European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Apr 2022
Derivation and validation of actionable quality indicators targeting reductions in complications for injury admissions.
Approximately, one out of five patients hospitalized following injury will develop at least one hospital complication, more than three times that observed for general admissions. We currently lack actionable Quality Indicators (QI) targeting specific complications in this population. We aimed to derive and validate QI targeting hospital complications for injury admissions and develop algorithms to identify patient charts to review. ⋯ In line with initiatives to improve the quality of trauma care, we propose QI targeting reductions in hospital complications for injury admissions and algorithms to generate case lists to facilitate the review of patient charts.
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Eur J Trauma Emerg Surg · Apr 2022
Impact of inflammatory cell ratio, biomarkers, activated partial thromboplastin time and prothrombin time on chronic subdural haematoma severity and outcome.
Chronic subdural haematoma (CSH) has multifactorial mechanisms involved in its development and progression. Identifying readily available inflammatory and coagulation indices that can predict the prognosis of CSH will help in clinical care, prognosis, generating objective criteria for assessing efficacy of treatment strategies and comparisons of treatment efficacy between clinical studies. We conducted a study in which we evaluated the impact value of neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), inflammatory biomarkers (erythrocyte sedimentation rate and C-reactive protein), activated partial thromboplastin time (APTT), prothrombin time (PT) and international normalized ratio (INR) at presentation on CSH severity and outcome using Glasgow outcome scale (GOS), Markwalder grading scale (MGS) and Lagos brain disability examination scale (LABDES). ⋯ Patients' admission APTT, PT, INR and PLR are good predictors of outcome using the GOS. A high admission INR is also associated with a worse outcome using MGS and LABDES grade.
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Eur J Trauma Emerg Surg · Apr 2022
Influence of unstable ankle fracture (type Weber C), osteosynthesis and syndesmotic transfixation on position of fibula in tibiofibular notch: a cadaveric study.
The aim of the cadaveric study was to determine the effects of an unstable ankle fracture on the position of the fibula in the incisural notch and subsequently to evaluate the alterations resulting from the individual steps of a guideline-based osteosynthesis. ⋯ The results indicate that there is a tendency for over-compression when adjusting the tibiofibular distance and that the fibula in the tibiofibular notch tends to remain slightly rotated externally.
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Eur J Trauma Emerg Surg · Apr 2022
Prognostic factors for mortality in 123 severe cases of necrotizing fasciitis in 5 hospitals in the Netherlands between 2003 and 2017.
Necrotizing fasciitis (NF) is a severe soft tissue infection with a high morbidity and mortality. With early diagnosis and treatment this could be reduced. Unfortunately, the diagnosis of necrotizing fasciitis can be very difficult. In recent years many risk factors have been identified. In 2004, the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was developed. A tool that could help diagnosing NF. In this study, we search for prognostic factors for mortality in necrotizing fasciitis. ⋯ LRINEC score should be calculated in all patients presenting with NF to provide an additional source for clinical outcome. A high LRINEC score could implicate a higher risk of mortality. Especially in elderly patients, with a cardiac history, more than two comorbidities or a lactate level greater than 1.7 mmol/L.
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Eur J Trauma Emerg Surg · Apr 2022
Trauma patients with SARS-CoV-2 in German ICUs during the 2nd wave of the COVID-19 pandemic.
In January and February 2021, about 4000 severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) positive patients were treated daily in German intensive care units (ICUs). The number of SARS-CoV-2-positive ICU patients with trauma, however, is not known and neither whether the trauma itself or COVID-19 causes the critical illness. ⋯ The proportion of trauma patients of all SARS-CoV-2-positive critically ill patients is small (~ 1%) but relevant. There is no concentration of these patients at Level 1 trauma centres. However, the traumatic insult is the most relevant cause for ICU treatment in most of these patients. Regarding a new wave of the pandemic, adequate trauma dedicated resources and perioperative structures and expertise have to be provided for COVID-19 trauma patients.