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1. ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

Author

Frassini, S, Cobianchi, L, Fugazzola, P, Biffl, W, Coccolini, F, Damaskos, D, Moore, E, Kluger, Y, Ceresoli, M, Coimbra, R, Davies, J, Kirkpatrick, A, Di Carlo, I, Hardcastle, T, Isik, A, Chiarugi, M, Gurusamy, K, Maier, R, Segovia Lohse, H, Jeekel, H, Boermeester, M, Abu-Zidan, F, Inaba, K, Weber, D, Augustin, G, Bonavina, L, Velmahos, G, Sartelli, M, Di Saverio, S, Ten Broek, R, Granieri, S, Dal Mas, F, Fare, C, Peverada, J, Zanghi, S, Vigano, J, Tomasoni, M, Dominioni, T, Cicuttin, E, Hecker, A, Tebala, G, Galante, J, Wani, I, Khokha, V, Sugrue, M, Scalea, T, Tan, E, Malangoni, M, Pararas, N, Podda, M, De Simone, B, Ivatury, R, Cui, Y, Kashuk, J, Peitzman, A, Kim, F, Pikoulis, E, Sganga, G, Chiara, O, Kelly, M, Marzi, I, Picetti, E, Agnoletti, V, De'Angelis, N, Campanelli, G, de Moya, M, Litvin, A, Martinez-Perez, A, Sall, I, Rizoli, S, Tomadze, G, Sakakushev, B, Stahel, P, Civil, I, Shelat, V, Costa, D, Chichom-Mefire, A, Latifi, R, Chirica, M, Amico, F, Pardhan, A, Seenarain, V, Boyapati, N, Hatz, B, Ackermann, T, Abeyasundara, S, Fenton, L, Plani, F, Sarvepalli, R, Rouhbakhshfar, O, Caleo, P, Ho-Ching Yau, V, Clement, K, Christou, E, Castillo, A, Gosal, P, Balasubramaniam, S, Hsu, J, Banphawatanarak, K, Pisano, M, Adriana, T, Michele, A, Cioffi, S, Spota, A, Catena, F, Ansaloni, L, Frassini S., Cobianchi L., Fugazzola P., Biffl W. L., Coccolini F., Damaskos D., Moore E. E., Kluger Y., Ceresoli M., Coimbra R., Davies J., Kirkpatrick A., Di Carlo I., Hardcastle T. C., Isik A., Chiarugi M., Gurusamy K., Maier R. V., Segovia Lohse H. A., Jeekel H., Boermeester M. A., Abu-Zidan F., Inaba K., Weber D. G., Augustin G., Bonavina L., Velmahos G., Sartelli M., Di Saverio S., Ten Broek R. P. G., Granieri S., Dal Mas F., Fare C. N., Peverada J., Zanghi S., Vigano J., Tomasoni M., Dominioni T., Cicuttin E., Hecker A., Tebala G. D., Galante J. M., Wani I., Khokha V., Sugrue M., Scalea T. M., Tan E., Malangoni M. A., Pararas N., Podda M., De Simone B., Ivatury R., Cui Y., Kashuk J., Peitzman A., Kim F., Pikoulis E., Sganga G., Chiara O., Kelly M. D., Marzi I., Picetti E., Agnoletti V., De'Angelis N., Campanelli G., de Moya M., Litvin A., Martinez-Perez A., Sall I., Rizoli S., Tomadze G., Sakakushev B., Stahel P. F., Civil I., Shelat V., Costa D., Chichom-Mefire A., Latifi R., Chirica M., Amico F., Pardhan A., Seenarain V., Boyapati N., Hatz B., Ackermann T., Abeyasundara S., Fenton L., Plani F., Sarvepalli R., Rouhbakhshfar O., Caleo P., Ho-Ching Yau V., Clement K., Christou E., Castillo A. M. G., Gosal P. K. S., Balasubramaniam S., Hsu J., Banphawatanarak K., Pisano M., Adriana T., Michele A., Cioffi S. P. B., Spota A., Catena F., Ansaloni L., Frassini, S, Cobianchi, L, Fugazzola, P, Biffl, W, Coccolini, F, Damaskos, D, Moore, E, Kluger, Y, Ceresoli, M, Coimbra, R, Davies, J, Kirkpatrick, A, Di Carlo, I, Hardcastle, T, Isik, A, Chiarugi, M, Gurusamy, K, Maier, R, Segovia Lohse, H, Jeekel, H, Boermeester, M, Abu-Zidan, F, Inaba, K, Weber, D, Augustin, G, Bonavina, L, Velmahos, G, Sartelli, M, Di Saverio, S, Ten Broek, R, Granieri, S, Dal Mas, F, Fare, C, Peverada, J, Zanghi, S, Vigano, J, Tomasoni, M, Dominioni, T, Cicuttin, E, Hecker, A, Tebala, G, Galante, J, Wani, I, Khokha, V, Sugrue, M, Scalea, T, Tan, E, Malangoni, M, Pararas, N, Podda, M, De Simone, B, Ivatury, R, Cui, Y, Kashuk, J, Peitzman, A, Kim, F, Pikoulis, E, Sganga, G, Chiara, O, Kelly, M, Marzi, I, Picetti, E, Agnoletti, V, De'Angelis, N, Campanelli, G, de Moya, M, Litvin, A, Martinez-Perez, A, Sall, I, Rizoli, S, Tomadze, G, Sakakushev, B, Stahel, P, Civil, I, Shelat, V, Costa, D, Chichom-Mefire, A, Latifi, R, Chirica, M, Amico, F, Pardhan, A, Seenarain, V, Boyapati, N, Hatz, B, Ackermann, T, Abeyasundara, S, Fenton, L, Plani, F, Sarvepalli, R, Rouhbakhshfar, O, Caleo, P, Ho-Ching Yau, V, Clement, K, Christou, E, Castillo, A, Gosal, P, Balasubramaniam, S, Hsu, J, Banphawatanarak, K, Pisano, M, Adriana, T, Michele, A, Cioffi, S, Spota, A, Catena, F, Ansaloni, L, Frassini S., Cobianchi L., Fugazzola P., Biffl W. L., Coccolini F., Damaskos D., Moore E. E., Kluger Y., Ceresoli M., Coimbra R., Davies J., Kirkpatrick A., Di Carlo I., Hardcastle T. C., Isik A., Chiarugi M., Gurusamy K., Maier R. V., Segovia Lohse H. A., Jeekel H., Boermeester M. A., Abu-Zidan F., Inaba K., Weber D. G., Augustin G., Bonavina L., Velmahos G., Sartelli M., Di Saverio S., Ten Broek R. P. G., Granieri S., Dal Mas F., Fare C. N., Peverada J., Zanghi S., Vigano J., Tomasoni M., Dominioni T., Cicuttin E., Hecker A., Tebala G. D., Galante J. M., Wani I., Khokha V., Sugrue M., Scalea T. M., Tan E., Malangoni M. A., Pararas N., Podda M., De Simone B., Ivatury R., Cui Y., Kashuk J., Peitzman A., Kim F., Pikoulis E., Sganga G., Chiara O., Kelly M. D., Marzi I., Picetti E., Agnoletti V., De'Angelis N., Campanelli G., de Moya M., Litvin A., Martinez-Perez A., Sall I., Rizoli S., Tomadze G., Sakakushev B., Stahel P. F., Civil I., Shelat V., Costa D., Chichom-Mefire A., Latifi R., Chirica M., Amico F., Pardhan A., Seenarain V., Boyapati N., Hatz B., Ackermann T., Abeyasundara S., Fenton L., Plani F., Sarvepalli R., Rouhbakhshfar O., Caleo P., Ho-Ching Yau V., Clement K., Christou E., Castillo A. M. G., Gosal P. K. S., Balasubramaniam S., Hsu J., Banphawatanarak K., Pisano M., Adriana T., Michele A., Cioffi S. P. B., Spota A., Catena F., and Ansaloni L.

Abstract

Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.

Published
2023

3. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery

Author

Bala, M, Catena, F, Kashuk, J, De Simone, B, Gomes, C, Weber, D, Sartelli, M, Coccolini, F, Kluger, Y, Abu-Zidan, F, Picetti, E, Ansaloni, L, Augustin, G, Biffl, W, Ceresoli, M, Chiara, O, Chiarugi, M, Coimbra, R, Cui, Y, Damaskos, D, Di Saverio, S, Galante, J, Khokha, V, Kirkpatrick, A, Inaba, K, Leppaniemi, A, Litvin, A, Peitzman, A, Shelat, V, Sugrue, M, Tolonen, M, Rizoli, S, Sall, I, Beka, S, Di Carlo, I, Ten Broek, R, Mircea, C, Tebala, G, Pisano, M, van Goor, H, Maier, R, Jeekel, H, Civil, I, Hecker, A, Tan, E, Soreide, K, Lee, M, Wani, I, Bonavina, L, Malangoni, M, Koike, K, Velmahos, G, Fraga, G, Fette, A, De'Angelis, N, Balogh, Z, Scalea, T, Sganga, G, Kelly, M, Khan, J, Stahel, P, Moore, E, Bala M., Catena F., Kashuk J., De Simone B., Gomes C. A., Weber D., Sartelli M., Coccolini F., Kluger Y., Abu-Zidan F. M., Picetti E., Ansaloni L., Augustin G., Biffl W. L., Ceresoli M., Chiara O., Chiarugi M., Coimbra R., Cui Y., Damaskos D., Di Saverio S., Galante J. M., Khokha V., Kirkpatrick A. W., Inaba K., Leppaniemi A., Litvin A., Peitzman A. B., Shelat V. G., Sugrue M., Tolonen M., Rizoli S., Sall I., Beka S. G., Di Carlo I., Ten Broek R., Mircea C., Tebala G., Pisano M., van Goor H., Maier R. V., Jeekel H., Civil I., Hecker A., Tan E., Soreide K., Lee M. J., Wani I., Bonavina L., Malangoni M. A., Koike K., Velmahos G. C., Fraga G. P., Fette A., de'Angelis N., Balogh Z. J., Scalea T. M., Sganga G., Kelly M. D., Khan J., Stahel P. F., Moore E. E., Bala, M, Catena, F, Kashuk, J, De Simone, B, Gomes, C, Weber, D, Sartelli, M, Coccolini, F, Kluger, Y, Abu-Zidan, F, Picetti, E, Ansaloni, L, Augustin, G, Biffl, W, Ceresoli, M, Chiara, O, Chiarugi, M, Coimbra, R, Cui, Y, Damaskos, D, Di Saverio, S, Galante, J, Khokha, V, Kirkpatrick, A, Inaba, K, Leppaniemi, A, Litvin, A, Peitzman, A, Shelat, V, Sugrue, M, Tolonen, M, Rizoli, S, Sall, I, Beka, S, Di Carlo, I, Ten Broek, R, Mircea, C, Tebala, G, Pisano, M, van Goor, H, Maier, R, Jeekel, H, Civil, I, Hecker, A, Tan, E, Soreide, K, Lee, M, Wani, I, Bonavina, L, Malangoni, M, Koike, K, Velmahos, G, Fraga, G, Fette, A, De'Angelis, N, Balogh, Z, Scalea, T, Sganga, G, Kelly, M, Khan, J, Stahel, P, Moore, E, Bala M., Catena F., Kashuk J., De Simone B., Gomes C. A., Weber D., Sartelli M., Coccolini F., Kluger Y., Abu-Zidan F. M., Picetti E., Ansaloni L., Augustin G., Biffl W. L., Ceresoli M., Chiara O., Chiarugi M., Coimbra R., Cui Y., Damaskos D., Di Saverio S., Galante J. M., Khokha V., Kirkpatrick A. W., Inaba K., Leppaniemi A., Litvin A., Peitzman A. B., Shelat V. G., Sugrue M., Tolonen M., Rizoli S., Sall I., Beka S. G., Di Carlo I., Ten Broek R., Mircea C., Tebala G., Pisano M., van Goor H., Maier R. V., Jeekel H., Civil I., Hecker A., Tan E., Soreide K., Lee M. J., Wani I., Bonavina L., Malangoni M. A., Koike K., Velmahos G. C., Fraga G. P., Fette A., de'Angelis N., Balogh Z. J., Scalea T. M., Sganga G., Kelly M. D., Khan J., Stahel P. F., and Moore E. E.

Abstract

Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.

Published
2022

4. Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Author

Reichert, M, Sartelli, M, Weigand, M, Hecker, M, Oppelt, P, Noll, J, Askevold, I, Liese, J, Padberg, W, Coccolini, F, Catena, F, Hecker, A, Peckham-Cooper, A, Camacho-Ortiz, A, Mastoraki, A, Landaluce-Olavarria, A, Pal, A, Kuriyama, A, Chichom-Mefire, A, Porcu, A, Martinez-Perez, A, Karamarkovic, A, Osipov, A, Coppola, A, Cucchetti, A, Spolini, A, Giordano, A, Reinisch-Liese, A, Kavalakat, A, Vasilescu, A, Alamin, A, Gupta, A, Dascalu, A, Musina, A, Bakopoulos, A, Zakaria, A, Vereczkei, A, Balla, A, Bottari, A, Baumann, A, Fette, A, Litvin, A, Reichert, A, Guariniello, A, Paspala, A, Schneck, A, Brillantino, A, Pesce, A, Isik, A, Leppaniemi, A, Papadopoulos, A, Kechagias, A, Mohamed, A, Mitul, A, Marinis, A, Syllaios, A, Mantoglu, B, De Simone, B, Weiss, B, Posentrup, B, Picardi, B, Zampogna, B, Sakakushev, B, Atanasov, B, Nardo, B, Calik, B, Cremonini, C, Ordonez, C, Seretis, C, Cascone, C, Chouliaras, C, Bendinelli, C, Lopes, C, Guerci, C, Weber, C, Nastos, C, Mesina, C, Caputo, D, Massalou, D, Cavaliere, D, Mcnamara, D, Demetriades, D, Pantalone, D, Coletta, D, Sasia, D, Visconti, D, Weber, D, Corallino, D, Chatzipetris, D, Manatakis, D, Ntourakis, D, Papaconstantinou, D, Schizas, D, Chrysikos, D, Adamovich, D, Elkafrawy, D, Seban, D, Garcia, E, Baldini, E, Picetti, E, Tan, E, Baili, E, Lostoridis, E, Toma, E, Colak, E, Cerutti, E, Steyn, E, Hsabo, E, Kapetanakis, E, Kaouras, E, Schneck, E, Akin, E, Gonullu, E, Celik, E, Cicuttin, E, Pinotti, E, Johnsson, E, Moore, E, Agastra, E, Dimitrov, E, Griffiths, E, D'Acapito, F, Saraceno, F, Alconchel, F, Zeppernick, F, Rodriguez, F, Abu-Zidan, F, Pecchini, F, Favi, F, Ferrara, F, Fleres, F, Pata, F, Roscio, F, Mulita, F, Dor, F, Linder, F, Dimofte, G, Rodrigues, G, Nita, G, Sganga, G, Martines, G, Mazzarella, G, Perrone, G, Velmahos, G, Lianos, G, Tomadze, G, Baiocchi, G, D'Ambrosio, G, Pellino, G, Pattacini, G, Giraudo, G, Lisi, G, Tebala, G, Pirozzolo, G, Montori, G, Argenio, G, Brisinda, G, Curro, G, Giuliani, G, Palomba, G, Roscitano, G, Avsar, G, Augustin, G, Clarizia, G, Vega, G, Fraga, G, Sethi, H, Eltyeb, H, Lohse, H, Bayhan, H, Hamid, H, Kryvoruchko, I, Iannone, I, Wani, I, Lazaridis, I, Katsaros, I, Nikolopoulos, I, Negoi, I, Reccia, I, Di Carlo, I, Olaoye, I, Czepiel, J, Kim, J, Meyer, J, Terrazas, J, Tochie, J, Galante, J, Davies, J, Sugand, K, Gonfa, K, Rasa, K, Kok, K, Apostolou, K, Lasithiotakis, K, Tsekouras, K, Angamuthu, K, Akhmeteli, L, Sydorchuk, L, Fortuna, L, Siragusa, L, Pagani, L, Solaini, L, Miller, L, Bains, L, Ansaloni, L, Ferrario, L, Bonavina, L, Conti, L, Buonomo, L, Tallon-Aguilar, L, Tomczyk, L, Widmer, L, Waledziak, M, Gachabayov, M, Bulanauca, M, Malbrain, M, Maegele, M, Catarci, M, Ceresoli, M, Ranucci, M, Antonopoulou, M, Papadoliopoulou, M, Valenti, M, Sotiropoulou, M, D'Oria, M, Martin, M, Hirschburger, M, Veroux, M, Fantoni, M, Nardi, M, Tolonen, M, Montuori, M, Podda, M, Scheiterle, M, Frountzas, M, Sarikaya, M, Yildirim, M, Bender, M, Vailas, M, Teuben, M, Campanelli, M, Ammendola, M, Malerba, M, Pisano, M, Pertea, M, Slavchev, M, Ukkonen, M, Bala, M, Chirica, M, Barone, M, Shaat, M, Mohammed, M, Abuelgasim, M, Gureh, M, Ouadii, M, Balkan, M, Mohamed, M, Hakseven, M, Velenciuc, N, Cillara, N, De'Angelis, N, Tamini, N, Zavras, N, Machairas, N, Michalopoulos, N, Koliakos, N, Pararas, N, Donlon, N, Medappil, N, Ben-Ishay, O, Stefano, O, Islam, O, Tammo, O, Ioannidis, O, Aparicio, O, Baraket, O, Kumar, P, Cianci, P, Ortenwall, P, Uchikov, P, de Reuver, P, Stahel, P, Barie, P, Piccoli, M, Major, P, Navsaria, P, Sasmal, P, Coimbra, R, Rahim, R, Capoglu, R, Koshy, R, Gonsaga, R, Pertile, R, Mohamed, R, Deryol, R, Sawyer, R, Angelico, R, Ragozzino, R, Bini, R, Cammarata, R, Scaramuzzo, R, Gioco, R, Sydorchuk, R, Ahmed, S, Di Saverio, S, Emile, S, Delibegovic, S, Marwah, S, Symeonidis, S, Thomas, S, Demir, S, Awad, S, Atici, S, Chooklin, S, Meric, S, Sarikaya, S, Chowdhury, S, Mirghani, S, Wren, S, Gargarella, S, Del Monte, S, Esposito, S, Xenaki, S, Mohamed, S, Beka, S, Lunca, S, Delis, S, Dritsas, S, Morarasu, S, Magnone, S, Rossi, S, Bitsianis, S, Kykalos, S, Baral, S, Jain, S, Ali, S, Pintar, T, Triantafyllou, T, Delko, T, Perra, T, Sidiropoulos, T, Scalea, T, Vilz, T, Hardcastle, T, Wannatoop, T, Herzog, T, Mishra, T, Boggi, U, Calu, V, Tomajer, V, Agnoletti, V, Lohsiriwat, V, Kong, V, Munoz-Cruzado, V, Shelat, V, Khokha, V, Ghannam, W, Biffl, W, Zuidema, W, Kara, Y, Kobe, Y, Demetrashvili, Z, Memish, Z, Madrazo, Z, Balogh, Z, Bayhan, Z, Reichert M., Sartelli M., Weigand M. A., Hecker M., Oppelt P. U., Noll J., Askevold I. H., Liese J., Padberg W., Coccolini F., Catena F., Hecker A., Peckham-Cooper A., Camacho-Ortiz A., Mastoraki A. T., Landaluce-Olavarria A., Pal A. K., Kuriyama A., Chichom-Mefire A., Porcu A., Martinez-Perez A., Karamarkovic A. R., Osipov A. V., Coppola A., Cucchetti A., Spolini A., Giordano A., Reinisch-Liese A., Kavalakat A. J., Vasilescu A., Alamin A., Gupta A., Dascalu A. M., Musina A. -M., Bakopoulos A., Zakaria A. D., Vereczkei A., Balla A., Bottari A., Baumann A., Fette A., Litvin A., Reichert A. K., Guariniello A., Paspala A., Schneck A. -S., Brillantino A., Pesce A., Isik A., Leppaniemi A. K., Papadopoulos A., Kechagias A., Mohamed A. Y. A., Mitul A. R., Marinis A., Syllaios A., Mantoglu B., De Simone B., Weiss B. S., Posentrup B., Picardi B., Zampogna B., Sakakushev B. E., Atanasov B. C., Nardo B., Calik B., Cremonini C., Ordonez C. A., Seretis C., Cascone C., Chouliaras C., Bendinelli C., Lopes C., Guerci C., Weber C., Nastos C., Mesina C., Caputo D., Massalou D., Cavaliere D., McNamara D. A., Demetriades D., Pantalone D., Coletta D., Sasia D., Visconti D., Weber D. G., Corallino D., Chatzipetris D., Manatakis D. K., Ntourakis D., Papaconstantinou D., Schizas D., Chrysikos D., Adamovich D. M., Elkafrawy D., Seban D., Garcia E. F. H., Baldini E., Picetti E., Tan E. C. T. H., Baili E., Lostoridis E., Toma E. A., Colak E., Cerutti E., Steyn E., Hsabo E. A., Kapetanakis E. I., Kaouras E., Schneck E., Akin E., Gonullu E., celik E., Cicuttin E., Pinotti E., Johnsson E., Moore E. E., Agastra E., Dimitrov E. N., Griffiths E. A., D'Acapito F., Saraceno F., Alconchel F., Zeppernick F. A., Rodriguez F. M., Abu-Zidan F., Pecchini F., Favi F., Ferrara F., Fleres F., Pata F., Roscio F. P. M., Mulita F., Dor F. J. M. F., Linder F., Dimofte G., Rodrigues G., Nita G., Sganga G., Martines G., Mazzarella G., Perrone G., Velmahos G., Lianos G. D., Tomadze G., Baiocchi G. L., D'Ambrosio G., Pellino G., Pattacini G. C., Giraudo G., Lisi G., Tebala G. D., Pirozzolo G., Montori G., Argenio G., Brisinda G., Curro G., Giuliani G., Palomba G., Roscitano G., Avsar G., Augustin G., Clarizia G., Vega G. M. M., Fraga G. P., Sethi H., Eltyeb H. A., Lohse H. A. S., Lohse H. R. S., Bayhan H., Hamid H. K. S., Kryvoruchko I. A., Iannone I., Wani I., Lazaridis I. I., Katsaros I., Nikolopoulos I., Negoi I., Reccia I., Di Carlo I., Olaoye I. O., Czepiel J., Kim J. I., Meyer J., Terrazas J. M. S., Tochie J. N., Galante J. M., Davies J., Sugand K., Gonfa K. B., Rasa K., Kok K. Y. Y., Apostolou K. G., Lasithiotakis K., Tsekouras K., Angamuthu K., Akhmeteli L., Sydorchuk L., Fortuna L., Siragusa L., Pagani L., Solaini L., Miller L. A., Bains L., Ansaloni L., Ferrario L., Bonavina L., Conti L., Buonomo L. A., Tallon-Aguilar L., Tomczyk L., Widmer L. W., Waledziak M., Gachabayov M., Bulanauca M. M., Malbrain M. L. N. G., Maegele M., Catarci M., Ceresoli M., Ranucci M. C., Antonopoulou M. I., Papadoliopoulou M., Valenti M. R., Sotiropoulou M., D'Oria M., Martin M. S., Hirschburger M., Veroux M., Fantoni M., Nardi M., Tolonen M., Montuori M., Podda M., Scheiterle M., Frountzas M., Sarikaya M., Yildirim M., Bender M., Vailas M., Teuben M., Campanelli M., Ammendola M., Malerba M., Pisano M., Pertea M., Slavchev M., Ukkonen M., Bala M., Chirica M., Barone M., Shaat M. M., Mohammed M. J. S., Abuelgasim M. A. A., Gureh M., Ouadii M., Balkan M., Mohamed M., Hakseven M., Velenciuc N., Cillara N., de'Angelis N., Tamini N., Zavras N. J., Machairas N., Michalopoulos N., Koliakos N. N., Pararas N., Donlon N. E., Medappil N., Ben-Ishay O., Stefano O., Islam O., Tammo O., Ioannidis O., Aparicio O., Baraket O., Kumar P., Cianci P., Ortenwall P., Uchikov P. A., de Reuver P., Stahel P. F., Barie P. S., Piccoli M., Major P., Navsaria P. H., Sasmal P. K., Coimbra R., Rahim R., Capoglu R., Koshy R. M., Gonsaga R. A. T., Pertile R., Mohamed R. R. M., Deryol R., Sawyer R. G., Angelico R., Ragozzino R., Bini R., Cammarata R., Scaramuzzo R., Gioco R., Sydorchuk R., Ahmed S., Di Saverio S., Emile S. H., Delibegovic S., Marwah S., Symeonidis S., Thomas S. G., Demir S., Awad S. S., Atici S. D., Chooklin S., Meric S., Sarikaya S., Chowdhury S., Mirghani S. F., Wren S. M., Gargarella S., Del Monte S. R., Esposito S., Xenaki S., Mohamed S. F. G., Beka S. G., Lunca S., Delis S. G., Dritsas S., Morarasu S., Magnone S., Rossi S., Bitsianis S., Kykalos S., Baral S., Jain S. A., Ali S. M., Pintar T., Triantafyllou T., Delko T., Perra T., Sidiropoulos T. A., Scalea T. M., Vilz T. O., Hardcastle T. C., Wannatoop T., Herzog T., Mishra T. S., Boggi U., Calu V., Tomajer V., Agnoletti V., Lohsiriwat V., Kong V., Munoz-Cruzado V. D., Shelat V. G., Khokha V., Ghannam W. M., Biffl W. L., Zuidema W., Kara Y., Kobe Y., Demetrashvili Z., Memish Z. A., Madrazo Z., Balogh Z. J., Bayhan Z., Reichert, M, Sartelli, M, Weigand, M, Hecker, M, Oppelt, P, Noll, J, Askevold, I, Liese, J, Padberg, W, Coccolini, F, Catena, F, Hecker, A, Peckham-Cooper, A, Camacho-Ortiz, A, Mastoraki, A, Landaluce-Olavarria, A, Pal, A, Kuriyama, A, Chichom-Mefire, A, Porcu, A, Martinez-Perez, A, Karamarkovic, A, Osipov, A, Coppola, A, Cucchetti, A, Spolini, A, Giordano, A, Reinisch-Liese, A, Kavalakat, A, Vasilescu, A, Alamin, A, Gupta, A, Dascalu, A, Musina, A, Bakopoulos, A, Zakaria, A, Vereczkei, A, Balla, A, Bottari, A, Baumann, A, Fette, A, Litvin, A, Reichert, A, Guariniello, A, Paspala, A, Schneck, A, Brillantino, A, Pesce, A, Isik, A, Leppaniemi, A, Papadopoulos, A, Kechagias, A, Mohamed, A, Mitul, A, Marinis, A, Syllaios, A, Mantoglu, B, De Simone, B, Weiss, B, Posentrup, B, Picardi, B, Zampogna, B, Sakakushev, B, Atanasov, B, Nardo, B, Calik, B, Cremonini, C, Ordonez, C, Seretis, C, Cascone, C, Chouliaras, C, Bendinelli, C, Lopes, C, Guerci, C, Weber, C, Nastos, C, Mesina, C, Caputo, D, Massalou, D, Cavaliere, D, Mcnamara, D, Demetriades, D, Pantalone, D, Coletta, D, Sasia, D, Visconti, D, Weber, D, Corallino, D, Chatzipetris, D, Manatakis, D, Ntourakis, D, Papaconstantinou, D, Schizas, D, Chrysikos, D, Adamovich, D, Elkafrawy, D, Seban, D, Garcia, E, Baldini, E, Picetti, E, Tan, E, Baili, E, Lostoridis, E, Toma, E, Colak, E, Cerutti, E, Steyn, E, Hsabo, E, Kapetanakis, E, Kaouras, E, Schneck, E, Akin, E, Gonullu, E, Celik, E, Cicuttin, E, Pinotti, E, Johnsson, E, Moore, E, Agastra, E, Dimitrov, E, Griffiths, E, D'Acapito, F, Saraceno, F, Alconchel, F, Zeppernick, F, Rodriguez, F, Abu-Zidan, F, Pecchini, F, Favi, F, Ferrara, F, Fleres, F, Pata, F, Roscio, F, Mulita, F, Dor, F, Linder, F, Dimofte, G, Rodrigues, G, Nita, G, Sganga, G, Martines, G, Mazzarella, G, Perrone, G, Velmahos, G, Lianos, G, Tomadze, G, Baiocchi, G, D'Ambrosio, G, Pellino, G, Pattacini, G, Giraudo, G, Lisi, G, Tebala, G, Pirozzolo, G, Montori, G, Argenio, G, Brisinda, G, Curro, G, Giuliani, G, Palomba, G, Roscitano, G, Avsar, G, Augustin, G, Clarizia, G, Vega, G, Fraga, G, Sethi, H, Eltyeb, H, Lohse, H, Bayhan, H, Hamid, H, Kryvoruchko, I, Iannone, I, Wani, I, Lazaridis, I, Katsaros, I, Nikolopoulos, I, Negoi, I, Reccia, I, Di Carlo, I, Olaoye, I, Czepiel, J, Kim, J, Meyer, J, Terrazas, J, Tochie, J, Galante, J, Davies, J, Sugand, K, Gonfa, K, Rasa, K, Kok, K, Apostolou, K, Lasithiotakis, K, Tsekouras, K, Angamuthu, K, Akhmeteli, L, Sydorchuk, L, Fortuna, L, Siragusa, L, Pagani, L, Solaini, L, Miller, L, Bains, L, Ansaloni, L, Ferrario, L, Bonavina, L, Conti, L, Buonomo, L, Tallon-Aguilar, L, Tomczyk, L, Widmer, L, Waledziak, M, Gachabayov, M, Bulanauca, M, Malbrain, M, Maegele, M, Catarci, M, Ceresoli, M, Ranucci, M, Antonopoulou, M, Papadoliopoulou, M, Valenti, M, Sotiropoulou, M, D'Oria, M, Martin, M, Hirschburger, M, Veroux, M, Fantoni, M, Nardi, M, Tolonen, M, Montuori, M, Podda, M, Scheiterle, M, Frountzas, M, Sarikaya, M, Yildirim, M, Bender, M, Vailas, M, Teuben, M, Campanelli, M, Ammendola, M, Malerba, M, Pisano, M, Pertea, M, Slavchev, M, Ukkonen, M, Bala, M, Chirica, M, Barone, M, Shaat, M, Mohammed, M, Abuelgasim, M, Gureh, M, Ouadii, M, Balkan, M, Mohamed, M, Hakseven, M, Velenciuc, N, Cillara, N, De'Angelis, N, Tamini, N, Zavras, N, Machairas, N, Michalopoulos, N, Koliakos, N, Pararas, N, Donlon, N, Medappil, N, Ben-Ishay, O, Stefano, O, Islam, O, Tammo, O, Ioannidis, O, Aparicio, O, Baraket, O, Kumar, P, Cianci, P, Ortenwall, P, Uchikov, P, de Reuver, P, Stahel, P, Barie, P, Piccoli, M, Major, P, Navsaria, P, Sasmal, P, Coimbra, R, Rahim, R, Capoglu, R, Koshy, R, Gonsaga, R, Pertile, R, Mohamed, R, Deryol, R, Sawyer, R, Angelico, R, Ragozzino, R, Bini, R, Cammarata, R, Scaramuzzo, R, Gioco, R, Sydorchuk, R, Ahmed, S, Di Saverio, S, Emile, S, Delibegovic, S, Marwah, S, Symeonidis, S, Thomas, S, Demir, S, Awad, S, Atici, S, Chooklin, S, Meric, S, Sarikaya, S, Chowdhury, S, Mirghani, S, Wren, S, Gargarella, S, Del Monte, S, Esposito, S, Xenaki, S, Mohamed, S, Beka, S, Lunca, S, Delis, S, Dritsas, S, Morarasu, S, Magnone, S, Rossi, S, Bitsianis, S, Kykalos, S, Baral, S, Jain, S, Ali, S, Pintar, T, Triantafyllou, T, Delko, T, Perra, T, Sidiropoulos, T, Scalea, T, Vilz, T, Hardcastle, T, Wannatoop, T, Herzog, T, Mishra, T, Boggi, U, Calu, V, Tomajer, V, Agnoletti, V, Lohsiriwat, V, Kong, V, Munoz-Cruzado, V, Shelat, V, Khokha, V, Ghannam, W, Biffl, W, Zuidema, W, Kara, Y, Kobe, Y, Demetrashvili, Z, Memish, Z, Madrazo, Z, Balogh, Z, Bayhan, Z, Reichert M., Sartelli M., Weigand M. A., Hecker M., Oppelt P. U., Noll J., Askevold I. H., Liese J., Padberg W., Coccolini F., Catena F., Hecker A., Peckham-Cooper A., Camacho-Ortiz A., Mastoraki A. T., Landaluce-Olavarria A., Pal A. K., Kuriyama A., Chichom-Mefire A., Porcu A., Martinez-Perez A., Karamarkovic A. R., Osipov A. V., Coppola A., Cucchetti A., Spolini A., Giordano A., Reinisch-Liese A., Kavalakat A. J., Vasilescu A., Alamin A., Gupta A., Dascalu A. M., Musina A. -M., Bakopoulos A., Zakaria A. D., Vereczkei A., Balla A., Bottari A., Baumann A., Fette A., Litvin A., Reichert A. K., Guariniello A., Paspala A., Schneck A. -S., Brillantino A., Pesce A., Isik A., Leppaniemi A. K., Papadopoulos A., Kechagias A., Mohamed A. Y. A., Mitul A. R., Marinis A., Syllaios A., Mantoglu B., De Simone B., Weiss B. S., Posentrup B., Picardi B., Zampogna B., Sakakushev B. E., Atanasov B. C., Nardo B., Calik B., Cremonini C., Ordonez C. A., Seretis C., Cascone C., Chouliaras C., Bendinelli C., Lopes C., Guerci C., Weber C., Nastos C., Mesina C., Caputo D., Massalou D., Cavaliere D., McNamara D. A., Demetriades D., Pantalone D., Coletta D., Sasia D., Visconti D., Weber D. G., Corallino D., Chatzipetris D., Manatakis D. K., Ntourakis D., Papaconstantinou D., Schizas D., Chrysikos D., Adamovich D. M., Elkafrawy D., Seban D., Garcia E. F. H., Baldini E., Picetti E., Tan E. C. T. H., Baili E., Lostoridis E., Toma E. A., Colak E., Cerutti E., Steyn E., Hsabo E. A., Kapetanakis E. I., Kaouras E., Schneck E., Akin E., Gonullu E., celik E., Cicuttin E., Pinotti E., Johnsson E., Moore E. E., Agastra E., Dimitrov E. N., Griffiths E. A., D'Acapito F., Saraceno F., Alconchel F., Zeppernick F. A., Rodriguez F. M., Abu-Zidan F., Pecchini F., Favi F., Ferrara F., Fleres F., Pata F., Roscio F. P. M., Mulita F., Dor F. J. M. F., Linder F., Dimofte G., Rodrigues G., Nita G., Sganga G., Martines G., Mazzarella G., Perrone G., Velmahos G., Lianos G. D., Tomadze G., Baiocchi G. L., D'Ambrosio G., Pellino G., Pattacini G. C., Giraudo G., Lisi G., Tebala G. D., Pirozzolo G., Montori G., Argenio G., Brisinda G., Curro G., Giuliani G., Palomba G., Roscitano G., Avsar G., Augustin G., Clarizia G., Vega G. M. M., Fraga G. P., Sethi H., Eltyeb H. A., Lohse H. A. S., Lohse H. R. S., Bayhan H., Hamid H. K. S., Kryvoruchko I. A., Iannone I., Wani I., Lazaridis I. I., Katsaros I., Nikolopoulos I., Negoi I., Reccia I., Di Carlo I., Olaoye I. O., Czepiel J., Kim J. I., Meyer J., Terrazas J. M. S., Tochie J. N., Galante J. M., Davies J., Sugand K., Gonfa K. B., Rasa K., Kok K. Y. Y., Apostolou K. G., Lasithiotakis K., Tsekouras K., Angamuthu K., Akhmeteli L., Sydorchuk L., Fortuna L., Siragusa L., Pagani L., Solaini L., Miller L. A., Bains L., Ansaloni L., Ferrario L., Bonavina L., Conti L., Buonomo L. A., Tallon-Aguilar L., Tomczyk L., Widmer L. W., Waledziak M., Gachabayov M., Bulanauca M. M., Malbrain M. L. N. G., Maegele M., Catarci M., Ceresoli M., Ranucci M. C., Antonopoulou M. I., Papadoliopoulou M., Valenti M. R., Sotiropoulou M., D'Oria M., Martin M. S., Hirschburger M., Veroux M., Fantoni M., Nardi M., Tolonen M., Montuori M., Podda M., Scheiterle M., Frountzas M., Sarikaya M., Yildirim M., Bender M., Vailas M., Teuben M., Campanelli M., Ammendola M., Malerba M., Pisano M., Pertea M., Slavchev M., Ukkonen M., Bala M., Chirica M., Barone M., Shaat M. M., Mohammed M. J. S., Abuelgasim M. A. A., Gureh M., Ouadii M., Balkan M., Mohamed M., Hakseven M., Velenciuc N., Cillara N., de'Angelis N., Tamini N., Zavras N. J., Machairas N., Michalopoulos N., Koliakos N. N., Pararas N., Donlon N. E., Medappil N., Ben-Ishay O., Stefano O., Islam O., Tammo O., Ioannidis O., Aparicio O., Baraket O., Kumar P., Cianci P., Ortenwall P., Uchikov P. A., de Reuver P., Stahel P. F., Barie P. S., Piccoli M., Major P., Navsaria P. H., Sasmal P. K., Coimbra R., Rahim R., Capoglu R., Koshy R. M., Gonsaga R. A. T., Pertile R., Mohamed R. R. M., Deryol R., Sawyer R. G., Angelico R., Ragozzino R., Bini R., Cammarata R., Scaramuzzo R., Gioco R., Sydorchuk R., Ahmed S., Di Saverio S., Emile S. H., Delibegovic S., Marwah S., Symeonidis S., Thomas S. G., Demir S., Awad S. S., Atici S. D., Chooklin S., Meric S., Sarikaya S., Chowdhury S., Mirghani S. F., Wren S. M., Gargarella S., Del Monte S. R., Esposito S., Xenaki S., Mohamed S. F. G., Beka S. G., Lunca S., Delis S. G., Dritsas S., Morarasu S., Magnone S., Rossi S., Bitsianis S., Kykalos S., Baral S., Jain S. A., Ali S. M., Pintar T., Triantafyllou T., Delko T., Perra T., Sidiropoulos T. A., Scalea T. M., Vilz T. O., Hardcastle T. C., Wannatoop T., Herzog T., Mishra T. S., Boggi U., Calu V., Tomajer V., Agnoletti V., Lohsiriwat V., Kong V., Munoz-Cruzado V. D., Shelat V. G., Khokha V., Ghannam W. M., Biffl W. L., Zuidema W., Kara Y., Kobe Y., Demetrashvili Z., Memish Z. A., Madrazo Z., Balogh Z. J., and Bayhan Z.

Abstract

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approach

Published
2022

8. Prevention and treatment of coagulopathy in patients receiving massive transfusions

Author

Levi, M., Fries, D., Gombotz, H., van der Linden, Ph., Nascimento, B., Callum, J. L., Bélisle, S., Rizoli, S., Hardy, J. -F., Johansson, P. I., Samama, C. M., Grottke, O., Rossaint, R., Henny, C. P., Goslings, J. C., Theusinger, O. M., Spahn, D. R., Ganter, M. T., Hess, J. R., Dutton, R. P., Scalea, T. M., Levy, J. H., Spinella, P. C., Panzer, S., and Reesink, H. W.

Published
2011
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10. Orthopedic injuries in patients with multiple injuries: Results of the 11th trauma update international consensus conference Milan, December 11, 2017

Author

Cimbanassi, S, O'Toole, R, Maegele, M, Henry, S, Scalea, T, Bove, F, Mezzadri, U, Capitani, D, Sala, F, Kanakaris, N, Coccolini, F, Ansaloni, L, Sgardello, S, Bindi, F, Renzi, F, Sammartano, F, Masse, A, Rampoldi, A, Puoti, M, Berlusconi, M, Moretti, B, Rueger, J, Arnez, Z, Del Bene, M, Chieregato, A, Menarini, M, Gordini, G, De Blasio, E, Cudoni, S, Dionigi, P, Fabbri, A, Scandroglio, I, Chiara, O, Cimbanassi S., O'Toole R., Maegele M., Henry S., Scalea T. M., Bove F., Mezzadri U., Capitani D., Sala F., Kanakaris N., Coccolini F., Ansaloni L., Sgardello S., Bindi F., Renzi F., Sammartano F., Masse A., Rampoldi A., Puoti M., Berlusconi M., Moretti B., Rueger J., Arnez Z., Del Bene M., Chieregato A., Menarini M., Gordini G., De Blasio E., Cudoni S., Dionigi P., Fabbri A., Scandroglio I., Chiara O., Cimbanassi, S, O'Toole, R, Maegele, M, Henry, S, Scalea, T, Bove, F, Mezzadri, U, Capitani, D, Sala, F, Kanakaris, N, Coccolini, F, Ansaloni, L, Sgardello, S, Bindi, F, Renzi, F, Sammartano, F, Masse, A, Rampoldi, A, Puoti, M, Berlusconi, M, Moretti, B, Rueger, J, Arnez, Z, Del Bene, M, Chieregato, A, Menarini, M, Gordini, G, De Blasio, E, Cudoni, S, Dionigi, P, Fabbri, A, Scandroglio, I, Chiara, O, Cimbanassi S., O'Toole R., Maegele M., Henry S., Scalea T. M., Bove F., Mezzadri U., Capitani D., Sala F., Kanakaris N., Coccolini F., Ansaloni L., Sgardello S., Bindi F., Renzi F., Sammartano F., Masse A., Rampoldi A., Puoti M., Berlusconi M., Moretti B., Rueger J., Arnez Z., Del Bene M., Chieregato A., Menarini M., Gordini G., De Blasio E., Cudoni S., Dionigi P., Fabbri A., Scandroglio I., and Chiara O.

Abstract

BACKGROUND In blunt trauma, orthopedic injuries are often associated with cerebral and torso injuries. The optimal timing for definitive care is a concern. The aim of the study was to develop evidence-based guidelines for damage-control orthopedic (DCO) and early total care (ETC) of pelvic and long-bone fractures, closed or open, and mangled extremities in adult trauma patients with and without associated injuries. METHODS The literature since 2000 to 2016 was systematically screened according to Preferred Reporting Items for Systematic Reviews and meta-analyses protocol. One hundred twenty-four articles were reviewed by a panel of experts to assign grade of recommendation and level of evidence using the Grading of recommendations Assessment, Development, and Evaluation system, and an International Consensus Conference, endorsed by several scientific societies was held. RESULTS The choice between DCO and ETC depends on the patient's physiology, as well as associated injuries. In hemodynamically unstable pelvic fracture patient, extraperitoneal pelvic packing, angioembolization, external fixation, C-clamp, and resuscitative endovascular balloon occlusion of the aorta are not mutually exclusive. Definitive reconstruction should be deferred until recovery of physiological stability. In long bone fractures, DCO is performed by external fixation, while ETC should be preferred in fully resuscitated patients because of better outcomes. In open fractures early debridement within 24 hours should be recommended and early closure of most grade I, II, IIIa performed. In mangled extremities, limb salvage should be considered for non-life-threatening injuries, mostly of upper limb. CONCLUSION Orthopedic priorities may be: To save a life: Control hemorrhage by stabilizing the pelvis and femur fractures; to save a limb: Treat soft tissue and vascular injuries associated with fractures, stabilize fractures, recognize, and prevent compartmental syndrome; to save functionality: Treat

Published
2020

12. Impact of trauma centre capacity and volume on the mortality risk of incoming new admissions

Author

Chiu, William C, Powers, D B, Hirshon, J M, Shackelford, S A, Hu, P F, Chen, S Y, Chen, H H, Mackenzie, C F, Miller, C H, DuBose, J J, Carroll, C, Fang, R, and Scalea, T M

Abstract

IntroductionTrauma centre capacity and surge volume may affect decisions on where to transport a critically injured patient and whether to bypass the closest facility. Our hypothesis was that overcrowding and high patient acuity would contribute to increase the mortality risk for incoming admissions.MethodsFor a 6-year period, we merged and cross-correlated our institutional trauma registry with a database on Trauma Resuscitation Unit (TRU) patient admissions, movement and discharges, with average capacity of 12 trauma bays. The outcomes of overall hospital and 24 hours mortality for new trauma admissions (NEW) were assessed by multivariate logistic regression.ResultsThere were 42 003 (mean=7000/year) admissions having complete data sets, with 36 354 (87%) patients who were primary trauma admissions, age ≥18 and survival ≥15 min. In the logistic regression model for the entire cohort, NEW admission hospital mortality was only associated with NEW admission age and prehospital Glasgow Coma Scale (GCS) and Shock Index (SI) (all p<0.05). When TRU occupancy reached ≥16 patients, the factors associated with increased NEW admission hospital mortality were existing patients (TRU >1 hour) with SI ≥0.9, recent admissions (TRU ≤1 hour) with age ≥65, NEW admission age and prehospital GCS and SI (all p<0.05).ConclusionThe mortality of incoming patients is not impacted by routine trauma centre overcapacity. In conditions of severe overcrowding, the number of admitted patients with shock physiology and a recent surge of elderly/debilitated patients may influence the mortality risk of a new trauma admission.

Published
2022
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14. Loop versus end colostomy reversal: has anything changed?

Author

Bruns, B. R., primary, DuBose, J., additional, Pasley, J., additional, Kheirbek, T., additional, Chouliaras, K., additional, Riggle, A., additional, Frank, M. K., additional, Phelan, H. A., additional, Holena, D., additional, Inaba, K., additional, Diaz, J., additional, and Scalea, T. M., additional

Published
2014
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15. Pharmacologic Treatment Reduces Pressure Times Time Dose and Relative Duration of Intracranial Hypertension.

Author

Colton, Katharine, Yang, S., Hu, P. F., Chen, H. H., Bonds, B., Stansbury, L. G., Scalea, T. M., and Stein, D. M.

Subjects
BRAIN injuries, INTRACRANIAL hypertension, INTRACRANIAL pressure, TIME, TERTIARY care, HYPERTONIC saline solutions, DISEASE complications
Abstract

Introduction: Past work has shown the importance of the “pressure times time dose” (PTD) of intracranial hypertension (intracranial pressure [ICP] > 19 mm Hg) in predicting outcome after severe traumatic brain injury. We used automated data collection to measure the effect of common medications on the duration and dose of intracranial hypertension. Methods: Patients >17 years old, admitted and requiring ICP monitoring between 2008 and 2010 at a single, large urban tertiary care facility, were retrospectively enrolled. Timing and dose of ICP-directed therapy were recorded from paper and electronic medical records. The ICP data were collected automatically at 6-second intervals and averaged over 5 minutes. The percentage of time of intracranial hypertension (PTI) and PTD (mm Hg h) were calculated. Results: A total of 98 patients with 664 treatment instances were identified. Baseline PTD ranged from 27 (before administration of propofol and fentanyl) to 150 mm Hg h (before mannitol). A “small” dose of hypertonic saline (HTS; ≤250 mL 3%) reduced PTD by 38% in the first hour and 37% in the second hour and reduced the time with ICP >19 by 38% and 39% after 1 and 2 hours, respectively. A “large” dose of HTS reduced PTD by 40% in the first hour and 63% in the second (PTI reduction of 36% and 50%, respectively). An increased dose of propofol or fentanyl infusion failed to decrease PTD but reduced PTI between 14% (propofol alone) and 30% (combined increase in propofol and fentanyl, after 2 hours). Barbiturates failed to decrease PTD but decreased PTI by 30% up to 2 hours after administration. All reductions reported are significantly changed from baseline, P < .05. Conclusion: Baseline PTD values before drug administration reflects varied patient criticality, with much higher values seen before the use of mannitol or barbiturates. Treatment with HTS reduced PTD and PTI burden significantly more than escalation of sedation or pain management, and this effect remained significant at 2 hours after administration. [ABSTRACT FROM AUTHOR]

Published
2016
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22. Central Venous Oxygen Saturation

Author

SCALEA, T. M., primary, HARTNETT, R. W., additional, DUNCAN, A. O., additional, ATWEH, N. A., additional, PHILLIPS, T. F., additional, SCLAFANI, S. J. A., additional, FUORTES, M., additional, and SHAFTAN, G. W., additional

Published
1991
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25. Multidisciplinary Approach for Patients with Pelvic Fractures and Hemodynamic Instability

Author

Stein, D. M., O'Toole, R., and Scalea, T. M.

Abstract

The hemodynamically unstable patient with a pelvic fracture presents a diagnostic and therapeutic challenge. The care of these patients requires a unique multidisciplinary approach with input and expertise from many different specialists. An understanding of pelvic anatomy and fracture patterns can help guide the diagnostic evaluation and treatment plan. The initial management of these patients must focus on rapid airway and hemorrhage control while preparing for ongoing blood loss. Rapid temporary fracture stabilization with simple bedside modalities is crucial in limiting additional blood loss. An exhaustive search must also be performed to evaluate for concomitant injuries that commonly accompany major pelvic fractures and the treatment of these other injuries must be appropriately prioritized. For patients who are unresponsive to standard resuscitation and bedside attempts at limiting hemorrhage, angiographic embolization is often utilized as the next step to attain hemodynamic stability. The key to successful management of these patients lies in the careful coordination of different specialists and the expertise that each brings to the clinical care of the patient.

Published
2007
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36. Pattern of Injury from Personal Watercraft.

Author

Haan, James M., Kramer, M. E., and Scalea, T. M.

Subjects
*PERSONAL watercraft, *WOUNDS & injuries, *ACCIDENTS
Abstract

Injury from personal watercraft has continued to increase. Prior attempts to delineate patterns of injury and relative frequencies have yielded varied results. We retrospectively reviewed Trauma Registry data and charts of all patients who suffered personal watercraft injury treated at the R. Adams Cowley Shock Trauma Center between August 1996 and January 2001. Patient demographics included mechanism of injury, injuries sustained, and outcomes. Attempts were made to correlate events around the injury and injury pattern. During the study period 24 patients were treated. Mechanisms consisted of direct collision, fails from the watercraft, handlebar straddle injuries, axial loading, and hydrostatic jet injury. Traumatic brain injury was most common occurring in 54 per cent of patients. Spinal injury was also common occurring in 29 per cent of patients. Axial loading from falls while wave jumping seemed to correlate with skeletal injury. Thoracolumbar spine injury were often skeletally unstable requiring either brace or operative fixation. Inexperience and reckless behavior were found to be the greatest contributing factors. Substance abuse did not influence injury. [ABSTRACT FROM AUTHOR]

Published
2002
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37. Impact of trauma centre capacity and volume on the mortality risk of incoming new admissions.

Author

Chiu WC, Powers DB, Hirshon JM, Shackelford SA, Hu PF, Chen SY, Chen HH, Mackenzie CF, Miller CH, DuBose JJ, Carroll C, Fang R, and Scalea TM

Subjects
Aged, Glasgow Coma Scale, Hospital Mortality, Humans, Resuscitation, Hospitalization, Trauma Centers
Abstract

Introduction: Trauma centre capacity and surge volume may affect decisions on where to transport a critically injured patient and whether to bypass the closest facility. Our hypothesis was that overcrowding and high patient acuity would contribute to increase the mortality risk for incoming admissions., Methods: For a 6-year period, we merged and cross-correlated our institutional trauma registry with a database on Trauma Resuscitation Unit (TRU) patient admissions, movement and discharges, with average capacity of 12 trauma bays. The outcomes of overall hospital and 24 hours mortality for new trauma admissions (NEW) were assessed by multivariate logistic regression., Results: There were 42 003 (mean=7000/year) admissions having complete data sets, with 36 354 (87%) patients who were primary trauma admissions, age ≥18 and survival ≥15 min. In the logistic regression model for the entire cohort, NEW admission hospital mortality was only associated with NEW admission age and prehospital Glasgow Coma Scale (GCS) and Shock Index (SI) (all p<0.05). When TRU occupancy reached ≥16 patients, the factors associated with increased NEW admission hospital mortality were existing patients (TRU >1 hour) with SI ≥0.9, recent admissions (TRU ≤1 hour) with age ≥65, NEW admission age and prehospital GCS and SI (all p<0.05)., Conclusion: The mortality of incoming patients is not impacted by routine trauma centre overcapacity. In conditions of severe overcrowding, the number of admitted patients with shock physiology and a recent surge of elderly/debilitated patients may influence the mortality risk of a new trauma admission., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2022
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38. Incidence of healthcare-associated infections in patients with fever during the first 48 hours after decannulation from veno-venous extracorporeal membrane oxygenation.

Author

Esposito EC, Jones KM, Galvagno SM Jr, Kaczorowski DJ, Mazzeffi MA, DiChiacchio L, Deatrick KB, Madathil RJ, Herrold JA, Rabinowitz RP, Scalea TM, and Menaker J

Subjects
Delivery of Health Care, Fever etiology, Humans, Incidence, Retrospective Studies, Extracorporeal Membrane Oxygenation adverse effects
Abstract

Introduction: Fevers following decannulation from veno-venous extracorporeal membrane oxygenation often trigger an infectious workup; however, the yield of this workup is unknown. We investigated the incidence of post-veno-venous extracorporeal membrane oxygenation decannulation fever as well as the incidence and nature of healthcare-associated infections in this population within 48 hours of decannulation., Methods: All patients treated with veno-venous extracorporeal membrane oxygenation for acute respiratory failure who survived to decannulation between August 2014 and November 2018 were retrospectively reviewed. Trauma patients and bridge to lung transplant patients were excluded. The highest temperature and maximum white blood cell count in the 24 hours preceding and the 48 hours following decannulation were obtained. All culture data obtained in the 48 hours following decannulation were reviewed. Healthcare-associated infections included blood stream infections, ventilator-associated pneumonia, and urinary tract infections., Results: A total of 143 patients survived to decannulation from veno-venous extracorporeal membrane oxygenation and were included in the study. In total, 73 patients (51%) were febrile in the 48 hours following decannulation. Among this cohort, seven healthcare-associated infections were found, including five urinary tract infections, one blood stream infection, and one ventilator-associated pneumonia. In the afebrile cohort (70 patients), four healthcare-associated infections were found, including one catheter-associated urinary tract infection, two blood stream infections, and one ventilator-associated pneumonia. In all decannulated patients, the majority of healthcare-associated infections were urinary tract infections (55%). No central line-associated blood stream infections were identified in either cohort. When comparing febrile to non-febrile cohorts, there was a significant difference between pre- and post-decannulation highest temperature (p < 0.001) but not maximum white blood cell count (p = 0.66 and p = 0.714) between the two groups. Among all positive culture data, the most commonly isolated organism was Klebsiella pneumoniae (41.7%) followed by Escherichia coli (33%). Median hospital length of stay and time on extracorporeal membrane oxygenation were shorter in the afebrile group compared to the febrile group; however, this did not reach a statistical difference., Conclusion: Fever is common in the 48 hours following decannulation from veno-venous extracorporeal membrane oxygenation. Differentiating infection from non-infectious fever in the post-decannulation veno-venous extracorporeal membrane oxygenation population remains challenging. In our febrile post-decannulation cohort, the incidence of healthcare-associated infections was low. The majority were diagnosed with a urinary tract infection. We believe obtaining cultures in febrile patients in the immediate decannulation period from veno-venous extracorporeal membrane oxygenation has utility, and even in the absence of other clinical suspicion, should be considered. However, based on our data, a urinalysis and urine culture may be sufficient as an initial work up to identify the source of infection.

Published
2021
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39. Molecular Adsorbent Recirculating System Support Followed by Liver Transplantation for Multiorgan Failure From Heatstroke.

Author

LaMattina JC, Akbar H, Sultan S, Hanish SI, Bruno DA, Hutson WR, Stein DM, Bartlett ST, Scalea TM, and Barth RN

Subjects
Adult, Fluid Therapy instrumentation, Humans, Liver Failure, Acute etiology, Liver Failure, Acute surgery, Male, Multiple Organ Failure surgery, Retrospective Studies, Young Adult, Fluid Therapy methods, Heat Stroke complications, Liver Transplantation methods, Multiple Organ Failure etiology
Abstract

Background: Exertional heatstroke is an extremely rare cause of fulminant hepatic failure. Maximal supportive care has failed to provide adequate survival in earlier studies. This is particularly true in cases accompanied by multiorgan failure., Methods and Materials: Our prospectively collected transplant database was retrospectively reviewed to identify patients undergoing liver transplantation for heatstroke between January 1, 2012, and December 31, 2016. We report 3 consecutive cases of male patients with fulminant hepatic failure from exertional heatstroke., Results: All patients developed multiorgan failure and required intubation, vasopressor support, and renal replacement therapy. All patients were listed urgently for liver transplantation and were supported with the molecular adsorbent recirculating system while awaiting transplantation. All patients underwent liver transplantation alone and are alive and well, with recovered renal function, normal liver allograft function, and no chronic sequelae of their multiorgan failure at more than one year., Conclusion: Extreme heatstroke leading to whole-body organ dysfunction and fulminant liver failure is a complex entity that may benefit from therapy using the Molecular Adsorbent Recirculating System while waiting for liver transplantation as a component of a multidisciplinary, multiorgan system approach., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Published
2018
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40. Responsiveness to therapy for increased intracranial pressure in traumatic brain injury is associated with neurological outcome.

Author

Colton K, Yang S, Hu PF, Chen HH, Stansbury LG, Scalea TM, and Stein DM

Subjects
Adult, Brain Injuries complications, Brain Injuries drug therapy, Brain Injuries epidemiology, Female, Glasgow Coma Scale, Humans, Intracranial Hypertension drug therapy, Intracranial Hypertension epidemiology, Intracranial Hypertension etiology, Male, Nervous System Diseases epidemiology, Nervous System Diseases prevention & control, Prognosis, Retrospective Studies, Treatment Outcome, United States epidemiology, Brain Injuries physiopathology, Diuretics, Osmotic therapeutic use, Intracranial Hypertension physiopathology, Nervous System Diseases physiopathology, Saline Solution, Hypertonic therapeutic use
Abstract

In patients with severe traumatic brain injury, increased intracranial pressure (ICP) is associated with poor functional outcome or death. Hypertonic saline (HTS) is a hyperosmolar therapy commonly used to treat increased ICP; this study aimed to measure initial patient response to HTS and look for association with patient outcome. Patients >17 years old, admitted and requiring ICP monitoring between 2008 and 2010 at a large urban tertiary care facility were retrospectively enrolled. The first dose of hypertonic saline administered after admission for ICP >19mmHg was recorded and correlated with vital signs recorded at the bedside. The absolute and relative change in ICP at 1 and 2h after HTS administration was calculated. Patients were stratified by mortality and long-term (≥6 months) functional neurological outcome. We identified 46 patients who received at least 1 dose of HTS for ICP>19, of whom 80% were male, mean age 34.4, with a median post-resuscitation GCS score of 6. All patients showed a significant decrease in ICP 1h after HTS administration. Two hours post-administration, survivors showed a further decrease in ICP (43% reduction from baseline), while ICP began to rebound in non-survivors (17% reduction from baseline). When patients were stratified for long-term neurological outcome, results were similar, with a significant difference in groups by 2h after HTS administration. In patients treated with HTS for intracranial hypertension, those who survived or had good neurological outcome, when compared to those who died or had poor outcomes, showed a significantly larger sustained decrease in ICP 2h after administration. This suggests that even early in a patient's treatment, treatment responsiveness is associated with mortality or poor functional outcome. While this work is preliminary, it suggests that early failure to obtain a sustainable response to hyperosmolar therapy may warrant greater treatment intensity or therapy escalation., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Published
2014
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41. Admission angiography for blunt splenic injury: advantages and pitfalls.

Author

Haan J, Scott J, Boyd-Kranis RL, Ho S, Kramer M, and Scalea TM

Subjects
Adult, Embolization, Therapeutic, Female, Humans, Injury Severity Score, Male, Medical Records, Patient Admission, Predictive Value of Tests, Retrospective Studies, Spleen diagnostic imaging, Tomography, X-Ray Computed, Trauma Centers, Treatment Outcome, Wounds, Nonpenetrating diagnostic imaging, Angiography standards, Spleen injuries, Wounds, Nonpenetrating diagnosis, Wounds, Nonpenetrating therapy
Abstract

Background: To analyze the use of admission angiography as a nonoperative adjunct for management of blunt splenic injury., Methods: Retrospective chart review of all blunt splenic injuries to a Level I trauma center from March 1997 through July 1999., Results: One hundred twenty-six patients underwent angiography for splenic injury. Eighty-six patients (68%) had a negative angiogram and were treated expectantly. Of these, seven patients (8%) required laparotomy, with a splenic salvage rate of 92%. Embolization was performed on 40 patients (32%) for evidence of vascular injury. Of these, three patients (8%) required laparotomy, for a total salvage of 92%. Repeat angiography was performed for suspicion of bleeding in 12 patients (10%), with 50% requiring embolization. Outcome based on CT grade demonstrated an average grade of 2.9, with a salvage rate of greater than 70% for grade IV and V injuries., Conclusion: Vascular injury increases with splenic injury grade. Embolization improves nonoperative salvage rates to 92%, even with high-grade injuries. Ten percent of patients require additional therapy including "second-look" angiography. A significant portion of patients with negative screening angiograms (10%) required either embolization or laparotomy to control delayed hemorrhage.

Published
2001
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42. Interventional techniques in vascular trauma.

Author

Scalea TM and Sclafani S

Subjects
Angiography methods, Hemostatic Techniques, Humans, Leg blood supply, Neck blood supply, Blood Vessels injuries, Radiography, Interventional methods
Abstract

This article addresses in detail the newer role for interventional angiography, including diagnosis and newer angioembolization techniques used to control bleeding and to deal with complications of vascular injuries.

Published
2001
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43. Triple-contrast helical CT in penetrating torso trauma: a prospective study to determine peritoneal violation and the need for laparotomy.

Author

Shanmuganathan K, Mirvis SE, Chiu WC, Killeen KL, and Scalea TM

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Laparotomy, Male, Middle Aged, Prospective Studies, Abdominal Injuries diagnostic imaging, Peritoneum injuries, Thoracic Injuries diagnostic imaging, Tomography, X-Ray Computed methods, Wounds, Penetrating diagnostic imaging
Abstract

Objective: A prospective study was performed to determine the usefulness of triple-contrast helical CT in predicting peritoneal violation and the need for laparotomy in the treatment of penetrating torso trauma., Subjects and Methods: Triple-contrast helical CT scans were obtained in 104 hemodynamically stable patients with penetrating injuries to the torso (thoracoabdominal region including tangential wounds to the anterior abdomen, flank, back, and pelvis) over a 17-month period. The study group included 54 patients with gunshot wounds and 50 with stab wounds. No patient had a radiographic or clinical indication for immediate laparotomy. A positive finding on CT was defined as evidence of peritoneal violation or injury to the retroperitoneal colon, major vessel, or urinary tract. Patients with a positive CT, except patients with isolated liver injury or free fluid, underwent laparotomy. Patients with a negative finding on CT were initially observed., Results: CT studies were positive in 35 (34%) of 104 patients and negative in 69 (66%) of 104 of patients. Laparotomy was performed in 21 (60%) of 35 patients with positive CT; 19 (86%) of 22 were therapeutic, two (9%) were nontherapeutic, and one (5%) was negative (no injury was found). Nine patients with isolated hepatic injuries were successfully treated without laparotomy. Among patients with a negative CT, 67 (97%) of 69 were treated nonoperatively with success. CT had 100% (19/19) sensitivity, 96% (69/72) specificity, 100% (69/69) negative predictive value, and 97% (101/104) accuracy in predicting the need for laparotomy., Conclusion: Triple-contrast helical CT can accurately predict the need for laparotomy and exclude peritoneal violation in penetrating torso trauma including tangential abdominal wounds.

Published
2001
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44. Determining the need for laparotomy in penetrating torso trauma: a prospective study using triple-contrast enhanced abdominopelvic computed tomography.

Author

Chiu WC, Shanmuganathan K, Mirvis SE, and Scalea TM

Subjects
Abdominal Injuries surgery, Adolescent, Adult, Aged, Aged, 80 and over, Contrast Media, Female, Humans, Male, Middle Aged, Needs Assessment, Prospective Studies, Radiographic Image Enhancement, Wounds, Penetrating surgery, Abdominal Injuries diagnostic imaging, Laparotomy, Tomography, X-Ray Computed standards, Wounds, Penetrating diagnostic imaging
Abstract

Background: The nontherapeutic laparotomy rate in penetrating abdominal trauma remains high and the morbidity rate in these cases is approximately 40%. Selective management, rather than mandatory laparotomy, has become a popular approach in both stab wounds and gunshot wounds. The advent of spiral technology has stimulated a reassessment of the role of computed tomography (CT) in many aspects of trauma care. We prospectively investigated the current utility of triple-contrast CT as a diagnostic tool to facilitate initial therapeutic management decisions in penetrating torso trauma., Methods: We studied hemodynamically stable patients with penetrating injury to the torso (abdomen, pelvis, flank, back, or lower chest) without definite indication for laparotomy, admitted to our trauma center during the 1-year period from 7/99 through 6/00. Patients underwent triple-contrast enhanced spiral CT as the initial study. A positive CT scan was defined as any evidence of peritoneal violation (free air or fluid, contrast leak, or visceral injury). Patients with positive CT, except those with isolated solid viscus injury, underwent laparotomy. Patients with negative CT were observed., Results: There were 75 consecutive patients studied: mean age 30 years (range 15-85 years); 67 (89%) male; 41 (55%) gunshot wound, 32 (43%) stab wound, 2 (3%) shotgun wound; mean admission systolic blood pressure 141 mm Hg (range 95-194 mm Hg); 26 (35%) had positive CT and 49 (65%) had negative CT. In patients with positive CT, 18 (69%) had laparotomy: 15 therapeutic, 2 nontherapeutic, and 1 negative. Five patients had isolated hepatic injury and 2 had hepatic and diaphragm injury on CT and all were successfully managed without laparotomy. Of these seven patients, three had angioembolization and two had thoracoscopic diaphragm repair. In patients with negative CT, 47/49 (96%) had successful nonoperative management and 1 had negative laparotomy. The single CT-missed peritoneal violation had a left diaphragm injury at laparotomy. CT accurately predicted whether laparotomy was needed in 71/75 (95%) patients., Conclusion: In penetrating torso trauma, triple-contrast abdominopelvic CT can accurately predict need for laparotomy, exclude peritoneal violation, and facilitate nonoperative management of hepatic injury. Adjunctive angiography and investigation for diaphragm injury may be prudent.

Published
2001
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45. Acute caval perforation by an inferior vena cava filter in a multitrauma patient: hemostatic control with a new surgical hemostat.

Author

Bochicchio GV and Scalea TM

Subjects
Fatal Outcome, Hemorrhage etiology, Humans, Male, Middle Aged, Multiple Trauma etiology, Pulmonary Embolism prevention & control, Punctures, Venous Thrombosis prevention & control, Hemorrhage prevention & control, Multiple Trauma therapy, Surgical Instruments, Vena Cava Filters adverse effects, Vena Cava, Inferior injuries
Published
2001
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46. Epidemic increases in cocaine and opiate use by trauma center patients: documentation with a large clinical toxicology database.

Author

Soderstrom CA, Dischinger PC, Kerns TJ, Kufera JA, Mitchell KA, and Scalea TM

Subjects
Adult, Age Distribution, Cocaine-Related Disorders diagnosis, Databases, Factual, Ethanol blood, Female, Humans, Male, Middle Aged, Opioid-Related Disorders diagnosis, Retrospective Studies, Sex Distribution, Violence, Cocaine-Related Disorders epidemiology, Opioid-Related Disorders epidemiology, Trauma Centers statistics & numerical data
Abstract

Background: Although reports have documented alcohol and other drug use by trauma patients, no studies of long-term trends have been published. We assessed substance use trends in a large cohort of patients admitted to a regional Level I adult trauma center between July 1984 and June 2000., Methods: Positive toxicology results, collected via retrospective database review, were analyzed for patients admitted directly to the center. Data were abstracted from a clinical toxicology database for 53,338 patients. Results were analyzed for alcohol, cocaine, and opiates relative to sex, age (< 40/> or = 40 years), and injury type (nonviolence/violence). Positive toxicology test result trends were assessed for the 3 years at the beginning and end of the period (chi2). Testing biases were assessed for sex, race, and injury type., Results: The patient profile was as follows: men, 72%; age < 40 years, 69%; nonviolence victims, 77%. Alcohol-positive results decreased 37%, but cocaine-positive and opiate-positive results increased 212% and 543%, respectively (all p < 0.001). Cocaine-positive/opiate-positive results increased 152%/640% for nonviolence and 226%/258% for violence victims, respectively (all p < 0.001). In fiscal year 2000, cocaine-positive and opiate-positive results were highest among violence victims (27.4% for both drugs). Cocaine-positive and opiate-positive results among nonviolence victims were 9.4% and 17.6%, respectively. Patients who were minorities or victims of violence were not tested more frequently than other patients., Conclusion: Epidemic increases in cocaine and opiate use were documented in all groups of trauma patients, with the greatest increases being in violence victims. Alcohol use decreased for all groups.

Published
2001
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47. Mesenteric and renal oxygen transport during hemorrhage and reperfusion: evaluation of optimal goals for resuscitation.

Author

Chiara O, Pelosi P, Segala M, Turconi MG, Brazzi L, Bottino N, Taccone P, Zambelli M, Tiberio G, Boswell S, and Scalea TM

Subjects
Acid-Base Equilibrium physiology, Animals, Female, Fluid Therapy, Gastric Acidity Determination, Hemodynamics physiology, Lactic Acid blood, Swine, Oxygen Consumption physiology, Renal Circulation physiology, Reperfusion Injury physiopathology, Resuscitation, Shock, Hemorrhagic physiopathology, Splanchnic Circulation physiology
Abstract

Background: Changes in flow to the gut and the kidney during hemorrhage and resuscitation contribute to organ dysfunction and outcome. We evaluated regional and splanchnic oxygen (O2) flow distribution and calculated oxygen supply distribution during hemorrhage and reperfusion and compared them with global measures., Methods: Seven anesthetized pigs were instrumented to evaluate global hemodynamics, visceral blood flow, and oxygen transport. Tonometric pH probes were positioned in the stomach and jejunum. Animals were bled to 45 mm Hg for 1 hour. Crystalloids and blood were infused during the following 2 hours to normalize blood pressure, heart rate, urine output, and hemo- globin., Results: During hemorrhage, mesenteric flow and O2 consumption were significantly decreased, whereas systemic consumption remained normal. Renal flow was reduced, but renal O2 consumption remained normal. After resuscitation, despite normal hemodynamics, neither systemic, mesenteric, nor renal O2 delivery returned to baseline. Lactate remained significantly increased. Arterial pH, base excess, and gastric and jejunal pH were all decreased., Conclusion: During hemorrhage, the gut is more prone than other regions to O2 consumption supply dependency. After resuscitation, standard clinical parameters do not detect residual O2 debt. Lactate, arterial pH, base excess, and intramucosal gut pH are all markers of residual tissue hypoperfusion.

Published
2001
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49. Systemic inflammatory response syndrome score at admission independently predicts infection in blunt trauma patients.

Author

Bochicchio GV, Napolitano LM, Joshi M, McCarter RJ Jr, and Scalea TM

Subjects
Adult, Female, Humans, Length of Stay, Logistic Models, Male, Middle Aged, Predictive Value of Tests, Prognosis, Risk Assessment, Injury Severity Score, Systemic Inflammatory Response Syndrome, Treatment Outcome, Wounds, Nonpenetrating complications
Abstract

Background: Systemic inflammatory response syndrome (SIRS) score has been demonstrated to be an accurate predictor of outcome in critical surgical illness. To our knowledge, there is a paucity of data using SIRS score as a tool to predict posttraumatic infection. Our goal was to determine whether the severity of SIRS score at admission is an accurate predictor of infection in trauma patients., Methods: Prospective data were collected on 4,887 blunt trauma patients admitted to a primary adult resource center designated trauma center over an 18-month period. Patients were stratified by age and Injury Severity Score (ISS). SIRS score was calculated at admission. SIRS was defined as an SIRS score > or = 2. Each patient was screened for infection by an infectious disease specialist. Those at high risk for infection were then monitored daily throughout their hospitalization. Centers for Disease Control and Prevention guidelines were used to diagnose infection., Results: Of the 4,887 patients, 1,850 (38%) were admitted > 24 hours and evaluated for subsequent infection (mean ISS, 16 +/- 9; mean age, 43 +/- 19, SD). Thirty-one percent (577) of the patients acquired an infection. The mean hospital length of stay (20.2 days vs. 6.5 days) and mortality (7.8% vs. 2.7%) were significantly greater in the infected group (p < 0.001). Of the four SIRS variables (temperature, heart rate, white blood cell count, and respiratory rate), hypothermia and leukocytosis were the most significant predictors of infection (p < 0.001) when adjusted for age and ISS. SIRS scores of > or = 2 were increasingly predictive of infection when analyzed by multiple logistic regression analysis., Conclusion: An admission SIRS score of > or = 2 is a significant independent predictor of infection and outcome in blunt trauma. Daily SIRS scores may be a meaningful method of assessing postinjury risk of infection, and may initiate earlier diagnostic intervention for determination of infection.

Published
2001
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50. Total cytokine immunoassay: a more accurate method of cytokine measurement?

Author

Malone D, Napolitano LM, Genuit T, Bochicchio GV, Kole K, and Scalea TM

Subjects
Adult, Enzyme-Linked Immunosorbent Assay, Humans, Injury Severity Score, Interleukin-1 analysis, Interleukin-10 analysis, Interleukin-6 analysis, Length of Stay, Middle Aged, Wounds, Gunshot blood, Wounds, Nonpenetrating blood, Cytokines analysis, Immunoassay methods, Wounds and Injuries blood
Abstract

Background: Cytokines signal the normal processes of inflammation and repair in all organs, yet the aberrant expression of these peptide mediators is associated with significant organ dysfunction. The accurate measurement of cytokines is therefore critical. In this study, we sought to investigate the alterations in cytokine expression early after trauma in humans using a new competitive binding immunoassay that measures both free and bound cytokine and compare this with standard enzyme-linked immunosorbent assay (ELISA), which measures only free cytokine., Methods: Peripheral blood was obtained from trauma patients at admission. Exclusion criteria were transfers, death within 24 hours, pregnancy, known acquired immunodeficiency syndrome, chemotherapy, transplant, or other chronic immune disorder. "Total" cytokine immunoassay was compared with ELISA for cytokines (interleukin [IL]-1, IL-6, and IL-10) measured in serum., Results: Cytokine concentrations measured by total immunoassay were significantly higher (10- to 500-fold increase) than those measured by ELISA, and correlation between the two methods was poor (r2 = 0.193 for IL-10). No significant differences in mean serum cytokine concentrations were noted between trauma patients and normal controls for IL-1 (56 vs. 37 pg/mL), IL-6 (16 vs. 25 pg/mL), and IL-10 (4 vs. 26 pg/mL) using the ELISA method. In contrast, trauma patients had significantly higher serum concentrations of IL-1 (3,320 vs. 1,470 pg/mL, p < 0.05), IL-6 (2,415 vs. 1,048 pg/mL, p < 0.05), and IL-10 (2,307 vs. 1,480 pg/mL, p < 0.05) at admission compared with normal controls using total cytokine immunoassays., Conclusion: Cytokine measurements in peripheral blood in trauma patients and normal controls are significantly (10- to 500-fold) higher when using a total cytokine assay that measures both free and bound cytokine. Competitive immunoassays may be the method of choice when measuring endogenous cytokine levels in biologic fluids, and new normal ranges for cytokines must be established for future accurate research in critical care and trauma.

Published
2001
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