European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Dec 2023
Review Meta AnalysisThoracostomy tube withdrawal during latter phases of expiration or inspiration: a systematic review and meta-analysis.
In patients with thoracic injuries, tube thoracostomy is routinely employed. There is disagreement over which manner of tube withdrawal is best, the latter phases of expiration or inspiration. Considering several earlier investigations' inconsistent findings, their comparative effectiveness is still up for debate. In light of this, we carried out a systematic analysis of studies contrasting the withdrawal of thoracostomy tubes during the latter stages of expiration versus inspiration for traumatic chest injuries. Analyzed outcomes are recurrent pneumothoraces, reinsertion of the thoracostomy tube, and hospital stay. ⋯ The thoracostomy tube can be removed during both the end-expiratory and end-inspiratory stages of respiration with no appreciable difference. Nevertheless, caution should be exercised when ascertaining the implications of these findings, taking into account the potential limitations and confounding variables that may exert influence upon the outcomes.
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Eur J Trauma Emerg Surg · Dec 2023
Meta AnalysisSurgical versus non-surgical treatment of flail chest: a meta-analysis of randomized controlled trials.
Conflicting evidence exists on the choice of surgical or non-surgical treatment of flail chest injuries. We aimed to perform a meta-analysis comparing outcomes in patients presenting flail chest undergoing surgical or non-surgical treatment. ⋯ Our results suggest that surgical treatment is advantageous compared to non-surgical treatment for patients with flail chest secondary to rib fractures.
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Eur J Trauma Emerg Surg · Dec 2023
ReviewTraumatic inflammatory response: pathophysiological role and clinical value of cytokines.
Severe trauma is an intractable problem in healthcare. Patients have a widespread immune system response that is complex and vital to survival. Excessive inflammatory response is the main cause of poor prognosis and poor therapeutic effect of medications in trauma patients. ⋯ Studies have demonstrated that cytokines are closely related to the severity of injuries and prognosis of trauma patients and help present cytokine-based diagnosis and treatment plans for trauma patients. In this review, we introduce the pathophysiological mechanisms of a traumatic inflammatory response and the role of cytokines in trauma patients. Furthermore, we discuss the potential of cytokine-based diagnosis and therapy for post-traumatic inflammatory response, although further clarification to elucidate the underlying mechanisms of cytokines following trauma is warranted.
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Eur J Trauma Emerg Surg · Dec 2023
ReviewEnhanced recovery protocols in trauma and emergency abdominal surgery: a scoping review.
Enhanced recovery protocols (ERP) have been shown to improve patient outcomes and is now regarded as standard of care in elective surgical setting. However, the literature addressing the use of ERP in trauma and emergency abdominal surgery (EAS) is limited and heterogenous. A scoping review was conducted to comprehensively assess the literature on ERP in trauma laparotomy and EAS. ⋯ Studies on ERP implementations in the EAS populations were published across a range of countries, with improved outcomes. However, a clear gap in ERP research on trauma laparotomy was identified. This scoping review indicates that standardization of care through ERP implementation has potential to improve the quality of care in both EAS and trauma laparotomy.
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Eur J Trauma Emerg Surg · Dec 2023
Multicenter StudyInfluence of residency discipline and seniority on traumatic musculoskeletal radiographs interpretation accuracy: a multicenter study.
Imaging studies are a significant and integral part of the initial assessment of patients admitted to the emergency department. Developing imaging diagnostic abilities early in residency is of paramount importance. The purpose of this study was to evaluate and compare diagnosis accuracy of common musculoskeletal X-rays (XR) between residency disciplines and seniority. ⋯ Orthopedic residents presented higher diagnosis accuracy of MSK imaging compared to EM and radiology residents. Seniority had a positive effect on diagnosis accuracy. The development of an educational program on MSK XR is necessary to enhance the competency of physicians in their daily practice.