European Journal of Trauma and Emergency Surgery最新文献

Purpose: This study aims to evaluate outcomes in patients with mesenteric artery embolism (MAE) who received primary endovascular therapy (EVT) or laparotomy, and investigate risk factors for 30-day mortality.

Methods: A retrospective analysis of 94 MAE patients who underwent two different treatment strategies was undertaken. An inverse probability of treatment weighting (IPTW) method was used to balance the confounding effects of baseline clinical data. Logistic regression analysis was performed to compare the outcomes according to type of treatment regimens before and after IPTW. Univariate and multivariable analysis were conducted to determine the risk factors for 30-day mortality.

Results: Twenty-eight MAE patients received primary EVT, and 66 Open Surgery (OS). Logistic regression analysis showed that there was no significant difference between the EVT and OS group in 30-day mortality rate before (odds ratio [OR] 0.477, 95% confidence interval [CI] 0.170 to 1.340, P = 0.160), and after IPTW (OR 0.647, 95% CI 0.210 to 1.993, P = 0.449). After IPTW, it revealed that the rates of second-look surgery (OR 36.727, 95% CI 5.407 to 249.458, P < 0.001) and hospital stay [> 30 days] (OR 0.006, 95% CI 0.000 to 0.363, P = 0.014) were different in the two groups. D-dimer (> 4 mg/L) and procalcitonin (> 0.5 ng/mL) were the independent risk factors for 30-day mortality in MAE patients postoperatively (P < 0.05).

Conclusion: In this retrospective study, MAE patients who performed primary EVT had no obvious difference in 30-day mortality rate compared to those who received OS; but it was conducive to reducing prolonged hospital stays. An increase in procalcitonin level and higher D-dimer were associated with short-term poor prognosis in patients with MAE.

The operative treatment of thoracolumbar fractures is a rapidly evolving improvement in the care of patients with this injury after trauma. This article describes the different techniques and principles. Considerations and methods of treatment are scientifically addressed and illustrated according to the classification and severity of the fracture pattern. The use of computer navigation and optimisation of minimally invasive techniques is inevitable. The timing of surgery as well the removal of the material after fracture healing are also discussed. The operative treatment of spinal fractures is emerging and there is still much more knowledge to gain.

Purpose: Necrotizing fasciitis is a rare but severe soft tissue infection, and its diagnosis is difficult and often delayed. Immediate treatment comprising extensive debridement, highly dosed broad-spectrum antibiotic therapy and intensive care is necessary to prevent fatal outcomes. Considering the global rise in overweight patients and the known negative effects of obesity on the immune system, the aim of this study was to analyze whether overweight results in a more severe course of necrotizing fasciitis, worse outcomes and an increased mortality rate among overweight patients compared than in normal weight patients.

Methods: The present study involved a retrospective analysis of 29 patients who were treated for necrotizing fasciitis in our level one trauma center during the eight-year period between 2013 and 2020. Based on their BMIs, the patients were assigned to either the overweight group (BMI > 25) or the normal weight group.

Results: In the study population, being overweight appeared to be a predictor for a more severe course of necrotizing fasciitis. Overweight patients suffered from sepsis significantly more often than normal weight patients (13 vs. 5; p = 0.027). Furthermore, they were dependent on invasive ventilation (26.6 ± 33.8 vs. 5.9 ± 11.9 days; p = 0.046) as well as catecholamine support (18.4 ± 23.7 vs. 3.6 ± 5.7 days; p = 0.039) for significantly longer.

Conclusion: Necrotizing fasciitis remains a challenging and potentially fatal disease. Within the patient collective, the severity of the disease and treatment effort were increased among overweight patients.

Purpose: Automatic virtual reconstruction of complex fractures would be helpful for pre-operative surgical planning. We developed a statistical shape model (SSM) which contains data of 200 intact 3D hemipelves. It allows for quantification of shape differences and is able to reconstruct abnormal shaped pelvises. We applied our SSM to reconstruct elementary and associate type acetabular fractures and assessed the reconstruction performance of the SSM, by comparing the reconstructed shape with the intact contralateral hemipelvis.

Methods: In this retrospective diagnostic imaging study, we used our SSM to virtually reconstruct fractured hemipelves of eighty-three patients with an acetabular fracture. A root mean square error (RMSE) was computed between the reconstructed shape and intact contralateral shape for the whole hemipelvis and for regions relevant for plate-fitting. These plate-fitting relevant regions were defined as: (1) Iliopectineal line length and radius; (2) ischial body line length and radius; (3) acetabular diameter, (4) quadrilateral slope and (5) weight-bearing acetabular dome.

Results: The median RMSE of the whole hemipelvis of the elementary type fractures was 2.2 (1.7-2.5) mm versus 3.2 (2.2-3.9) mm for the associate type fractures (p < 0.001). The median RMSE for the plate-fitting regions of elementary type fractures was 1.7 (1.4-2.1) mm versus 2.7 (2.0-4.1) mm for associate type fractures (p < 0.001).

Conclusion: Using a statistical shape model allows for accurate virtual reconstructions of elementary and associate type acetabular fractures within a clinically acceptable range, especially within regions important for plate-fitting. SSM-based reconstructions can serve as a valuable tool for pre-operative planning in clinical practice, when a template of the contralateral hemipelvis is unavailable.

Objectives: Aim of this work was the evaluation and validation of the AO/OTA classification of the anterior chest wall, here especially for the rib cartilage.

Methods: Study design was a retrospective analysis of patients who were hospitalized with fractures of the thoracic wall in the years 2010-2016. This resulted in a collective of n = 124 patients. All fractures of the anterior chest wall were classified according to their location, dislocation and fracture type according to the AO classification. An analysis of possible subtypes was carried out.

Results: 29.0% (36) of the patients had fractures of the rib cartilage. 23 of the 36 (64%) patients had multiple fractures, the total number of single fractures amounted to 94. 53.2% (50) of these fractures were in the right hemithorax, 46.8% (44) in the left hemithorax. 95.7% (90) of the fractures were A-fractures, 4.3% (4) were C-fractures. There were no B fractures. The C fractures also consisted exclusively of A fractures (AA fractures). 59.6% (56) of the fractures showed a dislocation. 30.9% (29) were avulsion fractures of either the osteochondral (22.3% (21)) or the sternocostal junction (8.5% (8)).

Discussion and conclusion: The costal cartilage obviously does not show typical B fractures as we know them from shaft fractures of long bones. We have compiled a structured analysis in the attached manuscript and validated the classification proposal. In conclusion, we propose an adaptation of the classification proposal based on our data with redefining type B fractures as fractures of the osteochondral joints.

Purpose: Wild boar (Sus scrofa) has spread and colonized urban areas. The closer contact with humans can lead to wild boar-inflicted injuries. The objectives of this study are: 1) to systematically review the literature on wild boar-inflicted injuries; 2) to describe our wild boar-inflicted wound management protocol; and 3) to analyse the features, outcomes and complications of our case series.

Methods: First, a systematic search of the literature was performed using the PubMed (MEDLINE) electronic database. Then, our evidence-based wild boar-inflicted wound management protocol was described. Finally, a retrospective case series study including all the patients with wild boar-inflicted injuries attended in our Emergency Department (2020-2022) was analysed.

Results: Fourteen studies (twelve case reports and two case series) were selected for the literature review. Our case series included 34 patients: 50.0% of them presented superficial wounds and 38.2% penetrating wounds. Most of the wounds occurred in the lower limbs (71.9%). Following our protocol, 30.0% of the wounds were primarily closed, the 70.0% of the patients received antibiotics (92.3% in penetrating injuries) and the 26.7% received an antitetanic vaccine. Only one patient (2.9%) presented a complication.

Conclusions: This study reports the first specific wild boar inflicted-wound management protocol, which led to a low complication rate. Open wounds affecting the lower limbs were the most common lesions. Care should be taken with penetrating tusk injuries. Wide-spectrum antibiotic and antitetanic treatments are recommended. Decisions on wound management should be taken case-by-case, while antirabies vaccination depends on the local status of the disease.

Purpose: To estimate the one-year sum of direct costs related to open lower limb fracture treatment in an academic setting in the Netherlands. The secondary objective was to estimate the impact of deep infection and nonunion on one-year total direct costs.

Methods: A multi-center, retrospective cost analysis of open lower limb fractures treated in an academic setting in the Netherlands, between 1 January 2017 and 31 December 2018, was conducted. The costing methodology was based on patient level aggregation using a bottom-up approach. A multiple linear regression model was used to predict the total costs based on Fracture-related-infections, multitrauma, intensive care unit (ICU) admission, Gustilo-Anderson grade and nonunion.

Results: Overall, 70 fractures were included for analysis, the majority Gustilo-Anderson grade III fractures (57%). Median (IQR) one-year hospital costs were €31,258 (20,812-58,217). Costs were primarily attributed to the length of hospital stay (58%) and surgical procedures (30%). The median length of stay was 16 days, with an increase to 50 days in Fracture-related infections. Subsequent costs (46,075 [25,891-74,938] vs. 15,244 [8970-30,173]; p = 0.002), and total hospital costs (90,862 [52,868-125,004] vs. 29,297 [21,784-40,677]; p < 0.001) were significantly higher for infected cases. It was found that Fracture-related infection, multitrauma, and Gustilo-Anderson grade IIIA-C fractures were significant predictors of increased costs.

Conclusion: In treatment of open lower limb fractures, deep infection, higher Gustilo-Anderson classification, and multitrauma significantly increase direct hospital costs. Considering the impact of infection on morbidity and total healthcare costs, future research should focus on preventing Fracture-related infections.

Purpose: The aim of this study is to investigate the opinions and perspectives of The Novel Integrated Toolkit for Enhanced Prehospital Life Support and Triage in Challenging and Large Emergencies (NIGHTINGALE) end-users and tool developers regarding Key Performance Indicators (KPIs) and benchmarks that assess the prehospital response to Mass Casualty Incidents (MCIs) enhanced by the NIT-MR.

Methods: A qualitative study employing focus group discussions was conducted to collect opinions and perspectives of end-users and tool developers regarding KPIs and benchmarks in MCI response using the NIT-MR. The criteria considered for the selection and distribution of participants within the groups was the nature of their involvement within the NIGHTINGALE project and their familiarity with the tools to be discussed.

Results: Thirty-one participants from different countries were included. Four themes emerged during data analysis which are: definition/explanation is the personal understanding of participants of the term KPI, process of KPI development and relationship with User Requirements is the decision process for assigning KPIs to user requirements, benchmarking is the mental process of associating a benchmark to a KPI or for developing a benchmark, and technical/medical gap is the gap of understanding between each sides' fields.

Conclusion: This study emphasized the need for a structured approach to using KPIs and bridging the gap between technological and medical worlds, taking the NIGHTINGALE project, funded by the European Union, which aims to develop a technological toolkit for first responders in mass casualty incidents as an example. These insights are crucial for enhancing disaster response.