22nd European Congress of Trauma & Emergency Surgery

Chairs

Over 15 years of trauma patient registry: What has changed?

Polytrauma

Visceral trauma

Abstract text (incl. references and figure legends) INTRODUCTION To improve the quality of care in trauma patients, it is necessary to have an adequate registry and to monitor it. Our objective is to assess changes observed in the last 15 years in our trauma centre. MATERIAL &amp; METHODS Descriptive study of trauma patients &gt;16 years admitted to our critical care unit (level 1 trauma centre) or dead before admission. Variables: demographic, mechanism, severity criteria, injuries and treatment, errors, missed injuries and mortality. RESULTS From 2006 to 2021, 2198 trauma patients were collected. 75.8% were men, with a mean age of 49 years, mean Charlson index was 1.48 ± 1.96 SD. Mean ISS was 19.3 ± 14.1 SD and 94.3% of the injuries were blunt. Most frequent injuries recorded were rib fractures, subarachnoid hemorrhage and vertebral fracture. 28.7% required urgent surgical treatment, while 8.3% underwent urgent arteriography. Overall mortality was 10.1%. Main causes of death were: neurological (54%) and hypovolemic shock (23%). Preventable mortality was 7.2% (0-2 deaths/year). 296 missed injuries were identified. Most common errors that lead to missed injuries were clinical (45.8%) and radiological (45.1%). In these 15 years, no significant changes in epidemiological data were identified. Although there were no differences in the overall mortality rate, changes on mortality pattern were identified (decrease in mortality during the first 24 hours as well as decrease in hypovolemic shock as a cause of death) There was also a decrease in the number of missed injuries and preventable mortality. CONCLUSIONS No relevant epidemiological differences have been observed in the last 15 years. The changes on the mortality pattern, and the decreasing of missed injuries and preventable mortality are probably related to better training of professionals. REFERENCES O"Reilly GM et al. Global trauma registry mapping: a scoping review. Injury. 2012 Jul;43(7):1148-53. 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

Prof.

Severe crush trauma with hemorrhagic shock: Where to look for the source of bleeding?

Abstract text (incl. references and figure legends) Introduction Crush injuries are always associated with multiple injuries. Outcomes are often poor due to the the severity of the injury, even with optimal treatment. Case presentation: 64-year-old male patient, crush trauma victim arrived intubated with severe hemodynamic instability after two episodes of cardiac arrest. EFAST was positive for left pneumothorax that was immediately drained. A trauma laparotomy was performed showing just a small amount of blood in right and left hypochondrium. Abdominal packing and of Bogota bag were performed with slight hemodynamic improvement. CT scan showed a right emo-pneumothorax and minimal pneumomediastinum. According to these finding a right pleural drainage was performed with leakage of abundant blood and air pressure. Therefore, the patient underwent urgent thoracotomy with evidence of diaphragmatic laceration through which there was a massive bleeding of probable hepatic origin due to disengagement and laceration of the right supra hepatic vein. Haemorrhagic control was obtained but the patient died immediately after due to another cardiac arrest. Discussion according to the ATLS the indications to emergency thoracotomy are: immediate drainage of 1500 ml of blood after chest drainage or initial blood &lt;1500ml but persistence of bleeding (200 ml/hour 2 to 4 hours). In our case, upon arrival the thoracic drainage did not charge large quantities of blood such as to indicate a massive haemothorax. It was the persistence of of hemodynamic instability, despite the negativity of abdominal surgical exploration, that led to an urgent, albeit late, thoracotomy. Conclusion: trauma of the supra hepatic veins are rare ad often fatal. However we have to keep in mind that in high energy trauma the bleeding source may be charged to one body district but give sign of if in another body district in light of the associated injuries. Therefore an aggressive surgical approach is the only one that allows to decrease the mortality rateDisclosure: 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.

Traumatic abdominal wall hernia as part of the seat-belt syndrome: A case report

Abstract text (incl. references and figure legends) CASE HISTORY A 34-year-old patient presented at the emergency department after suffering a vehicle collision. He was occupying the co-pilot seat and using the seat belt. The patient was transferred to Tertiary Referral Hospital. CLINICAL FINDINGS Initial assessment: A &amp; B: eupneic, not requiring intubation. C: hypotension that responded quickly after the infusion of 1000 ml of crystalloids. D: Glasgow Score 15/15. E: Abdominal seat belt sign. INVESTIGATION/RESULTS Initial gasometry revealed acidosis, haemoglobin 12.6 g/dL and hyperlactacidemia of 3.4 mmol/L. After hemodynamic stabilization, a bodyCT was performed. DIAGNOSIS Large posttraumatic hernia M4-5 and L3-4 W3 without active bleeding. THERAPY AND PROGRESSIONS The patient became unstable, so we decided to perform an exploratory laparotomy. A complete section of muscular bellies of the rectus abdominis at the arcuate line was found. Laterally, oblique musculature was also affected, being completely detached from the iliac crest. The patient also had a traumatic section of the rectosigmoid region. There was no active bleeding. Due to the instability, we decided to perform a damage control surgery, performing a packing, resection of damaged colon deferring the anastomosis, and placement of a mesh for fascial traction and ABTHERA© system. Definitive closure was deferred to POD 4 after 2 looks due to persistence of instability, performing colorectal anastomosis and wall reconstruction: bilateral TAR with placement of Bio-A mesh on the right side due to lack of peritoneum at this level and a polypropylene mesh. The mesh was fixed with bone anchors to iliac crest due to the oblique musculature detachment at this level. COMMENTS Optimal management of traumatic hernias remains to be defined. Timing of surgical repair should be based on patient&quot;s stability and concomitant lesions. REFERENCES LaPinska, M.P., Lewis, A. (2016). Open Flank Hernia Repair. In: Novitsky, Y. (eds) Hernia Surgery. Springer, Cham. 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.

Left traumatic diaphragmatic hernia: Single hollow viscus injury resulting from a car accident

Emergency surgery

Abstract text (incl. references and figure legends) Introduction: Traumatic diaphragmatic hernia is a condition in which the viscera located primarily intraabdominally migrate intrathoracically through a traumatic diaphragmatic opening. Despite being rare, it remains, a challenge because of a diagnoses delay and because in 90% of cases, is associated with multiple lesions with high morbidity and mortality. It is more common on the left side. An early diagnosis is essential because the best treatment is surgical intervention. Material and methods: Case report09/2022 Results: 26 yo, male, healthy . Victim of a high kinetic car accident, being the driver. At admission, SpO2 94%, tachycardic, hypertensive, GS 15. In the ER, he underwent chest X-ray with elevation of the left hemicupula and Efast without complications. After stabilization, a thoracoabdominopelvic CT was performed, with an elevation of the left hemicupula, with ascending hollow viscera (traumatic hernia). An exploratory laparoscopy was performed, finding a left traumatic diaphragmatic hernia with migration of the stomach, spleen and splenic angle of the colon; a periduodenal and transverse colon hematoma. Partial reduction of intrathoracic hollow viscera was performed with subsequent conversion to laparotomy. Primary repair of the diaphragm was performed with suture and subsequent packing. The patient was left with a laparostomy, which was reviewed at 24h, with the evidence of a hepatic laceration that was sutured and a decrease in the hematoma. There was no evidence of other injuries, with subsequent closure. Then the patient was discharged, fully recovered, without complications. Conclusion: Traumatic diaphragmatic hernia without injury to other hollow viscera is a rare condition. In this case, the early diagnosis allowed an early surgical intervention that resulted in a good outcome for the patient. References:Yeo C. et al, Shackelford&quot;s surgery of the alimentary tract, 8th edition; Zinner M et al, Maingot&quot;s Abdominal Operations, 13th editionDisclosure: 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

Management of pancreatic trauma in a tertiary care referral centre

Abstract text (incl. references and figure legends) Introduction Pancreatic trauma (PT) is an uncommon event often difficult to diagnose at an early stage. Pancreatic trauma occurs in approximately 4% abdominal trauma. The pancreas has an intimate relationship with the major upper abdominal vessels, and there is significant morbidity and mortality associated with severe pancreatic injury. Material &amp; Methods A retrospective study conducted between 2009 and 2021 in a tertiary care referral centre with 12 consecutive patients who presented to the emergency department with a history of abdominal trauma were registered. The CT findings and AAST grade of pancreatic injury, various intra-abdominal injuries and time elapsed since injury and other associated factors were analyzed. Results The median age was 28.5 (range: 20-44) years. In nine patients blunt abdominal trauma was the reason for PT, whereas penetrating trauma only occurred in three patients. Injury severity score was 11,16 (9-21). Of a total of 12 PT, 8 were grades II or I, 2 were grade III and 1 was grade IV. Procedures as i.e. an distal pancreatectomy or simple drainage were performed. Yet, parenchyma-sparing procedures demonstrated safety. Conclusions The diagnosis of pancreatic trauma requires a high index of suspicion and detailed imaging studies. Grading pancreatic injury is important to guide operative management. The most important prognostic factor is pancreatic duct disruption, and in these cases, experienced surgeons should be involved. Complications following pancreatic trauma are common and the majority can be managed without further surgery. References - Utility of serum pancreatic enzyme levels in diagnosing blunt trauma to the pancreas: a prospective study with systematic review. Injury. 2014 Sep;45(9):1384-93. - Clinical course and pancreas parenchyma sparing surgical treatment of severe pancreatic trauma. Injury.2020;51(9):1979-1986. 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

Predicting the survival in trauma patients using thromboelastographic parameters

Abstract text (incl. references and figure legends) Introduction The aim of the study is to identify related factors in mortality and blood transfusion in trauma patients using thromboelastography. Material and Methods It is a retrospective and observational study. The patients who visited the trauma center Uijeongbu Saint Mary's Hospital of the Catholic Medical University of Korea from March. 2018 to December. 2018 were enrolled. The exclusion criteria were &lt;19 years old, with severe burn injury, in pregnancy, and taking antiplatelets or anticoagulants. Totally 452 patients were included. We evaluated the thromboelastography(TEG) parameters and classic coagulation tests. The requirement of transfusion and mortality were also investigated. Results The mean age was 52.3 years and the mortality rate was 39/452 (8.6%). The independent factors associated with mortality were lower GCS, longer TEG K-time, and lower TEG MA. The lower MA group demonstrated the highest probability of survival (odds ratio 0.207), followed by prolonged R-time (odds ratio 0.220). The patient numbers in fibrinolysis shutdown (SD), physiologic fibrinolysis, and hyperfibrinolysis groups were 219 (52.3%), 131 (31.4%), and 68 (16.3%), respectively. The mortality rates of fibrinolysis SD group (11.9%) and hyperfibrinolysis (8.8%) were higher than the physiologic fibrinolysis groups (3.8%). The cutoff obtained from ROC analysis was found to be suitable for predicting survival. The transfusion requirements were significantly higher in the fibrinolysis SD group than in the other two groups Conclusion Compared to the classic coagulation tests, TEG-based parameters were more useful for making a diagnosis in coagulopathies and predicting the survival of the patients. Compared to the physiologic fibrinolysis group, the dysfunctional fibrinolysis group showed higher mortality. Using TEG parameters and integrating them, prompt diagnosis and treatment of coagulopathies would be possible. It would lead to a decrease in trauma patients' preventable deaths.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

Air rescue for pediatric trauma in a metropolitan region of brazil: Profiles, outcomes, and overtriage rates

Abstract text (incl. references and figure legends) Introduction: Helicopter rescue involves risks to staff and patients and has higher operational costs. Studying prehospital triage criteria, overtriage and outcomes could improve its use, providing better management of costs and risks. Our objective was to determine the epidemiologic profile and evaluate outcomes and overtriage rates of trauma victims aged &lt;18 years old (yo) rescued by helicopter in a Brazilian Metropolitan Area. Methods: Observational, retrospective study of 49 medical records from victims of trauma aged &lt;18 yo rescued by helicopter and transferred to a University Hospital. Results: 79.6% of the patients were male, with mean age of 11.3 yo. 30.6% of the traumas are due to vehicular collisions, and traumatic brain injuries occurred in 57.1%. A total of 59.1% patients had severe trauma (Injury Severity Score; ISS &gt;15), and 69.4% required admission to the intensive care unit. Overtriage varied from 18.4 to 40.8% depending on the criteria used, being more frequent in individuals between 1 and 5 yo. Death occurred in 20.4% patients. On prehospital evaluation, 90.6% of the patients presented severe trauma according to the Pediatric Trauma Score (PTS ≤8) and 72% according to the Revised Trauma Score (RTS ≤11). Of these, 24.1% and 33.3%, respectively, have ISS &lt;15. None of the patients with PTS &gt;8 and 42.8% of those with RTS &gt;11 have ISS &gt;15. Conclusion: Air rescue of pediatric trauma victims was used mainly for critically ill individuals, resulting in overtriage rates similar with that found in the literature. PTS showed the lowest rates of overtriage within excellent rates of undertriage. References: 1-Moront ML, et al. Helicopter transport of injured children: system effectiveness and triage criteria. J Pediatr Surg. (1996). 2-Mora MC, et al. Pediatric trauma triage: a pediatric trauma society research committee systematic review. J Trauma Acute Care Surg. (2020). 3-Michailidou M, et al. Helicopter overtriage in pediatric trauma. J Pediatr Surg. (2014).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

The reverse shock index multiplied by Glasgow coma scale (rSIG) is predictive of mortality in trauma patients according to age group

Education

Abstract text (incl. references and figure legends) Background The role of reverse shock index multiplied Glasgow coma scale (rSIG) in trauma patients with traumatic brain injury (TBI) has not yet been defined well. Our study aimed to investigate the predictive performance of rSIG according to age group. Method This is a prospective multi-national and multi-center cohort study using Pan-Asian Trauma Outcome Study registry in Asian-Pacific, conducted on trauma patients who visited participating hospitals. The main exposure was low rSIG measured at emergency department. The main outcome was in-hospital mortality. We performed multilevel logistic regression analysis to estimate the association low rSIG and study outcomes. Interaction analysis between rSIG and age group were also conducted. Results Low rSIG was significantly associated with an increase in in-hospital mortality in trauma patients with and without TBI (aOR (95% CI): 1.49 (1.04-2.13) and 1.71 (1.16-2.53), respectively). The ORs for in-hospital mortality differed according to the age group in trauma patients with TBI (1.72 (1.44-1.94) for the young group and 1.13 (1.07-1.52) for the old group; p&lt;0.05). Conclusion Low rSIG is associated with an increase in in-hospital mortality in adult trauma patients. However, in patients with TBI, the prediction of mortality is significantly better in younger patient group.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

Hanging by a hook

Abstract text (incl. references and figure legends) Introduction Despite current workplace protection measures, work-related acute injuries (eg, cuts, burns and falls) continue to be a substantial source of disability and lost work days around the world. Case report A 59-year-old male, anticoagulated with apixaban for atrial fibrillation, was admitted in emergency room after sustaining a perforating lesion by a 30cm iron hook on his right thigh. At admission he was hemodynamically stable, with a deep wound in the right inguinal area, with muscle exposure and without evidence of great vessels injury. A computed tomography (CT) revealed edema of the inner face of the right thigh, with abnormal gas and densification in the right inguinal and pubic region reaching the presacred fat. No lesions of the great vessels of the limb or anorectal involvement was observed. Abundant wound irrigation, passive drain placement and wound closure was performed after prophylactic antibiotic was given. The patient was discharged with local wound care and anti-inflammatory drugs and antibiotic. Despite the potential limb threatening outcome, this injury only affected soft tissue and the patient had a good recovering and could return to work after a few days. Discussion/Conclusion Work related injuries can have life-threatening outcomes and severe morbidity. It is important to exclude lesion of major structures when evaluating the patient on the initial trauma assessment. Furthermore, effective preventive measures, interventions and strategies at workplaces are essentials to adopt in order to reduce some of the potential mechanisms underlying the occurrence of occupational accidents.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

Complex perineal laceration caused by impalement

Abstract text (incl. references and figure legends) We present a case of a 42-year-old man who had a bicycle accident resulting in a complex perineal laceration caused by penetrating trauma with a sharp object. He was admitted to the emergency room with hemorrhagic shock. Latter is urgently operated with a multidisciplinary team including general surgery, orthopaedics and plastic surgery. He had an extensive perineal laceration from the base of the penis to the left pararectal region with the destruction of the anal sphincter and avulsive fracture of the left ischial tuberosity. The rectum wall was reconstructed, both sphincters, and a colostomy was performed. The patient was discharged 20 days after admission and was sent for consultation for pelvic floor rehabilitation, orthopaedics and general surgery. As of today, 6 months after the incident, he remains colostomized, with no deformities in the anal canal, but with sphincter hypotonicity. A complete study was requested with pelvic MRI, lower and upper digestive endoscopy and manometry, which we are awaiting completion.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

Extrapleural hematoma after blunt chest trauma

Abstract text (incl. references and figure legends) Case history An 83-year-old male was admitted to the emergency room after a fall from a ladder, resulting in right shoulder and right hemithorax trauma. The patient was submitted to a chest CT scan that showed a right clavicle fracture, fracture of 7 ribs on the right and a right extrapleural hematoma, with a 65 mm diameter. Conservative management was applied. Clinical findings However, on the fifth day the patient had an exacerbation of the dyspnea and the pain. Investigation/Results Another chest CT scan revealed an increase of the extrapleural hematoma dimensions, 103 x 61 mm, with no evidence of active hemorraghe. Diagnosis Increasing of the extrapleural hematoma. Therapy and Progressions Due to hemodynamic stability the patient was transfered to the Thoracic Surgery Department and submitted to drainage of the hematoma. Conclusion An extrapleural hematoma is a rare and potentially life-threatening condition defined as the accumulation of blood in the extrapleural space between the parietal pleura and the endothoracic fascia. It usually happens after blunt thoracic trauma that causes fractures of the sternum or the ribs, which can tear the intercostal or internal mammary vessels and is sometimes mistaken for hemothorax. The conservative approach can be done of taking in consideration the patient hemodynamic status and the available resources. References M.A. Rashid et al. Nomenclature, classification, and significance of traumatic extrapleural hematoma J Trauma (2000) J.Y. Jeong et al. Huge extrapleural hematoma by blunt trauma mimicking traumatic hemothora J Trauma Acute Care Surg (2012)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.

Severe Trauma due to train hit, needing emergent bilateral disarticulation of the lower limbs

Abstract text (incl. references and figure legends) We present the case of a 50-year-old man with a past medical history of anxiety and reference to problems at work. He was brought to the Resuscitation Room (RR) after being hit by a train, resulting in traumatic amputation of the left limb and partial amputation of the right limb with distal ischemia. Bilateral lower limbs (LL) tourniquet was applied, fluid resuscitation and tranexamic acid started and tracheal intubation was performed due to agitation and difficulty in pain management by the prehospital team. Primary assessment at RR showed: severe head and face trauma with multiple fractures of the facial bones, calvaria and basal skull, with suspected liquor fistula and pneumocephaly; vertebromedullary trauma with L5 transverse process fracture; upper extremities trauma with left scapula and forearm fractures; pelvic trauma with complex pelvic ring fractures; and lower extremities trauma with left femur amputation and open right femur fracture. Multidisciplinary trauma team, besides massive support, decided to perform bilateral amputation with disarticulation of the LL as a damage control strategy. He was afterwards transferred to the Intensive Care Department with diagnosis of severe multiple trauma with hemorrhagic shock requiring multiple transfusion, rhabdomyolysis and multiple-organ failure (neurological, respiratory, cardiovascular, renal and hematological). Intercurrent problems included type 2 acute myocardial infarction and ischemia and infection of the disarticulation stumps with secondary Enterococcus faecalis bacteremia, requiring antimicrobials and multiple surgical interventions. Regardless the severity of the case, the care provided allowed an overall favorable evolution, allowing extubation on the 20th day and discharge to the ward on the 27th day. The authors think that other strategies like the Resuscitative Endovascular Balloon Occlusion of the Aorta could be used in these situations and should be incorporated as resuscitative practices.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 Session 15
Polytrauma 4

Appointment

Chairs

Programme

Poster Session 15Polytrauma 4

Appointment

Chairs

Programme

Poster Session 15
Polytrauma 4