European Journal of Trauma and Emergency Surgery最新文献

Background: On February 6, 2023 a devastating earthquake hit the south-eastern region of Türkiye and thousands of people were either injured or died. The aim was to determine the characteristics, treatment and clinical outcomes of critically ill patients with crush injuries in ICU.

Subjects/methods: This study was performed with a retrospective design in ICU. Patients were included as follows; effected 6 February earthquake, need ICU treatment and being crush syndrome.

Results: A total of 62 patients were included. The mean age was 41 ± 19 years and 47% were male. The median APACHE II score was 14. The most common ICU admission was multitrauma and crush injury. A total of %77 patients were needed surgical procedure (most of them extremities surgery (36%)and fasciotomy 36% due to compartment syndrome) and %24 patients had extremity amputation. AKI was developed in %65 of patients. A total of 26 (%40) patients were received RRT. The mNUTRIC score (p = 0.022), the BUN (p = 0.043) and the blood lactate level (p = 0.012) were identified as independent risk factors for 28-day mortality. An independent risk factor for limb amputation was identified in patients with high APACHE II and SOFA scores (p = 0.026, p = 0.034, respectively). The 28-day mortality was 13%.

Conclusions: As a result of the study, most of the patients need surgical operations and a quarter of patients required extremity amputation. AKI developed at a high rate and 40% of those patients needed RRT. The mNUTRIC score was found to be the most powerful predictor of mortality at 28 days.

Purpose: In the elective setting, there are high mortality rates for patients with liver cirrhosis after surgery. Few studies focus on emergency surgery. This study investigates mortality and morbidity of patients with cirrhosis undergoing emergency abdominal surgery.

Methods: In a database established at two Copenhagen University Hospitals (Herlev and North Zealand), including all patients operated in an emergency setting (n = 1116), including all patients with known cirrhosis at time of surgery. Postoperative complications, and mortality rates were evaluated by a matched case-control method, matching cases and controls according to surgical procedure, age, sex and American Society of Anaesthesiologists-class (ASA). Medical and surgical complications were classified according to the Clavien-Dindo classification.

Results: In the study, 24 patients with cirrhosis and 48 matched controls were evaluated. The 30-day mortality was 37.5% for patients with cirrhosis and 12.5% for controls (OR 4.2, 95% CI [1.28, 13.80], p = 0.014) and 90-day mortality was 62.5% for patients with cirrhosis compared to 18.8% for controls (OR 7.22, 95% CI [2.41, 21.68], p < 0.001). For patients with cirrhosis 58.3% had surgical complications compared to 31.3% for the controls (p = 0.027). The reoperation rate was 45.8% in the cirrhosis group and 22.9% in the control group (p = 0.047). The days-alive-out-of-hospital at 90-days (DAOH-90) was 9 days in the cirrhosis group and 78 days in the control group (p < 0.001).

Conclusion: This retrospective study shows that patients with cirrhosis have significantly higher mortality rates after emergency surgery, more surgical complications and reoperations, and reduced DAOH-90.

Objectives: Pediatric elbow fractures are a common injury among children. Recent advancements in artificial intelligence (AI), particularly deep learning (DL), have shown promise in diagnosing these fractures. This study systematically evaluated the performance of DL models in detecting pediatric elbow fractures.

Materials and methods: A comprehensive search was conducted in PubMed (Medline), EMBASE, and IEEE Xplore for studies published up to October 20, 2023. Studies employing DL models for detecting elbow fractures in patients aged 0 to 16 years were included. Key performance metrics, including sensitivity, specificity, and area under the curve (AUC), were extracted. The study was registered in PROSPERO (ID: CRD42023470558).

Results: The search identified 22 studies, of which six met the inclusion criteria for the meta-analysis. The pooled sensitivity of DL models for pediatric elbow fracture detection was 0.93 (95% CI: 0.91-0.96). Specificity values ranged from 0.84 to 0.92 across studies, with a pooled estimate of 0.89 (95% CI: 0.85-0.92). The AUC ranged from 0.91 to 0.99, with a pooled estimate of 0.95 (95% CI: 0.93-0.97). Further analysis highlighted the impact of preprocessing techniques and the choice of model backbone architecture on performance.

Conclusion: DL models demonstrate exceptional accuracy in detecting pediatric elbow fractures. For optimal performance, we recommend leveraging backbone architectures like ResNet, combined with manual preprocessing supervised by radiology and orthopedic experts.

Introduction: The role of rib fixation (RF) in flail chest is debated, and guidelines conditionally recommend RF in highly selected patients. Patients with cardiopulmonary disease (CPD) have traditionally not been deemed surgical candidates. We hypothesize that RF would benefit even high-risk patients with CPD.

Methods: Adult patients with isolated flail chest and CPD were identified from the Trauma Quality Improvement Program database (2016-2018). Hospital transfers, patients dead within 72 h, penetrating mechanism, concomitant thoracic aortic injury or cancer were excluded. Primary outcome was in-hospital mortality. Secondary outcomes were in-hospital complications, ventilator days, need for tracheostomy, and length of stay. RF patients were propensity score matched (1:1) to non-operative management (NOM) patients. Multivariate regression identified independent risk factors for outcomes.

Results: In this 3 year period, 4614 patients were admitted with flail chest and history of CPD. After exclusions and propensity matching, 544 (12%) underwent analysis (RF n = 272, NOM n = 272). RF patients had a lower mortality compared to NOM patients (1.8% vs 5.5%, p = 0.023) but more likely to develop venous thromboembolic events (5.1% vs 1.85%, p = 0.036), prolonged ventilation (28.4% vs 15.1%, p < 0.001), and tracheostomy (15.4% vs 6.6%, p = 0.001). Multivariate analysis showed RF was independently associated with decreased mortality (OR 0.165, 95% CI 0.037-0.735, p = 0.018) while age > 85 years (OR 145.115, 95% CI 9.721-2166.262) and ventilator-associated pneumonia (OR 8.283, 95% CI 1.375-49.888) were associated with increased mortality.

Conclusions: RF shows a survival benefit even in high-risk patients with CPD. Patient selection should be individualized but RF should not be excluded based solely on pre-existing conditions.

Introduction: Lower back pain (LBP) is one of the most common musculoskeletal disorders in modern society, with a lifetime incidence of up to 90%. According to most national and international guidelines, educational interventions play a central role in the multimodal treatment of LBP. This systematic review and meta-analysis investigated the impact of educational interventions on pain and disability in patients with LBP undergoing physiotherapy compared to patients without educational interventions undergoing physiotherapy.

Methods: In October 2024, a comprehensive computer-aided search was performed to assess the online databases PubMed, Web of Science, Google Scholar, and Embase. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria with an established PICOTD algorithm. Two authors independently performed the data extraction and risk of bias evaluation. The primary outcome measures extracted were a pain score (VAS or NRS) and the Roland Morris Disability Questionnaire (RMQ).

Results: Data from 8152 patients were retrieved. The mean length of follow-up was 6.2 ± 3.9 months, the mean length of symptom duration was 66.7 ± 51.6 months, and the mean age of the patients was 46.7 ± 9.2 years. Compared to physiotherapy alone, additional education did not reduce pain (P = 0.4) or disability according to the RMQ (P = 0.9).

Conclusion: The addition of education did not impact pain and disability in patients undergoing physiotherapy for chronic non-specific LPB.

Level of evidence: Level I, systematic review and meta-analysis of RCTs.

Purpose: Effective patient handovers in healthcare settings are critical for ensuring patient safety and care quality. Handover tools have gained prominence as potential aids in improving these transitions. This systematic review seeks to answer the question if the use of validated handover protocols leads to better treatment outcomes in polytrauma patients compared to no use of validated handover protocols.

Methods: We searched PubMed, Cochrane Central Register of Controlled Trials and Web of Science to identify relevant studies from inception of each database to June 15, 2022. We intended to include systematic reviews and randomized controlled trials comparing the use of validated handover tools to no use of such tools in adult polytrauma patients.

Results: Despite the absence of systematic reviews and RCTs meeting our criteria, we included 26 initially excluded studies to glean insights into handover tool usage. This broader inclusion facilitated the identification of two categories of tools: standardized tools and customized tools. Among studies employing customized tools, positive outcomes were reported in various aspects, including enhanced information quality, improved staff communication, and reduced risks and treatment errors. In contrast, studies utilizing well-established standardized tools documented improvements in communication, documentation, and overall satisfaction among medical professionals, signaling a reduction in communication errors and lost information.

Conclusion: Heterogeneity of the studies and no trials meeting our eligibility criteria present challenges for conducting a traditional systematic review. In the lack of evidence from RCTs and systematic reviews, our analysis of the available studies sheds light on the complexities of assessing handover tools' utility, especially in diverse clinical settings. It highlights the need for more standardized methodologies and further investigation into the effectiveness of custom-designed tools. It emphasizes the importance of understanding the role of handover tools in healthcare. While some studies suggest positive outcomes, further research is necessary to elucidate the design and implementation of these tools to enhance care and support healthcare professionals in their roles.

Purpose: Total flap failure remains a reported complication, primarily due to arterial thrombosis. Although numerous studies have compared different intraoperative and postoperative anticoagulant regimens, none have specifically addressed the effectiveness of preoperative acetylsalicylic acid treatment. In this study, it was aimed to investigate the effect of pre-operative aspirin administration on free flap survival rate in lower extremity reconstruction.

Materials and methods: This retrospective study included patients who underwent free flap transfers for lower extremity reconstruction. The patients were divided into two groups: those who received preoperative acetylsalicylic acid treatment and those who did not. The two groups were compared in terms of flap success and complication rates.

Results: A total of 117 patients were included. Of these, 42 patients received preoperative acetylsalicylic acid, while 75 did not. Trauma was the most common etiology, while burns were the least common. There was no statistically significant difference between the groups in terms of flap type or recipient artery (p > 0.05). Arterial thrombosis developed in 13 patients (11%), of whom only one had received preoperative acetylsalicylic acid. 7 of these patients experienced total flap loss. There was a statistically significant difference regarding total flap loss and arterial thrombosis (p < 0.05).

Conclusion: Preoperative acetylsalicylic acid treatment may improve free flap success rates by preventing arterial thrombosis. It was found to be effective in preventing arterial thrombosis when initiated in the preoperative period, before endothelial damage occurs during anastomosis. However, Clinicians should weigh the potential benefits of reduced thrombotic events against the risks of complications, such as hematomas, when considering preoperative aspirin administration.

Purpose: Acute mesenteric ischaemia (AMI) is one of the abdominal surgical emergencies with high mortality and morbidity and early diagnosis and treatment are of vital importance. We aimed to evaluate the usefulness of serum vaspin level as a potential biomarker for early diagnosis of AMI in an experimental animal model.

Materials and methods: Sixty female Wistar-Albino rats were divided into 6 groups. Ischaemia groups (1, 3, 5) underwent SMA dissection and ligation, while control groups (2, 4, 6) did not. Blood and intestinal tissue samples were collected at 30 min, 2 h, and 6 h. Vaspin (ng/ml), TAS (Total antioxidant capacity, μmol Trolox equiv./L), TOS (Total oxidant capacity, μmol H₂O₂ equiv./L), ALT (Alanine Aminotransferase, U/L), AST (Aspartate Aminotransferase, U/L) and OSI (TOS/TAS) ratio of these biochemical values were studied.

Results: Vaspin levels were compared at 30 min, 2 h, and 6 h in ischaemia and control groups. No significant difference was found at 30 min and 2 h (p > 0.05), but a significant increase was observed at 6 h (p < 0.05). There was a statistically significant difference between the Vaspin (ng/ml) measurements of the ischaemia groups at three different times (p < 0.05). The highest Vaspin (ng/ml) value was obtained at the 6th hour and the lowest at the 30th minute.

Conclusion: In our study, a statistically significant increase in vaspin levels was detected with increasing ischaemia duration and necrosis. These findings suggest that vaspin may be a potential biomarker in the early diagnosis of AMI.

Purpose: Costal margin ruptures (CMR), though rare, are often associated with rib fractures and intercostal hernia. Injuries to the costal cartilages are often poorly recognised. Surgical stabilisation of rib fractures without fixing the CMR is known to result in failure of metalwork. The aim of this study was to characterise the associated rib and costal cartilage fractures according to different categories of the Sheffield Classification of CMR injuries, thus highlighting injury patterns which are of importance with respect to patient management.

Methods: Patients characterised by the Sheffield Classification were identified. Prospective clinical data were collected at the time of presentation. Computed Tomography (CT) multiplanar and 3D images were reviewed. Data were analysed according (i) to the absence or presence of Intercostal Hernia (i.e. CMR + IH and Trans Diaphragmatic Intercostal Hernia (TDIH) versus other CMR injury categories) and (ii) according to the aetiology (Expulsive versus other, where expulsive was defined as related to coughing, sneezing, retching or vomiting). Any associated rib or other costal cartilage fractures were recorded on heatmaps, according to Chest Wall Injury Society taxonomy.

Results: There were 64 patients with Costal Margin Rupture injuries included in the study. The presence of IH in addition to CMR was associated with chronic presentation, expulsive aetiology, higher body mass index, and CMR at the level of the 9th costal cartilage. IH (p = 0.002) and expulsive aetiology (p = 0.04) were associated with presence of rib fractures, but the absence of additional costal cartilage fractures (p < 0.0001 and p = 0.001 respectively). Fractures in the IH and expulsive groups were notably more focused in distribution to the posterior sector (p < 0.0001) and with the most common fracture being one level above the CMR.

Conclusion: Posterior sector, lower level rib fractures related to coughing and other "expulsive' aetiologies may be associated costal margin rupture and intercostal hernia. The latter injuries should not be overlooked in the assessment and successful management of the patient.