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
ReviewOptimizing acute pain management in trauma care: the role, structure and core principles of acute trauma pain services.
Trauma injuries, both accidental and violence-related, account for a significant number of fatalities and non-fatal injuries annually, with pain being a predominant symptom affecting trauma patients. Despite its prevalence, pain is often undertreated in emergency settings, leading to adverse outcomes such as delayed recovery, impaired respiratory function, and increased risk of chronic pain and post-traumatic stress disorder. ⋯ Effective pain management not only improves immediate patient well-being but also reduces long-term complications and economic burdens associated with extended hospital stays and readmissions. The integration of Acute pain service in trauma care emphasizes the importance of pain management as an integral part of patient recovery, highlighting the need for specialized services to enhance the quality and efficacy of trauma care.
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Eur J Trauma Emerg Surg · Feb 2025
Meta AnalysisEffectiveness of antibiotic prophylaxis in polytrauma patients: a systematic review and meta-analysis.
The use of antibiotic prophylaxis in trauma patients, particularly to prevent ventilator-associated pneumonia (VAP), is debated due to rising antibiotic resistance. Therefore, this systematic review evaluated the safety and effectiveness of antibiotic prophylaxis compared to placebo or standard care on clinical outcomes in adult polytrauma patients. ⋯ The results indicate that antibiotic prophylaxis has no significant effect on mortality and clinical status compared with placebo or standard care in adult polytrauma patients but may reduce the risk of VAP. However, the evidence is outdated and of very low certainty, with insufficient data to draw definitive conclusions regarding efficacy. Therefore, high-quality, up-to-date research is urgently needed to support clinical decision-making, and current interpretations should be treated with caution.
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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.
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Eur J Trauma Emerg Surg · Feb 2025
The optimal timing for definitive operative stabilization of pelvic fractures in polytrauma patients: effects on clinical outcomes - a systematic review.
The optimal timing for definitive surgical treatment of pelvic fractures in polytrauma patients remains a topic of ongoing discussion due to the complexity of these injuries. This analysis therefore aims to systematically compare early versus late definitive operative stabilization of pelvic fractures on outcome in polytrauma patients. ⋯ There is limited evidence regarding early definitive fracture repair (≤ 24 h) compared to late repair of pelvic fractures in polytrauma patients. One observational study showed a reduced incidence of septic respiratory complications, ARDS, and multi-organ failure (MOF) in polytrauma patients who received early definitive fracture repair.
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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.