Submit to JCM Review for JCM Propose a Special Issue

Journal Menu

Journal Browser

Diagnostic Protocols and Treatment Strategies in Unstable Trauma Patients

Special Issue Editors
Special Issue Information
Keywords
Published Papers

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

Deadline for manuscript submissions: closed (31 December 2020) | Viewed by 18822

Share This Special Issue

Special Issue Editor

Prof. Osvaldo Chiara

E-Mail Website
Guest Editor

Department of physiopathology and transplantation, General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, University of Milano, Milan, Italy
Interests: organization of trauma system; trauma registry; trauma surgery; acute care surgery

Special Issue Information

Dear Colleagues,

Since the beginning of the new century, a remarkable improvement in the quality of trauma care around the world has been experienced. In many countries, regionalized trauma systems have been organized, with the concept that pre-hospital personnel should recognize severe trauma in the field, support vital functions when needed, and centralize the patient in the shortest time to the facility of definitive care. Specialized trauma centers with full resources have been developed, capable of treating every type of injury 24/7. The US experience launched the surgeons into a full stewardship of trauma system development, while in Europe anesthesiologists and emergency physicians were more involved in the leadership of this field. Nowadays, modern trauma centers are staffed with multidisciplinary teams, where each component follows standardized protocols to support cardio-respiratory function, recognize the site and the severity of injuries, and prioritize treatments. Acute Care Surgery, a new teaching program of Acute Care Surgery which takes trauma, general emergency surgery, surgical critical care, and rescue surgery into consideration, is now available both in North America and Europe. A specific challenge of the traumatologist is the management of unstable trauma patients. This is a time-dependent disease where critical injuries should be recognized and treated with life-saving emergency maneuvers or damage control stepwise techniques in a matter of minutes. The aim of this Special Issue is to analyze the epidemiology and the techniques of diagnosis and treatment of major trauma patients with unstable vital signs.

Prof. Osvaldo Chiara
Guest Editor

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

multiple trauma
damage control
critical bleeding
pelvic fracture
traumatic brain injury

Published Papers (6 papers)

Download All Papers

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

17 pages, 2648 KiB

Open AccessArticle

Intraocular Foreign Body: Diagnostic Protocols and Treatment Strategies in Ocular Trauma Patients

by Hyun Chul Jung, Sang Yoon Lee, Chang Ki Yoon, Un Chul Park, Jang Won Heo and Eun Kyoung Lee

J. Clin. Med. 2021, 10(9), 1861; https://doi.org/10.3390/jcm10091861 - 25 Apr 2021

Cited by 19 | Viewed by 6687

Abstract

Intraocular foreign bodies (IOFBs) are critical ophthalmic emergencies that require urgent diagnosis and treatment to prevent blindness or globe loss. This study aimed to examine the various clinical presentations of IOFBs, determine the prognostic factors for final visual outcomes, establish diagnostic protocols, and update treatment strategies for patients with IOFBs. We retrospectively reviewed patients with IOFBs between 2005 and 2019. The mean age of the patients was 46.7 years, and the most common mechanism of injury was hammering (32.7%). The most common location of IOFBs was the retina and choroid (57.7%), and the IOFBs were mainly metal (76.9%). Multivariate regression analysis showed that poor final visual outcomes (<20/200) were associated with posterior segment IOFBs (odds ratio (OR) = 11.556, p = 0.033) and retinal detachment (OR = 4.781, p = 0.034). Diagnosing a retained IOFB is essential for establishing the management of patients with ocular trauma. To identify IOFBs, ocular imaging modalities, including computed tomography or ultrasonography, should be considered. Different strategies should be employed during the surgical removal of IOFBs depending on the material, location, and size of the IOFB. Full article

(This article belongs to the Special Issue Diagnostic Protocols and Treatment Strategies in Unstable Trauma Patients)

► Show Figures

Figure 1

13 pages, 1372 KiB

Open AccessArticle

Emergency Management of Pelvic Bleeding

by Simone Frassini, Shailvi Gupta, Stefano Granieri, Stefania Cimbanassi, Fabrizio Sammartano, Thomas M. Scalea and Osvaldo Chiara

J. Clin. Med. 2021, 10(1), 129; https://doi.org/10.3390/jcm10010129 - 1 Jan 2021

Cited by 4 | Viewed by 2877

Abstract

Pelvic trauma continues to have a high mortality rate despite damage control techniques for bleeding control. The aim of our study was to evaluate how Extra-peritoneal Pelvic Packing (EPP) and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) impact the efficacy on mortality and hemodynamic impact. We retrospectively evaluated patients who sustained blunt trauma, pelvic fracture and hemodynamic instability from 2002 to 2018. We excluded a concomitant severe brain injury, resuscitative thoracotomy, penetrating trauma and age below 14 years old. The study population was divided in EPP and REBOA Zone III group. Propensity score matching was used to adjust baseline differences and then a one-to-one matched analysis was performed. We selected 83 patients, 10 for group: survival rate was higher in EPP group, but not significantly in each outcome we analyzed (24 h, 7 day, overall). EPP had a significant increase in main arterial pressure after procedure (+20.13 mmHg, p < 0.001), but this was not as great as the improvement seen in the REBOA group (+45.10 mmHg, p < 0.001). EPP and REBOA are effective and improve hemodynamic status: both are reasonable first steps in a multidisciplinary management. Zone I REBOA may be useful in patients ‘in extremis condition’ with multiple sites of torso hemorrhage, particularly those in extremis. Full article

(This article belongs to the Special Issue Diagnostic Protocols and Treatment Strategies in Unstable Trauma Patients)

► Show Figures

Figure 1

11 pages, 1373 KiB

Open AccessArticle

Ten-Year in-Hospital Mortality Trends among Paediatric Injured Patients in Japan: A Nationwide Observational Study

by Chiaki Toida, Takashi Muguruma, Masayasu Gakumazawa, Mafumi Shinohara, Takeru Abe, Ichiro Takeuchi and Naoto Morimura

J. Clin. Med. 2020, 9(10), 3273; https://doi.org/10.3390/jcm9103273 - 12 Oct 2020

Cited by 7 | Viewed by 1740

Abstract

Injury is a major cause of worldwide child mortality. This retrospective nationwide study aimed to evaluate the characteristics of paediatric injured patients in Japan and their in-hospital mortality trends from 2009 to 2018. Injured patients aged <17 years were enrolled. Data were extracted from the Japan Trauma Data Bank. In the Cochran-Armitage test, in-hospital mortality significantly decreased during the study period (p < 0.001), except among patients <1 year old, and yearly reductions were observed among those with an Injury Severity Score ≥16 and survival rate ≥50% (p < 0.001). In regression analyses, patients who underwent urgent blood transfusion within 24 h after hospital admission (odds ratio (OR) = 3.24, 95% confidence interval (CI) = 2.38–4.41) had a higher in-hospital mortality risk. Higher survival probability as per the Trauma and Injury Severity Score was associated with lower in-hospital mortality (OR = 0.92, 95% CI = 0.91–0.92), a risk which decreased from 2009 to 2018 (OR = 6.16, 95% CI = 2.94–12.88). Based on our results, there is a need for improved injury surveillance systems for establishment of injury prevention strategies along with evaluation of the quality of injury care and outcome measures. Full article

(This article belongs to the Special Issue Diagnostic Protocols and Treatment Strategies in Unstable Trauma Patients)

► Show Figures

Figure 1

13 pages, 632 KiB

Open AccessArticle

Predictive Factors for Massive Transfusion in Trauma: A Novel Clinical Score from an Italian Trauma Center and German Trauma Registry

by Sara Giulia Cornero, Marc Maegele, Rolf Lefering, Claudia Abbati, Shailvi Gupta, Fabrizio Sammartano, Stefania Cimbanassi and Osvaldo Chiara

J. Clin. Med. 2020, 9(10), 3235; https://doi.org/10.3390/jcm9103235 - 10 Oct 2020

Cited by 6 | Viewed by 2684

Abstract

Early management of critical bleeding and coagulopathy can improve patient survival. The aim of our study was to identify independent predictors of critical bleeding and to build a clinical score for early risk stratification. A prospective analysis was performed on a cohort of trauma patients with at least one hypotensive episode during pre-hospital (PH) care or in the Emergency Department (ED). Patients who received massive transfusion (MT+) (≥4 blood units during the first hour) were compared to those who did not (MT−). Hemodynamics, Glagow Coma Score (GCS), diagnostics and blood tests were evaluated. Using multivariate analysis, we created and validated a predictive score for MT+ patients. The predictive score was validated on a matched cohort of patients of the German Trauma Registry TR-DGU. One hundred thirty-nine patients were included. Independent predictors of MT+ included a prehospital (PH) GCS of 3, PH administration of tranexamic acid, hypotension and tachycardia upon admission, coagulopathy and injuries with significant bleeding such as limb amputation, hemoperitoneum, pelvic fracture, massive hemothorax. The derived predictive score revealed an area under the curve (AUC) of 0.854. Massive transfusion is essential to damage control resuscitation. Altered GCS, unstable hemodynamics, coagulopathy and bleeding injuries can allow early identification of patients at risk for critical hemorrhage. Full article

(This article belongs to the Special Issue Diagnostic Protocols and Treatment Strategies in Unstable Trauma Patients)

► Show Figures

Figure 1

8 pages, 204 KiB

Open AccessArticle

Independent Predictors of Mortality in Torso Trauma Injuries

by Roberto Bini, Caterina Accardo, Stefano Granieri, Fabrizio Sammartano, Stefania Cimbanassi, Federica Renzi, Francesca Bindi, Laura Briani and Osvaldo Chiara

J. Clin. Med. 2020, 9(10), 3202; https://doi.org/10.3390/jcm9103202 - 3 Oct 2020

Cited by 2 | Viewed by 1732

Abstract

Noncompressible torso injuries (NCTIs) represent a trauma-related condition with high lethality. This study’s aim was to identify potential prediction factors of mortality in this group of trauma patients at a Level 1 trauma center in Italy. Materials and Methods: A total of 777 patients who had sustained a noncompressible torso injury (NCTI) and were admitted to the Niguarda Trauma Center in Milan from 2010 to 2019 were included. Of these, 166 patients with a systolic blood pressure (SBP) <90 mmHg were considered to have a noncompressible torso hemorrhage (NCTH). Demographic data, mechanism of trauma, pre-hospital and in-hospital clinical conditions, diagnostic/therapeutic procedures, and survival outcome were retrospectively recorded. Results: Among the 777 patients, 69% were male and 90.2% sustained a blunt trauma with a median age of 43 years. The comparison between survivors and non-survivors pointed out a significantly lower pre-hospital Glasgow coma scale (GCS) and SBP (p < 0.001) in the latter group. The multivariate backward regression model identified age, pre-hospital GCS and injury severity score (ISS) (p < 0.001), pre-hospital SBP (p = 0.03), emergency department SBP (p = 0.039), performance of torso contrast enhanced computed tomography (CeCT) (p = 0.029), and base excess (BE) (p = 0.008) as independent predictors of mortality. Conclusions: Torso trauma patients who were hemodynamically unstable in both pre- and in-hospital phases with impaired GCS and BE had a greater risk of death. The detection of independent predictors of mortality allows for the timely identification of a subgroup of patients whose chances of survival are reduced. Full article

(This article belongs to the Special Issue Diagnostic Protocols and Treatment Strategies in Unstable Trauma Patients)

9 pages, 488 KiB

Open AccessArticle

Falls from Height. Analysis of Predictors of Death in a Single-Center Retrospective Study

by Alberto Casati, Stefano Granieri, Stefania Cimbanassi, Elisa Reitano and Osvaldo Chiara

J. Clin. Med. 2020, 9(10), 3175; https://doi.org/10.3390/jcm9103175 - 30 Sep 2020

Cited by 9 | Viewed by 2618

Abstract

Falls from height (FFH) represent a distinct form of blunt trauma in urban areas. This study aimed to identify independent predictors of in-hospital mortality after accidental or intentional falls in different age groups. We conducted a retrospective study of all patients consecutively admitted after a fall in eight years, recording mechanism, intentionality, height of fall, age, site, classification of injuries, and outcome. We built multivariate regression models to identify independent predictors of mortality. A total of 948 patients with 82 deaths were observed. Among the accidental falls, mortality was 5.2%, whereas intentional jumpers showed a mortality of 20.4%. The death rate was higher for increasing heights, age >65, suicidal attempts, and injuries with AIS ≥3 (Abbreviated Injury Scale). Older patients reported a higher in-hospital mortality rate. Multivariate analysis identified height of fall, dynamic and severe head and chest injuries as independent predictors of mortality in the young adults’ group (18–65 years). For patients aged more than 65 years, the only risk factor independently related to death was severe head injuries. Our data demonstrate that in people older than 65, the height of fall may not represent a predictor of death. Full article

(This article belongs to the Special Issue Diagnostic Protocols and Treatment Strategies in Unstable Trauma Patients)

► Show Figures

Journal Menu

Journal Browser

Diagnostic Protocols and Treatment Strategies in Unstable Trauma Patients

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Published Papers (6 papers)

Research

Further Information

Guidelines

MDPI Initiatives

Follow MDPI