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7. Buiktrauma

Author

Vos, D. I., Hietbrink, F., Heineman, E., editor, Heineman, D.J., editor, Lange jr., J.F.M., editor, Blankensteijn, J.D., editor, Boermeester, M.A., editor, Borel Rinkes, I.H.M., editor, Klaase, J.M., editor, Schipper, I.B., editor, Schreurs, W.H., editor, and Wijnen, R.M.H., editor

Published
2021
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10. A cohort study to evaluate infection prevention protocol in pediatric trauma patients with blunt splenic injury in a Dutch level 1 trauma center

Author

Spijkerman R, Teuben MPJ, Hietbrink F, Kramer WLM, and Leenen LPH

Subjects
Spleen, blunt trauma, questionnaire, immunization, antibiotics, education., Medicine (General), R5-920
Abstract

Roy Spijkerman, Michel PJ Teuben, Falco Hietbrink, William LM Kramer, Luke PH Leenen Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands Purpose: Asplenic patients are at increased risk for the development of overwhelming postsplenectomy infection (OPSI) syndrome. It is believed that adequate immunization, antimicrobial prophylaxis, as well as appropriate education concerning risks on severe infection lead to the decreased incidence of OPSI. The aim of this study was to analyze the methods used to prevent OPSI in trauma patients splenectomized before the age of 18. Patients and methods: A retrospective, single-center study of all pediatric patients sustaining blunt splenic injury (BSI) managed at our level 1 trauma center from January 1979 to March 2012 was performed. A questionnaire was sent to all the included patients to determine the level of knowledge concerning infection risks, the use of antibiotics, and compliance to vaccination recommendations. Furthermore, we investigated whether the implementation of guidelines in 2003 and 2011 resulted in higher vaccination rates. Results: We included 116 children with BSI. A total of 93 completed interviews were eligible for analysis, resulting in a total response rate of 80% and 1,116 patient years. Twenty-seven patients were splenectomized, and 66 patients were treated by a spleen preserving therapy (including embolization). Only two out of 27 splenectomized patients were adequately vaccinated, five patients without a spleen used prophylactic antibiotics, and about half of the asplenic patients had adequate knowledge of the risk that asplenia entails. A total of 22/27 splenectomized patients were neither adequately vaccinated nor received prophylactic antibiotics. There was no OPSI seen in our study population during the 1,116 follow-up years. Conclusion: The vaccination status, the level of knowledge concerning prevention of an OPSI, and the use of prophylactic antibiotics are suboptimal in pediatric patients treated for BSI. Therefore, we created a new follow-up treatment guideline to have adequate preventive coverage to current standards for these patients. Keywords: spleen, blunt trauma, questionnaire, immunization, antibiotics, education

Published
2018

11. Clinical Studies in Vascular Trauma

Author

Leenen, L.P.H., Borst, G.J. de, Hietbrink, F., Vliet, Q.M.J. van der, Hundersmarck, Dennis, Leenen, L.P.H., Borst, G.J. de, Hietbrink, F., Vliet, Q.M.J. van der, and Hundersmarck, Dennis

Published
2023

12. Point-of-care neutrophil CD64 as a rule in diagnostic test for bacterial infections in the emergency department

Author

Zorgeenheid Traumatologie, Experimentele Afdeling Longziekten, Cancer, Infection & Immunity, MS Reumatologie/Immunologie/Infectie, Medische Staf Intensive Care, van de Ven, N L M, Bongers, S H, Spijkerman, R, Koenderman, L, Leenen, L P H, Hietbrink, F, COVPACH study group, Zorgeenheid Traumatologie, Experimentele Afdeling Longziekten, Cancer, Infection & Immunity, MS Reumatologie/Immunologie/Infectie, Medische Staf Intensive Care, van de Ven, N L M, Bongers, S H, Spijkerman, R, Koenderman, L, Leenen, L P H, Hietbrink, F, and COVPACH study group

Published
2023

14. Additional file 2 of Point-of-care neutrophil CD64 as a rule in diagnostic test for bacterial infections in the emergency department

Author

van de Ven, N. L. M., Bongers, S. H., Spijkerman, R., Koenderman, L., Leenen, L. P. H., and Hietbrink, F.

Abstract

Additional file 2. Exploratory analysis amongst patients with bacterial infections regarding the QSOFA score and nCD64 expression (Additional file 2A) and antibiotic use and nCD64 expression (Additional file 2B).

Published
2023
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23. Longitudinal assessment of the inflammatory response: The next step in personalized medicine after severe trauma

Author

Zorgeenheid Traumatologie, Experimentele Afdeling Longziekten, Infection & Immunity, Cancer, de Fraiture, E J, Vrisekoop, N, Leenen, L P H, van Wessem, K J P, Koenderman, L, Hietbrink, F, Zorgeenheid Traumatologie, Experimentele Afdeling Longziekten, Infection & Immunity, Cancer, de Fraiture, E J, Vrisekoop, N, Leenen, L P H, van Wessem, K J P, Koenderman, L, and Hietbrink, F

Published
2022

24. Outcomes of the resuscitative and emergency thoracotomy at a Dutch level-one trauma center: are there predictive factors for survival?

Author

CTC, Zorgeenheid Traumatologie, Other research (not in main researchprogram), Infection & Immunity, Sam, A. S.Y., Nawijn, F., Benders, K. E.M., Houwert, R. M., Leenen, L. P.H., Hietbrink, F., CTC, Zorgeenheid Traumatologie, Other research (not in main researchprogram), Infection & Immunity, Sam, A. S.Y., Nawijn, F., Benders, K. E.M., Houwert, R. M., Leenen, L. P.H., and Hietbrink, F.

Published
2022

25. Validation of the Thorax Trauma Severity Score for mortality and its value for the development of acute respiratory distress syndrome

Author

Leenen LPH, Beenen LFM, Hietbrink F, and Aukema TS

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Tjeerd S Aukema1, Ludo FM Beenen2, Falco Hietbrink1, Luke PH Leenen11Department of Surgery, University Medical Center Utrecht, Utrecht, 2Department of Radiology, Academic Medical Center, Amsterdam, The NetherlandsBackground: The aim of the present study was to evaluate and to validate the Thorax Trauma Severity Score for mortality (TTSS).Methods: By database analysis 712 patients with an injury to the chest admitted to the Universal Medical Center Utrecht between 2000 and 2004 were studied. All patients with a score of ≥1 on the AISthorax were included in the study. The patients' file was evaluated for: TTSS, intensive care unit stay, days on ventilation, thorax trauma-related complications (eg, acute respiratory distress syndrome [ARDS]), total hospital stay, and mortality.Results: Of the 516 patients included in the study, 140 (27%) developed thorax-related complications. The overall in-hospital mortality rate was 10%. The receiver operating characteristic curve for predicting mortality demonstrated an adequate discrimination by a value of 0.844. The TTSS was statistically significant higher in patients who died of thorax-related complications than in patients who died because of nonthorax-related complications and survivors (P

Published
2011

27. Analysis of human neutrophil phenotypes as biomarker to monitor exercise-induced immune changes

Author

Spijkerman, R., Hesselink, L., Bertinetto, C.G., Bongers, C.C.W.G., Hietbrink, F., Vrisekoop, N., Leenen, L.P.H., Hopman, M.T.E., Jansen, J.J., Koenderman, L., Spijkerman, R., Hesselink, L., Bertinetto, C.G., Bongers, C.C.W.G., Hietbrink, F., Vrisekoop, N., Leenen, L.P.H., Hopman, M.T.E., Jansen, J.J., and Koenderman, L.

Abstract

Contains fulltext : 231632.pdf (Publisher’s version ) (Open Access)

Published
2021

28. Study methodology in trauma care: towards question-based study designs

Author

Houwert, R.M., Beks, R.B., Dijkgraaf, M.G.W., Roes, K.C.B., Öner, F.C., Hietbrink, F., Leenen, L.P.H., Groenwold, R.H.H., Houwert, R.M., Beks, R.B., Dijkgraaf, M.G.W., Roes, K.C.B., Öner, F.C., Hietbrink, F., Leenen, L.P.H., and Groenwold, R.H.H.

Abstract

Contains fulltext : 235805.pdf (Publisher’s version ) (Open Access), The randomized controlled trial (RCT) in surgery may not always be ethical, feasible, or necessary to address a particular research question about the effect of a surgical intervention. If so, properly designed and conducted observational (non-randomized) studies may be valuable alternatives for an RCT and produce credible results. In this paper, we discus differences between RCTs and observational studies and differentiate between three types of comparisons of surgical interventions. We assert that results of different designs should be regarded as complementary to each other when evaluating surgical interventions. Criteria for credible observational research are presented to provide guidance for future observational research of surgical interventions. We argue that the research question that is being asked should guide the discussion about the value of a particular study design.

Published
2021

32. When observational studies are as helpful as randomized trials: Examples from orthopedic trauma : Examples from orthopedic trauma

Author

Beks, R B, Bhashyam, Abhiram R, Houwert, R M, van der Velde, D, van Heijl, M, Smeeing, Dpj, Hietbrink, F, Leenen, L P H, and Groenwold, Rhh

Subjects
Observational Studies as Topic, Bone and Bones/injuries, Journal Article, Humans, Orthopedic Procedures, Surgery, Critical Care and Intensive Care Medicine, Randomized Controlled Trials as Topic
Abstract

Randomized controlled trials (RCTs) are often challenging to design in surgical fields and can be misleading when poorly executed. While the prevailing belief is that observational studies on therapeutic efficacy are credible only in exceptional circumstances due to unrecognized confounding, we identify three types of intervention in orthopaedic trauma and illustrate relevant features that allow observational studies in orthopaedic surgery to be as helpful as RCTs.

Published
2019

33. Associated thoracic injury in patients with a clavicle fracture: a retrospective analysis of 1461 polytrauma patients

Author

Heelkunde Opleiding, Zorgeenheid Traumatologie, Infection & Immunity, van Laarhoven, J. J E M, Hietbrink, F., Ferree, S., Gunning, A. C., Houwert, R. M., Verleisdonk, Egbert Jan M M, Leenen, L. P H, Heelkunde Opleiding, Zorgeenheid Traumatologie, Infection & Immunity, van Laarhoven, J. J E M, Hietbrink, F., Ferree, S., Gunning, A. C., Houwert, R. M., Verleisdonk, Egbert Jan M M, and Leenen, L. P H

Published
2019

36. The effect of early broad-spectrum versus delayed narrow-spectrum antibiotic therapy on the primary cure rate of acute infection after osteosynthesis

Author

Hellebrekers, P. (Pien), Verhofstad, M.H.J. (Michiel), Leenen, L.P.H., Varol, H. (Hilal), Lieshout, E.M.M. (Esther) van, Hietbrink, F. (Falco), Hellebrekers, P. (Pien), Verhofstad, M.H.J. (Michiel), Leenen, L.P.H., Varol, H. (Hilal), Lieshout, E.M.M. (Esther) van, and Hietbrink, F. (Falco)

Abstract

Purpose: Infection near metal implants is a problem that presents challenging treatment dilemmas for physicians. The aim of this study was to analyse the efficacy of two treatment protocols for acute fracture-related infections. Methods: Seventy-one patients in two level-1 trauma centres in the Netherlands were retrospectively included in this study. These trauma centres had different standardised protocols for acute infection after osteosynthesis: 39 patients were selected from protocol A and 32 from protocol B. Both protocols involve immediate surgical debridement and soft tissue coverage, but differ in antibiotic approach: (A) immediate empirical combination antibiotic therapy with rifampicin, or (B) postponed (1–5 days) targeted antibiotic therapy. The primary outcome of these protocols was success, defined as a fracture healing in the absence of infection. The secondary outcome was antibiotic resistance patterns. Logistic regression was conducted on patients and treatment-related factors in association with primary success. Results: Primary success was achieved in 72% of protocol A patients, in 47% of those in protocol B (P = 0.033), and with prolongation of treatment success was achieved in 90% and 78% of patients, respectively. Protocol A exhibited a better primary success rate (adjusted OR 3.45, CI 1.13–10.52) when adjusted for age and soft tissue injury. There was no significant difference in antibiotic resistance between the two protocols. Conclusion: Both protocols yielded high overall success rates. Immediate empirical antibiotics can be used safely without additional bacterial resistance and may contribute to increased success rates.

Published
2019
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37. When observational studies are as helpful as randomized trials: Examples from orthopedic trauma: Examples from orthopedic trauma

Author

Zorgeenheid Traumatologie, Other research (not in main researchprogram), Regionaal Traumanetwerk, Infection & Immunity, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Methodologie, Beks, R B, Bhashyam, Abhiram R, Houwert, R M, van der Velde, D, van Heijl, M, Smeeing, Dpj, Hietbrink, F, Leenen, L P H, Groenwold, Rhh, Zorgeenheid Traumatologie, Other research (not in main researchprogram), Regionaal Traumanetwerk, Infection & Immunity, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Methodologie, Beks, R B, Bhashyam, Abhiram R, Houwert, R M, van der Velde, D, van Heijl, M, Smeeing, Dpj, Hietbrink, F, Leenen, L P H, and Groenwold, Rhh

Published
2019

38. Polytrauma and and High-energy Injury Mechanisms are Associated with Worse Patient-reported Outcomes After Distal Radius Fractures

Author

Zorgeenheid Traumatologie, Heelkunde Opleiding, Regionaal Traumanetwerk, Other research (not in main researchprogram), Infection & Immunity, van der Vliet, Q M J, Sweet, A A R, Bhashyam, A R, Ferree, S, van Heijl, M, Houwert, R M, Leenen, L P H, Hietbrink, F, Zorgeenheid Traumatologie, Heelkunde Opleiding, Regionaal Traumanetwerk, Other research (not in main researchprogram), Infection & Immunity, van der Vliet, Q M J, Sweet, A A R, Bhashyam, A R, Ferree, S, van Heijl, M, Houwert, R M, Leenen, L P H, and Hietbrink, F

Published
2019

44. Differentiation in an inclusive trauma system: Allocation of lower extremity fractures

Author

Zorgeenheid Traumatologie, Heelkunde Opleiding, Infection & Immunity, Other research (not in main researchprogram), Würdemann, F. S., Smeeing, D. P.J., Ferree, S., Nawijn, F., Verleisdonk, E. J.M.M., Leenen, L. P.H., Houwert, R. M., Hietbrink, F., Zorgeenheid Traumatologie, Heelkunde Opleiding, Infection & Immunity, Other research (not in main researchprogram), Würdemann, F. S., Smeeing, D. P.J., Ferree, S., Nawijn, F., Verleisdonk, E. J.M.M., Leenen, L. P.H., Houwert, R. M., and Hietbrink, F.

Published
2018

45. Trauma: the role of the innate immune system

Author

Rijkers GT, Koenderman L, Hietbrink F, and Leenen LPH

Subjects
Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Immune dysfunction can provoke (multiple) organ failure in severely injured patients. This dysfunction manifests in two forms, which follow a biphasic pattern. During the first phase, in addition to the injury by trauma, organ damage is caused by the immune system during a systemic inflammatory response. During the second phase the patient is more susceptible for sepsis due to host defence failure (immune paralysis). The pathophysiological model outlined in this review encompasses etiological factors and the contribution of the innate immune system in the end organ damage. The etiological factors can be divided into intrinsic (genetic predisposition and physiological status) and extrinsic components (type of injury or "traumaload" and surgery or "intervention load"). Of all the factors, the intervention load is the only one which, can be altered by the attending emergency physician. Adjustment of the therapeutic approach and choice of the most appropriate treatment strategy can minimize the damage caused by the immune response and prevent the development of immunological paralysis. This review provides a pathophysiological basis for the damage control concept, in which a staged approach of surgery and post-traumatic immunomonitoring have become important aspects of the treatment protocol. The innate immune system is the main objective of immunomonitoring as it has the most prominent role in organ failure after trauma. Polymorphonuclear phagocytes and monocytes are the main effector-cells of the innate immune system in the processes that lead to organ failure. These cells are controlled by cytokines, chemokines, complement factors and specific tissue signals. The contribution of tissue barrier integrity and its interaction with the innate immune system is further evaluated.

Published
2006
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46. De spoedlaparotomie bij een traumapatiënt

Author

Hietbrink, F, Simmermacher, R K J, de Vries, M B, van Wessem, K J P, de Jong, M B, and Leenen, L P H

Abstract

Emergency laparotomy in trauma patients can be part of the resuscitation process, is based on damage control principles and is therefore fundamentally different from elective laparotomy, for example in case of malignancies. - Indications for emergency laparotomy after trauma are based on haemodynamic instability of the patient and the procedure is focused on restoring the patient's physiological condition.- Haemodynamic and biochemical parameters are used to determine the rest of the strategy. In order to optimize the procedure, the entire treatment team should be practiced in this.- Fewer and fewer surgeons are carrying out general laparotomies and even fewer are carrying out emergency laparotomies after trauma.- Knowledge and skills about emergency laparotomy after trauma are at risk of disappearing because of this, not only for surgeons but also for other team members.- Increased centralisation, team training, more cooperation and consultation for specific indications may all contribute to expertise preservation.

Published
2017

50. De spoedlaparotomie bij een traumapatiënt

Author

UMC Utrecht, Zorgeenheid Traumatologie, Infection & Immunity, AIOS Psychiatrie, Medische Staf Spoedeisende Hulp, Hietbrink, F, Simmermacher, R K J, de Vries, M B, van Wessem, K J P, de Jong, M B, Leenen, L P H, UMC Utrecht, Zorgeenheid Traumatologie, Infection & Immunity, AIOS Psychiatrie, Medische Staf Spoedeisende Hulp, Hietbrink, F, Simmermacher, R K J, de Vries, M B, van Wessem, K J P, de Jong, M B, and Leenen, L P H

Published
2017

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