European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Feb 2025
Efficiency of a virtual fracture clinic review protocol in adult patients with distal radial fractures requiring semi-acute surgical treatment.
The aim of this study was to evaluate the effect of implementation of a Virtual Fracture Clinic (VFC) review protocol on the time between injury and surgery, and on secondary healthcare utilization, in patients with Distal Radius Fractures (DRFs) requiring semi-acute surgery. ⋯ Level III.
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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.
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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.
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Eur J Trauma Emerg Surg · Feb 2025
ReviewStop the bleed " - Prehospital bleeding control in patients with multiple and/or severe injuries - A systematic review and clinical practice guideline - A systematic review and clinical practice guideline.
Our aim was to develop new evidence-based and consensus-based recommendations for bleeding control in patients with multiple and/or severe injuries in the prehospital setting. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with Multiple and/or Severe Injuries. ⋯ Bleeding control is the basic objective of treatment. This can be easily justified based on empirical evidence. There is, however, a lack of reliable and high-quality studies that assess and compare methods for bleeding control in patients with multiple and/or severe injuries. The guideline provides reasonable and practical recommendations (although mostly with a low grade of recommendation) and also reveals several open research questions that can hopefully be answered when the guideline is revised again.