European Journal of Trauma and Emergency Surgery最新文献

Trauma injuries, both accidental and violence-related, account for a significant number of fatalities and non-fatal injuries annually, with pain being a predominant symptom affecting trauma patients. Despite its prevalence, pain is often undertreated in emergency settings, leading to adverse outcomes such as delayed recovery, impaired respiratory function, and increased risk of chronic pain and post-traumatic stress disorder. An Acute Trauma Pain Service (ATPS) is designed to address these issues through a multidisciplinary approach, involving anesthesiologists, pain nurses, and trauma specialists. This service aims to provide comprehensive pain management by employing multimodal analgesia, which integrates pharmacological methods and regional techniques throughout the entire trauma care continuum. Effective pain management not only improves immediate patient well-being but also reduces long-term complications and economic burdens associated with extended hospital stays and readmissions. The integration of Acute pain service in trauma care emphasizes the importance of pain management as an integral part of patient recovery, highlighting the need for specialized services to enhance the quality and efficacy of trauma care.

Introduction: This study aims to determine key demographic and behavioural risk factors contributing to firework-related injuries and their outcomes.

Methods: A retrospective study was conducted on pediatric and adult patients treated for firework-related injuries at the University Hospital Leipzig from December 28th to January 3rd over 10 years (2013-2023). Data were collected on demographics, injury details, weather conditions and classification of fireworks.

Results: A total of 155 patients (mean age 24 years, 80% male) were included. Injuries predominantly occurred within two hours after midnight, and all incidents involved violation of safety regulations. Most injuries were self-inflicted (48.4%), with hands being the most frequently affected body part (52.9%). Burn injuries were common (43.9%) but were less likely during rainy weather (OR 0.4, 95% CI 0.2-0.7, p = 0.004). Surgical intervention was required in 23.9% of cases, with significant risk factors being associated bone injuries (OR 107.1, 95% CI 22.7 to 505.6), male sex (OR 5.7, 95% CI 1.3-25.0) and multiple body region injuries (OR 4.9, 95% CI 2.1-11.7). Permanent loss of function was observed in 46.5% of all patients.

Conclusion: Firework-related injuries around New Year's Eve are associated with significant morbidity, particularly affecting the hands and often requiring surgical intervention. Bone injuries, male sex and multiple body region injuries were associated with higher need for surgical treatment. Despite most fireworks being purchased legally, there is widespread disregard to age restrictions and safety protocols. These findings highlight the necessity of public health initiatives to reduce the incidence and severity of such injuries, rather than stricter regulations.

Purpose: To study the effect of pre-existing psychiatric disorders on outcome following suicidal jump from a height.

Methods: Suicidal jumpers were identified from Helsinki Trauma Registry from 2006 to 2015. Trauma registry data were combined with administrative registry data to obtain long-term mortality and in-hospital treatment. The in-hospital treatment data was from 2 years preceding the index injury and up to 5 years post injury. Reasons for the in-hospital visits were also recorded. We analyzed the patients in two groups, namely patients without a pre-existing psychiatric diagnosis (group 1) and patients with a pre-existing psychiatric diagnosis (group 2).

Results: One-hundred twenty-seven patients were included in the analysis, with 73 patients having received pre-existing psychiatric treatment. A total of 57% of patients were males and 28% of patients suffered severe traumatic brain injury (head AIS ≥ 3). Group 2 patients had a higher number of in-hospital days pre- and post-injury than group 1 patients. Reason for in-hospital treatment in group 2 was psychiatric in over 80% of days except in the year beginning from the index injury. 30-day mortality was similar between the groups 1 and 2 (11% vs. 16%, p = 0.395). Five-year survival was 72% in group 2 patients to 86% in group 1 patients (p = 0.0001).

Conclusion: Patients with pre-existing psychiatric disorder reaching hospital alive have higher pre- and post-injury requirements for in-hospital treatment than patients without a pre-existing psychiatric disorder. Although pre-existing psychiatric disorder does not affect early mortality, long-term mortality is increased by 14%.

Trial registration: Trial registration number and date of registration: HUS/221/2017, 30.3.2017.

Purpose: The use of antibiotic prophylaxis in trauma patients, particularly to prevent ventilator-associated pneumonia (VAP), is debated due to rising antibiotic resistance. Therefore, this systematic review evaluated the safety and effectiveness of antibiotic prophylaxis compared to placebo or standard care on clinical outcomes in adult polytrauma patients.

Methods: We searched PubMed and the Cochrane Central Register of Controlled Trials to identify completed and ongoing studies from database inception to April 20, 2023. Eligible studies included systematic reviews and randomized controlled trials (RCTs) comparing antibiotic prophylaxis to placebo or standard care in adult polytrauma patients admitted to the intensive care unit (ICU).

Results: Of 1237 identified records, three RCTs involving 256 patients (n_antibiotics = 176, n_control = 165, mean age 37.4 years, 81.6% male) were included. Antibiotic prophylaxis showed little or no effect on all-cause mortality compared to placebo or standard care (RR 1.01, 95% CI 0.55-1.85; RD 2 more per 1000, 95% CI -79 to 150; 2 studies, 209 participants; I² = 0%; very low certainty of evidence).

Conclusion: The results indicate that antibiotic prophylaxis has no significant effect on mortality and clinical status compared with placebo or standard care in adult polytrauma patients but may reduce the risk of VAP. However, the evidence is outdated and of very low certainty, with insufficient data to draw definitive conclusions regarding efficacy. Therefore, high-quality, up-to-date research is urgently needed to support clinical decision-making, and current interpretations should be treated with caution.

Purpose: The objective of the present study is to examine how repairing the capsule affects the radiological and clinical results of treating acute Rockwood type V acromioclavicular joint dislocations using the endobutton method.

Methods: The study involved patients between the ages of 18 and 65 who had acute Rockwood type V acromioclavicular joint dislocation and were treated using the double endobutton technique, with or without capsule repair, from January 2021 to December 2023. Clinical and radiological assessment was conducted at various time points up to the last follow-up. Functional evaluation was conducted using the Disability of Arm, Shoulder and Hand (DASH) scoring system, Constant-Murley Score (CMS), and Specific Acromioclavicular Score (SACS) at the final follow-up. Radiological evaluation involved the measurement of the coracoclavicular distance and evaluation of complications. Statistical analysis was performed using Mann-Whitney U and Pearson's Chi-Square and Fisher's Exact test.

Results: In this study, a group of 23 patients were monitored over a period of approximately 20.91 ± 8.3 (12-36) months. Functional results were significantly different in favor of Group 2, when the groups were categorized from excellent to poor (p < 0.05). At the final radiograph, the mean coracoclavicular distance showed a statistically significant difference in favor of Group 2 (p = 0.039). Loss of reduction was statistically significantly seen more in Group 1 (p = 0.031). The total rate of complication was similarly in the two groups, showing no substantial variations.

Conclusion: The combination of the double endobutton method and capsule repair is a secure and dependable procedure that provides sufficient stability. This technique has provided favorable clinical and radiologic results in the treatment of acute Rockwood type V acromioclavicular dislocation.

Level of evidence: Level III, Retrospective comperative study.

Introduction: Ballistics is the science that studies the trajectory, range, and effects of projectiles. Knowledge of the principles of wound ballistics is of particular importance to the surgeon because they allow the optimization of the diagnosis and treatment of those injured by firearms. This review focuses on the updated knowledge of wound ballistics as it pertains to the diagnosis and treatment of gunshot wounds.

Methods: A literature review was performed using PubMed, Scopus, and Embase databases. The search was limited to observational articles pertaining to wound ballistics and its relationship to patient management in English and Spanish published between January 2014 and March 2024. Studies about weapon design, patients with lethal injuries, experimental, forensic, historical studies, and those reports on pediatric population were excluded.

Results: Eleven articles from twenty-eight publications meeting the inclusion criteria were reviewed.

Conclusions: The understanding of wound ballistics enhances the ability to identify potential injuries and to optimize the treatment of gunshot wounds in adults.

Purpose: The present study aims to describe initial changes in muscle thickness and composition, muscle growth signaling mediators, and systemic inflammation in critically ill patients after major trauma.

Methods: This observational study was carried out in a Level-I nonprofit trauma center. Thirty adults requiring mechanical ventilation were assessed within 24 h post-admission. Skeletal muscle wasting was evaluated using ultrasound for muscle thickness and echogenicity along with circulating insulin-like growth factor 1 (IGF-1) and inflammatory cytokines over five consecutive days. Changes over time were assessed using ANOVA repeated-measures analysis with a Bonferroni post-hoc test. Bivariate correlations were evaluated using Pearson or Spearman coefficients.

Results: Over five days, a significant decrease (11%) in rectus femoris thickness (3.91 ± 0.86 to 3.47 ± 0.64, cm, p = 0.01) and an increase (29%) in echogenicity (62.1 ± 13.1 to 80.4 ± 17.3, AU, p < 0.01) were observed among the 30 patients included in this study. Circulating levels of IGF-1 exhibited a 38% reduction (68.8 ± 43.6 to 42.4 ± 29.4, ng/mL, p = 0.01). Furthermore, pro-inflammatory cytokine (IFN-y) increased by 17% (4.83 ± 1.39 to 5.66 ± 1.61, pg./mL, p = 0.02) from day 1 to day 5.

Conclusions: These findings reveal substantial thickness and muscle composition alterations within 48 h post-admission, worsening over five days. Despite standard rehabilitation care, changes in IGF-1 and IFN-y levels suggest early declines in muscle growth stimulus and increased inflammation.

Background: Venous Thromboembolism (VTE) is a common, preventable complication in trauma. Low-molecular-weight heparin (LMWH) is recommended for VTE prophylaxis (VTEp). We investigated whether switching from fixed-dose dalteparin to anti-Xa-guided enoxaparin prophylaxis reduces VTE without increasing the risk of bleeding among hospitalized trauma patients.

Methods: This observational study compared injured patients admitted one year before (pre-P) and after (post-P) implementing a new VTEp protocol. The protocol was introduced as a performance improvement project (subcutaneous enoxaparin 30 mg twice daily), with dose calibration to peak plasma Anti-Xa level measured after the 3rd dose. The primary outcomes were the rate of VTE and bleeding.

Results: After protocol implementation (post-P), 305 patients were compared to 350 pre-protocol patients (pre-P). Anti-Xa levels were measured in 83% of post-P and none in the pre-P. 40% had low levels of anti-Xa, suggesting inadequate prophylaxis, and enoxaparin doses were accordingly increased. 51% attained the desired anti-Xa levels, 9% had higher levels, and LMWH doses were subsequently reduced. VTE incidence after protocol implementation decreased from 4 to 1.3% (OR 0.31; 95% CI 0.1-0.9, P = 0.03) without increasing the bleeding rate. The time intervals between two consecutive PE events were significantly longer after protocol implementation. Among TBI patients, the rate of VTE was lower. However, it did not reach statistical significance. 75% of patients with VTE had low anti-Xa levels, while 20% of those with bleeding had high anti-Xa levels.

Conclusion: Among adult patients in the trauma ICU, compared to a fixed dose dalteparin, enoxaparin prophylaxis with dose calibration according to peak anti-Xa levels was associated with lower VTE rates without increasing the risk of bleeding. About 40% of patients who received initial enoxaparin doses of 30 mg twice daily had anti-Xa levels suggestive of inadequate prophylaxis. Calibrating LMWH dosing may improve VTEp following traumatic injury.

Purpose: The aim of this study was to evaluate the effect of implementation of a Virtual Fracture Clinic (VFC) review protocol on the time between injury and surgery, and on secondary healthcare utilization, in patients with Distal Radius Fractures (DRFs) requiring semi-acute surgery.

Methods: Data for this retrospective before-after study were gathered between April 2017 and March 2019 (Pre-VFC n = 269), and between April 2021 and March 2023 (VFC n = 440) in a large level 2 urban trauma center. The primary outcome was the number of days between injury and operation. Furthermore secondary healthcare utilization was assessed.

Results: The average time between injury and surgery was 11.0 days (95% CI: 10.6-11.5) before and 9.2 days (95% CI: 8.9-9.6) after VFC-implementation ( p < 0.001). Following VFC-implementation, 33% (was 17%) of patients underwent surgery within 7 days, 92% (was 84%) within 2 weeks, and 99% (was 96%) within 3 weeks (p < 0.001). This included patients with delays of up to 15 days between injury and their initial hospital presentation. Hospital contacts decreased from 5 (IQR: 4-6) to 4 (IQR: 3-5) whereof physical consults decreased from 4 (IQR: 3-5) to 1 and telephone contacts increased from negligible to 1 (IQR: 1-2). Radiographs reduced from 6 (IQR: 5-7) to 4 (IQR: 3-5).

Conclusions: Implementation of a VFC-review protocol is associated with a reduced time between injury and semi-acute surgery for DRFs and reflects an improvement in quality of timely planning. Secondary healthcare utilization is reduced and a shift to remote delivery of care is observed.

Level of evidence: Level III.