European journal of trauma and emergency surgery : official publication of the European Trauma Society
-
Eur J Trauma Emerg Surg · Jun 2023
External ventricular drainage for intracranial hypertension after traumatic brain injury: is it really useful?
External ventricular drainage (EVD) is frequently used to control raised intracranial pressure after traumatic brain injury. However, the available evidence about its effectiveness in this context is limited. The aim of this study is to evaluate the effectiveness of EVD to control intracranial pressure and to identify the clinical and radiological factors associated with its success. ⋯ In a protocol-based management for traumatic brain injury, EVD allowed intracranial pressure control and avoided third tier therapeutic measures in 40% of cases with a favorable risk-benefit ratio.
-
Eur J Trauma Emerg Surg · Jun 2023
Acute abdominal pain at referral emergency departments: an analysis of performance of three time-dependent quality indicators.
Abdominal pain is one of the most frequent causes for emergency department (ED) visits. The quality of care and outcomes are determined by time-dependent interventions with barriers to implementation at crowded EDs. ⋯ Our investigation identified that non-compliance with pain assessment, analgesia and ED length of stay among patients presenting with abdominal pain to ED results in poor quality of care and detrimental outcomes. Our data support enhanced quality-assessment initiatives for this subset of ED patients.
-
Eur J Trauma Emerg Surg · Jun 2023
Does minimally invasive percutaneous transilial internal fixator became an effective option for sacral fractures? A prospective study with novel implantation technique.
To assess radiological and functional outcomes of transilial internal fixator (TIFI) for treatment of sacral complete transforaminal fractures with a novel implantation technique that decrease wound irritation problems in addition to facilitating easy application of reduction methods beside showing the best entry points, screw trajectories and angles. ⋯ TIFI through a minimally invasive technique represents a valid method for dealing with transforaminal sacral fractures. TIFI provides a rigid fixation for posterior ring injuries with few risks regarding iatrogenic nerve injury, avoiding different variations of upper sacral osseous anatomy or sacral dysmorphism. In addition, there is no necessity for high quality fluoroscopy for visualization of sacral foramina intraoperatively, decreasing risk of radiation exposure, unlike other methods of fixation as iliosacral screws. Our novel modification for implantation technique provides few risks for postoperative and wound complications.
-
Eur J Trauma Emerg Surg · Jun 2023
Development and first results of a national databank on care and treatment outcome after traumatic brain injury.
In absence of comprehensive data collection on traumatic brain injury (TBI), the German Society for Neurosurgery (DGNC) and the German Society for Trauma Surgery (DGU) developed a TBI databank for German-speaking countries. ⋯ Within five years, the TBI databank DGNC/DGU of the TR-DGU could be established and is since then prospectively enrolling TBI patients in German-speaking countries. With its large and harmonized data set and a 12-month follow-up, the TBI databank is a unique project in Europe, already allowing comparisons to other data collection structures and indicating a demographic change towards older and frailer TBI patients in Germany.
-
Eur J Trauma Emerg Surg · Jun 2023
Intermittent thoracic resuscitative endovascular balloon occlusion of the aorta improves renal function compared to 60 min continuous application after porcine class III hemorrhage.
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may be considered for stabilization of patients with hemorrhage from below the diaphragm. Occluding the aorta is a powerful means of hemorrhagic control but is also associated with acute kidney injury, which increases mortality in trauma patients. Allowing for intermittent distal blood flow during REBOA application (iREBOA) could decrease this risk, but circulatory consequences have not been sufficiently elucidated. Therefore, we investigated circulatory effects and the renal artery blood flow (RBF) in iREBOA versus continuous, complete aortic occlusion (cREBOA). ⋯ iREBOA was survivable, did not cause rebleeding, decreased the total ischemic time and increased the renal blood flow, urine output and decreased renal ischemic injury compared to cREBOA. Intermittent reperfusions during REBOA may be preferred to be continuous, complete occlusion in prolonged application to improve renal function.