Articles: trauma.
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Eur J Trauma Emerg Surg · Oct 2024
Angioembolization in patients with blunt splenic trauma in Germany -guidelines vs. Reality a retrospective registry-based cohort study of the TraumaRegister DGU®.
Nonoperative management (NOM) for blunt splenic injuries (BSIs) is supported by both international and national guidelines in Germany, with high success rates even for severe organ injuries. Angioembolization (ANGIO) has been recommended for stabilizable patients with BSI requiring intervention since the 2016 German National Trauma Guideline. The objectives were to study treatment modalities in the adult BSI population according to different severity parameters including NOM, ANGIO and splenectomy in Germany. ⋯ In this cohort splenic injuries AAST ≥ 3 were predominantly managed surgically and ANGIO was rarely used to augment NOM. Therefore, clinical reality deviates from guideline recommendations regarding the use of ANGIO and NOM. Local interdisciplinary treatment protocols might close that gap in the future.
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Eur J Trauma Emerg Surg · Oct 2024
Observational StudyThe utility of the prehospital shock index, age shock index, and modified shock index for predicting hypofibrinogenaemia in trauma patients: an observational retrospective study.
Reduced fibrinogen levels are associated with worse outcomes in bleeding trauma patients. The purpose of this study was to evaluate the potential of the prehospital shock index (SI) and its derivatives, the age shock index (aSI) and the modified shock index (mSI), as predictors of hypofibrinogenaemia in trauma patients. ⋯ Prehospital SI and prehospital mSI demonstrated moderate performance for identifying trauma patients with hypofibrinogenaemia. The prehospital aSI had poor predictive performance. In the prehospital setting, the use of prehospital SI or prehospital mSI as the sole predictor of hypofibrinogenaemia in trauma patients is not recommended.
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Eur J Trauma Emerg Surg · Oct 2024
Comparative Study Observational StudyComparison of whole body computed tomography findings with physician predictions in high-energy blunt trauma patients: prospective observational study.
The whole-body computed tomography (WBCT) procedure is increasingly common in evaluating patients presenting with high-energy trauma. However, it remains unclear in which population WBCT provides benefit and whether its routine application is truly beneficial. In this study, we aimed to compare physician predictions with WBCT findings in patients with high-energy blunt trauma. ⋯ The study included a total of 92 patients. The median age was 27 years (IQR 25-75; 20-54). Among the patients, 27 (%) had life-threatening injuries according to CT findings in any region. A total of 34 (37%) patients were predicted by physicians to have "no pathology" in all three regions. Among these patients, none had life-threatening pathology in all three regions. There were 10 (10.9%) patients with CT findings more severe than physician predictions in at least one region. The sensitivity of physician predictions for life-threatening injury to the head/cervical region was 94.1% (95% CI: 71.3-99.9). For life-threatening injury to the chest, the sensitivity was 85.7% (95% CI: 42.1-99.6). For the presence of life-threatening abdominal pathology, the sensitivity was 100% (95% CI: 63.1-100). CONCLUSıON: It appears reasonable to utilize WBCT in patients where physicians expect life-threatening injury in any system. However, in cases where no pathology is expected in any system according to clinical prediction, we believe that performing WBCT solely based on trauma mechanism will not provide sufficient benefit.