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23rd European Congress of Trauma & Emergency Surgery

Prof.

Ass. Prof.

Heat buildup in the bone drilling zone: Machine vs. human

Research

Education

Introduction: The principal operative fracture treatment is open reduction and internal fixation during which the plate is fixed to the bone by screws placed into predrilled holes. The highest rise in the temperature of the bone has been measured around the drilling point and it declines as the distances from the drilling point increases. The temperature of 47oC during one minute causes irreversible changes to bone structure and function which makes absolute fragment stability, one of the basic requirements of primary bone healing, unattainable. Objectives: So far, research has been able to establish the optimal conditions for bone drilling with standard surgical drills so the smallest rise in the bone temperature would be caused, but that research has been based on the linear motion of the drill exclusively. In the clinical environment the direction of the drilling depends on the surgeon, so it is not always possible to maintain a constant direction. Materials and metodes: The influence of hand-controlled drilling on the heat buildup in the drilling zone was analyzed systematically in cadaver bovine bones and it is compared with machine guided drill Results: It has been found that hand guided drill produces more heat compared to machine-controlled drilling Conclusion: The results of this research have a significant clinical impact: the implementation of the automatic bone drilling systems could reduce the occurrence of complications in bone and joint surgery connected to thermally induced bone damage that leads to destabilization of osteosynthesis materials.No

Poster

Prof. Dr.

Deferred consent in emergency trauma research: A qualitative study assessing the healthcare professional‘s opinion

Trauma and Emergency surgery | Miscellaneous

Introduction: Severely injured patients are often incapacitated to provide informed consent for clinical studies. Deferred consent could facilitate unbiased enrollment in studies involving these patients. Little is known about how healthcare professionals (HCPs) perceive deferred consent and how this impacts patient enrollment. The aim of this study was to identify factors that could influence HCPs decision-making during recruitment of patients for interventional studies in (pre)hospital emergency trauma research. Material &amp; Methods: This was a qualitative study in which physicians and nurses working in prehospital or in-hospital care were interviewed using a semi-structured interview guide. Interviews were audio-recorded, transcribed, and analyzed according to thematic analysis as described by Braun and Clarke. Results: Ten semi-structured interviews were conducted with six physicians and four nurses. Eight themes were identified as being relevant consent related factors influencing HCPs&quot; decision-making during patient recruitment in studies using deferred consent: 1) HCPs&quot; lack of knowledge; 2) Patients&quot; and proxies&quot; inability to be informed; 3) Practical (im)possibilities for informed consent; 4) Nature of intervention; 5) HCPs&quot; personal beliefs; 6) Importance of emergency care research; 7) HCPs&quot; trust in legal base; and 8) Communication and collaboration. Conclusions: Eight consent-related factors influencing HCPs&quot; decision making were identified. Insufficient knowledge about consent procedures among HCPs leads to significant negative attitudes towards deferred consent. References: None in abstract No

Efficacy of fibrinogen level correction in short- and long-term mortality of hypofibrinogenic traumatic patients with an injury severity score matched control group

Emergency surgery

Introduction. Fibrinogen concentrate (FC) is frequently used to treat bleeding trauma patients, while limited studies have examined its effect on mortality in patients with hypofibrinogenemia. This study aims to evaluate the effect of fibrinogen on short and long-term mortality and morbidity of patients with hypofibrinogenemia. Materials and Methods. This retrospective single-center study included patients ≥16 years old with multiple blunt traumas and hypofibrinogenemia (fibrinogen levels ≤ 150mg / dL). The study group received 1 gram of FC within one hour of admission, while the control group did not. In both groups, the sampling was unified based on Injury Severity Score (ISS) and Glasgow Coma Score (GCS), then the short-term (within the first 24 hours) and long-term mortality rates (after 24 hours) were compared. Results. 138 patients were enrolled (Case and Control groups: 41 and 97). In the short-term mortality study, the prevalence of death in the study group was 0% vs. 7.2% in the control group, but this difference was not statistically significant (p&gt;0.05). Likewise, the groups' need for intensive care unit (ICU) or surgery was similar during the first 24 hours (p&gt;0.05). In the long term, the admission rate to the ICU and length of stay in the ICU were significantly higher in the FC-receiving group than in the control group (p&lt;0.05). However, the need for surgery (19.5% in the study group versus 27.8%), the blood products (84.5% in the study group versus 72.9%), and the prevalence of death (36.6% vs 38.1%) did not show a significant difference between the two groups in the long term (p&lt;0.05). Conclusions. The present study indicates that using FC does not significantly affect short- and long-term mortality rates among traumatic patients with hypofibrinogenemia. FC administration even increases ICU admission in the long-term period. No

The epidemiology, trends and outcomes of off-road vehicle injuries [ORIVs]: An analysis of national trauma registry data

Introduction Off-road vehicle use in the Arabian Gulf is wholly recreational and a cause of preventable death and disability. Current and up-to-date epidemiologic information on this mechanism of injury is needed to inform injury prevention programs. Objective To analyze the epidemiology, trends and outcomes of ORVI patients treated at a national trauma center. Materials and Methods The national trauma registry was queried for epidemiologic and outcome data on all patients with moderate to severe ORVIs, seeking hospitalization and/or care at the Hamad Trauma Center from January 1, 2009 to December 31, 2019. Results There were 725 ORVIs during the study period, 80% were male, 20% were adolescents [12-15 years]. All-terrain vehicles [ATV] crashes made up 88% and 12% from motor vehicle crashes [MVC]. MVC were almost entirely rollovers, victims were older, almost entirely male and had a higher ISS and mortality. There was a 61% increase in ORVIs, ATVs increased by 46% and MVCs increased by 333%, during the study period, most noted in the 12-15 year olds and females. Conclusion ORVIs are increasing with the most marked increase in MVCs. ATVs safety must be emphasized for the younger population, adolescents and females. Off-road MVC safety must emphasize proven efforts to prevent rollovers and focused on an older, male population.No

An epidemiologic evaluation of alcohol-related trauma in Qatar (ARTQ)

Introduction In Qatar, previous studies have shown that from 8-12 % of all trauma patients test positive for alcohol in tests for BAC, most of these were intentional trauma, i.e., assault or intentional self-harm and traffic-related trauma. There is a marked paucity of epidemiologic data on alcohol use and abuse among trauma patients in the Eastern Mediterranean Region of the world. Objective To prospectively collect and analyze key epidemiologic data from patient interviews of blood alcohol concentration positive BAC[+] trauma patients at a national trauma center. Methods All BAC [+] trauma patients admitted for more than 24 hours to the Hamad Trauma Center, with moderate to severe injuries from 1 November 2022 to 30 September 2023, were interviewed using a standard, open-ended interview, based on globally recognized risk factors for alcohol-related injury, conducted by a trained interviewer. Results There were 132 BAC [+] trauma patients during the study period, 88 met inclusion criteria, 64 were approached for interview, 55 were interviewed. 96% were male, with a mean age of 35 years, 50% suffered road traffic injuries, 24% fell, 10% were assaulted, 45% occurred on Fridays and 56% between 2200 to 0400H. The patients with the highest BAC levels were victims of assault or pedestrians. Cyclists and pedestrians suffered the most severe injuries. One-third required an ICU admission and 3% died from their injuries. Conclusion The study describes the epidemiology of alcohol-related trauma in Qatar. This education of the public and law enforcement about the most common times, days and mechanism of these injuries can inform focused interventions to reduce these preventable deaths and injury.NO

Challenges for effective urban mobility for the elderly

Introduction: Brazil is witnessing a noticeable increase in its aging population, but effective public measures to ensure the safe mobility of the elderly have been lacking. Furthermore, older individuals are more susceptible to trauma and face challenges in recovery, elevating the risk of severe injuries, prolonged hospitalization, and even mortality. In response to these concerns, the "Trauma Prevention" project seeks to engage with the elderly community to identify urban mobility issues and propose future public initiatives. Materials and Methods: This project was a collaborative effort involving the extension group and Vitalità. Participants completed printed questionnaires covering topics like driving, modes of transportation, and traffic-related difficulties. Following the questionnaire, a discussion took place on the topic "What is your main traffic-related difficulty?" Data collected were processed and analyzed. Results: The initial phase of the project involved 14 elderly participants from the Vitalità center, with the majority aged between 60 and 65 (64%). A significant number (71.4%) did not currently drive. Buses were the primary mode of transportation. Regarding traffic safety, 85.6% perceived Campinas' traffic as unsafe for elderly drivers, while 100% considered it unsafe for elderly pedestrians. Key traffic difficulties included: Inadequate accessibility (lack of access ramps, handrails, pedestrian crosswalks), Poor infrastructure (short traffic light intervals, road potholes, high bus entry steps) and Non-compliance with traffic signals by other road users. Conclusions: The initial data provide insights into the mobility needs and preferences of the elderly, guiding future initiatives. The next steps include productive dialogues between participants and Campinas' bus companies. References: Rodrigues J. Elderly trauma victims: an analysis of risk factors. Revista da Escola de Enfermagem da USP, 2012.No

Epidemiology and outcomes of severe traumatic brain injuries admitted to the estonian level 1 trauma centers

Introduction. Severe traumatic brain injuries (sTBI) constitute a major burden of disease and are associated with high morbidity and mortality [1]. Thus, we initiated the current study to scrutinize the contemporary demographics and outcomes of this subgroup of trauma victims. Materials &amp; methods. All adult patients with AIS-head &gt;= 4 admitted to Estonian trauma centers (the Tartu University Hospital and the North Estonia Medical Centre) between 01.01.2021 and 31.12.2022 were accrued from the Estonian trauma registry. Primary outcome was mortality. Results. Overall, 122 cases were included. Median age was 49.5 years (IQR: 35.25 - 63.0) and 82.8% (n=101) were male. The two most frequent mechanisms of injury were ground-level falls (28.7%, n=35) and falls from height (25.4%, n=31), followed by motor vehicle accidents (16.4%, n=20). Positive blood alcohol level was obtained in 29.5% of the cases. The median ISS was 25 (IQR: 25 - 30). About half of the patients (52.5%) had associated extra-cranial injuries. On admission to the emergency department 63.9% (n=78) of the patients had a GCS &lt;= 8. Median HLOS was 8.5 days (IQR: 2.25 – 18.0). About every third patient (34.4%) was subjected to craniotomy/ craniectomy. Overall crude mortality was 35.2%. Thirty-four patients (27.9%) were discharged without neurological impairment. Conclusion. sTBI contributes a significant burden of disease for health-care system and the society. This is illustrated by the high prevalence of neurological disability at discharge and a significant mortality rate. Further research is warranted to evaluate injury preventive measures and alcohol prevention programs in Estonia. References. [1] Brazinova A, Rehorcikova V, Taylor MS, et al. Epidemiology of Traumatic Brain Injury in Europe: A Living Systematic Review. J Neurotrauma. 2021;38(10):1411-1440.No

Mortality and injuries after avalanche accidents in Troms county, Norway

Introduction Avalanche accidents claim the life of about 100 people each year in the European Alps. There are many studies based on data from the Alps, but fewer from northern Europe. In Norway, Troms county has the highest incident of avalanche accidents. Objectives This study aims to describe the mortality, and the injuries requiring hospital admission after avalanche accidents in Troms county. Patients &amp; Methods This is a retrospective observation study. Data on mortality were collected from the Norwegian water recourses and Energy Directorate. Injured patients admitted to UNN with trauma team activation from 2013 to 2022 were included based on the mechanism of injury as recorded in the National Trauma Registry (NTR). Data were further collected from the electronic patient record at UNN. Results A total of 30 patients died. 30 of the patients were admitted to UNN with trauma team activation in the study period, including 3 patients who died after admission due to hypothermia and/or asphyxia. Of the 30 admitted patients, 7 were buried (10-150 min). Injures included extremities (16 patients), thoracic (9 patients), hypothermia (9 patients) pelvic fracture (3 patients) spinal (1 patient), brain (2 patients). Average Injury Severity Score was 11, (range 0-43), average number of days hospitalized was 3 (range 1-173). 5 patients spent an average of 16 (range 4-54) days in the Intensive Care Unit. 12 received surgical procedures, 3 received multiple procedures, most procedures were orthopedic fixations. Conclusion Our study identified a total of 30 deaths and 27 injured patients admitted to hospital over a period of 10 years in Troms county. Avalanche accidents are infrequent compared to other types of accidents, but cause both serious and fatal injuries. No

The higher the level of acute spinal cord injury, the higher the risk of hyponatremia: A single center retrospective study

Skeletal trauma and sports medicine

Introduction Hyponatremia is frequently observed in patients with central nervous system disease. In the traumatology, it is well known that hyponatremia develops in traumatic brain injury patients1). However, much is still unknown about the relationship between spinal cord injury and hyponatremia2). Here, we aimed to identify the risk factors for hyponatremia in acute spinal cord injury patients, and the association of the level of spinal cord injury and hyponatremia in the acute phase. Methods Patients with spinal cord injury who were admitted to the Advanced Critical Care Center of Gifu University Hospital, a Japanese tertiary-care emergency and trauma center, between April 2007 to March 2023 were included. We reviewed the medical records of them and collected the necessary data: sex, age, Level of spinal cord injury, Frankel grade, sodium concentration, renal function, complication of severe traumatic brain injury, complication of multiple trauma, surgical treatment, use of diuretics, and use of steroids. Hyponatremia was counted if it occurred within 2 weeks of admission. Logistic regression models were used to evaluate the association between hyponatremia and other variables. Results Of the 237 enrolled patients, 116 (42.5%) had hyponatremia. The median age was 58, and 151 (63.7%) were male. Cervical, thoracic, and lumbar spine injury were 154 (65.0%), 40 (16.9%), and 43 (18.1%), respectively. Statistical analysis revealed that hyponatremia within 2 weeks was significantly associated with higher level of spinal cord injury and complication of multiple trauma(Figure 1&amp;2). Conclusions Higher level of spinal cord injury and complication of multiple trauma may be associated with hyponatremia in patients with acute spinal cord injury. It is expected that he higher the level of spinal cord injury, the higher the risk of hyponatremia. References 1, Moro N, et al. Surgical Neurology 2007; 68:387-393. 2, Ohbe H, et al. Spinal Cord 2019; 57:240-246.No

Impact of clinical history, gender, and age on 6-month mortality in major trauma patients admited to the ICU

Polytrauma

Introduction: In this study, we explore a critical aspect of trauma management: the influence of preexisting clinical conditions, gender and age on patient survival after trauma. Objectives: To investigate the impact of preexisting clinical conditions, gender and age on patients" mortality at 6 months since implementation of the trauma fast-track on a tertiary hospital. Materials/methods: 159 patients were selected out of 386. We included patients admitted to the ICU that were approached under a trauma fast-track in the emergency department a tertiary hospital (November 2020 - August 2023). To assess the impact of categorical variables (gender, arterial hypertension, diabetes mellitus, chronic heart failure, chronic kidney disease, obesity, alcoholism and smoking) on 6-month mortality we conducted a chi-squared test. As for the impact of age, a logistic regression was applied. Results: A statistically significant association between the presence of chronic heart failure (CHF) and 6-month mortality following trauma was found. The Pearson Chi-Square test yielded a p-value of 0.032, and the Likelihood Ratio test produced a p-value of 0.046, indicating a significant association. The Continuity Correction and Fisher's Exact Test, while not reaching statistical significance (p = 0.115; p = 0.065) further support the presence of an association that could become more evident in larger samples. Conversely, the analysis of gender, age and additional preexisting medical conditions did not yield statistically significant associations with 6-month mortality following trauma. Conclusions: These results underline the importance of recognizing the role of chronic heart failure in influencing long-term mortality in trauma patients. As for the remaining conditions included, as well as age and gender, no significant impact on 6-month survival was found.No

Impact of trauma mechanisms on clinical outcomes in patients approached under an emergency trauma fast-track system

Introduction: Trauma remains a significant public health concern. In this study, we delve into the clinical outcomes of patients treated within the context of a Trauma fast-track and admitted to the ICU. Objectives: To investigate the impact of various trauma mechanisms on patient outcomes at ICU discharge (stable, recovered or deceased) since implementation of the trauma fast-track system on a tertiary hospital. Materials/methods: 159 patients were selected out of 386. Our criteria included patients approached under a trauma fast-track from its implementation at a tertiary hospital on November 2020 until August 2023. To assess the association between categorical variables we conducted hypothesis testing, including the chi-squared test. The categorical variables included the mechanism of trauma (fall &gt;3m, light vehicle crash &gt;60km/h, motorcycle crash &gt;30km/h, motor vehicle crash with projection, run over) and outcome at discharge (improved, stable, or deceased). Results: The analysis revealed a statistically significant association between the &quot;fall &gt; 3m&quot; mechanism of trauma and outcome at discharge. The p-values obtained were 0.018 for the Person Chi-Square test and 0.032 for the Likelihood Ratio test. However, for the other mechanisms of trauma, such as &quot;light vehicle crash &gt;60km/h&quot;, &quot;motorcycle crash &gt;30km/h&quot;, &quot;motor vehicle crash with projection&quot; and &quot;run over&quot; our analysis did not identify statistically significant associations with the outcome at discharge. Conclusions: These findings underscore the importance of recognizing heterogeneity in patient outcomes based on the specific mechanism of trauma. While 'fall &gt; 3m' emerged as a significant predictor of discharge outcomes, the lack of significant associations for the other mechanisms suggests the need for further investigation into the factors contributing to patient prognosis after trauma.No

Prof. em. Dr. med. Dr. h.c.

Dr. med.

Development and biomechanical evaluation of an internal ring fixator (RingFix) for treatment of fragility fractures of the pelvic ring

Introduction The observed increasing incidence of fragility fractures of the pelvis (FFP) caused a special interest in these pathologies and opened up a wide field of research. A known and persisting problem remains the observed potential fracture progression from an initially unilateral fracture to a bilateral fracture involving the anterior and posterior pelvic ring. The objective of the present study was the experimental development and biomechanical evaluation of an in itself fully closed internal ring fixator for treatment of fragility fractures of the pelvis. Material &amp; Methods The ring fixator (RingFix) built up on two 5.0mm Steinmann pins with central thread introduced slightly lateral to the spina iliaca anterior inferior iliac spine, passing the ilium completely intraosseous and ending up in the area of the spina iliaca posterior superior iliac spine, and an anterior and posterior connection of the Steinmann pins over pre-bent 5.0 mm rods as used for posterior instrumentation in spine surgery. Testing was performed on 24 osteoporotic bone models (Fa. Sawbone) with a standardized FFP IIIc/OF3 fracture, subdivided into three groups of fixation method: RingFix, trans-iliosacral screws in S1 with (SI+) and without retrograde transpubic screw (SI-). Each bone model underwent cyclical axial loading (25 - 1200N) for 1000 cycles according to a test protocol published by our group before. Results We observed statistically significant differences between the three groups with the highest stability in the group of SI+ (median number of reached test cycles 862.5), followed by the RingFix (349.0) and statistically significant less stability in SI- (41.0). Conclusion Our results showed that the integrity or adequate refixation of the anterior fracture part plays an important role for ring stability. The indirect fixation of the anterior fracture with the in itself closed ring fixator was inferior to direct fixation of the single fracture components.No

Why did mortality increase for acute cholecystitis during the COVID-19 pandemic?

Introduction During the COVID-19 pandemic, an increased incidence of acute cholecystitis was reported and correlated with SARS-CoV-2 infection. The ChoCO-W study showed that the incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients, the incidence of gangrenous cholecystitis is doubled in patients with SARS-CoV-2 infection and that gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay, and higher mortality rate. The aim of this secondary analysis of ChoCO data is to investigate risk factors correlated with mortality in patients admitted with acute cholecystitis during the COVID-19 pandemic. Material and methods Data were collected over a 6-month period from October 1, 2020, to April 30, 2021.Continuous data were presented as mean (SD), ordinal data as median (IQR), and categorical data as number (%). Non-parametric statistical univariate analysis was used to compare patients presenting acute cholecystitis who died and those who survived. Results 2593 patients from 42 countries and 218 centres were included in the study. Out of these patients, 47 (1.8%) missed the outcome variable (alive or dead). Out of the remaining 2546 patients, 2482 survived, while 64 died.Patients who died showed significantly higher rate of urgent open cholecystectomy (31.3% compared with 8.1%) and cholecystostomy/percutaneous drainage (25% compared with 7.3%)The significant factors that increased death were having a COVID-19 infection (p&lt;.001), having a complication (p&lt;.001), and the type of surgical intervention (p=0.003). Conclusions Patients presenting with SARS-CoV-2 infection and acute cholecystitis experienced delayed surgical management after initial non-operative management, with a higher rate of open cholecystectomy and postoperative complications and a higher mortality rate. References De Simone B et al The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis? World J Emerg Surg. 2022 Dec 16;17(1):61.No

Injuries of the Chopart Complex: A case series from a level 2 trauma center and literature review

Introduction The Chopart joint complex consists of the calcaneocuboidal and talonavicular joints, forming the articulation of the hindfoot and midfoot. Chopart joint complex injuries (CCI) are often missed or misdiagnosed. Inadequately treated CCIs may severely impair foot function. Treatment depends on injury severity and complexity. Objectives This case series aims to present the diagnostic process, treatment steps and outcomes of five CCI cases, contributing to the currently limited body of knowledge regarding these injuries. Materials &amp; methods The authors retrospectively reviewed data from five patients with CCIs who presented at a level-2 trauma center between 2013 and 2021. Pediatric patients and patients who underwent traumatic amputation of the Chopart joint were excluded. Radiographic evidence was used to confirm CCI. Follow-up involved clinical assessment and radiographic imaging. Additionally, an extensive literature search was performed. Results Patient demographics, injury mechanism, and treatment are presented in Table 1. All patients presented with midfoot swelling and tenderness. Trauma mechanism was predominantly low-energetic. Two patients underwent surgical intervention involving multi-stage fixation, while three patients received conservative treatment with closed reduction and immobilization. Follow-up ranged from 6 weeks to 12 months. Conclusion This case series presents treatment steps and outcomes for CCIs, thereby facilitating more adequate treatment of these rare injuries. Notably, four patients sustained CCIs due to low energetic trauma mechanisms, and three patients were treated conservatively, an area virtually untouched upon by current literature. Other literature pertaining to treatment of CCIs mostly reports on surgical treatment via the ORIF principle. However, evidence of existing studies is limited. Consequently, there is a compelling need for high-level evidence to establish comprehensive treatment guidelines for CCIs. No

Poster session 37
Research 3

Appointment

Chairs

Topic

Programme

Poster session 37Research 3

Appointment

Chairs

Topic

Programme

Poster session 37
Research 3