European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Feb 2019
Trauma-induced coagulopathy upon emergency room arrival: still a significant problem despite increased awareness and management?
Over the last decade, the pivotal role of trauma-induced coagulopathy has been described and principal drivers have been identified. We hypothesized that the increased knowledge on coagulopathy of trauma would translate into a more cautious treatment, and therefore, into a reduced overall incidence rate of coagulopathy upon ER admission. ⋯ During the 12 years observed, a substantial decline of coagulopathy has been observed. This was paralleled by a significant decrease of i.v.-fluids administered in the pre-hospital treatment. The reduced presence of coagulopathy translated into decreased transfusion requirements and mortality. Nevertheless, especially in the most severely injured patients, posttraumatic coagulopathy remains a frequent and life-threatening syndrome.
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Eur J Trauma Emerg Surg · Feb 2019
Diagnosis and management of long-bone nonunions: a nationwide survey.
There is variability among surgeons on definitions regarding the degree of bone healing of long-bone fractures. A lack of consensus may negatively affect communication between surgeons, and lead to unintended and unwanted variability in treatment of patients suffering from abnormal healing of long-bone fractures. We aimed to identify differences between surgeons regarding their views on the degree of union of long-bone fractures. ⋯ Level V.
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Eur J Trauma Emerg Surg · Feb 2019
Observational StudyPrognostic potential of markers of bone turnover in delayed-healing tibial diaphyseal fractures.
Clinical and radiographic examinations detect delayed or nonunion only after the event has occurred. Biochemical markers of bone turnover (BTMs) are promising laboratory tools that offer an early insight into the likelihood of delayed union. We hypothesized that BTMs display temporal variations following fractures and the behavior of BTMs differ between normal and delayed union of fractures. ⋯ Serial monitoring of biochemical markers of bone turnover can be used as an adjunct to clinical and radiological observations to predict delayed union LEVEL OF EVIDENCE: Level 2 (prospective observational study).
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Eur J Trauma Emerg Surg · Feb 2019
Comparative StudyInjury severity in polytrauma patients is underestimated using the injury severity score: a single-center correlation study in air rescue.
Prehospital estimation of injury severity is essential for prehospital therapy, deciding on the destination hospital and the associated emergency room care. The aim of this study was to compare prehospital estimates of the abbreviated injury scale (AIS) and the Injury Severity Score (ISS) by emergency physicians with the values of AIS and ISS of injury severity determined at the conclusion of diagnostics. ⋯ Multiple-trauma patients can be identified using the ISS. Anatomic scores might be used for transport decisions; however, an accurate estimation of the injury severity should also be based on other criteria such as patient status, mechanism of injury, and other triage criteria.
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Eur J Trauma Emerg Surg · Feb 2019
Which pre-hospital triage parameters indicate a need for immediate evaluation and treatment of severely injured patients in the resuscitation area?
To find ways to reduce the rate of over-triage without drastically increasing the rate of under-triage, we applied a current guideline and identified relevant pre-hospital triage predictors that indicate the need for immediate evaluation and treatment of severely injured patients in the resuscitation area. ⋯ The trauma team activation criteria could be reduced to eight predictors without losing its predictive performance. Non-relevant parameters such as EMS provider judgement, endotracheal intubation, suspected paralysis, the presence of burned body surface of > 20% and suspected fractures of two proximal long bones could be excluded for full trauma team activation. The fact that the emergency physicians did a better job in reducing under-triage compared to our final triage model suggests that other variables not present in the S3 guideline may be relevant for prediction.