Trauma Surgery Research Articles

Improving agreement in assessing subtrochanteric fracture healing among orthopedic surgeons using the Radiographic Union Score for Hip (RUSH)

BackgroundPrompt identification of fracture healing is crucial for medical decision-making and clinical research. This study aims to assess the effectiveness of the Radiographic Union Score for Hip (RUSH) in subtrochanteric fractures and determine the optimal scoring threshold for fracture healing.MethodsWe obtained 94 sets of X-ray films from the postoperative follow-up of 35 patients who underwent intramedullary nail fixation for subtrochanteric fractures. Six orthopedic trauma surgeons evaluated the imaging data and determined fracture healing based on subjective judgment. They then scored the X-ray images using the RUSH form. After four weeks, the same observers re-evaluated 47 randomly selected sets of radiographs. Subsequently, the observers and study designer conducted a consensus meeting where they agreed on whether the fractures had healed. We used Fleiss kappa to evaluate agreement among observers based on subjective impressions, and the intraclass correlation coefficient assessed RUSH score consistency. Regression analysis examined the relationship between scores and fracture healing consensus using a receiver operator characteristic (ROC) curve.ResultsBased on overall impressions, the agreement level among orthopedic trauma surgeons for determining the healing status of subtrochanteric fractures was moderate (Kappa = 0.564, 95% CI: 0.511–0.616). However, utilizing the RUSH scoring system can improve the consistency to a substantial level of agreement (ICC = 0.748, 95% CI: 0.663–0.817). Regarding intraobserver reliability, there were significant differences among orthopedic trauma surgeons in judging fracture healing based on overall impressions. However, using the RUSH scoring form, the attending group achieved better intraobserver consistency than the resident group. Regression analysis and ROC curve analysis revealed a strong correlation between the RUSH total score, cortical bone score, cancellous bone score, and consensus on fracture healing. The AUC values are 0.769 (95% CI: 0.670–0.868), 0.779 (95% CI: 0.681–0.876), and 0.771 (95% CI: 0.674–0.867), respectively.ConclusionsOur study highlights the effectiveness of the RUSH scoring system in enhancing interobserver agreement and intraobserver consistency when evaluating subtrochanteric fracture healing in orthopedic trauma surgeons. We propose setting 21 points as the threshold for the simplified RUSH scoring system to determine fracture healing. This system includes only eight items related to cortical bone, with a total score of 24 points.

Possibilities of the utilization of trauma networks of the German Society for Trauma Surgery using digital solutions

This paper describes the use of digital solutions to improve the care of trauma patients in Germany. The focus is on the trauma networks of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU). The use of digital solutions includes quality assurance through the TraumaRegister, which enables comprehensive data analysis as well as preregistration and resource utilization through programs such as the interdisciplinary proof of treatment IVENA eHealth, Rescuetrack and Rescue-Net. In addition, Predictive Hospital Resource Planning is presented, which optimizes resource forecasting using artificial intelligence (AI). Telemedical services such as Medgate and teleradiology solutions (Nexus/Chili) offer additional support, especially in rural areas. The paper shows how the digitalization of medical care is crucial to improving the efficiency and quality of treatment of trauma patients. In addition, the paper shows possible developments in the field of clinical decision making through AI.

Damage control thoracic surgery: What you need to know.

Damage control surgery in trauma prioritizes patient stabilization through an initial temporizing surgical approach to rapidly control hemorrhage and contamination, minimizing intraoperative time to allow for resuscitation and the correction of hypothermia, coagulopathy, and acidosis in the intensive care unit. This is followed by definitive repair of injuries once physiological parameters have improved. While damage control techniques for traumatic intra-abdominal and extremity injuries are well established and frequently utilized, the same cannot be said for damage control thoracic surgery. The complexity of thoracic injuries, the intricate decision making process, the level of surgical expertise required, and potential complications make damage control thoracic surgery particularly challenging. However, advances in surgical techniques, improvements in perioperative care, and the emergence of adjuncts such as extracorporeal membrane oxygenation have significantly enhanced decision making and underscored the importance of timely and decisive intervention in damage control thoracic surgery to optimize patient outcomes. This review aims to provide a comprehensive overview of damage control thoracic surgery, detailing the principles, indications, operative techniques, perioperative management, and the integration of advanced therapies to improve outcomes in patients with severe thoracic injuries.

Pancreatic Trauma: A Case Report

Pancreatic trauma has high morbidity and mortality rates, especially when other organs are injured. Delayed treatment significantly reduces survival, and duct injuries can lead to severe complications if undiagnosed. The American Association for the Surgery of Trauma introduced a Pancreas Injury Scale to improve management. A 49-year-old woman with multiple trauma from a road accident showed signs of pancreatic injury, including elevated lipase and peripancreatic fluid. A CT scan revealed pancreatic and liver injuries. The case highlights the difficulty of diagnosing pancreatic trauma, particularly in non-violent cases, and the importance of using CT scans for evaluation.

OCORRÊNCIA DE COMPLICAÇÕES PÓS-OPERATÓRIAS EM PACIENTES VÍTIMAS DE TRAUMA ABDOMINAL EM UM HOSPITAL DE CEILÂNDIA.

The present study addresses the incidence of traumatic injuries in the abdominal region due to its large exposed area and the presence of vital structures, such as parenchymal organs, hollows and blood vessels, which can significantly alter the clinical outcome depending on the affected organ. For educational purposes, abdominal trauma is classified into two categories: blunt abdominal trauma (TAF) and penetrating abdominal trauma (TAP). Under this bias, the work aims to evaluate post- and intra- operative complications in trauma surgeries in a hospital in Brasilia, highlighting the entities and mechanisms involved in these complications.

Study of Carpal Tunnel Syndrome Using Electroneurography and Ultrasound in a Spanish Cohort

Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Its diagnosis is clinically supported by the electroneurography (ENG). The use of ultrasound (US) has increased in recent years. Our objectives are: to describe the ENG and US findings in patients with suspected CTS, based on age, sex and anthropometric data; and to study the correlation of both tests based on the severity of CTS. Material and methods: prospective study of patients with suspected CTS who undergo ENG and US. ENG examination: antidromic sensory median at 3rd and 4th finger; distal motor of median. US: crosssectional area (CSA) prior to or within the tunnel (higher values). Inclusion criteria: patients aged 18 to 85 years. Exclusion criteria: previous trauma or previous surgery for CTS or forearm, carpus or hand. Statistical study with the SPSS 29.0 program. Results: 400 nerves from 266 patients (52.59 ± 12.09 years) were studied, 183 women and 83 men. According to the ENG, 129 did not have CTS, 61 were incipient, 113 mild, 19 moderate and 75 severe. The mean CSA was 8.37 ± 1.21 mm2 in non-CTS, 10.09 ± 1.45 mm2 in early, 11.33 ± 1.87 mm2 in mild, 14.63 ± 1.92 mm2 in moderate and 15.46 ± 3.33 mm2 in severe CTS, with a significance of p<0.01 (95% CI) in the ANOVA test. The highest and inverse correlation appears between the conduction velocities (CV) at the 4th finger with CSA (-0.816) and CV at the 3rd finger with CSA (-0.800), which coincides with the most sensitive ENG values for the diagnosis of CTS. Discussion: CSA is an appropriate test as a complement to ENG in the diagnosis of CTS. However, it has limitations when establishing the cut-off point between normality and neuropathy, as well as when classifying based on severity

Spontaneous transomental hernia: A case report of a rare internal hernia with a challenging diagnosis

Introduction and importance: Transomental Hernia (TOH) is an extremely rare clinical condition that represents 1 to 4% of all internal hernias. Spontaneous TOH occurs in patients with no history of surgery or previous abdominal trauma. It happens after protrusion of the abdominal viscera, commonly the small bowel loops through a defect on the great omentum. Presentation of the case: We present a case of an occlusion due to TOH in 66- years- old man who underwent a laparotomy and operative exploration showed 10 cm of small bowel incarcerated through a defect in the right side of the greater omentum of 4 cm in diameter. Discussion: The diagnosis is usually delayed because symptoms are non-specific. Postoperative morbidity and mortality are important because patients present most frequently with gangrenous bowel making morbidity and mortality higher. Therefore, it constitutes a critical surgical emergency and must be quickly recognized and managed. Computed tomography (CT) scan plays a prominent role in diagnosis. Midline laparotomy is the main emergency approach for patients with unknown bowel obstruction. Some authors suggest laparoscopic approach but it requires surgeon’s experience and propitious patient’s conditions. Conclusion: TOH is the rarest type of internal hernia with extremely difficult preoperative diagnosis due to non-specific semiology. This type of hernia has the highest morbidity and mortality rates of all internal hernias. Thus; it must be suspected whenever there is bowel obstruction of unknown origin and quickly managed.

Validity and Reliability of Wearable Sensors for Continuous Postoperative Vital Signs Monitoring in Patients Recovering from Trauma Surgery

(1) Background: Wearable sensors support healthcare professionals in clinical decision-making by measuring vital parameters such as heart rate (HR), respiration rate (RR), and blood oxygenation saturation (SpO2). This study assessed the validity and reliability of two types of wearable sensors, based on electrocardiogram or photoplethysmography, compared with continuous monitoring of patients recovering from trauma surgery at the postanesthesia care unit. (2) Methods: In a prospective observational study, HR, RR, SpO2, and temperature of patients were simultaneously recorded with the VitalPatch and Radius PPG and compared with reference monitoring. Outcome measures were formulated as correlation coefficient for validity and mean difference with 95% limits of agreement for reliability for four random data pairs and 30-min pairs per vital sign per patient. (3) Results: Included were 60 patients. Correlation coefficients for VitalPatch were 0.57 to 0.85 for HR and 0.08 to 0.16 for RR, and for Radius PPG, correlation coefficients were 0.60 to 0.83 for HR, 0.20 to 0.12 for RR, and 0.57 to 0.61 for SpO2. Both sensors presented mean differences within the cutoff values of acceptable difference. (4) Conclusions: Moderate to strong correlations for HR and SpO2 were demonstrated. Although mean differences were within acceptable cutoff values for all vital signs, only limits of agreement for HR measured by electrocardiography were considered clinically acceptable.

Periprosthetic acetabular fractures: classifications, treatment and challenges

Periprosthetic acetabular fractures (PPAF) are fractures of the acetabulum with ahip endoprosthesis in place. They are arare complication, although they are occurring more frequently due to the increase in patients being fitted with total hip arthroplasty (THA) and the long service life of the implants. At present, only asmall amount of scientific literature exists, particularly regarding the surgical treatment of these fracture types.The aim of this paper is to provide an overview of the topic of PPAF with acritical review of the current literature and to present the necessary surgical treatment.An evaluation of the current literature on the topic of PPAF with afocus on the surgical treatment of fractures is carried out.Surgical treatment is technically demanding due to the pelvic ring instability with removal of the bone tension for secure acetabular cup fixation and should lead to the recovery of the biomechanical stability of the pelvis and thus the secure anchoring of the acetabular cup. An interdisciplinary approach requiring both trauma surgery and orthopaedic expertise is certainly recommended, as older and comorbid patients with poor bone quality are particularly frequently affected.The treatment of periprosthetic acetabular fractures, especially in older patients, requires not only the individual expertise of surgeon involved in the operation but also agoal-oriented and consistent interdisciplinary approach by the surgeons involved from the fields of orthopaedics and trauma surgery in view of the patients' frequent comorbidities. By working together, the optimal and individualized operation can be performed for the patient.

Outcomes of burn patients presenting with hypotension within 48 hrs of admission to a level 1 Burn Centre

IntroductionBurns is one of the important presentations in trauma surgery in both first and third-world countries. Hypotension is often seen in the clinical presentation of a burn injury. Hypotension is the strongest independent predictor of an adverse outcome, according to a study done on emergency departments’ hospital outcomes; the lower the systolic, the worse the outcome. No direct study shows that presenting with or developing hypotension within 48hrs of admission and burn injury will have a worse outcome in our low-middle income setting. ObjectivesTo determine the outcomes of burn patients who developed hypotension within 48hrs of arrival at a Burn Centre in Johannesburg. In a singled time event. MethodsA retrospective descriptive study was conducted at a Level 1 Trauma Centre Burn unit in Johannesburg from 01 Jan 2019 – 31 Dec 2020. Patients who had a hypotensive episode at any point during the 48 h period were recruited. Hypotension was defined as a systolic blood pressure of less than 90mmhg. The patients were then divided into two groups: those who presented with or developed hypotension within 48hrs and those who did not. After that, the in-hospital mortality of both groups was to be determined. The study included all the patients who presented to the Burn Centre. Those younger than 18, or requiring readmission in the same study or delayed admissions of more than 24 h were excluded. Demographics, burn information, resuscitation data, outcomes and disposition status were evaluated. The STATA Statistics/Data Analysis version 16.0 was used to analyse the data. The level of significance was set at a p-value < 0.05. Ethical approval was obtained from the Human Research Ethics Committee (HREC) (medical) of the University of the Witwatersrand with the clearance number: M220132. ResultsOf the 132 patients seen, only 105 met the study inclusion criteria. Most patients were male: 91/105 (86.6 %). Flame burns accounted for the majority of the burns, 64/105 (60.95 %), followed by electrical burns, 26/105 (24.76 %). Hot water and chemical burns only accounted for 11/105 (10.48 %) and 4 (3.81 %) cases. Hypotension within 48hrs was noted in 37/105(35 %) of the cases. Hypotensive patients had an increased burn depth (p = 0.03), higher inhalation rate component (p = <0.001), greater lactate levels(p = 0.00001), higher baux score(p = 0.00001) and more likelihood of being placed on the ventilator (p = <0.00001) or dialysis (p = 0.008). Mortality was noted in 16 (43 %) of the patients who developed hypotension compared to 5 (7.4 %) patients of non-hypotensive patients (p < 0.001). The mortality of patients who presented with or developed hypotension was 9.59 times (95 % CI 3.1–29.4; p = 0.00001) higher than those who did not develop hypotension. Age and TBSA affected by burn, were found to have significant predictive value for mortality (p < 0.0001), respectively. Propensity matching was limited due to sample size. TBSA and the development of hypotension were matched, and the odds ratio of developing mortality was still increased. ConclusionHypotension was seen among burn injury patients admitted to a specialized intensive care unit. Hypotension was associated with higher TBSA % and increased age. In terms of characteristics, increased used of organ support was more likely with hypotensive patients with ventilation, inotropes, and dialysis. Length of stay was decreased in hypotensive patients. The odds of mortality were much higher in hypotensive patients, with age and TBSA being significant variables.

Healthcare professionals beliefs and priorities for the rehabilitation of patients after ankle fracture surgery: A qualitative study

ObjectiveThe study aims to understand healthcare professionals’ (HCPs) beliefs and practices in the treatment and rehabilitation of patients after ankle fracture surgery, with the goal of informing new rehabilitation interventions based on these insights. BackgroundThere is considerable variation in postoperative rehabilitation advice given to patients with ankle fractures, leading to inconsistent care. Prior studies have primarily focused on patients' experiences, making it crucial to explore HCPs' perspectives to identify areas for intervention. MethodsThe study utilised semi-structured interviews with HCPs involved in the multicentre randomised controlled Weightbearing in Ankle Fractures (WAX) trial. Interviewees included physiotherapists, consultant trauma and orthopaedic surgeons, and trainee surgeons. Interviews were conducted between February 2020 and December 2021. Data were analysed using a mixed deductive and inductive approach, aligning with the Behavioural Change Wheel framework to translate findings into potential intervention strategies. Results18 Interviews were conducted, revealing discrepancies between patient and HCP beliefs about recovery, particularly regarding weight-bearing and managing physical symptoms like swelling and numbness. HCPs expressed varying beliefs on the safety of early weight-bearing and recognised historical practice and medicolegal concerns influencing rehabilitation advice. Themes highlighted the need for clearer communication, standardised advice, and the impact of HCPs' remarks on patients' recovery confidence. ConclusionsFindings underscore the mismatch between patient expectations and HCP guidance, emphasising the need for consensus on rehabilitation protocols. The study advocates for tailored rehabilitation pathways that address individual patient recovery trajectories, reduce dependency on HCPs, and encourage patient self-management.

Early placement of a non-invasive, pressure-regulated, fascial reapproximation device improves reduction of the fascial gap in open abdomens: a retrospective cohort study

BackgroundSince current fascial traction methods involve invasive procedures, they are generally employed late in the management of the open abdomen (OA). This study aimed to evaluate early versus late placement...

Application of Handheld Point-of-Care Ultrasound in the Setting of Craniomaxillofacial Trauma: A Technical Note

Computed tomography (CT) is the standard of care imaging in craniomaxillofacial (CMF) trauma. Despite the clear advantages of high-resolution multiplanar and three-dimensional (3D) reconstructions, which facilitate accurate diagnosis and provide intraoperative (IO) real-time visual feedback, CT's main drawbacks remain availability, cost, and high radiation exposure. The decision to perform a CT scan is based on the integration of the patient's trauma mechanism, clinical examination, subjective judgment of the CMF surgeon, and the complexity of the surgery if used IO. Handheld point-of-care ultrasound (HPOCUS) is a small, portable device that can provide valuable additional data directing clinical decisions for CT referral in minor trauma cases and assist IO maneuvers. We describe a novel HPOCUS application concept as a clinical supplementary tool in CMF trauma diagnosis and surgery.

The MOST (Mortality Score for TBI): A Novel Prediction Model Beyond CRASH-Basic and IMPACT-Core for Isolated Traumatic Brain Injury

BackgroundDue to significant injury heterogeneity, outcome prediction following traumatic brain injury (TBI) is challenging. This study aimed to develop a simple model for high-accuracy mortality risk prediction after TBI. Study DesignData from the American College of Surgeons (ACS) Trauma Quality Program (TQP) from 2019 to 2021 was used to develop a summary score based on age, the Glasgow Coma Scale (GCS) component subscores, and pupillary reactivity data. We then compared the predictive accuracy to that of the Corticosteroid Randomisation After Significant Head Injury Trial (CRASH)-Basic and International Mission for Prognosis and Analysis of Clinical Trial in TBI (IMPACT)-Core models. Two separate series of sensitivity analyses were conducted to further assess our model's generalizability. We evaluated predictive performance of the models with discrimination [the area under the receiver-operating characteristic curves (AUC), sensitivity, specificity] and calibration (Brier score). Discriminative ability was compared with DeLong tests. Results259,404 patients were included in the present study (mean age, 60 years; 93,495 (36%) female). The mortality score after TBI (MOST) model (AUC = 0.875) had better discrimination (DeLong test p values < 0.00001) than CRASH-Basic (AUC = 0.837) and IMPACT-Core (AUC = 0.821) models, and superior calibration (MOST = 0.02729, CRASH-Basic = 0.02962, IMPACT-Core = 0.02962) in predicting in-hospital mortality. The MOST model similarly outperformed in predicting 3-, 7-, 14-, and 30-day mortality. ConclusionThe MOST model can be rapidly calculated and outperforms two widely used models for predicting mortality in TBI patients. It utilizes a larger, contemporaneous dataset that reflects modern trauma care.

Scoping it Out: The Use of Laparoscopy After Penetrating Trauma in Stable Children

IntroductionIn stable children with penetrating abdominal trauma, literature regarding the use of laparoscopy (LAP) remains limited. Given increasing evidence in favor of LAP for selective adult trauma patients, we reviewed contemporary practices and outcomes in pediatric trauma patients. MethodsThe American College of Surgeons (ACS) Trauma Quality Programs data was utilized to identify children (<18 years) from 2016 to 2021 with a penetrating abdominal injury who underwent surgery within 24 h of admission. Patients with non-abdominal abbreviated injury score (AIS) ≥3, Glasgow Coma Scale (GCS) < 13, or instability using a shock index pediatric adjusted (SIPA) cutoff were excluded. Patients were compared based on whether they had LAP, open, or laparoscopic converted to open (LCO) exploration. Primary outcomes were length of stay (LOS) and complications, including missed injuries. ResultsAmong 1945 patients who underwent abdominal surgery for penetrating trauma, 32% were stabbed and 68% had gunshot wounds (GSW). LAP occurred in 235 (12%) and LCO in 145 (7.4%) patients. The proportion of LAP did not change over the study period. LAP was used more in patients presenting with stab wounds than GSW (24 vs. 7%, p < .01). There was higher use of LAP at pediatric centers (p < .01). Although there was no difference in mortality or complications by operative type, open patients were more severely injured, had a longer LOS (p < .01), and had more subsequent procedures (11% of open, 2 % LAP, 7% LCO, p < .01). ConclusionIn stable children with penetrating abdominal trauma, LAP is most often utilized after stabbing and at pediatric trauma centers, but its overall use remains uncommon. LAP patients had lower rates of subsequent procedures and no increase in unexpected operations suggesting low rates of missed injuries. Criteria are needed to identify stable patients presenting after penetrating trauma who can benefit from a LAP approach. Level of EvidenceIII.

The Double 90 Rule: A New Strategy for Resuscitation in Non-academic Level II Trauma Centers

BackgroundEfficient resuscitation after trauma and shorter time to definitive hemorrhage control help improve trauma outcomes. We aimed to improve the speed and efficiency of resuscitation for critically ill trauma patients in the emergency department by involving interventional radiology and a second surgeon. Study DesignIn 2017 our community, non-academic level II trauma center implemented the Double 90 rule—for trauma patients with 2 confirmed systolic blood pressures less than 90 mm Hg—which involves a second activation including the interventional radiology team, backup trauma surgeon, and operating room charge nurse. We retrospectively reviewed our trauma registry to compare data for high-level trauma patients before (2016, “Pre-Dbl90”) and 3 consecutive years after intervention (2018-2020, “Dbl90”). ResultsAmong 613 patients who met criteria for our highest level of trauma activation, 100 either had activation of the Double 90 rule (Dbl90 patients, n=76) or met Double 90 rule criteria (Pre-Dbl90 patients, n=24). The groups were similar in age, sex, injury severity score, penetrating trauma incidence, and admission vitals. Median time to computed tomography decreased throughout the study period, from 34 minutes in 2016 to 18 minutes in 2020 (P<.001). Median time to first hemorrhage control procedure decreased from 118 minutes (2016) to 43 minutes (2020), (P=.013).Mean packed red blood cell transfusion decreased from 9.1 to 4.8 units (P = 0.016). Mortality rates were similar between groups. ConclusionThe Double 90 rule is effective for expediting trauma care starting in the emergency department, shortening the times to computed tomography, hemorrhage control intervention, and decreasing packed red blood cell transfusion.

Management of Traumatic Duodenal Injury: Is There a Role for Early Parenteral Nutrition?

IntroductionTraumatic duodenal injuries are complex in nature and pose major challenges to trauma surgeons. These injuries are associated with high mortality rates ranging from 18% to 30% and require prompt, comprehensive care. Traumatic injury induces a hypercatabolic state that mobilizes body energy stores, leading to muscle wasting, delayed healing, and potential multi-organ failure. Nutritional support is vital in keeping up with the metabolic demands of traumatically injured patients. However, exactly when and how nutrition should be provided for traumatic duodenal injuries is unclear. We hypothesize that patients who sustain high-grade duodenal injuries (grades III-V) will be unable to tolerate enteral nutrition (EN) and may benefit from early initiation of total parenteral nutrition (TPN). MethodsIn this retrospective chart review study, we queried the trauma registry for patients admitted between January 2018 and December 2022 with duodenal injury. Individuals under the age of 18 and individuals who were pregnant were excluded. Twenty-eight patients met the inclusion/exclusion criteria. The primary endpoint was median number of days from initial injury to supplemental nutrition. We also evaluated the route used to achieve adequate nutrition based on duodenal injury grade (I-V), mortality based on duodenal injury grade, morbidity based on route of nutrition supplementation (hospital length of stay [LOS], intensive care unit LOS, and ventilator days), and complications based on route of nutrition supplementation. ResultsOf the 28 patients analyzed, 11 received EN, 10 received TPN (6 of which survived to transition to EN), and 7 died within 3 d of admission and did not receive any form of nutrition. The median number of days post-trauma to toleration of enteral feeding (defined as by mouth or tube feeding that meet total caloric needs based on nutritionist recommendations) was 4 d for those who did tolerate and maintained tolerance of enteral feeding, compared to 7.5 d post-trauma to initiate total parenteral feeding (P = 0.061). Injury grades I and II tolerated EN within a median of 6 d, whereas injury grades III and IV showed inability to tolerate EN until after a median of 22 d or longer (P = 0.02). Mortality increased as injury grade increased. Patients who received TPN were more likely to develop abscesses than those receiving EN (80% vs 27%, P = 0.03) but not more likely to develop a duodenal leak (P = 0.31). Patients who received TPN had longer hospital LOS (35.5 d vs 9 d, P = 0.008), longer intensive care unit LOS (17 d vs 4 d, P = 0.005), and increased ventilator days (9 d vs 1 d, P = 0.005) when compared to patients who received EN. ConclusionsIndividuals with higher grade duodenal injuries showed inability to tolerate EN until after a median of 22 d, and therefore, consideration should be given to initiating TPN early to mitigate the catabolic effects of malnutrition. Further studies need to be done with a larger number of patients to evaluate the effects of malnutrition in these patients.

Occupational stress profiles of prehospital and clinical staff in emergency medicine-a cross-sectional baseline study.

Occupational stress among emergency medical staff remains a central problem. Prior to the COVID-19 pandemic, many studies were focused on the working conditions of clinical emergency staff, but few examined the occupational stress profiles of prehospital emergency dispatchers (ED). The aim of this study is therefore to provide baseline data on the differences in occupational stress profiles between prehospital and clinical emergency medical staff. ED, emergency nurses (EN), and trauma surgeons on duty (TS) were questioned using the established and validated standardized short version of the instrument for stress-related job analysis for hospital physicians (ISAK-K). Differences between occupational groups were compared using the Mann-Whitney U test. Our data indicate significant differences in perception of stressors between professional groups (p < 0.05), with ED showing the highest psychological stress, followed by EN. Social stressors and emotional dissonance were significantly higher in ED and EN compared to TS (p < 0.05). Time pressure was identified as major stressor for ED and TS, but not for EN (p < 0.01). All professions showed moderate high levels of uncertainty and frustration (p = n.s.). Support from colleagues and supervisors was the greatest positive resource for all professional groups (p = n.s.). In accordance with current literature, our results advocate for a re-evaluation of the identified stressors, as ED, EN, and TS continue to show high levels of occupational stress. Training programs for coping with emotional dissonance and social stressors are likely to be crucial for reducing job stress among ED and EN.

External validation of the MiGUTS nomogram for the prediction of bleeding control intervention after renal trauma.

The American Association for the Surgery of Trauma (AAST) renal trauma grading leads to a variable management of patients with high-grade renal injuries. For a better prediction of the risk for bleeding interventions, Keihani et al. introduced the multi-institutional genito-urinary trauma study (MiGUTS) renal trauma nomogram in 2019. The aim of this study was to conduct an external validation and generalization for all kidney trauma cases of the nomogram with a European cohort of a Swiss level 1 trauma center. We collected data from the clinical information system of the Kantonsspital Graubünden, Chur, Switzerland. All patients ≥ 18 years of age from 01.01.2008 to 01.12.2020 with a renal trauma who underwent computed tomography imaging of the abdomen were included. The descriptive analysis was performed by a t-test/Wilcoxon signed-rank test and a Chi-square test. The predictions of the nomogram were analysed by the Pearson correlation coefficient. The threshold of prediction of a bleeding intervention was optimized by a ROC analysis. Overall, 166 patients were included. Most patients were male (80.7%) with a median age of 44 years. Using the prediction from the MiGUTS nomogram developed by Keihani et al. we were able to identify a threshold with a sensitivity of 1.00, specificity of 0.87, positive predictive value of 0.44, negative predictive value of 1.00 and accuracy of 0.88. The MiGUTS nomogram by Keihani et al. demonstrated to be reliable in the prediction of an intervention for bleeding control in our validation study in a European cohort.

Interdisciplinary Management of Traumatic Injuries to the Kidneys and Urinary Tract Caused by Blunt Abdominopelvic Trauma.

Purpose: Blunt abdominopelvic trauma frequently results in injuries to the urinary organs, especially in polytrauma. The urotrauma is rarely an acute life-threatening event; however, it may lead to severe complications. Methods: This review addresses the under-representation of urological trauma management in interdisciplinary medical training and its impact on patient outcomes. It compiles evidence-based recommendations and guidelines from multiple specialties, focusing on common challenges in managing these injuries. The resource is tailored for primary care physicians in radiology, trauma surgery, internal medicine, urology, and nephrology. Results: Urinary tract injuries can occur even if the patient's condition initially appears normal. An exclusion diagnosis is obligatory by contrast medium tomography of the entire urinary tract and, if suspected, an additional uroendoscopic examination. Interventional therapy by catheterisation of the urinary tract is often required. Urosurgical treatment is not commonly needed, but when there is a demand, it must be administered via an interdisciplinary approach with visceral and trauma surgery. Over 90% of life-threatening kidney injuries (usually up to grade 4-5 AAST) are presently treated by interventional radiologists. Acute kidney injury (AKI) as a complication in trauma patients may complicate clinical management and often worsens the outcome. The incidence of trauma-associated AKI in patients admitted to an intensive care unit is high. Conclusions: Patients suffering from blunt abdominopelvic trauma should ideally be referred to certified trauma centres with subspecialised or fully specialised care provided by visceral/vascular surgery, trauma surgery, interventional radiology, urology, and nephrology. This recommendation is based on the complex nature of most damage patterns.