg Surg 2024; 50:925-935. [PMID: 37872264 PMCID: PMC11249757 DOI: 10.1007/s00068-023-02374-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/24/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The purpose of this study was to identify predictive factors for peri-pelvic vascular injury in patients with pelvic fractures and to incorporate these factors into a pelvic vascular injury score (P-VIS) to detect severe bleeding during the prehospital trauma management. METHODS To identify potential predictive factors, data were taken (1) of a Level I Trauma Centre with 467 patients (ISS ≥ 16 and AISPelvis ≥ 3). Analysis including patient's charts and digital recordings, radiographical diagnostics, mechanism and pattern of injury as well as the vascular bleeding source was performed. Statistical analysis was performed descriptively and through inference statistical calculation. To further analyse the predictive factors and finally develop the score, a 10-year time period (2012-2021) of (2) the TraumaRegister DGU® (TR-DGU) was used in a second step. Relevant peri-pelvic bleeding in patients with AISPelvis ≥ 3 (N = 9227) was defined as a combination of the following entities (target group PVITR-DGU N = 2090; 22.7%): pelvic fracture with significant bleeding (> 20% of blood volume), Injury of the iliac or femoral artery or blood transfusion of ≥ 6 units (pRBC) prior to ICU admission. The multivariate analysis revealed nine items that constitute the pelvic vascular injury score (P-VIS). RESULTS In study (1), 467 blunt pelvic trauma patients were included of which 24 (PVI) were presented with significant vascular injury (PVI, N = 24; control (C, N = 443). Patients with pelvic fractures and vascular injury showed a higher ISS, lower haemoglobin at admission and lower blood pressure. Their mortality rate was higher (PVI: 17.4%, C: 10.3%). In the defining and validating process of the score within the TR-DGU, 9227 patients met the inclusion criteria. 2090 patients showed significant peripelvic vascular injury (PVITR-DGU), the remaining 7137 formed the control group (CTR-DGU). Nine predictive parameters for peripelvic vascular injury constituted the peripelvic vascular injury score (P-VIS): age ≥ 70 years, high-energy-trauma, penetrating trauma/open pelvic injury, shock index ≥ 1, cardio-pulmonary-resuscitation (CPR), substitution of > 1 l fluid, intubation, necessity of catecholamine substitution, remaining shock (≤ 90 mmHg) under therapy. The multi-dimensional scoring system leads to an ordinal scaled rating according to the probability of the presence of a vascular injury. A score of ≥ 3 points described the peripelvic vascular injury as probable, a result of ≥ 6 points identified a most likely vascular injury and a score of 9 points identified an apparent peripelvic vascular injury. Reapplying this score to the study population a median score of 5 points (range 3-8) (PVI) and a median score of 2 points (range 0-3) (C) (p < 0.001). The OR for peripelvic vascular injury was 24.3 for the patients who scored > 3 points vs. ≤ 2 points. The TR-DGU data set verified these findings (median of 2 points in CTR-DGU vs. median of 3 points with in PVITR-DGU). CONCLUSION The pelvic vascular injury score (P-VIS) allows an initial risk assessment for the presence of a vascular injury in patients with unstable pelvic injury. Thus, the management of these patients can be positively influenced at a very early stage, prehospital resuscitation performed safely targeted and further resources can be activated in the final treating Trauma Centre.
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Affiliation(s)
- Christopher Spering
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, Goettingen University Medical Center, Universitaetsmedizin Goettingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, Goettingen University Medical Center, Universitaetsmedizin Goettingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Stefanie Möller
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, Goettingen University Medical Center, Universitaetsmedizin Goettingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- Department of Orthopedic Trauma Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Dan Bieler
- Department of Orthopaedics and Trauma Surgery, Heinrich Heine University Medical School, Düsseldorf, Germany
- Department for Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery, Burn Medicine, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Uwe Schweigkofler
- Department of Orthopedic Trauma Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Lisa Hackenberg
- Department for Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery, Burn Medicine, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Stephan Sehmisch
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, Goettingen University Medical Center, Universitaetsmedizin Goettingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- Department of Trauma Surgery, Hannover Medical School (MHH), Hannover, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
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Groven RVM, Kuik C, Greven J, Mert Ü, Bouwman FG, Poeze M, Blokhuis TJ, Huber-Lang M, Hildebrand F, Cillero-Pastor B, van Griensven M. Fracture haematoma proteomics. Bone Joint Res 2024; 13:214-225. [PMID: 38699779 PMCID: PMC11090216 DOI: 10.1302/2046-3758.135.bjr-2023-0323.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
Aims The aim of this study was to determine the fracture haematoma (fxH) proteome after multiple trauma using label-free proteomics, comparing two different fracture treatment strategies. Methods A porcine multiple trauma model was used in which two fracture treatment strategies were compared: early total care (ETC) and damage control orthopaedics (DCO). fxH was harvested and analyzed using liquid chromatography-tandem mass spectrometry. Per group, discriminating proteins were identified and protein interaction analyses were performed to further elucidate key biomolecular pathways in the early fracture healing phase. Results The early fxH proteome was characterized by immunomodulatory and osteogenic proteins, and proteins involved in the coagulation cascade. Treatment-specific proteome alterations were observed. The fxH proteome of the ETC group showed increased expression of pro-inflammatory proteins related to, among others, activation of the complement system, neutrophil functioning, and macrophage activation, while showing decreased expression of proteins related to osteogenesis and tissue remodelling. Conversely, the fxH proteome of the DCO group contained various upregulated or exclusively detected proteins related to tissue regeneration and remodelling, and proteins related to anti-inflammatory and osteogenic processes. Conclusion The early fxH proteome of the ETC group was characterized by the expression of immunomodulatory, mainly pro-inflammatory, proteins, whereas the early fxH proteome of the DCO group was more regenerative and osteogenic in nature. These findings match clinical observations, in which enhanced surgical trauma after multiple trauma causes dysbalanced inflammation, potentially leading to reduced tissue regeneration, and gained insights into regulatory mechanisms of fracture healing after severe trauma.
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Affiliation(s)
- Rald V. M. Groven
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, Netherlands
- Division of Trauma Surgery, Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Christel Kuik
- Maastricht Multimodal Molecular Imaging (M4i) Institute, Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, Netherlands
| | - Johannes Greven
- Experimental Orthopaedics and Trauma Surgery, Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Ümit Mert
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Freek G. Bouwman
- NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Martijn Poeze
- Division of Trauma Surgery, Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Taco J. Blokhuis
- Division of Trauma Surgery, Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, Ulm, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Berta Cillero-Pastor
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, Netherlands
- Maastricht Multimodal Molecular Imaging (M4i) Institute, Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, Netherlands
| | - Martijn van Griensven
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, Netherlands
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Knobloch R, Metelmann C, Metelmann B, Rübsam ML, Krämer B, Krämer S, Metelmann IB. [Prehospital chest tube placement: Which factors are associated with feeling confident to perform the procedure?]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 186:27-34. [PMID: 38658233 DOI: 10.1016/j.zefq.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The prehospital placement of chest tubes is a rare but potentially life-saving procedure. A high level of subjective confidence with the procedure is essential for emergency medical doctors. This study aims to identify if there is a statistically significant difference in the subjective sense of confidence in prehospital chest tube placement regarding medical experience and qualification, clinical routine, and attendance at simulation courses. METHODS Prehospital emergency physicians of three emergency medical services in Southwest Saxony, Greifswald, and Vechta, Germany, were invited to participate in an online survey from January to March 2022 using the online survey service limesurvey. The question "Do you feel confident in chest tube placement?" was used to measure the subjective level of confidence. Answers were compared with data concerning medical qualification, experience in prehospital emergency medicine, clinical routine, and attendance at simulation courses. Statistical analysis was performed using chi-squared test and Fisher's exact test. RESULTS Three out of four participants felt confident in chest tube placement (53/71; 74.6%). More than half of the participants reported that they did not perform this procedure regularly (35/53, 66%). Subjective confidence was highest in physicians who regularly place chest tubes during their non-prehospital work (34/37; 91,9%; p<0.001), and more often when participants had clinical routine and attended simulation courses than when none of this applied (p=0.012). Attendance at simulation courses alone was not associated with a higher level of confidence (p=0.002). Specialists showed significantly more often subjective confidence in chest tube placement (p=0.0401). CONCLUSION Prehospital chest tube placement is rare, but potentially lifesaving. An adequately high level of subjective confidence in the placement of chest tubes is a key condition for prehospital emergency doctors. Inhospital clinical routine and attendance at simulation courses are significantly associated with high levels of confidence. Our data indicate that working only in prehospital emergency settings without further clinical routine or medical specialization is not sufficient for achieving and ensuring subjective confidence in chest tube placement.
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Affiliation(s)
- Rebecca Knobloch
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Bereich Thoraxchirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - Camilla Metelmann
- Klinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald KöR, Greifswald, Deutschland
| | - Bibiana Metelmann
- Klinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald KöR, Greifswald, Deutschland
| | - Marie-Luise Rübsam
- Klinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald KöR, Greifswald, Deutschland; Malteser Lohne e.V, Lohne, Landkreis Vechta, Deutschland
| | - Bernd Krämer
- Rettungszweckverband Südwestsachsen, Plauen, Plauen, Deutschland
| | - Sebastian Krämer
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Bereich Thoraxchirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - Isabella B Metelmann
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Bereich Thoraxchirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland.
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Heo Y, Chang SW, Lee SW, Ma DS, Kim DH. Hemostatic effect of fibrinogen concentrate on traumatic massive hemorrhage: a propensity score matching study. Trauma Surg Acute Care Open 2024; 9:e001271. [PMID: 38298819 PMCID: PMC10828838 DOI: 10.1136/tsaco-2023-001271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Background Fibrinogen concentrate (FC) can be administered during massive transfusions to manage trauma-induced coagulopathy. However, its effectiveness in survival remains inconclusive due to scarce high-level evidence. This study aimed to investigate the hemostatic effects of FC regarding mortality in massive hemorrhage caused by trauma. Methods This retrospective study analyzed 839 patients who received massive transfusions (red blood cells (RBCs) ≥5 units in 4 hours or ≥10 units in 24 hours) at a level I trauma center between 2015 and 2022. Patients who were transferred to other hospitals or were deceased upon arrival, suffered or died from severe brain injury, and were aged 15 years or less were excluded (n=334). 1:2 propensity score matching was performed to compare the 'FC (+)' group who had received FC in 24 hours (n=68) with those who had not ('FC (-)', n=437). The primary outcome was mortality, and the secondary outcomes included transfusion volume. Results The variables for matching included vital signs, injury characteristics, prehospital time, implementation of resuscitative endovascular balloon occlusion of the aorta, and blood gas analysis results. The administration of FC did not significantly reduce or predict mortality (in-hospital, 24 hours, 48 hours, or 7 days). The FC (-) group received more units of RBC (25.69 units vs. 16.71 units, p<0.001, standardized mean difference [SMD] 0.595), fresh frozen plasma (16.79 units vs. 12.91 units, p=0.023, SMD 0.321), and platelets (8.76 units vs. 5.46 units, p=0.002, SMD 0.446) than the FC (+) group. Conclusion The use of FC did not show survival benefits but reduced transfusion requirements in traumatic massive hemorrhages, highlighting a need for future investigations. In the future, individualized goal-directed transfusion with FC may play a significant role in treating massive bleeding. Level of evidence IV, retrospective study having more than one negative criterion.
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Affiliation(s)
- Yoonjung Heo
- Division of Surgery, Department of Medicine, Dankook University Graduate School, Cheonan, Chungnam, Korea (the Republic of)
- Department of Trauma Surgery, Trauma Center, Dankook University Hospital, Cheonan, Chungnam, Korea (the Republic of)
| | - Sung Wook Chang
- Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan, Chungnam, Korea (the Republic of)
| | - Seok Won Lee
- Department of Trauma Surgery, Trauma Center, Dankook University Hospital, Cheonan, Chungnam, Korea (the Republic of)
| | - Dae Sung Ma
- Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan, Chungnam, Korea (the Republic of)
| | - Dong Hun Kim
- Division of Trauma Surgery, Department of Surgery, Dankook University College of Medicine, Cheonan, Chungnam, Korea (the Republic of)
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Tewari N, Saji S, Goel S, Srivastav S, Alani A, Mathur VP, Rahul M, Bansal K. Prevalence of sports-related traumatic orofacial and dental injuries in Asian countries: a systematic review and meta-analysis. J Sports Med Phys Fitness 2023; 63:982-994. [PMID: 37314438 DOI: 10.23736/s0022-4707.23.14915-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The head and face, due to their prominent positions, are at risk of intentional and unintentional injuries in the majority of competitive sports. There are regional preferences for sports and differences in infrastructural facilities. The majority of the recommendations for sports have been based on the studies conducted in the western world. Hence, this systematic review aimed to estimate the prevalence of sports-related orofacial and dental injuries in professional-sportspersons living in Asian countries. EVIDENCE ACQUISITION A protocol was prepared as per the best practices of evidence-based medicine and registered (PROSPERO-CRD42021252488). Search strategy was based on the research question and conducted in six databases using text words and MeSH terms. Scrutiny of title and abstracts and later full-texts were done as per eligibility criteria. Data extraction was done using a pre-piloted sheet and the risk of bias (ROB) was assessed. Qualitative synthesis and meta-analyses were performed and the strength of evidence was assessed by using GRADE-approach. EVIDENCE SYNTHESIS Twenty-three studies published between 1998 to 2021 and from nine countries were included. The highest numbers were from Türkiye (N.=7). The total number of professional sportspersons assessed in all the included studies was 14,457. The highest prevalence of orofacial and dental injuries observed was 66.18% and the highest prevalence of dental injuries was 39.81%. Low risk of bias was seen only in four studies. The changes were observed during the sensitivity analysis with all the meta-analyses showing significant publication bias and heterogeneity. CONCLUSIONS The pooled prevalence of the combined orofacial and dental injuries was found to be 40.6%, while that of orofacial injury was 17.1% and dental injuries was 15.9%. There were 23 studies included in this review which covered 27 different sports from nine Asian countries. A high level of heterogeneity and the high ROB were observed in the majority of the studies. Further studies on the basis of the recommendations provided in the systematic review will improve the quality of evidence in this area in future.
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Affiliation(s)
- Nitesh Tewari
- Department of Pediatric and Preventive Dentistry, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India -
| | - Seba Saji
- Department of Pediatric and Preventive Dentistry, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Shubhi Goel
- Department of Pediatric and Preventive Dentistry, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Sukeshana Srivastav
- Department of Pediatric and Preventive Dentistry, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Aws Alani
- Section of Restorative Dentistry, Kings College London, London, UK
| | - Vijay P Mathur
- Department of Pediatric and Preventive Dentistry, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Morankar Rahul
- Department of Pediatric and Preventive Dentistry, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Kalpana Bansal
- Department of Pediatric and Preventive Dentistry, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Anheuser P, Michels G, Gakis G, Neisius A, Steffens J, Kranz J. [Position paper of the working group Urological Acute Medicine]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:936-940. [PMID: 37115300 DOI: 10.1007/s00120-023-02090-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
Emergency patients with acute genitourinary system diseases are frequently encountered in both outpatient and clinical emergency structures. It is estimated that one-third of all inpatients in a urology clinic initially present as an emergency. In addition to general emergency medicine knowledge, specialized urologic expertise is a prerequisite for the care of these patients, which is needed early and specifically for optimal treatment outcomes. It must be taken into account that, on the one hand, the current structures of emergency care still lead to delays in patient care despite positive developments in recent years. On the other hand, most hospital emergency facilities need urologic expertise on site. In addition, politically intended changes in our health care system, which drive an increasing ambulantization of medicine and condition a further centralization of emergency clinics, become effective. The aim of the newly established working group "Urological Acute Medicine" is to ensure and further improve the quality of care for emergency patients with acute genitourinary system diseases and, in consensus with the German Society of Interdisciplinary Emergency and Acute Medicine, to define precise task distributions and interfaces of both specialities.
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Affiliation(s)
- Petra Anheuser
- Klinik für Urologie, Asklepios Klinik Wandsbek, Alphonsstr. 14, 22403, Hamburg, Deutschland.
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St. Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Georgios Gakis
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Andreas Neisius
- Abteilung für Urologie und Kinderurologie, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Trier, Deutschland
| | - Joachim Steffens
- Klinik für Urologie und Kinderurologie, St. Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Jennifer Kranz
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
- Klinik für Urologie und Kinderurologie, Uniklinik RWTH Aachen, Aachen, Deutschland
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He W, Pan J. Concurrent Spinal Trauma in Patients with Traumatic Head Injury: A Seven-Year Retrospective Analysis. Med Sci Monit 2023; 29:e939215. [PMID: 37596775 PMCID: PMC10445503 DOI: 10.12659/msm.939215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/28/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Assessing spinal injuries in patients with traumatic head injuries is crucial due to their potential to alter functionality and increase mortality rates. This single-center retrospective study was conducted to understand the prevalence and characteristics of concurrent spinal injuries in adults with traumatic head injury from April 2015 to April 2022. MATERIAL AND METHODS The study incorporated demographic, clinical, traumatological, and hemodynamic data from 1,501 adult patients presenting with traumatic head injuries. Spinal injuries were identified through symptoms, physical signs, and radiological findings. RESULTS During the study period, 179 patients (12%) were reported with associated spinal injuries. These patients were predominantly male (p=0.0012), aged 65 years or above (p=0.0452), had thoracic injuries (p=0.0004), and arrived at the emergency department more than three hours post-trauma (p=0.0004). Most injuries were caused by motor vehicle accidents (p=0.0412) or falls from heights greater than 3 meters (p=0.0481). In addition, these patients had higher Abbreviated Injury Scale scores (≥2, p=0.0391), Eppendorf-Cologne Scale scores (≥2, p=0.0412), and lower systolic and diastolic blood pressure readings (p=0.0481, p=0.0412) along with lower heart rates (p=0.0482). However, no correlation was found between systolic and diastolic pressures and age among patients with spinal injuries. CONCLUSIONS This study reveals that the prevalence and severity of spinal injuries in patients with traumatic head injuries are influenced not only by demographic and clinical parameters, but also by the degree and extent of head trauma.
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23
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Kaim A, Bodas M, Bieler D, Radomislensky I, Matthes G, Givon A, Trentzsch H, Waydhas C, Lefering R. Severe trauma in Germany and Israel: are we speaking the same language? A trauma registry comparison. Front Public Health 2023; 11:1136159. [PMID: 37200993 PMCID: PMC10186152 DOI: 10.3389/fpubh.2023.1136159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023] Open
Abstract
Background Trauma registries are a crucial component of trauma systems, as they could be utilized to perform a benchmarking of quality of care and enable research in a critical but important area of health care. The aim of this study is to compare the performance of two national trauma systems: Germany (TraumaRegister DGU®, TR-DGU) and Israel (Israeli National Trauma Registry, INTR). Methods The present study was a retrospective analysis of data from the described above trauma registries in Israel and Germany. Adult patients from both registries treated during 2015-2019 with an Injury Severity Score (ISS) ≥ 16 points were included. Patient demographics, type, distribution, mechanism, and severity of injury, treatment delivered and length of stay (LOS) in the ICU and in the hospital were included in the analysis. Results Data were available from 12,585 Israeli patients and 55,660 German patients. Age and sex distribution were comparable, and road traffic collisions were the most prevalent cause of injuries. The ISS of German patients was higher (ISS 24 vs. 20), more patients were treated on an intensive care unit (92 vs. 32%), and mortality was higher (19.4 vs. 9.5%) as well. Conclusion Despite similar inclusion criteria (ISS ≥ 16), remarkable differences between the two national datasets were observed. Most probably, this was caused by different recruitment strategies of both registries, like trauma team activation and need for intensive care in TR-DGU. More detailed analyses are needed to uncover similarities and differences of both trauma systems.
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Affiliation(s)
- Arielle Kaim
- Israel National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
- Department of Emergency and Disaster Management, Faculty of Medicine, School of Public Health, Sackler Tel Aviv University, Tel Aviv, Israel
| | - Moran Bodas
- Israel National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
- Department of Emergency and Disaster Management, Faculty of Medicine, School of Public Health, Sackler Tel Aviv University, Tel Aviv, Israel
| | - Dan Bieler
- Department of Trauma Surgery and Orthopedics, University Düsseldorf, Düsseldorf, Germany
- Department for Trauma Surgery and Orthopedics, Reconstructive Surgery, Hand Surgery, Burn Medicine, German Armed Forces Central Hospital, Koblenz, Germany
| | - Irina Radomislensky
- Israel National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
| | - Gerrit Matthes
- Department of Trauma and Reconstructive Surgery, Hospital Ernst-von-Bergmann, Potsdam, Germany
| | - Adi Givon
- Israel National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
| | - Heiko Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Munich, Germany
| | | | - Christian Waydhas
- Department of Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
- Medical Faculty of University Duisburg-Essen, Essen, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany
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Kuupiel D, Jessani NS, Boffa J, Naude C, De Buck E, Vandekerckhove P, McCaul M. Prehospital clinical practice guidelines for unintentional injuries: a scoping review and prioritisation process. BMC Emerg Med 2023; 23:27. [PMID: 36915034 PMCID: PMC10010958 DOI: 10.1186/s12873-023-00794-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Globally, millions of people die and many more develop disabilities resulting from injuries each year. Most people who die from injuries do so before they are transported to hospital. Thus, reliable, pragmatic, and evidence-based prehospital guidance for various injuries is essential. We systematically mapped and described prehospital clinical practice guidelines (CPGs) for injuries in the global context, as well as prioritised injury topics for guidance development and adolopment. METHODS This study was sequentially conducted in three phases: a scoping review for CPGs (Phase I), identification and refinement of gaps in CPGs (Phase II), and ranking and prioritisation of gaps in CPGs (Phase III). For Phase I, we searched PubMed, SCOPUS, and Trip Database; guideline repositories and websites up to 23rd May 2021. Two authors in duplicate independently screened titles and abstract, and full-text as well as extracted data of eligible CPGs. Guidelines had to meet 60% minimum methodological quality according to rigour of development domain in AGREE II. The second and third phases involved 17 participants from 9 African countries and 1 from Europe who participated in a virtual stakeholder engagement workshop held on 5 April 2022, and followed by an online ranking process. RESULTS Fifty-eight CPGs were included out of 3,427 guidance documents obtained and screened. 39/58 (67%) were developed de novo compared to 19 that were developed using alternative approaches. Twenty-five out of 58 guidelines (43%) were developed by bodies in countries within the WHO European Region, while only one guideline was targeted to the African context. Twenty-five (43%) CPGs targeted emergency medical service providers, while 13 (22%) targeted first aid providers (laypeople). Forty-three CPGs (74%) targeted people of all ages. The 58 guidance documents contained 32 injury topics. Injuries linked to road traffic accidents such as traumatic brain injuries and chest injuries were among the top prioritised topics for future guideline development by the workshop participants. CONCLUSION This study highlights the availability, gaps and priority injury topics for future guideline development/adolopment, especially for the African context. Further research is needed to evaluate the recommendations in the 58 included CPGs for possible adaptation to the African context.
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Affiliation(s)
- Desmond Kuupiel
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa.
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa.
- Faculty of Health Sciences, Durban University of Technology, Durban, 4001, South Africa.
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.
| | - Nasreen S Jessani
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Jody Boffa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa
- The Aurum Institute, Johannesburg, South Africa
| | - Celeste Naude
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Motstraat 42, 2800, Mechelen, Belgium
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35 block D, 3000, Leuven, Belgium
- Cochrane First Aid, Motstraat 42, Mechelen, Belgium
| | - Philippe Vandekerckhove
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35 block D, 3000, Leuven, Belgium
- Belgian Red Cross, Motstraat 42, 2800, Mechelen, Belgium
| | - Michael McCaul
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine & Health Science, Stellenbosch University, Cape Town, 7530, South Africa
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Chen D, Luo J, Zhang C, Tang L, Deng H, Chang T, Xu H, He M, Wan D, Zhang F, Wu M, Qian M, Zhou W, Yin G, Wang W, Dong L, Tang Z. Venous Thrombus Embolism in Polytrauma: Special Attention to Patients with Traumatic Brain Injury. J Clin Med 2023; 12:1716. [PMID: 36902502 PMCID: PMC10003329 DOI: 10.3390/jcm12051716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/06/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023] Open
Abstract
Venous thrombus embolism (VTE) is common after polytrauma, both of which are considered significant contributors to poor outcomes and mortality. Traumatic brain injury (TBI) is recognized as an independent risk factor for VTE and one of the most common components of polytraumatic injuries. Few studies have assessed the impact of TBI on the development of VTE in polytrauma patients. This study sought to determine whether TBI further increases the risk for VTE in polytrauma patients. A retrospective, multi-center trial was performed from May 2020 to December 2021. The occurrence of venous thrombosis and pulmonary embolism from injury to 28 days after injury was observed. Of 847 enrolled patients, 220 (26%) developed DVT. The incidence of DVT was 31.9% (122/383) in patients with polytrauma with TBI (PT + TBI group), 22.0% (54/246) in patients with polytrauma without TBI (PT group), and 20.2% (44/218) in patients with isolated TBI (TBI group). Despite similar Glasgow Coma Scale scores, the incidence of DVT in the PT + TBI group was significantly higher than in the TBI group (31.9% vs. 20.2%, p < 0.01). Similarly, despite no difference in Injury Severity Scores between the PT + TBI and PT groups, the DVT rate was significantly higher in the PT + TBI group than in the PT group (31.9% vs. 22.0%, p < 0.01). Delayed anticoagulant therapy, delayed mechanical prophylaxis, older age, and higher D-dimer levels were independent predictive risk factors for DVT occurrence in the PT + TBI group. The incidence of PE within the whole population was 6.9% (59/847). Most patients with PE were in the PT + TBI group (64.4%, 38/59), and the PE rate was significantly higher in the PT + TBI group compared to the PT (p < 0.01) or TBI (p < 0.05) group. In conclusion, this study characterizes polytrauma patients at high risk for VTE occurrence and emphasizes that TBI markedly increases the incidence of DVT and PE in polytrauma patients. Delayed anticoagulant therapy and delayed mechanical prophylaxis were identified as the major risk factors for a higher incidence of VTE in polytrauma patients with TBI.
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Affiliation(s)
- Deng Chen
- Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jialiu Luo
- Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Cong Zhang
- Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Liangsheng Tang
- Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hai Deng
- Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Teding Chang
- Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Huaqiang Xu
- Intensive Care Unit, Trauma Center, Suizhou Central Hospital, Hubei University of Medicine, Suizhou 441300, China
| | - Miaobo He
- Intensive Care Unit, Trauma Center, Suizhou Central Hospital, Hubei University of Medicine, Suizhou 441300, China
| | - Dongli Wan
- Intensive Care Unit, Trauma Center, Suizhou Central Hospital, Hubei University of Medicine, Suizhou 441300, China
| | - Feiyu Zhang
- Department of Trauma Surgery, Trauma Center, Tianmen First People’s Hospital, Hubei University of Science and Technology, Tianmen 417300, China
| | - Mengfan Wu
- Department of Trauma Surgery, Trauma Center, Tianmen First People’s Hospital, Hubei University of Science and Technology, Tianmen 417300, China
| | - Min Qian
- Department of Emergency Medicine, The People’s Hospital of China Three Gorges University, China Three Gorges University, Yichang 443000, China
| | - Wen Zhou
- Department of Emergency Medicine, The People’s Hospital of China Three Gorges University, China Three Gorges University, Yichang 443000, China
| | - Gang Yin
- Department of Trauma Surgery, Trauma Center, Tianmen First People’s Hospital, Hubei University of Science and Technology, Tianmen 417300, China
| | - Wenguo Wang
- Intensive Care Unit, Trauma Center, Suizhou Central Hospital, Hubei University of Medicine, Suizhou 441300, China
| | - Liming Dong
- Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhaohui Tang
- Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Störmann P, Krämer S, Raab S, Kalverkamp S, Graeff P. [Pathophysiology, Diagnostics and Therapy of Pulmonary Contusion - Recommendations of the Interdisciplinary Group on Thoracic Trauma of the Section NIS of the German Society for Trauma Surgery (DGU) and the German Society for Thoracic Surgery (DGT)]. Zentralbl Chir 2023; 148:50-56. [PMID: 36716768 DOI: 10.1055/a-1991-9599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Pulmonary contusion usually occurs in combination with other injuries and is indicative of a high level of force. Especially in multiply injured patients, pulmonary contusions are frequently detected. The injury is characterised by dynamic development, which might result in difficulties in recognising the actual extent of the injury at an early stage. Subsequently, correct classification of the extent of injury and appropriate initiation of therapeutic steps are essential to achieve the best possible outcome. The main goal of all therapeutic measures is to preserve lung function as best as possible and to avoid associated complications such as the development of pneumonia or Acute Respiratory Distress Syndrome (ARDS).The present report from the interdisciplinary working group "Chest Trauma" of the German Society for Trauma Surgery (DGU) and the German Society for Thoracic Surgery (DGT) includes an extensive literature review on the background, diagnosis and treatment of pulmonary contusion. Without exception, papers with a low level of evidence were included due to the lack of studies with large cohorts of patients or randomised controlled studies. Thus, the recommendations given in the present article correspond to a consensus of the aforementioned interdisciplinary working group.Computed tomography (CT) of the chest is recommended for initial diagnosis; the extent of pulmonary contusion correlates with the incidence and severity of complications. A conventional chest X-ray may initially underestimate the injury, but is useful during short-term follow-up.Therapy for pulmonary contusion is multimodal and symptom-based. In particular, intensive care therapy with lung-protective ventilation and patient positioning are key factors of treatment. In addition to invasive ventilation, non-invasive ventilation should be considered if the patient's comorbidities and compliance allows this. Furthermore, depending on the extent of the lung injury and the general patient's condition, ECMO therapy may be considered as an ultima ratio. In particular, this should only be performed at specialised hospitals, which is why patient assignment or anticipation of early transfer of the patient should be anticipated at an early time during the course.
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Affiliation(s)
- Philipp Störmann
- Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Sebastian Krämer
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Stephan Raab
- Thoracic Surgery, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | | | - Pascal Graeff
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
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Zivkovic AR, Paul GM, Hofer S, Schmidt K, Brenner T, Weigand MA, Decker SO. Increased Enzymatic Activity of Acetylcholinesterase Indicates the Severity of the Sterile Inflammation and Predicts Patient Outcome following Traumatic Injury. Biomolecules 2023; 13:biom13020267. [PMID: 36830636 PMCID: PMC9952955 DOI: 10.3390/biom13020267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Traumatic injury induces sterile inflammation, an immune response often associated with severe organ dysfunction. The cholinergic system acts as an anti-inflammatory in injured patients. Acetylcholinesterase (AChE), an enzyme responsible for the hydrolysis of acetylcholine, plays an essential role in controlling cholinergic activity. We hypothesized that a change in the AChE activity might indicate the severity of the traumatic injury. This study included 82 injured patients with an Injury Severity Score (ISS) of 4 or above and 40 individuals without injuries. Bedside-measured AChE was obtained on hospital arrival, followed by a second measurement 4-12 h later. C-reactive protein (CRP), white blood cell count (WBCC), and Sequential Organ Failure Assessment (SOFA) score were simultaneously collected. Injured patients showed an early and sustained increase in AChE activity. CRP remained unaffected at hospital admission and increased subsequently. Initially elevated WBCC recovered 4-12 h later. AChE activity directly correlated with the ISS and SOFA scores and predicted the length of ICU stay when measured at hospital admission. An early and sustained increase in AChE activity correlated with the injury severity and could predict the length of ICU stay in injured patients, rendering this assay a complementary diagnostic and prognostic tool at the hand of the attending clinician in the emergency unit.
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Affiliation(s)
- Aleksandar R. Zivkovic
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Correspondence: (A.R.Z.); (S.O.D.); Tel.: +49-(0)-62-21-56-36-843 (A.R.Z.); +49-(0)-62-21-56-36-380 (S.O.D.); Fax: +49-(0)-62-21-56-53-45 (A.R.Z. & S.O.D.)
| | - Georgina M. Paul
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Stefan Hofer
- Clinic for Anesthesiology, Intensive Care, Emergency Medicine I and Pain Therapy, Westpfalz Hospital, 67661 Kaiserslautern, Germany
| | - Karsten Schmidt
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Markus A. Weigand
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Sebastian O. Decker
- Department of Anesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Correspondence: (A.R.Z.); (S.O.D.); Tel.: +49-(0)-62-21-56-36-843 (A.R.Z.); +49-(0)-62-21-56-36-380 (S.O.D.); Fax: +49-(0)-62-21-56-53-45 (A.R.Z. & S.O.D.)
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Luckscheiter A, Zink W, Lohs T, Eisenberger J, Thiel M, Viergutz T. Machine learning for the prediction of preclinical airway management in injured patients: a registry-based trial. Clin Exp Emerg Med 2022; 9:304-313. [PMID: 36418016 PMCID: PMC9834832 DOI: 10.15441/ceem.22.335] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/16/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the feasibility of using machine learning to establish the need for preclinical airway management for injured patients based on a standardized emergency dataset. METHODS A registry-based, retrospective analysis was conducted of adult trauma patients who were treated by physician-staffed emergency medical services in southwestern Germany between 2018 and 2020. The primary outcome was to assess the feasibility of using the random forest (RF) and Naive Bayes (NB) machine learning algorithms to predict the need for preclinical airway management. The secondary outcome was to use a principal component analysis to determine the attributes that can be used and advanced for future model development. RESULTS In total, 25,556 adults with multiple injuries were identified, including 1,451 patients (5.7%) who required airway management. Key attributes were auscultation, injury pattern, oxygen therapy, thoracic drainage, noninvasive ventilation, catecholamines, pelvic sling, colloid infusion, initial vital signs, preemergency status, and shock index. The area under the receiver operating characteristics curve was between 0.96 (RF; 95% confidence interval [CI], 0.96-0.97) and 0.93 (NB; 95% CI, 0.92-0.93; P<0.01). For the prediction of airway management, RF yielded a higher precision-recall area than NB (0.83 [95% CI, 0.8-0.85] vs. 0.66 [95% CI, 0.61-0.72], respectively; P<0.01). CONCLUSION To predict the need for preclinical airway management in injured patients, attributes that are commonly recorded in standardized datasets can be used with machine learning. In future models, the RF algorithm could be used because it has robust prediction accuracy.
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Affiliation(s)
- André Luckscheiter
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Ludwigshafen Municipal Hospital, Ludwigshafen, Germany,Correspondence to: André Luckscheiter Department of Anesthesiology, Intensive Care and Emergency Medicine, Ludwigshafen Municipal Hospital, Bremserstrasse 79, Ludwigshafen 67063, Germany E-mail:
| | - Wolfgang Zink
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Ludwigshafen Municipal Hospital, Ludwigshafen, Germany
| | - Torsten Lohs
- Center for Quality Management in Emergency Medical Services Baden-Wuerttemberg (SQR-BW), Stuttgart, Germany
| | - Johanna Eisenberger
- Center for Quality Management in Emergency Medical Services Baden-Wuerttemberg (SQR-BW), Stuttgart, Germany
| | - Manfred Thiel
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Tim Viergutz
- Clinic for Anesthesia, Intensive Care and Pain Therapy, BG Trauma Center Tuebingen, Tuebingen, Germany
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Multifactorial Shock: A Neglected Situation in Polytrauma Patients. J Clin Med 2022; 11:jcm11226829. [PMID: 36431304 PMCID: PMC9698644 DOI: 10.3390/jcm11226829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Shock after traumatic injury is likely to be hypovolemic, but different types of shock (distributive shock, obstructive shock, or cardiogenic shock) can occur in combination, known as multifactorial shock. Multifactorial shock is a neglected area of study, and is only reported sporadically. Little is known about the incidence, characteristics, and outcomes of multifactorial shock after polytrauma. Methods: A retrospective, observational, multicenter study was conducted in four Level I trauma centers involving 1051 polytrauma patients from June 2020 to April 2022. Results: The mean Injury Severity Score (ISS) was 31.1, indicating a severely injured population. The most common type of shock in the early phase after polytrauma (≤48 h) is hypovolemic shock (83.2%), followed by distributive shock (14.4%), obstructive shock (8.7%), and cardiogenic shock (3.8%). In the middle phase after polytrauma (>48 h or ≤14 days), the most common type of shock is distributive shock (70.7%), followed by hypovolemic shock (27.2%), obstructive shock (9.9%), and cardiogenic shock (7.2%). Multifactorial shock accounted for 9.7% of the entire shock population in the early phase and 15.2% in the middle phase. In total, seven combinations of multifactorial shock were described. Patients with multifactorial shock have a significantly higher complication rate and mortality than those with single-factor shock. Conclusions: This study characterizes the incidence of various types of shock in different phases after polytrauma and emphasizes that different types of shock can occur simultaneously or sequentially in polytrauma patients. Multifactorial shock has a relatively high incidence and mortality in polytrauma patients, and trauma specialists should be alert to the possibility of their occurrence.
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Häske D, Blumenstock G, Hossfeld B, Wölfl C, Schweigkofler U, Stock JP. The Immo Traffic Light System as a Decision-Making Tool for Prehospital Spinal Immobilization. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:753-758. [PMID: 35978468 PMCID: PMC9853232 DOI: 10.3238/arztebl.m2022.0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 01/24/2022] [Accepted: 07/21/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Spinal injuries are difficult injuries to assess yet can be associated with significant neurological damage. To avoid secondary damage, immobilization is considered state of the art trauma care. The indication for spinal immobilization must be assessed, however, for potential complications as well as its advantages and disadvantages. METHODS This systematic review addressing the question of the correct indication for spinal immobilization in trauma patients was compiled on the basis of our previously published analysis of possible predictors from the Trauma Registry of the German Society for Trauma Surgery. A Delphi procedure was then used to develop suggestions for action regarding immobilization based on the results of this review. RESULTS The search of the literature yielded 576 publications. The 24 publications included in the qualitative analysis report of 2 228 076 patients. A decision tool for spinal immobilization in prehospital trauma care was developed (Immo traffic light system) based on the results of the Delphi procedure. According to this system, severely injured patients with blunt trauma, severe traumatic brain injury, peripheral neurological symptoms, or spinal pain requiring treatment should be immobilized. Patients with a statistically increased risk of spinal injury as a result of the four cardinal features (fall >3m, severe trunk injury, supra clavicular injury, seniority [age >65 years]) should only have their spinal motion restricted after weighing up the pros and cons. Isolated penetrating trunk injuries should not be immobilized. CONCLUSION High-quality studies demonstrating the benefit of prehospital spinal immobilization are still lacking. Decision tools such as the Immo traffic light system can help weigh up the pros and cons of immobilization.
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Affiliation(s)
- David Häske
- Center for Public Health and Health Services Research, University Hospital of Tübingen, and German Red Cross Emergency Services Reutlingen,*Center for Public Health and Health Services Research University Hospital of Tübingen Osianderstr. 5 72076 Tübingen, Germany
| | - Gunnar Blumenstock
- Institute of Clinical Epidemiology and Applied Biometry, University Hospital of Tübingen
| | - Björn Hossfeld
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Federal Armed Forces Hospital of Ulm
| | - Christoph Wölfl
- Department for Orthopedic Surgery, Trauma and Sports Traumatology – Hand and Plastic Surgery, Musculoskeletal Center Neuwied, Marienhaus Hospital Neuwied
| | - Uwe Schweigkofler
- Department of Trauma and Orthopedic Surgery, BG Trauma Center, Frankfurt am Main
| | - Jan-Philipp Stock
- Department for Anesthesiology, Intensive Care Medicine, Emergency Medicine, Pain Therapy and Palliative Care, am Steinenberg Hospital, Reutlingen: Jan-Philipp Stock
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Nau C, Weber B, Marzi I. [Treatment of prehospital emergencies and multiple trauma]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:776-779. [PMID: 36042052 DOI: 10.1007/s00113-022-01230-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Christoph Nau
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Goethe Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Birte Weber
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Goethe Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Ingo Marzi
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Goethe Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
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Stefanou N, Arnaoutoglou C, Papageorgiou F, Matsagkas M, Varitimidis SE, Dailiana ZH. Update in combined musculoskeletal and vascular injuries of the extremities. World J Orthop 2022; 13:411-426. [PMID: 35633747 PMCID: PMC9125001 DOI: 10.5312/wjo.v13.i5.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/31/2021] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
Combined musculoskeletal and vascular injuries of the extremities are conditions in which a multidisciplinary approach is a sine qua non to ensure life initially and limb viability secondarily. Vascular injuries as part of musculoskeletal trauma are usually the result of the release of a high energy load in the wound site so that the prognosis is determined by the degree of soft-tissue damage, duration of limb ischemia, patient's medical status and presence of associated injuries. The management of these injuries is challenging and requires a specific algorithm of action, because they are usually characterized by increased morbidity, amputation rate, infection, neurological and functional deficits, and they could be life threatening. Although vascular injuries are rare and occur either isolated or in the context of major combined musculoskeletal trauma, the high index of suspicion, imaging control, and timely referral of the patient to organized trauma centers ensure the best functional outcome of the extremity in such challenging cases. Even after a successful initial treatment of a combined trauma pattern, long-term follow-up is crucial to prevent and detect early possible complications. The purpose of this manuscript is to provide an update on diagnosis and treatment of combined musculoskeletal and vascular injuries of the extremities, from an orthopedic point of view.
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Affiliation(s)
- Nikolaos Stefanou
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Christina Arnaoutoglou
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Fotios Papageorgiou
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Miltiadis Matsagkas
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Sokratis E Varitimidis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
- Department of Hand, Upper Extremity and Microsurgery, IASO Thessalias, Larissa 41500, Greece
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Becker L, Schulz-Drost S, Spering C, Franke A, Dudda M, Kamp O, Lefering R, Matthes G, Bieler D. Impact of Time of Surgery on the Outcome after Surgical Stabilization of Rib Fractures in Severely Injured Patients with Severe Chest Trauma—A Matched-Pairs Analysis of the German Trauma Registry. Front Surg 2022; 9:852097. [PMID: 35647014 PMCID: PMC9130625 DOI: 10.3389/fsurg.2022.852097] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeIn severely injured patients with multiple rib fractures, the beneficial effect of surgical stabilization is still unknown. The existing literature shows divergent results, and the indication and especially the right timing of an operation are the subject of a broad discussion. The aim of this study was to determine the influence of the time point of surgical stabilization of rib fractures (SSRF) on the outcome in a multicenter database with special regard to the duration of ventilation, intensive care, and overall hospital stay.MethodsData from the TraumaRegister DGU collected between 2010 and 2019 were used to evaluate patients above 16 years of age with severe rib fractures [Abbreviated Injury Score (AIS) ≥ 3] who received an SSRF in a matched-pairs analysis. In this matched-pairs analysis, we compared the effects of an early SSRF within 48 h after initial trauma vs. late SSRF 3–10 days after trauma.ResultsAfter the selection process, we were able to find 142 matched pairs for further evaluation. Early SSRF was associated with a significantly shorter length of stay in the intensive care unit (16.2 days vs. 12.7 days, p = 0.020), and the overall hospital stay (28.5 days vs. 23.4 days, p = 0.005) was significantly longer in the group with late SSRF. Concerning the days on mechanical ventilation, we were able to demonstrate a trend for an approximately 1.5 day shorter ventilation time for patients after early SSRF, although this difference was not statistically significant (p = 0.226).ConclusionsWe were able to determine the significant beneficial effects of early SSRF resulting in a shorter intensive care unit stay and a shorter length of stay in hospital and additionally a trend to a shorter time on mechanical ventilation.
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Affiliation(s)
- L. Becker
- Department of Trauma Surgery, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
- Correspondence: L. Becker
| | - S. Schulz-Drost
- Department of Trauma Surgery, Helios Hospital Schwerin, Schwerin, Germany
- Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Erlangen, Germany
| | - C. Spering
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Hospital Göttingen Medical Center, Göttingen, Germany
| | - A. Franke
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Hand Surgery, Burn Medicine, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - M. Dudda
- Department of Trauma Surgery, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - O. Kamp
- Department of Trauma Surgery, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - R. Lefering
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany
| | - G. Matthes
- Department of Trauma Surgery and Reconstructive Surgery, Ernst von Bergmann Hospital, Potsdam, Germany
| | - D. Bieler
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Hand Surgery, Burn Medicine, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
- Department of Orthopaedics and Trauma Surgery, Heinrich Heine University Hospital, Düsseldorf, Germany
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Diagnostic value of chest radiography in the early management of severely injured patients with mediastinal vascular injury. Eur J Trauma Emerg Surg 2022; 48:4223-4231. [PMID: 35389063 PMCID: PMC9532297 DOI: 10.1007/s00068-022-01966-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/23/2022] [Indexed: 11/12/2022]
Abstract
Introduction Time is of the essence in the management of severely injured patients. This is especially true in patients with mediastinal vascular injury (MVI). This rare, yet life threatening injury needs early detection and immediate decision making. According to the ATLS guidelines [American College of Surgeon Committee on Trauma in Advanced Trauma Life Support (ATLS®), 10th edn, 2018], chest radiography (CXR) is one of the first-line imaging examinations in the Trauma Resuscitation Unit (TRU), especially in patients with MVI. Yet thorough interpretation and the competence of identifying pathological findings are essential for accurate diagnosis and drawing appropriate conclusion for further management. The present study evaluates the role of CXR in detecting MVI in the early management of severely injured patients. Method We addressed the question in two ways. (1) We performed a retrospective, observational, single-center study and included all primary blunt trauma patients over a period of 2 years that had been admitted to the TRU of a Level-I Trauma Center. Mediastinal/chest (M/C) ratio measurements were calculated from CXRs at three different levels of the mediastinum to identify MVI. Two groups were built: with MVI (VThx) and without MVI (control). The accuracy of the CXR findings were compared with the results of whole-body computed tomography scans (WBCT). (2) We performed another retrospective study and evaluated the usage of sonography, CXR and WBCT over 15 years (2005–2019) in level-I–III Trauma Centers in Germany as documented in the TraumaRegister DGU® (TR-DGU). Results Study I showed that in 2 years 267 patients suffered from a significant blunt thoracic trauma (AIS ≥ 3) and met the inclusion criteria. 27 (10%) of them suffered MVI (VThx). Through the initial CXR in a supine position, MVI was detected in 56–92.6% at aortic arch level and in 44.4–100% at valve level, depending on different M/C-ratios (2.0–3.0). The specificity at different thresholds of M/C ratio was 63.3–2.9% at aortic arch level and 52.9–0.4% at valve level. The ROC curve showed a statistically random process. No significant differences of the cardiac silhouette were observed between VThx and Control (mean cardiac width was 136.5 mm, p = 0.44). Study II included 251,095 patients from the TR-DGU. A continuous reduction of the usage of CXR in the TRU could be observed from 75% in 2005 to 25% in 2019. WBCT usage increased from 35% in 2005 to 80% in 2019. This development was observed in all trauma centers independently from their designated level of care. Conclusion According to the TRU management guidelines (American College of Surgeon Committee on Trauma in Advanced Trauma Life Support (ATLS®), 10th edn, 2018; Reissig and Kroegel in Eur J Radiol 53:463–470, 2005) CXR in supine position is performed to detect pneumothorax, hemothorax and MVI. Our study showed that sensitivity and specificity of CXR in detecting MVI was statistically and clinically not reliable. Previous studies have already shown that CXR is inferior to sonography in detecting pneumothorax and hemothorax. Therefore, we challenge the guidelines and suggest that the use of CXR in the early management of severely injured patients should be individualized. If sonography and WBCT are available and reasonable, CXR is unnecessary and time consuming. The clinical reality reflected in the usage of CXR and WBCT over time, as documented in the TR-DGU, seems to support our statement.
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Prevention of severe injuries of child passengers in motor vehicle accidents: is re-boarding sufficient? Eur J Trauma Emerg Surg 2022; 48:3989-3996. [PMID: 35364691 PMCID: PMC9532307 DOI: 10.1007/s00068-022-01917-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/12/2022] [Indexed: 11/12/2022]
Abstract
Purpose The purpose of this study was to evaluate whether prolonged re-boarding of restraint children in motor vehicle accidents is sufficient to prevent severe injury. Methods Data acquisition was performed using the Trauma Register DGU® (TR-DGU) in the time period from 2010 to 2019 of seriously injured children (AIS 2 +) aged 0–5 years as motor vehicle passengers (MVP). Primarily treated and transferred patients where included. Results The study group included 727 of 2030 (35.8%) children, who were severely injured (AIS 2 +) in road traffic accidents, among them 268 (13.2%) as MVPs in the age groups: 0–1 years (42.5%), 2–3 years (26.1%) and 4–5 years (31.3%). The pattern of severe injury was head/brain (56.0%), thoracic (42.2%), abdominal (13.1%), fractures (extremities and pelvis, 52.6%) and spine/severe whiplash (19.8%). The 0–1-year-old MVPs showed the significantly highest proportion of brain injuries with Glasgow Coma Score (GCS) < 8 and severe injury to the spine. The 2–3-year-olds showed the significantly highest proportion of fractures especially the lower extremity and highest proportion of cervical spine injuries of all spine injuries, while the 4–5-year-olds, the significantly highest proportion of abdominal injury and second highest proportion of cervical spine injury of all spine injuries. MVPs of the 0–1-year-old and 2–3-year-old groups showed a higher median Injury Severity Score (ISS) of 21.5 and 22.1 points than the older children (17.0 points). They also suffered an AIS-6-injury significantly more often (9 of 21) of spine (p = 0.001). Especially the cervical spine was significantly more often involved. Passengers at the age of 0–1 years were treated with cardiopulmonary resuscitation (CPR) three times as often as older children in the prehospital setting and twice as often at admission in the Trauma Resuscitation Unit (TRU). Their survival rate was 7 out of 8 (0–1 years), 1 out of 6 (2–3 years) and 1 out of 4 (4–5 years). Conclusion Although the younger MVPs are restraint in a re-boarding position, severe injury to the spine and head occurred more often, while older children as front-faced positioned MVPs suffered from significantly higher rates of abdominal and more often severe facial injury. Our data show, that it is more important to properly restrain children in their adequate car seats (i-size-Norm) and additionally consider the age-related physiological and anatomical specific risks of injury as well as co-factors in road traffic accidents, than only prolonging the re-boarding position over the age of 15 months as a single method.
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A retrospective cohort study on association of age and physician decision making for or against rapid sequence intubation in unconscious patients. Sci Rep 2022; 12:3336. [PMID: 35228569 PMCID: PMC8885918 DOI: 10.1038/s41598-022-06787-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/04/2022] [Indexed: 11/08/2022] Open
Abstract
In unconscious individuals, rapid sequence intubation (RSI) may be necessary for cardiopulmonary stabilisation and avoidance of secondary damage. Opinions on such invasive procedures in people of older age vary. We thus sought to evaluate a possible association between the probability of receiving prehospital RSI in unconsciousness and increasing age. We conducted a retrospective study in all missions (traumatic and non-traumatic) of the prehospital emergency physician response unit in Graz between January 1st, 2010 and December 31st, 2019, which we searched for Glasgow Coma Scale (GCS) below 9. Cardiac arrests were excluded. We performed multivariable regression analysis for RSI with age, GCS, independent living, and suspected cause as independent variables. Of the 769 finally included patients, 256 (33%) received RSI, whereas 513 (67%) did not. Unadjusted rates of RSI were significantly lower in older patients (aged 85 years and older) compared to the reference group aged 50-64 years (13% vs. 51%, p < 0.001). In multivariable regression analysis, patients aged 85 years and older were also significantly less likely to receive RSI [OR (95% CI) 0.76 (0.69-0.84)]. We conclude that advanced age, especially 85 years or older, is associated with significantly lower odds of receiving prehospital RSI in cases of unconsciousness.
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Becker L, Schulz-Drost S, Spering C, Franke A, Dudda M, Lefering R, Matthes G, Bieler D. Effect of surgical stabilization of rib fractures in polytrauma: an analysis of the TraumaRegister DGU ®. Eur J Trauma Emerg Surg 2022; 48:2773-2781. [PMID: 35118558 PMCID: PMC9360126 DOI: 10.1007/s00068-021-01864-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 12/26/2021] [Indexed: 11/29/2022]
Abstract
Purpose In severely injured patients with multiple rib fractures the beneficial effect of surgical stabilization is still unknown. The existing literature shows divergent results and especially the indication and the right timing of an operation are subject of a broad discussion. The aim of this study was to determine the influence of a surgical stabilization of rib fractures (SSRF) on the outcome in a multi-center database with special regard to the duration of ventilation, intensive care and overall hospital stay. Methods Data from the TraumaRegister DGU® collected between 2008 and 2017 were used to evaluate patients over 16 years with severe rib fractures (AIS ≥ 3). In addition to the basic comparison a matched pair analysis of 395 pairs was carried out in order to find differences and to increase comparability. Results In total 483 patients received an operative treatment and 29,447 were treated conservatively. SSRF was associated with a significantly lower mortality rate (7.6% vs. 3.3%, p = 0.008) but a longer ventilation time and longer stay as well as in the intensive care unit (ICU) as the overall hospital stay. Both matched pair groups showed a good or very good neurological outcome according to the Glasgow Outcome Scale (GOS) in 4 of 5 cases. Contrary to the existing recommendations most of the patients were not operated within 48 h. Conclusions In our data set, obviously most of the patients were not treated according to the recent literature and showed a delay in the time for operative care of well over 48 h. This may lead to an increased rate of complications and a longer stay at the ICU and the hospital in general. Despite of these findings patients with operative treatment show a significant lower mortality rate.
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Affiliation(s)
- Lars Becker
- Department of Trauma Surgery, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany.
| | - Stefan Schulz-Drost
- Department of Trauma Surgery, Helios Hospital Schwerin, Schwerin, Germany.,Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Christopher Spering
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Hospital Göttingen Medical Center, Göttingen, Germany
| | - Axel Franke
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Hand Surgery, Burn Medicine, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Marcel Dudda
- Department of Trauma Surgery, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany
| | - Gerrit Matthes
- Department of Trauma Surgery and Reconstructive Surgery, Ernst Von Bergmann Hospital, Potsdam, Germany
| | - Dan Bieler
- Department of Trauma Surgery and Orthopaedics, Reconstructive and Hand Surgery, Burn Medicine, German Armed Forces Central Hospital Koblenz, Koblenz, Germany.,Department of Orthopaedics and Trauma Surgery, Heinrich Heine University Hospital, Düsseldorf, Düsseldorf, Germany
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Hörauf JA, Nau C, Mühlenfeld N, Verboket RD, Marzi I, Störmann P. Injury Patterns after Falling down Stairs-High Ratio of Traumatic Brain Injury under Alcohol Influence. J Clin Med 2022; 11:jcm11030697. [PMID: 35160145 PMCID: PMC8836855 DOI: 10.3390/jcm11030697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 02/04/2023] Open
Abstract
Falling down a staircase is a common mechanism of injury in patients with severe trauma, but the effect of varying fall height according to the number of steps on injury patterns in these patients has been little studied. In this retrospective study, prospectively collected data from a Level 1 Trauma Center in Germany were analyzed regarding the injury patterns of patients admitted through the trauma room with suspicion of multiple injuries following a fall down a flight of stairs between January 2016 and December 2019. In total 118 patients were examined which where consecutively included in this study. More than 80% of patients suffered a traumatic brain injury, which increased as a function of the number of stairs fallen. Therefore, the likelihood of intracranial hemorrhage increased with higher numbers of fallen stairs. Fall-associated bony injuries were predominantly to the face, skull and the spine. In addition, there was a high coincidence of staircase falls and alcohol intake. Due to a frequent coincidence of staircase falls and alcohol, the (pre-)clinical neurological assessment is complicated. As the height of the fall increases, severe traumatic brain injury should be anticipated and diagnostics to exclude intracranial hemorrhage and spinal injuries should be performed promptly to ensure the best possible patient outcome.
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Gottlieb J, Capetian P, Hamsen U, Janssens U, Karagiannidis C, Kluge S, Nothacker M, Roiter S, Volk T, Worth H, Fühner T. German S3 Guideline: Oxygen Therapy in the Acute Care of Adult Patients. Respiration 2021; 101:214-252. [PMID: 34933311 DOI: 10.1159/000520294] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Oxygen (O2) is a drug with specific biochemical and physiological properties, a range of effective doses and may have side effects. In 2015, 14% of over 55,000 hospital patients in the UK were using oxygen. 42% of patients received this supplemental oxygen without a valid prescription. Health care professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. METHODS A national S3 guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. A literature search was performed until February 1, 2021, to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System ("The Oxford 2011 Levels of Evidence") was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of evidence and for grading guideline recommendation, and a formal consensus-building process was performed. RESULTS The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are based depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. CONCLUSION This is the first national guideline on the use of oxygen in acute care. It addresses health care professionals using oxygen in acute out-of-hospital and in-hospital settings.
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Affiliation(s)
- Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Philipp Capetian
- Department of Neurology, University Hospital Würzburg, Wuerzburg, Germany
| | - Uwe Hamsen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Uwe Janssens
- Medical Clinic and Medical Intensive Care Medicine, St. Antonius Hospital, Eschweiler, Germany
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany
| | - Stefan Kluge
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Nothacker
- AWMF-Institute for Medical Knowledge Management, Marburg, Germany
| | - Sabrina Roiter
- Intensive Care Unit, Israelite Hospital Hamburg, Hamburg, Germany
| | - Thomas Volk
- Department of Anesthesiology, University Hospital of Saarland, Saarland University, Homburg, Germany
| | | | - Thomas Fühner
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory Medicine, Siloah Hospital, Hannover, Germany
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Schindler CR, Woschek M, Franz JN, Störmann P, Henrich D, Marzi I. Influence of Antibiotic Management on Microbial Selection and Infectious Complications After Trauma. Front Med (Lausanne) 2021; 8:678382. [PMID: 34568354 PMCID: PMC8461005 DOI: 10.3389/fmed.2021.678382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The inflammatory response and post-traumatic complications like infections play an important role in the pathophysiology of severe injuries. This study examines the microbiological aspects in anti-infective treatment of trauma patients and their inflammatory response in post-traumatic infections complications. Patients and Methods: A retrospective analysis of prospectively collected data in trauma patients (ISS ≥ 16) over a 1-year period (01/2018 to 12/2018) is provided. Patient population was stratified into severely injured patients without post-traumatic infection (inf-PT), and severely injured patients who developed an infection (inf+PT). Results: Of 114 trauma patients, 45 suffered from post-traumatic infection during the first 10 days of hospitalization. Severely injured patients with concomitant traumatic brain injury (PT+TBI) showed the highest rate of post-traumatic infection. Pro-inflammatory reaction was tracked by levels of Interleukin (IL-)6 (day 3: inf+T 190.8 ± 359.4 pg/dL > inf-PT 56.2 ± 57.7 pg/mL (mean ± SD); p = 0.008) and C-Reactive-Protein (CRP, day 3: inf+PT 15.3 mg/dL > inf-PT 6.7 mg/dL, p = 0.001) which were significantly higher in trauma patients who develop an infectious complication and showed a significant positive correlation with the occurrence of infection. The leading entity of infection was pneumonia followed by infections of the urinary tract mainly caused by gram-negative Enterobacteriaceae. 67.5% of all trauma patients received single-shot antibiosis during initial care in trauma bay. The development of secondary colonization was not relevant positively correlated with single-shot antibiosis (r = 0.013, p = 0.895) and prophylactically calculated antibiotic administration (r = 0.066, p = 0.500). Conclusion: Severely injured trauma patients have an increased risk for development of infectious complications, which mainly is pneumonia followed by infection of the urinary tract mainly caused by gram-negative Enterobacteriaceae. Based on the data in this study, the one-time antibiotic and prophylactic calculated use of antibiotics, like Cephalosporins must be critically discussed in terms of their role in the development of post-traumatic infections and microbial selection.
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Affiliation(s)
- Cora Rebecca Schindler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Mathias Woschek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Jan-Niklas Franz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Philipp Störmann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Dirk Henrich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
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Jorg T, Heckmann JC, Mildenberger P, Hahn F, Düber C, Mildenberger P, Kloeckner R, Jungmann F. Structured reporting of CT scans of patients with trauma leads to faster, more detailed diagnoses: An experimental study. Eur J Radiol 2021; 144:109954. [PMID: 34563796 DOI: 10.1016/j.ejrad.2021.109954] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 08/13/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to determine whether structured reports (SRs) reduce reporting time and/or increase the level of detail for trauma CT scans compared to free-text reports (FTRs). METHOD Eight radiology residents used SRs and FTRs to describe 14 whole-body CT scans of patients with polytrauma in a simulated emergency room setting. Each resident created both a brief report and a detailed report for each case using one of the two formats. We measured the time to complete the detailed reports and established a scoring system to objectively measure report completeness and the level of detail. Scoring sheets divided the CT findings into main and secondary criteria. Finally, the radiological residents completed a questionnaire on their opinions of the SRs and FTRs. RESULTS The detailed SRs were completed significantly faster than the detailed FTRs (mean 19 min vs. 25 min; p < 0.001). The maximum allowance of 25 min was used for 25% of SRs and 59% of FTRs. For brief reports, the SRs contained more secondary criteria than the FTRs (p = 0.001), but no significant differences were detected in main criteria. Study participants rated their own SRs as significantly more time-efficient, concise, and clearly structured compared to the FTRs. However, SRs and FTRs were rated similarly for quality, accuracy, and completeness. CONCLUSION We found that SRs for whole-body trauma CT add clinical value compared to FTRs because SRs reduce reporting time and increase the level of detail for trauma CT scans.
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Affiliation(s)
- Tobias Jorg
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Julia Caroline Heckmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Philipp Mildenberger
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Peter Mildenberger
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Florian Jungmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
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Gottlieb J, Capetian P, Hamsen U, Janssens U, Karagiannidis C, Kluge S, König M, Markewitz A, Nothacker M, Roiter S, Unverzagt S, Veit W, Volk T, Witt C, Wildenauer R, Worth H, Fühner T. [German S3 Guideline - Oxygen Therapy in the Acute Care of Adult Patients]. Pneumologie 2021; 76:159-216. [PMID: 34474487 DOI: 10.1055/a-1554-2625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oxygen (O2) is a drug with specific biochemical and physiologic properties, a range of effective doses and may have side effects. In 2015, 14 % of over 55 000 hospital patients in the UK were using oxygen. 42 % of patients received this supplemental oxygen without a valid prescription. Healthcare professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. METHODS A S3-guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. Literature search was performed until Feb 1st 2021 to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System ("The Oxford 2011 Levels of Evidence") was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used and for assessing the quality of evidence and for grading guideline recommendation and a formal consensus-building process was performed. RESULTS The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. CONCLUSION This is the first national guideline on the use of oxygen in acute care. It addresses healthcare professionals using oxygen in acute out-of-hospital and in-hospital settings. The guideline will be valid for 3 years until June 30, 2024.
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Affiliation(s)
- Jens Gottlieb
- Klinik für Pneumologie, Medizinische Hochschule Hannover.,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) im Deutschen Zentrum für Lungenforschung (DZL)
| | - Philipp Capetian
- Klinik für Neurologie, Neurologische Intensivstation, Universitätsklinikum Würzburg
| | - Uwe Hamsen
- Fachbereich für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum
| | - Uwe Janssens
- Innere Medizin und internistische Intensivmedizin, Sankt Antonius Hospital GmbH, Eschweiler
| | - Christian Karagiannidis
- Abteilung für Pneumologie und Beatmungsmedizin, ARDS/ECMO Zentrum, Lungenklinik Köln-Merheim
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg
| | - Marco König
- Deutscher Berufsverband Rettungsdienst e. V., Lübeck
| | - Andreas Markewitz
- ehem. Klinik für Herz- und Gefäßchirurgie Bundeswehrzentralkrankenhaus Koblenz
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., Marburg
| | | | | | - Wolfgang Veit
- Bundesverband der Organtransplantierten e. V., Marne
| | - Thomas Volk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Christian Witt
- Seniorprofessor Innere Medizin und Pneumologie, Charité Berlin
| | | | | | - Thomas Fühner
- Krankenhaus Siloah, Klinik für Pneumologie und Beatmungsmedizin, Klinikum Region Hannover.,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) im Deutschen Zentrum für Lungenforschung (DZL)
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Schwarz AM, Hohenberger GM, Grechenig P, Kerner A, Gänsslen A, Staresinic M, Bakota B. The 2-2-2-20-20 concept for supraacetabular schanz screw insertion without additional radiography. Injury 2021; 52 Suppl 5:S58-S62. [PMID: 32736822 DOI: 10.1016/j.injury.2020.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/18/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Application of supraacetabular Schanz screws is usually performed under image intensifier guidance. The aim of this study was to perform it without imaging, with the hypothesis that, respecting anatomical landmarks, pre- and intraoperative fluoroscopy can be avoided. MATERIAL & METHODS Insertion of the supra-acetabular Schanz screws was performed by two trauma surgery residents in a study sample of 14 human adult cadavers which had been embalmed by use of Thiel`s method. With cadavers placed in supine position, the anterior superior iliac spine (ASIS) was palpated. Starting from this landmark, 2 cm were measured in a distal and 2 cm in the medial direction. At this point, a 2 cm long oblique skin incision was performed. Through this approach, 150 mm Schanz screws were drilled bilaterally into the supra-acetabular corridor with an angulation of 20° to distal as well as 20° to medial. Following screw application, combined obturator oblique-outlet views (COOO) were taken bilaterally in each specimen by use of an Arcadis© Orbic 3D C-arm to prove the screw position. Six of the specimens underwent a 3D-CT-scan. Images were evaluated concerning correct screw positioning by a further traumatologist. Skin and subcutaneous tissues were removed in the ilioinguinal region and possible lesions to the lateral femoral cutaneous nerve (LFCN) or to the joint capsule were evaluated. RESULTS The sample consisted of eight pelves from female and six pelves from male cadavers. During radiographic evaluation of the COOO-scans (14 specimens) and the 3D-scans (6 specimens), the Schanz screws were placed inside the supra-acetabular corridor in all specimens (14/14). During dissections, no intracapsular screw placements or LFCN lesions were found. CONCLUSION According to the described anatomical data, we defined a 2-2-2-20-20 concept, starting with a 2 cm skin incision 2 cm distal and 2 cm medial to the ASIS with a drill angulation of 20° inferior and 20° lateral orientation. Using this technique, all Schanz screws could be sufficiently inserted without intraprocedural x-ray imaging.
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Affiliation(s)
- A M Schwarz
- AUVA - Trauma Hospital (UKH) Styria
- Graz, Göstinger Straße 24, 8020, Graz, Austria.
| | - G M Hohenberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - P Grechenig
- Division of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria
| | - A Kerner
- Division of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria
| | - A Gänsslen
- Clinic for Trauma Surgery, Orthopaedics and Hand Surgery, Klinikum Wolfsburg, Sauerbruchstraße 7, 38440, Wolfsburg, Germany
| | - M Staresinic
- General and Sports Trauma Department,University Hospital Merkur Zagreb, Zajceva 19, 10000, Zagreb, Croatia
| | - B Bakota
- Trauma and Orthopaedics department, Medical University Hospital LKH Graz, Austria
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Meng H, Yan JZ, Wang B, Ma ZB, Kang WB, Liu BG. Influence of volar margin of the lunate fossa fragment fixation on distal radius fracture outcomes: A retrospective series. World J Clin Cases 2021; 9:7022-7031. [PMID: 34540957 PMCID: PMC8409212 DOI: 10.12998/wjcc.v9.i24.7022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/13/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Distal radius fractures accompanied by the volar margin of the lunate fossa (VMLF) lesions are often overlooked or inadequately reduced in clinical practice.
AIM To investigate the impact of VMLF fragment in distal radius fractures on the stability and function of the wrist joint.
METHODS This was a retrospective study of patients with distal radius fractures who underwent surgical treatment between January 2013 and December 2017. The patients were divided into two groups according to whether the VMLF fragments were fixed or not. X-rays and computed tomography were performed before surgery, immediately postoperatively, and at 1, 3, and 6 mo to measure the scapholunate angle, radiolunate angle, capitolunate angle, and effective radiolunate flexion (ERLF). The Mayo wrist score and disabilities of the arm, shoulder, and hand (DASH) score were determined at 1 year.
RESULTS Thirty-five patients were included. There were 15 males and 20 females. Their mean age was 52.5 ± 14.3 (range: 19-70) years. There were 38 wrists (17 on the left side, 15 on the right, and three bilateral; 16 in the fixed group, and 22 in the unfixed group). The interval between trauma and surgery was from 1 h to 1 mo. The incidence of postoperative wrist instability in the unfixed group (86.4%) was higher than in the fixed group (25.0%) (P ≤ 0.001). Ten patients had ERLF > 25° in the unfixed group and none in the fixed group (P = 0.019). The Mayo wrist score was 94 ± 5.7 in the fixed group and 68 ± 15.1 in the unfixed group (P < 0.001). The DASH score was 4.6 ± 2.5 in the fixed group and 28.5 ± 19.5 in the unfixed group (P < 0.001).
CONCLUSION Injuries of VMLF, even small fractures, might damage the radial-lunar ligament, leading to postoperative wrist instability, sagittal force line imbalance, and poor recovery of wrist joint function.
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Affiliation(s)
- Hua Meng
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Jia-Zhi Yan
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Bing Wang
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Zong-Bo Ma
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Wei-Bo Kang
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Bao-Ge Liu
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
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Häske D, Gross Z, Atzbach U, Bernhard M, Gather A, Hoedtke J, Hossfeld B, Schele S, Münzberg M. Comparison of manual statements from out-of-hospital trauma training programs and a national guideline on treatment of patients with severe and multiple injuries. Eur J Trauma Emerg Surg 2021; 48:2207-2217. [PMID: 34426883 DOI: 10.1007/s00068-021-01768-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Training programs help establish evidence-based knowledge in prehospital emergency care. This study aimed to compare manual statements from prehospital trauma training programs and evidence-based guidelines on treatment of patients with severe and multiple injuries. METHODS A systematic comparison with the primary endpoint of the highest grades of recommendation (GoR A, "must") of the current version of the German guidelines and recent recommendations of the prehospital trauma training programs International Trauma Life Support (ITLS), Prehospital Trauma Life Support (PHTLS), and Traumamanagement® (TM) based on their official textbooks was done. The recommendations were categorized as agreement or minor or major variation. The comparison was made using a rating system by experts who were blinded to the training programs. If the consensus strength of the experts was < 75%, affected statements were finalized in a Delphi procedure. RESULTS Overall, 92 statements were compared. Fleiss-kappa of the first rating was 0.385 (p < 0.001, 95% CI: 0.376-0.393). Finally, comparable recommendations of the guideline with the training programs in principle agree with the statement of the guidelines were > 90% for all programs. The agreement with GoR A recommendations and each course program were 33.9%, 30.6%, and 35.5% (ITLS, PHTLS, and TM, respectively), p = 0.715. CONCLUSIONS Despite small differences, the training programs showed high degrees of compliance with the guidelines and international agreement with some minor differences. Furthermore, the results did not allow any conclusions regarding the quality of the courses, the didactic methodology, and local adaptability. The practical implementation of the courses is probably even higher and closer to the guidelines.
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Affiliation(s)
- David Häske
- Center of Public Health and Health Services Research, University Hospital Tübingen, Tübingen, Germany.,Emergency Medical Service, German Red Cross, Reutlingen, Germany
| | - Zeno Gross
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, University Hospital Heidelberg, Ludwigshafen, Germany
| | - Ulrich Atzbach
- PHTLS, Academy of the German Association of Emergency Medical Services, Lübeck, Germany
| | - Michael Bernhard
- Emergency Department, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Andreas Gather
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, University Hospital Heidelberg, Ludwigshafen, Germany
| | - Jochen Hoedtke
- Asklepios Klinik Barmbek, Department of Anesthesiology, Intensive and Emergency Medicine, Pain Therapy, Hamburg, Germany.,Trauma Management Network, Training Center Schlump, Hamburg, Germany
| | - Björn Hossfeld
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, HEMS 'Christoph 22', Federal Armed Forces Hospital Ulm, Ulm, Germany
| | - Stephan Schele
- Department of Anesthesiology, Intensive and Emergency Medicine, Klinikverbund Allgäu gGmbH, Immenstadt, Germany.,ITLS-International Trauma Life Support Germany e.V., Mölln, Germany
| | - Matthias Münzberg
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, University Hospital Heidelberg, Ludwigshafen, Germany. .,Department of Rescue and Emergency Medicine, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.
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Imach S, Wafaisade A, Lefering R, Böhmer A, Schieren M, Suárez V, Fröhlich M. The impact of prehospital tranexamic acid on mortality and transfusion requirements: match-pair analysis from the nationwide German TraumaRegister DGU®. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:277. [PMID: 34348782 PMCID: PMC8336395 DOI: 10.1186/s13054-021-03701-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/20/2021] [Indexed: 12/14/2022]
Abstract
Background Outcome data about the use of tranexamic acid (TXA) in civilian patients in mature trauma systems are scarce. The aim of this study was to determine how severely injured patients are affected by the widespread prehospital use of TXA in Germany. Methods The international TraumaRegister DGU® was retrospectively analyzed for severely injured patients with risk of bleeding (2015 until 2019) treated with at least one dose of TXA in the prehospital phase (TXA group). These were matched with patients who had not received prehospital TXA (control group), applying propensity score-based matching. Adult patients (≥ 16) admitted to a trauma center in Germany with an Injury Severity Score (ISS) ≥ 9 points were included. Results The matching yielded two comparable cohorts (n = 2275 in each group), and the mean ISS was 32.4 ± 14.7 in TXA group vs. 32.0 ± 14.5 in control group (p = 0.378). Around a third in both groups received one dose of TXA after hospital admission. TXA patients were significantly more transfused (p = 0.022), but needed significantly less packed red blood cells (p ≤ 0.001) and fresh frozen plasma (p = 0.023), when transfused. Massive transfusion rate was significantly lower in the TXA group (5.5% versus 7.2%, p = 0.015). Mortality was similar except for early mortality after 6 h (p = 0.004) and 12 h (p = 0.045). Among non-survivors hemorrhage as leading cause of death was less in the TXA group (3.0% vs. 4.3%, p = 0.021). Thromboembolic events were not significantly different between both groups (TXA 6.1%, control 4.9%, p = 0.080). Conclusion This is the largest civilian study in which the effect of prehospital TXA use in a mature trauma system has been examined. TXA use in severely injured patients was associated with a significantly lower risk of massive transfusion and lower mortality in the early in-hospital treatment period. Due to repetitive administration, a dose-dependent effect of TXA must be discussed.
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Affiliation(s)
- Sebastian Imach
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany.
| | - Arasch Wafaisade
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - Andreas Böhmer
- Department of Anaesthesiology and Intensive Care Medicine, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
| | - Mark Schieren
- Department of Anaesthesiology and Intensive Care Medicine, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
| | - Victor Suárez
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Matthias Fröhlich
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
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Johannsen S, Brohi K, Johansson PI, Moore EE, Reinhold AK, Schöchl H, Shepherd JM, Slater B, Stensballe J, Zacharowski K, Meybohm P. Getting hit by the bus around the world - a global perspective on goal directed treatment of massive hemorrhage in trauma. Curr Opin Anaesthesiol 2021; 34:537-543. [PMID: 34074885 DOI: 10.1097/aco.0000000000001025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Major trauma remains one of the leading causes of death worldwide with traumatic brain injury and uncontrolled traumatic bleeding as the main determinants of fatal outcome. Interestingly, the therapeutic approach to trauma-associated bleeding and coagulopathy shows differences between geographic regions, that are reflected in different guidelines and protocols. RECENT FINDINGS This article summarizes main principles in coagulation diagnostics and compares different strategies for treatment of massive hemorrhage after trauma in different regions of the world. How would a bleeding trauma patient be managed if they got hit by the bus in the United States, United Kingdom, Germany, Switzerland, Austria, Denmark, Australia, or in Japan? SUMMARY There are multiple coexistent treatment standards for trauma-induced coagulopathy in different countries and different trauma centers. Most of them initially follow a protocol-based approach and subsequently focus on predefined clinical and laboratory targets.
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Affiliation(s)
- Stephan Johannsen
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Karim Brohi
- Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Pär I Johansson
- Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ernest E Moore
- Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, Colorado, USA
| | - Ann-Kristin Reinhold
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Herbert Schöchl
- Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria
| | - Joanna M Shepherd
- Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ben Slater
- Department of Anaesthesia and Acute Pain Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Jakob Stensballe
- Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Anesthesia and Trauma Center, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
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48
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Jensen KO, Teuben MPJ, Lefering R, Halvachizadeh S, Mica L, Simmen HP, Pfeifer R, Pape HC, Sprengel K. Pre-hospital trauma care in Switzerland and Germany: do they speak the same language? Eur J Trauma Emerg Surg 2021; 47:1273-1280. [PMID: 31996977 PMCID: PMC7223374 DOI: 10.1007/s00068-020-01306-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/14/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Swiss and German (pre-)hospital systems, distribution and organization of trauma centres differ from each other. It is unclear if outcome in trauma patients differs as well. Therefore, this study aims to determine differences in characteristics, therapy and outcome of trauma patients between both German-speaking countries. METHODS The TraumaRegister DGU® (TR-DGU) was used. Patients with Injury Severity Score ≥ 9 admitted to a level 1 trauma centre between 01/2009 and 12/2017 were included if they required ICU care or died. Trauma pattern, pre-hospital procedures and outcome were compared between Swiss (CH, n = 4768) and German (DE, n = 66,908) groups. RESULTS Swiss patients were older than German patients (53 vs. 50 years). ISS did not differ between groups (CH 23.8 vs. DE 23.0 points). There were more low falls < 3 m (34% vs. 21%) at the expense of less traffic accidents (37% vs. 52%) in the Swiss population. In Switzerland 30% of allocations were done without physician involvement, whereas this occurred in 4% of German cases. Despite a comparable number of patients with a GCS ≤ 8 (CH 29.6%; DE 26.4%), differences in pre-hospital intubation rates occurred (CH 31% vs. DE 40%). Severe traumatic brain injuries were diagnosed most frequently in Switzerland (CH 62% vs. DE 49%). Admission vital signs were similar, and standardized mortality ratios were close to one in both countries. CONCLUSION This study demonstrates that patients' age, trauma patterns and pre-hospital care differ between Germany and Switzerland. However, adjusted mortality was almost similar. Further benchmarking studies are indicated to optimize trauma care in both German-speaking countries.
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Affiliation(s)
- Kai Oliver Jensen
- Division of Trauma Surgery, Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Michel Paul Johan Teuben
- Division of Trauma Surgery, Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - Sascha Halvachizadeh
- Division of Trauma Surgery, Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ladislav Mica
- Division of Trauma Surgery, Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Hans-Peter Simmen
- Division of Trauma Surgery, Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Roman Pfeifer
- Division of Trauma Surgery, Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Hans-Christoph Pape
- Division of Trauma Surgery, Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Kai Sprengel
- Division of Trauma Surgery, Department of Trauma, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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Summer T, Abou Mrad M, Bota O, Bienger K, Dragu A. Multistep reconstruction of a post-traumatic defect in the lower limb with AV loop and free myocutaneous latissimus dorsi flap combined with a perforator monitor skin island after loss of ALT flap. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2021; 10:Doc05. [PMID: 34194916 PMCID: PMC8204669 DOI: 10.3205/iprs000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Crush injuries of the lower extremity with extensive osseous and soft tissue damage impose a big challenge even for an interdisciplinary reconstructive approach. Multistep reconstruction with negative wound pressure therapy for soft tissue management and external fixation for osseous stability preceding free flap transfer leads to optimized outcome. We report the successful multistep reconstruction of a third-degree open right tibial fracture with extensive soft tissue defect with an arteriovenous loop preceding latissimus dorsi flap coverage with a perforator skin island after loss of an anterior lateral thigh (ALT) flap due to intima damage of the recipient vessels. The described method is a safe reconstructive concept after primary flap loss with persistent extensive tissue damage.
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Affiliation(s)
- Tobias Summer
- Department for Plastic and Hand Surgery, UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Germany
| | | | - Olimpiu Bota
- Department for Plastic and Hand Surgery, UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Germany
| | - Kevin Bienger
- Department for Plastic and Hand Surgery, UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Germany
| | - Adrian Dragu
- Department for Plastic and Hand Surgery, UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Germany
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50
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Nau C, Leiblein M, Verboket RD, Hörauf JA, Sturm R, Marzi I, Störmann P. Falls from Great Heights: Risk to Sustain Severe Thoracic and Pelvic Injuries Increases with Height of the Fall. J Clin Med 2021; 10:2307. [PMID: 34070640 PMCID: PMC8199183 DOI: 10.3390/jcm10112307] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 11/24/2022] Open
Abstract
Falls from a height are a common cause of polytrauma care in Level I Trauma Centers worldwide. The expected injury consequences depend on the height of the fall and the associated acceleration, as well as the condition of the ground. In addition, we further hypothesize a correlation between the cause of the fall, the age of the patient, and the patient's outcome. A total of 178 trauma patients without age restriction who were treated in our hospital after a fall >3 m within a 5-year period were retrospectively analyzed. The primary objective was a clinically and radiologically quantifiable increase in the severity of injuries after falls from different relevant heights (>3 m, >6 m, and >9 m). The cause of the fall, either accidental or suicidal; age and duration of intensive care unit stay, including duration of ventilation; and total hospital stay were analyzed. Additionally, the frequency of urgent operations, such as, external fixation of fractures or hemi-craniectomies, laboratory parameters; and clinical outcomes were also among the secondary objectives. Sustaining a thoracic trauma or pelvis fractures increases significantly with height, and vital parameters are significantly compromised. We also found significant differences in urgent pre- and in-hospital emergency interventions, as well as organ complications and outcome parameters depending on the fall's height.
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Affiliation(s)
- Christoph Nau
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.L.); (R.D.V.); (J.A.H.); (R.S.); (I.M.); (P.S.)
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