European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Apr 2019
Trauma care in German-speaking countries: have changes in the curricula led to changes in practice after 10 years?
Traditionally, in the German-speaking countries, trauma patients are treated by general surgeons specialized in trauma surgery known as the Unfallchirurg. Over the last decade, a trend towards a lower influence of surgeons and a higher influence of subspecialties in the emergency department has been noted. With additional transformations in the health care system towards highly specialized medicine and the arising of new (sub-) specialties, diversification in the management of the trauma patient appears to occur. The new curricula for surgical disciplines providing trauma care will widen this issue even further, moreover, triggered by the Anglo-American medical model. The primary aim of this study was to evaluate the current situation in German-speaking countries concerning the management of trauma patients. The interfaces between emergency physicians, orthopaedic and general surgeons have been investigated concerning the management of the trauma patients. Additionally, different future scenarios have been evaluated. ⋯ Despite the growing importance of emergency physicians, separated in the emergency room between surgical and internal medicine fields, in the acute care of surgical patients in the emergency departments, their role in the management of the polytraumatized patients remains limited. More than 13 years after the new curricula for orthopaedic and general surgery have been implemented in Germany, fracture care is still predominantly provided by general surgeons specialized in trauma surgery. In conclusion, it seems that the general surgeon specialized in trauma surgery still plays and wants to play the key role in the management of the polytrauma patient and fracture care in German-speaking countries.
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Eur J Trauma Emerg Surg · Apr 2019
Neutrophil-to-lymphocyte ratio as a feasible prognostic marker for pyogenic liver abscess in the emergency department.
The neutrophil-to-lymphocyte ratio (NLR) is an effective predictor of mortality in patients with for various conditions. To date, there are no previous studies on NLR as a prognostic marker for pyogenic liver abscess (PLA), especially on admission to the emergency department (ED). ⋯ NLR was positively associated with poor prognosis of PLA; elevated NLR could predictor of high risk of death, ICU admission, and development of septic shock. Emergency physicians should consider NLR for the prognosis of PLA and early aggressive treatment, especially in patients with NLR > 16.9.
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Eur J Trauma Emerg Surg · Apr 2019
Corrective osteotomies using patient-specific 3D-printed guides: a critical appraisal.
Over the last decade, the technique of 3D planning has found its way into trauma surgery. The use of this technique in corrective osteotomies for treatment of malunions provides the trauma surgeon with a powerful tool. However, this technique is not entirely straightforward. We aimed to define potential pitfalls of this technique and possible solutions to overcome these shortcomings. ⋯ Four major pitfalls were encountered using the 3D printing technique: (1) careful examination of the planned guide positioning is mandatory, since suboptimal intra-operative guide positioning is most likely the main cause of the incomplete correction; (2) the use of pre-drilled screw holes do not guarantee adequate screw positioning; (3) translation of bone fragments over the osteotomy planes in case of an oblique osteotomy is a potential hazard; (4) the depth of the osteotomy is hard to estimate, potentially leading to extensive cartilage damage.
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Eur J Trauma Emerg Surg · Apr 2019
Analysis of quality of life after major trauma: a spanish follow-up cohort study.
Study objectives are to determine whether quality of life is recovered completely after major injury and to identify determinants associated with a worse quality of life. ⋯ The quality of life score improves during the first year after major trauma. However, it does not return to the reference levels for the normal population. Female gender and age ≥ 55 years are statistically significant determinants of poorer EQvas and EQus.
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Eur J Trauma Emerg Surg · Apr 2019
Percutaneous cholecystostomy for severe (Tokyo 2013 stage III) acute cholecystitis.
To evaluate the impact of percutaneous cholecystostomy (PC) on severe acute cholecystitis (AC). ⋯ This study confirms that PC is a valuable tool in the treatment of severe AC. Randomized trials are needed to clarify the criteria for patient selection and to optimize the timing for both cholecystostomy and cholecystectomy.