European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Oct 2024
Comparative Study Observational StudyComparison of whole body computed tomography findings with physician predictions in high-energy blunt trauma patients: prospective observational study.
The whole-body computed tomography (WBCT) procedure is increasingly common in evaluating patients presenting with high-energy trauma. However, it remains unclear in which population WBCT provides benefit and whether its routine application is truly beneficial. In this study, we aimed to compare physician predictions with WBCT findings in patients with high-energy blunt trauma. ⋯ The study included a total of 92 patients. The median age was 27 years (IQR 25-75; 20-54). Among the patients, 27 (%) had life-threatening injuries according to CT findings in any region. A total of 34 (37%) patients were predicted by physicians to have "no pathology" in all three regions. Among these patients, none had life-threatening pathology in all three regions. There were 10 (10.9%) patients with CT findings more severe than physician predictions in at least one region. The sensitivity of physician predictions for life-threatening injury to the head/cervical region was 94.1% (95% CI: 71.3-99.9). For life-threatening injury to the chest, the sensitivity was 85.7% (95% CI: 42.1-99.6). For the presence of life-threatening abdominal pathology, the sensitivity was 100% (95% CI: 63.1-100). CONCLUSıON: It appears reasonable to utilize WBCT in patients where physicians expect life-threatening injury in any system. However, in cases where no pathology is expected in any system according to clinical prediction, we believe that performing WBCT solely based on trauma mechanism will not provide sufficient benefit.
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Eur J Trauma Emerg Surg · Oct 2024
Multicenter StudyNon-operative treatment of metacarpal fractures and patient-reported outcomes: a multicentre snapshot study.
This study aimed to investigate practice variation in non-operative treatment methods and immobilisation duration for metacarpal fractures, and to evaluate patient-reported outcomes. ⋯ The results showed practice variation in the treatment of metacarpal fractures, especially in the treatment of fifth MC neck fractures, with some hospitals following the Dutch guideline that advocates functional treatment while others did not. There are suggestions that prolonged immobilisation of metacarpal shaft fractures may lead to a worse MHQ score. These findings underscore the need for adherence to treatment protocols and emphasize functional treatment to potentially improve patient outcomes and cost-effectiveness.
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Eur J Trauma Emerg Surg · Oct 2024
Outcomes of severe isolated blunt chest trauma in young and geriatric patients.
Our understanding of the growing geriatric population's risk factors for outcomes after traumatic injury remains incomplete. This study aims to compare outcomes of severe isolated blunt chest trauma between young and geriatric patients and assess predictors of mortality. ⋯ The geriatric trauma patient with isolated severe blunt chest injury has significantly higher mortality and morbidity compared to younger patients and warrants special consideration of multiple factors that affect outcomes. Individual predictors of mortality carry a greater impact on mortality in geriatric patients.
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Eur J Trauma Emerg Surg · Oct 2024
Contrast-enhanced ultrasound (CEUS) in the follow-up of abdominal solid organ trauma: an international survey prior to the PseAn study.
The blunt and penetrating abdominal trauma follow-up relies on contrast CT scan to detect solid organ injuries. CEUS is not widely used worldwide, despite its accuracy and feasibility in identifying parenchymal and vascular lesions. This survey aims to define the current use of CEUS in Trauma Centers and the expectations of Emergency Surgeons regarding its role. ⋯ Our survey shows that CEUS is still underutilized in the follow-up of abdominal trauma, even though many emergency surgeons consider it as a valid alternative to contrast CT scan.
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Eur J Trauma Emerg Surg · Oct 2024
Comparative StudyLaparoscopic Hartmann's procedure for complicated diverticulitis is associated with lower superficial surgical site infections compared to open surgery with similar other outcomes: a NSQIP-based, propensity score matched analysis.
Open Hartmann's procedure has traditionally been the procedure of choice to treat complicated diverticulitis. We analyzed the ACS-NSQIP database to compare outcomes in patients who underwent emergent laparoscopic Hartmann's procedure (LHP) to those who had an open Hartmann's procedure (OHP). ⋯ The LHP is associated with lower rates of SSSI. However, it is not associated with lower rates of mortality, OSSSI, readmissions and reoperations within 30 days. Surgical times are longer in LHP. More studies are needed to determine whether LHP offers advantages in the long-term, particularly in rates of incisional hernia and colostomy closure.