European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Feb 2020
Observational StudyThe impact of timing of antibiotics on in-hospital outcomes after major emergency abdominal surgery.
Patients undergoing major open emergency abdominal surgery experience high morbidity and mortality rates and often have sepsis at admission. The purpose of this study was to evaluate the association between antibiotic timing and in-hospital outcomes such as complications, need for reoperation, length of stay, and 30-day mortality. ⋯ Antibiotic administration more than 12 h from triage was associated with a significantly increased risk of postoperative complications, need for reoperation, 30-day mortality, and a prolonged length of stay, when compared to patients that received antibiotic treatment 0-6 h and 6-12 h after triage. Our data suggest that prophylactic antibiotics should be administered to all patients undergoing major open emergency abdominal surgery; however, the dose and duration cannot be concluded on the basis of our data and should be further examined.
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Eur J Trauma Emerg Surg · Feb 2020
Comparative StudyComparison of thick- and thin-slice images in thoracoabdominal trauma CT: a retrospective analysis.
To compare thick (5 mm) and thin slice images (1.5 mm) of lung, soft tissue, and bone window in thoracoabdominal trauma computed tomography. ⋯ Thin-slice images do not bring any significant benefit in thoracoabdominal trauma CT of soft-tissue and lung injuries, but they can be helpful for the diagnosis of bone fractures and incidental findings.
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Eur J Trauma Emerg Surg · Feb 2020
Are injury admissions on weekends and weeknights different from weekday admissions?
To examine whether hours of a day and days of a week influence injury pattern, means of evacuation, and hospital resource utilization. ⋯ Injury pattern and resource utilization are related to time. Therefore, injury prevention and intervention efforts should account for hours of a day and days of a week, particularly in relation with age, gender, and ethnicity.
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Eur J Trauma Emerg Surg · Feb 2020
Does lack of thoracic trauma attenuate the severity of pulmonary failure? An 8-year analysis of critically injured patients.
Patients with thoracic trauma are presumed to be at higher risk for pulmonary dysfunction, but adult respiratory distress syndrome (ARDS) may develop in any patient, regardless of associated chest injury. This study evaluated the impact of thoracic trauma and pulmonary failure on outcomes in trauma patients admitted to the intensive-care unit (ICU). ⋯ ARDS development was more common in patients with thoracic trauma. Nevertheless, the development of ARDS in patients without chest injury was associated with a tenfold higher risk of death. The presence of VAP was found to be the only potentially preventable and treatable risk factor for the development of ARDS in ICU patients without chest injury.
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Eur J Trauma Emerg Surg · Feb 2020
Pre-operative psoas major measurement compared to P-POSSUM as a prognostic indicator in over-80s undergoing emergency laparotomy.
Emergency laparotomy in patients over the age of 80 is associated with high morbidity and mortality. Accurate risk prediction in this patient population is desirable. Sarcopenia has been shown to be associated with outcome in multiple clinical settings and the psoas major muscle as measured on computed tomography (CT) imaging has been demonstrated as a marker of sarcopenia. We aim to assess the use of psoas major measurement on pre-operative CT as a prognostic indicator in over-80s undergoing emergency laparotomy and compare this measurement to P-POSSUM. ⋯ CT imaging of the abdomen and pelvis is routinely used in over-80s prior to emergency laparotomy making PM:L3 calculation feasible for the majority of patients in this group. PM:L3 ratio is a useful prognostic indicator for prediction of mortality in patients over the age of 80. PM:L3 is superior to the P-POSSUM score in this series.