European journal of trauma and emergency surgery : official publication of the European Trauma Society
-
Eur J Trauma Emerg Surg · Feb 2025
ReviewPrinciples of wound ballistics and their clinical implications in firearm injuries.
Ballistics is the science that studies the trajectory, range, and effects of projectiles. Knowledge of the principles of wound ballistics is of particular importance to the surgeon because they allow the optimization of the diagnosis and treatment of those injured by firearms. This review focuses on the updated knowledge of wound ballistics as it pertains to the diagnosis and treatment of gunshot wounds. ⋯ The understanding of wound ballistics enhances the ability to identify potential injuries and to optimize the treatment of gunshot wounds in adults.
-
Eur J Trauma Emerg Surg · Feb 2025
Observational StudyAnti-xa guided enoxaparin thromboprophylaxis is associated with less thromboembolism than fixed dose dalteparin in trauma patients admitted to intensive care.
Venous Thromboembolism (VTE) is a common, preventable complication in trauma. Low-molecular-weight heparin (LMWH) is recommended for VTE prophylaxis (VTEp). We investigated whether switching from fixed-dose dalteparin to anti-Xa-guided enoxaparin prophylaxis reduces VTE without increasing the risk of bleeding among hospitalized trauma patients. ⋯ Among adult patients in the trauma ICU, compared to a fixed dose dalteparin, enoxaparin prophylaxis with dose calibration according to peak anti-Xa levels was associated with lower VTE rates without increasing the risk of bleeding. About 40% of patients who received initial enoxaparin doses of 30 mg twice daily had anti-Xa levels suggestive of inadequate prophylaxis. Calibrating LMWH dosing may improve VTEp following traumatic injury.
-
Eur J Trauma Emerg Surg · Feb 2025
Observational StudyEarly detection of muscle wasting assessed by ultrasound and analysis of growth factor and systemic inflammation mediators in critically ill trauma patients: an observational study.
The present study aims to describe initial changes in muscle thickness and composition, muscle growth signaling mediators, and systemic inflammation in critically ill patients after major trauma. ⋯ These findings reveal substantial thickness and muscle composition alterations within 48 h post-admission, worsening over five days. Despite standard rehabilitation care, changes in IGF-1 and IFN-y levels suggest early declines in muscle growth stimulus and increased inflammation.
-
Eur J Trauma Emerg Surg · Feb 2025
Impact of interhospital transport on outcome in traumatic epidural hematoma: experiences of a level-1 trauma center.
Epidural hematomas (EDH) are associated with a high rate of mortality and morbidity. Good clinical outcome depends on initial Glasgow Coma Scale (GCS), pupillary abnormalities, hematoma volume, age and time to surgery. The latter is mostly influenced by distance to the next level-1-trauma center. ⋯ Interhospital transport did not cause a significant delay of surgical treatment and outcome was comparable between direct and indirect transport to specialized neurosurgical care. Direct transport was more common on severe TBI and in patients with pupillary abnormalities, but secondary transport also allowed for adequate care.
-
Eur J Trauma Emerg Surg · Feb 2025
A single-centre, retrospective study on the impact of omitting preoperative antibiotic prophylaxis on wound infections in minor orthopedic implant removals.
The use of preoperative antibiotic prophylaxis (POAP) in elective implant removal (IR) is controversial due to a lack of evidence-based recommendations. First-generation cephalosporins, which are commonly used in orthopedic IR, are believed to reduce wound infection risks. However, the potential for serious side effects had raised concerns about their necessity. This study was intended to evaluate whether omitting POAP in small IR increases the risk of wound infections. ⋯ Withholding POAP in elective IR procedures does not significantly increase wound infection rates, suggesting it may be unnecessary in uncomplicated cases.