Editorial Board Members’ Collection Series: Trauma and Emergency Surgery

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: closed (31 January 2025) | Viewed by 2345

Special Issue Editor


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Special Issue Information

Dear Colleagues,

In the last three decades we have seen a Copernican revolution in the decision making and management of trauma. In emergency surgery, the first milestone was the Treatise on Emergency Surgery, published by Felix Lejars at the turn of the 19th century, which was the best educational book on the topic throughout the early years of the twentieth century. About half a century later, Henri Mondor published his treatise on emergency abdominal surgery, which became the new milestone for emergency surgery. The old paradigms were progressively abandoned, and new landmarks were proposed; during this “new age”, Feliciano, Moore, and Mattox published their textbook on trauma. The reasons for this change are based on the common use of new technologies in radiology, such as ultrasound and contrast-enhanced computed tomography, that reduce the rate of unnecessary exploratory operations and support the common use of non-operative management (NOM). Despite the progress of medical science, today there are still many clinical controversies associated with a low evidence level; in situations where there is a lack of quality, expert opinion is still the guide that supports surgeons’ choices. In fact, systematic reviews on the treatment of abdominal trauma commonly reported a lack of controlled clinical trials. Bias is still associated with the impossibility to obtain any meaningful conclusions, and for this reason key expert opinion remains the highest level of evidence. The aim of this Special Issue is to encourage every trauma service to submit evidence of high quality; this policy is still the only way to improve the level of evidence more than 110 years after Lejars’ hallmark effort.

Dr. Roberto Cirocchi
Guest Editor

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Keywords

  • trauma
  • prehospital emergency service
  • emergency department

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Published Papers (1 paper)

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14 pages, 3718 KiB  
Systematic Review
Is the Use of Tourniquets More Advantageous than Other Bleeding Control Techniques in Patients with Limb Hemorrhage? A Systematic Review and Meta-Analysis
by Roberto Cirocchi, Dominica Prigorschi, Luca Properzi, Matteo Matteucci, Francesca Duro, Giovanni Domenico Tebala, Bruno Cirillo, Paolo Sapienza, Gioia Brachini, Sara Lauricella, Diletta Cassini, Antonia Rizzuto and Andrea Mingoli
Medicina 2025, 61(1), 93; https://doi.org/10.3390/medicina61010093 - 9 Jan 2025
Cited by 2 | Viewed by 1913
Abstract
Background and Objectives: Trauma, particularly uncontrolled bleeding, is a major cause of death. Recent evidence-based guidelines recommend the use of a tourniquet when life-threating limb bleeding cannot be controlled with direct pressure. Prehospital hemorrhage management, according to the XABCDE protocol, emphasizes the critical [...] Read more.
Background and Objectives: Trauma, particularly uncontrolled bleeding, is a major cause of death. Recent evidence-based guidelines recommend the use of a tourniquet when life-threating limb bleeding cannot be controlled with direct pressure. Prehospital hemorrhage management, according to the XABCDE protocol, emphasizes the critical role of tourniquets in controlling massive bleeding. The aim of this systematic review and meta-analysis was to summarize data from the available scientific literature on the effectiveness of prehospital tourniquet use for extremity bleeding. Materials and Methods: A systematic review and meta-analysis was performed between March 2022 and March 2024, adhering to PRISMA guidelines, to determine whether prehospital tourniquets are clinically effective. The protocol was published on PROSPERO (ID number: CRD42023450373). Results: A comprehensive literature search yielded 925 articles and 11 studies meeting the inclusion criteria. The analysis showed a non-statistically significant reduction in mortality risk with tourniquet application (4.02% vs. 6.43%, RR 0.70, 95% CI 0.46–1.07). Analysis of outcomes of amputation of the traumatized limb indicated a statistically higher incidence of initial amputation in the tourniquet group (19.32% vs. 6.4%, RR 2.07, 95% CI 1.21–3.52), while delayed amputation showed no difference (9.39% vs. 3.66%, RR 0.93, 95% CI 0.42–2.07). Tourniquet use demonstrated a non-significant reduction in the number of blood components transfused (MD = −0.65; 95% CI −5.23 to 3.93 for pRBC, MD = −0.55; 95% CI −4.06 to 2.97 for plasma). Conclusions: Despite increasing use in civilian settings, this systematic review and meta-analysis showed no significant reduction in mortality or blood product use associated with prehospital tourniquet use. Further research, including high-quality randomized controlled trials, is required, as well as awareness and education campaigns relating to proper tourniquet use in the prehospital setting. Full article
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