22nd European Congress of Trauma & Emergency Surgery

Professor

Chairs

Prof.

Validation of the Swedish trauma registry (SweTrau)

Abstract text (incl. references and figure legends) Introduction Validation of registries is essential to ensure solid and reliable research data. This is often done by comparisons of the original registry data with other sources, e.g. another registry or re-registration of data. The Swedish Trauma Registry (SweTrau) [1] was founded in 2011, with variables based on international consensus (the Utstein Template of Trauma [2]). This project aimed to perform the first validation of the SweTrau registry. Material &amp; Methods On-site re-registration was performed on a number of randomly selected trauma patients and compared with the original registration in SweTrau. Accuracy (exact agreement), correctness (exact agreement plus data within acceptable range), comparability (similarity with other registries), data completeness (1-missing data) and case completeness (1-missing cases) were determined as good (85%), adequate (70-84%) or poor (&lt;70%). Correlation was deemed as either excellent (0.8), strong (0.6-0.79), moderate (0.4-0.59) or weak (&lt;0.4). Results The data in SweTrau had a strong to excellent correlation (87.5%), with good data completeness (88.5%), accuracy (85.8%) and correctness (89.7%). Median time to registration was 4.5 months, with 84.2% registered after one year. Case completeness was 44.3%, however; for NISS&gt;15, case completeness was 100%. The comparability showed an accordance with the Utstein Template of Trauma of almost 90%. Conclusions The validity of SweTrau is good, with high accuracy, correctness, data completeness and correlation. The data is comparable to other trauma registries using the Utstein Template of Trauma; however, timeliness and case completeness are areas of improvement. References Swedish Trauma Registry (SweTrau). 2020 07-26-2020]; Available from: http://rcsyd.se/swetrau/. Ringdal, K.G., et al., The Utstein template for uniform reporting of data following major trauma: a joint revision by SCANTEM, TARN, DGU-TR and RITG. Scand J Trauma Resusc Emerg Med, 2008. 16: p. 7. 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

Education

Polytrauma

Quick shot presentation

Anticoagulation reversal: The current treatment landscape and unmet needs in the USA

Abstract text (incl. references and figure legends) Introduction Specific direct oral anticoagulation (DOAC) inhibitors and 4-factor prothrombin complex concentrates (4F-PCCs) may be used for urgent anticoagulation reversal owing to major bleeding/surgery. However, guidelines acknowledge the need for consistent and appropriate use of DOAC reversal agents.1 This market research study aimed to examine real-world treatment patterns of anticoagulation reversal in the USA. Materials &amp; Methods This double-blind study recruited healthcare professionals (HCPs) and pharmacy and therapeutics (P&amp;T) committee members (July–August 2021) to gain their insights on the anticoagulation reversal treatment landscape in the USA and identify any unmet needs associated with the current standard of care. Data were gathered from 60-min telephone interviews based on two discussion guides and conducted by an independent research firm. All participants received a fee. Results In total, 18 HCPs and 6 P&amp;T committee members were interviewed (Fig. 1). Data showed that the disease burden was dependent on the site/severity of bleed and type of anticoagulation reversal agent; gastrointestinal and intracranial bleeds were most common. The cost of treatment was considered higher in patients with intracranial bleeds versus other bleeds. The efficacy, safety and availability in the hospital formulary were key in driving the choice of reversal agent (Fig. 2). The need to add an indication specific to DOAC reversal to the 4F-PCC label was rated between 5 and 7 by 50% (9/18) of HCPs (1=least important; 7=most important). HCPs agreed there is a need for a regulatory-approved reversal agent with improved efficacy and thromboembolic safety, reduced reconstitution time, a DOAC-level detection assay to guide treatment decisions, and availability of a universal reversal agent. Conclusions There is an unmet need for an effective, feasible and universal regulatory-approved agent for rapid anticoagulation reversal. References Cuker A et al. Am J Hematol 2019;94:697–709. 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.) Conflicts of interest CA and DR are employees of Takeda Development Center Americas, Inc., as well as a stockholder of Takeda Pharmaceutical Company Limited. HA is an employee of Massachusetts General Hospital and Takeda Development Center Americas, Inc., as well as a stockholder of Takeda Pharmaceutical Company Limited. MKK is an employee of Takeda Pharmaceuticals International AG and a stockholder of Takeda Pharmaceutical Company Limited. This study was funded by Takeda Pharmaceuticals USA, Inc. Medical writing support was provided by Jessica Boles, PhD, of PharmaGenesis London, London, UK, and funded by Takeda Pharmaceuticals International AG.

Emergency surgery

Pediatric adjusted shock index as a predictor of mortality by sex disparity in pediatric trauma: A pan-asian trauma outcome study (PATOS)

Abstract text (incl. references and figure legends) Background There were no reports of sex-specific, pediatric age-adjusted shock index (PASI) for pediatric trauma patients in previous studies. We aimed to determined the association of PASI and in-hospital mortality of pediatric trauma patients and whether this association is differ depending on sex. Methods This is a prospective multi-national and multi-center cohort study using Pan-Asian Trauma Outcome Study (PATOS) registry in Asian-Pacific, conducted on pediatric patients who visited participating hospitals. The main exposure of our study was abnormal (elevated) PASI meausured at emergency department (ED). The main outcomes were in-hospital mortality. We performed multivariable logistic regression analysis to estimated the association abnormal PASI and study outcomes after adjusting potential confounders. Interaction analysis between PASI and sex were also conducted. Results A total 6,280 pediatric trauma patients, 10.9% (686/6,280) patients had abnormal PASI. In multivariable logistic regression analysis, abnormal PASI significantly associated with increasing in-hospital mortality (aORs (95% CI): 1.71 (1.16—2.53)). The abnormal PASI had interaction effects with sex for in-hospital mortality (1.86 (1.18—2.92) for male and 1.38 (0.64—2.95) for female (p for interaction&lt;0.01)). Conclusions Abnormal PASI is associated with increase in-hospital mortality in pediatric trauma patients. The prediction power of PASI on in-hospital mortality was maintained only in the male patients. Further studies on sex-specific shock index, as well as age-specific, are needed.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

Intensivist performed compression ultrasound for early detection of deep venous thrombosis in critically ill trauma patients – Prospective cohort study

Abstract text (incl. references and figure legends) Background: Venous thrombo-embolism (VTE) is a serious, potentially preventable, complication of trauma. The aim of this study was to assess the value of bedside Compression Ultrasound performed by trauma intensivists (IPCUS) in detecting early deep venous thrombosis (DVT) in the trauma intensive care units. The secondary aim was to assess risk factors for DVT and its complications in trauma patients. Materials and Method: We enrolled 362 trauma patients (Nov 1, 2021- June 12, 2022) utilizing IPCUS on Days 0,3,7,14,21 and 28 post admission. Hematology studies including ROTEM and D-Dimer were done on the initial three screening days. Scanning was continued until the patients were discharged, ambulated, therapeutically anticoagulated, completed 28 days of hospital stay, or died. Patients who became ambulatory or were discharged prior to 28 days were followed up clinically as outpatient. Patients with positive or equivocal IPCUS had confirmatory Duplex scan. All pulmonary embolisms (PE) were confirmed by computerized tomographic pulmonary angiograms. Results: The incidence of VTE in our cohort was 4.7% (Only DVT: 1.4%, only PE: 2.5%, concomitant DVT &amp; PE: 0.8%). All IPCUS detected DVT"s were confirmed by Duplex (n=7), All equivocal results on IPCUS were confirmed negative by Duplex (n=7), 1 patient with negative IPCUS proved to have a clot in the Posterior Tibial vein by Duplex. In the 9 patients with PE without DVT, DVT was ruled out by IPCUS in 9 and Duplex in 7 (In two patients Duplex scanning was missed).The median time post admission for diagnosing DVT was 4.5 days (0-17) and for PE was 2.5 days (0-19). Patients who developed VTE had higher Injury Severity Score, admission Lactate, more central venous lines inserted in the first 24 hours, and delay in the initiation of VTE chemo- prophylaxis. Conclusion: Our interim analysis showed that bedside Intensivist Performed Compression Ultrasound (IPCUS) is a valuable time-effective tool for early detection of DVT.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 conflict to declare

Visceral trauma

Is thoracic endovascular aortic repair after 24 hours risky in patients with traumatic thoracic aortic injury?

Abstract text (incl. references and figure legends) Introduction Traumatic thoracic aortic injury is the second leading cause of mortality among patients with multiple trauma. Recently, thoracic endovascular aortic repair (TEVAR) has been used as a treatment option. In trauma patients, it may be challenging to repair immediately if hemodynamically unstable. Therefore, we aim to investigate the outcomes of patients who underwent immediate and delayed TEVAR. Material &amp; Methods Among the patients who visited the trauma center from January 2012 to July 2022, we retrospectively analyzed the medical records of patients who underwent TEVAR. We divided patients into a group with time from admission to procedure within 24 hours and a group after 24 hours. And complications such as in-hospital and endoleak were identified. Results From January 2012 to July 2022, a total of 31 patients out of 83 patients who visited the trauma center for traumatic thoracic aortic injury underwent TEVAR (80.6% males, mean age 58 years). The average ISS was 37.69. Among them, 18 were in the group within 24 hours of admission to the procedure, and 13 were in the group after 24 hours. There were no statistical differences in initial vital signs, Glasgow Coma Scale score, injury severity score, and aortic injury grades between the two groups. There was a significant difference in vasoactive inotropic score (VIS) in the group within 24 hours (9.33) and in the group after 24 hours (26.02) (p=0.068). Two deaths and 3 patients with endoleak were confirmed only in the within 24 hours group. Conclusions Even if TEVAR is performed after resuscitation in multiple trauma patients with high VIS, the incidence of complications, such as death or endoleak does not increase. References Marcaccio CL, Dumas RP, Huang Y, Yang W, Wang GJ, Holena DN. Delayed endovascular aortic repair is associated with reduced in-hospital mortality in patients with blunt thoracic aortic injury. Journal of vascular surgery. 2018;68(1):64-73.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

Dr. med.

Prof. Dr. med.

PD Dr.

Prof. Dr.

Functional outcome after single vs. double sacroiliac screw fixation for lateral compression-type pelvic ring injuries

Abstract text (incl. references and figure legends) Introduction Lateral compression (LC) fractures are the commonest pelvic ring injury. Sacroiliac (SI) screws are used for posterior pelvic ring stabilization. Dual SI-screw stabilization (S1 plus S2) is associated with superior biomechanical properties compared with single SI-screw-stabilizations (S1-only). The current study aimed to compare functional outcome of single and dual SI-screws for LC-fractures. Material&amp;Methods A retrospective study of patients treated with SI-screw stabilization of traumatic LC-fractures at a level 1 trauma center was performed. Patients were grouped based on applied treatment modality (Gr. S1: S1-screw only vs. Gr. Dual: S1 and S2-screws). Clinical and functional outcome were compared. Results 93 patients have been included. Groups had similar patient and trauma characteristics and a pooled ISS of 18 was found. Gr. S1 consisted of 19 patients, whereas Gr. Dual included 74 individuals. LC-1 fractures were diagnosed most frequently (N=46), 38 patients had LC-2 fractures and 9 patients had LC-3 injuries. Screw loosening/malpositioning/breakage and reoperation rates did not differ between groups. Equal hospitalization times were found as well: Gr. S1: 17(10) days vs. 15 (10) days in Gr. Dual (P=0.41). At discharge, the ability to sit/stand independently did not differ (respectively: Gr. S1: 83/17% vs. Gr. Dual: 71/28%, P= 0.41/0.55. Significantly more patients from the Dual-group were discharged home than from the S1-group (28% vs. 5%, P=0.002). Conclusion This study shows that both single S1 and dual (S1 and S2) percutaneous SI-screw fixation for LC-fractures are feasible treatment options. Hardware-related complications as well as functional outcome are very similar. Interestingly, dual screw-fixation is associated with more discharge to home. Future studies should focus on the identification of patients who benefit most from single or dual SI-screw stabilizations.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.

"Doing the same with less": Assessment the clinical outcomes of artisanal or commercial negative pressure systems for trauma patients with delayed abdominal closure

Abstract text (incl. references and figure legends) Introduction: Negative pressure system (NPS) has been proposed as a tool for delayed abdominal closure in patients with severe trauma and hemodynamic instability. The potential benefits of NPS are prevention of abdominal compartment syndrome, control of contamination, wound healing, and bridge to definitive management. However, NPS has evolved from a self-made proposal like Barker&quot;s vacuum pack to commercial systems. A gradual transition was made at our institution from self-made to commercial NPS between 2011 to 2017. This study aims to assess the clinical outcomes of trauma patients undergoing self-made or commercial NPS with delayed abdominal closure. Methods: A retrospective, single-center study was performed in a high-complexity trauma center in Cali, Colombia. Trauma patients undergoing damage control surgery with delayed abdominal closure between 2011 and 2019 were included. Patients were classified according to the NPS: self-made (Wittman Patch or Barker&quot;s Vacuum Pack) and commercial (VAC system of ABThera VAC System). Variables such as injury severity, time to definitive closure, complications, and mortality were analyzed. Results: A total of 184 patients were included, 75 with self-made NPS and 109 with commercial NPS. Median of age was 29(IQR:23-41) years. Penetrating trauma was the most common mechanism in 85.9%(158/184). There was no difference between groups in injury severity [ISS median(IQR): Self-made 25(17-33) vs. Commercial 21(16-26)]. Time to definitive closure was 3(IQR:4-11) days, with no differences between groups (Log-rank test 0.439). The proportion of complications such as organic dysfunction, peritonitis, and intestinal fistula was not different. In-hospital mortality was 2.7%(5/184). Conclusions: There is no difference between the self-made and commercial NPS for delayed abdominal closure in terms of time to definitive closure, complications, and mortality.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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