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New coronavirus SARS-CoV-2 infection (coronavirus disease 2019 [COVID-19]) has determined the necessity of reorganization in many centers all over the world. Spain, as an epicenter of the disease, has been forced to assume health policy changes in all the territory. However, and from the beginning of the pandemic, every center attending surgical urgencies had to guarantee the continuous coverage adopting correct measures to maintain the excellence of quality of care. This document resumes general guidelines for emergency surgery and trauma care, obtained from the available bibliography and evaluated by a subgroup of professionals designated from the general group of investigators Cirugia-AEC-COVID-19 from the Spanish Association of Surgeons, directed to minimize professional exposure, to contemplate pandemic implications over different urgent perioperative scenarios and to adjust decision making to the occupational pressure caused by COVID-19 patients.

Resumen El modelo Acute Care Surgery agrupa bajo una misma disciplina el trauma, la cirugia de urgencias y los cuidados intensivos posquirurgicos. Concebido y extendido durante las 2 ultimas decadas por territorio norteamericano, la magnitud e idiosincrasia clinica de la urgencia quirurgica han hecho que este modelo se haya asumido en muchos otros puntos de la geografia mundial. En nuestro pais, el reflejo ha sido la creacion e implantacion de las denominadas unidades de trauma y cirugia de urgencias, cuyos objetivos son comunes a las publicadas para el modelo original: evitar la nocturnidad en las urgencias quirurgicas, liberar a los profesionales vinculados a la cirugia electiva en horario laboral y convertirse en el eslabon y referente perfectos de la continuidad asistencial. En el presente articulo se resumen el nacimiento y la expansion del modelo original, la evidencia aportada en cuanto a resultados y la situacion actual en nuestro pais.

The spleen is one of the most frequently injured organs in blunt abdominal trauma. In the past decades, the treatment of patients with blunt splenic injury has shifted from operative to non-operative management. The knowledge of physiology and immunology of the spleen have been the main reasons to develop techniques for splenic salvage. The advances in high-resolution imaging techniques, as well as less invasive procedures, including angiography and angioembolization, have allowed a higher rate of success in the non-operative management. Non-operative management has showed a decrease in overall mortality and morbidity. The aim of this article is to analyze the current management of splenic injury based on a literature review of the last 30 years, from we have identified 63,205 patients. This would enable the surgeons to provide the best care possible in every case.

Pancreatic injury is an uncommon event often difficult to diagnose at an early stage. After abdominal trauma, the surgeon must always be aware of the possibility of pancreatic trauma due to the complications associated with missed pancreatic injuries. Due to its retroperitoneal position, asociated organs and vascular injuries are almost always present, which along with frequent extra abdominal injuries explain the high morbidity and mortality. The aim of this study is to present a concise description of the incidence of these injuries, lesional mechanisms, recommended diagnostic methods, therapeutic indications including nonoperative management, endoscopy and surgery, and an analysis of pancreas-specific complications and mortality rates in these patients based on a 60-year review of the literature, encompassing 6,364 patients. Due to pancreatic retroperitoneal position, asociated organs and vascular injuries are almost always present, which along with frequent extraaabdominal injuries explain the high morbidity and mortality of these patients.

Pancreatic injury is an uncommon event often difficult to diagnose at an early stage. After abdominal trauma, the surgeon must always be aware of the possibility of pancreatic trauma due to the complications associated with missed pancreatic injuries. Due to its retroperitoneal position, associated organs and vascular injuries are almost always present, which along with frequent extra abdominal injuries explain the high morbidity and mortality. The aim of this study is to present a concise description of the incidence of these injuries, lesional mechanisms, recommended diagnostic methods, therapeutic indications including nonoperative management, endoscopy and surgery, and an analysis of pancreas-specific complications and mortality rates in these patients based on a 60-year review of the literature, encompassing 6364 patients. Due to pancreatic retroperitoneal position, associated organs and vascular injuries are almost always present, which along with frequent extraaabdominal injuries explain the high morbidity and mortality of these patients.

The Acute Care Surgery model groups trauma and emergency surgery with surgical critical care. Conceived and extended during the last 2 decades throughout North America, the magnitude and clinical idiosyncrasy of emergency general surgery have determined that this model has been expanded to other parts of the world. In our country, this has led to the introduction and implementation of the so-called trauma and emergency surgery units, with common objectives as those previously published for the original model: to decrease the rates of emergency surgery at night, to allow surgeons linked to elective surgery to develop their activity in their own disciplines during the daily schedule, and to become the perfect link and reference for the continuity of care. This review summarizes how the original model was born and how it expanded throughout the world, providing evidence in terms of results and a description of the current situation in our country.

The spleen is one of the most frequently injured organs in blunt abdominal trauma. In the past decades, the treatment of patients with blunt splenic injury has shifted from operative to non-operative management. The knowledge of physiology and immunology of the spleen have been the main reasons to develop techniques for splenic salvage. The advances in high-resolution imaging techniques, as well as less invasive procedures, including angiography and angioembolization, have allowed a higher rate of success in the non-operative management. Non-operative management has showed a decrease in overall mortality and morbidity. The aim of this article is to analyze the current management of splenic injury based on a literature review of the last 30 years, from we have identified 63,205 patients. This would enable the surgeons to provide the best care possible in every case.

Resumen Introduccion Aunque el tratamiento del traumatismo esplenico ha cambiado en las ultimas decadas, no existen datos de la actitud que los cirujanos espanoles adoptamos frente a este tipo de lesion tan frecuente. El proposito de este estudio es determinar el perfil del traumatismo esplenico en los adultos con traumatismo abdominal severo y el tratamiento que se realiza en nuestro medio. Metodo Estudio de datos de registros de trauma de 6 hospitales espanoles: Hospital Gregorio Maranon, Hospital de Getafe, Hospital Doce de Octubre, Hospital Virgen de la Vega, Hospital de Torrevieja y Corporacio Sanitaria Parc Tauli. Resultados Se analizo a 566 pacientes con lesiones esplenicas (448 hombres y 118 mujeres). El tipo de traumatismo fue fundamentalmente cerrado (94%) y el mecanismo lesional mas frecuente fue el accidente de trafico El ISS medio de la serie fue de 25,2. El tratamiento fue inicialmente quirurgico en el 56,6%, siendo en el 43,4% restante, conservador. De estos, el 6,5% de los pacientes requirio finalmente cirugia y en el 8,8% se realizo angioembolizacion esplenica. De los pacientes intervenidos al inicio, en el 85,3% de los casos se realizo esplenectomia, y cirugia conservadora de bazo en el 14,7%, de los que el 4,6% fracasaron y requirieron nueva intervencion quirurgica con esplenectomia. Conclusion El tratamiento en Espana para el traumatismo esplenico continua siendo en su mayoria quirurgico (fundamentalmente esplenectomia). La angioembolizacion y el tratamiento conservador continuan teniendo escasa presencia.

Background Trauma injuries are the main cause of death in the world. The aim of this study is to determine how trauma patients are treated in Spain at an organizational level.

Background Trauma injuries are the main cause of death in the world. The aim of this study is to determine how trauma patients are treated in Spain at an organizational level. Material and methods A questionnaire was prepared consisting of 14 questions regarding aspects of the trauma care organization and trauma education. It was posted on the web site of the Spanish College of Surgeons and all members were encouraged to participate. Results One hundred and ninety questionnaires from 110 different hospitals were received. More than two-thirds (67.3%) of the centers had protocols for treating trauma patients, with 81% of them based on ATLS guidelines. Almost three-quarters (72.6%) of the doctors had completed the ATLS course, and 38.9% the DSTC course. There was a specific education program in trauma in 24.5% of the centers, and 35.5% had a Trauma Committee. There was a rehabilitation program in 24.5% of the centers. Conclusion Very few of the participating centers would fulfill the requirements of the American College of Surgeons accreditation for trauma centers. Trauma care in Spain has improved a lot in the recent years, but there is still a lot to do to reach the level of that in the United States of America.

Pancreatic injury is an uncommon event often difficult to diagnose at an early stage. After abdominal trauma, the surgeon must always be aware of the possibility of pancreatic trauma due to the complications associated with missed pancreatic injuries. Due to its retroperitoneal position, asociated organs and vascular injuries are almost always present, which along with frequent extra abdominal injuries explain the high morbidity and mortality. The aim of this study is to present a concise description of the incidence of these injuries, lesional mechanisms, recommended diagnostic methods, therapeutic indications including nonoperative management, endoscopy and surgery, and an analysis of pancreas-specific complications and mortality rates in these patients based on a 60-year review of the literature, encompassing 6,364 patients. Due to pancreatic retroperitoneal position, asociated organs and vascular injuries are almost always present, which along with frequent extraaabdominal injuries explain the high morbidity and mortality of these patients.

Resumen El tratamiento conservador no operatorio se ha convertido en la actualidad en la mejor opcion terapeutica de la mayoria de los traumatismos hepaticos cerrados en pacientes hemodinamicamente estables. Sin embargo, todavia hay dudas acerca de que pacientes deben ser tratados de forma conservadora, si se puede predecir el fallo del tratamiento antes de que aparezcan las complicaciones y como debe hacerse el seguimiento de estos pacientes. El presente estudio de revision trata de establecer los criterios de seleccion de los pacientes teniendo en cuenta su estabilidad hemodinamica, su integridad neurologica, la presencia de signos peritoneales, el grado de la lesion, la posibilidad de controlar adecuadamente a los pacientes, la cantidad de hemoperitoneo, la cantidad de transfusion sanguinea, la presencia de lesiones asociadas, la calidad de la tomografia computarizada, la ausencia de hemorragia activa, la edad, la terapia anticoagulante y la etiologia del traumatismo. En la actualidad se dispone de suficientes datos que sugieren que es razonable realizar un tratamiento no operatorio de los traumatismos hepaticos cerrados tras haberse demostrado su eficacia en diferentes estudios, lo que en muchas ocasiones evita una laparotomia en blanco y precisa una menor cantidad de transfusion sanguinea, asi como una estancia hospitalaria y en la unidad de cuidados intensivos (UCI) mas reducida. Se revisa tambien el control y el seguimiento de los pacientes y se discute cuanto tiempo deben permanecer en la UCI, ingresados, en cama o sin hacer ninguna actividad fisica importante, asi como cada cuanto tiempo deben realizarse pruebas radiologicas. En pacientes estables, la mayoria de los traumatismos hepaticos cerrados pueden ser tratados de forma conservadora con una baja morbimortalidad.

En el articulo original «Analisis de los resultados de una encuesta sobre los sistemas de trauma en Espana: la enfermedad abandonada de la sociedad moderna» (Cir Esp. 2013;91(7):432-437, se ha detectado un error en el titulo del articulo en ingles. El titulo correcto es «Analysis of the results of survey on trauma systems: The neglected disease of the modern society». c i r e s p . 2 0 1 3 ; x x ( x x ) : x x x – x x x