BackgroundIdentification of trauma patients at significant risk of death in the prehospital setting is challenging. The prediction probability of basic indices like vital signs, Shock Index (SI), SI multiplied by age (SIA) or the GCS is limited and more complex scores are not feasible on-scene. The Reverse SI multiplied by GCS score (rSIG) has been proposed as a triage tool to identify trauma patients with an increased risk of dying at EDs. Age adjustment (rSIG/A) displayed no advantage.We aim to (1) validate the accuracy of the rSIG in predicting death or early transfusion in a large trauma registry population, and (2) determine if the rSIG is valid for evaluation of trauma patients in the prehospital setting.Methods70 829 trauma patients were retrieved from the TraumaRegister DGU database (time period between 2008 and 2017). The area under the receiver operating characteristic curve (AUROC) was calculated to measure the ability of SI, SIA, rSIG and rSIG divided by age (rSIG/A) to predict in-hospital mortality from data at the time of hospital arrival and solely from prehospital data.ResultsThe rSIG at time of hospital admission was not sufficiently predictive for clinical decision-making. However, rSIG calculated solely from prehospital data accurately predicted risk of death. Using prehospital data, the AUROC for mortality of rSIG/A was the highest (0.85; CI: 0.85 to 0.86), followed by rSIG (0.76; CI: 0.75 to 0.77), SIA (0.71; CI: 0.70 to 0.71) and SI (0.48; CI: 0.47 to 0.49).ConclusionThe prehospital rSIG/A can be a useful adjunct for the prehospital evaluation of trauma patients and their allocation to trauma centres or trauma team activation. However, we could not confirm that the rSIG at hospital admission is a reliable tool for risk stratification.

Background Most trauma patients admitted to the hospital alive and die later on, decease during the initial care in the emergency department or the intensive care unit (ICU). However, a number of patients pass away after having been discharged from the ICU during the initial hospital stay. On first sight these cases could be seen as “failure to rescue” of potentially salvageable patients. A low rate of such patients might be a potential indicator of quality for trauma care on ICUs and surgical wards. Methods Retrospective analysis of the TraumaRegister DGU® with data from 2015 to 2017. Patients that died during the initial ICU stay were compared to those who were discharged from the initial ICU stay for at least 24 h but died later on. Results A total of 82,313 trauma patients were included in the TraumaRegister DGU®. In total, 6576 patients (8.0%) died during their hospital stay. Out of those, 5481 were admitted to the ICU alive and 972 patients (17.7%) were discharged from ICU and died later on. Those were older (mean age: 77 vs. 68 years), less severely injured (mean ISS: 23.1 vs. 30.0 points) and had a longer mean ICU length of stay (10 vs. 6 days). A limitation of life-sustaining therapy due to a documented living will was present in 46.1% of all patients who died during their initial ICU stay and in 59.9% of patients who died after discharge from their initial ICU stay. Conclusions 17.7% of all non-surviving severely injured trauma patients died within the hospital after discharge from their initial ICU treatment. Their death can partially be explained by a limitation of therapy due to a living will. In conclusion, the rate of such late deaths may partially represent patients that died of potentially avoidable or treatable complications.

Study Design Retrospective cohort study. Objectives With steadily increasing implementation of far lateral approaches in spine surgery, surgeons can utilize the advantages of different approaches synergistically to ensure an optimal patient outcome. Our single institution study aimed to assess the complication rates of patients who underwent a lateral interbody fusion as the index procedure and additional anterior or posterior instrumentation as part of a planned staged surgical reconstruction effort. Methods This study was approved by our institutional review board (STUDY2021000113). We included 576 patients who received a lateral lumbar interbody fusion (LLIF) as the index procedure followed by transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF) or anterior lumbar interbody fusion (ALIF) between 2016 and 2020. Primary outcomes were complications identified during the initial inpatient stay, which were categorized into approach-related and secondary complications. Secondary outcomes tracked up to 6 years post-surgery. Results The overall complication rate was 19.2% (10.5% approach related, 8.7% secondary complications). Significant intraoperative hemorrhage (mean 659.3 mL vs 131.4 mL, P < .01) was the most common approach related complication with an incidence of 4%, followed by temporary hip flexor weakness in 2.6%. A permanent (femoral) nerve damage was verified in 1 patient. The most common secondary complication was impaired wound healing in 12 patients (2.1%). We identified a 7.1% (41 of 576 patients) rate of revision surgery, on average after 372 days (±34 days). Conclusions We recorded an overall complication rate of 19.2% for staged adult deformity corrective surgeries utilizing far lateral interbody fusions at several lumbar levels followed by a more comprehensive posterior surgical reconstruction.

The SAPIEN ® /SAPIEN XT ® prostheses achieved good degrees of stent expansion and circularity regardless of the morphology of the landing zone. Increased stent ovality was associated with an elevated risk for aortic regurgitation. The total calcification volume, degree of annular ovality and stent expansion were not associated with residual AR.