Tertiary survey in polytrauma patients should be an ongoing process

Ferree, Steven; Houwert, Roderick M.; Laarhoven, J.J.E.M. van; Smeeing, Diederik P.J.; Leenen, Luke P. H.; Hietbrink, Falco

doi:10.1016/j.injury.2015.11.040

Cited by 25 publications

(22 citation statements)

References 23 publications

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“…This correlation is comprehensible, since minor concomitant injuries with an AIS of 1 would not constitute a relevant distraction. In the case of life-threatening injuries with an urgent need for intervention or acute lack of time in the emergency room, special focus should be placed on the follow-up examination of SCJ and ACJ and at the latest, in the tertiary survey in polytrauma patients 49 .…”

Section: Discussionmentioning

confidence: 99%

Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients

Bakır

Lefering

Haralambiev

et al. 2020

Sci Rep

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Preliminary studies show that clavicle fractures (CF) are known as an indicator in the severely injured for overall injury severity that are associated with relevant concomitant injuries in the thorax and upper extremity. In this regard, little data is available for the rarer injuries of the sternoclavicular and acromioclavicular joints (SCJ and ACJ, respectively). Our study will answer whether clavicular joint injuries (CJI), by analogy, have a similar relevance for the severely injured. We performed an analysis from the TraumaRegister DGU (TR-DGU). The inclusion criterion was an Injury Severity Score (ISS) of at least 16. In the TR-DGU, the CJI were registered as one entity. The CJI group was compared with the CF and control groups (those without any clavicular injuries). Concomitant injuries were distinguished using the Abbreviated Injury Scale according to their severity. The inclusion criteria were met by n = 114,595 patients. In the case of CJI, n = 1228 patients (1.1%) were found to be less severely injured than the controls in terms of overall injury severity. Compared to the CF group (n = 12,030; 10.5%) with higher ISS than the controls, CJI cannot be assumed as an indicator for a more severe trauma; however, CF can. Concomitant injuries were more common for severe thoracic and moderate upper extremity injuries than other body parts for CJI. This finding confirms our hypothesis that CJI could be an indicator of further specific severe concomitant injuries. Despite the rather lower relevance of the CJI in the cohort of severely injured with regard to the overall injury severity, these injuries have their importance in relation to the indicator effect for thoracic concomitant injuries and concomitant injuries of the upper extremity. A limitation is the collective registration of SCJ and ACJ injuries as one entity in the TR-DGU. A distorted picture of the CJI in favor of ACJ injuries could arise from the significantly higher incidence of the ACJ dislocation compared to the SCJ. Therefore, these two injury entities should be recorded separately in the future, and prospective studies should be carried out in order to derive a standardized treatment strategy for the care of severely injured with the respective CJI.

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Section: Discussionmentioning

confidence: 99%

Acromioclavicular and sternoclavicular joint dislocations indicate severe concomitant thoracic and upper extremity injuries in severely injured patients

Bakır

Lefering

Haralambiev

et al. 2020

Sci Rep

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“…On the other hand, in countries where the visceral surgeon is in charge of trauma care, a major part of injuries (and patients) is treated outside their scope as these concern only extremity injuries. This could result in a relative large number of missed or delayed diagnosed injuries [44,45]. Additionally, when care is provided by a multitude of subspecialists, costs will rise extensively without a proven benefit for patients outcomes as stated previously [6].…”

Section: Keeping the Trauma Surgeon Alive?mentioning

confidence: 99%

The evolution of trauma care in the Netherlands over 20 years

Hietbrink

Houwert

Wessem

et al. 2019

Eur J Trauma Emerg Surg

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Introduction In 1999 an inclusive trauma system was initiated in the Netherlands and a nationwide trauma registry, including all admitted trauma patients to every hospital, was started. The Dutch trauma system is run by trauma surgeons who treat both the truncal (visceral) and extremity injuries (fractures). Materials and Methods In this comprehensive review based on previous published studies, data over the past 20 years from the central region of the Netherlands (Utrecht) was evaluated. Results It is demonstrated that the initiation of the trauma systems and the governance by the trauma surgeons led to a regionwide mortality reduction of 50% and a mortality reduction for the most severely injured of 75% in the level 1 trauma centre. Furthermore, major improvements were found in terms of efficiency, demonstrating the quality of the current system and its constructs such as the type of surgeon. Due to the major reduction in mortality over the past few years, the emphasis of trauma care evaluation shifts towards functional outcome of severely injured patients. For the upcoming years, centralisation of severely injured patients should also aim at the balance between skills in primary resuscitation and surgical stabilization versus longitudinal surgical involvement. Conclusion Further centralisation to a limited number of level 1 trauma centres in the Netherlands is necessary to consolidate experience and knowledge for the trauma surgeon. The future trauma surgeon, as specialist for injured patients, should be able to provide the vast majority of trauma care in this system. For the remaining part, intramural, regional and national collaboration is essential

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“…Secondly, we did not include paediatric trauma patients which will be the subject of a separate analysis, due to the complexity of current paediatric trauma referral patterns and the presence of paediatric trauma at some mixed adult trauma services and specialist paediatric centres. Finally, we excluded patients with length of stay less than one day as it often takes more than a day to fully investigate and define injuries through trauma tertiary surveys [26].…”

Section: Discussionmentioning

confidence: 99%