European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Jun 2024
Multicenter StudyDiagnostic accuracy of doctors at the emergency department and radiologists in differentiating between complicated and uncomplicated acute appendicitis.
To determine the accuracy of final judgements of doctors at the emergency department (ED) and radiologists to differentiate between complicated and uncomplicated acute appendicitis, because these have different treatment options. ⋯ More than half of all patients with true complicated appendicitis is incorrectly classified as uncomplicated appendicitis according to the judgements of doctors at ED, integrating clinical, laboratory, and imaging results, and of radiologists assessing diagnostic imaging. These judgements are thereby not sufficiently reliable in ruling out complicated appendicitis.
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Eur J Trauma Emerg Surg · Jun 2024
Multicenter StudyTibial plateau fracture morphology based on injury force mechanism is predictive for patient-reported outcome and conversion to total knee arthroplasty.
The aim of this study was to assess the relationship between injury mechanism-based fracture patterns and patient-reported outcome as well as conversion rate to total knee arthroplasty (TKA) at follow-up. ⋯ Tibial plateau fracture patterns based on injury force mechanisms are associated with clinical outcome. Varus-flexion injuries have a worse prognosis in terms of patient-reported outcome and conversion rate to TKA at follow-up. Valgus-extension injuries have least risk on conversion to TKA.
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Eur J Trauma Emerg Surg · Jun 2024
Polytrauma scoring revisited: prognostic validity and usability in daily clinical practice.
Scores are widely used for the assessment of injury severity and therapy guidance in severely injured patients. They differ vastly regarding complexity, applicability, and prognostic accuracy. The objective of this study was to compare well-established with more recently developed trauma scores as well as intensive care unit (ICU) scores. ⋯ RISC II provided the strongest predictive capability for mortality. In comparison, more simple scores focusing on injury pattern (ISS, NISS), physiological abnormalities (RTS, EAC), or a combination of both (PTGS) only provided inferior mortality prediction. Established ICU scores like APACHE II, SOFA and Marshall score were proven to be helpful tools in severely injured trauma patients.
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Eur J Trauma Emerg Surg · Jun 2024
Developments in the understanding of staging a "major fracture" in polytrauma: results from an initiative by the polytrauma section of ESTES.
Although the term "major fracture" is commonly used in the management of trauma patients, it is defined insufficiently to date. The polytrauma section of ESTES is trying to develop a more standardized use and a definition of the term. In this process, a standardized literature search was undertaken. We test the hypothesis that the understanding of "major fractures" has changed and is modified by a better understanding of patient physiology. ⋯ Over time, the way "major fractures" influenced surgical treatment strategies has changed notably. While femur fractures have long been the only focus, fixation of pelvic and spinal fractures have become more important over the last decade. In addition to the fracture location, associated conditions and injuries (chest trauma and head injuries) influence surgical decision-making as well. Hemodynamic stability and injury-specific factors (soft tissue injuries) have increased in importance over time.
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Eur J Trauma Emerg Surg · Jun 2024
Standards of fracture care in polytrauma: results of a Europe-wide survey by the ESTES polytrauma section.
Fixation of major fractures plays a pivotal role in the surgical treatment of polytrauma patients. In addition to ongoing discussions regarding the optimal timing in level I trauma centers, it appears that the respective trauma systems impact the implementation of both, damage control and safe definitive surgery strategies. This study aimed to assess current standards of polytrauma treatment in a Europe-wide survey. ⋯ Different definitions of polytrauma are used in the clinical setting. Indication for and the extent of secondary (definitive) surgery are mainly dependent on the polytrauma patient`s physiology. The «Window of Opportunity» plays a less important role in decision making.