Pub Date : 2025-10-27DOI: 10.1186/s13017-025-00647-x
Kris R Wiendels,Joris Lemson,Manouk Backes,Erik Hermans,Jan Bollen,Diederik P J Smeeing,Stijn D Nelen,
BACKGROUNDDamage Control Surgery is a technique aimed at reducing mortality in trauma patients, but its use in pediatric patients lacks standardized indications. Proper patient selection is essential to mitigate morbidity associated with Damage Control Surgery.OBJECTIVEThis review aims to clarify the reported indications for Damage Control Surgery in pediatric trauma patients.METHODSA systematic search of PubMed and Embase was conducted without publication year restrictions to identify studies reporting indications for performing Damage Control Surgery in pediatric trauma patients. Backward citation analysis was performed on identified review articles that were excluded. Indications or patient characteristics guiding surgical decision-making in the emergency department were extracted and categorized.RESULTSForty studies were included: 25 case reports, 13 case series, and 2 observational studies. The case reports and case series involved 98 patients with 368 reported indications, with severe trauma (26.1%), hemodynamic instability (18.2%), and radiological or clinical evidence of severe hemorrhage or contamination (28.2%) being the most observed. The observational studies found a higher Injury Severity Score, lower systolic blood pressure, decreased Glasgow Coma Scale, lower body temperature, and more frequent blood transfusions in the Damage Control Surgery groups compared to the control groups.CONCLUSIONS AND RELEVANCESevere trauma, hemodynamic instability, and injuries related to severe hemorrhage or contamination emerged as key indications for Damage Control Surgery in pediatric trauma, consistent with findings in adult trauma populations. However, the lethal triad of acidosis, hypothermia and coagulopathy was infrequently reported as a primary indication for Damage Control Surgery in children. This may reflect the greater compensatory capacity of pediatric patients, potentially delaying the manifestation of these physiological derangements. Our findings suggest that early intervention with Damage Control Surgery in cases of severe trauma, exsanguination, gross contamination, and hemodynamic instability may help prevent the progression to critical physiological states such as the lethal triad. This underscores the importance of timely recognition and intervention in pediatric trauma management.
{"title":"Indications to perform damage control surgery in pediatric trauma: a scoping review-Are children little adults?","authors":"Kris R Wiendels,Joris Lemson,Manouk Backes,Erik Hermans,Jan Bollen,Diederik P J Smeeing,Stijn D Nelen, ","doi":"10.1186/s13017-025-00647-x","DOIUrl":"https://doi.org/10.1186/s13017-025-00647-x","url":null,"abstract":"BACKGROUNDDamage Control Surgery is a technique aimed at reducing mortality in trauma patients, but its use in pediatric patients lacks standardized indications. Proper patient selection is essential to mitigate morbidity associated with Damage Control Surgery.OBJECTIVEThis review aims to clarify the reported indications for Damage Control Surgery in pediatric trauma patients.METHODSA systematic search of PubMed and Embase was conducted without publication year restrictions to identify studies reporting indications for performing Damage Control Surgery in pediatric trauma patients. Backward citation analysis was performed on identified review articles that were excluded. Indications or patient characteristics guiding surgical decision-making in the emergency department were extracted and categorized.RESULTSForty studies were included: 25 case reports, 13 case series, and 2 observational studies. The case reports and case series involved 98 patients with 368 reported indications, with severe trauma (26.1%), hemodynamic instability (18.2%), and radiological or clinical evidence of severe hemorrhage or contamination (28.2%) being the most observed. The observational studies found a higher Injury Severity Score, lower systolic blood pressure, decreased Glasgow Coma Scale, lower body temperature, and more frequent blood transfusions in the Damage Control Surgery groups compared to the control groups.CONCLUSIONS AND RELEVANCESevere trauma, hemodynamic instability, and injuries related to severe hemorrhage or contamination emerged as key indications for Damage Control Surgery in pediatric trauma, consistent with findings in adult trauma populations. However, the lethal triad of acidosis, hypothermia and coagulopathy was infrequently reported as a primary indication for Damage Control Surgery in children. This may reflect the greater compensatory capacity of pediatric patients, potentially delaying the manifestation of these physiological derangements. Our findings suggest that early intervention with Damage Control Surgery in cases of severe trauma, exsanguination, gross contamination, and hemodynamic instability may help prevent the progression to critical physiological states such as the lethal triad. This underscores the importance of timely recognition and intervention in pediatric trauma management.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"21 1","pages":"81"},"PeriodicalIF":8.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373691","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}
BACKGROUNDBowel obstruction is a critical emergency. Although imaging like X-ray and computed tomography (CT) aids diagnosis, cost-effective hematological biomarkers are still needed. This study evaluates the diagnostic values of hematological biomarkers for detecting complications, determining the need for surgery, and predicting prognosis in patients with bowel obstruction.METHODSA systematic review and meta-analysis was conducted following PRISMA guidelines. We systematically searched Web of Science, PubMed, Scopus, Embase and Cochrane Library for studies published up to June 2025. Inclusion criteria encompassed observational or case-control studies reporting sensitivity/specificity of neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, or lactate in bowel obstruction outcomes. Data extraction included true/false, positives/negatives, cutoff values, and receiver operating characteristic (ROC) parameters. Bivariate models pooled sensitivity/specificity, while summary ROC curves and Youden index determined optimal thresholds.RESULTSThis study included 34 articles comprising a total of 5871 patients. CRP at a cutoff of 26.91 mg/L (Youden index: 0.97) for diagnosing bowel ischemia showed pooled sensitivity and specificity of 0.80 and 0.92, respectively, with a summary receiver operating characteristic (SROC) curve and an area under the curve (AUC) of 0.91. PCT in determining the need for surgery achieved a cutoff of 0.12 ng/mL (Youden index: 0.8), with sensitivity and specificity of 0.75 and 0.74 (AUC: 0.79). NLR showed a cutoff of 7.2 (Youden index: 0.68), yielding sensitivity and specificity of 0.74 and 0.83 (AUC: 0.84) in the diagnosis of bowel ischemia. D-dimer (cutoff: 1.72 mg/L, Youden index: 0.91) and lactate (cutoff: 2.98 mmol/L, Youden index: 0.8) exhibited sensitivities of 0.83 and 0.77, specificities of 0.70 and 0.79, and AUCs of 0.85 for both, in the diagnosis of bowel ischemia.CONCLUSIONNLR, CRP, PCT, D-dimer, and lactate may provide supplementary diagnostic value for bowel ischemia in patients with bowel obstruction. A PCT threshold > 0.12 ng/mL may assist in evaluating the need for surgery.
{"title":"Diagnostic accuracy of routine hematological biomarkers for complications and prognosis in bowel obstruction: a systematic review and meta-analysis.","authors":"Huanyu Hu,Guobiao Chen,Dan Bai,Guanting Wu,Yifei Wu,Shijing Guo,Yiyang Tang,Qianyu Liu,Jiani Hu,Yunhong Tian","doi":"10.1186/s13017-025-00652-0","DOIUrl":"https://doi.org/10.1186/s13017-025-00652-0","url":null,"abstract":"BACKGROUNDBowel obstruction is a critical emergency. Although imaging like X-ray and computed tomography (CT) aids diagnosis, cost-effective hematological biomarkers are still needed. This study evaluates the diagnostic values of hematological biomarkers for detecting complications, determining the need for surgery, and predicting prognosis in patients with bowel obstruction.METHODSA systematic review and meta-analysis was conducted following PRISMA guidelines. We systematically searched Web of Science, PubMed, Scopus, Embase and Cochrane Library for studies published up to June 2025. Inclusion criteria encompassed observational or case-control studies reporting sensitivity/specificity of neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, or lactate in bowel obstruction outcomes. Data extraction included true/false, positives/negatives, cutoff values, and receiver operating characteristic (ROC) parameters. Bivariate models pooled sensitivity/specificity, while summary ROC curves and Youden index determined optimal thresholds.RESULTSThis study included 34 articles comprising a total of 5871 patients. CRP at a cutoff of 26.91 mg/L (Youden index: 0.97) for diagnosing bowel ischemia showed pooled sensitivity and specificity of 0.80 and 0.92, respectively, with a summary receiver operating characteristic (SROC) curve and an area under the curve (AUC) of 0.91. PCT in determining the need for surgery achieved a cutoff of 0.12 ng/mL (Youden index: 0.8), with sensitivity and specificity of 0.75 and 0.74 (AUC: 0.79). NLR showed a cutoff of 7.2 (Youden index: 0.68), yielding sensitivity and specificity of 0.74 and 0.83 (AUC: 0.84) in the diagnosis of bowel ischemia. D-dimer (cutoff: 1.72 mg/L, Youden index: 0.91) and lactate (cutoff: 2.98 mmol/L, Youden index: 0.8) exhibited sensitivities of 0.83 and 0.77, specificities of 0.70 and 0.79, and AUCs of 0.85 for both, in the diagnosis of bowel ischemia.CONCLUSIONNLR, CRP, PCT, D-dimer, and lactate may provide supplementary diagnostic value for bowel ischemia in patients with bowel obstruction. A PCT threshold > 0.12 ng/mL may assist in evaluating the need for surgery.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"837 1","pages":"80"},"PeriodicalIF":8.0,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338683","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 : 2025-10-15DOI: 10.1186/s13017-025-00651-1
Federico Coccolini, Camilla Cremonini, Ernest E. Moore, Ian Civil, Zsolt Balogh, Ari Leppaniemi, Tal Horer, Viktor Reva, Chad Ball, Andrew W. Kirkpatrick, Andrea Colli, Laura Besola, Fank Plani, Bruno Viaggi, Giacomo Bellani, Marco Ceresoli, Enrico Cicuttin, Diego Mariani, Andreas Hecker, Stefania Cimbanassi, Ettore Melai, Francesco Forfori, Lorenzo Ghiadoni, Alessandro Cipriano, Boris Sakakushev, Krstina Doklestich, Edward Tan, Timothy Hardcastle, Mauro Podda, Arda Isik, Edoardo Picetti, Anastasia Pikoulis, Andrey Litvin, Joseph M. Galante, Nicola de Angelis, Stefano Cioffi, Giulia Montori, Fikri Abu-Zidan, Giuseppe Procida, Simone Frassini, Silvia Pini, Francesco Corradi, Belinda de Simone, Mircea Chirica, Carlos Ordonez, Dieter Weber, Vishal Shelat, Yoram Kluger, Aleix Martinez Perez, Pablo Ottolino, Igor Kryvoruchko, Walt L. Biffl, Fausto Catena, Massimo Sartelli, Emmanouil Pikoulis, Raul Coimbra
Chest trauma is a common consequence of traumatic events. It may be blunt or penetrating. A low number of patients with blunt chest trauma require surgical intervention; in contrast, penetrating ones frequently require surgery and are associated with higher mortality. Chest trauma due to its anatomical location and to its potential effects on different systems must be multidisciplinary, and emergency and trauma systems should be organized and prepared to face all aspects. The present paper describes the recommendations provided by World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST), about comprehensive management of thoracic trauma.
{"title":"Thoracic trauma WSES-AAST guidelines","authors":"Federico Coccolini, Camilla Cremonini, Ernest E. Moore, Ian Civil, Zsolt Balogh, Ari Leppaniemi, Tal Horer, Viktor Reva, Chad Ball, Andrew W. Kirkpatrick, Andrea Colli, Laura Besola, Fank Plani, Bruno Viaggi, Giacomo Bellani, Marco Ceresoli, Enrico Cicuttin, Diego Mariani, Andreas Hecker, Stefania Cimbanassi, Ettore Melai, Francesco Forfori, Lorenzo Ghiadoni, Alessandro Cipriano, Boris Sakakushev, Krstina Doklestich, Edward Tan, Timothy Hardcastle, Mauro Podda, Arda Isik, Edoardo Picetti, Anastasia Pikoulis, Andrey Litvin, Joseph M. Galante, Nicola de Angelis, Stefano Cioffi, Giulia Montori, Fikri Abu-Zidan, Giuseppe Procida, Simone Frassini, Silvia Pini, Francesco Corradi, Belinda de Simone, Mircea Chirica, Carlos Ordonez, Dieter Weber, Vishal Shelat, Yoram Kluger, Aleix Martinez Perez, Pablo Ottolino, Igor Kryvoruchko, Walt L. Biffl, Fausto Catena, Massimo Sartelli, Emmanouil Pikoulis, Raul Coimbra","doi":"10.1186/s13017-025-00651-1","DOIUrl":"https://doi.org/10.1186/s13017-025-00651-1","url":null,"abstract":"Chest trauma is a common consequence of traumatic events. It may be blunt or penetrating. A low number of patients with blunt chest trauma require surgical intervention; in contrast, penetrating ones frequently require surgery and are associated with higher mortality. Chest trauma due to its anatomical location and to its potential effects on different systems must be multidisciplinary, and emergency and trauma systems should be organized and prepared to face all aspects. The present paper describes the recommendations provided by World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST), about comprehensive management of thoracic trauma.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145289194","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 : 2025-10-15DOI: 10.1186/s13017-025-00650-2
Dong Jin Park, Seung Min Baik, Kyung Sook Hong, Heejung Yi, Jae Gil Lee, Jae-Myeong Lee
Existing predictive models in critical care, specifically for postoperative critically ill patients, often struggle to accurately predict prolonged intensive care unit (ICU) stays, a key aspect of patient care. The integration of artificial intelligence (AI) offers a promising approach for bridging this gap. We aimed to develop an AI-based model to predict mortality and prolonged ICU stay in postoperative critically ill patients, enhance prognostic accuracy, and address the shortcomings of current models. This retrospective study included data from 6,029 postoperative critically ill patients from two medical centers, including a wide range of clinical, surgical, and laboratory variables. Multiple machine-learning models, including extreme gradient boosting, light gradient boosting, category boosting, random forest, and multilayer perceptron, were employed. A soft-voting ensemble model was developed to aggregate the strengths of individual models. The models underwent external validation, and the SHapley Additive exPlanations (SHAP) method was utilized to assess the impact of various features on predictions. In internal validation, the ensemble model demonstrated superior performance with an area under the receiver operating characteristic curve (AUROC) of 0.8812 for mortality and 0.7944 for prolonged ICU stay. It achieved 0.9095 accuracy and an F1 score of 0.7014 for mortality predictions. For prolonged ICU stay, it attained an accuracy of 0.9368 and an F1 score of 0.5762. During external validation, the model maintained high performance, with an AUROC of 0.8330 for mortality and 0.7376 for prolonged ICU stay. It showed 0.9200 accuracy and an F1 score of 0.6768 for mortality and 0.9028 accuracy with an F1 score of 0.5689 for prolonged ICU stay. SHAP analysis confirmed that key predictors, including emergency surgery, serum osmolality, lactate levels, and diastolic blood pressure, remained significant. This study represents a significant advancement in the application of AI in critical care, especially for postoperative critically ill patients. The developed AI model outperformed existing models in predicting mortality and prolonged ICU stay, demonstrating notable accuracy and reliability. Its ability to identify critical, under-emphasized clinical factors could enhance decision-making in critical care settings. Although promising, further validation in diverse clinical settings is essential to confirm the model’s efficacy and broader applicability.
{"title":"Development and external validation of an artificial intelligence model for predicting mortality and prolonged ICU stay in postoperative critically ill patients: a retrospective study","authors":"Dong Jin Park, Seung Min Baik, Kyung Sook Hong, Heejung Yi, Jae Gil Lee, Jae-Myeong Lee","doi":"10.1186/s13017-025-00650-2","DOIUrl":"https://doi.org/10.1186/s13017-025-00650-2","url":null,"abstract":"Existing predictive models in critical care, specifically for postoperative critically ill patients, often struggle to accurately predict prolonged intensive care unit (ICU) stays, a key aspect of patient care. The integration of artificial intelligence (AI) offers a promising approach for bridging this gap. We aimed to develop an AI-based model to predict mortality and prolonged ICU stay in postoperative critically ill patients, enhance prognostic accuracy, and address the shortcomings of current models. This retrospective study included data from 6,029 postoperative critically ill patients from two medical centers, including a wide range of clinical, surgical, and laboratory variables. Multiple machine-learning models, including extreme gradient boosting, light gradient boosting, category boosting, random forest, and multilayer perceptron, were employed. A soft-voting ensemble model was developed to aggregate the strengths of individual models. The models underwent external validation, and the SHapley Additive exPlanations (SHAP) method was utilized to assess the impact of various features on predictions. In internal validation, the ensemble model demonstrated superior performance with an area under the receiver operating characteristic curve (AUROC) of 0.8812 for mortality and 0.7944 for prolonged ICU stay. It achieved 0.9095 accuracy and an F1 score of 0.7014 for mortality predictions. For prolonged ICU stay, it attained an accuracy of 0.9368 and an F1 score of 0.5762. During external validation, the model maintained high performance, with an AUROC of 0.8330 for mortality and 0.7376 for prolonged ICU stay. It showed 0.9200 accuracy and an F1 score of 0.6768 for mortality and 0.9028 accuracy with an F1 score of 0.5689 for prolonged ICU stay. SHAP analysis confirmed that key predictors, including emergency surgery, serum osmolality, lactate levels, and diastolic blood pressure, remained significant. This study represents a significant advancement in the application of AI in critical care, especially for postoperative critically ill patients. The developed AI model outperformed existing models in predicting mortality and prolonged ICU stay, demonstrating notable accuracy and reliability. Its ability to identify critical, under-emphasized clinical factors could enhance decision-making in critical care settings. Although promising, further validation in diverse clinical settings is essential to confirm the model’s efficacy and broader applicability.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"9 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145289192","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 : 2025-10-14DOI: 10.1186/s13017-025-00653-z
Yingjian Ye, Yan Hu, Xianqun Ji, Junyan Zhang, Hui Xu, Peng An
This prospective multinational substudy of the AMESI project provides critical insights into managing acute SMA occlusion. By comparing endovascular versus surgical revascularization, the authors demonstrate that baseline illness severity, reflected by elevated lactate levels and mechanical ventilation requirements, dominates prognostic outcomes, with adjusted analyses confirming no independent mortality effect from treatment modality (surgery OR 1.59, 95% CI 0.57–4.37). Notably, unadjusted mortality rates varied substantially (endovascular-effective: 2.9% vs. surgical: 45.8%), primarily attributable to patient selection bias toward higher disease severity in the surgical cohort. The inability to identify reliable thresholds for endovascular efficacy underscores the necessity of individualized decision-making based on etiology and physiological status, challenging time-based intervention paradigms.
这项前瞻性的跨国亚研究AMESI项目为管理急性SMA闭塞提供了关键的见解。通过比较血管内与手术血运重建术，作者证明，乳酸水平升高和机械通气需求反映的基线疾病严重程度主导了预后结果，调整分析证实治疗方式没有独立的死亡率影响（手术OR 1.59, 95% CI 0.57-4.37）。值得注意的是，未经调整的死亡率差异很大（血管内有效：2.9% vs.手术：45.8%），主要归因于手术队列中患者选择偏向于更高疾病严重程度。无法确定血管内疗效的可靠阈值强调了基于病因和生理状态的个性化决策的必要性，挑战了基于时间的干预范式。
{"title":"Refining patient stratification and treatment decision-making in acute SMA occlusion","authors":"Yingjian Ye, Yan Hu, Xianqun Ji, Junyan Zhang, Hui Xu, Peng An","doi":"10.1186/s13017-025-00653-z","DOIUrl":"https://doi.org/10.1186/s13017-025-00653-z","url":null,"abstract":"This prospective multinational substudy of the AMESI project provides critical insights into managing acute SMA occlusion. By comparing endovascular versus surgical revascularization, the authors demonstrate that baseline illness severity, reflected by elevated lactate levels and mechanical ventilation requirements, dominates prognostic outcomes, with adjusted analyses confirming no independent mortality effect from treatment modality (surgery OR 1.59, 95% CI 0.57–4.37). Notably, unadjusted mortality rates varied substantially (endovascular-effective: 2.9% vs. surgical: 45.8%), primarily attributable to patient selection bias toward higher disease severity in the surgical cohort. The inability to identify reliable thresholds for endovascular efficacy underscores the necessity of individualized decision-making based on etiology and physiological status, challenging time-based intervention paradigms.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"22 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145283452","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 : 2025-10-10DOI: 10.1186/s13017-025-00649-9
Hannah M. Thomas, Huthayfa Kahf, Benjamin Bush, Jeffry Nahmias, Philip K. Lim
Tranexamic acid (TXA) is a well-known antifibrinolytic agent with increasing evidence supporting its use in trauma patients. This review evaluates the current available literature regarding TXA and its potential use to improve patient survival and reduce transfusion needs across multiple trauma surgical subspecialties and contexts. A literature review was conducted on the efficacy and safety of tranexamic acid in trauma surgical specialties using PubMed (MEDLINE) and Google Scholar from database inception to October 2024. Selected articles were written in the English language and encompassed reviews, experimental studies, and basic science articles. There is conflicting evidence on the mortality benefit of TXA, particularly in the prehospital setting. However, multiple large, high-quality studies have shown that TXA is an effective agent to reduce bleeding after trauma. Extensive evidence exists that TXA is a safe medication, with numerous studies demonstrating no increased risk of thromboembolic events after administration of TXA in trauma settings. Additionally, multiple cost-effectiveness studies conducted in several countries have found TXA to be a highly cost-effective intervention following trauma. TXA is a safe, effective, and cost-effective medication to reduce bleeding after trauma. Future research on TXA is needed to elucidate the potential benefit of TXA after traumatic brain and spine injury and the optimal dose and route of administration of TXA.
{"title":"Use of tranexamic acid in trauma surgical specialties: a narrative review","authors":"Hannah M. Thomas, Huthayfa Kahf, Benjamin Bush, Jeffry Nahmias, Philip K. Lim","doi":"10.1186/s13017-025-00649-9","DOIUrl":"https://doi.org/10.1186/s13017-025-00649-9","url":null,"abstract":"Tranexamic acid (TXA) is a well-known antifibrinolytic agent with increasing evidence supporting its use in trauma patients. This review evaluates the current available literature regarding TXA and its potential use to improve patient survival and reduce transfusion needs across multiple trauma surgical subspecialties and contexts. A literature review was conducted on the efficacy and safety of tranexamic acid in trauma surgical specialties using PubMed (MEDLINE) and Google Scholar from database inception to October 2024. Selected articles were written in the English language and encompassed reviews, experimental studies, and basic science articles. There is conflicting evidence on the mortality benefit of TXA, particularly in the prehospital setting. However, multiple large, high-quality studies have shown that TXA is an effective agent to reduce bleeding after trauma. Extensive evidence exists that TXA is a safe medication, with numerous studies demonstrating no increased risk of thromboembolic events after administration of TXA in trauma settings. Additionally, multiple cost-effectiveness studies conducted in several countries have found TXA to be a highly cost-effective intervention following trauma. TXA is a safe, effective, and cost-effective medication to reduce bleeding after trauma. Future research on TXA is needed to elucidate the potential benefit of TXA after traumatic brain and spine injury and the optimal dose and route of administration of TXA.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"122 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255797","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}
Intra-abdominal pressure (IAP) critically drives organ failure progression in severe acute pancreatitis (SAP). However, traditional static IAP monitoring inadequately captures dynamic injury evolution. This study aimed to assess the impact of cumulative IAP exposure (CumIAP) and dynamic trajectories on the prognosis of SAP. This retrospective cohort study analyzed 1,008 ICU-admitted SAP patients from the Jiangxi cohort (2005–2023) and 83 from MIMIC-IV (2008–2019). CumIAP was quantified via time-weighted integration of serial IAP measurements. Multivariate Cox regression models and restricted cubic splines (RCS) were established to analyze the dose–response relationships between CumIAP and death, infectious pancreatic necrosis (IPN), and persistent multiple organ failure (PMOF). Mediation analysis evaluated CumIAP’s role in albumin (ALB)- and acute necrotic collection (ANC)-associated outcomes. Latent class growth mixture model (LCGMM) was employed to identify dynamic IAP trajectory subtypes, and the associations between each trajectory group and poor prognosis were analyzed. Over a median inpatient follow-up of 17 days in the Jiangxi cohort, 200 (19.8%) patients died in hospital, while 208 (20.6%) and 329 (32.6%) developed IPN and PMOF, respectively. Regression analysis revealed that for each standard deviation increase in CumIAP, the risks of in-hospital death and PMOF increased by 37% and 86%, respectively, and there was a U-shaped association with the risk of IPN (P for nonlinearity = 0.004). Mediation analysis showed that CumIAP mediated 24.26% and 33.76% of the associations between ALB, ANC, and the risk of in-hospital death, respectively. Three IAP trajectories were identified by LCGMM: the high-pressure rapid decline group (HRD-T1), the low-pressure gradual decline group (LGD-T2), and the low-pressure progressive increase group (LPI-T3). Among them, compared with HRD-T1 and LGD-T2, the subjects in the LPI-T3 group had a significantly increased risk of adverse clinical outcomes. This is the first study to revealed that CumIAP is linearly positively correlated with death and PMOF, while exhibits a U-shaped relationship with IPN. Notably, patients with low baseline IAP and a rising trajectory exhibited worse outcomes than those with high baseline IAP and a declining trend. This is the first study to introduce CumIAP as a quantitative metric to assess the early IAP burden and its prognostic significance in SAP, overcoming the limitations of static IAP monitoring. RCS and regression analyses revealed a positive linear association between CumIAP and in hospital mortality/PMOF, and a U-shaped relationship with IPN, suggesting the possible presence of a risk threshold. LCGMM identified three IAP trajectory patterns; the "low baseline with rising trend" group (LPI-T3) had the worst outcomes, underscoring the value of dynamic over static IAP monitoring. Mediation analysis showed that CumIAP partly mediated the effects of hypoalbuminemia and ANC on o
腹内压（IAP）是严重急性胰腺炎（SAP）患者器官衰竭进展的关键驱动因素。然而，传统的静态IAP监测无法充分捕捉到损伤的动态演变。本研究旨在评估累积IAP暴露（CumIAP）和动态轨迹对SAP预后的影响。本回顾性队列研究分析了来自江西队列（2005-2023）的1008例icu住院SAP患者和来自MIMIC-IV（2008-2019）的83例患者。通过一系列IAP测量的时间加权积分来量化CumIAP。建立多变量Cox回归模型和限制性三次样条（RCS）分析CumIAP与死亡、感染性胰腺坏死（IPN）和持续性多器官衰竭（PMOF）之间的剂量-反应关系。中介分析评估了CumIAP在白蛋白（ALB）和急性坏死收集（ANC）相关结果中的作用。采用潜类生长混合模型（Latent class growth mixture model， LCGMM）识别IAP动态轨迹亚型，并分析各轨迹组与不良预后的关系。在江西队列中位17天的住院随访中，200例（19.8%）患者在医院死亡，208例（20.6%）和329例（32.6%）患者分别发生IPN和PMOF。回归分析显示，CumIAP每增加一个标准差，院内死亡和PMOF的风险分别增加37%和86%，与IPN的风险呈u型相关（非线性P = 0.004）。中介分析显示，CumIAP分别介导了24.26%和33.76%的ALB、ANC与院内死亡风险之间的关联。LCGMM识别出三种IAP轨迹：高压快速下降组（HRD-T1）、低压逐渐下降组（LGD-T2）和低压逐渐增加组（LPI-T3）。其中，与HRD-T1和LGD-T2相比，LPI-T3组受试者出现临床不良结局的风险显著增加。这是首次发现CumIAP与死亡和PMOF呈线性正相关，而与IPN呈u型关系。值得注意的是，基线IAP低且呈上升趋势的患者比基线IAP高且呈下降趋势的患者表现出更差的结果。这是首次引入CumIAP作为定量指标来评估SAP早期IAP负担及其预后意义的研究，克服了静态IAP监测的局限性。RCS和回归分析显示，CumIAP与院内死亡率/PMOF呈正线性关系，与IPN呈u型关系，表明可能存在风险阈值。LCGMM确定了三种IAP轨迹模式；“低基线有上升趋势”组（LPI-T3）的结果最差，强调了动态IAP监测比静态IAP监测的价值。中介分析显示，CumIAP在一定程度上介导了低白蛋白血症和ANC对预后的影响，表明IAP可能是SAP的一个重要中介途径和治疗靶点。
{"title":"Cumulative intra-abdominal pressure exposure and dynamic trajectories in ICU-admitted patients reveal prognostic determinants of severe acute pancreatitis","authors":"Maobin Kuang, Yaoyu Zou, Shixuan Xiong, Cong He, Nianshuang Li, Ling Ding, Xueyang Li, Huijie Zhang, Yupeng Lei, Xin Huang, Huifang Xiong, Lingyu Luo, Liang Xia, Wenhua He, Nonghua Lv, Jianhua Wan, Yin Zhu","doi":"10.1186/s13017-025-00646-y","DOIUrl":"https://doi.org/10.1186/s13017-025-00646-y","url":null,"abstract":"Intra-abdominal pressure (IAP) critically drives organ failure progression in severe acute pancreatitis (SAP). However, traditional static IAP monitoring inadequately captures dynamic injury evolution. This study aimed to assess the impact of cumulative IAP exposure (CumIAP) and dynamic trajectories on the prognosis of SAP. This retrospective cohort study analyzed 1,008 ICU-admitted SAP patients from the Jiangxi cohort (2005–2023) and 83 from MIMIC-IV (2008–2019). CumIAP was quantified via time-weighted integration of serial IAP measurements. Multivariate Cox regression models and restricted cubic splines (RCS) were established to analyze the dose–response relationships between CumIAP and death, infectious pancreatic necrosis (IPN), and persistent multiple organ failure (PMOF). Mediation analysis evaluated CumIAP’s role in albumin (ALB)- and acute necrotic collection (ANC)-associated outcomes. Latent class growth mixture model (LCGMM) was employed to identify dynamic IAP trajectory subtypes, and the associations between each trajectory group and poor prognosis were analyzed. Over a median inpatient follow-up of 17 days in the Jiangxi cohort, 200 (19.8%) patients died in hospital, while 208 (20.6%) and 329 (32.6%) developed IPN and PMOF, respectively. Regression analysis revealed that for each standard deviation increase in CumIAP, the risks of in-hospital death and PMOF increased by 37% and 86%, respectively, and there was a U-shaped association with the risk of IPN (P for nonlinearity = 0.004). Mediation analysis showed that CumIAP mediated 24.26% and 33.76% of the associations between ALB, ANC, and the risk of in-hospital death, respectively. Three IAP trajectories were identified by LCGMM: the high-pressure rapid decline group (HRD-T1), the low-pressure gradual decline group (LGD-T2), and the low-pressure progressive increase group (LPI-T3). Among them, compared with HRD-T1 and LGD-T2, the subjects in the LPI-T3 group had a significantly increased risk of adverse clinical outcomes. This is the first study to revealed that CumIAP is linearly positively correlated with death and PMOF, while exhibits a U-shaped relationship with IPN. Notably, patients with low baseline IAP and a rising trajectory exhibited worse outcomes than those with high baseline IAP and a declining trend. This is the first study to introduce CumIAP as a quantitative metric to assess the early IAP burden and its prognostic significance in SAP, overcoming the limitations of static IAP monitoring. RCS and regression analyses revealed a positive linear association between CumIAP and in hospital mortality/PMOF, and a U-shaped relationship with IPN, suggesting the possible presence of a risk threshold. LCGMM identified three IAP trajectory patterns; the \"low baseline with rising trend\" group (LPI-T3) had the worst outcomes, underscoring the value of dynamic over static IAP monitoring. Mediation analysis showed that CumIAP partly mediated the effects of hypoalbuminemia and ANC on o","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"23 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182766","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 : 2025-09-29DOI: 10.1186/s13017-025-00648-w
Jiaqi Lou, Ziyi Xiang, Xiaoyu Zhu, Jingyao Song, Neng Huang, Jiliang Li, Guoying Jin, Youfen Fan, Shengyong Cui
Severe burn injuries induce hypermetabolism, leading to protein catabolism, impaired wound healing, and increased infection risk. Burn patients often experience androgen depletion, exacerbating these issues. Oxandrolone, a synthetic anabolic steroid, has shown promise in counteracting these metabolic disturbances. This updated meta-analysis evaluates the efficacy and safety of oxandrolone in burn patients, incorporating recent studies, pediatric populations, long-term outcomes, and combination therapies. This PRISMA 2020-compliant systematic review searched 9 databases (PubMed, Embase, Cochrane, WOS, WHO-ICTRP, CNKI, VIP, Wanfang, CBMdisc) for RCTs published between 2005 and 2025 using validated strategies combining controlled vocabulary (MeSH/Emtree) and free-text terms for burn/trauma AND androgen analogs (e.g., oxandrolone, nandrolone). Included trials compared androgen analogs vs. controls (placebo/standard care) in burn patients, reporting ≥ 1 predefined outcome: (1) Lean body mass (recovery phase, ≥ 14 days post-burn); (2) Mild side effects (hepatic dysfunction [ALT/AST ≥ 2 × ULN] or edema); (3) Infections; (4) Mortality; (5) Surgical procedures; (6) LOS/TBSA; (7) Absolute LOS. Dual-independent screening, data extraction, and risk-of-bias assessment (Cochrane RoB 2.0 per outcome) were performed. Random-effects meta-analyses generated standardized mean differences (SMD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% CIs. Fourteen RCTs (2005–2025; n = 2822 patients: 1203 intervention vs. 1619 controls) demonstrated significant reductions in surgical procedures (SMD = − 1.25; 95% CI − 2.45 to − 0.04; p = 0.04; I2 = 97.2%) and length of stay normalized to TBSA (LOS/TBSA) (SMD = − 1.07; 95% CI − 2.43 to 0.29; p = 0.007; I2 = 98.1%), alongside enhanced anabolic recovery evidenced by increased weight gain (SMD = 0.58; 95% CI − 1.21 to 2.38; p < 0.001) and lean mass (SMD = 1.30; 95% CI − 0.47 to 3.24; p < 0.001; I2 ≥ 95.0%). However, no mortality benefit was observed (RR = 1.04; 95% CI 0.47–2.32; p = 0.913; I2 = 66.5%), with unchanged infection rates (RR = 0.83; 95% CI 0.67–1.02; p = 0.639) and no improvement in donor site healing (SMD = − 1.48; 95% CI − 2.18 to 0.77; p = 0.116). Safety analysis revealed a non-significant increase in treatment-related side effects (hepatic dysfunction/edema; RR = 1.82; 95% CI 0.52–6.42; p = 0.34), notably higher transaminase elevations in adults (19% vs. 5% placebo; p = 0.002). Oxandrolone demonstrates clinical utility in burn management by significantly reducing surgical burden (SMD = − 1.25; p = 0.04), shortening hospitalization (LOS/TBSA SMD = − 1.07; p = 0.007), and enhancing anabolic recovery (weight gain SMD = 0.58; lean mass SMD = 1.30; both p < 0.001). However, extreme heterogeneity (I2 ≥ 95.0%) and temporal limitations necessitate cautious interpretation. Critically, it confers no mortality benefit (RR = 1.04; p = 0.913), fails to reduce infections (RR = 0.83; p = 0.639), an
严重烧伤诱导高代谢，导致蛋白质分解代谢，伤口愈合受损，感染风险增加。烧伤患者经常经历雄激素消耗，加剧了这些问题。奥雄龙，一种合成的合成代谢类固醇，已经显示出对抗这些代谢紊乱的希望。这项最新的荟萃分析评估了奥胺龙在烧伤患者中的疗效和安全性，结合了最近的研究、儿科人群、长期结果和联合治疗。这项符合PRISMA 2020标准的系统评价检索了9个数据库（PubMed、Embase、Cochrane、WOS、WHO-ICTRP、CNKI、VIP、万方、CBMdisc），检索了2005年至2025年间发表的随机对照试验，使用了有效的策略，结合了烧伤/创伤和雄激素类似物（如oxandronone、nandronone）的控制词汇（MeSH/Emtree）和自由文本术语。纳入的试验比较了烧伤患者的雄激素类似物与对照组（安慰剂/标准治疗），报告了≥1个预定义结果：(1)瘦体重（恢复阶段，烧伤后≥14天）；(2)轻微副作用（肝功能障碍[ALT/AST≥2 × ULN]或水肿）；(3)感染;(4)死亡率;（五）外科手术；(6)洛杉矶/回溯;(7)绝对LOS。进行了双独立筛选、数据提取和偏倚风险评估（每个结果的Cochrane RoB 2.0）。随机效应荟萃分析产生了连续结局的标准化平均差异（SMD）和95% ci的二分类结局的风险比（RR）。十四相关(2005 - 2025年;n = 2822例:1203 1619年干预与控制)证明显著减少外科手术(SMD =−1.25;95%可信区间2.45−−0.04;p = 0.04; I2 = 97.2%)和滞留时间规范化回溯(洛杉矶/回溯)(SMD =−1.07;95%可信区间2.43−0.29;p = 0.007; I2 = 98.1%),与增强合成代谢恢复就是增加体重增加(SMD = 0.58; 95%可信区间1.21−2.38;p < 0.001)和精益质量(SMD = 1.30; 95%可信区间0.47−3.24;p < 0.001;i2≥95.0%)。然而，没有观察到死亡率的改善（RR = 1.04; 95% CI 0.47-2.32; p = 0.913; I2 = 66.5%），感染率不变（RR = 0.83; 95% CI 0.67-1.02; p = 0.639），供体部位愈合无改善（SMD = - 1.48; 95% CI - 2.18 - 0.77; p = 0.116）。安全性分析显示治疗相关副作用（肝功能障碍/水肿；RR = 1.82; 95% CI 0.52-6.42; p = 0.34）无显著增加，成人转氨酶升高明显（19% vs 5%安慰剂；p = 0.002）。奥胺龙在烧伤治疗中具有临床应用价值，可显著减轻手术负担（SMD = - 1.25, p = 0.04），缩短住院时间（LOS/TBSA SMD = - 1.07, p = 0.007），促进合成代谢恢复（体重增加SMD = 0.58，瘦质量SMD = 1.30， p均< 0.001）。然而，极端异质性（I2≥95.0%）和时间限制需要谨慎解释。关键的是，它没有死亡率方面的益处（RR = 1.04; p = 0.913），不能减少感染（RR = 0.83; p = 0.639），并增加成人的肝毒性风险（19% vs. 5%; p = 0.002）。这些发现支持其在代谢康复中的辅助作用，但要求风险分层实施。
{"title":"Oxandrolone for burn patients: a systematic review and updated meta-analysis of randomized controlled trials from 2005 to 2025","authors":"Jiaqi Lou, Ziyi Xiang, Xiaoyu Zhu, Jingyao Song, Neng Huang, Jiliang Li, Guoying Jin, Youfen Fan, Shengyong Cui","doi":"10.1186/s13017-025-00648-w","DOIUrl":"https://doi.org/10.1186/s13017-025-00648-w","url":null,"abstract":"Severe burn injuries induce hypermetabolism, leading to protein catabolism, impaired wound healing, and increased infection risk. Burn patients often experience androgen depletion, exacerbating these issues. Oxandrolone, a synthetic anabolic steroid, has shown promise in counteracting these metabolic disturbances. This updated meta-analysis evaluates the efficacy and safety of oxandrolone in burn patients, incorporating recent studies, pediatric populations, long-term outcomes, and combination therapies. This PRISMA 2020-compliant systematic review searched 9 databases (PubMed, Embase, Cochrane, WOS, WHO-ICTRP, CNKI, VIP, Wanfang, CBMdisc) for RCTs published between 2005 and 2025 using validated strategies combining controlled vocabulary (MeSH/Emtree) and free-text terms for burn/trauma AND androgen analogs (e.g., oxandrolone, nandrolone). Included trials compared androgen analogs vs. controls (placebo/standard care) in burn patients, reporting ≥ 1 predefined outcome: (1) Lean body mass (recovery phase, ≥ 14 days post-burn); (2) Mild side effects (hepatic dysfunction [ALT/AST ≥ 2 × ULN] or edema); (3) Infections; (4) Mortality; (5) Surgical procedures; (6) LOS/TBSA; (7) Absolute LOS. Dual-independent screening, data extraction, and risk-of-bias assessment (Cochrane RoB 2.0 per outcome) were performed. Random-effects meta-analyses generated standardized mean differences (SMD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% CIs. Fourteen RCTs (2005–2025; n = 2822 patients: 1203 intervention vs. 1619 controls) demonstrated significant reductions in surgical procedures (SMD = − 1.25; 95% CI − 2.45 to − 0.04; p = 0.04; I2 = 97.2%) and length of stay normalized to TBSA (LOS/TBSA) (SMD = − 1.07; 95% CI − 2.43 to 0.29; p = 0.007; I2 = 98.1%), alongside enhanced anabolic recovery evidenced by increased weight gain (SMD = 0.58; 95% CI − 1.21 to 2.38; p < 0.001) and lean mass (SMD = 1.30; 95% CI − 0.47 to 3.24; p < 0.001; I2 ≥ 95.0%). However, no mortality benefit was observed (RR = 1.04; 95% CI 0.47–2.32; p = 0.913; I2 = 66.5%), with unchanged infection rates (RR = 0.83; 95% CI 0.67–1.02; p = 0.639) and no improvement in donor site healing (SMD = − 1.48; 95% CI − 2.18 to 0.77; p = 0.116). Safety analysis revealed a non-significant increase in treatment-related side effects (hepatic dysfunction/edema; RR = 1.82; 95% CI 0.52–6.42; p = 0.34), notably higher transaminase elevations in adults (19% vs. 5% placebo; p = 0.002). Oxandrolone demonstrates clinical utility in burn management by significantly reducing surgical burden (SMD = − 1.25; p = 0.04), shortening hospitalization (LOS/TBSA SMD = − 1.07; p = 0.007), and enhancing anabolic recovery (weight gain SMD = 0.58; lean mass SMD = 1.30; both p < 0.001). However, extreme heterogeneity (I2 ≥ 95.0%) and temporal limitations necessitate cautious interpretation. Critically, it confers no mortality benefit (RR = 1.04; p = 0.913), fails to reduce infections (RR = 0.83; p = 0.639), an","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"20 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188597","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 : 2025-09-02DOI: 10.1186/s13017-025-00643-1
Vladimir Sergeevich Gordeev, Esubalew Assefa, Rupert Pearse, Mark Edwards, Borislava Mihaylova
Patients’ survival and quality of life are key factors in assessing value of treatments. However, limited evidence exists about the trajectory and key determinants of patients’ health-related quality of life (QoL) following emergency abdominal surgery. Using the Enhanced Peri-Operative Care for High-risk patients study with measured QoL during eight months follow-up using the EQ-5D-3L questionnaire, we summarise the trajectory of patients’ QoL after emergency abdominal surgery and use multivariable regression models to relate patients’ demographic and clinical characteristics, pre-surgery characteristics, and time elapsed since surgery with their QoL. In further analysis we assess the contribution of post-surgery patient characteristics. Data from 686 patients undergoing emergency abdominal surgery (50.4% female; mean age 66.6 (standard deviation (SD) 12.8) years; 50.1% with intestinal obstruction as indication for surgery), with QoL measurements were analysed. Shortly after surgery (mean days 7.59 (SD 7.48)), the mean EQ-5D-3L QoL utility score was 0.21 (SD 0.46), which improved among survivors to 0.74 (SD 0.31) in the medium- to long-term (i.e., three to eight months) following surgery. Patient’s sex and preoperative risk of mortality were key determinants of QoL shortly after surgery. In addition to time since surgery, patient’s sex, Charlson Comorbidity index, ASA physical status and indication for surgery were key pre-surgery predictors of QoL in the medium- to long-term post-surgery. From post-surgery characteristics, duration of hospital admission for index surgery and further days in hospital within 30 days prior to QoL measurement were key further determinants of QoL in the medium- to long-term. Individual patient, surgery, and recovery characteristics determine QoL post-emergency abdominal surgery and can help inform clinician-patient discussions and assessments of value of abdominal surgery interventions.
{"title":"Health-related quality of life after emergency abdominal surgery","authors":"Vladimir Sergeevich Gordeev, Esubalew Assefa, Rupert Pearse, Mark Edwards, Borislava Mihaylova","doi":"10.1186/s13017-025-00643-1","DOIUrl":"https://doi.org/10.1186/s13017-025-00643-1","url":null,"abstract":"Patients’ survival and quality of life are key factors in assessing value of treatments. However, limited evidence exists about the trajectory and key determinants of patients’ health-related quality of life (QoL) following emergency abdominal surgery. Using the Enhanced Peri-Operative Care for High-risk patients study with measured QoL during eight months follow-up using the EQ-5D-3L questionnaire, we summarise the trajectory of patients’ QoL after emergency abdominal surgery and use multivariable regression models to relate patients’ demographic and clinical characteristics, pre-surgery characteristics, and time elapsed since surgery with their QoL. In further analysis we assess the contribution of post-surgery patient characteristics. Data from 686 patients undergoing emergency abdominal surgery (50.4% female; mean age 66.6 (standard deviation (SD) 12.8) years; 50.1% with intestinal obstruction as indication for surgery), with QoL measurements were analysed. Shortly after surgery (mean days 7.59 (SD 7.48)), the mean EQ-5D-3L QoL utility score was 0.21 (SD 0.46), which improved among survivors to 0.74 (SD 0.31) in the medium- to long-term (i.e., three to eight months) following surgery. Patient’s sex and preoperative risk of mortality were key determinants of QoL shortly after surgery. In addition to time since surgery, patient’s sex, Charlson Comorbidity index, ASA physical status and indication for surgery were key pre-surgery predictors of QoL in the medium- to long-term post-surgery. From post-surgery characteristics, duration of hospital admission for index surgery and further days in hospital within 30 days prior to QoL measurement were key further determinants of QoL in the medium- to long-term. Individual patient, surgery, and recovery characteristics determine QoL post-emergency abdominal surgery and can help inform clinician-patient discussions and assessments of value of abdominal surgery interventions.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"66 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144928038","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 : 2025-08-30DOI: 10.1186/s13017-025-00645-z
Chi Peng, Yibin Guo, Fan Yang, Qi Chen, Lei Li, Faran Bokhari, Zhichao Jin, Shuogui Xu
Uncontrolled bleeding contributes to 40% of trauma deaths. While higher platelet-to-red blood cell (PLT/RBC) transfusion ratios may improve outcomes, the optimal ratio remains unclear. This study aimed to determine the threshold of PLT/RBC ratio and its impact on in-hospital mortality in trauma patients requiring massive transfusions. This retrospective, multicenter study used 2014–2018 National Trauma Database (NTDB) data. Adult patients admitted to Level I/II trauma centers with massive transfusions within 24 h of emergency department (ED) admission were included. Patients were divided into high-PLT group (PLT/RBC ratio > 0.7) and low-PLT group (ratio ≤ 0.7). Primary outcomes: 24-hour and 30-day mortality; secondary outcomes: transfusion-related adverse events. Among 9,330 patients (median age 37 (26–54) years; 78.9% male), 46.1% had a high PLT/RBC ratio. Restricted cubic spline analysis revealed a nonlinear relationship: mortality dropped significantly at > 0.7 and stabilized above 1.5. After inverse probability treatment weighting, the high-PLT group showed lower 24-hour mortality (OR, 0.45; 95% CI, 0.42–0.48) and 30-day mortality (OR, 0.66; 95% CI, 0.62–0.70). However, the high ratio group experienced higher rates of adverse events, including pulmonary embolism, acute kidney injury, and sepsis. Subgroup analyses confirmed consistent survival benefits despite increased adverse events. Sensitivity analysis further supported the robustness of these findings. In this multicenter study, a high PLT/RBC ratio (> 0.7) was associated with improved survival in trauma patients requiring massive transfusions, reducing 24-hour and 30-day mortality. However, it also increased the risk of adverse events, with a ceiling effect observed at ratios above 1.5. These findings underscore the need for high-quality clinical trials to validate the benefits of high PLT/RBC ratios and optimize transfusion strategies for trauma patients.
{"title":"High platelet-to-red blood cell ratio and outcomes in trauma patients requiring massive transfusions","authors":"Chi Peng, Yibin Guo, Fan Yang, Qi Chen, Lei Li, Faran Bokhari, Zhichao Jin, Shuogui Xu","doi":"10.1186/s13017-025-00645-z","DOIUrl":"https://doi.org/10.1186/s13017-025-00645-z","url":null,"abstract":"Uncontrolled bleeding contributes to 40% of trauma deaths. While higher platelet-to-red blood cell (PLT/RBC) transfusion ratios may improve outcomes, the optimal ratio remains unclear. This study aimed to determine the threshold of PLT/RBC ratio and its impact on in-hospital mortality in trauma patients requiring massive transfusions. This retrospective, multicenter study used 2014–2018 National Trauma Database (NTDB) data. Adult patients admitted to Level I/II trauma centers with massive transfusions within 24 h of emergency department (ED) admission were included. Patients were divided into high-PLT group (PLT/RBC ratio > 0.7) and low-PLT group (ratio ≤ 0.7). Primary outcomes: 24-hour and 30-day mortality; secondary outcomes: transfusion-related adverse events. Among 9,330 patients (median age 37 (26–54) years; 78.9% male), 46.1% had a high PLT/RBC ratio. Restricted cubic spline analysis revealed a nonlinear relationship: mortality dropped significantly at > 0.7 and stabilized above 1.5. After inverse probability treatment weighting, the high-PLT group showed lower 24-hour mortality (OR, 0.45; 95% CI, 0.42–0.48) and 30-day mortality (OR, 0.66; 95% CI, 0.62–0.70). However, the high ratio group experienced higher rates of adverse events, including pulmonary embolism, acute kidney injury, and sepsis. Subgroup analyses confirmed consistent survival benefits despite increased adverse events. Sensitivity analysis further supported the robustness of these findings. In this multicenter study, a high PLT/RBC ratio (> 0.7) was associated with improved survival in trauma patients requiring massive transfusions, reducing 24-hour and 30-day mortality. However, it also increased the risk of adverse events, with a ceiling effect observed at ratios above 1.5. These findings underscore the need for high-quality clinical trials to validate the benefits of high PLT/RBC ratios and optimize transfusion strategies for trauma patients.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"29 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144919118","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}
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