European Journal of Trauma and Emergency Surgery最新文献

Purpose: With advances in technology, early computed tomography (CT) scanning is advocated for trauma patients. However, the benefits of early CT scanning remain unclear. Thus, we examined whether time elapsed from hospital arrival to CT acquisition is associated with the prognoses of severe trauma patients.

Methods: We utilized the Japan Trauma Data Bank, a nationwide database. Patients directly transferred from the trauma scene were included. Severe trauma patients, defined as those with Injury Severity Scores (ISS) greater than 15, were enrolled. We excluded patients with cardiac arrest on hospital arrival, ISS of 75, missing data on timing of CT, inappropriate CT time, and elapsed time from hospital arrival to CT scan longer than or equal to 60 min, as well as those who required damage control surgery and those who died within 24 h. Patients were divided into six groups based on elapsed time to CT acquisition (0-9, 10-19, 20-29, 30-39, 40-49, 50-59 min.). The primary outcome was in-hospital mortality, and the secondary outcome was amount of transfusion, including red blood cells, fresh frozen plasma, and platelets.

Results: Of the registered trauma cases, 13,802 cases were included in this study. The crude proportion of in-hospital mortality in the 0-9 min. group was the highest (15.4% [138/898]) compared to other groups. Compared to the 0-9 min. group, multivariable logistic regression analysis revealed that the earlier elapsed time to CT acquisition did not contribute to the improved rate of in-hospital mortality (10-19 min.; OR 0.84, 95% CI 0.64-1.09, p = 0.19, 20-29 min.; OR 0.89, 95% CI 0.69-1.16, p = 0.39, 30-39 min.: OR 0.88, 95% CI 0.67-1.16, p = 0.36, 40-49 min.: OR 0.92, 95% CI 0.67-1.26, p = 0.60, 50-59 min.: OR 1.03, 95% CI 0.73-1.46, p = 0.85). Transfusion amounts did not differ between groups.

Conclusion: Early CT scanning after hospital arrival did not contribute to improved in-hospital mortality or reduce the transfusion amount for severe trauma patients.

Not all hospitals have the resources to manage trauma patients, which is why many countries have introduced trauma systems to connect hospitals within specific regions. When definitive care cannot be provided at a hospital, the patient should be transferred to the closest appropriate facility with the necessary resources and capabilities. Telecommunication is a critical tool for data exchange (e.g., imaging) and multidisciplinary consultations. Ideally, a unified telecommunication system should be implemented across all hospitals in a network, with the long-term goal of nationwide or even European-level standardisation. While criteria for onward transfer vary slightly between trauma systems across countries, they can be adapted to meet the needs of any healthcare system. Decisions regarding patient transfer should be based on objective, prospectively agreed criteria. In addition, a common European trauma registry is essential to evaluate quality of care.

Purpose: Pre-analytic interferences can influence the laboratory downstream measurements. We recognized hemolysis, lipemia and bilirubin in some of the serum/plasma samples of the NTF-Biobank from polytraumatized patients. Aim of the present study was to detect interferences, find reasons and describe the influence on downstream analyses.

Methods: The study included serum samples of n = 88 polytraumatized patients admitted to a Level 1 Trauma Center in Germany at the ER & up to 10 days after trauma. Optical absorption spectra of UV-VIS (350-660 nm) were measured to detect hemolysis, lipemia and bilirubin. To find reasons for the interferences, clinical parameters like triglycerides (TAGs), nutrition, anaesthesia or transfusions were collected from patients' record. Extracellular vesicles (EVs) were isolated by SEC from controls, lipidemic and hemolytic samples and analysed via NTA.

Results: Within 10 days after trauma 31.8% of polytraumatized patients' samples showed hemolysis, 12.5% showed increased bilirubin and 15.9% lipemia. Hemolysis occurred in samples mostly at the ER (18%) and was not associated with the number of red blood cell transfusions or the ISS. Both contaminants, hemolysis and lipemia interfered with EV/EV-miRNA measurements. EV miR-16-5p was significantly increased in patients with hemolysis. The presence of lipids further influenced the EV particle size distribution and concentration.

Conclusion: The optical absorption spectra measurement is an easy tool for a robust pre-analytic sample controlling for the presence of interferences. Nutrition and anaesthesia were found to be related with lipemia in samples. Hemolysis and lipemia interfered with EV/EV-miRNA analysis. Therefore, the optical absorption spectra pre-analyses should be incorporated in the EV-biobank sampling.

Trauma is the leading cause of death in the working population. The World Health Organisation (WHO) reports 4.4 million deaths annually due to unintentional or violence-related injuries; one in three of these deaths results from road traffic injuries (RTIs). For individuals aged 5-29 years, three of the top five causes of death are injury-related. Major trauma is the eighth leading cause of death across all age groups and the leading cause of death among children and young adults. The highest rates of trauma-related deaths are observed in low-income countries. Globally, men face twice the risk of dying from injuries as women, with approximately 75% of injury-related deaths resulting from trauma and RTIs.

With a rise in traumatic incidents across Europe, there is an escalating need for a proactive and coordinated approach to trauma prevention. This chapter outlines evidence-informed strategies and collaborative efforts aimed at reducing the incidence and impact of trauma in Europe.

Fracture healing is a physiological process that is always accompanied by an immunologically mediated inflammatory reaction, resulting in primary bone healing. Heat shock proteins (HSPs) are omnipresent stress proteins produced by cells in response to exposure to stressful conditions, which function as intracellular proteins that accomplish protein folding and transport intracellularly. This narrative review aims to shed light on the underlying molecular mechanisms of HSPs with respect to the currently available Medline literature. The initial search for "heat shock protein AND fracture" identified 70 studies; after reviewing the texts and checking for content, 9 studies remained. The second search for "heat shock protein AND trauma AND bone" identified 67 studies. After manually searching through the titles and abstracts, six articles remained, three of which were already found in the first search. One study was excluded because it did not include HSPs or fractures, resulting in two additional papers being included. The third search for "heat shock protein AND osteogenesis imperfecta AND fracture" resulted in nine studies. After reviewing the texts, three articles that were already included from the first search remained. This review highlights the significant potential of HSPs and the established HSP investigations related to fracture healing. Our review indicates that, despite the few studies available, those that were selected are very important for identifying research approaches and areas that require further study.

Rehabilitation is a vital component of the holistic care of severely injured patients, addressing physical limitations, preventing complications, and promoting social and professional reintegration. Tailored measures are required across all phases of care, depending on individual injury patterns. Adequate early rehabilitation within inpatient settings necessitates appropriate personnel and infrastructure. Rehabilitation teams must include specialists from diverse therapeutic disciplines. Although financial frameworks vary by country, comprehensive funding for high-quality therapy programmes is essential for effective treatment.

Background: Necrotizing soft tissue infection (NSTI) is a rapidly progressing infection of the soft tissues under the skin, which poses a life-threatening risk if not treated promptly. Due to the non-specific nature of symptoms at presentation, the diagnosis is often delayed, leading to a high mortality rate and increased risk of amputation. Early treatment requires both surgical intervention and antibiotic therapy. This study aims to investigate the effects of clinical parameters, applied treatments, and initial interventions on mortality and amputation rates in patients with NSTI.

Materials and methods: In a retrospective study, 50 patients diagnosed with NSTI between 2021 and 2024 were included. Patient demographic characteristics (age, gender, comorbidities), isolated microorganisms, antibiotics administered, interventions performed, and the final outcomes were analyzed. Additionally, the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, duration of intensive care unit (ICU) stay, length of hospital stay, rates of mortality and amputation were examined.

Results: Among the 50 patients in this study, the mortality rate due to NSTI was 20% (10 patients), and the amputation rate was 60% (30 patients). Both the length of hospital stay and duration of ICU stay were significantly associated with mortality. Diabetes mellitus (DM) was found to be significantly related to amputation. The LRINEC score, presence of chronic renal failure, sepsis, hyperbaric oxygen therapy (HBOT), smoking, and timing of surgical intervention were not significantly associated with amputation rates. The most common isolated microorganism was Streptococcus pyogenes.

Conclusion: Although the LRINEC score is widely used, it does not play a critical role in the management of NSTI. Factors like underlying comorbidities and hospital stay more significantly affect mortality and amputation rates. Early diagnosis and treatment are recommended to improve patient outcomes.

Biomechanical testing is essential for evaluating osteosyntheses, particularly in assessing stability, stiffness, and fragment motion. However, traditional flat-fracture models created via osteotomy fail to replicate the complex morphology of real-world fractures, potentially reducing the applicability of results. This study introduces patient-specific distal femur fracture models to investigate the impact of fracture morphology on the biomechanical performance of osteosyntheses. Realistic fracture models were generated using 3D printing and molding, based on CT-derived geometry, alongside traditional osteotomy models. Four groups were tested: osteotomized and realistic fracture models, with and without gaps. All constructs were treated with distal femur locking plates and subjected to axial and torsional loading. Dynamic testing simulated physiological conditions and tracked interfragmentary motions with a 3D optical motion system. Realistic fracture models exhibited higher torsional stiffness and reduced interfragmentary motion compared to osteotomized models, particularly in closed fracture gaps. Axial stiffness increased significantly upon fracture gap closure in all gap groups, transitioning from exclusively plate-bearing to construct-bearing configurations. The irregular geometry of realistic fractures provided enhanced interlocking, improving stability under both axial and torsional loads. Patient-specific fracture models better replicate the mechanical behaviour of clinical distal femur fractures, demonstrating advantages over osteotomized fracture models. The inclusion of realistic fracture geometries in biomechanical testing improves the transfer of biomechanical results into a clinical setting and offers valuable insights for optimizing designs and improving clinical outcomes.