22nd European Congress of Trauma & Emergency Surgery

Chairs

The diurnal and seasonal relationships of pedestrian injuries secondary to motor vehicles in young people

Abstract text (incl. references and figure legends) Introduction/Aim: There remains a significant morbidity and mortality in young pedestrians hit by motor vehicles, even in the era of pedestrian crossings and speed limits. The aim of this study was to compare the incidence and injury severity of motor vehicle-related pedestrian trauma according to time of day and season in a young population. Methods: Data was retrieved for patients between 10-25 years old from the national Trauma Audit and Research Network (TARN) database, who had been involved as pedestrians in motor vehicle accidents between 2013 -2020. The incidence of injuries, their severity (Injury Severity Score [ISS]) and mortality were analysed according to the hours of daylight, darkness and season. Results: The study identified a seasonal pattern, showing that autumn was the predominant season and lead to 34.9% of injuries, in comparison to summer, with 18.3% of injuries. Importantly, the greatest injury rate (number of injuries/hour) occurred between 1500-1630 correlating to school pick up times. A further significant relationship between ISS and daylight was demonstrated (p-value 0.0124) with moderate injuries (ISS=9-14) occurring commonly during the day (72.7%) and more severe injuries (ISS&gt;15) during the night (55.8%). Conclusion: We have identified a relationship between time of day and the frequency and severity of pedestrian trauma in young people. In addition, particular time groupings correspond to the greatest injury rate, suggesting that reduced visibility coupled with school pick up times may play a significant role. We recommend targeted public health measures that focus on these times and that increase the visibility of children.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) none

Emergency surgery

Polytrauma

Quick shot presentation

Prof.

Multi-centric study on organ donation after trauma: A cluster analysis

Abstract text (incl. references and figure legends) Introduction: The critical gap between organs available for transplantation and patients on waiting lists calls for the need to identify ways to increase the donor pool1-4. The primary aim of this study is to characterize subtypes of trauma donors and examine a relationship between damage control strategies and organ donatios. Materials and Method: The revision of data from three major hospitals in Northern Italy was assessed: Niguarda in Milan, Papa Giovanni XXIII in Bergamo, and Ospedale Maggiore Policlinico in Milan. Data search identified deceased organ donors whose cause of death was major trauma, from January 2012 to September 2021. A cluster analysis algorithm was used to group patients. Results: Two main clusters were identified, which significantly differ in age (29.39 ± 18.87 vs. 61.26 ± 14.36, p&lt;0.001), injury severity score (42.93 ± 17.38 vs. 34.19 ± 13.27, p=0.002) and in the total number of Damage Control Strategies (DCS) applied (4.31 ± 2.54 vs. 1.98 ± 1.54, p&lt;0.001). With regards to solid organ donation, Cluster 1 donated more organs per donor than Cluster 2 (4.5 ± 1.62 vs. 3.59 ± 1.43, p=0.001) and, in particular, produced significantly more hearts (65% vs. 34%, p=0.001). The functional response rate, defined as the proportion of organs that did not have primary dysfunction in the first 30-days, was equal (93% vs. 93%, p=0.929). Conclusion: Aggressive DCS does not negatively impact the possibility of organ donation from severely injured patients but rather contributes to the production of a significant number of organs for transplantation with comparable functional outcomes. References: 1.Ackerman A, Organ donation after trauma: A 30-year review. J Trauma Acute Care Surg. 2019; 2.Altomare M, Organ Donation after Damage Control Strategy in Trauma Patients: Experience from First Level Trauma Center in Italy. Life. 2022; Peetz AB, Regional ethics of surgeon resuscitation for organ transplantation after lethal injury. Surgery. 2021.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) Do not have any significant financial interest.

Visceral trauma

Compliance with international guidelines in the management of Gustilo-Anderson III fractures in multi-trauma patients. A perspective from a level 1 trauma center

Abstract text (incl. references and figure legends) IntroductionThe GA classification(GAC)is the most used for open fractures. The real-world compliance with published guidelines (GL) for GAC fractures is not well explored. We aimed to assess the adherence to the GL on orthopedic injuries in trauma published in the Journal of Trauma in 2020 and study the clinical impact of non-adherence.MethodsWe included trauma patients with long bone GAC grade III fractures treated in 2018-20 at Niguarda Level-1 Trauma Center,Milan,Italy.We selected five points from GL for compliance assessment: application of GAC;x-rays performed in stable patients or after stabilization in unstable ones; antibiotic administration within 3 hours from trauma;soft tissue coverage within 72 hours from trauma for GACIIIA and within 7 days for GACIIIB-C.We performed a group comparison considering compliance to GL to explore differences in infectious complications(IC)or need for amputation(AMP).ResultsWe included 107 patients.The GAC was applied in58%;79.4% underwent X-rays of the extremities. Soft tissue debridement was performed in all patients within 24 hours.The prophylactic antibiotic was administered within 3 hours in75.7%; Soft tissue coverage was performed within 72 hours for GAC IIIA in44% and within seven days for GAC IIIB-C in16.2%.The rate of IC was higher after delayed closure in GAC IIIA.The AMP rate was higher after delayed GAC III A and B-C coverage.The occurrence of IC delayed access to definitive care.ConclusionsWe report sub-optimal compliance with GL,due to delayed coverage for any GAC III with an impact on IC rates,delaying definitive treatment,and AMP. The absence of an ortho-plastic team is a major flaw in our center with clinical effects. Future clinical GL should focus on optimal strategies for compliance and standardize the creation of institutional ortho-plastic teams.Multicenter studies are necessary to investigate factors related to poor compliance with GL.References JTraumaAcuteCareSurg2020Feb;88(2):e53-e76.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No disclosure from any of the authors related to the topic

Skeletal trauma and sports medicine

Severity of the liver injury as predictor of survival in polytraumatized patient

Abstract text (incl. references and figure legends) Introduction Patients who have multiple associated severe injuries are still extremely demanding to treat which raises the old question of which are the most important predictors of the outcome Material and Methods Study analysis included 21 variables to predicting outcomes in polytraumatized patient (Injury Severity Score, ISS ≥15) with associated liver trauma (World Society of Emergency Surgery, WSES I-IV, American Association for the Surgery of Trauma, AAST-OIS II -V). Results The mean age was 41.86 ± 17.93 years. In 74 (55.6%) patients liver injury was severe. Liver trauma was treated by non-operative management (NOM) in 81 (60.9%), single laparotomy 35(26.3%) and Damage Control Surgery (DCS) 17(12.8%). Associated injuries were spleen 93 (69.9%), 10 (7.5%) pancreas, 9(6.8%) kidney, 20 (15%) intestines injuries; neurosurgical 34 (25.6%), orthopedic 54 (40.6%) and 70 (52.6%) thoracic. Considering Clavien-Dindo classification 34(25.6%) patients had complications grade III, 54 (40.6%) grade IV and 28 (21.1%) grade V. In the multivariate logistic regression model with preoperative predictors, statistically significant predictors of death were severe liver injury compared to mild liver injury (OR=11.3; p&lt;0.001) and sustained neurosurgical injuries (OR=5.3; p=0.002). In the multivariate logistic regression model with operative predictors, statistically significant predictors of death were Massive Blood Transfusion (OR=30.5; p&lt;0.001) and relaparotomies (OR=51.2; p=0.002). Conclusions In this study patients with severe liver injury have more than 11 times greater chance of death comparing with other factors, which represents the severity of liver trauma as the most significant predictor of outcome in polytrauma. References 1. Adnan, S.M. et al. Outcomes following abdominal trauma in Scotland. Eur J Trauma Emerg Surg 47, 1713–1719 (2021). https://doi.org/10.1007/s00068-019-01146-wDisclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Association between visitation restriction and delirium incidence among emergency trauma inpatients: A single-center retrospective observational cohort study in Japan

Abstract text (incl. references and figure legends) Introduction: Delirium is associated with many adverse outcomes. Prevention of the development of delirium is important, and family engagement is accordingly incorporated as an &quot;F&quot; component in the ABCDEF bundle. To prevent the coronavirus 2019 (COVID-19) transmission, many hospitals have restricted visits to inpatients by their family members and close contacts. We hypothesized that visitation restrictions to inpatients may increase their risk of delirium. This study aimed to identify the association between total visitation restriction because of the COVID-19 pandemic and the incidence of delirium for trauma inpatients. Methods: Adult emergency trauma patients hospitalized between January 1, 2019, and June 30, 2020, were recruited. In response to the COVID-19 pandemic, our hospital began restricted visitation on March 28, 2020. This study defined before visitation restriction as January 1, 2019, through March 31, 2020, and after visitation restriction as April 1, 2020, through June 30, 2020. The primary outcome was the incidence of delirium. The adjusted odds ratio (AOR) with 95% confidence interval (CI) for delirium incidence was calculated to compare the before and after visitation restriction periods, and the logistic model was used to adjust for six variables: age, sex, ward type on admission, ventilator management, general anesthesia surgery, and dementia. Results: This study analyzed 1,042 patients, with a median age of 73.5 years (57–83) and included 566 men (54.3%). The total delirium incidence in entire research period was 3.9% (41 of 1,042 patients), comprising 3.0% (26/876) before visitation restriction and 9.0% (15/166) after visitation restriction. The AOR for delirium incidence was 4.19 (95% CI,2.09–8.41) after visitation restriction versus before visitation restriction. Conclusions: Visitation restriction was associated with an increased incidence of delirium in emergency trauma inpatients.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Aortic cross-clamping vs REBOA. Is it a fair fight?

Abstract text (incl. references and figure legends) Introduction Resuscitative endovascular balloon occlusion of the aorta (REBOA) is matched to aortic cross-clamping (ACC) and described as a superior strategy. This study compares the severity of trauma between REBOA or ACC patients, as we believe previous studies might fall into survival and indication bias Methods We included patients between 2015-2017 in a Level I trauma hospital who had aortic occlusion (AO) with ACC or REBOA. Demographics, trauma characteristics, interventions, and outcomes were analyzed. Continuous variables were compared by Wilcoxon-Mann-Whitney test; categoric variables with Chi2 or Fisher"s test Results We included 94 cases, 50 of ACC and 44 of REBOA. Age, sex, and ISS were similar between them. Penetrating trauma (PT) was most common in ACC than in REBOA (98% vs. 65%). REBOA had ≥1 lesioned system in 52.3% vs. 44% in ACC. Pulseless electric activity occurred in 38% of ACC and 4% of REBOA. All patients with pelvic fractures were treated with REBOA. ACC had lower heart rate (median [IQR]) (62.5 [0-115] vs 110 [95.5-132]), systolic blood pressure (median [IQR]) (40 [0-80] vs 67 [56-85]) and Glasgow coma scale (median [IQR]) (8 [3-12] vs 14 [8-15]) than REBOA. REBOA group received more hemoderivates in 24 hours (median [IQR]) (32.5 [15-50] vs 12.5 [6-27]). Thoracic surgical approach and resuscitative thoracotomy (RT) were more common in ACC than REBOA (82% vs. 38.6% and 72% vs. 2.3%, respectively). Blood pressure recovered after AO less often and later in ACC because of higher intraoperative death. The observed hospital survival was 70% in REBOA vs. 30% in ACC, similar to TRISS probability of survival (median [IQR]) (0.81 [0.29 - 0.95] vs. 0.31 (0.05-0.83)] Conclusions Both groups have divergent characteristics. ACC patients suffered more frequently PT and required RT, arrived in more deranged hemodynamic conditions, and had lower and observed probability of survival. Therefore, we believe these differences impede crude comparisons with REBOA patientsDisclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) NO

Dr. med.

Prof. Dr. med.

Prof. Dr.

Surgical load – A step towards quantification of surgical trauma load in polytraumatized patients

Abstract text (incl. references and figure legends) Introduction It is known that the amount and timing as well as the surgical procedure itself play a crucial role in polytraumatized patients. Still there is little knowledge, which factors should be considered most when it comes to evaluating the damage dealt to the patient by surgery. In addition, there is little evidence which body regions and operational procedures are associated with a higher surgical impact. The aim of this study was to approximate a definition of the Surgical Load. Material &amp; Methods A standardized questionnaire was developed by experts from SICOT-Trauma committee. Questions included relevance and composition of the Surgical Load, operational staging criteria and stratification of operation procedures in different anatomic region. The questionnaire was completed online by members of the SICOT society. Results 196 trauma surgeons from 63 countries with a median of 13 years work experience in polytrauma care participated between 06/27/22 and 08/16/22. Surgical Load (SL) overall was considered as very important (77%; important: 20.9%). Intraoperative blood loss (43.2%) and soft tissue damage (29.6%) were chosen as the most relevant factors. Staging procedures were mostly planned according to body region (56.1%), followed by bleeding risk (18.9%) and fracture complexity (9.2%). Open surgical procedures of the pelvis (SL=3.55), spine (SL=3.36), long bones (SL humerus=3.01; SL femur=3.33) and knee (SL=3.24) or elbow joint (SL=3.12) were ranked highest in their Surgical Load. Percutaneous or intramedullary procedures as well as more distal fractures were constantly ranked lower. Conclusions Operational staging in polytraumatized patients might benefit from taking the Surgical Load into consideration. Further studies are needed to determine the role of the Surgical Load in planning surgical care of polytrauma patients. References NoneDisclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Effect of in-hospital delay on acute appendicitis severity: Does time really matter?

Abstract text (incl. references and figure legends) Introduction Appendicitis is one of the most common abdominal emergencies. Evidence is controversial in determining if the in-hospital time delay to surgery can worsen the clinical presentation of appendicitis, with a larger proportion of complicated appendicitis and subsequent increased morbidity. This study aimed to clarify if in-hospital surgical delay significantly affected the proportion of complicated appendicitis in a large prospective cohort of patients treated with appendectomy for acute appendicitis. Materials and Methods This is an analysis of a prospectively collected register of all consecutive patients treated with appendectomy at our center for acute appendicitis between 2013-2021. Patients were stratified according to the Alvarado score predicted risk of acute appendicitis: the low risk group included patients with a score from 0 to 3, medium risk from 4 to 6 and high risk from 7 to 10. Appendicitis were defined as complicated in case of perforated and necrotic appendicitis, peritoneal abscess or peritonitis. The primary outcome was correlation of in-hospital delay with the proportion of complicated appendicitis. Results The study included 916 patients: 559 were male (61%) and median age was 24 (14-46). 278 (30.4%) had complicated appendicitis. Median time delay to surgery was 19.6 hours (11.2-30.3) for the uncomplicated appendicitis group and 19.3 hours for the complicated group. In each Alvarado risk group in-hospital delay to surgery was not associated with the presence of complicated appendicitis [OR(CI 95%) low risk: 1.002(0.994-1.009); medium risk: 1.005(0.994-1.016); high risk: 1.004(0.982-1.025)]. No significant correlation was observed between time delay and severity of complications, using Clavien Dindo Classification and Comprehensive Complication Index. Conclusions In-hospital delay was not associated with an increased proportion of complicated acute appendicitis. Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Astronaut‘s fast learning to treat a tibial shaft fracture: A mars analogue simulation

Abstract text (incl. references and figure legends) INTRODUCTION As long-duration exploration missions (LDEM) delve deeper into outer space, the likelihood of adverse effects on skeletal system increases with mission duration [1]. Astronauts are prone to long bone fracture during/after LDEM and their autonomy has to be improved [2]. This study shows how easily astronauts can address a single fracture without surgical skills or extensive training. MATERIAL &amp; METHODS A newly developed external fixation (ExFix) [3] was employed to repair artificial tibial shaft fractures during a two weeks inhabited mission at the Mars Desert Research Station (USA). Six analogue astronauts carried out this ExFix in spatial conditions (Fig. 1). To assess the efficacy of the procedure, patient safety, steps respected during the surgery, reduction accuracy and time taken were evaluated. Fig 1. ExFix material (A). ExFix mounted on a broken artificial leg (B), after removing soft tissues to measure analysis parameters on a frontal, sagittal and upper view (C). RESULTS Patient safety was almost always respected (23/24 surgeries). 79.2% of fractures were treated correctly when only the main criteria (skin compression and stability) are considered. The average time for each completed surgery was 52 minutes. Steps 2 (ExFix positioning) and 4 (fracture reduction and stabilization) were the most time-consuming steps, though the most relevant for a successful surgery. The most important reduction defects were recurvatum and internal rotation. Educational background and learning conditions did not affect the outcome (p&gt;0.05). CONCLUSION Astronauts achieve nearly 80% of success at repairing tibial fractures by using the ExFix. Just 2 weeks training was sufficient to become autonomous without extensive surgical education. This technique should be considered for LDEM to increase astronauts&quot; self-sufficiency. REFERENCES 1 L. Vico et al, The Lancet (2000) 2 T.P. Swaffield et al, AMHP (2018) 3 K.J.-E. Kouassi et al, International Orthopaedics (2022)Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Amplatzer vascular plug 4 for proximal splenic artery embolization in trauma: A preliminary experience

Abstract text (incl. references and figure legends) Introduction: splenic artery embolization(SAE) is nowadays widely used for hemodynamically stable patients with splenic trauma as part of non-operative management. The purpose of the study is to evaluate the efficacy of Amplatzer vascular plug(AVP) in the emergency setting. Material and method: in the last 2 years 14 SAE were performed at Cattinara University hospital for blunt splenic trauma. Three patients underwent proximal SAE with AVP4. Data were retrospectively collected and analyzed. An angioCT scan was performed 48-72 hours after SAE to verify the procedure&quot;s success. The follow-up was carried out with abdominal ultrasound until complete spleen healing. Results: all patients were admitted for motor-vehicle-accident. At admission patients were hemodynamically stable. The CT scan revealed in both cases a grade IV splenic injury(AAST classification). After CT scan, patients immediately underwent SAE with AVP4. Mean time to occlusion was 33 minutes. Angio-CT scan performed after 48-72 hours confirmed the correct placement of AVP and no complications were registered after the procedure. During follow up no splenic infarction, migration of plug or rebleeding was recorded. Conclusions: The possibility to obtain a precise and rapid deployment, combined with the low risk of migration as compared to coils, are very useful in emergency setting. Our preliminary experience confirmed the efficacy, usefulness and safety of AVP. Furthermore, during the follow-up persistent occlusion of the artery was observed. References: Edmund H et al. AMPLATZER Vascular Plug 4 for Proximal Splenic Artery Embolization in Blunt Trauma. J Vasc Interv Radiol 2012;23:976–979 Jambon E, et al. Proximal embolization of splenic artery in acute trauma: Comparison between Penumbra occlusion device versus coils or Amplatzer vascular plug. Diagn Interv Imaging(2018), Coccolini et al. Splenic trauma:WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg(2017) Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Epidemiology of post-traumatic renal impairment: A 10-year descriptive study

Abstract text (incl. references and figure legends) Background: The incidence and risk factors of acute kidney injury (AKI) in young trauma population is not well described. We aimed to evaluate the epidemiology, clinical characteristics, and outcome of AKI after trauma. Methods: A retrospective study of all adult trauma patients admitted at a level 1 trauma centre between 2011 and 2021 was conducted. The diagnosis of AKI was based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results: A total of 17,341 trauma patients were evaluated, of which 140 developed AKI (0.8%). Patients with AKI were older (40±20 vs 32±16 years), had more comorbidities, and higher Injury Severity Score (ISS) and in-hospital mortality (65% vs 3.2%) than non-AKI patients. Direct trauma to the kidney was reported in only 9 (6.4%) cases in the AKI group. Moreover, non-survivors AKI patients had higher ISS, more likely to have hypotension, elevated serum lactate, positive troponin, and lower platelet-to-lymphocyte ratio. Multiple logistic regression analyses showed that age, ISS, acute respiratory distress syndrome , blood transfusion, diabetes mellitus, and on-admission Glasgow coma scale and shock index were predictors of AKI in trauma patients, whereas ISS (OR =1.05; 95% CI: 1.003-1.100; P=0.03), serum lactate (OR =1.25; 95% CI: 1.019-1.533; P=0.03), and hypotension (OR =3.22; 95% CI: 1.044-9.945; P=0.04) were independent predictors of mortality in patients with AKI. Cox-regression analysis showed that none of the AKI stages has impact on mortality after adjustment for age, hypotension and ISS. Conclusion: AKI in young trauma patients is uncommon and associated with prolonged hospital course and higher mortality. This study identified factors that independently predicted the development of AKI and its outcome in trauma patients.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) no

How much urological know-how does a trauma surgeon need? – Discussion about essential urological skills in damage control surgery based on two case reports

Abstract text (incl. references and figure legends) Introduction Urological trauma has been reported with a frequency up to 12% in trauma patients. Combined with abdominal trauma, penetrating or blunt, the numbers may rise up to 50%. Diagnosis and treatment strategies can be quite challenging for a trauma surgeon particularly with a patient in extremis. In military operations the limited material resources and the tactical situation are relevant for the surgeon´s strategy in addition to the physical status of the patient. Related rules apply for smaller hospitals with no urological surgeon on call or present at all. Material and methods Based on two case reports of trauma patients we demonstrate potential urological injuries, diagnostics and treatment. Case report The first patient suffered from an abdominal stab wound with a laceration of the stomache and the hilus vessels of the left kidney. The initial attempt to preserve the kidney and perform vascular sutures wasn´t successful, so the kidney had to be removed in an early second look laparotomy. The second patient was a victim of a traffic accident with an extensive belt injury of the right abdomen. As a part of the initial damage control procedures a right nephrectomy hab to be performed. Discussion Urological injuries are not as rare as assumed, often they can be treated conservatively until transfer to a specialized treatment facility is possible. However a trauma surgeon may face patients in extremis particularly with abdominal trauma, who require urgent urological surgery. Therefor a broad training for damge control surgery strategies in urological trauma must be mandatory to gain the necessary skills. In adverse situations a nephrectomy or nephrostomy might be lifesaving procedures. The learning of how to deal with traumatized patients is an ongoing and challanging process for every trauma surgeon, especially in a world of progressive specialization and minimal-invasive surgery. It needs training on a regular base and sharing of practical knowledge.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) no

Interdisciplinary acute care of a tracheal rupture in a child with whiplash injury

Abstract text (incl. references and figure legends) Case history A 10-year-old girl was involved as a passenger in the back of a car in an accident on the Autobahn and suffered a severe decelaration trauma. Clinical findings The patient was unresponsive upon arrival in the trauma room. Clinically, there was pronounced shortness of breath. Physical examination revealed soft tissue emphysema on the left chest wall and hyperresonant percussion on the left side of the chest. Investigation/results Computer-tomography of the chest showed multiple fractures of the cervical vertebrae (CV 2, 6 and 7) and a rupture of the trachea at the cervico-thoracic junction with complete dehiscence of the airways. Bronchoscopy confirmed complete transection of the trachea a few cm below the larynx. The tracheal ends were detached for several cm. Diagnosis Tension pneumothorax on left side and tracheal rupture. Therapy and Progressions The tension pneumothorax on the left side was relieved immediately through a puncture needle and then treated with a chest drain. The tracheal rupture was bridged using bronchoscopically guided intubation and the airways were secured. The cervical fractures were rated as stable and were treated conservatively. The airways were reconstructed surgically on the day of the accident by end-to-end anastomosis. An oesophageal injury was excluded intraoperatively. The patient was extubated on the 2nd postoperative day and the chest tube was removed the following day. Further clinical course was uneventful. Postoperatively, vocal cord function was intact on both sides. Comments Airway ruptures are rare and life-threatening injuries. Early surgical primary reconstruction secures the airways and prevents mediastinitis. By bundling the clinical competencies of various specialist areas at centers with maximum care, the care of children is also ensured.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Validation of a new simplified scoring system for the treatment of acute calculous cholecystitis

Abstract text (incl. references and figure legends) Introduction: Acute Calculous Cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. There no worldwide consensus on who is the unfit patient for surgery. A recent study identified 4 risk factors that predicts the mortality in a 92% of patients (Acute Cholecystitis Mortality Estimation, ACME). Methodology: retrospective single-center observational study of 387 adults with ACC during 2 non-consecutive years (2017 and 2019). The primary outcome is to study the prediction of mortality of ACME compared with Tokyo Guidelines 2018 (TG!18) severity classification, ASA and Charlson Comorbidity Index (CCI). Results: the 89% of the patients had surgical treatment.The mortality was 3.3%; Almost all deaths had ACME, and the mortality without ACME was 0.45%. The punctuation of ACME varies from 0 to 10. A mortality related to ACME"s punctuation varies from 8.6% to 100%. ACME above 1 has a 9,6% of mortality, &gt; 2 points a 10,2%, &gt;3 a 28,1%, &gt;4 a 43,8%, &gt;5 a 66,7%, &gt;6 a 75%, and &gt;7 a 100%. ACME develops the best AUC: 0.96 (0.795-1) comparing to TG18 (AUC 0.896; 0.795-0.996),CCI &gt;5 (AUC 0.789; 0.616-0.962) and ASA &gt;2(AUC 0.792; 0.713-0.871). Conclusions: ACME is a good and easy tool to predict the mortality in ACC in clinical practice. Its external validation with a prospective multicenter study is now obligatory.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

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