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Recent Developments in Emergency Trauma Treatment

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

Deadline for manuscript submissions: closed (20 March 2024) | Viewed by 8526

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Special Issue Editors

Prof. Dr. Patrick Schober

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Guest Editor

Department of Anesthesiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 Amsterdam, The Netherlands
Interests: emergency medicine; trauma; cadiopulmonary resuscitation; anesthesia; medical statistics

Dr. Lothar Andreas Schwarte

E-Mail Website
Guest Editor

Department of Anesthesiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 Amsterdam, The Netherlands
Interests: emergency medicine; trauma care; resuscitation; anesthesia; monitoring of circulation; diving medicine; hyper-baric medicine; HEMS

Dr. Georgios F. Giannakopoulos

E-Mail Website
Guest Editor

Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 Amsterdam, The Netherlands
Interests: pre- and in-hospital trauma care; trauma surgery; spine surgery; treatment of open fractures

Special Issue Information

Dear Colleagues,

In recent years, significant advances have been achieved in our understanding of the pathophysiology of trauma and in the implementation of new treatment strategies. Nonetheless, trauma remains a leading cause of mortality in adolescents and young adults worldwide. Early detection of patients at risk of adverse outcomes and efficient emergency care are considered pivotal to improving patient outcomes. In this context, the aim of this Special Issue is to highlight recent advances in the emergency care of trauma patients, including prehospital and early in-hospital care in the emergency department, operating room, and intensive care unit.

Areas of interest in this Special Issue include but are not limited to:

Diagnostic techniques, including echography, radiology, and monitoring of vital functions;
Management of the acutely bleeding patient, including damage control surgery and transfusion medicine;
Management of multi-trauma as well as severe isolated trauma, including thoracic, abdominal, and pelvic trauma;
Management of traumatic brain injury;
Management of burn and inhalation injuries;
Traumatic resuscitation;
Emergency anesthesia and critical care;
Emergency medicine procedures and surgical techniques;
Pediatric trauma care.

We welcome high-quality original studies (clinical and experimental), well-designed meta-analyses, and informative reviews. We look forward to your contribution.

Sincerely,

Prof. Dr. Patrick Schober
Dr. Lothar Andreas Schwarte
Dr. Georgios F. Giannakopoulos
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

trauma
traumatic brain injury
emergency care
emergency medical services
hemorrhage
burns

Published Papers (6 papers)

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Research

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12 pages, 953 KiB

Open AccessArticle

Traumatic Spinal Injury in Children; Time to Revise Pre-Hospital and Diagnostic Protocols?

by Michelle Oude Alink, Huub Stassen, Jochem Spoor, Jeroen Renkens, Xavier Moors, Marjolein Dremmen, Robert Jan Stolker and Caroline van der Marel

J. Clin. Med. 2024, 13(8), 2372; https://doi.org/10.3390/jcm13082372 - 18 Apr 2024

Viewed by 397

Abstract

Background: Traumatic spinal injury in children is a rare but serious life event. Predicting pediatric patients at risk for spinal injury remains difficult. This study focuses on the cause of the injury and predictors to identify children at risk and appropriate diagnostic procedures. Methods: Retrospective chart review from the Landelijke Trauma Registratie of patients with spinal injury from 2010 to 2021 in a level 1 pediatric trauma center. Results: We included 114 children with spinal injury, 79.8% of whom were aged 12–17 years. In the overall trauma population, the incidence of spinal injury was 10% in children aged 12–17 years, 2.3% in children aged 6–11 years, and 0.4% in children 0–5 years of age. Neurological deficits were present in 27.2% of patients in the emergency department, with permanent deficits in 14.0%. Spinal fractures were present in 91.2% of 12–17-year-olds, 43.8% in 6–11-year-olds, and 71.4% in 0–5-year-olds. ISS was 23 (SD 14) in children with spinal injury compared to 8 (SD 9) for children without spinal injury. Conclusions: In children 0–11 years old, spinal injury is very rare compared to the overall trauma population, and there are more non-osseous injuries. Clinicians should consider MRI as the next step after conventional X-ray to diagnose or exclude spinal injuries in this group. In older children aged 12–17 years, the incidence of spinal injury is much higher, at 10%. Although ISS is higher in children with spinal injury, a low ISS does not exclude spinal injury. If one fracture is found, more fractures in other regions of the spine may be present. Full article

(This article belongs to the Special Issue Recent Developments in Emergency Trauma Treatment)

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12 pages, 815 KiB

Open AccessArticle

Patients at Risk for Transfusion—A Six-Year Multicentre Analysis of More Than 320,000 Helicopter Emergency Medical Service Missions

by Christoph Jänig, Chadlia Willms, Jens Schwietring, Christoph Güsgen, Arnulf Willms, Nicole Didion, Tobias Gruebl, Dan Bieler and Willi Schmidbauer

J. Clin. Med. 2023, 12(23), 7310; https://doi.org/10.3390/jcm12237310 - 25 Nov 2023

Viewed by 1023

Abstract

Background. In Europe, ambulances are increasingly being equipped with blood products for prehospital use. Available evidence on the early administration of blood products comes from military medicine and the Anglo-American medical literature; the evidence cannot be easily transferred to European countries. Objectives. This study assesses the incidence of patients with massive haemorrhage after trauma and the potential need for prehospital blood transfusions. Methods. Data reported by 37 German air rescue stations between 2015 and 2020 were retrospectively analysed to predict the need for massive transfusion. Results. A total of 320,347 helicopter emergency medical service (HEMS) missions were performed and involved 2982 patients with potential need for massive transfusion after trauma (approximately 13 transfusions per helicopter per year). Men were most affected (73%). The median age of patients was 38 years. Traffic accidents accounted for 59% of the cases. Most patients sustained multiple injuries including traumatic brain injuries (62%), as well as thoracic (54%), abdominal (39%), and extremity injuries (41%). The median “rSIG” (reversed shock index multiplied with the Glasgow Coma Scale) decreased from 4.31 to 3.78. Conclusions. Although the incidence of haemorrhagic trauma patients is low, the prehospital administration of blood products might be useful as a potentially life-saving bridging treatment until hospital admission. Full article

(This article belongs to the Special Issue Recent Developments in Emergency Trauma Treatment)

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18 pages, 499 KiB

Open AccessArticle

Sex Differences in Outcome of Trauma Patients Presented with Severe Traumatic Brain Injury: A Multicenter Cohort Study

by Elise Beijer, Stefan F. van Wonderen, Wietse P. Zuidema, Marieke C. Visser, Michael J. R. Edwards, Michael H. J. Verhofstad, Tjarda N. Tromp, Charissa E. van den Brom, Esther M. M. van Lieshout, Frank W. Bloemers and Leo M. G. Geeraedts, Jr.

J. Clin. Med. 2023, 12(21), 6892; https://doi.org/10.3390/jcm12216892 - 01 Nov 2023

Cited by 1 | Viewed by 813

Abstract

The objective of this study was to determine whether there is an association between sex and outcome in trauma patients presented with severe traumatic brain injury (TBI). A retrospective multicenter study was performed in trauma patients aged ≥ 16 years who presented with severe TBI (Head Abbreviated Injury Scale (AIS) ≥ 4) over a 4-year-period. Subgroup analyses were performed for ages 16–44 and ≥45 years. Also, patients with isolated severe TBI (other AIS ≤ 2) were assessed, likewise, with subgroup analysis for age. Sex differences in mortality, Glasgow Outcome Score (GOS), ICU admission/length of stay (LOS), hospital LOS, and mechanical ventilation (MV) were examined. A total of 1566 severe TBI patients were included (831 patients with isolated TBI). Crude analysis shows an association between female sex and lower ICU admission rates, shorter ICU/hospital LOS, and less frequent and shorter MV in severe TBI patients ≥ 45 years. After adjusting, female sex appears to be associated with shorter ICU/hospital LOS. Sex differences in mortality and GOS were not found. In conclusion, this study found sex differences in patient outcomes following severe TBI, potentially favoring (older) females, which appear to indicate shorter ICU/hospital LOS (adjusted analysis). Large prospective studies are warranted to help unravel sex differences in outcomes after severe TBI. Full article

(This article belongs to the Special Issue Recent Developments in Emergency Trauma Treatment)

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Graphical abstract

14 pages, 1550 KiB

Open AccessArticle

Pelvic Ring Fractures in Older Adult Patients—Assessing Physician Practice Variation among (Orthopedic) Trauma Surgeons

by Anna H. M. Mennen, Sharon Oud, Jens A. Halm, Rolf W. Peters, Hanna C. Willems and Daphne Van Embden

J. Clin. Med. 2023, 12(19), 6344; https://doi.org/10.3390/jcm12196344 - 03 Oct 2023

Viewed by 947

Abstract

Purpose: Pelvic fractures in older adults are a major public health problem and socioeconomic burden. The standard of care has changed over the past years, and there is limited consensus on which patients benefit from surgical fixation. There is currently no nationwide treatment protocol to guide the decision-making process. Therefore, the aim of this survey was to provide more insight into if, when, and why patients with a fragility fracture of the pelvis (FFPs) would be considered for additional imaging and surgical fixation by treating physicians. Methods: An online clinical vignette-based survey of hypothetical scenarios was sent out to all orthopedic and trauma surgeons in the Netherlands. The questionnaire comprised multiple-choice questions and radiographic images. Differences between subgroups were calculated using the X2 test or the Fisher exact test. Results: 169 surgeons responded to the survey, with varying levels of experience and working in different types of hospitals. In a patient with a simple pubic ramus fracture and ASA 2 or ASA 4, 32% and 18% of the respondents would always advise a CT scan for further analysis. In the same patients, 11% and 31% of the respondents would not advise a CT scan, respectively. When presented with three cases of increasing severity of co-morbidity (ASA) and/or increasing age and/or different clinical presentation of an FFP type 3c on a CT scan, an increasing number of respondents would not consider surgical fixation. There was significant variation in practice patterns between the respondents who do not work in a hospital performing pelvic and acetabular (P&A) fracture surgery and those who do work in a P&A referral hospital. Most respondents (77%) refer patients 1–5 times a year to an expert center for surgical fixation. Conclusion: There is currently a wide variety of clinical practices regarding the imaging and management of FFPs, which seems to be influenced by the type of hospital the patients are presented to. A regional or national evidence-based treatment protocol should be implemented to ensure a more uniform approach. Full article

(This article belongs to the Special Issue Recent Developments in Emergency Trauma Treatment)

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Review

Jump to: Research

13 pages, 666 KiB

Open AccessReview

Parenteral, Non-Intravenous Analgesia in Acute Traumatic Pain—A Narrative Review Based on a Systematic Literature Search

by Midas N. de Grunt, Bianca de Jong, Markus W. Hollmann, Milan L. Ridderikhof and Robert P. Weenink

J. Clin. Med. 2024, 13(9), 2560; https://doi.org/10.3390/jcm13092560 - 26 Apr 2024

Viewed by 294

Abstract

Traumatic pain is frequently encountered in emergency care and requires immediate analgesia. Unfortunately, most trauma patients report sustained pain upon arrival at and discharge from the Emergency Department. Obtaining intravenous access to administer analgesics can be time-consuming, leading to treatment delay. This review provides an overview of analgesics with both fast onset and parenteral, non-intravenous routes of administration, and also indicates areas where more research is required. Full article

(This article belongs to the Special Issue Recent Developments in Emergency Trauma Treatment)

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14 pages, 947 KiB

Open AccessReview

Traumatic Cardiac Arrest—A Narrative Review

by Patrick Schober, Georgios F. Giannakopoulos, Carolien S. E. Bulte and Lothar A. Schwarte

J. Clin. Med. 2024, 13(2), 302; https://doi.org/10.3390/jcm13020302 - 05 Jan 2024

Cited by 1 | Viewed by 4488

Abstract

A paradigm shift in traumatic cardiac arrest (TCA) perception switched the traditional belief of futility of TCA resuscitation to a more optimistic perspective, at least in selected cases. The goal of TCA resuscitation is to rapidly and aggressively treat the common potentially reversible causes of TCA. Advances in diagnostics and therapy in TCA are ongoing; however, they are not always translating into improved outcomes. Further research is needed to improve outcome in this often young and previously healthy patient population. Full article

(This article belongs to the Special Issue Recent Developments in Emergency Trauma Treatment)

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