22nd European Congress of Trauma & Emergency Surgery

Chairs

Prof.

Laparoscopic approach of a complex blunt liver, splenic and galbladder avulsion

Polytrauma

Visceral trauma

Abstract text (incl. references and figure legends) Male, 17 years old, victim of abdominal trauma (motorcycle crash against a wall IN high velocity), sustaining abdominal pain (peritoneal irritation), hemodynamic stability and no further apparent injuries. Abdominal CT scan (low available contrast) showed complex liver injury (Grade IV), moderate amount of free fluid around the liver and spleen and hematoma close to the gallbladder site with no clear definition of the gallbladder wall; no injuries were found in the head, neck and thorax CT. The patient was carried to the Operate Room for a Diagnostic Laparoscopy. It was observed moderate amount of blood, complex stellate liver injury (deep laceration) in segments IV, V, VI and VII, presenting active bleeding, Grade II spleen injury (laceration with no active bleeding) at the gastric surface and gallbladder and liver parenchyma avulsion presenting active bleeding, with no apparent common bile duct injury. After systematic diagnostic laparoscopy, no further injuries were identified. Liver injury was treated with simple interrupted suturing with catgut 3.0 achieving hemostasis after the proceeding. The splenic injury was treated with hemostatic agent and it was performed cholecystectomy with hemostasis of the liver surface with monopolar energy and hemostatic agent. Tubular intra-abdominal drainage was allocated at Morrisson´s space. The patient in the PO1 was awake, presenting hemoglobin levels from 11 to 9, with no hemodynamic or clinic change, and no drain debt. The patient presented no abdominal pain, tubular drain debt of 5ml (bilious appearance), decreasing each day until no debt at PO7 when he was discharged.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

Poster

Esophageal fistula after anterior cervical spine fixation: First level trauma center experience

Emergency surgery

Abstract text (incl. references and figure legends) Pharyngoesophageal fistula (PEF) is a rare but life-threatening complication after anterior cervical spine fixation (ACSF) in cervical spine injuries. In literature, there is a lack of consensus on PEF management. This study aims to evaluate the management of PEF in major trauma patients. A retrospective analysis was performed. All patients referred to ASST Niguarda Hospital in Milan for PEF following ACSF between January 2015 and September 2022 were included. Different types of management were described, and outcomes were reported. Four cervical spine trauma patients were referred to our center for PEF following ACSF. Their mean age was 15.5 (SD±8.01). Three reported fractures of C5 and C6 in three patients, and one had anterolisthesis of C4-C5 associated with rupture of the anterior and posterior ligament from C4 to C7. PEF showed up fourteen days after ACSF in two patients and thirty days in the other two. The first treatment of choice was different in each case. Conservative management with endoscopic procedures such as a stent or endo-sponge placement were bridges to surgery. In the end, all four patients underwent surgery. The most common approach was a direct double-layer suture covered with a left sternocleidomastoid flap (75%). Complete healing of the fistula was achieved in 3 patients, and in one, a permanent cervical esophagostomy was necessary. The management of patients with PEF after ACSF is complex, and carrying them to a tertiary referral center with a multidisciplinary approach should be considered early. References: Ghirelli et al Pharyngo-Esophageal Perforations After Anterior Cervical Spine Surgery: Management and Outcomes.World Neurosurg.2020 Jul;139:e463-e473 Yuan et al Treatment for early postoperative esophageal fistula complicated with anterior cervical surgery. JOrthopSurg (Hong Kong).2017 Jan;25(1) Vogel et al Esophageal perforation in adults,aggressive,conservative treatment lowers morbidity and mortality. AnnSurg 2005;241:1016–1023 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

Prof. Dr.

One-year of work-related Injuries and deaths in Qatar: An initial report from the work-related injury unified registry for Qatar

Education

Abstract text (incl. references and figure legends) Introduction: Worker safety is recognized as a public health priority in Qatar but national data is historically incomplete. This paper shall describe the findings from the initial 1-year of collection, through the Work-related injury Unified Registry for Qatar (WURQ), of data on work-related injuries and deaths in Qatar for the year 2020. Methods: The WURQ was queried for all work-related injuries [WRIs] from 1 January to 31 December 2020. This data was classified by date of injury, age, sex, nationality, mechanism of injury, severity of injury, location of medical consultation and clinical outcome. Results: There were 50 deaths caused by work-related injuries in 2020 [2.3 occupational fatalities per 100,000 workers]. Sixty percent of WRI deaths were in the pre-hospital setting with the 64% of fatal injuries occurring at the worksite and 22% due to falls. Five hundred six workers sustained severe WRIs [23.3 severe occupational injuries per 100,000 workers], a 57% reduction from 2008. A total of 37,601 workers sustained mild to moderate WRIs [1,728.9 mild to moderate occupational injuries per 100,000 workers]. The severe WRIs were most commonly due to falls from height [45%] and falling heavy objects [16%]. Conclusion: WURQ has described WRIs in Qatar for 2020. Work related injury and fatality rates are lower than or comparable with those from other high-income countries. This registry can be used to inform worksite inspections, investigations, worker safety education, environmental improvements and injury prevention programs to make Qatar safer for all its workers. References: Consunji R, Mehmood A, Hirani N, El-Menyar, Abeid AA, Hyder AA, Mollazehi M, Al-Thani H &amp; Peralta R. Epidemiologic and temporal trends of work-related injuries in expatriate workers in a high-income rapidly developing country: evidence for preventive programs. Proceedings of the 9th International Conference on the Prevention of Accidents at Work, Prague, Czech Republic. Oct 2017Disclosure: 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

A comparative analysis of the epidemiology and outcomes of hospitalizations for moderate to severe injuries during the holy month of Ramadan and non-Ramadan months

Abstract text (incl. references and figure legends) Introduction: There have been reports of the unique epidemiology of injuries and trauma during the Holy Month of Ramadan, especially in Islamic countries. Fasting may cause physiological, habitual and behavioral changes. Likewise, driving behavior before Sohour and Iftar may be contributory to increased motor vehicle crashes around these times. This study shall describe and compare the epidemiology of injuries during Ramadan months compared to the other non-fasting months of the year. Methods: Data on all patients with moderate to severe injuries seeking hospitalization and/or care at the Hamad Trauma Center during the Ramadan month [R] and during the months before [P] and after Ramadan [A], for the years 2010-2012, were collected for the 30-day period before, during and after the Ramadan months, from the trauma registry of the national Level 1 trauma referral center of Qatar. Results: There were 1,141 patients admitted during the 3-year study periods [P-353, R-357 and A-431]. Road traffic injuries, motor vehicle [34.8%] and pedestrian crashes [11.1%] were the leading mechanism of injury. Falls [30.8%] and falling objects [4.4%] were next most common. There were significant differences between P and R groups for: proportion of and hourly rate of injuries between 0500-1659H and 2001-0159H, proportion of patients with ISS 6-15 and the home as the site of injury. No differences were seen between the R and A groups. Conclusion: There are distinct changes in the epidemiology of trauma during the Ramadan months, when compared to the pre-Ramadan period. There is a higher rate of injuries during the overnight hours, less during the daytime, more are of moderate severity and occur at home. These changes are sustained in the post-Ramadan month; the reason/s for this should be the focus of future research. Reference: Road traffic crashes in Ramadan: an observational study. Tahir MN, Macassa G et al.. East Mediterr Health J. 2014 Jan 9;19 Suppl 3:S147-51.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

Assessing trauma care through assistance times and evolution indicators: A cross-sectional analysis

Abstract text (incl. references and figure legends) ITRODUCTION AND PURPOSE Assess quality of care and prognosis of trauma patients through 3 assistance times: time from arrival to hospital to revision by medical team, time from arrival to imaging techniques, and time from arrival to patient endpoint; and 2 evolution indicators: hemodynamic instability between arrival at emergency department and 10 minutes from arrival, and hemoglobin worsening between blood test at arrival and the second blood test at emergency department. METHODS Participants in this cross-sectional study were 538 individuals attended under activation of Polytraumatic Patient (PPT) code in Hospital del Mar in Barcelona, between October 2020 and October 2021. Between October 2020 and February 2022 data was completed to a prospectively maintained database from hospital data records, subsequently at the hospital discharge. RESULTS In a group with low-severity (ISS&lt;15 487 [90.5%]) and low-priority (priority 2-3 468 [87%]) profile, with and extremely low mortality (9 [1.7%]), no significative associations between in-hospital assistance times or evolution indicators, mortality, complications or length of hospital stay, were found. CONCLUSION - ISS (Injury Severity Score), RTS (Revised Trauma Score) and hemodynamic instability continue to be indicators of prognosis and severity. - The time of care may not be a great prognostic factor in a center like ours because we are already below the threshold of mortality, complications and days of hospital stay. - Using acute times of care in polytraumatics in high-volume centers does not demonstrate a significant association with final prognosis and studies that should be considered longer time measures, especially those that include non-acute time and hospital stays after critical care. 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

A retrospective cohort study to determine the injury prevalence sustained from elderly patients undergoing full trauma CT

Skeletal trauma and sports medicine

Abstract text (incl. references and figure legends) Study Aim: The aim of the study was to determine the prevalence of injuries and injury patterns in elderly patients (&gt;65 years) with low level falls who underwent a full trauma series. Introduction: The Emergency Department at North Manchester General Hospital is a non- trauma centre but see a significant number of elderly fallers. Our previous experience has shown that many of the patients have significant orthopaedic injuries often with few signs or symptoms. The aim of this retrospective cohort study was to determine the injury prevalence and injury patterns in elderly patients either from low level falls, Methodology: The CT scan reports and clinical notes were reviewed of all elderly patients (over 65 years of age) who had a full trauma CT (head, neck, chest, abdomen and pelvis) over a twelve-month period (September 2020–September 2021). The indications for performing a full trauma CT rather than selective CT (e.g. head and neck) at our institution is based upon the following:- haemodynamic instability, signs of multisystem injury or clinical suspicion of injury in more than one anatomical area. Results: Sixty-six elderly patients underwent a full trauma series over the twelve-month period. The mean age of the cohort was 83.2 years, 39% (n=26) of the patients were identified to have a least one injury detected on CT scan. 86% (n=57) were due to ground level falls. The remaining cases were made up of patients falling down steps or stairs (n=5) or low speed road traffic accidents (n=4). In total 12% of patients sustained two or more rib fractures, with or without an associate heamopneumothorax. The remaining injuries were orthopaedic in nature (long bone, pelvic or spinal fractures). Conclusion. The results of this study justified a fairly liberal approach to the use of the full trauma CT in elderly patients. Elderly patients may have few signs or symptoms despite having significant injuries which were found to be are predominantly orthopaedic in nature.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 to declare.

A retrospective cohort study to determine the chest injury prevalence sustained from elderly patients presented with low energy falls

Abstract text (incl. references and figure legends) Study Aim: The aim of the study was to determine the prevalence of chest wall injuries and injury patterns in elderly patients (&gt;65 years) with low level falls who underwent trauma CT. Introduction: North Manchester General Hospital is a non- trauma centre but sees a significant number of elderly fallers. Our previous clinical experience has demonstrated that many elderly fallers sustain chest wall injuries which are relatively occult. Our current institution uses a selective approach to trauma CT in this cohort. Methodology: Our current practice is firstly to perform a selective Trauma CT scan (head, neck, thorax or pelvis) for patients low level falls or evidence of rib fractures on CXR. The CT scan reports and clinical notes were reviewed of all elderly patients (over 65 years of age) who had a trauma CT (head, neck, chest, abdomen and pelvis) or a CT thorax and abdomen over a twelve-month period (September 2020 – September 2021). Results: One hundred and eighty-three elderly patients underwent a CT scan following trauma over the specified twelve-month period. Ninety-three patients had a pan trauma CT and ninety patients had a thorax /abdomen). The mean age of the cohort was 82.11 years. 22.4% (n=41) of the cohort were found to have one or more rib fractures on CT. 13.9% (n=6) of the patients were identified to have a one rib fracture detected on CT scan. 25.5% (n=11) of the patients were identified to have a two rib fractures and 55.8% (n=24) of the patients were identified to have a more than 2 rib fractures detected on CT scan. 16.2% (n=7) had associated haemothorax identified on CT scan while 11.6% (n=5) had associated pneumothorax. Conclusion: This study found that for elderly patients with low level falls multiple rib fractures were more common than isolated rib fractures. The study There is a significant risk of chest wall injuries in elderly patients presenting after low energy falls.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.) Nothing to disclose.

Polytrauma patient with unstable pelvic and tibial plateau fracture

Abstract text (incl. references and figure legends) Case history A 61-year-old man fell on both legs from a 10-meter-high tree. Clinical findings On arrival, he was notable for having a clear airway, a respiratory rate of24 breaths per minute, and a SpO2 of 93% without additional oxygen. The pulse rate was100 beats per minute, and the blood pressure was 100/70 mmHg. No signs of paralysis oropen wounds on the limbs were observed. The left hemithorax, lumbar, and suprapubicregions were painful. The left knee was swollen. The right leg was shortened and externallyrotated, with a painful calcaneus. Investigations and results The patient was in class II hemorrhagic shock. FAST showedretroperitoneal hemathoma. A WBCT with contrast was performed and showed bilateralsacral and right pubic rami fractures with active extravasation of contrast at fracture sitesand from the sacral venous plexus. No active arterial extravasation was detected. A leftpulmonary contusion, fractures of the proximal tibia, fibula, calcaneus, and both L5processes transversus were seen. Diagnosis Vertically unstable pelvic fracture with retroperitoneal hemorrhage; contusion ofthe lower left pulmonary lobe; fracture of the left tibial plateau and proximal fibula;multifragmentary fracture of the right calcaneus; bilateral fracture of the transversus processof the 5th lumbar vertebra. Therapy and progressions He received 3 units of RBC. We performed DCS with theapplication of a pelvic external fixator. On day five, we performed definitive pelvicstabilization. Two weeks after the injury, osteosynthesis of the proximal tibia with anangulary stable plate was performed. We treated the calcaneal fracture conservatively. Comments A multidisciplinary approach with defined diagnostic and treatment modalitiesand appropriate timing saves a patient with multiple injuries.References 1. Coccolini et al. World Journal of Emergency Surgery (2017) 12:5.2. Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: anupdate. EFORT Open Rev (2016) ;1:225-232.3. Frassini et al. Emergency Management of Pelvic Bleeding. J. Clin. Med. (2021); 10, 129.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

Sternal fractures and thoracic injury. A review of 288 sternal fractures attending a major trauma centre

Abstract text (incl. references and figure legends) Introduction Sternal fractures (SF) are rare injuries usually associated with significant mechanism of injury. Concomitant injury with SFs can include damage to the thoracic viscera, resulting in a sharp rise in morbidity and mortality compared to isolated SFs. Methods In this retrospective study, we aim to identify the patients in a single major trauma centre who sustained SFs, evaluate their concomitant injuries, and identify the incidence of associated thoracic and mediastinal injury in this group. Results Over a 7-year period, 288 patients attended with SFs. The most common concomitant injuries were Rib fractures (56%), Lung Contusions (31.15%) and Haemothorax (21.88%). There was an 8% mortality associated with SF. The incidence of cardiac injuries in SFs was low (1.74%). The presence of an SF although may be an important finding, it is not a marker of clinically significant myocardial injury and rarely causes death when not associated with other thoracic injuries. Our patients attended with a mean ISS of 22.49 and 25% of patients with SF attended with systolic BP of &lt;110 mmHg. The chest was the most severe injured body region in 51% of patients. This highlights clearly that SF is often associated with severe injuries, particularly to the chest which can compromise haemodynamic stability. Conclusion Sternal Fractures are rare but serious injuries. More investigations should be performed to determine whether early interventions, for example, rib fixation, chest drain insertion and appropriate analgesia and oxygen therapy can reduce the risk of mortality and morbidity even further.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

Characteristics and outcomes of pediatric trauma at a level 1 trauma centre

Abstract text (incl. references and figure legends) Background: We aimed to describe the injury pattern, treatment, and outcomes of pediatric trauma in a level 1 trauma centre in a rapidly developing country. Methods: A retrospective analysis of paediatric injury data (2012-2021) was conducted. All trauma patients (&lt;18y) requiring hospitalization were included. Patients were categorized and compared based on mechanism of injuries (MOI), age-group and injury severity. Results: A 3058 pediatric patients (20% of the total trauma admissions) were included in the study. The incidence rate in 2020 was 86 cases per 100,000 pediatric population in Qatar. The majority were male (78%). Mean age was 9.3±5.7y. Nearly 40% had head injuries. The in-hospital mortality rate was 3.8%. The mean ISS was 10±9 and GCS was 13.6±3.4. Almost 18% required Intensive Care Unit admission. Road Traffic Injuries (RTIs) were more frequent in 15-18y whereas ≤ 4y group was mostly injured by falling objects. The Case Fatality Rate (CFR) was higher among females (5.0%), and in 15-18y (4.6%) and &lt; 4y (4.4%) group. Pedestrian injuries were more lethal among the MOI. One fifth had severe injury with a mean age of 11±6 and 9.5% had ISS of ≥25. The predictors of severe injury were age (10 years and above) and RTI. Conclusion: Almost one-fifth of the trauma admissions at the level 1 trauma centre in Qatar is pediatric population. Developing strategies that are based on understanding of the age- and mechanism-specific patterns of traumatic injuries among pediatric population is crucial.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

Six meter, the criterion for severe adult trauma to falls from heights in CDC field triage needs to be lowered

Abstract text (incl. references and figure legends) Introduction: Trauma is one of major public health care issue which is costly to society. Differences vary from region to region, but blunt trauma accounts for a large part of the total trauma, and the rates of the falls from heights among the blunt trauma is getting higher. It is serious that falls from heights is often accompanied by severe multiple trauma. Therefore, authors studied the relationship between the height of the fall/other related factors and outcomes including hospital stay/mortality. Materials and Methods Retrospective cohort study of the 670 adult falls-from-heights patients visited a regional trauma center for 4 years (from 2014.01.01 to 2017.12.31). Results Of total 670 patients, the number of D.O.A patients were 69. The height from falls of the deceased patients was statistically significantly higher than that of the survived patients. (19.4 ± 15.3 m vs. 4.3 ± 4.2, p &lt; 0.001) The AUC of the ROC curve of the height from fall to mortality was 0.879. (Fig.) The sensitivity of 3.75m was 90.7% and 6.5m was 81.4%, respectively. The traumatic brain injury, pelvis fracture, visceral organ injury, age, and the height from fall were statistically significant risk factors in multivariate analysis for mortality (p=&lt;0.001, 0.11, 0,001, 0.004, and 0.03 respectively) Conclusions We think the current height for the severe fall injury in CDC field triage for trauma is high and needs to be lower to 3.5 m with about 90% sensitivity for survival. 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.) I do not have any significant disclosure.

Impact of standing e-scooter accident and injury patterns: 3 years experience from a trauma department in Rome

Abstract text (incl. references and figure legends) Purpose In 2019, Electric motorized rental Scooters (ES) have been launched in Italy as an alternative mode of urban transportation, to reduce car traffic. With ES increasing popularity, the ES related injuries also increased. We aimed to investigate the impact of ES injuries on health care system and identify the adjustable risk factors for ES injuries. Material and Methods All consecutive patients admitted to the Emergency Department (ED) of Policlinico Umberto I in Rome from January 2020 to September 2022 were retrospectively observed. Demographics, use of the helmet, alcohol intoxication, mechanism of injury, pattern of injuries, Injury Severity Score (ISS), and clinical outcome were analyzed. Results During the study period, 323 (217 males) patients as riders or pedestrians presented to the ED with ES injuries.Mean age was 29.8 years. Thirty-seven (11,4%) patients were younger than 18 years, 37 (11,4%) were accidents at work.Two riders (0,6%) were documented as having worn a helmet, 8 (2,5 %) patients had blood alcohol level greater than 0.50 g/l. The principal mechanism of injury was rider fall (82,6%), followed by rider collision (12%), while 5,2% were pedestrians hit by an ES. The mean ISS was 4,5; 14 (4,3%) patients presented ISS&gt;16. One or more orthopedic injuries were documented in a total of 270 (83,5%) patients, while maxillofacial injuries were detected in 93 (28,8%). Traumatic brain injuries (TBI) were reported in 89 (27,5%) cases; 12 were severe TBI. Thirty-one (9,5%) patients were hospitalized with mean stay of 9,4 days.Three patients (0,9%) were transferred to the intensive care unit. None died. Conclusion along with the increasing use of ES, the ES related injuries will increase as well. A national effort is needed to improve the safety profile of ES, through obligatory use of the helmet and limb protections, alcohol avoidance and speed limitations.To our knowledge, this is the first Italian study on the impact of ES injuries on ED admission.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

Laparoscopic repair of a traumatic right diaphragmatic hernia

Abstract text (incl. references and figure legends) INTRODUCTION: Blunt diaphragmatic injury has been increasing and frequently is associated with considerable comorbidity. This injury is often missed at the time of the initial event. Some studies indicate that 2,7% to 50% of diaphragmatic ruptures may not be diagnosed initially. The development of imaging techniques, in particular computed tomography, have increased the rate of early diagnosis. Some ruptures only can be seen later because an unidentified rupture can enlarge when intra-abdominal pressure rises. Therefore, we can classify the diaphragmatic hernias in acute or chronic. The definition of chronic diaphragmatic hernia is controversial. Some authors use a specific time such as 1 month as a cutoff for acute. Left-sided hernias are more common than right-sided. METHODS: Presenting a case report. RESULTS: Female patient, 33 years old. She was admitted to the emergency department after a fall from height, which resulted in thoracic, abdominal and vertebral trauma. The thoracic imaging study revealed rib fratures with bilateral pneumothorax. She underwent bilateral chest drainage and was admitted to intensive care. On the 13th day of hospitalization due to failure to resolve the pneumothorax on the right side, an imaging study with tomography (CT) and bronchoscopy was done. Bronchoscopy excluded bronchopleural fistula. CT scan revealed extensive diaphragmatic rupture with hepatic herniation. The patient was proposed for laparoscopic correction of the hernia. The defect was closed with primary repair and a mesh. The surgery and the postoperative period went uneventfully. Prior to discharge, she underwent imaging reassessment with CT that revealed complete lung expansion and resolution of the pneumothorax. She was discharged home asymptomatic. CONCLUSIONS: Improved awareness of diaphragmatic injuries will increase the rate of early diagnosis and improve prognosis. The laparoscopic approach is safe and less aggressive for the patient.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 disclosures.

Poster Session 14
Polytrauma 3

Appointment

Chairs

Programme

Poster Session 14Polytrauma 3

Appointment

Chairs

Programme

Poster Session 14
Polytrauma 3