Pub Date : 2025-01-27DOI: 10.1186/s13017-024-00569-0
Chien-Hung Liao, David A. Spain, Chih-Chi Chen, Chi-Tung Cheng, Wei-Cheng Lin, Dong-Ru Ho, Heng-Fu Lin, Fausto Catena
Intrabdominal pressure (IAP) is an important parameter. Elevated IAP can reduce visceral perfusion, lead to intraabdominal hypertension, and result in life-threatening abdominal compartment syndrome. While ingestible capsular devices have been used for various abdominal diagnoses, their application in continuous IAP monitoring remains unproven. We conducted a prospective clinical trial to evaluate the feasibility of IAP measurement using a digital capsule PressureDOT, an ingestible capsule equipped with wireless transmission capability and a pressure sensor, then compared its reliability with conventional intravesical method. Patients undergoing laparoscopic or robotic surgeries were recruited. During surgery, we created pneumoperitoneum by inflating CO2 into the peritoneal cavity and IAP was simultaneously monitored using both the ingestible capsules and intravesical measurements from Foley catheter. We assessed the feasibility of signal transmission and the accuracy of pressure measurements. Six patients were enrolled in this pilot study. No adverse events were reported, and the average first-intake time was within 24 h. All capsules were successfully expelled, with an average excretion time of 81 h. In the summarized data, the mean IAPdot is 0.6 mmHg lower than the IAPivp, with a standard deviation of 1.68 mmHg. However, capsule measurements showed excellent correlation with intravesical IAP measurements, with an intraclass correlation coefficient of 0.916 (95% CI: 0.8821–0.9320). Our study demonstrates the feasibility and safety of using digital capsules for continuous IAP monitoring, providing the agreement between IAP measurements from digital capsules and conventional intravesical measurement within a near-normal pressure.
{"title":"Feasibility and accuracy of continuous intraabdominal pressure monitoring with a capsular device in human pilot trial","authors":"Chien-Hung Liao, David A. Spain, Chih-Chi Chen, Chi-Tung Cheng, Wei-Cheng Lin, Dong-Ru Ho, Heng-Fu Lin, Fausto Catena","doi":"10.1186/s13017-024-00569-0","DOIUrl":"https://doi.org/10.1186/s13017-024-00569-0","url":null,"abstract":"Intrabdominal pressure (IAP) is an important parameter. Elevated IAP can reduce visceral perfusion, lead to intraabdominal hypertension, and result in life-threatening abdominal compartment syndrome. While ingestible capsular devices have been used for various abdominal diagnoses, their application in continuous IAP monitoring remains unproven. We conducted a prospective clinical trial to evaluate the feasibility of IAP measurement using a digital capsule PressureDOT, an ingestible capsule equipped with wireless transmission capability and a pressure sensor, then compared its reliability with conventional intravesical method. Patients undergoing laparoscopic or robotic surgeries were recruited. During surgery, we created pneumoperitoneum by inflating CO2 into the peritoneal cavity and IAP was simultaneously monitored using both the ingestible capsules and intravesical measurements from Foley catheter. We assessed the feasibility of signal transmission and the accuracy of pressure measurements. Six patients were enrolled in this pilot study. No adverse events were reported, and the average first-intake time was within 24 h. All capsules were successfully expelled, with an average excretion time of 81 h. In the summarized data, the mean IAPdot is 0.6 mmHg lower than the IAPivp, with a standard deviation of 1.68 mmHg. However, capsule measurements showed excellent correlation with intravesical IAP measurements, with an intraclass correlation coefficient of 0.916 (95% CI: 0.8821–0.9320). Our study demonstrates the feasibility and safety of using digital capsules for continuous IAP monitoring, providing the agreement between IAP measurements from digital capsules and conventional intravesical measurement within a near-normal pressure.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"58 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-23DOI: 10.1186/s13017-025-00580-z
Hassan Elbiss, Shamsa Al Awar, Jamal Koteesh, Howaida Khair, Sara Maki, Dana H. Abdalla, Fikri M. Abu-Zidan
Postpartum hemorrhage (PPH) is one of the leading preventable causes of maternal morbidity and mortality causing one-fourth of all maternal deaths. We aimed to study the role of uterine artery embolization (UAE) in controlling PPH and its impact on the need for hysterectomy. We studied patients who were diagnosed with primary PPH between February 2012 and March 2020 at Al Ain Hospital, United Arab Emirates. We studied the characteristics and outcomes of those undergoing interventional radiology via UAE. Logistic regression analysis was done to define the factors that predict the need for emergency UAE. Out of 79 patients who had elective (n = 53) or emergency (n = 26) embolization, the placenta previa accreta (69.8% vs. 23.1%) and placenta previa (24.4% vs. 3.8%) were the common indications for elective versus emergency UAE (p < 0.001). The indication for UAE was the most significant factor for predicting an emergency procedure (p = 0.002) with placenta previa being significantly different from other indications (p < 0.001). Bleeding stopped in 78/79 patients (success rate of 98.7%) following UAE. Those who failed stopping of the bleeding were similar between the elective and emergency IR, (1/53 (1.9%) compared with 0/26 (0%), p = 0.99 Fisher’s Exact test). Overall, eight patients (10%) had hysterectomy, one of them was needed as the final solution to stop bleeding. There were no maternal deaths. Interventional radiological UAE is very efficient in controlling postpartum hemorrhage. It should be recommended as the first line of treatment for significant bleeding when expertise and facilities are available. It increases survival, reduces hysterectomy rate, without a difference if done as an emergency or elective procedure.
{"title":"Uterine artery embolization in the management of postpartum hemorrhage","authors":"Hassan Elbiss, Shamsa Al Awar, Jamal Koteesh, Howaida Khair, Sara Maki, Dana H. Abdalla, Fikri M. Abu-Zidan","doi":"10.1186/s13017-025-00580-z","DOIUrl":"https://doi.org/10.1186/s13017-025-00580-z","url":null,"abstract":"Postpartum hemorrhage (PPH) is one of the leading preventable causes of maternal morbidity and mortality causing one-fourth of all maternal deaths. We aimed to study the role of uterine artery embolization (UAE) in controlling PPH and its impact on the need for hysterectomy. We studied patients who were diagnosed with primary PPH between February 2012 and March 2020 at Al Ain Hospital, United Arab Emirates. We studied the characteristics and outcomes of those undergoing interventional radiology via UAE. Logistic regression analysis was done to define the factors that predict the need for emergency UAE. Out of 79 patients who had elective (n = 53) or emergency (n = 26) embolization, the placenta previa accreta (69.8% vs. 23.1%) and placenta previa (24.4% vs. 3.8%) were the common indications for elective versus emergency UAE (p < 0.001). The indication for UAE was the most significant factor for predicting an emergency procedure (p = 0.002) with placenta previa being significantly different from other indications (p < 0.001). Bleeding stopped in 78/79 patients (success rate of 98.7%) following UAE. Those who failed stopping of the bleeding were similar between the elective and emergency IR, (1/53 (1.9%) compared with 0/26 (0%), p = 0.99 Fisher’s Exact test). Overall, eight patients (10%) had hysterectomy, one of them was needed as the final solution to stop bleeding. There were no maternal deaths. Interventional radiological UAE is very efficient in controlling postpartum hemorrhage. It should be recommended as the first line of treatment for significant bleeding when expertise and facilities are available. It increases survival, reduces hysterectomy rate, without a difference if done as an emergency or elective procedure.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"49 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-20DOI: 10.1186/s13017-025-00578-7
Jin Young Lee, Seheon Kim, Jin Bong Ye, Jin Suk Lee, Younghoon Sul
Trauma surgery is a fundamental aspect of medicine. According to the 2023 mortality report from Statistics Korea, external factors such as intentional self-harm and transportation incidents are leading causes of death among individuals aged 10 to 30, accounting for 7.9% of overall mortality. Despite advances in the field, specialization has hindered comprehensive trauma care. In South Korea, regional trauma centers have been established to meet critical trauma management needs; however, challenges remain, including a shortage of trauma surgeons and inefficient resource utilization. The reluctance of surgical residents to pursue trauma training exacerbates the scarcity of qualified specialists. Trauma surgeons often bear extensive responsibilities, which limits their ability to perform prompt interventions. Acute Care Surgery (ACS) offers a model to integrate trauma and non-trauma surgical care, enabling hospitals to implement effective protocols for urgent cases and improving patient outcomes. Research indicates that ACS enhances emergency surgical management, increases training opportunities for residents, and improves job satisfaction among participating surgeons. Integrating ACS into South Korea’s healthcare system is essential to optimize resource allocation and improve emergency care, ultimately leading to enhanced public health outcomes.
{"title":"Integrating acute care surgery in South Korea: enhancing trauma and non-trauma emergency care","authors":"Jin Young Lee, Seheon Kim, Jin Bong Ye, Jin Suk Lee, Younghoon Sul","doi":"10.1186/s13017-025-00578-7","DOIUrl":"https://doi.org/10.1186/s13017-025-00578-7","url":null,"abstract":"Trauma surgery is a fundamental aspect of medicine. According to the 2023 mortality report from Statistics Korea, external factors such as intentional self-harm and transportation incidents are leading causes of death among individuals aged 10 to 30, accounting for 7.9% of overall mortality. Despite advances in the field, specialization has hindered comprehensive trauma care. In South Korea, regional trauma centers have been established to meet critical trauma management needs; however, challenges remain, including a shortage of trauma surgeons and inefficient resource utilization. The reluctance of surgical residents to pursue trauma training exacerbates the scarcity of qualified specialists. Trauma surgeons often bear extensive responsibilities, which limits their ability to perform prompt interventions. Acute Care Surgery (ACS) offers a model to integrate trauma and non-trauma surgical care, enabling hospitals to implement effective protocols for urgent cases and improving patient outcomes. Research indicates that ACS enhances emergency surgical management, increases training opportunities for residents, and improves job satisfaction among participating surgeons. Integrating ACS into South Korea’s healthcare system is essential to optimize resource allocation and improve emergency care, ultimately leading to enhanced public health outcomes.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"31 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142990061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-10DOI: 10.1186/s13017-025-00576-9
Mahmoud Diaa Hindawi, Arda Isik, Fausto Rosa, Diego Visconti, Taras Nechay, Sharfuddin Chowdhury, Abdourahmane Ndong, Tushar S. Mishra, Stefano Piero Bernardo Cioffi, Francesco Piscioneri, Edward C.T.H. Tan
Around five billion people globally lack access to safe, timely, and affordable surgical facilities and care in low-income and middle-income countries (LMICs). Global initiatives have been launched, including efforts led by organizations. Also, regional efforts have shed light on the unique challenges faced by different areas within LMICs. Despite these efforts, many countries still face significant challenges, including inadequate infrastructure, limited availability of trained surgical personnel, lack of essential medical equipment, and insufficient financial resources allocated to healthcare and their related possible factors. Here is that we aim to identify the progress made in areas such as capacity building, training programs, infrastructure development, and policy reforms, as well as highlight the gaps that persist, providing a foundation for future research. Such a comprehensive scoping review will be crucial to enhance surgical care services and ultimately improve health outcomes in LMICs. A comprehensive literature search up to November 2024 will be conducted across six major databases. PubMed, Scopus, Ovoid, Web of Science, Cochrane Central, CNKI (China National Knowledge Infrastructure) database. The methodology will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. The first version of this project will not include a quality appraisal.
在低收入和中等收入国家，全球约有50亿人无法获得安全、及时和负担得起的手术设施和护理。全球倡议已经启动，包括由各组织领导的努力。此外，区域努力揭示了中低收入国家不同地区面临的独特挑战。尽管作出了这些努力，但许多国家仍然面临重大挑战，包括基础设施不足、训练有素的外科人员有限、缺乏基本医疗设备、分配给保健及其相关可能因素的财政资源不足。我们的目标是确定在能力建设、培训计划、基础设施发展和政策改革等领域取得的进展，并强调仍然存在的差距，为未来的研究奠定基础。这种全面的范围审查对于加强外科护理服务并最终改善中低收入国家的健康结果至关重要。截止到2024年11月，将在6个主要数据库中进行全面的文献检索。PubMed、Scopus、Ovoid、Web of Science、Cochrane Central、CNKI数据库。方法将遵循系统评价和荟萃分析扩展范围评价（PRISMA-ScR）清单的首选报告项目。这个项目的第一个版本将不包括质量评估。
{"title":"Global perspectives in acute and emergency general surgery in low and middle-income countries: a WSES project protocol for scoping review on global surgery","authors":"Mahmoud Diaa Hindawi, Arda Isik, Fausto Rosa, Diego Visconti, Taras Nechay, Sharfuddin Chowdhury, Abdourahmane Ndong, Tushar S. Mishra, Stefano Piero Bernardo Cioffi, Francesco Piscioneri, Edward C.T.H. Tan","doi":"10.1186/s13017-025-00576-9","DOIUrl":"https://doi.org/10.1186/s13017-025-00576-9","url":null,"abstract":"Around five billion people globally lack access to safe, timely, and affordable surgical facilities and care in low-income and middle-income countries (LMICs). Global initiatives have been launched, including efforts led by organizations. Also, regional efforts have shed light on the unique challenges faced by different areas within LMICs. Despite these efforts, many countries still face significant challenges, including inadequate infrastructure, limited availability of trained surgical personnel, lack of essential medical equipment, and insufficient financial resources allocated to healthcare and their related possible factors. Here is that we aim to identify the progress made in areas such as capacity building, training programs, infrastructure development, and policy reforms, as well as highlight the gaps that persist, providing a foundation for future research. Such a comprehensive scoping review will be crucial to enhance surgical care services and ultimately improve health outcomes in LMICs. A comprehensive literature search up to November 2024 will be conducted across six major databases. PubMed, Scopus, Ovoid, Web of Science, Cochrane Central, CNKI (China National Knowledge Infrastructure) database. The methodology will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. The first version of this project will not include a quality appraisal.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-10DOI: 10.1186/s13017-025-00574-x
Camilo Ramírez-Giraldo, Isabella Van-Londoño, Antonio Pesce
Empirical antibiotic therapy is often initiated during the hospital stay while awaiting laparoscopic cholecystectomy. This approach is generally justified in patients with moderate (Tokyo II) and severe (Tokyo III) acute cholecystitis, where organ dysfunction occurs as a result of the inflammatory or infectious process. However, there is no clear consensus regarding the use of antibiotics in patients with mild (Tokyo I) cholecystitis. This study aimed to evaluate the impact of preoperative antibiotic use on outcomes in patients with acute cholecystitis. A systematic review of PubMed, Embase and Cochrane was conducted following the PRISMA methodology. Studies were eligible for inclusion if they were randomized controlled trials or non-randomized comparative studies evaluating the use or non-use of preoperative antibiotics in patients with acute cholecystitis. Eligible studies were required to provide at least one of the following datasets: postoperative complication rate, postoperative infectious complication rate, or positive culture rate. The synthesis reports were prepared using the Synthesis Without Meta-analysis (SWiM) framework. A total of 622 articles were initially identified, of which 2 met the inclusion criteria. These two articles included 331 patients. They reported higher rates of postoperative complications and bacterobilia in the group that received preoperative antibiotics; however, the differences were not statistically significant (p > 0.05). Based on current evidence, no recommendation can be made regarding the therapeutic use of antibiotics in mild acute cholecystitis while awaiting laparoscopic cholecystectomy.
{"title":"Pre-operative antibiotics in patients with acute mild cholecystitis undergoing laparoscopic cholecystectomy: is it really useful? A systematic review","authors":"Camilo Ramírez-Giraldo, Isabella Van-Londoño, Antonio Pesce","doi":"10.1186/s13017-025-00574-x","DOIUrl":"https://doi.org/10.1186/s13017-025-00574-x","url":null,"abstract":"Empirical antibiotic therapy is often initiated during the hospital stay while awaiting laparoscopic cholecystectomy. This approach is generally justified in patients with moderate (Tokyo II) and severe (Tokyo III) acute cholecystitis, where organ dysfunction occurs as a result of the inflammatory or infectious process. However, there is no clear consensus regarding the use of antibiotics in patients with mild (Tokyo I) cholecystitis. This study aimed to evaluate the impact of preoperative antibiotic use on outcomes in patients with acute cholecystitis. A systematic review of PubMed, Embase and Cochrane was conducted following the PRISMA methodology. Studies were eligible for inclusion if they were randomized controlled trials or non-randomized comparative studies evaluating the use or non-use of preoperative antibiotics in patients with acute cholecystitis. Eligible studies were required to provide at least one of the following datasets: postoperative complication rate, postoperative infectious complication rate, or positive culture rate. The synthesis reports were prepared using the Synthesis Without Meta-analysis (SWiM) framework. A total of 622 articles were initially identified, of which 2 met the inclusion criteria. These two articles included 331 patients. They reported higher rates of postoperative complications and bacterobilia in the group that received preoperative antibiotics; however, the differences were not statistically significant (p > 0.05). Based on current evidence, no recommendation can be made regarding the therapeutic use of antibiotics in mild acute cholecystitis while awaiting laparoscopic cholecystectomy.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-07DOI: 10.1186/s13017-024-00572-5
Charles Dupuy, Thibault Martinez, Olivier Duranteau, Tobias Gauss, Natacha Kapandji, Jean Pasqueron, Mathilde Holleville, Georges Abi Abdallah, Anatole Harrois, Véronique Ramonda, Delphine Huet-Garrigue, Théophane Doublet, Marc Leone, Vincent Legros, Julien Pottecher, Gérard Audibert, Ingrid Millot, Benjamin Popoff, Benjamin Cohen, Fanny Vardon-Bounes, Mathieu Willig, Pierre Gosset, Emilie Angles, Nouchan Mellati, Nicolas Higel, Mathieu Boutonnet, Pierre Pasquier
To reduce the number of deaths caused by exsanguination, the initial management of severe trauma aims to prevent, if not limit, the lethal triad, which consists of acidosis, coagulopathy, and hypothermia. Recently, several studies have suggested adding hypocalcemia to the lethal triad to form the lethal diamond, but the evidence supporting this change is limited. Therefore, the aim of this study was to compare the lethal triad and lethal diamond for their respective associations with 24-h mortality in severe trauma patients receiving transfusion. We performed a multicenter retrospective analysis of patients in TraumaBase®, a French database (2011–2023). The patients included in this study were all trauma patients who had received transfusions of at least 1 unit of red blood cells (RBCs) within the first 6 h of hospital admission and for whom ionized calcium measurements were available. Hypocalcemia was defined as an ionized calcium level < 1.1 mmol/L. A total of 2141 severe trauma patients were included (median age: 39, interquartile range [IQR]: 26–57; median injury severity score: 27, IQR: 17–41). Patients primarily presented with blunt trauma (81.7%), and a 24-h mortality rate of 16.1% was observed. Receiver operating characteristic curve analysis revealed no significant difference in the association with 24-h mortality between the lethal diamond (area under the curve [AUC]: 0.71) and the lethal triad (AUC: 0.72) (p = 0.26). The strength of the association with 24-h mortality was similar between the lethal triad and the lethal diamond, with Cramer’s V values of 0.29 and 0.28, respectively. This study revealed no significant difference between the lethal triad and the lethal diamond in terms of their respective associations with 24-h mortality in severe trauma patients requiring transfusion. These results raise questions about the independent role of hypocalcemia in early mortality.
{"title":"Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort","authors":"Charles Dupuy, Thibault Martinez, Olivier Duranteau, Tobias Gauss, Natacha Kapandji, Jean Pasqueron, Mathilde Holleville, Georges Abi Abdallah, Anatole Harrois, Véronique Ramonda, Delphine Huet-Garrigue, Théophane Doublet, Marc Leone, Vincent Legros, Julien Pottecher, Gérard Audibert, Ingrid Millot, Benjamin Popoff, Benjamin Cohen, Fanny Vardon-Bounes, Mathieu Willig, Pierre Gosset, Emilie Angles, Nouchan Mellati, Nicolas Higel, Mathieu Boutonnet, Pierre Pasquier","doi":"10.1186/s13017-024-00572-5","DOIUrl":"https://doi.org/10.1186/s13017-024-00572-5","url":null,"abstract":"To reduce the number of deaths caused by exsanguination, the initial management of severe trauma aims to prevent, if not limit, the lethal triad, which consists of acidosis, coagulopathy, and hypothermia. Recently, several studies have suggested adding hypocalcemia to the lethal triad to form the lethal diamond, but the evidence supporting this change is limited. Therefore, the aim of this study was to compare the lethal triad and lethal diamond for their respective associations with 24-h mortality in severe trauma patients receiving transfusion. We performed a multicenter retrospective analysis of patients in TraumaBase®, a French database (2011–2023). The patients included in this study were all trauma patients who had received transfusions of at least 1 unit of red blood cells (RBCs) within the first 6 h of hospital admission and for whom ionized calcium measurements were available. Hypocalcemia was defined as an ionized calcium level < 1.1 mmol/L. A total of 2141 severe trauma patients were included (median age: 39, interquartile range [IQR]: 26–57; median injury severity score: 27, IQR: 17–41). Patients primarily presented with blunt trauma (81.7%), and a 24-h mortality rate of 16.1% was observed. Receiver operating characteristic curve analysis revealed no significant difference in the association with 24-h mortality between the lethal diamond (area under the curve [AUC]: 0.71) and the lethal triad (AUC: 0.72) (p = 0.26). The strength of the association with 24-h mortality was similar between the lethal triad and the lethal diamond, with Cramer’s V values of 0.29 and 0.28, respectively. This study revealed no significant difference between the lethal triad and the lethal diamond in terms of their respective associations with 24-h mortality in severe trauma patients requiring transfusion. These results raise questions about the independent role of hypocalcemia in early mortality.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"7 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-06DOI: 10.1186/s13017-024-00571-6
Ying Ma, Man Luo, Guoxin Guan, Xingming Liu, Xingye Cui, Fuwen Luo
Gangrenous cholecystitis (GC) is a serious clinical condition associated with high morbidity and mortality rates. Machine learning (ML) has significant potential in addressing the diverse characteristics of real data. We aim to develop an explainable and cost-effective predictive model for GC utilizing ML and Shapley Additive explanation (SHAP) algorithm. This study included a total of 1006 patients with 26 clinical features. Through 5-fold CV, the best performing integrated learning model, XGBoost, was identified. The model was interpreted using SHAP to derive the feature subsets WBC, NLR, D-dimer, Gallbladder width, Fibrinogen, Gallbladder wallness, Hypokalemia or hyponatremia, these subsets comprised the final diagnostic prediction model. The study developed a explainable predictive tool for GC at an early stage. This could assist doctors to make quick surgical intervention decisions and perform surgery on patients with GC as soon as possible. Using clinical data from 1006 cholecystitis patients, we developed a machine learning-based diagnostic prediction model to help identify patients at high risk for acute gangrenous cholecystitis. During the study, the deficiency and imbalance of actual clinical data were directly addressed, leading to the ultimate selection of the integrated learning model XGBoost as the predictive model exhibiting superior performance and stability on a novel, unidentified validation set and compared to preoperative clinical diagnosis. The model employs variables that are non-specific, readily available, reasonably priced, and appropriate for clinical generalization.
{"title":"An explainable predictive machine learning model of gangrenous cholecystitis based on clinical data: a retrospective single center study","authors":"Ying Ma, Man Luo, Guoxin Guan, Xingming Liu, Xingye Cui, Fuwen Luo","doi":"10.1186/s13017-024-00571-6","DOIUrl":"https://doi.org/10.1186/s13017-024-00571-6","url":null,"abstract":"Gangrenous cholecystitis (GC) is a serious clinical condition associated with high morbidity and mortality rates. Machine learning (ML) has significant potential in addressing the diverse characteristics of real data. We aim to develop an explainable and cost-effective predictive model for GC utilizing ML and Shapley Additive explanation (SHAP) algorithm. This study included a total of 1006 patients with 26 clinical features. Through 5-fold CV, the best performing integrated learning model, XGBoost, was identified. The model was interpreted using SHAP to derive the feature subsets WBC, NLR, D-dimer, Gallbladder width, Fibrinogen, Gallbladder wallness, Hypokalemia or hyponatremia, these subsets comprised the final diagnostic prediction model. The study developed a explainable predictive tool for GC at an early stage. This could assist doctors to make quick surgical intervention decisions and perform surgery on patients with GC as soon as possible. Using clinical data from 1006 cholecystitis patients, we developed a machine learning-based diagnostic prediction model to help identify patients at high risk for acute gangrenous cholecystitis. During the study, the deficiency and imbalance of actual clinical data were directly addressed, leading to the ultimate selection of the integrated learning model XGBoost as the predictive model exhibiting superior performance and stability on a novel, unidentified validation set and compared to preoperative clinical diagnosis. The model employs variables that are non-specific, readily available, reasonably priced, and appropriate for clinical generalization.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"9 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142929094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-23DOI: 10.1186/s13017-024-00570-7
Anoeska Schipper, Peter Belgers, Rory O’Connor, Kim Ellis Jie, Robin Dooijes, Joeran Sander Bosma, Steef Kurstjens, Ron Kusters, Bram van Ginneken, Matthieu Rutten
Acute abdominal pain (AAP) constitutes 5–10% of all emergency department (ED) visits, with appendicitis being a prevalent AAP etiology often necessitating surgical intervention. The variability in AAP symptoms and causes, combined with the challenge of identifying appendicitis, complicate timely intervention. To estimate the risk of appendicitis, scoring systems such as the Alvarado score have been developed. However, diagnostic errors and delays remain common. Although various machine learning (ML) models have been proposed to enhance appendicitis detection, none have been seamlessly integrated into the ED workflows for AAP or are specifically designed to diagnose appendicitis as early as possible within the clinical decision-making process. To mimic daily clinical practice, this proof-of-concept study aims to develop ML models that support decision-making using comprehensive clinical data up to key decision points in the ED workflow to detect appendicitis in patients presenting with AAP. Data from the Dutch triage system at the ED, vital signs, complete medical history and physical examination findings and routine laboratory test results were retrospectively extracted from 350 AAP patients presenting to the ED of a Dutch teaching hospital from 2016 to 2023. Two eXtreme Gradient Boosting ML models were developed to differentiate cases with appendicitis from other AAP causes: one model used all data up to and including physical examination, and the other was extended with routine laboratory test results. The performance of both models was evaluated on a validation set (n = 68) and compared to the Alvarado scoring system as well as three ED physicians in a reader study. The ML models achieved AUROCs of 0.919 without laboratory test results and 0.923 with the addition of laboratory test results. The Alvarado scoring system attained an AUROC of 0.824. ED physicians achieved AUROCs of 0.894, 0.826, and 0.791 without laboratory test results, increasing to AUROCs of 0.923, 0.892, and 0.859 with laboratory test results. Both ML models demonstrated comparable high accuracy in predicting appendicitis in patients with AAP, outperforming the Alvarado scoring system. The ML models matched or surpassed ED physician performance in detecting appendicitis, with the largest potential performance gain observed in absence of laboratory test results. Integration could assist ED physicians in early and accurate diagnosis of appendicitis.
{"title":"Machine-learning based prediction of appendicitis for patients presenting with acute abdominal pain at the emergency department","authors":"Anoeska Schipper, Peter Belgers, Rory O’Connor, Kim Ellis Jie, Robin Dooijes, Joeran Sander Bosma, Steef Kurstjens, Ron Kusters, Bram van Ginneken, Matthieu Rutten","doi":"10.1186/s13017-024-00570-7","DOIUrl":"https://doi.org/10.1186/s13017-024-00570-7","url":null,"abstract":"Acute abdominal pain (AAP) constitutes 5–10% of all emergency department (ED) visits, with appendicitis being a prevalent AAP etiology often necessitating surgical intervention. The variability in AAP symptoms and causes, combined with the challenge of identifying appendicitis, complicate timely intervention. To estimate the risk of appendicitis, scoring systems such as the Alvarado score have been developed. However, diagnostic errors and delays remain common. Although various machine learning (ML) models have been proposed to enhance appendicitis detection, none have been seamlessly integrated into the ED workflows for AAP or are specifically designed to diagnose appendicitis as early as possible within the clinical decision-making process. To mimic daily clinical practice, this proof-of-concept study aims to develop ML models that support decision-making using comprehensive clinical data up to key decision points in the ED workflow to detect appendicitis in patients presenting with AAP. Data from the Dutch triage system at the ED, vital signs, complete medical history and physical examination findings and routine laboratory test results were retrospectively extracted from 350 AAP patients presenting to the ED of a Dutch teaching hospital from 2016 to 2023. Two eXtreme Gradient Boosting ML models were developed to differentiate cases with appendicitis from other AAP causes: one model used all data up to and including physical examination, and the other was extended with routine laboratory test results. The performance of both models was evaluated on a validation set (n = 68) and compared to the Alvarado scoring system as well as three ED physicians in a reader study. The ML models achieved AUROCs of 0.919 without laboratory test results and 0.923 with the addition of laboratory test results. The Alvarado scoring system attained an AUROC of 0.824. ED physicians achieved AUROCs of 0.894, 0.826, and 0.791 without laboratory test results, increasing to AUROCs of 0.923, 0.892, and 0.859 with laboratory test results. Both ML models demonstrated comparable high accuracy in predicting appendicitis in patients with AAP, outperforming the Alvarado scoring system. The ML models matched or surpassed ED physician performance in detecting appendicitis, with the largest potential performance gain observed in absence of laboratory test results. Integration could assist ED physicians in early and accurate diagnosis of appendicitis. ","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"148 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-29DOI: 10.1186/s13017-024-00564-5
Prashant Nasa, Robert D Wise, Marije Smit, Stefan Acosta, Scott D'Amours, William Beaubien-Souligny, Zsolt Bodnar, Federico Coccolini, Neha S Dangayach, Wojciech Dabrowski, Juan Duchesne, Janeth C Ejike, Goran Augustin, Bart De Keulenaer, Andrew W Kirkpatrick, Ashish K Khanna, Edward Kimball, Abhilash Koratala, Rosemary K Lee, Ari Leppaniemi, Edgar V Lerma, Valerie Marmolejo, Alejando Meraz-Munoz, Sheila N Myatra, Daniel Niven, Claudia Olvera, Carlos Ordoñez, Clayton Petro, Bruno M Pereira, Claudio Ronco, Adrian Regli, Derek J Roberts, Philippe Rola, Michael Rosen, Gentle S Shrestha, Michael Sugrue, Juan Carlos Q Velez, Ron Wald, Jan De Waele, Annika Reintam Blaser, Manu L N G Malbrain
Background: The Abdominal Compartment Society (WSACS) established consensus definitions and recommendations for the management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in 2006, and they were last updated in 2013. The WSACS conducted an international survey between 2022 and 2023 to seek the agreement of healthcare practitioners (HCPs) worldwide on current and new candidate statements that may be used for future guidelines.
Methods: A self-administered, online cross-sectional survey was conducted under the auspices of the WSACS to assess the level of agreement among HCPs over current and new candidate statements. The survey, distributed electronically worldwide, collected agreement or disagreement with statements on the measurement of intra-abdominal pressure (IAP), pathophysiology, definitions, and management of IAH/ACS. Statistical analysis assessed agreement levels, expressed in percentages, on statements among respondents, and comparisons between groups were performed according to the respondent's education status, base specialty, duration of work experience, role (intensivist vs non-intensivist) and involvement in previous guidelines. Agreement was considered to be reached when 80% or more of the respondents agreed with a particular statement.
Results: A total of 1042 respondents from 102 countries, predominantly physicians (73%), of whom 48% were intensivists, participated. Only 59% of HCPs were aware of the 2013 WSACS guidelines, and 41% incorporated them into practice. Despite agreement in most statements, significant variability existed. Notably, agreement was not reached on four new candidate statements: "normal intra-abdominal pressure (IAP) is 10 mmHg in critically ill adults" (77%), "clinical assessment and estimation of IAP is inaccurate" (65.2%), "intragastric can be an alternative to the intravesical route for IAP measurement" (70.4%), and "measurement of IAP should be repeated in the resting position after measurement in a supine position" (71.9%). The survey elucidated nuances in clinical practice and highlighted areas for further education and standardization.
Conclusion: More than ten years after the last published guidelines, this worldwide cross-sectional survey collected feedback and evaluated the level of agreement with current recommendations and new candidate statements. This will inform the consensus process for future guideline development.
{"title":"International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome.","authors":"Prashant Nasa, Robert D Wise, Marije Smit, Stefan Acosta, Scott D'Amours, William Beaubien-Souligny, Zsolt Bodnar, Federico Coccolini, Neha S Dangayach, Wojciech Dabrowski, Juan Duchesne, Janeth C Ejike, Goran Augustin, Bart De Keulenaer, Andrew W Kirkpatrick, Ashish K Khanna, Edward Kimball, Abhilash Koratala, Rosemary K Lee, Ari Leppaniemi, Edgar V Lerma, Valerie Marmolejo, Alejando Meraz-Munoz, Sheila N Myatra, Daniel Niven, Claudia Olvera, Carlos Ordoñez, Clayton Petro, Bruno M Pereira, Claudio Ronco, Adrian Regli, Derek J Roberts, Philippe Rola, Michael Rosen, Gentle S Shrestha, Michael Sugrue, Juan Carlos Q Velez, Ron Wald, Jan De Waele, Annika Reintam Blaser, Manu L N G Malbrain","doi":"10.1186/s13017-024-00564-5","DOIUrl":"10.1186/s13017-024-00564-5","url":null,"abstract":"<p><strong>Background: </strong>The Abdominal Compartment Society (WSACS) established consensus definitions and recommendations for the management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in 2006, and they were last updated in 2013. The WSACS conducted an international survey between 2022 and 2023 to seek the agreement of healthcare practitioners (HCPs) worldwide on current and new candidate statements that may be used for future guidelines.</p><p><strong>Methods: </strong>A self-administered, online cross-sectional survey was conducted under the auspices of the WSACS to assess the level of agreement among HCPs over current and new candidate statements. The survey, distributed electronically worldwide, collected agreement or disagreement with statements on the measurement of intra-abdominal pressure (IAP), pathophysiology, definitions, and management of IAH/ACS. Statistical analysis assessed agreement levels, expressed in percentages, on statements among respondents, and comparisons between groups were performed according to the respondent's education status, base specialty, duration of work experience, role (intensivist vs non-intensivist) and involvement in previous guidelines. Agreement was considered to be reached when 80% or more of the respondents agreed with a particular statement.</p><p><strong>Results: </strong>A total of 1042 respondents from 102 countries, predominantly physicians (73%), of whom 48% were intensivists, participated. Only 59% of HCPs were aware of the 2013 WSACS guidelines, and 41% incorporated them into practice. Despite agreement in most statements, significant variability existed. Notably, agreement was not reached on four new candidate statements: \"normal intra-abdominal pressure (IAP) is 10 mmHg in critically ill adults\" (77%), \"clinical assessment and estimation of IAP is inaccurate\" (65.2%), \"intragastric can be an alternative to the intravesical route for IAP measurement\" (70.4%), and \"measurement of IAP should be repeated in the resting position after measurement in a supine position\" (71.9%). The survey elucidated nuances in clinical practice and highlighted areas for further education and standardization.</p><p><strong>Conclusion: </strong>More than ten years after the last published guidelines, this worldwide cross-sectional survey collected feedback and evaluated the level of agreement with current recommendations and new candidate statements. This will inform the consensus process for future guideline development.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"19 1","pages":"39"},"PeriodicalIF":6.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11605967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752063","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}
Pub Date : 2024-11-22DOI: 10.1186/s13017-024-00560-9
Eleanor Felsy Philip, Retnagowri Rajandram, Mariana Zuber, Tak Loon Khong, April Camilla Roslani
Surgical site infection (SSI) is a very common complication of emergency laparotomy and causes significant morbidity. The PICO◊ device delivers negative pressure wound therapy (NPWT) to closed incisions, with some studies suggesting a role for prevention of SSI in heterogenous surgical populations. We aimed to compare SSI rates between patients receiving PICO◊ versus conventional dressing post-emergency laparotomy. Secondary objectives were to observe seroma and dehiscence rates, length of stay, days on dressing and patients’ wound experience. This double blinded randomized controlled trial was conducted in University Malaya Medical Centre between October 2019 and March 2022. Patients undergoing emergency laparotomy requiring incisions less than 35 cm were included. Statistical analysis was performed using χ2 test for categorical variables, independent T-test or Mann–Whitney U were used for parametric or non-parametric data respectively besides logistic regression. P values of < 0.05 were considered to be significant. Ninety-six patients were analyzed (47 interventions, 49 controls). The duration on dressing was more consistent in the intervention arm (PICO◊) versus control arm [9.78 ± 10.20 vs 17.78 ± 16.46 days, P < 0.001]. There was a trend towards lower SSI [14.3 vs 4.3%, P = 0.09], dehiscence [27.1 vs 10.6%, P = 0.07] and seroma [40.8 vs 23.4%, P = 0.08] rates in the intervention arm but this did not reach statistical significance. Length of stay [9 (IQR: 6–14) vs 11 (IQR: 6–22.5) days, P = 0.18] was fairly similar between the two arms, but more patients were very satisfied with PICO◊ compared to the conventional dressing [80% vs 57.1%, P = 0.03]. The use of NPWT in emergency laparotomy improves patients wound care experience, and was associated with trends towards fewer wound related complications. Cost effectiveness needs to be explored in order to further validate its use in the emergency setting, especially for patients with additional risk for SSI. Trial registration National Medical Research Registry (NMRR): NMRR-20-1975-55222.
手术部位感染（SSI）是急诊开腹手术中非常常见的并发症，会导致严重的发病率。PICO◊设备可为闭合切口提供负压伤口疗法（NPWT），一些研究表明该设备可在不同手术人群中起到预防SSI的作用。我们的目的是比较急诊开腹手术后接受PICO◊和传统敷料的患者的SSI感染率。次要目标是观察血清肿和开裂率、住院时间、敷料使用天数和患者的伤口体验。这项双盲随机对照试验于2019年10月至2022年3月期间在马来亚大学医疗中心进行。研究对象包括接受急诊开腹手术、切口小于35厘米的患者。统计分析对分类变量采用χ2检验，对参数或非参数数据分别采用独立T检验或曼-惠特尼U检验，此外还采用逻辑回归。P 值小于 0.05 视为显著。共分析了 96 名患者（47 名干预者，49 名对照者）。干预组（PICO◊）与对照组的敷料持续时间更为一致[9.78 ± 10.20 vs 17.78 ± 16.46天，P < 0.001]。干预组的 SSI [14.3% vs 4.3%，P = 0.09]、开裂 [27.1% vs 10.6%，P = 0.07]和血清肿 [40.8% vs 23.4%，P = 0.08]发生率呈下降趋势，但未达到统计学意义。两组患者的住院时间[9（IQR：6-14）天 vs 11（IQR：6-22.5）天，P = 0.18]相当接近，但与传统敷料相比，更多患者对PICO◊非常满意[80% vs 57.1%，P = 0.03]。在急诊开腹手术中使用NPWT可改善患者的伤口护理体验，并有减少伤口相关并发症的趋势。为了进一步验证 NPWT 在急诊环境中的使用效果，尤其是对有 SSI 额外风险的患者，还需要对其成本效益进行探讨。试验注册国家医学研究注册中心（NMRR）：NMRR-20-1975-55222。
{"title":"Prophylactic PICO◊ dressing shortens wound dressing requirements post emergency laparotomy (EL-PICO◊ trial)","authors":"Eleanor Felsy Philip, Retnagowri Rajandram, Mariana Zuber, Tak Loon Khong, April Camilla Roslani","doi":"10.1186/s13017-024-00560-9","DOIUrl":"https://doi.org/10.1186/s13017-024-00560-9","url":null,"abstract":"Surgical site infection (SSI) is a very common complication of emergency laparotomy and causes significant morbidity. The PICO◊ device delivers negative pressure wound therapy (NPWT) to closed incisions, with some studies suggesting a role for prevention of SSI in heterogenous surgical populations. We aimed to compare SSI rates between patients receiving PICO◊ versus conventional dressing post-emergency laparotomy. Secondary objectives were to observe seroma and dehiscence rates, length of stay, days on dressing and patients’ wound experience. This double blinded randomized controlled trial was conducted in University Malaya Medical Centre between October 2019 and March 2022. Patients undergoing emergency laparotomy requiring incisions less than 35 cm were included. Statistical analysis was performed using χ2 test for categorical variables, independent T-test or Mann–Whitney U were used for parametric or non-parametric data respectively besides logistic regression. P values of < 0.05 were considered to be significant. Ninety-six patients were analyzed (47 interventions, 49 controls). The duration on dressing was more consistent in the intervention arm (PICO◊) versus control arm [9.78 ± 10.20 vs 17.78 ± 16.46 days, P < 0.001]. There was a trend towards lower SSI [14.3 vs 4.3%, P = 0.09], dehiscence [27.1 vs 10.6%, P = 0.07] and seroma [40.8 vs 23.4%, P = 0.08] rates in the intervention arm but this did not reach statistical significance. Length of stay [9 (IQR: 6–14) vs 11 (IQR: 6–22.5) days, P = 0.18] was fairly similar between the two arms, but more patients were very satisfied with PICO◊ compared to the conventional dressing [80% vs 57.1%, P = 0.03]. The use of NPWT in emergency laparotomy improves patients wound care experience, and was associated with trends towards fewer wound related complications. Cost effectiveness needs to be explored in order to further validate its use in the emergency setting, especially for patients with additional risk for SSI. Trial registration National Medical Research Registry (NMRR): NMRR-20-1975-55222.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"16 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：