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Pediatric trauma and emergency surgery: an international cross-sectional survey among WSES members. 儿科创伤和急诊外科:WSES成员的国际横断面调查。
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-13 DOI: 10.1186/s13017-022-00473-5
Martin Reichert, Massimo Sartelli, Ingolf H Askevold, Jaqueline Braun, Markus A Weigand, Matthias Hecker, Vanni Agnoletti, Federico Coccolini, Fausto Catena, Winfried Padberg, Jens G Riedel, Andreas Hecker

Background: In contrast to adults, the situation for pediatric trauma care from an international point of view and the global management of severely injured children remain rather unclear. The current study investigates structural management of pediatric trauma in centers of different trauma levels as well as experiences with pediatric trauma management around the world.

Methods: A web-survey had been distributed to the global mailing list of the World Society of Emergency Surgery from 10/2021-03/2022, investigating characteristics of respondents and affiliated hospitals, case-load of pediatric trauma patients, capacities and infrastructure for critical care in children, trauma team composition, clinical work-up and individual experiences with pediatric trauma management in response to patients´ age. The collaboration group was subdivided regarding sizes of affiliated hospitals to allow comparisons concerning hospital volumes. Comparable results were conducted to statistical analysis.

Results: A total of 133 participants from 34 countries, i.e. 5 continents responded to the survey. They were most commonly affiliated with larger hospitals (> 500 beds in 72.9%) and with level I or II trauma centers (82.0%), respectively. 74.4% of hospitals offer unrestricted pediatric medical care, but only 63.2% and 42.9% of the participants had sufficient experiences with trauma care in children ≤ 10 and ≤ 5 years of age (p = 0.0014). This situation is aggravated in participants from smaller hospitals (p < 0.01). With regard to hospital size (≤ 500 versus > 500 in-hospital beds), larger hospitals were more likely affiliated with advanced trauma centers, more elaborated pediatric intensive care infrastructure (p < 0.0001), treated children at all ages more frequently (p = 0.0938) and have higher case-loads of severely injured children < 12 years of age (p = 0.0009). Therefore, the majority of larger hospitals reserve either pediatric surgery departments or board-certified pediatric surgeons (p < 0.0001) and in-hospital trauma management is conducted more multi-disciplinarily. However, the majority of respondents does not feel prepared for treatment of severe pediatric trauma and call for special educational and practical training courses (overall: 80.2% and 64.3%, respectively).

Conclusions: Multi-professional management of pediatric trauma and individual experiences with severely injured children depend on volumes, level of trauma centers and infrastructure of the hospital. However, respondents from hospitals at all levels of trauma care complain about an alarming lack of knowledge on pediatric trauma management.

背景:与成人相比,从国际角度来看,儿童创伤护理的情况和严重受伤儿童的全球管理仍然相当不清楚。目前的研究调查了不同创伤程度的中心对儿童创伤的结构性管理以及世界各地儿童创伤管理的经验。方法:从2021年10月至2022年3月,通过网络调查向世界急诊外科学会的全球邮件列表发送问卷,调查受访者及其附属医院的特征、儿科创伤患者的病例量、儿童重症监护的能力和基础设施、创伤团队的组成、临床检查和针对患者年龄的儿科创伤管理的个人经验。根据附属医院的规模对合作组进行细分,以便对医院数量进行比较。比较结果进行统计分析。结果:共有来自5大洲34个国家的133名参与者参与了调查。他们最常隶属于大型医院(床位大于500张的占72.9%)和一级或二级创伤中心(82.0%)。74.4%的医院提供无限制的儿科医疗服务,但只有63.2%和42.9%的参与者有足够的创伤护理经验≤10岁和≤5岁儿童(p = 0.0014)。这种情况在小型医院的参与者中更为严重(p 500住院床位),大型医院更有可能隶属于先进的创伤中心,更完善的儿科重症监护基础设施(p结论:儿科创伤的多专业管理和严重受伤儿童的个人经验取决于医院的数量、创伤中心的水平和基础设施)。然而,来自各级创伤护理医院的受访者抱怨儿科创伤管理知识的缺乏令人震惊。
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引用次数: 2
Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES). 在不具备神经外科能力的医院对孤立的严重创伤性脑损伤患者进行早期管理:世界急诊外科协会 (WSES) 的共识和临床建议。
IF 6 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-09 DOI: 10.1186/s13017-022-00468-2
Edoardo Picetti, Fausto Catena, Fikri Abu-Zidan, Luca Ansaloni, Rocco A Armonda, Miklosh Bala, Zsolt J Balogh, Alessandro Bertuccio, Walt L Biffl, Pierre Bouzat, Andras Buki, Davide Cerasti, Randall M Chesnut, Giuseppe Citerio, Federico Coccolini, Raul Coimbra, Carlo Coniglio, Enrico Fainardi, Deepak Gupta, Jennifer M Gurney, Gregory W J Hawryluk, Raimund Helbok, Peter J A Hutchinson, Corrado Iaccarino, Angelos Kolias, Ronald W Maier, Matthew J Martin, Geert Meyfroidt, David O Okonkwo, Frank Rasulo, Sandro Rizoli, Andres Rubiano, Juan Sahuquillo, Valerie G Sams, Franco Servadei, Deepak Sharma, Lori Shutter, Philip F Stahel, Fabio S Taccone, Andrew Udy, Tommaso Zoerle, Vanni Agnoletti, Francesca Bravi, Belinda De Simone, Yoram Kluger, Costanza Martino, Ernest E Moore, Massimo Sartelli, Dieter Weber, Chiara Robba

Background: Severe traumatic brain-injured (TBI) patients should be primarily admitted to a hub trauma center (hospital with neurosurgical capabilities) to allow immediate delivery of appropriate care in a specialized environment. Sometimes, severe TBI patients are admitted to a spoke hospital (hospital without neurosurgical capabilities), and scarce data are available regarding the optimal management of severe isolated TBI patients who do not have immediate access to neurosurgical care.

Methods: A multidisciplinary consensus panel composed of 41 physicians selected for their established clinical and scientific expertise in the acute management of TBI patients with different specializations (anesthesia/intensive care, neurocritical care, acute care surgery, neurosurgery and neuroradiology) was established. The consensus was endorsed by the World Society of Emergency Surgery, and a modified Delphi approach was adopted.

Results: A total of 28 statements were proposed and discussed. Consensus was reached on 22 strong recommendations and 3 weak recommendations. In three cases, where consensus was not reached, no recommendation was provided.

Conclusions: This consensus provides practical recommendations to support clinician's decision making in the management of isolated severe TBI patients in centers without neurosurgical capabilities and during transfer to a hub center.

背景:严重创伤性脑损伤(TBI)患者应主要入住中心创伤中心(具备神经外科能力的医院),以便在专业环境中立即提供适当的护理。有时,严重创伤性脑损伤患者会被送往辐条医院(不具备神经外科能力的医院),而对于无法立即获得神经外科治疗的严重孤立创伤性脑损伤患者,有关其最佳治疗方法的数据却很少:方法:成立了一个多学科共识小组,该小组由 41 名医生组成,他们在创伤性脑损伤患者的急性期管理方面具有公认的临床和科研专长,并拥有不同的专业(麻醉/重症监护、神经重症监护、急诊外科、神经外科和神经放射学)。该共识得到了世界急诊外科学会的认可,并采用了改良德尔菲法:结果:共提出并讨论了 28 项声明。就 22 项强建议和 3 项弱建议达成了共识。在 3 个未达成共识的案例中,未提供任何建议:该共识为临床医生在没有神经外科能力的中心处理孤立的严重创伤性脑损伤患者以及在向枢纽中心转运过程中的决策提供了实用建议。
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引用次数: 0
Who should operate patients presenting with emergent colon cancer? A comparison of short- and long-term outcome depending on surgical sub-specialization. 谁应该为出现突发性结肠癌的患者做手术?不同外科专科的短期和长期预后比较。
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-09 DOI: 10.1186/s13017-023-00474-y
Örvar Arnarson, Ingvar Syk, Salma Tunå Butt

Background: Colorectal cancer presents as emergencies in 20% of the cases. Emergency resection is associated with high postoperative morbidity and mortality. The specialization of the operating team in the emergency settings differs from the elective setting, which may have an impact on outcome. The aim of this study was to evaluate short- and long-term outcomes following emergent colon cancer surgery depending on sub-specialization of the operating team.

Methods: This is a retrospective population study based on data from the Swedish Colorectal Cancer Registry (SCRCR). In total, 656 patients undergoing emergent surgery for colon cancer between 2011 and 2016 were included. The cohort was divided in groups according to specialization of the operating team: (1) colorectal team (CRT); (2) emergency surgical team (EST); (3) general surgical team (GST). The impact of specialization on short- and long-term outcomes was analyzed.

Results: No statistically significant difference in 5-year overall survival (CRT 48.3%; EST 45.7%; GST 42.5%; p = 0.60) or 3-year recurrence-free survival (CRT 80.7%; EST 84.1%; GST 77.7%21.1%; p = 0.44) was noted between the groups. Neither was any significant difference in 30-day mortality (4.4%; 8.1%; 5.5%, p = 0.20), 90-day mortality (8.8; 11.9; 7.9%, p = 0.37) or postoperative complication rate (35.5%, 35.9 30.7, p = 0.52) noted between the groups. Multivariate analysis adjusted for case-mix showed no difference in hazard ratios for long-term survival or postoperative complications. The rate of permanent stoma after 3 years was higher in the EST group compared to the CRT and GST groups (34.5% vs. 24.3% and 23.9%, respectively; p < 0.0.5).

Conclusion: Surgical sub-specialization did not significantly affect postoperative complication rate, nor short- or long-term survival after emergent operation for colon cancer. Patients operated by emergency surgical teams were more likely to have a permanent stoma after 3 years.

背景:结直肠癌的急诊发生率为20%。急诊切除与术后高发病率和死亡率相关。急诊情况下手术团队的专业化程度不同于非急诊情况,这可能会对结果产生影响。本研究的目的是评估急诊结肠癌手术后的短期和长期结果,这取决于手术团队的亚专业化。方法:这是一项基于瑞典结直肠癌登记处(SCRCR)数据的回顾性人群研究。在2011年至2016年期间,共有656名因结肠癌接受紧急手术的患者被纳入研究。根据手术团队的专业划分队列:(1)结直肠组(CRT);(2)急诊外科小组(EST);(3)普外科团队(GST)。分析了专业化对短期和长期结果的影响。结果:两组患者5年总生存率(CRT 48.3%;美国东部时间45.7%;销售税42.5%;p = 0.60)或3年无复发生存率(CRT 80.7%;美国东部时间84.1%;销售税77.7% - 21.1%;P = 0.44)。30天死亡率均无显著差异(4.4%;8.1%;5.5%, p = 0.20), 90天死亡率(8.8;11.9;7.9%, p = 0.37)或术后并发症发生率(35.5%,35.9,30.7,p = 0.52)。经病例混合校正的多变量分析显示,长期生存或术后并发症的风险比无差异。3年后,EST组永久性造口率高于CRT组和GST组(分别为34.5%比24.3%和23.9%;结论:手术亚专科对结肠癌紧急手术后并发症发生率及短期、长期生存率无显著影响。急诊手术组的患者在3年后更有可能出现永久性造口。
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引用次数: 0
Hypertonic saline infusion does not improve the chance of primary fascial closure after damage control laparotomy: a randomized controlled trial. 高渗盐水输注不能提高损伤控制剖腹手术后初级筋膜关闭的机会:一项随机对照试验。
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-09 DOI: 10.1186/s13017-023-00475-x
Alberto F García, Ramiro Manzano-Nunez, Diana Cristina Carrillo, Julian Chica-Yanten, María Paula Naranjo, Álvaro I Sánchez, Jorge Humberto Mejía, Gustavo Adolfo Ospina-Tascón, Carlos A Ordoñez, Juan Gabriel Bayona, Juan Carlos Puyana

Background: Previous observational studies showed higher rates of abdominal wall closure with the use of hypertonic saline in trauma patients with abdominal injuries. However, no randomized controlled trials have been performed on this matter. This double-blind randomized clinical trial assessed the effect of 3% hypertonic saline (HS) solution on primary fascial closure and the timing of abdominal wall closure among patients who underwent damage control laparotomy for bleeding control.

Methods: Double-blind randomized clinical trial. Patients with abdominal injuries requiring damage control laparotomy (DCL) were randomly allocated to receive a 72-h infusion (rate: 50 mL/h) of 3% HS or 0.9 N isotonic saline (NS) after the index DCL. The primary endpoint was the proportion of patients with abdominal wall closure in the first seven days after the index DCL.

Results: The study was suspended in the first interim analysis because of futility. A total of 52 patients were included. Of these, 27 and 25 were randomly allocated to NS and HS, respectively. There were no significant differences in the rates of abdominal wall closure between groups (HS: 19 [79.2%] vs. NS: 17 [70.8%]; p = 0.71). In contrast, significantly higher hypernatremia rates were observed in the HS group (HS: 11 [44%] vs. NS: 1 [3.7%]; p < 0.001).

Conclusion: This double-blind randomized clinical trial showed no benefit of HS solution in primary fascial closure rates. Patients randomized to HS had higher sodium concentrations after the first day and were more likely to present hypernatremia. We do not recommend using HS in patients undergoing damage control laparotomy. Trial registration The trial protocol was registered in clinicaltrials.gov (identifier: NCT02542241).

背景:先前的观察性研究表明,在腹部损伤的创伤患者中,使用高渗盐水可以提高腹壁闭合率。然而,在这个问题上没有进行随机对照试验。本双盲随机临床试验评估了3%高渗生理盐水(HS)溶液对行损伤控制性剖腹手术以控制出血的患者初级筋膜闭合和腹壁闭合时间的影响。方法:双盲随机临床试验。腹部损伤需要损伤控制性剖腹手术(DCL)的患者随机分配,在指数DCL后接受3% HS或0.9 N等渗盐水(NS) 72 h输注(速率:50 mL/h)。主要终点是指数DCL后7天内腹壁闭合的患者比例。结果:由于无效,该研究在第一次中期分析中被暂停。共纳入52例患者。其中,27和25只随机分配到NS组和HS组。两组间腹壁闭合率无显著差异(HS: 19 [79.2%] vs. NS: 17 [70.8%];p = 0.71)。相比之下,HS组的高钠血症发生率明显更高(HS: 11 [44%] vs. NS: 1 [3.7%];结论:这项双盲随机临床试验显示,HS溶液在原发性筋膜闭合率方面没有任何益处。随机分配到HS组的患者在第一天后钠浓度较高,更有可能出现高钠血症。我们不建议在进行损伤控制剖腹手术的患者中使用HS。试验方案已在clinicaltrials.gov(标识符:NCT02542241)上注册。
{"title":"Hypertonic saline infusion does not improve the chance of primary fascial closure after damage control laparotomy: a randomized controlled trial.","authors":"Alberto F García,&nbsp;Ramiro Manzano-Nunez,&nbsp;Diana Cristina Carrillo,&nbsp;Julian Chica-Yanten,&nbsp;María Paula Naranjo,&nbsp;Álvaro I Sánchez,&nbsp;Jorge Humberto Mejía,&nbsp;Gustavo Adolfo Ospina-Tascón,&nbsp;Carlos A Ordoñez,&nbsp;Juan Gabriel Bayona,&nbsp;Juan Carlos Puyana","doi":"10.1186/s13017-023-00475-x","DOIUrl":"https://doi.org/10.1186/s13017-023-00475-x","url":null,"abstract":"<p><strong>Background: </strong>Previous observational studies showed higher rates of abdominal wall closure with the use of hypertonic saline in trauma patients with abdominal injuries. However, no randomized controlled trials have been performed on this matter. This double-blind randomized clinical trial assessed the effect of 3% hypertonic saline (HS) solution on primary fascial closure and the timing of abdominal wall closure among patients who underwent damage control laparotomy for bleeding control.</p><p><strong>Methods: </strong>Double-blind randomized clinical trial. Patients with abdominal injuries requiring damage control laparotomy (DCL) were randomly allocated to receive a 72-h infusion (rate: 50 mL/h) of 3% HS or 0.9 N isotonic saline (NS) after the index DCL. The primary endpoint was the proportion of patients with abdominal wall closure in the first seven days after the index DCL.</p><p><strong>Results: </strong>The study was suspended in the first interim analysis because of futility. A total of 52 patients were included. Of these, 27 and 25 were randomly allocated to NS and HS, respectively. There were no significant differences in the rates of abdominal wall closure between groups (HS: 19 [79.2%] vs. NS: 17 [70.8%]; p = 0.71). In contrast, significantly higher hypernatremia rates were observed in the HS group (HS: 11 [44%] vs. NS: 1 [3.7%]; p < 0.001).</p><p><strong>Conclusion: </strong>This double-blind randomized clinical trial showed no benefit of HS solution in primary fascial closure rates. Patients randomized to HS had higher sodium concentrations after the first day and were more likely to present hypernatremia. We do not recommend using HS in patients undergoing damage control laparotomy. Trial registration The trial protocol was registered in clinicaltrials.gov (identifier: NCT02542241).</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"4"},"PeriodicalIF":8.0,"publicationDate":"2023-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9830760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10740989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Structured approach with primary and secondary survey for major trauma care: an overview of reviews. 结构方法与主要创伤护理的初级和二级调查:综述综述。
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-04 DOI: 10.1186/s13017-022-00472-6
Silvia Gianola, Silvia Bargeri, Annalisa Biffi, Stefania Cimbanassi, Daniela D'Angelo, Daniela Coclite, Gabriella Facchinetti, Alice Josephine Fauci, Carla Ferrara, Marco Di Nitto, Antonello Napoletano, Ornella Punzo, Katya Ranzato, Alina Tratsevich, Primiano Iannone, Greta Castellini, Osvaldo Chiara

Background: A structured approach involves systematic management of trauma patients. We aim to conduct an overview of reviews about the clinical efficacy and safety of structured approach (i.e., primary and secondary survey) by guideline checklist compared to non-structured approach (i.e. clinical examination); moreover, routine screening whole-body computer tomography (WBCT) was compared to non-routine WBCT in patients with suspected major trauma.

Methods: We systematically searched MEDLINE (PubMed), EMBASE and Cochrane Database of Systematic Reviews up to 3 May 2022. Systematic reviews (SRs) that investigated the use of a structured approach compared to a non-structured approach were eligible. Two authors independently extracted data, managed the overlapping of primary studies belonging to the included SRs and calculated the corrected covered area (CCA). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

Results: We included nine SRs investigating two comparisons in stable trauma patients: structured approach vs non-structured approach (n = 1) and routine WBCT vs non-routine WBCT (n = 8). The overlap of included primary studies was generally high across outcomes (CCA ranged between 20.85 and 42.86%) with some discrepancies in the directions of effects across reviews. The application of a structured approach by checklist may improve adherence to guidelines (e.g. Advanced Trauma Life Support) during resuscitation and might lead to a reduction in mortality among severely injured patients as compared to clinical examination (Adjusted OR 0.51; 95% CI 0.30-0.89; p = 0.018; low certainty of evidence). The use of routine WBCT seems to offer little to no effects in reducing mortality and time spent in emergency room or department, whereas non-routine WBCT seems to offer little to no effects in reducing radiation dose, intensive care unit length of stay (LOS) and hospital LOS (low-to-moderate certainty of evidence).

Conclusions: The application of structured approach by checklist during trauma resuscitation may improve patient- and process-related outcomes. Including non-routine WBCT seems to offer the best trade-offs between benefits and harm. Clinicians should consider these findings in the light of their clinical context, the volume of patients in their facilities, the need for time management, and costs.

背景:一种结构化的方法涉及对创伤患者的系统管理。我们的目标是通过指南清单比较结构化方法(即一次和二次调查)与非结构化方法(即临床检查)的临床疗效和安全性;此外,对怀疑有重大创伤的患者进行常规筛查全身计算机断层扫描(WBCT)与非常规筛查全身计算机断层扫描(WBCT)的比较。方法:系统检索截至2022年5月3日的MEDLINE (PubMed)、EMBASE和Cochrane系统评价数据库。调查结构化方法与非结构化方法的使用情况的系统评价(SRs)是合格的。两位作者独立提取数据,管理纳入SRs的主要研究的重叠,并计算校正覆盖面积(CCA)。证据的确定性采用分级建议评估、发展和评价(GRADE)方法进行评估。结果:我们纳入了9例SRs,研究了稳定创伤患者的两种比较:结构化入路与非结构化入路(n = 1)和常规WBCT与非常规WBCT (n = 8)。纳入的主要研究在不同结局之间的重叠程度普遍较高(CCA范围在20.85 - 42.86%之间),但在不同综述的效应方向上存在一些差异。应用检查表的结构化方法可以提高复苏过程中对指南的依从性(如高级创伤生命支持),与临床检查相比,可能导致严重受伤患者死亡率降低(调整OR 0.51;95% ci 0.30-0.89;p = 0.018;证据的低确定性)。常规WBCT的使用似乎对降低死亡率和在急诊室或科室花费的时间几乎没有影响,而非常规WBCT在降低辐射剂量、重症监护病房住院时间(LOS)和医院LOS(低至中等证据确定性)方面似乎几乎没有影响。结论:在创伤复苏中应用结构化的检查表方法可以改善患者和过程相关的结果。包括非常规的WBCT似乎在利与弊之间提供了最好的权衡。临床医生应该根据他们的临床背景、医院的病人数量、时间管理的需要和成本来考虑这些发现。
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引用次数: 1
Surgeons' perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey. 外科医生对人工智能支持创伤和急诊临床决策的看法:一项国际调查的结果。
IF 6 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2023-01-03 DOI: 10.1186/s13017-022-00467-3
Lorenzo Cobianchi, Daniele Piccolo, Francesca Dal Mas, Vanni Agnoletti, Luca Ansaloni, Jeremy Balch, Walter Biffl, Giovanni Butturini, Fausto Catena, Federico Coccolini, Stefano Denicolai, Belinda De Simone, Isabella Frigerio, Paola Fugazzola, Gianluigi Marseglia, Giuseppe Roberto Marseglia, Jacopo Martellucci, Mirko Modenese, Pietro Previtali, Federico Ruta, Alessandro Venturi, Haytham M Kaafarani, Tyler J Loftus

Background: Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons' knowledge and perception of using AI-based tools in clinical decision-making processes.

Methods: An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society's website and Twitter profile.

Results: 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidelines, traditional training, and the support of their multidisciplinary colleagues. A lack of knowledge about several AI-related aspects emerges and is associated with mistrust.

Discussion: The trauma and emergency surgical community is divided into those who firmly believe in the potential of AI and those who do not understand or trust AI-enabled surgical decision-making aids. Academic societies and surgical training programs should promote a foundational, working knowledge of clinical AI.

背景:人工智能(AI)在医学和外科领域的应用日益广泛。基于人工智能的应用可以提供工具来检查大量数据,为支持复杂决策过程的预测分析提供信息。具有时间敏感性的创伤和急诊情况往往具有挑战性。本研究旨在调查创伤和急诊外科医生对在临床决策过程中使用基于人工智能的工具的了解和看法:一个多学科委员会根据有关人工智能手术决策辅助工具的文献编制了一份在线调查,并得到了世界急诊外科学会(WSES)的认可。调查通过该学会的网站和推特向917名WSES会员进行了宣传:来自五大洲 71 个国家的 650 名外科医生参与了调查。调查结果显示,外科医生中既有技术爱好者,也有怀疑论者,他们更倾向于使用传统的决策辅助工具,如临床指南、传统培训和多学科同事的支持。外科医生对人工智能的一些相关方面缺乏了解,这与不信任有关:讨论:创伤和急诊外科界分为两派,一派坚信人工智能的潜力,另一派则不理解或不信任人工智能手术决策辅助工具。学术团体和外科培训项目应推广临床人工智能的基础工作知识。
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引用次数: 0
The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis? ChoCO-W前瞻性观察性全球研究:COVID-19是否会增加坏疽性胆囊炎?
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2022-12-16 DOI: 10.1186/s13017-022-00466-4
Belinda De Simone, Fikri M Abu-Zidan, Elie Chouillard, Salomone Di Saverio, Massimo Sartelli, Mauro Podda, Carlos Augusto Gomes, Ernest E Moore, Susan J Moug, Luca Ansaloni, Yoram Kluger, Federico Coccolini, Aitor Landaluce-Olavarria, Begoña Estraviz-Mateos, Ana Uriguen-Etxeberria, Alessio Giordano, Alfonso Palmieri Luna, Luz Adriana Hernández Amín, Adriana María Palmieri Hernández, Amanda Shabana, Zakaria Andee Dzulkarnaen, Muhammad Asyraf Othman, Mohamad Ikhwan Sani, Andrea Balla, Rosa Scaramuzzo, Pasquale Lepiane, Andrea Bottari, Fabio Staderini, Fabio Cianchi, Andrea Cavallaro, Antonio Zanghì, Alessandro Cappellani, Roberto Campagnacci, Angela Maurizi, Mario Martinotti, Annamaria Ruggieri, Asri Che Jusoh, Karim Abdul Rahman, Anis Suraya M Zulkifli, Barbara Petronio, Belén Matías-García, Ana Quiroga-Valcárcel, Fernando Mendoza-Moreno, Boyko Atanasov, Fabio Cesare Campanile, Ilaria Vecchioni, Luca Cardinali, Grazia Travaglini, Elisa Sebastiani, Serge Chooklin, Serhii Chuklin, Pasquale Cianci, Enrico Restini, Sabino Capuzzolo, Giuseppe Currò, Rosalinda Filippo, Michele Rispoli, Daniel Aparicio-Sánchez, Virginia Durán Muñóz-Cruzado, Sandra Dios Barbeito, Samir Delibegovic, Amar Kesetovic, Diego Sasia, Felice Borghi, Giorgio Giraudo, Diego Visconti, Emanuele Doria, Mauro Santarelli, Davide Luppi, Stefano Bonilauri, Ugo Grossi, Giacomo Zanus, Alberto Sartori, Giacomo Piatto, Maurizio De Luca, Domenico Vita, Luigi Conti, Patrizio Capelli, Gaetano Maria Cattaneo, Athanasios Marinis, Styliani-Aikaterini Vederaki, Mehmet Bayrak, Yasemin Altıntas, Mustafa Yener Uzunoglu, Iskender Eren Demirbas, Yuksel Altinel, Serhat Meric, Yunus Emre Aktimur, Derya Salim Uymaz, Nail Omarov, Ibrahim Azamat, Eftychios Lostoridis, Eleni-Aikaterini Nagorni, Antonio Pujante, Gabriele Anania, Cristina Bombardini, Francesco Bagolini, Emre Gonullu, Baris Mantoglu, Recayi Capoglu, Stefano Cappato, Elena Muzio, Elif Colak, Suleyman Polat, Zehra Alan Koylu, Fatih Altintoprak, Zülfü Bayhan, Emrah Akin, Enrico Andolfi, Sulce Rezart, Jae Il Kim, Sung Won Jung, Yong Chan Shin, Octavian Enciu, Elena Adelina Toma, Fabio Medas, Gian Luigi Canu, Federico Cappellacci, Fabrizio D'Acapito, Giorgio Ercolani, Leonardo Solaini, Francesco Roscio, Federico Clerici, Roberta Gelmini, Francesco Serra, Elena Giulia Rossi, Francesco Fleres, Guglielmo Clarizia, Alessandro Spolini, Francesco Ferrara, Gabriela Nita, Jlenia Sarnari, Mahir Gachabayov, Abakar Abdullaev, Gaetano Poillucci, Gian Marco Palini, Simone Veneroni, Gianluca Garulli, Micaela Piccoli, Gianmaria Casoni Pattacini, Francesca Pecchini, Giulio Argenio, Mariano Fortunato Armellino, Giuseppe Brisinda, Silvia Tedesco, Pietro Fransvea, Giuseppe Ietto, Caterina Franchi, Giulio Carcano, Gennaro Martines, Giuseppe Trigiante, Giulia Negro, Gustavo Machain Vega, Agustín Rodríguez González, Leonardo Ojeda, Gaetano Piccolo, Andrea Bondurri, Anna Maffioli, Claudio Guerci, Boo Han Sin, Zamri Zuhdi, Azlanudin Azman, Hussam Mousa, Shadi Al Bahri, Goran Augustin, Ivan Romic, Trpimir Moric, Ioannis Nikolopoulos, Jacopo Andreuccetti, Giusto Pignata, Rossella D'Alessio, Jakub Kenig, Urszula Skorus, Gustavo Pereira Fraga, Elcio Shiyoiti Hirano, Jackson Vinícius de Lima Bertuol, Arda Isik, Eray Kurnaz, Mohammad Sohail Asghar, Ameer Afzal, Ali Akbar, Taxiarchis Konstantinos Nikolouzakis, Konstantinos Lasithiotakis, Emmanuel Chrysos, Koray Das, Nazmi Özer, Ahmet Seker, Mohamed Ibrahim, Hytham K S Hamid, Ahmed Babiker, Konstantinos Bouliaris, George Koukoulis, Chrysoula-Christina Kolla, Andrea Lucchi, Laura Agostinelli, Antonio Taddei, Laura Fortuna, Carlotta Agostini, Leo Licari, Simona Viola, Cosimo Callari, Letizia Laface, Emmanuele Abate, Massimiliano Casati, Alessandro Anastasi, Giuseppe Canonico, Linda Gabellini, Lorenzo Tosi, Anna Guariniello, Federico Zanzi, Lovenish Bains, Larysa Sydorchuk, Oksana Iftoda, Andrii Sydorchuk, Michele Malerba, Federico Costanzo, Raffaele Galleano, Michela Monteleone, Andrea Costanzi, Carlo Riva, Maciej Walędziak, Andrzej Kwiatkowski, Łukasz Czyżykowski, Piotr Major, Marcin Strzałka, Maciej Matyja, Michal Natkaniec, Maria Rosaria Valenti, Maria Domenica Pia Di Vita, Maria Sotiropoulou, Stylianos Kapiris, Damien Massalou, Massimiliano Veroux, Alessio Volpicelli, Rossella Gioco, Matteo Uccelli, Marta Bonaldi, Stefano Olmi, Matteo Nardi, Giada Livadoti, Cristian Mesina, Theodor Viorel Dumitrescu, Mihai Calin Ciorbagiu, Michele Ammendola, Giorgio Ammerata, Roberto Romano, Mihail Slavchev, Evangelos P Misiakos, Emmanouil Pikoulis, Dimitrios Papaconstantinou, Mohamed Elbahnasawy, Sherief Abdel-Elsalam, Daniel M Felsenreich, Julia Jedamzik, Nikolaos V Michalopoulos, Theodoros A Sidiropoulos, Maria Papadoliopoulou, Nicola Cillara, Antonello Deserra, Alessandro Cannavera, Ionuţ Negoi, Dimitrios Schizas, Athanasios Syllaios, Ilias Vagios, Stavros Gourgiotis, Nick Dai, Rekha Gurung, Marcus Norrey, Antonio Pesce, Carlo Vittorio Feo, Nicolo' Fabbri, Nikolaos Machairas, Panagiotis Dorovinis, Myrto D Keramida, Francesk Mulita, Georgios Ioannis Verras, Michail Vailas, Omer Yalkin, Nidal Iflazoglu, Direnc Yigit, Oussama Baraket, Karim Ayed, Mohamed Hedi Ghalloussi, Parmenion Patias, Georgios Ntokos, Razrim Rahim, Miklosh Bala, Asaf Kedar, Robert G Sawyer, Anna Trinh, Kelsey Miller, Ruslan Sydorchuk, Ruslan Knut, Oleksandr Plehutsa, Rumeysa Kevser Liman, Zeynep Ozkan, Saleh Abdel Kader, Sanjay Gupta, Monika Gureh, Sara Saeidi, Mohsen Aliakbarian, Amin Dalili, Tomohisa Shoko, Mitsuaki Kojima, Raira Nakamoto, Semra Demirli Atici, Gizem Kilinc Tuncer, Tayfun Kaya, Spiros G Delis, Stefano Rossi, Biagio Picardi, Simone Rossi Del Monte, Tania Triantafyllou, Dimitrios Theodorou, Tadeja Pintar, Jure Salobir, Dimitrios K Manatakis, Nikolaos Tasis, Vasileios Acheimastos, Orestis Ioannidis, Lydia Loutzidou, Savvas Symeonidis, Tiago Correia de Sá, Mónica Rocha, Tommaso Guagni, Desiré Pantalone, Gherardo Maltinti, Vladimir Khokha, Wafaa Abdel-Elsalam, Basma Ghoneim, José Antonio López-Ruiz, Yasin Kara, Syaza Zainudin, Firdaus Hayati, Nornazirah Azizan, Victoria Tan Phooi Khei, Rebecca Choy Xin Yi, Harivinthan Sellappan, Zaza Demetrashvili, Nika Lekiashvili, Ana Tvaladze, Caterina Froiio, Daniele Bernardi, Luigi Bonavina, Angeles Gil-Olarte, Sebastiano Grassia, Estela Romero-Vargas, Francesco Bianco, Andrew A Gumbs, Agron Dogjani, Ferdinando Agresta, Andrey Litvin, Zsolt J Balogh, George Gendrikson, Costanza Martino, Dimitrios Damaskos, Nikolaos Pararas, Andrew Kirkpatrick, Mikhail Kurtenkov, Felipe Couto Gomes, Adolfo Pisanu, Oreste Nardello, Fabrizio Gambarini, Hager Aref, Nicola De' Angelis, Vanni Agnoletti, Antonio Biondi, Marco Vacante, Giulia Griggio, Roberta Tutino, Marco Massani, Giovanni Bisetto, Savino Occhionorelli, Dario Andreotti, Domenico Lacavalla, Walter L Biffl, Fausto Catena

Background: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not.

Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not.

Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001].

Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands.

背景:据报道,在COVID-19大流行期间,高发病率和潜在致命性坏疽性胆囊炎的发病率有所增加。ChoCO-W研究的目的是比较COVID-19疾病患者与非COVID-19疾病患者急性胆囊炎的临床表现和结局。方法:前瞻性收集数据6个月(2020年10月1日至2021年4月30日),随访1个月。2020年10月,SARS CoV-2的Delta变体首次被分离出来。根据STROBE指南对人口学和临床数据进行分析和报告。将感染COVID-19的患者与未感染COVID-19的患者的基线特征和临床结果进行比较。结果:共有2893名患者,来自42个国家,218个中心,纳入本研究,中位年龄为61.3岁(SD: 17.39)岁;男性1481例(51%)。新冠肺炎阳性180例(6.9%),阴性2412例(93.1%)。结论:急诊就诊的急性胆囊炎患者中,新冠肺炎患者坏疽性胆囊炎的发生率高于非新冠肺炎患者。COVID患者的坏疽性胆囊炎与高级别Clavien-Dindo术后并发症、更长的住院时间和更高的死亡率相关。新冠肺炎患者开腹胆囊切除术率高于非新冠肺炎患者。建议尽可能推迟新冠肺炎患者的手术治疗,以降低发病率和死亡率。COVID-19感染和坏疽性胆囊炎不是腹腔镜胆囊切除术的绝对禁忌症,由专家逐个评估。
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Ruggieri,&nbsp;Asri Che Jusoh,&nbsp;Karim Abdul Rahman,&nbsp;Anis Suraya M Zulkifli,&nbsp;Barbara Petronio,&nbsp;Belén Matías-García,&nbsp;Ana Quiroga-Valcárcel,&nbsp;Fernando Mendoza-Moreno,&nbsp;Boyko Atanasov,&nbsp;Fabio Cesare Campanile,&nbsp;Ilaria Vecchioni,&nbsp;Luca Cardinali,&nbsp;Grazia Travaglini,&nbsp;Elisa Sebastiani,&nbsp;Serge Chooklin,&nbsp;Serhii Chuklin,&nbsp;Pasquale Cianci,&nbsp;Enrico Restini,&nbsp;Sabino Capuzzolo,&nbsp;Giuseppe Currò,&nbsp;Rosalinda Filippo,&nbsp;Michele Rispoli,&nbsp;Daniel Aparicio-Sánchez,&nbsp;Virginia Durán Muñóz-Cruzado,&nbsp;Sandra Dios Barbeito,&nbsp;Samir Delibegovic,&nbsp;Amar Kesetovic,&nbsp;Diego Sasia,&nbsp;Felice Borghi,&nbsp;Giorgio Giraudo,&nbsp;Diego Visconti,&nbsp;Emanuele Doria,&nbsp;Mauro Santarelli,&nbsp;Davide Luppi,&nbsp;Stefano Bonilauri,&nbsp;Ugo Grossi,&nbsp;Giacomo Zanus,&nbsp;Alberto Sartori,&nbsp;Giacomo Piatto,&nbsp;Maurizio De Luca,&nbsp;Domenico Vita,&nbsp;Luigi Conti,&nbsp;Patrizio Capelli,&nbsp;Gaetano Maria Cattaneo,&nbsp;Athanasios Marinis,&nbsp;Styliani-Aikaterini Vederaki,&nbsp;Mehmet Bayrak,&nbsp;Yasemin Altıntas,&nbsp;Mustafa Yener Uzunoglu,&nbsp;Iskender Eren Demirbas,&nbsp;Yuksel Altinel,&nbsp;Serhat Meric,&nbsp;Yunus Emre Aktimur,&nbsp;Derya Salim Uymaz,&nbsp;Nail Omarov,&nbsp;Ibrahim Azamat,&nbsp;Eftychios Lostoridis,&nbsp;Eleni-Aikaterini Nagorni,&nbsp;Antonio Pujante,&nbsp;Gabriele Anania,&nbsp;Cristina Bombardini,&nbsp;Francesco Bagolini,&nbsp;Emre Gonullu,&nbsp;Baris Mantoglu,&nbsp;Recayi Capoglu,&nbsp;Stefano Cappato,&nbsp;Elena Muzio,&nbsp;Elif Colak,&nbsp;Suleyman Polat,&nbsp;Zehra Alan Koylu,&nbsp;Fatih Altintoprak,&nbsp;Zülfü Bayhan,&nbsp;Emrah Akin,&nbsp;Enrico Andolfi,&nbsp;Sulce Rezart,&nbsp;Jae Il Kim,&nbsp;Sung Won Jung,&nbsp;Yong Chan Shin,&nbsp;Octavian Enciu,&nbsp;Elena Adelina Toma,&nbsp;Fabio Medas,&nbsp;Gian Luigi Canu,&nbsp;Federico Cappellacci,&nbsp;Fabrizio D'Acapito,&nbsp;Giorgio Ercolani,&nbsp;Leonardo Solaini,&nbsp;Francesco Roscio,&nbsp;Federico Clerici,&nbsp;Roberta Gelmini,&nbsp;Francesco Serra,&nbsp;Elena Giulia Rossi,&nbsp;Francesco Fleres,&nbsp;Guglielmo Clarizia,&nbsp;Alessandro Spolini,&nbsp;Francesco Ferrara,&nbsp;Gabriela Nita,&nbsp;Jlenia Sarnari,&nbsp;Mahir Gachabayov,&nbsp;Abakar Abdullaev,&nbsp;Gaetano Poillucci,&nbsp;Gian Marco Palini,&nbsp;Simone Veneroni,&nbsp;Gianluca Garulli,&nbsp;Micaela Piccoli,&nbsp;Gianmaria Casoni Pattacini,&nbsp;Francesca Pecchini,&nbsp;Giulio Argenio,&nbsp;Mariano Fortunato Armellino,&nbsp;Giuseppe Brisinda,&nbsp;Silvia Tedesco,&nbsp;Pietro Fransvea,&nbsp;Giuseppe Ietto,&nbsp;Caterina Franchi,&nbsp;Giulio Carcano,&nbsp;Gennaro Martines,&nbsp;Giuseppe Trigiante,&nbsp;Giulia Negro,&nbsp;Gustavo Machain Vega,&nbsp;Agustín Rodríguez González,&nbsp;Leonardo Ojeda,&nbsp;Gaetano Piccolo,&nbsp;Andrea Bondurri,&nbsp;Anna Maffioli,&nbsp;Claudio Guerci,&nbsp;Boo Han Sin,&nbsp;Zamri Zuhdi,&nbsp;Azlanudin Azman,&nbsp;Hussam Mousa,&nbsp;Shadi Al Bahri,&nbsp;Goran Augustin,&nbsp;Ivan Romic,&nbsp;Trpimir Moric,&nbsp;Ioannis Nikolopoulos,&nbsp;Jacopo Andreuccetti,&nbsp;Giusto Pignata,&nbsp;Rossella D'Alessio,&nbsp;Jakub Kenig,&nbsp;Urszula Skorus,&nbsp;Gustavo Pereira Fraga,&nbsp;Elcio Shiyoiti Hirano,&nbsp;Jackson Vinícius de Lima Bertuol,&nbsp;Arda Isik,&nbsp;Eray Kurnaz,&nbsp;Mohammad Sohail Asghar,&nbsp;Ameer Afzal,&nbsp;Ali Akbar,&nbsp;Taxiarchis Konstantinos Nikolouzakis,&nbsp;Konstantinos Lasithiotakis,&nbsp;Emmanuel Chrysos,&nbsp;Koray Das,&nbsp;Nazmi Özer,&nbsp;Ahmet Seker,&nbsp;Mohamed Ibrahim,&nbsp;Hytham K S Hamid,&nbsp;Ahmed Babiker,&nbsp;Konstantinos Bouliaris,&nbsp;George Koukoulis,&nbsp;Chrysoula-Christina Kolla,&nbsp;Andrea Lucchi,&nbsp;Laura Agostinelli,&nbsp;Antonio Taddei,&nbsp;Laura Fortuna,&nbsp;Carlotta Agostini,&nbsp;Leo Licari,&nbsp;Simona Viola,&nbsp;Cosimo Callari,&nbsp;Letizia Laface,&nbsp;Emmanuele Abate,&nbsp;Massimiliano Casati,&nbsp;Alessandro Anastasi,&nbsp;Giuseppe Canonico,&nbsp;Linda Gabellini,&nbsp;Lorenzo Tosi,&nbsp;Anna Guariniello,&nbsp;Federico Zanzi,&nbsp;Lovenish Bains,&nbsp;Larysa Sydorchuk,&nbsp;Oksana Iftoda,&nbsp;Andrii Sydorchuk,&nbsp;Michele Malerba,&nbsp;Federico Costanzo,&nbsp;Raffaele Galleano,&nbsp;Michela Monteleone,&nbsp;Andrea Costanzi,&nbsp;Carlo Riva,&nbsp;Maciej Walędziak,&nbsp;Andrzej Kwiatkowski,&nbsp;Łukasz Czyżykowski,&nbsp;Piotr Major,&nbsp;Marcin Strzałka,&nbsp;Maciej Matyja,&nbsp;Michal Natkaniec,&nbsp;Maria Rosaria Valenti,&nbsp;Maria Domenica Pia Di Vita,&nbsp;Maria Sotiropoulou,&nbsp;Stylianos Kapiris,&nbsp;Damien Massalou,&nbsp;Massimiliano Veroux,&nbsp;Alessio Volpicelli,&nbsp;Rossella Gioco,&nbsp;Matteo Uccelli,&nbsp;Marta Bonaldi,&nbsp;Stefano Olmi,&nbsp;Matteo Nardi,&nbsp;Giada Livadoti,&nbsp;Cristian Mesina,&nbsp;Theodor Viorel Dumitrescu,&nbsp;Mihai Calin Ciorbagiu,&nbsp;Michele Ammendola,&nbsp;Giorgio Ammerata,&nbsp;Roberto Romano,&nbsp;Mihail Slavchev,&nbsp;Evangelos P Misiakos,&nbsp;Emmanouil Pikoulis,&nbsp;Dimitrios Papaconstantinou,&nbsp;Mohamed Elbahnasawy,&nbsp;Sherief Abdel-Elsalam,&nbsp;Daniel M Felsenreich,&nbsp;Julia Jedamzik,&nbsp;Nikolaos V Michalopoulos,&nbsp;Theodoros A Sidiropoulos,&nbsp;Maria Papadoliopoulou,&nbsp;Nicola Cillara,&nbsp;Antonello Deserra,&nbsp;Alessandro Cannavera,&nbsp;Ionuţ Negoi,&nbsp;Dimitrios Schizas,&nbsp;Athanasios Syllaios,&nbsp;Ilias Vagios,&nbsp;Stavros Gourgiotis,&nbsp;Nick Dai,&nbsp;Rekha Gurung,&nbsp;Marcus Norrey,&nbsp;Antonio Pesce,&nbsp;Carlo Vittorio Feo,&nbsp;Nicolo' Fabbri,&nbsp;Nikolaos Machairas,&nbsp;Panagiotis Dorovinis,&nbsp;Myrto D Keramida,&nbsp;Francesk Mulita,&nbsp;Georgios Ioannis Verras,&nbsp;Michail Vailas,&nbsp;Omer Yalkin,&nbsp;Nidal Iflazoglu,&nbsp;Direnc Yigit,&nbsp;Oussama Baraket,&nbsp;Karim Ayed,&nbsp;Mohamed Hedi Ghalloussi,&nbsp;Parmenion Patias,&nbsp;Georgios Ntokos,&nbsp;Razrim Rahim,&nbsp;Miklosh Bala,&nbsp;Asaf Kedar,&nbsp;Robert G Sawyer,&nbsp;Anna Trinh,&nbsp;Kelsey Miller,&nbsp;Ruslan Sydorchuk,&nbsp;Ruslan Knut,&nbsp;Oleksandr Plehutsa,&nbsp;Rumeysa Kevser Liman,&nbsp;Zeynep Ozkan,&nbsp;Saleh Abdel Kader,&nbsp;Sanjay Gupta,&nbsp;Monika Gureh,&nbsp;Sara Saeidi,&nbsp;Mohsen Aliakbarian,&nbsp;Amin Dalili,&nbsp;Tomohisa Shoko,&nbsp;Mitsuaki Kojima,&nbsp;Raira Nakamoto,&nbsp;Semra Demirli Atici,&nbsp;Gizem Kilinc Tuncer,&nbsp;Tayfun Kaya,&nbsp;Spiros G Delis,&nbsp;Stefano Rossi,&nbsp;Biagio Picardi,&nbsp;Simone Rossi Del Monte,&nbsp;Tania Triantafyllou,&nbsp;Dimitrios Theodorou,&nbsp;Tadeja Pintar,&nbsp;Jure Salobir,&nbsp;Dimitrios K Manatakis,&nbsp;Nikolaos Tasis,&nbsp;Vasileios Acheimastos,&nbsp;Orestis Ioannidis,&nbsp;Lydia Loutzidou,&nbsp;Savvas Symeonidis,&nbsp;Tiago Correia de Sá,&nbsp;Mónica Rocha,&nbsp;Tommaso Guagni,&nbsp;Desiré Pantalone,&nbsp;Gherardo Maltinti,&nbsp;Vladimir Khokha,&nbsp;Wafaa Abdel-Elsalam,&nbsp;Basma Ghoneim,&nbsp;José Antonio López-Ruiz,&nbsp;Yasin Kara,&nbsp;Syaza Zainudin,&nbsp;Firdaus Hayati,&nbsp;Nornazirah Azizan,&nbsp;Victoria Tan Phooi Khei,&nbsp;Rebecca Choy Xin Yi,&nbsp;Harivinthan Sellappan,&nbsp;Zaza Demetrashvili,&nbsp;Nika Lekiashvili,&nbsp;Ana Tvaladze,&nbsp;Caterina Froiio,&nbsp;Daniele Bernardi,&nbsp;Luigi Bonavina,&nbsp;Angeles Gil-Olarte,&nbsp;Sebastiano Grassia,&nbsp;Estela Romero-Vargas,&nbsp;Francesco Bianco,&nbsp;Andrew A Gumbs,&nbsp;Agron Dogjani,&nbsp;Ferdinando Agresta,&nbsp;Andrey Litvin,&nbsp;Zsolt J Balogh,&nbsp;George Gendrikson,&nbsp;Costanza Martino,&nbsp;Dimitrios Damaskos,&nbsp;Nikolaos Pararas,&nbsp;Andrew Kirkpatrick,&nbsp;Mikhail Kurtenkov,&nbsp;Felipe Couto Gomes,&nbsp;Adolfo Pisanu,&nbsp;Oreste Nardello,&nbsp;Fabrizio Gambarini,&nbsp;Hager Aref,&nbsp;Nicola De' Angelis,&nbsp;Vanni Agnoletti,&nbsp;Antonio Biondi,&nbsp;Marco Vacante,&nbsp;Giulia Griggio,&nbsp;Roberta Tutino,&nbsp;Marco Massani,&nbsp;Giovanni Bisetto,&nbsp;Savino Occhionorelli,&nbsp;Dario Andreotti,&nbsp;Domenico Lacavalla,&nbsp;Walter L Biffl,&nbsp;Fausto Catena","doi":"10.1186/s13017-022-00466-4","DOIUrl":"https://doi.org/10.1186/s13017-022-00466-4","url":null,"abstract":"<p><strong>Background: </strong>The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not.</p><p><strong>Methods: </strong>Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not.</p><p><strong>Results: </strong>A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001].</p><p><strong>Conclusions: </strong>The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"17 1","pages":"61"},"PeriodicalIF":8.0,"publicationDate":"2022-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9755784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10525453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Decreasing use of pancreatic necrosectomy and NSQIP predictors of complications and mortality. 减少使用胰腺坏死切除术和NSQIP预测并发症和死亡率。
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2022-12-12 DOI: 10.1186/s13017-022-00462-8
Amy E Liepert, George Ventro, Jessica L Weaver, Allison E Berndtson, Laura N Godat, Laura M Adams, Jarrett Santorelli, Todd W Costantini, Jay J Doucet

Background: Surgical pancreatic necrosectomy (SPN) is an option for the management of infected pancreatic necrosis. The literature indicates that an escalating, combined endoscopic, interventional radiology and minimally invasive surgery "step-up" approach, such as video-assisted retroperitoneal debridement, may reduce the number of required SPNs and ICU complications, such as multiple organ failure. We hypothesized that complications for surgically treated severe necrotizing pancreatitis patients decreased during the period of adoption of the "step-up" approach.

Methods: The American college of surgeons national surgery quality improvement program database (ACS-NSQIP) was used to find SPN cases from 2007 to 2019 in ACS-NSQIP submitting hospitals. Mortality and Clavien-Dindo class 4 (CD4) ICU complications were collected. Predictors of outcomes were identified by univariate and multivariate analyses.

Results: There were 2457 SPN cases. SPN cases decreased from 0.09% in 2007 to 0.01% in 2019 of NSQIP operative cases (p < 0.001). Overall mortality was 8.5% and did not decrease with time. CD4 complications decreased from 40 to 27% (p < 0.001). There was a 65% reduction in SPN cases requiring a return to the operating room. Multivariate predictors of complications were emergency general surgery (EGS, p < 0.001), serum albumin (p < 0.0001) and modified frailty index (mFI) (p < 0.0001). Multivariate predictors of mortality were EGS (p < 0.0001), serum albumin (p < 0.0001), and mFI (p < 0.04). The mFI decreased after 2010 (p < 0.001).

Conclusion: SPNs decreased after 2010, with decreasing CD4 complications, decreasing reoperation rates and stable mortality rates, likely indicating broad adoption of a "step-up" approach. Larger, prospective studies to compare indications and outcomes for "step up" versus open SPN are warranted.

背景:手术胰腺坏死切除术(SPN)是治疗感染性胰腺坏死的一种选择。文献表明,逐步升级的内镜、介入放射学和微创手术“升级”方法,如视频辅助腹膜后清创,可能会减少所需spn的数量和ICU并发症,如多器官衰竭。我们假设手术治疗的严重坏死性胰腺炎患者在采用“升级”方法期间并发症减少。方法:采用美国外科医师学会国家手术质量改进计划数据库(ACS-NSQIP)检索2007 - 2019年提交ACS-NSQIP的医院的SPN病例。收集死亡率和Clavien-Dindo 4级(CD4) ICU并发症。通过单变量和多变量分析确定预测结果的因素。结果:SPN 2457例。结论:2010年后SPN下降,CD4并发症减少,再手术率下降,死亡率稳定,可能表明“加坡”方法被广泛采用。有必要进行更大规模的前瞻性研究,比较“强化”与开放SPN的适应症和结果。
{"title":"Decreasing use of pancreatic necrosectomy and NSQIP predictors of complications and mortality.","authors":"Amy E Liepert,&nbsp;George Ventro,&nbsp;Jessica L Weaver,&nbsp;Allison E Berndtson,&nbsp;Laura N Godat,&nbsp;Laura M Adams,&nbsp;Jarrett Santorelli,&nbsp;Todd W Costantini,&nbsp;Jay J Doucet","doi":"10.1186/s13017-022-00462-8","DOIUrl":"https://doi.org/10.1186/s13017-022-00462-8","url":null,"abstract":"<p><strong>Background: </strong>Surgical pancreatic necrosectomy (SPN) is an option for the management of infected pancreatic necrosis. The literature indicates that an escalating, combined endoscopic, interventional radiology and minimally invasive surgery \"step-up\" approach, such as video-assisted retroperitoneal debridement, may reduce the number of required SPNs and ICU complications, such as multiple organ failure. We hypothesized that complications for surgically treated severe necrotizing pancreatitis patients decreased during the period of adoption of the \"step-up\" approach.</p><p><strong>Methods: </strong>The American college of surgeons national surgery quality improvement program database (ACS-NSQIP) was used to find SPN cases from 2007 to 2019 in ACS-NSQIP submitting hospitals. Mortality and Clavien-Dindo class 4 (CD4) ICU complications were collected. Predictors of outcomes were identified by univariate and multivariate analyses.</p><p><strong>Results: </strong>There were 2457 SPN cases. SPN cases decreased from 0.09% in 2007 to 0.01% in 2019 of NSQIP operative cases (p < 0.001). Overall mortality was 8.5% and did not decrease with time. CD4 complications decreased from 40 to 27% (p < 0.001). There was a 65% reduction in SPN cases requiring a return to the operating room. Multivariate predictors of complications were emergency general surgery (EGS, p < 0.001), serum albumin (p < 0.0001) and modified frailty index (mFI) (p < 0.0001). Multivariate predictors of mortality were EGS (p < 0.0001), serum albumin (p < 0.0001), and mFI (p < 0.04). The mFI decreased after 2010 (p < 0.001).</p><p><strong>Conclusion: </strong>SPNs decreased after 2010, with decreasing CD4 complications, decreasing reoperation rates and stable mortality rates, likely indicating broad adoption of a \"step-up\" approach. Larger, prospective studies to compare indications and outcomes for \"step up\" versus open SPN are warranted.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"17 1","pages":"60"},"PeriodicalIF":8.0,"publicationDate":"2022-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9743619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10356277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial. 腹腔镜阑尾切除术后急性无并发症阑尾炎的门诊治疗:一项随机对照试验。
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2022-11-23 DOI: 10.1186/s13017-022-00465-5
Jordi Elvira López, Ricard Sales Mallafré, Erlinda Padilla Zegarra, Luis Carrillo Luna, Joan Ferreres Serafini, Roisin Tully, Robert Memba Ikuga, Rosa Jorba Martin

Objective: To confirm the safety and efficacy of outpatient management of laparoscopic appendectomy, with an enhanced recovery after surgery (ERAS) protocol, in adult patients with uncomplicated acute appendicitis. Outpatient laparoscopic appendectomy is feasible and secure in selected patients in observational studies. The benefits include reduced length of stay (LOS) and postoperative complications. This is the first randomized controlled trial of outpatient management following ERAS protocol.

Methods: Patients admitted from the emergency department with acute appendicitis were randomized into one of two groups: standard care within the hospital (HG) or the outpatient group (OG). An ERAS protocol was followed for both groups. Patients in the HG were admitted to the surgical ward. Patients in the OG were referred to the day-surgery unit. The primary endpoint was the length of stay.

Results: Ninety-seven patients were included: 49 in the OG and 48 in the HG. LOS was significantly shorter in the OG (mean 8.82 h) than in the HG (mean 43.53 h), p < 0.001. There was no difference in readmission rates (p = 0.320); we observed only one readmission in the OG. No further emergency consultations or complications were observed. The cost saving was $516.52/patient as a result of the intervention.

Conclusion: Outpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost.

Trial registration: Registration: www.

Clinicaltrials: gov (NCT05401188) Clinical Trial ID: NCT05401188.

目的:探讨成人无并发症急性阑尾炎患者腹腔镜阑尾切除术门诊管理的安全性和有效性。门诊腹腔镜阑尾切除术在观察性研究中是可行和安全的。其好处包括减少住院时间(LOS)和术后并发症。这是第一个按照ERAS方案进行门诊管理的随机对照试验。方法:急诊科收治的急性阑尾炎患者随机分为两组:院内标准治疗组(HG)和门诊组(OG)。两组均采用ERAS治疗方案。HG患者被送进外科病房。OG组的患者被转到日间外科。主要终点是住院时间。结果:本组共97例,OG组49例,HG组48例。OG组的术后时间(平均8.82 h)明显短于HG组(平均43.53 h)。结论:门诊治疗阑尾切除术是安全可行的。该方法可成为无并发症阑尾炎患者的标准治疗方法,并发症少,LOS低,费用低。注册:www.Clinicaltrials: gov (NCT05401188)临床试验ID: NCT05401188。
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引用次数: 2
The outcomes of right-sided and left-sided colonic diverticulitis following non-operative management: a systematic review and meta-analysis. 非手术治疗后右侧和左侧结肠憩室炎的结果:一项系统回顾和荟萃分析。
IF 8 1区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2022-11-01 DOI: 10.1186/s13017-022-00463-7
Sih-Shiang Huang, Chih-Wei Sung, Hsiu-Po Wang, Wan-Ching Lien

Background: There is no sufficient overview of outcomes in right-sided and left-sided colonic diverticulitis (CD) following non-operative management. This systematic review was conducted to evaluate the recurrence/treatment failure in right-sided and left-sided CD.

Methods: A systematic review was conducted following PRISMA guidelines. MEDLINE, Embase, and Cochrane Library from inception to Dec 2021 were searched. The study characteristics, recurrence/treatment failure, and risk factors for recurrence/treatment failure were extracted. Proportional meta-analyses were performed to calculate the pooled recurrent/treatment failure rate of right-sided and left-sided CD using the random effect model. Logistic regression was applied for the factors associated with the recurrence/treatment failure.

Results: Thirty-eight studies with 10,129 patients were included, and only two studies comprised both sides of CD. None of the studies had a high risk of bias although significant heterogeneity existed. The pooled recurrence rate was 10% (95% CI 8-13%, I2 = 86%, p < 0.01) in right-sided and 20% (95% CI 16-24%, I2 = 92%, p < 0.01) in left-sided CD. For the uncomplicated CD, the pooled recurrence rate was 9% (95% CI 6-13%, I2 = 77%, p < 0.01) in right-sided and 15% (95% CI 8-27%, I2 = 97%, p < 0.01) in the left-sided. Age and gender were not associated with the recurrence of both sides. The treatment failure rate was 5% (95% CI 2-10%, I2 = 84%, p < 0.01) in right-sided and 4% (95% CI 2-7%, I2 = 80%, p < 0.01) in left-sided CD. The risk factors for recurrence and treatment failure were limited.

Conclusion: Non-operative management is effective with low rates of recurrence and treatment failure for both right-sided and left-sided CD although left-sided exhibits a higher recurrence. The recurrence rates did not differ between patients receiving antibiotics or not in uncomplicated CD. Age and sex were not associated with the recurrence although other risk factors were dispersing. Further risk factors for recurrence and treatment failure would be investigated for precise clinical decision-making and individualized strategy.

背景:非手术治疗后右侧和左侧结肠憩室炎(CD)的预后没有足够的综述。本系统综述旨在评估右侧和左侧cd的复发/治疗失败。方法:遵循PRISMA指南进行系统综述。检索了MEDLINE、Embase和Cochrane Library从成立到2021年12月的资料。提取研究特点、复发/治疗失败及复发/治疗失败的危险因素。采用随机效应模型进行比例荟萃分析,计算右侧和左侧CD的合并复发/治疗失败率。Logistic回归分析与复发/治疗失败相关的因素。结果:38项研究共纳入10129例患者,其中只有2项研究包括了CD的两侧。尽管存在显著的异质性,但没有一项研究具有高偏倚风险。合并复发率为10% (95% CI 8 ~ 13%, I2 = 86%, p2 = 92%, p2 = 77%, p2 = 97%, p2 = 84%, p2 = 80%)。结论:非手术治疗对左右侧CD均有效,复发率低,治疗失败率低,但左侧CD复发率较高。在无并发症的乳糜泻中,接受抗生素治疗和未接受抗生素治疗的患者的复发率没有差异。年龄和性别与复发无关,尽管其他危险因素正在分散。进一步研究复发和治疗失败的危险因素,以制定准确的临床决策和个性化的治疗策略。
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引用次数: 4
期刊
World Journal of Emergency Surgery
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