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Khan M, Hayat W, ullah H, Khan NH. Reconstruction of soft tissue defects of hand: A systematic approach. Pak J Med Sci 2024; 40:36-40. [PMID: 38196456 PMCID: PMC10772424 DOI: 10.12669/pjms.40.1.7484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/09/2023] [Accepted: 08/28/2023] [Indexed: 01/11/2024] Open
Abstract
Background and Objective A thorough insight into the management of hand injuries can shape the approach of a surgeon in order to achieve optimal outcomes for the patients. The aim of this study was to share our experience in reconstruction of the hand and establishing an algorithm for classification and treatment of hand injuries. Methods This is a descriptive cross sectional study and was conducted from January 2020 to August 2022 at Burns and Plastic Surgery center, Peshawar. Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (<5cm), medium (5cm to 10 cm) and large (>10cm). The defect site and size was cross tabulated against the method of soft tissue reconstruction in order to make the algorithm for reconstruction of hand injuries. Data was analyzed using SPSS. Results The study population included 41 (75.9%) male and 13 (24.1%) female patients, mean age 31.56±14.1. Machine injuries (33.3%) and electric burns (24.1%) were the most common cause of hand soft tissue defects. The most commonly performed flap was Posterior introsseous artery (PIA) flap, followed by First dorsal metacarpal artery (FDMA) flap. Flap necrosis was observed in three cases (5.6%). Conclusion This treatment algorithm for coverage of soft tissue defects in hand injuries will help with the decision making process of hand reconstruction and has didactic value for novice surgeons. It will also form the foundation for further work on this aspect of hand injuries.
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Affiliation(s)
- Mansoor Khan
- Mansoor Khan, MBBS, FCPS Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Waqas Hayat
- Waqas Hayat, MBBS, FCPS Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Hidayat ullah
- Hidayat ullah, MBBS, FCPS Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Nasir Hayat Khan
- Nasir Hayat Khan, MBBS, FCPS Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan
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2
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Jain S, Puranik A. Trauma and Emergency Surgery: Conceptual Framework, Dedicated Distinctiveness, and Dignification. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03796-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/25/2023] [Indexed: 09/12/2023] Open
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3
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Bini R, Virdis F, Cioffi SPB, Altomare M, Sammartano F, Borotto E, Chiara O, Cimbanassi S. "Stabilize the Unstable": Treatment Pathophysiology in Bleeding Trauma Patients, from the Field to the ICU. State of the Art. J Pers Med 2023; 13:jpm13040667. [PMID: 37109053 PMCID: PMC10145706 DOI: 10.3390/jpm13040667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The results of the Global Burden of Disease (GBD) study showed that, in 2019, 8% of deaths worldwide were trauma related [...].
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Affiliation(s)
| | | | | | | | - Fabrizio Sammartano
- Trauma Center, San Carlo Borromeo ASST Santi Paolo e Carlo, 20162 Milan, Italy
| | - Erika Borotto
- Intensive Care Unit, Macchi Hospital, 21100 Varese, Italy
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Meshkinfamfard M, Narvestad JK, Wiik Larsen J, Kanani A, Vennesland J, Reite A, Vetrhus M, Thorsen K, Søreide K. Structured and Systematic Team and Procedure Training in Severe Trauma: Going from 'Zero to Hero' for a Time-Critical, Low-Volume Emergency Procedure Over Three Time Periods. World J Surg 2021; 45:1340-1348. [PMID: 33566121 PMCID: PMC8026408 DOI: 10.1007/s00268-021-05980-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 11/26/2022]
Abstract
Background Resuscitative emergency thoracotomy is a potential life-saving procedure but is rarely performed outside of busy trauma centers. Yet the intervention cannot be deferred nor centralized for critically injured patients presenting in extremis. Low-volume experience may be mitigated by structured training. The aim of this study was to describe concurrent development of training and simulation in a trauma system and associated effect on one time-critical emergency procedure on patient outcome. Methods An observational cohort study split into 3 arbitrary time-phases of trauma system development referred to as ‘early’, ‘developing’ and ‘mature’ time-periods. Core characteristics of the system is described for each phase and concurrent outcomes for all consecutive emergency thoracotomies described with focus on patient characteristics and outcome analyzed for trends in time. Results Over the study period, a total of 36 emergency thoracotomies were performed, of which 5 survived (13.9%). The “early” phase had no survivors (0/10), with 2 of 13 (15%) and 3 of 13 (23%) surviving in the development and mature phase, respectively. A decline in ‘elderly’ (>55 years) patients who had emergency thoracotomy occurred with each time period (from 50%, 31% to 7.7%, respectively). The gender distribution and the injury severity scores on admission remained unchanged, while the rate of patients with signs on life (SOL) increased over time. Conclusion The improvement over time in survival for one time-critical emergency procedure may be attributed to structured implementation of team and procedure training. The findings may be transferred to other low-volume regions for improved trauma care. Supplementary Information The online version contains supplementary material available at (doi:10.1007/s00268-021-05980-1).
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Affiliation(s)
- Maryam Meshkinfamfard
- Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway
| | - Jon Kristian Narvestad
- Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway
- Section for Traumatology, Surgical Clinic, Stavanger University Hospital, Stavanger, Norway
| | - Johannes Wiik Larsen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway
| | - Arezo Kanani
- Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway
| | - Jørgen Vennesland
- Department of Surgery, Vascular & Thoracic Surgery Unit, Stavanger University Hospital, Stavanger, Norway
| | - Andreas Reite
- Section for Traumatology, Surgical Clinic, Stavanger University Hospital, Stavanger, Norway
- Department of Surgery, Vascular & Thoracic Surgery Unit, Stavanger University Hospital, Stavanger, Norway
| | - Morten Vetrhus
- Department of Surgery, Vascular & Thoracic Surgery Unit, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kenneth Thorsen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway
- Section for Traumatology, Surgical Clinic, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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5
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Sarmiento Altamirano D, Himmler A, Chango Sigüenza O, Pino Andrade R, Flores Lazo N, Reinoso Naranjo J, Sacoto Aguilar H, Fernández de Córdova L, Rodas E, Puyana JC, Salamea Molina JC. The Successful Implementation of a Trauma and Acute Care Surgery Model in Ecuador. World J Surg 2021; 44:1736-1744. [PMID: 32107595 DOI: 10.1007/s00268-020-05435-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND For years, surgical emergencies in Ecuador were managed on a case-by-case basis without significant standardization. To address these issues, the Regional Hospital Vicente Corral Moscoso adapted and implemented a model of "trauma and acute care surgery" (TACS) to the reality of Cuenca, Ecuador. METHODS A cohort study was carried out, comparing patients exposed to the traditional model and patients exposed to the TACS model. Variables assessed included number of surgical patients attended to in the emergency department, number of surgical interventions, number of surgeries performed per surgeon, surgical wait time, length of stay and in-hospital mortality. RESULTS The total number of surgical interventions increased (3919.6-5745.8, p ≤ 0.05); by extension, the total number of surgeries performed per surgeon also increased (5.37-223.68, p ≤ 0.05). We observed a statistically significant decrease in surgical wait time (10.6-3.2 h for emergency general surgery, 6.3-1.6 h for trauma, p ≤ 0.05). Length of stay decreased in trauma patients (9-6 days, p ≤ 0.05). Higher mortality was found in the traditional model (p ≤ 0.05) compared to the TACS model. CONCLUSIONS The implementation of TACS model in a resource-restrained hospital in Latin America had a positive impact by decreasing surgical waiting time in trauma and emergency surgery patients and length of stay in trauma patients. We also noted a statistically significant decrease in mortality. Savings to the overall system and patients can be inferred by decreased mortality, length of stay and surgical wait times. To our knowledge, this is the first implementation of a TACS model described in Latin America.
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Affiliation(s)
| | - Amber Himmler
- Division of Surgery, Medstar Georgetown University Hospital and Washington Hospital Center, Washington, DC, USA. .,University of Pittsburgh, Pittsburgh, PA, USA.
| | - Oscar Chango Sigüenza
- Division of Trauma and Acute Care Surgery, Hospital Vicente Corral Moscoso, Cuenca, Ecuador
| | - Raúl Pino Andrade
- Division of Trauma and Acute Care Surgery, Hospital Vicente Corral Moscoso, Cuenca, Ecuador.,Facultad de Medicina, Universidad de Cuenca, Cuenca, Ecuador
| | - Nube Flores Lazo
- Division of Trauma and Acute Care Surgery, Hospital Vicente Corral Moscoso, Cuenca, Ecuador.,Facultad de Medicina, Universidad de Cuenca, Cuenca, Ecuador
| | - Jeovanni Reinoso Naranjo
- Division of Trauma and Acute Care Surgery, Hospital Vicente Corral Moscoso, Cuenca, Ecuador.,Facultad de Medicina, Universidad de Cuenca, Cuenca, Ecuador
| | - Hernán Sacoto Aguilar
- Facultad de Medicina, Universidad de Azuay, Cuenca, Ecuador.,Division of Trauma and Acute Care Surgery, Hospital Vicente Corral Moscoso, Cuenca, Ecuador
| | - Lenin Fernández de Córdova
- Division of Trauma and Acute Care Surgery, Hospital Vicente Corral Moscoso, Cuenca, Ecuador.,Facultad de Medicina, Universidad Católica de Cuenca, Cuenca, Ecuador
| | - Edgar Rodas
- Division of Trauma and Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Juan Carlos Puyana
- Division of Trauma and Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Juan Carlos Salamea Molina
- Facultad de Medicina, Universidad de Azuay, Cuenca, Ecuador.,Division of Trauma and Acute Care Surgery, Hospital Vicente Corral Moscoso, Cuenca, Ecuador
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Kosola J, Brinck T, Leppäniemi A, Handolin L. Blunt Abdominal Trauma in a European Trauma Setting: Need for Complex or Non-Complex Skills in Emergency Laparotomy. Scand J Surg 2019; 109:89-95. [PMID: 30782110 DOI: 10.1177/1457496919828244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon. MATERIALS AND METHODS The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006-2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated. RESULTS A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p < 0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4). CONCLUSION The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.
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Affiliation(s)
- J Kosola
- Department of Orthopedics and Traumatology, Trauma Unit, Töölö Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Brinck
- Department of Orthopedics and Traumatology, Trauma Unit, Töölö Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Leppäniemi
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - L Handolin
- Department of Orthopedics and Traumatology, Trauma Unit, Töölö Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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7
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Coccolini F, Kluger Y, Ansaloni L, Moore EE, Coimbra R, Fraga GP, Kirkpatrick A, Peitzman A, Maier R, Baiocchi G, Agnoletti V, Gamberini E, Leppaniemi A, Ivatury R, Sugrue M, Sartelli M, Di Saverio S, Biffl W, Catena F. WSES worldwide emergency general surgery formation and evaluation project. World J Emerg Surg 2018; 13:13. [PMID: 29563962 PMCID: PMC5851068 DOI: 10.1186/s13017-018-0174-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 12/29/2022] Open
Abstract
Optimal management of emergency surgical patients represents one of the major health challenges worldwide. Emergency general surgery (EGS) was identified as multidisciplinary surgery performed for traumatic and non-traumatic acute conditions during the same admission in the hospital. EGS represents the easiest viable way to provide affordable and high-quality level of care to emergency surgical and trauma patients. It may result from the association of different physicians with other specialties in a cooperative model. The World Society of Emergency Surgery (WSES) has been working on the EGS organization and implementation since its foundation believing in the need of common benchmarks for training and educational programs throughout the world. This is a plea in different languages to all World Prime Ministers and Presidents to support the creation in all nations of an organized hub-spoke system for emergency general surgery to improve standards of care and to save lives.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, 47521 Cesena, Italy
| | - Yoram Kluger
- Division of General Surgery Rambam Health Care Campus Haifa, Haifa, Israel
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, 47521 Cesena, Italy
| | | | - Raul Coimbra
- Trauma Surgery, Riverside University Health System Medical Center, Riverside, CA USA
| | - Gustavo P. Fraga
- Faculdade de Ciências Médicas (FCM)—Unicamp Campinas, Campinas, SP Brazil
| | | | - Andrew Peitzman
- Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Gianluca Baiocchi
- General and Emergency Surgery, Civili University Hospital, Brescia, Italy
| | | | | | - Ari Leppaniemi
- Second Department of Surgery, Meilahti Hospital, Helsinki, Finland
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA USA
| | - Michael Sugrue
- General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland
| | | | - Salomone Di Saverio
- Trauma Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Walt Biffl
- Emergency and Trauma Surgery, Scripps Memorial Hospital, La Jolla, CA USA
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8
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Kuhn-Régnier S, Stickel M, Link BC, Fischer H, Babst R, Beeres FJP. Trauma care in German-speaking countries: have changes in the curricula led to changes in practice after 10 years? Eur J Trauma Emerg Surg 2018; 45:309-314. [PMID: 29306971 DOI: 10.1007/s00068-017-0894-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/19/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Traditionally, in the German-speaking countries, trauma patients are treated by general surgeons specialized in trauma surgery known as the Unfallchirurg. Over the last decade, a trend towards a lower influence of surgeons and a higher influence of subspecialties in the emergency department has been noted. With additional transformations in the health care system towards highly specialized medicine and the arising of new (sub-) specialties, diversification in the management of the trauma patient appears to occur. The new curricula for surgical disciplines providing trauma care will widen this issue even further, moreover, triggered by the Anglo-American medical model. The primary aim of this study was to evaluate the current situation in German-speaking countries concerning the management of trauma patients. The interfaces between emergency physicians, orthopaedic and general surgeons have been investigated concerning the management of the trauma patients. Additionally, different future scenarios have been evaluated. METHODS An online questionnaire was submitted to members of the German Society of Trauma and Orthopaedic Surgery [Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU)], including both general and orthopaedic surgeons, emergency physicians and also some members from Austria, the Netherlands and Switzerland. Questions dealt with demographic data, the current situation in the clinic of the responders in terms of management of mono- and polytrauma patients as well as fracture care. In addition, various future scenarios were evaluated. RESULTS 293 members of the DGOU answered the questionnaire. The majority of the responders (45%) were orthopaedic surgeons and 34% were general trauma surgeons. Sixty-two per cent of hospitals run their emergency departments with emergency physicians. Treatment of both mono- and polytrauma patients in the emergency department is equally distributed between general and orthopaedic surgeons. Fracture care, however, is predominantly (65%) being performed by general trauma surgeons in both mono- and polytrauma patients. The majority of the respondents (80%) do not want to change the current situation and predict that in the future fracture care will still be performed by general surgeons' specialized in trauma surgery. Approximately two-thirds of the responders do not believe that emergency physicians will play a bigger role in the management of trauma patients in the future. CONCLUSION Despite the growing importance of emergency physicians, separated in the emergency room between surgical and internal medicine fields, in the acute care of surgical patients in the emergency departments, their role in the management of the polytraumatized patients remains limited. More than 13 years after the new curricula for orthopaedic and general surgery have been implemented in Germany, fracture care is still predominantly provided by general surgeons specialized in trauma surgery. In conclusion, it seems that the general surgeon specialized in trauma surgery still plays and wants to play the key role in the management of the polytrauma patient and fracture care in German-speaking countries.
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Affiliation(s)
- Sarah Kuhn-Régnier
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Michael Stickel
- Interdisziplinäres Notfallzentrum, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Björn-Christian Link
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Henning Fischer
- Interdisziplinäres Notfallzentrum, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Reto Babst
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Frank J P Beeres
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Lucerne, Switzerland.
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9
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Ghorbani P, Ringdal KG, Hestnes M, Skaga NO, Eken T, Ekbom A, Strömmer L. Comparison of risk-adjusted survival in two Scandinavian Level-I trauma centres. Scand J Trauma Resusc Emerg Med 2016; 24:66. [PMID: 27164973 PMCID: PMC4862151 DOI: 10.1186/s13049-016-0257-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/03/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Assessment of trauma-system performance is important for improving the care of injured patients. The aim of the study was to compare risk-adjusted survival in two Scandinavian Level-I trauma centres. METHODS This was an observational, retrospective study of prospectively-collected trauma registry data for patients >14 years from Karolinska University Hospital - Solna (KUH), Sweden, and Oslo University Hospital - Ullevål (OUH), Norway, from 2009-2011. Probability of survival (Ps) was calculated according to the Trauma and Injury Severity Score (TRISS) method. Risk-adjusted survival per patient was calculated by assigning every patient a value corresponding to gained or lost fractional life: Each survivor contributed a reward of 1-Ps and each death a penalty of -Ps. The sum of penalties and rewards, corresponding to the difference between expected and actual mortality, was compared between the centres. We present the data as excess survivors per 100 trauma patients. RESULTS There were 4485 admissions at KUH and 3591 at OUH. The proportion of severely injured patients was higher at OUH compared with KUH (Injury Severity Score [ISS] >15: 33.9 % vs. 21.1 %, p <0.001). OUH had a larger proportion of patients >65 years (16.0 % vs. 13.4 %, p <0.001) and greater comorbidity (ASA-PS ≥3: 14.6 % vs. 6.9 %, p <0.001) compared with KUH. The frequency of helicopter transport and presence of prehospital physicians was higher at OUH compared with KUH (27.6 % vs. 15.5 % and 30.5 % vs. 3.7 %, both p <0.001). Secondary admissions were 5.2-fold more common at OUH compared with KUH (p <0.001). There were no differences in 30-day mortality for severely injured patients (ISS >15). Risk-adjusted survival rate was higher at OUH than at KUH for primary (0.59 vs. 0.51) but lower for secondary (1.41 vs. 2.85) admissions (both p <0.001). CONCLUSION Adjustments for age as a continuous variable and comorbidity should be made when comparing risk-adjusted survival between hospitals, but this is not possible with the TRISS model. A survival prediction model that takes this into account may be a better choice for Scandinavian trauma populations. The current study could not rule out the influence of the system differences between the centres on risk-adjusted survival.
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Affiliation(s)
- Poya Ghorbani
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
| | - Kjetil Gorseth Ringdal
- Department of Anaesthesiology, Vestfold Hospital Trust, Tønsberg, Norway
- Norwegian Trauma Registry, Oslo University Hospital, Oslo, Norway
| | - Morten Hestnes
- Norwegian Trauma Registry, Oslo University Hospital, Oslo, Norway
- Oslo University Hospital Trauma Registry, Oslo University Hospital, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital - Ullevål, Oslo, Norway
| | - Nils Oddvar Skaga
- Oslo University Hospital Trauma Registry, Oslo University Hospital, Oslo, Norway
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital - Ullevål, Oslo, Norway
| | - Torsten Eken
- Oslo University Hospital Trauma Registry, Oslo University Hospital, Oslo, Norway
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital - Ullevål, Oslo, Norway
| | - Anders Ekbom
- Department of Medicine, Karolinska University Hospital - Solna, Stockholm, Sweden
| | - Lovisa Strömmer
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
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10
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Pearce L, Smith SR, Parkin E, Hall C, Kennedy J, Macdonald A. Emergency General Surgery: evolution of a subspecialty by stealth. World J Emerg Surg 2016; 11:2. [PMID: 26733342 PMCID: PMC4700620 DOI: 10.1186/s13017-015-0058-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 12/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency surgical patients account for around half of all NHS surgical workload and 80 % of surgical deaths. Few trainees opt to CCT in General Surgery, and there is no recognised subspecialty training program in Emergency General Surgery (EGS). Despite this lack of training and relevant assessment by examination, there appears to be an increasing number of EGS posts advertised. This study aims to provide information about potential future employment opportunities for surgical trainees. METHODS All consultant surgeon posts, advertised in the British Medical Journal between January 2009 and December 2014 were included. Data collected included specialty, region and institute of advertised post. For the purposes of statistical analysis, data was divided into two separate year bands: 2009-2011 and 2012-2014. Statistical analysis was by Chi-squared test; p <0.01 was considered statistically significant. An online tool was also used to determine experience and attitudes towards EGS amongst Consultant members of the ASGBI and all UK trainees in national training number (NTN) posts. RESULTS Over the six-year study period, there were 1240 consultant job adverts in a general surgical specialty. Nine hundred and 75 were substantive posts; the region with the most jobs was London and the South East (n = 278). There were 55 jobs advertised in EGS, either with (20) or without (35) another subspecialty. The number of EGS adverts increased significantly in 2012-14 compared to 2009-11 (p = 0.008). 229 (28 %) Consultants and 309 (22 %) trainees responded to the survey. 16 % of consultants work in NHS institutions with Emergency General Surgeons. Only 21 % of trainees believe EGS will be delivered by EGS consultants in the future whilst 8.2 % of trainees stated EGS as their career plan. Less than half of all UK consultant surgeons see EGS as a subspecialty. CONCLUSIONS This data demonstrates increasing societal need for EGS consultants over the last six years and the emergence of Emergency Surgery as a new subspecialty. In order to meet the EGS needs of the NHS, general surgical training and the examination system need to be revised.
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Affiliation(s)
- L Pearce
- Clinical Research Fellow, Department of General Surgery, Central Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - S R Smith
- Clinical Research Fellow, Department of General Surgery, Central Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - E Parkin
- Clinical Research Fellow, Department of General Surgery, Central Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - C Hall
- Clinical Research Fellow, Department of General Surgery, Central Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - J Kennedy
- Clinical Research Fellow, Department of General Surgery, Central Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - A Macdonald
- Clinical Research Fellow, Department of General Surgery, Central Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, M13 9WL UK
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11
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Affiliation(s)
- S A Sovtsov
- South Ural State Medical University, Ministry of Health of the Russian Federation, Chelyabinsk, Russia
| | - A V Fedorov
- Vishnevsky Institute of Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
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12
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Søreide K. Emergency surgery over 111 years: are we still at a crossroads or ready for emergency surgery 2.0? Scand J Trauma Resusc Emerg Med 2015; 23:107. [PMID: 26689822 PMCID: PMC4687313 DOI: 10.1186/s13049-015-0189-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/09/2015] [Indexed: 01/28/2023] Open
Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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Sharrock AE, Gokani VJ, Harries RL, Pearce L, Smith SR, Ali O, Chu H, Dubois A, Ferguson H, Humm G, Marsden M, Nepogodiev D, Venn M, Singh S, Swain C, Kirkby-Bott J. Defining our destiny: trainee working group consensus statement on the future of emergency surgery training in the United Kingdom. World J Emerg Surg 2015; 10:26. [PMID: 26161133 PMCID: PMC4496942 DOI: 10.1186/s13017-015-0019-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/22/2015] [Indexed: 11/16/2022] Open
Abstract
The United Kingdom National Health Service treats both elective and emergency patients and seeks to provide high quality care, free at the point of delivery. Equal numbers of emergency and elective general surgical procedures are performed, yet surgical training prioritisation and organisation of NHS institutions is predicated upon elective care. The increasing ratio of emergency general surgery consultant posts compared to traditional sub-specialities has yet to be addressed. How should the capability gap be bridged to equip motivated, skilled surgeons of the future to deliver a high standard of emergency surgical care? The aim was to address both training requirements for the acquisition of necessary emergency general surgery skills, and the formation of job plans for trainee and consultant posts to meet the current and future requirements of the NHS. Twenty nine trainees and a consultant emergency general surgeon convened as a Working Group at The Association of Surgeons in Training Conference, 2015, to generate a united consensus statement to the training requirement and delivery of emergency general surgery provision by future general surgeons. Unscheduled general surgical care provision, emergency general surgery, trauma competence, training to meet NHS requirements, consultant job planning and future training challenges arose as key themes. Recommendations have been made from these themes in light of published evidence. Careful workforce planning, education, training and fellowship opportunities will provide well-trained enthusiastic individuals to meet public and societal need.
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Affiliation(s)
- A. E. Sharrock
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
- />Department of Emergency Surgery, Southampton General Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD UK
| | - V. J. Gokani
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - R. L. Harries
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - L. Pearce
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - S. R. Smith
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - O. Ali
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - H. Chu
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - A. Dubois
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - H. Ferguson
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - G. Humm
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - M. Marsden
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - D. Nepogodiev
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - M. Venn
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - S. Singh
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - C. Swain
- />Association of Surgeons in Training (ASiT), Royal College of Surgeons England, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3P3 UK
| | - J. Kirkby-Bott
- />Department of Emergency Surgery, Southampton General Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD UK
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Søreide K, Desserud KF. Emergency surgery in the elderly: the balance between function, frailty, fatality and futility. Scand J Trauma Resusc Emerg Med 2015; 23:10. [PMID: 25645443 PMCID: PMC4320594 DOI: 10.1186/s13049-015-0099-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/21/2015] [Indexed: 12/15/2022] Open
Abstract
Becoming old is considered a privilege and results from the socioeconomic progress and improvements in health care systems worldwide. However, morbidity and mortality increases with age, and even more so in acute onset disease. With the current prospects of longevity, a considerable number of elderly patients will continue to live with good function and excellent quality of life after emergency surgical care. However, mortality in emergency surgery may be reported at 15-30%, doubled if associated with complications, and notably higher in patients over 75 years. A number of risks associated with death are reported, and a number of scores proposed for prediction of risk. Frailty, a decline in the physiological reserves that may make the person vulnerable to even the most minor of stressful event, appears to be a valid indicator and predictor of risk and poor outcome, but how to best address and measure frailty in the emergency setting is not clear. Futility may sometimes be clearly defined, but most often becomes a borderline decision between ethics, clinical predictions and patient communication for which no solid evidence currently exists. The number and severity of other underlying condition(s), as well as the treatment alternatives and their consequences, is a complex picture to interpret. Add in the onset of the acute surgical disease as a further potential detrimental factor on function and quality of life – and you have a perfect storm to handle. In this brief review, some of the challenging aspects related to emergency surgery in the elderly will be discussed. More research, including registries and trials, are needed for improved knowledge to a growing health care challenge.
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Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Kari F Desserud
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
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Provision of acute general surgery: a systematic review of models of care. J Trauma Acute Care Surg 2014; 76:219-25. [PMID: 24368384 DOI: 10.1097/ta.0b013e3182a92481] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This article systematically reviews currently available models in Europe, the United Kingdom, Australia and New Zealand for the provision of acute general surgical service and acute care surgery. METHOD Four hundred and thirty eight articles were identified in a literature search. Of these, 13 were included within the systematic review. RESULTS Each acute care model is unique to its local and regional setting but all models have common goals. These include being consultant led, adequate resourcing with junior medical staff, theatre space and anaesthetic support and no competing elective surgical or out-patient commitments. All models require an individual, service and institutional commitment to prioritising the assessment and treatment of acute surgical patients and are characterised by uninterrupted periods of work focussed on the care of acute surgical patients supported by comprehensive patient handover to maintain safe staff working hours. CONCLUSION The provision of acute care for surgical patients is a fundamental role of general surgeons. With the diverse demands on surgeons of teaching, research, elective surgery and patient assessments as well as a family and lifestyle obligations newer systems of service provision based on collective, rather than individualised service commitment, are being developed. These systems emphasise discrete periods of defined service without elective surgical commitments with formal and structured surgeon to surgeon handover. Initial experience indicates that patient care is satisfactory, continuity of care is maintained, and acute care pathways function efficiently. LEVEL OF EVIDENCE Systematic review, level IV.
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Babu S. Acute care surgery in the USA: the orthopaedic conflict. Eur J Trauma Emerg Surg 2012; 38:525-7. [PMID: 26816254 DOI: 10.1007/s00068-012-0197-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 05/04/2012] [Indexed: 10/28/2022]
Affiliation(s)
- S Babu
- William Harvey Hospital, Ashford, TN24 0LZ, UK.
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Kristiansen T, Ringdal KG, Skotheimsvik T, Salthammer HK, Gaarder C, Naess PA, Lossius HM. Implementation of recommended trauma system criteria in south-eastern Norway: a cross-sectional hospital survey. Scand J Trauma Resusc Emerg Med 2012; 20:5. [PMID: 22281020 PMCID: PMC3285082 DOI: 10.1186/1757-7241-20-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 01/26/2012] [Indexed: 02/03/2023] Open
Abstract
Background Formalized trauma systems have shown beneficial effects on patient survival and have harvested great recognition among health care professionals. In spite of this, the implementation of trauma systems is challenging and often met with resistance. Recommendations for a national trauma system in Norway were published in 2007. We wanted to assess the level of implementation of these recommendations. Methods A survey of all acute care hospitals that receive severely injured patients in the south-eastern health region of Norway was conducted. A structured questionnaire based on the 2007 national recommendations was used in a telephone interview of hospital trauma personnel between January 17 and 21, 2011. Seventeen trauma system criteria were identified from the recommendations. Results Nineteen hospitals were included in the study and these received more than 2000 trauma patients annually via their trauma teams. Out of the 17 criteria that had been identified, the hospitals fulfilled a median of 12 criteria. Neither the size of the hospitals nor the distance between the hospitals and the regional trauma centre affected the level of trauma resources available. The hospitals scored lowest on the criteria for transfer of patients to higher level of care and on the training requirements for members of the trauma teams. Conclusion Our study identifies a major shortcoming in the efforts of regionalizing trauma in our region. The findings indicate that training of personnel and protocols for inter-hospital transfer are the major deficiencies from the national trauma system recommendations. Resources for training of personnel partaking in trauma teams and development of inter-hospital transfer agreements should receive immediate attention.
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Affiliation(s)
- Thomas Kristiansen
- Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway.
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Maruthappu M, Sharma A, Shalhoub J, Davies A. General surgery: allow its extinction or begin its revival? Br J Hosp Med (Lond) 2011; 72:304-5. [PMID: 21727806 DOI: 10.12968/hmed.2011.72.6.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kristiansen T, Søreide K, Ringdal KG, Rehn M, Krüger AJ, Reite A, Meling T, Naess PA, Lossius HM. Trauma systems and early management of severe injuries in Scandinavia: review of the current state. Injury 2010; 41:444-52. [PMID: 19540486 DOI: 10.1016/j.injury.2009.05.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 05/26/2009] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Scandinavian countries face common challenges in trauma care. It has been suggested that Scandinavian trauma system development is immature compared to that of other regions. We wanted to assess the current status of Scandinavian trauma management and system development. METHODS An extensive search of the Medline/Pubmed, EMBASE and SweMed+ databases was conducted. Wide coverage was prioritized over systematic search strategies. Scandinavian publications from the last decade pertaining to trauma epidemiology, trauma systems and early trauma management were included. RESULTS The incidence of severe injury ranged from 30 to 52 per 100,000 inhabitants annually, with about 90% due to blunt trauma. Parts of Scandinavia are sparsely populated with long pre-hospital distances. In accordance with other European countries, pre-hospital physicians are widely employed and studies indicate that this practice imparts a survival benefit to trauma patients. More than 200 Scandinavian hospitals receive injured patients, increasingly via multidisciplinary trauma teams. Challenges remain concerning pre-hospital identification of the severely injured. Improved triage allows for a better match between patient needs and the level of resources available. Trauma management is threatened by the increasing sub-specialisation of professions and institutions. Scandinavian research is leading the development of team- and simulation-based trauma training. Several pan-Scandinavian efforts have facilitated research and provided guidelines for clinical management. CONCLUSION Scandinavian trauma research is characterised by an active collaboration across countries. The current challenges require a focus on the role of traumatology within an increasingly fragmented health care system. Regional networks of predictable and accountable pre- and in-hospital resources are needed for efficient trauma systems. Successful development requires both novel research and scientific assessment of imported principles of trauma care.
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Affiliation(s)
- Thomas Kristiansen
- Norwegian Air Ambulance Foundation, Department of Research, Drøbak, Norway.
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