Trauma Surgery & Acute Care Open最新文献

Introduction: Acute myocardial infarction (MI), ischemic cerebrovascular accident (CVA), and peripheral vascular disease (PVD) are significant global health burdens that have been associated with cholelithiasis by multiple studies. However, the relationship between cholecystectomy and these vascular morbidities remains unclear. This study aims to investigate the long-term impact of cholecystectomy on MI, CVA and PVD.

Methods: This nationwide study analyzed data, which accounted for 59% of the Israeli population. Adult patients with cholelithiasis and no prior vascular morbidity (MI, CVA, and PVD) were followed for over 8 years and categorized into two groups: those who underwent cholecystectomy and those who did not. Incidence rates of MI, ischemic CVA (including transient ischemic attack), and PVD were compared between the groups using Cox regression models adjusted for demographics and comorbidities.

Results: Among the 142 834 eligible patients with cholelithiasis, 37 173 underwent cholecystectomy. Cholecystectomy cohort was associated with a modest protective effect on MI, ischemic CVA, and PVD, with lower incidence rates of MI (HR 0.91, 95% CI 0.86 to 0.96), ischemic CVA (HR 0.94, 95% CI 0.89 to 0.99), and PVD (HR 0.87, 95% CI 0.80 to 0.95) compared with the No-cholecystectomy cohort. Kaplan-Meier curves demonstrated significant separation in cumulative incidence rates favoring the cholecystectomy group for all three outcomes.

Conclusion: Cholecystectomy appears to be associated with reduced cumulative incidences of MI, ischemic CVA, and PVD in patients with cholelithiasis. Nonetheless, the relatively modest risk reduction observed in our study raises questions about the procedure's overall benefit versus the potential risks in the context of risk reduction measures.

Level of evidence: Level IV.

Background: 'Exception from informed consent' research requires community consultation to ensure that the views of the local population have been considered. Using market research companies to distribute surveys across local populations is attractive because it ensures adequate response rates. It is not known whether individuals who respond to surveys are typical of the targeted communities. The purpose of this study is to compare the demographics of the survey respondents with that of the general population in the same area.

Methods: This is an analysis of data collected as part of the 'Trauma Resuscitation with Group O Whole Blood or Products' (TROOP) trial. The surveys used a commercial market research service to reach the communities of interest and consisted of 18 questions designed to evaluate respondents' willingness to be enrolled in the TROOP trial and the demographics of survey respondents.

Results: Catchment populations varied from 0.5 to 9.4 million residents, with a total of 33.5 million. The racial and ethnic composition of the population (and the survey respondents, in brackets) was 44.8% (57.0%) white, 25.7% (13.4%) Hispanic, 12.7% (19.4%) black, 8.0% (2.5%) multiracial, 7.9% (4.4%) Asian, 0.7% (0.9%) Native American, and 0.2% (0.5%) Islanders. Of the male population (and survey respondents, in brackets), 12.2% (15.3%) were aged 18years to 24 years, 20.5% (22.3%) aged 25 years to 34 years, 18.1% (24.9%) aged 35 years to 44 years, 16.3% (18.5%) aged 45 years to 54 years, 15.5% (14.8%) aged 55 years to 64 years, and 17.4% (4.3%) aged 65 years and over. Of the female population (and survey respondents, in brackets), 11.0% (18.5%) were aged 18 years to 24 years, 18.4% (22.6%) aged 25 years to 34 years, 16.4% (23.5%) aged 35 years to 44 years, 15.0% (17.3%) aged 45 years to 54 years, 18.5% (14.1%) aged 55 years to 64 years, and 20.6% (3.9%) aged 65 years and over.

Conclusions: For this trial, using a market research company to distribute community surveys resulted in respondents that are broadly representative of the geographic areas where the trial will be conducted, except for individuals over the age of 65 years and older. This finding provides reassurance to investigators and institutional review boards that the views expressed by respondents are representative of the population where the trial will be conducted.

Level of evidence: III.

Background: Road traffic injuries (RTIs) are a leading cause of mortality in low and middle-income countries. The study aimed to assess the magnitude of RTIs, determine the length of stay (LoS) for RTI patients and identify factors associated with prolonged LoS.

Methods: A retrospective study was conducted at the Addis Ababa Burn, Emergency and Trauma Hospital in Addis Ababa, Ethiopia. Data were extracted from medical records for the period between 1 April 2021 and 30 March 2022, using a structured data collection form. Descriptive statistics were used to summarize patient and injury characteristics, and Poisson regression model with robust variance was applied to identify factors associated with prolonged LoS in the emergency department (ED).

Results: Over the 1 year, 2693 RTI patient records were reviewed, accounting for 38.5% (95% CI 37.4% to 39.7%) of all injury cases. Of these, 2661 patients' data were included in the analysis. The majority of patients were male (n=1932, 72.6%) and 1031 (38.7%) were aged 18-29 years. The most frequently affected body region was the head (n=966, 36.3%), and fracture was the most common injury (n=991, 37.2%). Overall, 59 (2.2%) patients died, and 780 (29.0%; 95% CI 27.6 to 31.0) experienced a LoS exceeding 24 hours. The identified factors associated with prolonged LoS included: residence outside Addis Ababa (adjusted prevalence ratio (APR)=1.41; 95% CI (1.24 to 1.60)), being in the age group of 18-29 years (APR=0.78; 95% CI (0.63 to 0.95), neck injuries (APR: 1.75; 95% CI 1.17 to 2.65), trunk injuries (APR: 1.43; 95% CI 1.09 to 1.89) and outcome of fractures (APR: 4.34; 95% CI 2.66 to 7.00); and contusions and crushing injuries (APR: 3.81; 95% CI 2.33 to 6.21).

Conclusions: The magnitude of RTI was substantially high compared with previous studies in Ethiopia. One-third of RTI patients' LoS in the ED exceeded the country's health system standard. The study highlights the need for enhanced road safety and healthcare resource allocation to manage RTIs effectively.

Level of evidence: III.

Introduction: Patients with atrial fibrillation (AF) on anticoagulation (AC) have increased mortality after trauma. Left atrial appendage closure (LAAC) procedures may reduce the need for AC in patients with AF. The purpose of this study is to evaluate the outcomes of trauma patients with AF on AC compared with patients not taking AC, and assess the frequency in which trauma patients are candidates for LAAC procedures.

Methods: A retrospective review of adult trauma patients after a fall was performed. AF patients on AC (+AC) were compared with patients not on AC (-AC). A CHA2DS2-VASc score is a stroke-risk stratification tool incorporating congestive heart failure, hypertension, age >75 (2 points), prior stroke (2 points), vascular disease, age 65-74, and female sex. This score was calculated for +AC patients to analyze their candidacy for LAAC.

Results: +AC patients (3452 total) were found to have increased red cell (7.3% vs 6.1%, p=0.02) and plasma (2.1% vs 1.2%, p<0.001) requirements. +AC patients had increased mortality (4.6% vs 3.5%, p=0.02). 54.8% of +AC patients had a CHA2DS2VASc score of >3 and met criteria for LAAC.

Conclusion: A substantial proportion of AF patients on AC meet existing criteria for LAAC. Further exploration of referral pathways may be warranted to analyze whether offering information on such procedures could reduce the risk of AC-related complications in high-risk trauma populations.

Evidence level: III.