Pub Date : 2024-03-04DOI: 10.1186/s13017-023-00529-0
Paola Fugazzola, Carlo Maria Bianchi, Francesca Calabretto, Enrico Cicuttin, Francesca Dal Mas, Tommaso Dominioni, Marcello Maestri, Aurelio Mauro, Alice Podestà, Matteo Tomasoni, Francesco Brucchi, Jacopo Viganò, Luca Ansaloni, Andrea Anderloni, Lorenzo Cobianchi
The development of a new cholangioscope, the SpyGlass™ Discover (Boston Scientific), has allowed the laparoscopic transcystic common bile duct exploration and stone clearance. The possibility of simultaneous treatment of choledocholithiasis during early laparoscopic cholecystectomy offers the opportunity to enormously reduce the time between acute cholecystitis diagnosis and the execution of cholecystectomy with better outcomes for patients. Furthermore, an altered anatomy of the gastrointestinal tract is not an obstacle to this technique. The aim of the study was to determine whether this new procedure is feasible, safe, and effective. The investigation employs a retrospective case series study including all consecutive patients with a diagnosis of common bile duct stones undergoing cholecystectomy and intraoperative laparoscopic common bile duct clearance using SpyGlass™ Discover at IRCCS Policlinico San Matteo in Pavia (Italy). Eighteen patients were included from May 2022 to May 2023. A complete clearance of the common bile duct was obtained in 88.9% of patients. The mean postoperative length of stay was 3 days. No major complications occurred. After a median follow-up of 8 months, no recurrence of biliary events or readmissions occurred. This procedure has proven to be feasible, safe, and effective.
{"title":"Intraoperative transcystic laparoscopic common bile duct stone clearance with SpyGlass™ discover during emergency and elective cholecystectomy: a single-center case series","authors":"Paola Fugazzola, Carlo Maria Bianchi, Francesca Calabretto, Enrico Cicuttin, Francesca Dal Mas, Tommaso Dominioni, Marcello Maestri, Aurelio Mauro, Alice Podestà, Matteo Tomasoni, Francesco Brucchi, Jacopo Viganò, Luca Ansaloni, Andrea Anderloni, Lorenzo Cobianchi","doi":"10.1186/s13017-023-00529-0","DOIUrl":"https://doi.org/10.1186/s13017-023-00529-0","url":null,"abstract":"The development of a new cholangioscope, the SpyGlass™ Discover (Boston Scientific), has allowed the laparoscopic transcystic common bile duct exploration and stone clearance. The possibility of simultaneous treatment of choledocholithiasis during early laparoscopic cholecystectomy offers the opportunity to enormously reduce the time between acute cholecystitis diagnosis and the execution of cholecystectomy with better outcomes for patients. Furthermore, an altered anatomy of the gastrointestinal tract is not an obstacle to this technique. The aim of the study was to determine whether this new procedure is feasible, safe, and effective. The investigation employs a retrospective case series study including all consecutive patients with a diagnosis of common bile duct stones undergoing cholecystectomy and intraoperative laparoscopic common bile duct clearance using SpyGlass™ Discover at IRCCS Policlinico San Matteo in Pavia (Italy). Eighteen patients were included from May 2022 to May 2023. A complete clearance of the common bile duct was obtained in 88.9% of patients. The mean postoperative length of stay was 3 days. No major complications occurred. After a median follow-up of 8 months, no recurrence of biliary events or readmissions occurred. This procedure has proven to be feasible, safe, and effective.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"263 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140024902","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 : 2024-02-28DOI: 10.1186/s13017-024-00535-w
Michiel Damhuis, Raymond van der Wal, Harriet Frielink, Robert Nijveldt, Joost ten Brinke, Edward Tan
Skydiving is the fastest nonmotorized sport; and consequently is not without risk. In the last decades, skydiving has become considerably safer but injuries and fatalities still occur. Incidents are reported to and administered by the Royal Netherlands Aeronautical Association (KNVvL). From 1995 to 2020, 2715 incidents were reported; of which 1503 resulted in injury and 26 in fatality. There is a need for more information available on the particular type, severity, and factors which contribute to skydiving-related injuries worldwide. This study aims to investigate patterns in occurrence rates, examine demographic and skydiving-related factors linked to injuries, and analyze the types and severity of injuries relating to these contributing factors. The Dutch KNVvL database – covering more than 25 years of data – was examined for contributing factors. An analysis of the severity and types of injury resulting from incidents over the last five years were matched with a search of hospital databases. The rate of injuries pattern increases starting from 2016, with novice jumpers having the highest risk of injury. Most injuries occur during the landing phase. The lower extremities and the spine are most affected, with fractures being the most prevalent type of injury. More than half of the patients were admitted to hospital, with 10% requiring surgery, resulting in months of rehabilitation. This study is the first in the Netherlands, and only the second worldwide to analyze technical incident databases in combination with data from medical information systems. Skydiving accidents of experienced jumpers should be considered as ‘high-energy trauma,’ therefore treatment should follow standard trauma guidelines. In less experienced skydivers, it is critical to conduct a secondary survey to assess the extremities adequately. Clinicians should also pay attention to friction burns that can arise due to friction between the skin and skydive equipment, a phenomenom that is already known in road traffic accidents.
{"title":"The ground is the limit: epidemiology of skydiving accidents over 25 years and in 2.1 million jumps in the Netherlands with sub-analysis of injuries reported by medical professionals in the past five years","authors":"Michiel Damhuis, Raymond van der Wal, Harriet Frielink, Robert Nijveldt, Joost ten Brinke, Edward Tan","doi":"10.1186/s13017-024-00535-w","DOIUrl":"https://doi.org/10.1186/s13017-024-00535-w","url":null,"abstract":"Skydiving is the fastest nonmotorized sport; and consequently is not without risk. In the last decades, skydiving has become considerably safer but injuries and fatalities still occur. Incidents are reported to and administered by the Royal Netherlands Aeronautical Association (KNVvL). From 1995 to 2020, 2715 incidents were reported; of which 1503 resulted in injury and 26 in fatality. There is a need for more information available on the particular type, severity, and factors which contribute to skydiving-related injuries worldwide. This study aims to investigate patterns in occurrence rates, examine demographic and skydiving-related factors linked to injuries, and analyze the types and severity of injuries relating to these contributing factors. The Dutch KNVvL database – covering more than 25 years of data – was examined for contributing factors. An analysis of the severity and types of injury resulting from incidents over the last five years were matched with a search of hospital databases. The rate of injuries pattern increases starting from 2016, with novice jumpers having the highest risk of injury. Most injuries occur during the landing phase. The lower extremities and the spine are most affected, with fractures being the most prevalent type of injury. More than half of the patients were admitted to hospital, with 10% requiring surgery, resulting in months of rehabilitation. This study is the first in the Netherlands, and only the second worldwide to analyze technical incident databases in combination with data from medical information systems. Skydiving accidents of experienced jumpers should be considered as ‘high-energy trauma,’ therefore treatment should follow standard trauma guidelines. In less experienced skydivers, it is critical to conduct a secondary survey to assess the extremities adequately. Clinicians should also pay attention to friction burns that can arise due to friction between the skin and skydive equipment, a phenomenom that is already known in road traffic accidents.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"51 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139988443","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 : 2024-01-28DOI: 10.1186/s13017-024-00534-x
Adriana Toro, Martina Rapisarda, Davide Maugeri, Alessandro Terrasi, Luisa Gallo, Luca Ansaloni, Fausto Catena, Isidoro Di Carlo
The aim of this manuscript is to illustrate a new method permitting safe cholecystectomy in terms of complications with respect to the common bile duct (CBD). The core of this new technique is identification of the continuity of the cystic duct with the infundibulum. The cystic duct can be identified between the inner gallbladder wall and inflamed outer wall. In the last 2 years, from January 2019 until December 2021, 3 patients have been treated with the reported technique without complications. Among the various cholecystectomy procedures, this is a new approach that ensures the safety of the structures of Calot’s triangle while providing the advantages gained from total removal of the gallbladder.
{"title":"Acute cholecystitis: how to avoid subtotal cholecystectomy—preliminary results","authors":"Adriana Toro, Martina Rapisarda, Davide Maugeri, Alessandro Terrasi, Luisa Gallo, Luca Ansaloni, Fausto Catena, Isidoro Di Carlo","doi":"10.1186/s13017-024-00534-x","DOIUrl":"https://doi.org/10.1186/s13017-024-00534-x","url":null,"abstract":"The aim of this manuscript is to illustrate a new method permitting safe cholecystectomy in terms of complications with respect to the common bile duct (CBD). The core of this new technique is identification of the continuity of the cystic duct with the infundibulum. The cystic duct can be identified between the inner gallbladder wall and inflamed outer wall. In the last 2 years, from January 2019 until December 2021, 3 patients have been treated with the reported technique without complications. Among the various cholecystectomy procedures, this is a new approach that ensures the safety of the structures of Calot’s triangle while providing the advantages gained from total removal of the gallbladder.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"17 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139568264","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 : 2024-01-24DOI: 10.1186/s13017-024-00533-y
Francesca Dal Mas, Lorenzo Cobianchi, Daniele Piccolo, Jeremy Balch, Helena Biancuzzi, Walter L Biffl, Stefano Campostrini, Enrico Cicuttin, Federico Coccolini, Dimitris Damaskos, Amanda C Filiberto, Claudia Filisetti, Gustavo Fraga, Simone Frassini, Paola Fugazzola, Timothy Hardcastle, Haytham M Kaafarani, Yoran Kluger, Maurizio Massaro, Jacopo Martellucci, Ernest Moore, Federico Ruta, Massimo Sartelli, Philip F Stahel, George Velmahos, Dieter G Weber, Fausto Catena, Tyler J Loftus, Luca Ansaloni
Background: The importance of environmental sustainability is acknowledged in all sectors, including healthcare. To meet the United Nations Sustainable Development Goals 2030 Agenda, healthcare will need a paradigm shift toward more environmentally sustainable practices that will also impact clinical decision-making. The study investigates trauma and emergency surgeons' perception, acceptance, and employment of environmentally friendly habits.
Methods: An online survey based on the most recent literature regarding environmental sustainability in healthcare and surgery was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to the 917 WSES members through the society's website and Twitter/X profile.
Results: 450 surgeons from 55 countries participated in the survey. Results underline both a generally positive attitude toward environmental sustainability but also a lack of knowledge about several concepts and practices, especially concerning the potential contribution to patient care.
Discussion: The topic of environmental sustainability in healthcare and surgery is still in its infancy. There is a clear lack of salient guidance and knowledge, and there is a critical need for governments, institutions, health agencies, and scientific societies to promote, disseminate, and report environmentally friendly initiatives and their potential impacts while employing an interdisciplinary approach.
{"title":"Are we ready for \"green surgery\" to promote environmental sustainability in the operating room? Results from the WSES STAR investigation.","authors":"Francesca Dal Mas, Lorenzo Cobianchi, Daniele Piccolo, Jeremy Balch, Helena Biancuzzi, Walter L Biffl, Stefano Campostrini, Enrico Cicuttin, Federico Coccolini, Dimitris Damaskos, Amanda C Filiberto, Claudia Filisetti, Gustavo Fraga, Simone Frassini, Paola Fugazzola, Timothy Hardcastle, Haytham M Kaafarani, Yoran Kluger, Maurizio Massaro, Jacopo Martellucci, Ernest Moore, Federico Ruta, Massimo Sartelli, Philip F Stahel, George Velmahos, Dieter G Weber, Fausto Catena, Tyler J Loftus, Luca Ansaloni","doi":"10.1186/s13017-024-00533-y","DOIUrl":"10.1186/s13017-024-00533-y","url":null,"abstract":"<p><strong>Background: </strong>The importance of environmental sustainability is acknowledged in all sectors, including healthcare. To meet the United Nations Sustainable Development Goals 2030 Agenda, healthcare will need a paradigm shift toward more environmentally sustainable practices that will also impact clinical decision-making. The study investigates trauma and emergency surgeons' perception, acceptance, and employment of environmentally friendly habits.</p><p><strong>Methods: </strong>An online survey based on the most recent literature regarding environmental sustainability in healthcare and surgery was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to the 917 WSES members through the society's website and Twitter/X profile.</p><p><strong>Results: </strong>450 surgeons from 55 countries participated in the survey. Results underline both a generally positive attitude toward environmental sustainability but also a lack of knowledge about several concepts and practices, especially concerning the potential contribution to patient care.</p><p><strong>Discussion: </strong>The topic of environmental sustainability in healthcare and surgery is still in its infancy. There is a clear lack of salient guidance and knowledge, and there is a critical need for governments, institutions, health agencies, and scientific societies to promote, disseminate, and report environmentally friendly initiatives and their potential impacts while employing an interdisciplinary approach.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"19 1","pages":"5"},"PeriodicalIF":6.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10809586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546451","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 : 2024-01-18DOI: 10.1186/s13017-023-00532-5
Dongmin Seo, Inhae Heo, Donghwan Choi, Kyoungwon Jung, Hohyung Jung
Hemorrhage control is a time-critical task, and recent studies have demonstrated that a shorter time to definitive care is positively associated with patient survival and functional outcomes. The concept of direct transport to the operating room was proposed in the 1960s to reduce treatment time. Some trauma centers have developed protocols for direct-to-operating room resuscitation (DOR) programs. Moreover, few studies have reported the clinical outcomes of DOR in patients with trauma; however, their clinical effect in improving the efficiency and quality of care remains unclear. In this systematic review, we aimed to consolidate all published studies reporting the effect of DOR on severe trauma and evaluate its utility. The PubMed, EMBASE, and Cochrane databases were searched from inception to April 2023, to identify all articles published in English that reported the effect of direct-to-operating room trauma resuscitation for severe trauma. The articles were reviewed as references of interest. We reviewed six studies reporting the clinical effect of operating room trauma resuscitation. A total of 3232 patients were identified. Five studies compared the actual mortality with the predicted mortality using the trauma score and injury severity score, while one study compared mortality using propensity matching. Four studies reported that the actual survival rate for overall injuries was better than the predicted survival rate, whereas two studies reported no difference. Some studies performed subgroup analyses. Two studies showed that the survival rate for penetrating injuries was better than the predicted survival rate, and one showed that the survival rate for blunt injuries was better than the predicted survival rate. Five studies reported the time to surgical intervention, which was within 30 min. Two studies time-compared surgical intervention, which was shorter in patients who underwent DOR. Implementing DOR is likely to have a beneficial effect on mortality and can facilitate rapid intervention in patients with severe shock. Future studies, possibly clinical trials, are needed to ensure a proper comparison of the efficiency.
出血控制是一项时间紧迫的任务，最近的研究表明，缩短最终治疗时间与患者的存活率和功能预后呈正相关。为了缩短治疗时间，20 世纪 60 年代提出了直接送往手术室的概念。一些创伤中心已经制定了直接送入手术室复苏（DOR）计划。此外，也有少数研究报告了直接转运到手术室对创伤患者的临床疗效，但其在提高护理效率和质量方面的临床效果仍不明确。在这篇系统性综述中，我们旨在整合所有已发表的关于 DOR 对严重创伤影响的研究报告，并评估其效用。我们在 PubMed、EMBASE 和 Cochrane 数据库中检索了从开始到 2023 年 4 月发表的所有报道严重创伤直接手术室创伤复苏效果的英文文章。这些文章作为相关参考文献进行了审查。我们审查了六项报告手术室创伤复苏临床效果的研究。共发现 3232 名患者。五项研究使用创伤评分和损伤严重程度评分比较了实际死亡率和预测死亡率，一项研究使用倾向匹配法比较了死亡率。四项研究报告称，总体受伤的实际存活率优于预测存活率，而两项研究报告称两者没有差异。一些研究进行了亚组分析。两项研究表明，穿透伤的存活率优于预测存活率，一项研究表明，钝伤的存活率优于预测存活率。五项研究报告了手术干预的时间，均在 30 分钟以内。两项研究对手术干预时间进行了比较，结果显示接受 DOR 的患者手术干预时间更短。实施 DOR 可能会对死亡率产生有利影响，并有助于对严重休克患者进行快速干预。今后还需要进行更多的研究（可能是临床试验），以确保对其效率进行适当的比较。
{"title":"Efficacy of direct-to-operating room trauma resuscitation: a systematic review","authors":"Dongmin Seo, Inhae Heo, Donghwan Choi, Kyoungwon Jung, Hohyung Jung","doi":"10.1186/s13017-023-00532-5","DOIUrl":"https://doi.org/10.1186/s13017-023-00532-5","url":null,"abstract":"Hemorrhage control is a time-critical task, and recent studies have demonstrated that a shorter time to definitive care is positively associated with patient survival and functional outcomes. The concept of direct transport to the operating room was proposed in the 1960s to reduce treatment time. Some trauma centers have developed protocols for direct-to-operating room resuscitation (DOR) programs. Moreover, few studies have reported the clinical outcomes of DOR in patients with trauma; however, their clinical effect in improving the efficiency and quality of care remains unclear. In this systematic review, we aimed to consolidate all published studies reporting the effect of DOR on severe trauma and evaluate its utility. The PubMed, EMBASE, and Cochrane databases were searched from inception to April 2023, to identify all articles published in English that reported the effect of direct-to-operating room trauma resuscitation for severe trauma. The articles were reviewed as references of interest. We reviewed six studies reporting the clinical effect of operating room trauma resuscitation. A total of 3232 patients were identified. Five studies compared the actual mortality with the predicted mortality using the trauma score and injury severity score, while one study compared mortality using propensity matching. Four studies reported that the actual survival rate for overall injuries was better than the predicted survival rate, whereas two studies reported no difference. Some studies performed subgroup analyses. Two studies showed that the survival rate for penetrating injuries was better than the predicted survival rate, and one showed that the survival rate for blunt injuries was better than the predicted survival rate. Five studies reported the time to surgical intervention, which was within 30 min. Two studies time-compared surgical intervention, which was shorter in patients who underwent DOR. Implementing DOR is likely to have a beneficial effect on mortality and can facilitate rapid intervention in patients with severe shock. Future studies, possibly clinical trials, are needed to ensure a proper comparison of the efficiency.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"8 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139489705","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 : 2024-01-18DOI: 10.1186/s13017-023-00525-4
Edoardo Picetti, Andreas K. Demetriades, Fausto Catena, Bizhan Aarabi, Fikri M. Abu-Zidan, Oscar L. Alves, Luca Ansaloni, Rocco A. Armonda, Rafael Badenes, Miklosh Bala, Zsolt J. Balogh, Andrea Barbanera, Alessandro Bertuccio, Walter L. Biffl, Pierre Bouzat, Andras Buki, Ana Maria Castano-Leon, Davide Cerasti, Giuseppe Citerio, Federico Coccolini, Raul Coimbra, Carlo Coniglio, Francesco Costa, Federico De Iure, Bart Depreitere, Enrico Fainardi, Michael J. Fehlings, Nikolay Gabrovsky, Daniel Agustin Godoy, Peter Gruen, Deepak Gupta, Gregory W. J. Hawryluk, Raimund Helbok, Iftakher Hossain, Peter J. Hutchinson, Corrado Iaccarino, Kenji Inaba, Marcel Ivanov, Stanislav Kaprovoy, Andrew W. Kirkpatrick, Sam Klein, Angelos Kolias, Nikolay A. Konovalov, Alfonso Lagares, Laura Lippa, Angelica Loza-Gomez, Teemu M. Luoto, Andrew I. R. Maas, Andrzej Maciejczak, Ronald V. Maier, Niklas Marklund, Matthew J. Martin, Ilaria Melloni, Sergio Mendoza-Lattes, Geert Meyfroidt, Marina Munari, Lena..
The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies. A multidisciplinary consensus panel of physicians selected for their established clinical and scientific expertise in the acute management of tSCI polytrauma patients with different specializations was established. The World Society of Emergency Surgery (WSES) and the European Association of Neurosurgical Societies (EANS) endorsed the consensus, and a modified Delphi approach was adopted. A total of 17 statements were proposed and discussed. A consensus was reached generating 17 recommendations (16 strong and 1 weak). This consensus provides practical recommendations to support a clinician’s decision making in the management of tSCI polytrauma patients.
{"title":"Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)","authors":"Edoardo Picetti, Andreas K. Demetriades, Fausto Catena, Bizhan Aarabi, Fikri M. Abu-Zidan, Oscar L. Alves, Luca Ansaloni, Rocco A. Armonda, Rafael Badenes, Miklosh Bala, Zsolt J. Balogh, Andrea Barbanera, Alessandro Bertuccio, Walter L. Biffl, Pierre Bouzat, Andras Buki, Ana Maria Castano-Leon, Davide Cerasti, Giuseppe Citerio, Federico Coccolini, Raul Coimbra, Carlo Coniglio, Francesco Costa, Federico De Iure, Bart Depreitere, Enrico Fainardi, Michael J. Fehlings, Nikolay Gabrovsky, Daniel Agustin Godoy, Peter Gruen, Deepak Gupta, Gregory W. J. Hawryluk, Raimund Helbok, Iftakher Hossain, Peter J. Hutchinson, Corrado Iaccarino, Kenji Inaba, Marcel Ivanov, Stanislav Kaprovoy, Andrew W. Kirkpatrick, Sam Klein, Angelos Kolias, Nikolay A. Konovalov, Alfonso Lagares, Laura Lippa, Angelica Loza-Gomez, Teemu M. Luoto, Andrew I. R. Maas, Andrzej Maciejczak, Ronald V. Maier, Niklas Marklund, Matthew J. Martin, Ilaria Melloni, Sergio Mendoza-Lattes, Geert Meyfroidt, Marina Munari, Lena..","doi":"10.1186/s13017-023-00525-4","DOIUrl":"https://doi.org/10.1186/s13017-023-00525-4","url":null,"abstract":"The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies. A multidisciplinary consensus panel of physicians selected for their established clinical and scientific expertise in the acute management of tSCI polytrauma patients with different specializations was established. The World Society of Emergency Surgery (WSES) and the European Association of Neurosurgical Societies (EANS) endorsed the consensus, and a modified Delphi approach was adopted. A total of 17 statements were proposed and discussed. A consensus was reached generating 17 recommendations (16 strong and 1 weak). This consensus provides practical recommendations to support a clinician’s decision making in the management of tSCI polytrauma patients.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"19 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139489529","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 : 2024-01-13DOI: 10.1186/s13017-023-00531-6
Francesco Brucchi, Greta Bracchetti, Paola Fugazzola, Jacopo Viganò, Claudia Filisetti, Luca Ansaloni, Francesca Dal Mas, Lorenzo Cobianchi, Piergiorgio Danelli
The aim of this study is to provide a meta-analysis of randomized controlled trials (RCT) comparing conservative and surgical treatment in a population of adults with uncomplicated acute appendicitis. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL. We have exclusively incorporated randomized controlled trials (RCTs). Studies involving participants with complicated appendicitis or children were excluded. The variables considered are as follows: treatment complications, complication-free treatment success at index admission and at 1 year follow-up, length of hospital stay (LOS), quality of life (QoL) and costs. Eight RCTs involving 3213 participants (1615 antibiotics/1598 appendectomy) were included. There was no significant difference between the two treatments in terms of complication rates (RR = 0.66; 95% CI 0.61—1.04, P = 0.07, I2 = 69%). Antibiotics had a reduced treatment efficacy compared with appendectomy (RR = 0.80; 95% CI 0.71 to 0.90, p < 0.00001, I2 = 87%) and at 1 year was successful in 540 out of 837 (64.6%, RR = 0.69, 95% confidence interval 0.61 to 0.77, p < 0.00001, I2 = 81%) participants. There was no difference in LOS (mean difference − 0.58 days 95% confidence interval − 1.59 to 0.43, p = 0.26, I2 = 99%). The trial sequential analysis has revealed that, concerning the three primary outcomes, it is improbable that forthcoming RCTs will significantly alter the existing body of evidence. As further large-scale trials have been conducted, antibiotic therapy proved to be safe, less expensive, but also less effective than surgical treatment. In order to ensure well-informed decisions, further research is needed to explore patient preferences and quality of life outcomes.
{"title":"A meta-analysis and trial sequential analysis comparing nonoperative versus operative management for uncomplicated appendicitis: a focus on randomized controlled trials","authors":"Francesco Brucchi, Greta Bracchetti, Paola Fugazzola, Jacopo Viganò, Claudia Filisetti, Luca Ansaloni, Francesca Dal Mas, Lorenzo Cobianchi, Piergiorgio Danelli","doi":"10.1186/s13017-023-00531-6","DOIUrl":"https://doi.org/10.1186/s13017-023-00531-6","url":null,"abstract":"The aim of this study is to provide a meta-analysis of randomized controlled trials (RCT) comparing conservative and surgical treatment in a population of adults with uncomplicated acute appendicitis. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL. We have exclusively incorporated randomized controlled trials (RCTs). Studies involving participants with complicated appendicitis or children were excluded. The variables considered are as follows: treatment complications, complication-free treatment success at index admission and at 1 year follow-up, length of hospital stay (LOS), quality of life (QoL) and costs. Eight RCTs involving 3213 participants (1615 antibiotics/1598 appendectomy) were included. There was no significant difference between the two treatments in terms of complication rates (RR = 0.66; 95% CI 0.61—1.04, P = 0.07, I2 = 69%). Antibiotics had a reduced treatment efficacy compared with appendectomy (RR = 0.80; 95% CI 0.71 to 0.90, p < 0.00001, I2 = 87%) and at 1 year was successful in 540 out of 837 (64.6%, RR = 0.69, 95% confidence interval 0.61 to 0.77, p < 0.00001, I2 = 81%) participants. There was no difference in LOS (mean difference − 0.58 days 95% confidence interval − 1.59 to 0.43, p = 0.26, I2 = 99%). The trial sequential analysis has revealed that, concerning the three primary outcomes, it is improbable that forthcoming RCTs will significantly alter the existing body of evidence. As further large-scale trials have been conducted, antibiotic therapy proved to be safe, less expensive, but also less effective than surgical treatment. In order to ensure well-informed decisions, further research is needed to explore patient preferences and quality of life outcomes.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"74 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139436833","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}
The appropriateness of a restrictive transfusion strategy for those with active bleeding after traumatic injury remains uncertain. Given the association between tissue hypoxia and lactate levels, we hypothesized that the optimal transfusion strategy may differ based on lactate levels. This post hoc analysis of the RESTRIC trial sought to investigate the association between transfusion strategies and patient outcomes based on initial lactate levels. We performed a post hoc analysis of the RESTRIC trial, a cluster-randomized, crossover, non-inferiority multicenter trials, comparing a restrictive and liberal red blood cell transfusion strategy for adult trauma patients at risk of major bleeding. This was conducted during the initial phase of trauma resuscitation; from emergency department arrival up to 7 days after hospital admission or intensive care unit (ICU) discharge. Patients were grouped by lactate levels at emergency department arrival: low (< 2.5 mmol/L), middle (≥ 2.5 and < 4.0 mmol/L), and high (≥ 4.0 mmol/L). We compared 28 days mortality and ICU-free and ventilator-free days using multiple linear regression among groups. Of the 422 RESTRIC trial participants, 396 were analyzed, with low (n = 131), middle (n = 113), and high (n = 152) lactate. Across all lactate groups, 28 days mortality was similar between strategies. However, in the low lactate group, the restrictive approach correlated with more ICU-free (β coefficient 3.16; 95% CI 0.45 to 5.86) and ventilator-free days (β coefficient 2.72; 95% CI 0.18 to 5.26) compared to the liberal strategy. These findings persisted even after excluding patients with severe traumatic brain injury. Our results suggest that restrictive transfusion strategy might not have a significant impact on 28-day survival rates, regardless of lactate levels. However, the liberal transfusion strategy may lead to shorter ICU- and ventilator-free days for patients with low initial blood lactate levels.
{"title":"Association of initial lactate levels and red blood cell transfusion strategy with outcomes after severe trauma: a post hoc analysis of the RESTRIC trial","authors":"Yoshinori Kosaki, Takashi Hongo, Mineji Hayakawa, Daisuke Kudo, Shigeki Kushimoto, Takashi Tagami, Hiromichi Naito, Atsunori Nakao, Tetsuya Yumoto","doi":"10.1186/s13017-023-00530-7","DOIUrl":"https://doi.org/10.1186/s13017-023-00530-7","url":null,"abstract":"The appropriateness of a restrictive transfusion strategy for those with active bleeding after traumatic injury remains uncertain. Given the association between tissue hypoxia and lactate levels, we hypothesized that the optimal transfusion strategy may differ based on lactate levels. This post hoc analysis of the RESTRIC trial sought to investigate the association between transfusion strategies and patient outcomes based on initial lactate levels. We performed a post hoc analysis of the RESTRIC trial, a cluster-randomized, crossover, non-inferiority multicenter trials, comparing a restrictive and liberal red blood cell transfusion strategy for adult trauma patients at risk of major bleeding. This was conducted during the initial phase of trauma resuscitation; from emergency department arrival up to 7 days after hospital admission or intensive care unit (ICU) discharge. Patients were grouped by lactate levels at emergency department arrival: low (< 2.5 mmol/L), middle (≥ 2.5 and < 4.0 mmol/L), and high (≥ 4.0 mmol/L). We compared 28 days mortality and ICU-free and ventilator-free days using multiple linear regression among groups. Of the 422 RESTRIC trial participants, 396 were analyzed, with low (n = 131), middle (n = 113), and high (n = 152) lactate. Across all lactate groups, 28 days mortality was similar between strategies. However, in the low lactate group, the restrictive approach correlated with more ICU-free (β coefficient 3.16; 95% CI 0.45 to 5.86) and ventilator-free days (β coefficient 2.72; 95% CI 0.18 to 5.26) compared to the liberal strategy. These findings persisted even after excluding patients with severe traumatic brain injury. Our results suggest that restrictive transfusion strategy might not have a significant impact on 28-day survival rates, regardless of lactate levels. However, the liberal transfusion strategy may lead to shorter ICU- and ventilator-free days for patients with low initial blood lactate levels.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"81 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139081949","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 : 2023-12-19DOI: 10.1186/s13017-023-00527-2
Mahbod Issaiy, Diana Zarei, Amene Saghazadeh
To assess the efficacy of artificial intelligence (AI) models in diagnosing and prognosticating acute appendicitis (AA) in adult patients compared to traditional methods. AA is a common cause of emergency department visits and abdominal surgeries. It is typically diagnosed through clinical assessments, laboratory tests, and imaging studies. However, traditional diagnostic methods can be time-consuming and inaccurate. Machine learning models have shown promise in improving diagnostic accuracy and predicting outcomes. A systematic review following the PRISMA guidelines was conducted, searching PubMed, Embase, Scopus, and Web of Science databases. Studies were evaluated for risk of bias using the Prediction Model Risk of Bias Assessment Tool. Data points extracted included model type, input features, validation strategies, and key performance metrics. In total, 29 studies were analyzed, out of which 21 focused on diagnosis, seven on prognosis, and one on both. Artificial neural networks (ANNs) were the most commonly employed algorithm for diagnosis. Both ANN and logistic regression were also widely used for categorizing types of AA. ANNs showed high performance in most cases, with accuracy rates often exceeding 80% and AUC values peaking at 0.985. The models also demonstrated promising results in predicting postoperative outcomes such as sepsis risk and ICU admission. Risk of bias was identified in a majority of studies, with selection bias and lack of internal validation being the most common issues. AI algorithms demonstrate significant promise in diagnosing and prognosticating AA, often surpassing traditional methods and clinical scores such as the Alvarado scoring system in terms of speed and accuracy.
目的：与传统方法相比，评估人工智能（AI）模型在诊断和预后成人急性阑尾炎（AA）方面的功效。急性阑尾炎是急诊科就诊和腹部手术的常见原因。它通常通过临床评估、实验室检测和影像学检查来诊断。然而，传统的诊断方法既耗时又不准确。机器学习模型在提高诊断准确性和预测结果方面大有可为。我们按照 PRISMA 指南进行了一项系统性综述，检索了 PubMed、Embase、Scopus 和 Web of Science 数据库。使用预测模型偏倚风险评估工具对研究进行了偏倚风险评估。提取的数据点包括模型类型、输入特征、验证策略和关键性能指标。共分析了 29 项研究，其中 21 项侧重于诊断，7 项侧重于预后，1 项同时侧重于诊断和预后。人工神经网络（ANN）是最常用的诊断算法。人工神经网络和逻辑回归也被广泛用于 AA 类型的分类。人工神经网络在大多数情况下都表现出很高的性能，准确率通常超过 80%，AUC 值最高可达 0.985。这些模型在预测术后结果（如脓毒症风险和入住重症监护室）方面也显示出良好的效果。大多数研究都存在偏倚风险，最常见的问题是选择偏倚和缺乏内部验证。人工智能算法在诊断和预后AA方面大有可为，其速度和准确性往往超过传统方法和临床评分，如阿尔瓦拉多评分系统。
{"title":"Artificial Intelligence and Acute Appendicitis: A Systematic Review of Diagnostic and Prognostic Models","authors":"Mahbod Issaiy, Diana Zarei, Amene Saghazadeh","doi":"10.1186/s13017-023-00527-2","DOIUrl":"https://doi.org/10.1186/s13017-023-00527-2","url":null,"abstract":"To assess the efficacy of artificial intelligence (AI) models in diagnosing and prognosticating acute appendicitis (AA) in adult patients compared to traditional methods. AA is a common cause of emergency department visits and abdominal surgeries. It is typically diagnosed through clinical assessments, laboratory tests, and imaging studies. However, traditional diagnostic methods can be time-consuming and inaccurate. Machine learning models have shown promise in improving diagnostic accuracy and predicting outcomes. A systematic review following the PRISMA guidelines was conducted, searching PubMed, Embase, Scopus, and Web of Science databases. Studies were evaluated for risk of bias using the Prediction Model Risk of Bias Assessment Tool. Data points extracted included model type, input features, validation strategies, and key performance metrics. In total, 29 studies were analyzed, out of which 21 focused on diagnosis, seven on prognosis, and one on both. Artificial neural networks (ANNs) were the most commonly employed algorithm for diagnosis. Both ANN and logistic regression were also widely used for categorizing types of AA. ANNs showed high performance in most cases, with accuracy rates often exceeding 80% and AUC values peaking at 0.985. The models also demonstrated promising results in predicting postoperative outcomes such as sepsis risk and ICU admission. Risk of bias was identified in a majority of studies, with selection bias and lack of internal validation being the most common issues. AI algorithms demonstrate significant promise in diagnosing and prognosticating AA, often surpassing traditional methods and clinical scores such as the Alvarado scoring system in terms of speed and accuracy.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"306 3 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138740536","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 : 2023-12-19DOI: 10.1186/s13017-023-00528-1
Philippe Montravers, Nathalie Grall, Elie Kantor, Pascal Augustin, Kevin Boussion, Nathalie Zappella
Temporal changes in the microbiological resistance profile have been reported in several life-threatening infections. However, no data have ever assessed this issue in postoperative peritonitis (POP). Our purpose was to assess the rate of multidrug-resistant organisms (MDROs) in POP over a two-decade period and to analyse their influence on the adequacy of empirical antibiotic therapy (EAT). This retrospective monocentric analysis (1999–2019) addressed the changes over time in microbiologic data, including the emergence of MDROs and the adequacy of EAT for all intensive care unit adult patients treated for POP. The in vitro activities of 10 antibiotics were assessed to determine the most adequate EAT in the largest number of cases among 17 antibiotic regimens in patients with/without MDRO isolates. Our primary endpoint was to determine the frequency of MDRO and their temporal changes. Our second endpoint assessed the impact of MDROs on the adequacy of EAT per patient and their temporal changes based on susceptibility testing. In this analysis, the subgroup of patients with MDRO was compared with the subgroup of patients free of MDRO. A total of 1,318 microorganisms were cultured from 422 patients, including 188 (45%) patients harbouring MDROs. The growing proportions of MDR Enterobacterales were observed over time (p = 0.016), including ESBL-producing strains (p = 0.0013), mainly related to Klebsiella spp (p < 0.001). Adequacy of EAT was achieved in 305 (73%) patients. Decreased adequacy rates were observed when MDROs were cultured [p = 0.0001 vs. MDRO-free patients]. Over the study period, decreased adequacy rates were reported for patients receiving piperacillin/tazobactam in monotherapy or combined with vancomycin and imipenem/cilastatin combined with vancomycin (p < 0.01 in the three cases). In patients with MDROs, the combination of imipenem/cilastatin + vancomycin + amikacin or ciprofloxacin reached the highest adequacy rates (95% and 91%, respectively) and remained unchanged over time. We observed high proportions of MDRO in patients treated for POP associated with increasing proportions of MDR Enterobacterales over time. High adequacy rates were only achieved in antibiotic combinations involving carbapenems and vancomycin, while piperacillin/tazobactam is no longer a drug of choice for EAT in POP in infections involving MDRO.
{"title":"Microbiological profile of patients treated for postoperative peritonitis: temporal trends 1999–2019","authors":"Philippe Montravers, Nathalie Grall, Elie Kantor, Pascal Augustin, Kevin Boussion, Nathalie Zappella","doi":"10.1186/s13017-023-00528-1","DOIUrl":"https://doi.org/10.1186/s13017-023-00528-1","url":null,"abstract":"Temporal changes in the microbiological resistance profile have been reported in several life-threatening infections. However, no data have ever assessed this issue in postoperative peritonitis (POP). Our purpose was to assess the rate of multidrug-resistant organisms (MDROs) in POP over a two-decade period and to analyse their influence on the adequacy of empirical antibiotic therapy (EAT). This retrospective monocentric analysis (1999–2019) addressed the changes over time in microbiologic data, including the emergence of MDROs and the adequacy of EAT for all intensive care unit adult patients treated for POP. The in vitro activities of 10 antibiotics were assessed to determine the most adequate EAT in the largest number of cases among 17 antibiotic regimens in patients with/without MDRO isolates. Our primary endpoint was to determine the frequency of MDRO and their temporal changes. Our second endpoint assessed the impact of MDROs on the adequacy of EAT per patient and their temporal changes based on susceptibility testing. In this analysis, the subgroup of patients with MDRO was compared with the subgroup of patients free of MDRO. A total of 1,318 microorganisms were cultured from 422 patients, including 188 (45%) patients harbouring MDROs. The growing proportions of MDR Enterobacterales were observed over time (p = 0.016), including ESBL-producing strains (p = 0.0013), mainly related to Klebsiella spp (p < 0.001). Adequacy of EAT was achieved in 305 (73%) patients. Decreased adequacy rates were observed when MDROs were cultured [p = 0.0001 vs. MDRO-free patients]. Over the study period, decreased adequacy rates were reported for patients receiving piperacillin/tazobactam in monotherapy or combined with vancomycin and imipenem/cilastatin combined with vancomycin (p < 0.01 in the three cases). In patients with MDROs, the combination of imipenem/cilastatin + vancomycin + amikacin or ciprofloxacin reached the highest adequacy rates (95% and 91%, respectively) and remained unchanged over time. We observed high proportions of MDRO in patients treated for POP associated with increasing proportions of MDR Enterobacterales over time. High adequacy rates were only achieved in antibiotic combinations involving carbapenems and vancomycin, while piperacillin/tazobactam is no longer a drug of choice for EAT in POP in infections involving MDRO. ","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"69 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138740583","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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