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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (15 October 2024) | Viewed by 13765

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Dr. Christoph Georg Wölfl

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Guest Editor

Marienhaus Klinikum Hetzelstift, Klin Orthopadie Unfallchirurg & Sporttraumatol, D-67434 Neustadt, Germany
Interests: trauma, multi injured patients; ATLS

Dr. Dan Bieler

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Guest Editor

Department of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital Koblenz, Ruebenacher Strasse 170, 56072 Koblenz, Germany
Interests: trauma surgery; orthopedics

Special Issue Information

Dear Colleagues,

"Advances in Trauma Treatment" is a topic that focuses on the latest developments and techniques used in trauma treatment. These clinical advancements aim to improve the outcomes of patients who have experienced physical harm due to accidents, falls, or other traumatic experiences. The treatment of trauma injuries is crucial, as it often requires immediate surgical intervention by a skilled team of surgeons. Clinicians face challenges such as managing hypotension, preventing myocardial injury, identifying patients who require a trauma team, and stabilizing rib fractures in polytrauma cases. Differentiated hemotherapy after trauma, rehabilitation requirements for trauma centers, and risk factors that affect mortality in patients with hip fractures at regional trauma centers are the key areas of focus. The Journal of Clinical Medicine aims to present this topic with a view to enhancing the knowledge base of physicians and surgeons on new treatment options and best practices in the critical area of trauma care.

Dr. Christoph Georg Wölfl
Dr. Dan Bieler
Guest Editors

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Keywords

trauma surgery
hypotension
myocardial injury
differentiated hemotherapy
trauma rehabilitation
rib fracture stabilization
major adverse cardiac events and epidemiology

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Published Papers (7 papers)

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Research

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14 pages, 219 KiB

Open AccessArticle

The Role of Modern Radiological Procedures in Diagnosing Blunt Liver Injuries Manifested by Upper Gastrointestinal Bleeding

by Piotr Tomasz Arkuszewski, Maciej Adam Rybicki, Bartłomiej Białas and Konrad Szymczyk

J. Clin. Med. 2025, 14(1), 175; https://doi.org/10.3390/jcm14010175 - 31 Dec 2024

Viewed by 708

Abstract

Objectives: Posttraumatic upper gastrointestinal bleeding (UGIB) is a very rare consequence of blunt liver trauma. It can be quite a diagnostic challenge for clinicians, as it can clinically manifest many weeks after the trauma or be scantily symptomatic. Methods: The following article would like to provide an analysis of clinical cases of 13 patients following blunt liver injuries, the main symptoms of which was bleeding into the gastrointestinal tract through the biliary tree. The article is research of the published literature concentrating on the influence of modern diagnostic methods (scintigraphy, USG and CT) on the diagnosis and long-term survival of patients with haemobilia caused by blunt liver trauma. In each patient, the condition was presented with UGIB symptoms following blunt trauma, before initiation of operative treatment or before death. The cases were divided into 2 groups: prior to and after introduction of modern diagnostic procedures, and then compared together. Results: The study indicates that liver damage can cause symptoms of UGIB, even after minor abdominal trauma and with delayed and uncharacteristic symptoms. Conclusions: Modern diagnostic methods, such as ultrasound, scintigraphy and CT, make it easier to identify these injuries and choose appropriate treatment, reducing the risk of death. Full article

(This article belongs to the Special Issue Advances in Trauma Treatment)

12 pages, 1278 KiB

Open AccessArticle

Early Point-of-Care Thromboelastometry Reduces Mortality in Patients with Severe Trauma and Risk of Transfusion: An Analysis Based on the TraumaRegister DGU^®

by Christoph Beyersdorf, Dan Bieler, Rolf Lefering, Sebastian Imach, Lisa Hackenberg, Erik Schiffner, Simon Thelen, Felix Lakomek, Joachim Windolf, Carina Jaekel and TraumaRegister DGU^®

J. Clin. Med. 2024, 13(14), 4059; https://doi.org/10.3390/jcm13144059 - 11 Jul 2024

Cited by 1 | Viewed by 1254

Abstract

Background: Thromboelastometry like ROTEM^® is a point-of-care method used to assess the coagulation status of patients in a rapid manner being particularly useful in critical care settings, such as trauma, where quick and accurate assessment of coagulation can guide timely and appropriate treatment. Currently, this method is not yet comprehensively available with sparse data on its effectiveness in resuscitation rooms. The aim of this study was to assess the effect of early thromboelastometry on the probability of mass transfusions and mortality of severely injured patients. Methods: The TraumaRegister DGU^® was retrospectively analyzed for severely injured patients (2011 until 2020) with information available regarding blood transfusions and Trauma-Associated Severe Hemorrhage (TASH) score components. Patients with an estimated risk of mass transfusion >2% were included in a matched-pair analysis. Cases with and without use of ROTEM^® diagnostic were matched based on risk categories for mass transfusion. A total of 1722 patients with ROTEM^® diagnostics could be matched with a non-ROTEM^® patient with an identical risk category. Adult patients (≥16) admitted to a trauma center in Germany, Austria, or Switzerland with Maximum Abbreviated Injury Scale severity ≥3 were included. Results: A total of 83,798 trauma victims were identified after applying the inclusion and exclusion criteria. For 7740 of these patients, the use of ROTEM^® was documented. The mean Injury Severity Score (ISS) in patients with ROTEM^® was 24.3 compared to 19.7 in the non-ROTEM^® group. The number of mass transfusions showed no significant difference (14.9% ROTEM^® group vs. 13.4% non-ROTEM^® group, p = 0.45). Coagulation management agents were given significantly more often in the ROTEM^® subgroup. Mortality in the ROTEM^® group was 4.1% less than expected (estimated mortality based on RISC II 34.6% vs. observed mortality 30.5% (n = 525)). In the non-ROTEM^® group, observed mortality was 1.6% less than expected. Therefore, by using ROTEM^® analysis, the expected mortality could be reduced by 2.5% (number needed to treat (NNT) 40; SMR of ROTEM^® group: 1:0.88; SMR of non-ROTEM^® group: 1:0.96; p = 0.081). Conclusions: Hemorrhage is still one of the leading causes of death of severely injured patients in the first hours after trauma. Early thromboelastometry can lead to a more targeted coagulation management, but is not yet widely available. This study demonstrated that ROTEM^® was used for the more severely injured patients and that its use was associated with a less than expected mortality as well as a higher utilization of hemostatic products. Full article

(This article belongs to the Special Issue Advances in Trauma Treatment)

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10 pages, 1580 KiB

Open AccessArticle

Where Do We Stand on Cervical Spine Immobilisation? A Questionnaire among Prehospital Staff

by Pascal Gräff, Lisa Bolduan, Christian Macke, Jan-Dierk Clausen, Stephan Sehmisch and Marcel Winkelmann

J. Clin. Med. 2024, 13(8), 2325; https://doi.org/10.3390/jcm13082325 - 17 Apr 2024

Cited by 1 | Viewed by 1948

Abstract

Background: Cervical collars (CC) are routinely used in prehospital trauma treatment. However, over the past years, their application was discussed more critically since they increase intravenous pressure due to reduced venous drainage and the possibility of secondary cervical spine injury. Guidelines have been adjusted accordingly. The question is how efficient has this been put into practice, and how good, as well as up to date, is the knowledge of prehospital emergency medicine personnel about indications on cervical spine immobilisation? Methods: A 15-item questionnaire regarding the self-evaluation and result checking of the right indications for the use of a cervical collar in the prehospital setting was sent to paramedics and emergency doctors in Germany. Two hundred and nineteen completed surveys were statistically analysed. Results: Mean age of the participants was 30.45 ± 8.8. 72% were male. Regarding subjective safety, the appropriate indication of CC participants reached 79.8 ± 19.5 on a metric scale from 0 (no safety) to 100 (full safety). Mean right answers were as follows: Ambulance man (RS) 0.78 ± 0.84, paramedic (RA) 0.9 ± 0.74, paramedic (NFS) 1.03 ± 0.83 and emergency doctor (ED) 1.75 ± 1.06 (p = 0.013, Kruskal–Wallis Test). Participants who estimated their knowledge < 85% had 0.83 ± 0.8 right answers, and > 85% had 1.14 ± 0.9 right answers. Conclusions: Rational spine immobilisation is still necessary in severely injured patients. This study highlights the importance of continuing education using ongoing training, lectures or online learning with a questionnaire as a monitor for success to ensure the transfer of evidence-based medicine into daily practice. Full article

(This article belongs to the Special Issue Advances in Trauma Treatment)

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13 pages, 491 KiB

Open AccessArticle

Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation—Results from a Prospective Study in 12 Level one German Trauma Centers

by Helena Düsing, Paul Hagebusch, Markus Baacke, Dan Bieler, Michael Caspers, Valentin Clemens, Matthias Fröhlich, Lisa Hackenberg, Renè Hartensuer, Sebastian Imach, Kai Oliver Jensen, Annette Keß, Christian Kleber, Fabian Laue, Rolf Lefering, Mindaugas Maslauskas, Gerrit Matthes, André Nohl, Orkun Özkurtul, Thomas Paffrath, Vera Pedersen, Tristan Pfläging, Kai Sprengel, Philipp Störmann, Heiko Trentzsch, Christian Waydhas, Uwe Schweigkofler and on behalf of the NIS-Trauma TAcTIC Study Group Show full author list Hide full author list

J. Clin. Med. 2024, 13(6), 1714; https://doi.org/10.3390/jcm13061714 - 16 Mar 2024

Cited by 1 | Viewed by 1476

Abstract

Background/Objective: This prospective, multicenter observational cohort study was carried out in 12 trauma centers in Germany and Switzerland. Its purpose was to evaluate the rate of undertriage, as well as potential consequences, and relate these with different Trauma Team Activation Protocols (TTA-Protocols), as this has not been done before in Germany. Methods: Each trauma center collected the data during a three-month period between December 2019 and February 2021. All 12 participating hospitals are certified as supra-regional trauma centers. Here, we report a subgroup analysis of undertriaged patients. Those included in the study were all consecutive adult patients (age ≥ 18 years) with acute trauma admitted to the emergency department of one of the participating hospitals by the prehospital emergency medical service (EMS) within 6 h after trauma. The data contained information on age, sex, trauma mechanism, pre- and in-hospital physiology, emergency interventions, emergency surgical interventions, intensive care unit (ICU) stay, and death within 48 h. Trauma team activation (TTA) was initiated by the emergency medical services. This should follow the national guidelines for severe trauma using established field triage criteria. We used various denominators, such as ISS, and criteria for the appropriateness of TTA to evaluate the undertriage in four groups. Results: This study included a total of 3754 patients. The average injury severity score was 5.1 points, and 7.0% of cases (n = 261) presented with an injury severity score (ISS) of 16+. TTA was initiated for a total of 974 (26%) patients. In group 1, we evaluated how successful the actual practice in the EMS was in identifying patients with ISS 16+. The undertriage rate was 15.3%, but mortality was lower in the undertriage cohort compared to those with a TTA (5% vs. 10%). In group 2, we evaluated the actual practice of EMS in terms of identifying patients meeting the appropriateness of TTA criteria; this showed a higher undertriage rate of 35.9%, but as seen in group 1, the mortality was lower (5.9% vs. 3.3%). In group 3, we showed that, if the EMS were to strictly follow guideline criteria, the rate of undertriage would be even higher (26.2%) regarding ISS 16+. Using the appropriateness of TTA criteria to define the gold standard for TTA (group 4), 764 cases (20.4%) fulfilled at least one condition for retrospective definition of TTA requirement. Conclusions: Regarding ISS 16+, the rate of undertriage in actual practice was 15.3%, but those patients did not have a higher mortality. Full article

(This article belongs to the Special Issue Advances in Trauma Treatment)

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13 pages, 2079 KiB

Open AccessArticle

Mortality Risk Factors of Severely Injured Polytrauma Patients (Prehospital Mortality Prediction Score)

by Jana Vorbeck, Manuel Bachmann, Helena Düsing and René Hartensuer

J. Clin. Med. 2023, 12(14), 4724; https://doi.org/10.3390/jcm12144724 - 17 Jul 2023

Cited by 5 | Viewed by 2257

Abstract

The aim of this study was to analyze the mortality of polytrauma patients and identify prediction parameters. A further aim was to create from the results a score for the prehospital predictive evaluation of 30-day survival. The study was conducted with a retrospective, observational design and was carried out unicentrically at a Level 1 Trauma Center. During the 4-year investigation period, patients with an Injury Severity Score (ISS) ≥ 16 were examined and their demographic basic data, laboratory values, and vital parameters were recorded. The mortality data analysis was performed using Kaplan–Meier Analysis and Log-Rank tests. Cox regressions were carried out to determine influencing factors and Receiver Operating Characteristic (ROC) curves were plotted to establish limit values for potential influencing factors. All statistical tests were conducted at a significance level of p ≤ 0.05. Coronary Heart Disease (CHD), cardiopulmonary resuscitation (CPR), age at admission, sex, and Glasgow Coma Scale (GCS) had a significant impact on the survival of polytrauma patients. The identified prediction parameters were combined with the shock index (SI). The generated score showed a sensitivity of 93.1% and a specificity of 73.3% in predicting the mortality risk. The study was able to identify significant influencing prehospital risk factors on 30-day survival after polytrauma. A score created from these parameters showed higher specificity and sensitivity than other prediction scores. Further studies with a larger number of participants and the inclusion of slightly injured patients could verify these findings. Full article

(This article belongs to the Special Issue Advances in Trauma Treatment)

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10 pages, 1653 KiB

Open AccessArticle

Performing Advanced Trauma Life Support (ATLS) across Borders: Midterm Follow-Up of the Aeromedical Evacuation after Civilian Bus Accident at Madeira

by Sebastian Imach, Andreas Deschler, Stefan Sammito, Miguel Reis, Sylta Michaelis, Beneditk Marche, Thomas Paffrath, Bertil Bouillon and Thorsten Tjardes

J. Clin. Med. 2023, 12(14), 4556; https://doi.org/10.3390/jcm12144556 - 8 Jul 2023

Cited by 2 | Viewed by 1869

Abstract

On 17 April 2019, a coach with tourists from Germany crashed in Madeira, requiring repatriation by the German Air Force. The Advanced Trauma Life Support (ATLS) concept was the central component of patient care. Data in Madeira were collected through a structured interview. The analysis of the Aeromedical Evacuation was based on intensive care transport records. In Germany, all available medical data sheets were reviewed for data collection. Quality of life (HRQoL) was evaluated by the 12-item Short Form Health Survey (SF-12). Twenty-eight prehospital patients were transported to the Level III Trauma Center in Funchal (Madeira). Five operative procedures were performed. Fifteen patients were eligible for Aeromedical Evacuation (AE). In the second hospital phase in Germany, in total 82 radiological images and 9 operations were performed. Hospital stay lasted 11 days (median, IQR 10–18). Median follow-up (14 of 15 patients) was 16 months (IQR 16–21). Eighty percent (8 out of 10) showed an increased risk for post-traumatic stress disorder (PTSD). Six key findings were identified in this study: divergent injury classification, impact of AE mission on health status, lack of communication, need of PTSD prophylaxis, patient identification, and media coverage. Those findings may improve AE missions in the future, e.g., when required after armed conflicts. Full article

(This article belongs to the Special Issue Advances in Trauma Treatment)

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Review

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18 pages, 1282 KiB

Open AccessReview

Impairment of Mesenteric Perfusion as a Marker of Major Bleeding in Trauma Patients

by Péter Jávor, Tibor Donka, Tamara Horváth, Lilla Sándor, László Török, Andrea Szabó and Petra Hartmann

J. Clin. Med. 2023, 12(10), 3571; https://doi.org/10.3390/jcm12103571 - 20 May 2023

Cited by 2 | Viewed by 3277

Abstract

The majority of potentially preventable mortality in trauma patients is related to bleeding; therefore, early recognition and effective treatment of hemorrhagic shock impose a cardinal challenge for trauma teams worldwide. The reduction in mesenteric perfusion (MP) is among the first compensatory responses to blood loss; however, there is no adequate tool for splanchnic hemodynamic monitoring in emergency patient care. In this narrative review, (i) methods based on flowmetry, CT imaging, video microscopy (VM), measurement of laboratory markers, spectroscopy, and tissue capnometry were critically analyzed with respect to their accessibility, and applicability, sensitivity, and specificity. (ii) Then, we demonstrated that derangement of MP is a promising diagnostic indicator of blood loss. (iii) Finally, we discussed a new diagnostic method for the evaluation of hemorrhage based on exhaled methane (CH₄) measurement. Conclusions: Monitoring the MP is a feasible option for the evaluation of blood loss. There are a wide range of experimentally used methodologies; however, due to their practical limitations, only a fraction of them could be integrated into routine emergency trauma care. According to our comprehensive review, breath analysis, including exhaled CH₄ measurement, would provide the possibility for continuous, non-invasive monitoring of blood loss. Full article

(This article belongs to the Special Issue Advances in Trauma Treatment)

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