22nd European Congress of Trauma & Emergency Surgery

Prof.

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Prof. Dr.

C-reactive protein/albumin ratio (CAR) for the prediction of long-term clinical outcomes in patients with mild traumatic brain injury

Abstract text (incl. references and figure legends) Introduction The CRP albumin ratio (CAR), a novel inflammation-based prognostic score, is useful in predicting clinical outcomes, including those in central nervous system diseases. However, no report has identified the relationship between CAR and long-term clinical outcomes in patients with mild TBI (mTBI). We aimed to evaluate the relationship between CAR and long-term functional outcomes in patients with mTBI and analyze whether CAR is associated with the presence of fever. Methods This was a retrospective observational study on adult patients with mTBI who were transported to a level-1 trauma center between 2017 and 2021. The main exposure variable was an elevated CAR, and the main outcomes were degrees of disability and quality of life measured using the modified Rankin scale (mRs). A multivariable logistic regression analysis was performed to estimate the effect size of CAR on study outcomes. An interaction analysis was performed between CAR and fever on study outcomes. Results Elevated CAR had no significant association with poor functional outcomes (aOR [95% CI]: 1.35 [0.39–4.69]). In the interaction analysis, elevated CAR was not associated with increased poor functional outcomes in the absence of fever (1.08 [0.55–2.13]), but a significant increase in poor functional outcomes was observed when elevated CAR was accompanied by fever (1.32 (1.14-2.56)). Conclusions Elevated CAR with fever increased the risk of poor functional recovery at 6 months after hospital discharge in patients with mTBI. Our study findings form the basis of suggesting the need for strategies for the prevention of long-term poor functional recovery in the presence of CAR elevation and fever in patients with mTBI.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

Poster

A study of blunt severe trauma cases in the elderly: Single-center, retrospective analysis

Abstract text (incl. references and figure legends) Introduction: Japan has been progressing toward an aging society in recent years. In this study, we examined the physiological and anatomical status and outcome of elderly patients with blunt trauma who were admitted to our hospital. Material &amp; Methods: This observational study is a retrospective analysis of data from patients admitted and treated at our hospital and enrolled in a nationwide hospital-based database called the Japan Trauma Data Bank (JTDB). In this study, we collected the accident type the anatomical and physiological situations of injury, and outcomes. A total of 4647 patients were registered in the JTDB from 2011 to 2019 in our hospital. 2472 of Patients between 65 and 74 years old (Group A), and over 75 years old (Group B) were selected in the analysis. Results: Physiological comparisons between group A and group B showed that group B had a significantly higher proportion of women and significantly higher systolic blood pressure and body temperature at arrival to hospital. The rate of alcohol consumption and Focused Assessment with Sonography for Trauma (FAST) positive were significantly higher in group A. Injury Severity Score (ISS) and AIS of head, face, neck, chest, abdomen, spine, and upper extremities were significantly higher in group A. Independent factors attributed to death were head AIS in group A, whereas FAST positive and AIS of head, chest, and spine. Conclusions: Blunt trauma among the elderly is often caused by traffic accidents and alcohol consumption, and it is necessary for society to create an environment that protects the elderly from traffic accidents. Anatomical head injuries are associated with death in both groups, so it is important to prevent head injuries. In addition, it is important to prevent thoracic and spinal injuries in the elderly over 75 years of age. References: Elderly trauma: the two years experience of a university-affiliated emergency department. Yildiz M. Eur Rev Med Pharmacol Sci. 2012; 16: 62-7. 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

Training the trauma team – Why we need to focus on ton-technical skills

Abstract text (incl. references and figure legends) Introduction: Trauma teams improve patients' outcome. Team function requires attention to non-technical skills and regular training in simulation-based programs can improve non-technical skills, teamwork and team cohesion. Our aim was to present the initial experience of an original, dedicated trauma team training program in a level 1 trauma center. Material &amp; Methods: Since April 2021, eight editions of an original trauma team training course were held, training 82 trauma team members (46 female, median age 45 years old; 54 doctors and 28 nurses). Most common specialties: general surgery (22), intensive care medicine (18) and anesthesiology (10). The candidates organized trauma teams with a prearrival briefing. After initial assessment and decision for transfer, the scenario concluded, and the faculty led a debriefing focusing on non-technical skills. The participants answered a voluntary post course survey and 56 answers were collected (68% compliance rate). Results: We found an increase in self perceived comfort in trauma management and in overall team performance. Candidates reported that the prearrival briefing of the team, as well as the post-resuscitation debriefing, were key components of the team function. Conclusions: This initial experience demonstrates that a local in-house trauma team training course, designed according to local protocols and focusing on non-technical skills, can improve team member perceptions on the role of teamwork. References Gillman LM, Brindley PG, Blaivas M, Widder S, Karakitsos D. Trauma team dynamics. Journal of Critical Care. 2016;32:218–21. D T Risser, et al. The Potential for Improved Teamwork to Reduce Medical Errors in the Emergency Department. The MedTeams Research Consortium. Ann Emerg Med. 1999;34(3):373–83. Gerardo CJ, et al. The rapid impact on mortality rates of a dedicated care team including trauma and emergency physicians at an Academic Medical Center. J Emerg Med. 2011;40(5):586–91.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

Visceral trauma

Modification of the TRISS: Simple and practical mortality prediction after trauma in an all-inclusive registry

Abstract text (incl. references and figure legends) Numerous studies have modified the Trauma Injury and Severity Score (TRISS) to improve its predictive accuracy for specific trauma populations. The aim of this study was to develop and validate a simple and practical prediction model that accurately predicts mortality for all acute trauma admissions. This retrospective study used Dutch National Trauma Registry data recorded between 2015 and 2018. New models were developed based on nonlinear transformations of TRISS variables (age, systolic blood pressure (SBP), Glasgow Coma Score (GCS) and Injury Severity Score (ISS)), the New Injury Severity Score (NISS), the sex*age interaction, the best motor response (BMR) and the American Society of Anesthesiologists (ASA) physical status classification. The models were validated in 2018 data and for specific patient subgroups. The models&quot; performance was assessed based on discrimination (areas under the curve (AUCs)) and by calibration plots. Multiple imputation was applied to account for missing values. The mortality rates in the development and validation datasets were 2.3% (5709/245363) and 2.5% (1959/77343), respectively. A model with sex, ASA class, and nonlinear transformations of age, SBP, the ISS and the BMR showed significantly better discrimination than the TRISS (AUC 0.915 vs. 0.861). This model was well calibrated and demonstrated good discrimination in different subsets of patients, including isolated hip fractures patients (AUC:0.796), elderly (AUC:0.835), less severely injured (ISS16) (AUC:878), severely injured (ISS≥16) (AUC:0.889), traumatic brain injury (AUC:0.910). Moreover, discrimination for patients admitted to the intensive care (AUC:0.846), and for both non-major and major trauma center patients was excellent, with AUCs of 0.940 and 0.895, respectively. This study presents a simple and practical mortality prediction model that performed well for important subgroups of patients as well as for the heterogeneous population of all acute trauma admissions in the Netherlands. Because this model includes widely available predictors, it can also be used for international evaluations of trauma care within institutions and trauma systems.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.) All authors declare to have no conflict of interest, including financial, consultant, institutional, and other relationships that might lead to bias or a conflict of interest.

Emergency surgery

Emergency general surgery – A novel training opportunity

Abstract text (incl. references and figure legends) Introduction Emergency General Surgery (EGS) is not yet recognised as a subspecialty interest by The Joint Committee on Surgical Training (JCST) and trainees have not previously been assigned to EGS departments in our deanery. This pilot study aims to evaluate whether a placement in an EGS department is able to meet the training needs of the UK higher surgical curriculum. Additionally, we propose JCST-style training requirements for a General Surgery trainee with a subspecialty interest in EGS. Material and Methods The objective logbook and portfolio material and subjective training experience of a ST5 General Surgery StR placed with a EGS department for 6 months is presented and evaluated against higher surgical trainees working in other subspecialties. Results 141 operations were recorded, with 85 (60%) performed as primary surgeon between 06/04/22 - 04/10/22. This was compared to an average of 138 operations with 58 (42%) performed as primary surgeon amongst other trainees. Index procedures performed as primary surgeon included 13 inguinal hernia, 17 cholecystectomy, 5 segmental colectomy, 17 appendicectomy, 13 emergency laparotomy and 1 Hartmann's. This was compared to an average of 2 inguinal hernia, 8 cholecystectomy, 7 segmental colectomy, 14 appendicectomy, 10 emergency laparotomy and 2 Hartmann's by other trainees. Conclusion This study objectively demonstrates that equivalent training outcomes can be achieved in a EGS department for the indicative operative numbers and assessments that are currently measured for surgical trainees in the UK. In particular, a higher proportion of primary surgeon operating and index procedures were reported. In order to train and shape the EGS Consultants of the future, a new set of EGS-subspecialty outcomes should be developed, with emphasis on assessment of competency in procedures such as hot cholecystectomy, incarcerated hernia, bile duct exploration, emergency laparotomy and abdominal wall reconstruction.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

Non-traumatic splenic rupture – A rare first presentation of Malaria

Abstract text (incl. references and figure legends) Introduction: It is important for physicians to know the clinical course of malaria, since it is an uncommon disease in developed countries but travelers can also be exposed. The spleen can harbour parasites that can cause recurrent infection, leading to splenomegaly and rupture of the spleen. During the course of severe malaria, spontaneous rupture of the spleen is a rare but potentially life-threatening complication. There is no doubt that being aware is of utmost importance, since a delayed or missed diagnosis can have fatal consequences for the patient. Most of the splenic ruptures have been associated with Plasmodium vivax; however, on rare occasions, other Plasmodium infections have also resulted in the rupture of the spleen. Results: We report a case of a 45 years old male, who traveled from Angola to Portugal, that went to the Emergency room with generalized abdominal pain, predominantly epigastric, fever and purulent cough, with 76/54mmHg blood pressure and a heart rate of 115 bpm. Blood tests revealed: Hemoglobin 11,9 g/dL; P. falciparum 5%; platelets 35000/uL; Type 1 respiratory insufficiency; Lactats 2,9 mmol/L. CT scan showed signs of splenic rupture, with a volumous perisplenic hematoma, with blush, and a moderate volume hemoperitoneum. An angiography was performed and showed no active hemorraghy. It was then admitted to an ICU unit to perform vigilance. After 2 days, the Hb went to 8,3 g/dL and become stable after. It was discharged 16 days later, asymptomatic with Hb 8,9 g/dL. Conclusion: Spontaneous splenic hemorrhage is a rare complication of infectious diseases in western world. Due to the life threatning complications, the clinician should be aware of the pathology to rapidly diagnose and treat. In this particular case, a conservative treatment was successful in a severe case of malaria.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

Society-based research and publication ethical challenges – The case of multinational societies such as the european society of trauma and emergency surgery

Abstract text (incl. references and figure legends) Introduction: Academic publications are increasing at an exponential rate every year. ESTES is an academic society that aims to disseminate knowledge on the epidemiology, pathophysiology, and treatment of trauma and emergency surgery. The annual congress and the European Journal of Trauma and Emergency Surgery are its primary vehicles. This study aimed to evaluate possible challenges specific to society-based research and society-based publications. Material &amp; Methods: This was a review of research and publication ethics literature. Issues that may be related to society-based research and publications were identified or extrapolated from relevant sources. Results: The main issues identified in multinational society-based research are the lack of uniformity of laws and regulations concerning research ethics approval across different countries. Another problem is the validation of the tools. The main issues with publication ethics relate to inappropriate peer review and conflicts of interest that may lead to increased bias in publication. Conclusions: Multinational society-based research shares with research from other setups many ethical problems. Solutions exist. Still, the structure of a closed society where members come from different countries but are also acquainted with each other limits the applicability of many agreed-upon solutions, leaving many ethical problems not fully resolved. The different problems and possible solutions will be discussed.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

When not to operate with significant pneumoperitoneum as an emergency surgeon

Abstract text (incl. references and figure legends) Case History A 83 old man reffered to our District General Hospital following a CT Abdomen and Pelvis with large pneumoperitoneum, Ct was conducted in a different tertiary center 4 days ago Clinical findings The patient was clinically asymptomatic and his bloods were unremarkable with normal crp Investigations / Result His Ct Abdomen and pelvis with contrast showed evidence of bowel perforation and intramural gas effecting mainly jejunum area indicative of ischemic changes Diagnosis Radiologically there was suspicion of bowel perforation and evidence of intramural gas mainly jejunal loop suspicious of ischemic changes . There was impression of linear filling defect in superior mesenteric artery which raised supicion of thrmbus Therapy and Progression After careful multi disciplinary meetings and discussions with radiologist and CT scans with oral contrasts he was managed conservatively and discharged after 2 weeks with a further repeat Ct scan . Comments Despite radiological evidence of extensive pneumoperitoneum, the patient was clinically stable with no abdominal signs, therefore he was managed with close observation, repeat bloods, and radiological imaging, rather than agressive operative approach Team approach, discussion with colleagues, careful monitoring of lactate, inflammatory markers, nutritional support, Ct with oral and intravenous contrast can save negative laprotomy in sub group of elderly patients with multiple co-morbidities like in our case where our pateint was having prostate cancer and multiple metastasis. References Int J Surg Case Rep . 2019;63:10-12.doi: 10.1016/j.ijscr.2019.08.015. Epub 2019 Aug 17. The clinical dilemma of the persistent idiopathic pneumoperitoneum: A case report Enda Hannan 1, Eltaib Saad 2, Shu Hoashi 2, Desmond Toomey 2 1Department of General Surgery, Regional Hospital Mullingar, Ireland. Electronic address: endahannan@rcsi.ie. PMID: 31499325 PMCID: PMC6734534 DOI: 10.1016/j.ijscr.2019.08.015 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

Comparative analysis of the impact of Covid-19 pandemic on road traffic injuries with fatal victims in Campinas – Brazil

Abstract text (incl. references and figure legends) Worldwide the major impact of the COVID-19 pandemic overlapping other difficulties that already exist in the health systems.In Brazil, deaths for external cause are in the third position among all deaths. Road traffic injuries remain a seriously global health problem which causes 1.35 million deaths per year. At the end of the 2019, the world population observed the first reported cases of a respiratory distress syndrome whose spread swiftly and globally from China. In addition to the severity of the virus infection, the pandemic significantly and directly affects the community health, behaviors, social relationships, and economy. In Brazil, there are no data correlating the numbers for traffic injuries with fatal victims after the establishment of COVID-19 pandemic. Descriptive retrospective analysis of epidemiological bulletin records was divided into two groups for population study and the variables analyzed in 839 days of pandemic. Group I pré pandemic, Group II pandemic. Variables analyzed for of trauma mechanism, epidemiology, alcohol consumption, mortality, type of vehicle, day of week and period day of the collision. Traffic volume dropped during the pandemic in Campinas, there was also a drop in the number of admitted patients hospitals related to road traffic injuries. Figure 01 and 02 represent the results. While the traffic volume dropped, notably, traffic deaths remained stable despite the effect of the COVID-19 pandemic effects and the lockdown periods. Overall, with a predominance of motorcycle collisions and increased the bicycle collision. Our findings serve as a baseline for urgent traffic injury prevention programs.Fig1:Percentage share of deaths by type of vehicle involved in traffic road injuries. Fig2: Comparison between pré pandemic and pandemic group. Yasin YJ, Grivna M, Abu-Zidan FM. Global impact of COVID-19 pandemic on road traffic collisions. World J Emerg Surg. 2021 Sep 28;16(1):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"

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Poster Session 2
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