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Thies KC, Bergmans E, Billington A, Fraga GP, Trummer F, Nasr AO, Tilsed J, Kamaras G, Cebula G, Protic A, Khalifa GEA, Vänni V, Alouini S, Uštar KK, Perfetti P, Sari F, Cimpoesu D, Cassar MR, Lott C, Blondeel L, Kooij F, Neutel E, Verdonck P. The European Trauma Course: Transforming systems through training. Resusc Plus 2024; 18:100599. [PMID: 38515443 PMCID: PMC10955415 DOI: 10.1016/j.resplu.2024.100599] [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] [Indexed: 03/23/2024] Open
Abstract
The European Trauma Course (ETC) exemplifies an innovative approach to multispecialty trauma education. This initiative was started as a collaborative effort among the European Society for Emergency Medicine, the European Society for Trauma and Emergency Surgery, and the European Society of Anaesthesiology under the auspices of the European Resuscitation Council. With the robust support of these societies, the project has evolved into the independent European Trauma Course Organisation. Over the past 15 years, the ETC has transcended traditional training by integrating team dynamics and non-technical skills into a scenario-based simulation course, helping to shape trauma care practice and education. A distinctive feature of the ETC is its training of doctors and allied healthcare professionals, fostering a collaborative and holistic approach to trauma care. The ETC stands out for its unique team-teaching approach, which has gained widespread recognition as the standard for in-hospital trauma care training not only in Europe but also beyond. Since its inception ETC has expanded geographically from Finland to Sudan and from Brazil to the Emirates, training nearly 20,000 healthcare professionals and shaping trauma care practice and education across 25 countries. Experiencing exponential growth, the ETC continues to evolve, reflecting its unmet demand in trauma team education. This review examines the evolution of the ETC, its innovative team-teaching methodology, national implementation strategies, current status, and future challenges. It highlights its impact on trauma care, team training, and the effect on other life support courses in various countries.
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Affiliation(s)
- Karl-Christian Thies
- EvKB, Dept of Anaesthesia and Critical Care, Bielefeld University Medical Center-Campus Bethel, Bielefeld, Germany
- European Trauma Course Organisation, Niel, Belgium
| | - Elonka Bergmans
- EvKB, Dept of Anaesthesia and Critical Care, Bielefeld University Medical Center-Campus Bethel, Bielefeld, Germany
| | | | - Gustavo P. Fraga
- Dept of Trauma Surgery, Vera Cruz Hospital-Trauma Center, Faculty of Medicine, University of Campinas, Campinas, Brazil
| | | | - Ayman O. Nasr
- Trauma Unit, King Fahad University Hospital & College of Medicine, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Jonathan Tilsed
- European Trauma Course Organisation, Niel, Belgium
- Hull York Medical School, United Kingdom
- UEMS Division of Emergency Surgery, European Society for Trauma and Emergency Surgery, United Kingdom
| | - Georgie Kamaras
- Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Gregorz Cebula
- Jagiellonian University Medical College, Center for Innovative Medical Education, Kraków, Poland
| | - Alen Protic
- Department of Anesthesiology, Intensive Medicine and Pain Therapy, University Hospital Rijeka, Rijeka, Croatia
| | - Gamal Eldin Abbas Khalifa
- European Trauma Course Organisation, Niel, Belgium
- Emergency and Disaster Medicine, Egyptian Resuscitation Council, Egypt
| | | | | | - Katja Kalan Uštar
- Dept of Anaesthesia and Critical Care, Trbovlje General Hospital, Trbovlje, Slovenia
| | - Paola Perfetti
- Emergency Department at Latisana, Azienda Sanitaria Universitaria Friuli Centrale, Italy
| | - Ferenc Sari
- European Trauma Course Organisation, Niel, Belgium
- Department of Emergency Medicine, Skellefteå Hospital, Region Västerbotten, Sweden
| | - Diana Cimpoesu
- University of Medicine and Pharmacy “Grigore T. Popa”, Emergency Medicine, II-nd Surgery Department, Hospital “Sf. Spiridon” Iasi, Romania
| | - Mary Rose Cassar
- Emergency Department, Mater Dei Hospital, Malta, University of Malta, Malta
| | - Carsten Lott
- European Trauma Course Organisation, Niel, Belgium
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Mainz, Germany
| | | | - Fabian Kooij
- European Trauma Course Organisation, Niel, Belgium
- Anesthesiologie Amsterdam UMC, locatie AMC, Amsterdam Zuidoost, Netherlands
| | - Elizabete Neutel
- European Trauma Course Organisation, Niel, Belgium
- Department of Anaesthesiology, Intensive Care Medicine and Emergency. Unidade Local de Saúde de Santo António, Porto, Portugal
| | - Philip Verdonck
- Emergency Departement, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
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Haută A, Iacobescu RA, Corlade-Andrei M, Nedelea PL, Cimpoeșu CD. Translating training to medical practice in trauma care, a literature review. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02548-1. [PMID: 38819677 DOI: 10.1007/s00068-024-02548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024]
Abstract
Trauma, a global health challenge, remains a significant cause of mortality despite advances in trauma management. The establishment of trauma teams has revolutionized care in trauma resuscitation. The training of these teams is designed to promote self-trust and empower trainees in trauma care, enhance performance, and improve patient outcomes. Various training curricula have been developed, utilizing a plethora of teaching methods such as lectures, simulations, debriefings, skill workshops, and demonstrations. However, a universally accepted gold standard curriculum in trauma training is yet to be defined, and there is no standard method for delivering education in injury care teaching. In this review, we have examined relevant literature data on standard teaching programs, the educational delivery methods used, and their impact on adult trauma patients' outcomes and trained team-related outcomes. While most studies indicate improved trained team performance, they consistently show no improvement in patient-specific outcomes such as mortality, morbidity, and length of stay. However, data hints at optimal educational delivery and the role that technology may play in the future of trauma training development.
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Affiliation(s)
- Alexandra Haută
- Department of Surgery II-Emergency Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania
- Department of Emergency Care, "Sf. Spiridon" University Emergency Hospital, Iași, Romania
| | - Radu-Alexandru Iacobescu
- Department of Medicine II-Nursing, University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania.
- Department of Thoracic Surgery, Pulmonary Disease University Hospital, Iași, Romania.
| | - Mihaela Corlade-Andrei
- Department of Surgery II-Emergency Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania
- Department of Emergency Care, "Sf. Spiridon" University Emergency Hospital, Iași, Romania
| | - Paul Lucian Nedelea
- Department of Surgery II-Emergency Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania
- Department of Emergency Care, "Sf. Spiridon" University Emergency Hospital, Iași, Romania
| | - Carmen Diana Cimpoeșu
- Department of Surgery II-Emergency Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania
- Department of Emergency Care, "Sf. Spiridon" University Emergency Hospital, Iași, Romania
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Kani K, Yoshimura S, Ikeda N, Miyamae N, Sumida Y. Awake Fiberoptic Tracheal Intubation in a Patient With Traumatic Retropharyngeal Hematoma. Cureus 2023; 15:e48813. [PMID: 38106694 PMCID: PMC10721434 DOI: 10.7759/cureus.48813] [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] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Retropharyngeal hematoma is a rare disease triggered by neck trauma and can result in airway obstruction, requiring early recognition and consideration of tracheal intubation. We present a case of a 42-year-old woman brought to the emergency department with dyspnea after a traffic trauma, and a mild stridor was heard on cervical auscultation, indicating airway compromise. Contrast-enhanced computed tomography (CT) scan showed retropharyngeal hematoma. Considering her obesity and short neck, we performed awake fiberoptic intubation successfully without any complications. Awake fiberoptic intubation, directly confirming anatomic abnormalities, may increase the success rate of intubation and prevent complications, especially in patients at high risk for cannot intubate, cannot ventilate (CICV). Cervical auscultation may contribute to early diagnosis and treatment for airway obstruction in patients with cervical trauma. We report a case of awake fiberoptic tracheal intubation for a retropharyngeal hematoma in a patient at high risk for CICV and cervical auscultation in a primary survey.
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Affiliation(s)
- Keigo Kani
- Emergency Medicine, Rakuwakai Otowa Hospital, Kyoto, JPN
| | - Satoshi Yoshimura
- Preventive Services, Kyoto University, Kyoto, JPN
- Emergency Medicine, Rakuwakai Otowa Hospital, Kyoto, JPN
| | - Nobuhiro Ikeda
- Emergency Medicine, Rakuwakai Otowa Hospital, Kyoto, JPN
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Bento A, Ferreira L, Yánez Benitez C, Koleda P, Fraga GP, Kozera P, Baptista S, Mesquita C, Alexandrino H. Worldwide snapshot of trauma team structure and training: an international survey. Eur J Trauma Emerg Surg 2023; 49:1771-1781. [PMID: 36414695 DOI: 10.1007/s00068-022-02166-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Trauma teams (TTs) are a key tool in trauma care, as they bring a multidisciplinary approach to the trauma patient, improving outcomes. Excellent teamwork (TW) requires not only individual skills but also training at non-technical skills (NTS). Although there is evidence supporting TTs, there is little information regarding how they are organized and trained. With this study, we intend to assess the reality of TTs all over the world, focusing on how they are organized and trained. MATERIALS AND METHODS We composed a 42-question sheet on Google Forms, in four different languages (English, Polish, Portuguese, and Spanish). The questions regarded the respondents' background, and their respective hospitals' trauma patient management, TT features and its training, NTS and TW. The survey was shared on social media, through the International Assessment Group of Online Surgical & Trauma Education community, and the European Society of Trauma and Emergency Surgery. Statistical analysis was performed on Statistical Package for the Social Sciences (SPSS®) version 27. RESULTS We obtained 296 answers from 52 different countries, with 6 having at least 10 answers (Brazil, Portugal, Poland, Spain, Italy, and USA). While the majority of the respondents (97%) agreed that TTs can improve outcomes, only 61% have a TT in their hospital, with 69% of these being dedicated TTs. General surgery (76%), trauma surgery (68%), and anesthesia (66%) were the three most common specialties in the teams. Teams performed briefings and debriefings with a frequency of, at least, "often" in only 49% and 38%, respectively. Only 50% and 33% of the respondents stated that their hospital provided trauma management courses focusing on individual technical skills, and TT training courses, respectively. The Advanced Trauma Life Support (85%), the Definitive Surgical and Anesthetic Trauma Care (38%), and the European Trauma Course (31%) were the three trauma management courses of choice. Regarding TT training courses, the European Trauma Course (52%) and local/in-house (42%) courses were the most common ones. Most participants (93%) stated that NTS were highly important in trauma care. However, only 60% of the respondents had postgraduate training on NTS and TW, and only 24% had this type of training on an undergraduate level. CONCLUSION The number of TTs worldwide does not match their relevance in trauma care. Institutions are not providing enough trauma courses, particularly TT training courses and NTS teaching. Implementing TT should include promotion of team courses, as well as team briefings and debriefings.
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Affiliation(s)
- André Bento
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Luís Ferreira
- Department of General Surgery, Hospital Central do Funchal, SESARAM, Funchal, Portugal
| | - Carlos Yánez Benitez
- General and Gastrointestinal Surgery, Royo Villanova Hospital, SALUD, Zaragoza, Spain
| | - Piotr Koleda
- Department of Medical Simulation, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences (SMS), University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Piotr Kozera
- Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Sérgio Baptista
- Department of Anesthesiology, Centro Hospitalar do Médio Tejo, EPE, Tomar, Portugal
| | - Carlos Mesquita
- Head of Clinic (Consultancy in General and Emergency Surgery and Trauma), Private Practice Coimbra, Coimbra, Portugal
| | - Henrique Alexandrino
- Department of General Surgery, Faculty of Medicine, Coimbra University Hospital Center, University of Coimbra, Praceta Mota Pinto, 3000-045, Coimbra, Portugal
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Gianola S, Bargeri S, Biffi A, Cimbanassi S, D’Angelo D, Coclite D, Facchinetti G, Fauci AJ, Ferrara C, Di Nitto M, Napoletano A, Punzo O, Ranzato K, Tratsevich A, Iannone P, Castellini G, Chiara O. Structured approach with primary and secondary survey for major trauma care: an overview of reviews. World J Emerg Surg 2023; 18:2. [PMID: 36600301 PMCID: PMC9814503 DOI: 10.1186/s13017-022-00472-6] [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: 11/09/2022] [Accepted: 12/25/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND A structured approach involves systematic management of trauma patients. We aim to conduct an overview of reviews about the clinical efficacy and safety of structured approach (i.e., primary and secondary survey) by guideline checklist compared to non-structured approach (i.e. clinical examination); moreover, routine screening whole-body computer tomography (WBCT) was compared to non-routine WBCT in patients with suspected major trauma. METHODS We systematically searched MEDLINE (PubMed), EMBASE and Cochrane Database of Systematic Reviews up to 3 May 2022. Systematic reviews (SRs) that investigated the use of a structured approach compared to a non-structured approach were eligible. Two authors independently extracted data, managed the overlapping of primary studies belonging to the included SRs and calculated the corrected covered area (CCA). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS We included nine SRs investigating two comparisons in stable trauma patients: structured approach vs non-structured approach (n = 1) and routine WBCT vs non-routine WBCT (n = 8). The overlap of included primary studies was generally high across outcomes (CCA ranged between 20.85 and 42.86%) with some discrepancies in the directions of effects across reviews. The application of a structured approach by checklist may improve adherence to guidelines (e.g. Advanced Trauma Life Support) during resuscitation and might lead to a reduction in mortality among severely injured patients as compared to clinical examination (Adjusted OR 0.51; 95% CI 0.30-0.89; p = 0.018; low certainty of evidence). The use of routine WBCT seems to offer little to no effects in reducing mortality and time spent in emergency room or department, whereas non-routine WBCT seems to offer little to no effects in reducing radiation dose, intensive care unit length of stay (LOS) and hospital LOS (low-to-moderate certainty of evidence). CONCLUSIONS The application of structured approach by checklist during trauma resuscitation may improve patient- and process-related outcomes. Including non-routine WBCT seems to offer the best trade-offs between benefits and harm. Clinicians should consider these findings in the light of their clinical context, the volume of patients in their facilities, the need for time management, and costs.
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Affiliation(s)
- Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Silvia Bargeri
- grid.417776.4Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Annalisa Biffi
- grid.7563.70000 0001 2174 1754National Centre for Healthcare Research and Pharmacoepidemiology,, University of Milano-Bicocca, Milan, Italy ,grid.7563.70000 0001 2174 1754Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Stefania Cimbanassi
- grid.4708.b0000 0004 1757 2822General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Daniela D’Angelo
- grid.416651.10000 0000 9120 6856Centro Nazionale per l Eccellenza Clinica, laQualità e la Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, Italy
| | - Daniela Coclite
- grid.416651.10000 0000 9120 6856Centro Nazionale per l Eccellenza Clinica, laQualità e la Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, Italy
| | - Gabriella Facchinetti
- grid.416651.10000 0000 9120 6856Centro Nazionale per l Eccellenza Clinica, laQualità e la Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, Italy
| | - Alice Josephine Fauci
- grid.416651.10000 0000 9120 6856Centro Nazionale per l Eccellenza Clinica, laQualità e la Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, Italy
| | - Carla Ferrara
- grid.416651.10000 0000 9120 6856Centro Nazionale per l Eccellenza Clinica, laQualità e la Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Di Nitto
- grid.416651.10000 0000 9120 6856Centro Nazionale per l Eccellenza Clinica, laQualità e la Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, Italy
| | - Antonello Napoletano
- grid.416651.10000 0000 9120 6856Centro Nazionale per l Eccellenza Clinica, laQualità e la Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, Italy
| | - Ornella Punzo
- grid.416651.10000 0000 9120 6856Centro Nazionale per l Eccellenza Clinica, laQualità e la Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, Italy
| | - Katya Ranzato
- grid.420421.10000 0004 1784 7240Gruppo MultiMedica, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Alina Tratsevich
- grid.7563.70000 0001 2174 1754National Centre for Healthcare Research and Pharmacoepidemiology,, University of Milano-Bicocca, Milan, Italy ,grid.7563.70000 0001 2174 1754Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Primiano Iannone
- grid.416290.80000 0004 1759 7093Dipartimento di Medicina Interna, Azienda USL, Ospedale Maggiore, Largo Nigrisoli 2, 40133 Bologna, Italy
| | - Greta Castellini
- grid.417776.4Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Osvaldo Chiara
- grid.4708.b0000 0004 1757 2822General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
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Maurer A, Thaler M, Kremser Y, Golger P, Baubin M, Schinnerl A, Neumayr A. PAR-AVISO – die strukturierte Patientenübergabe in der Notaufnahme. Notf Rett Med 2022. [DOI: 10.1007/s10049-022-01094-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gräff I, Pin M, Ehlers P, Seidel M, Hossfeld B, Dietz-Wittstock M, Rossi R, Gries A, Ramshorn-Zimmer A, Reifferscheid F, Reinhold T, Band H, Kuhl KH, König MK, Kasberger J, Löb R, Krings R, Schäfer S, Wienen IM, Strametz R, Wedler K, Mach C, Werner D, Schacher S. Empfehlungen zum strukturierten Übergabeprozess in der zentralen Notaufnahme. Notf Rett Med 2022. [DOI: 10.1007/s10049-020-00810-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Ali Ali B, Brinck T, Handolin L, Belzunegui Otano T. Severe head injury in elderly: 6-year comparison of treatment and outcome between southern Finland and Navarra (Spain). Eur J Trauma Emerg Surg 2019; 47:1429-1436. [PMID: 30747276 DOI: 10.1007/s00068-019-01091-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/07/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the profile, treatment and outcome of elderly patients with severe traumatic brain injuries (TBI) between southern Finland and Navarra (Spain). METHODS Data collected from, 2010 to 2015, in the Major Trauma Registry of Navarra (MTR-N) and the Helsinki Trauma Registry (HTR) were compared. Patients with New Injury Severity Score (NISS) ≥ 16 and age ≥ 65 with isolated severe TBI were considered. Patients who had been admitted to the hospital ≥ 24 h after the trauma, had been pronounced dead before hospital arrival, or had been injured by hanging, drowning or burns, were excluded. Outcome was defined by 30-day hospital mortality. The expected mortality was calculated using the Revised Injury Severity Classification score II (RISC II). Other compared data included demographics, injury mechanism, pre-hospital and hospital treatment, and time intervals. RESULTS A total of 305 (MTR-N) and 137 (HTR) patients were included in the outcome analysis. The standardized mortality ratio with 95% confidence interval was for MTR-N 1.4 (1.1-1.6) and for HTR 0.8 (0.6-1.1). Patients in Navarra were older (average 79.7 vs. 75.0) while in southern Finland the percentage of pre-hospital intubation in patients with GCS ≤ 8 (75.0% vs 50.0%) and ICU admission (72.2% vs 22.0%) were higher. CONCLUSION The better adjusted outcome of elderly patients with severe TBI in southern Finland in comparison to Navarra could be due to higher rate of pre-hospital intubation and/or higher rate of ICU admissions in southern Finland. Increasing number of elderly patients with severe TBI necessitate uniformly accepted protocols in pre- and in-hospital management.
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Affiliation(s)
- Bismil Ali Ali
- Accident and Emergency Department, Complejo Hospitalario de Navarra, Health service of Navarra-Osasunbidea, 31011, Pamplona, Spain.
| | - Tuomas Brinck
- Trauma Unit, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Lauri Handolin
- Trauma Unit, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Tomas Belzunegui Otano
- Accident and Emergency Department, Complejo Hospitalario de Navarra, Health service of Navarra-Osasunbidea, 31011, Pamplona, Spain.,Department of Health, Public University of Navarra, Pamplona, Spain
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Prehospital care of spinal injuries: a historical quest for reasoning and evidence. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2999-3006. [PMID: 30220041 DOI: 10.1007/s00586-018-5762-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/08/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The practice of prehospital immobilization is coming under increasing scrutiny. Unravelling the historical sequence of prehospital immobilization might shed more light on this matter and help resolve the situation. Main purpose of this review is to provide an overview of the development and reasoning behind the implementation of prehospital spine immobilization. METHODS An extensive search throughout historical literature and recent evidence based studies was conducted. RESULTS The history of treating spinal injuries dates back to prehistoric times. Descriptions of prehospital spinal immobilization are more recent and span two distinct periods. First documentation of its use comes from the early 19th century, when prehospital trauma care was introduced on the battlefields of the Napoleonic wars. The advent of radiology gradually helped to clarify the underlying pathology. In recent decades, adoption of advanced trauma life support has elevated in-hospital trauma-care to an high standard. Practice of in-hospital spine immobilization in case of suspected injury has also been implemented as standard-care in prehospital setting. Evidence for and against prehospital immobilization is equally divided in recent evidence-based studies. In addition, recent studies have shown negative side-effects of immobilisation in penetrating injuries. CONCLUSION Although widely implementation of spinal immobilization to prevent spinal cord injury in both penetrating and blunt injury, it cannot be explained historically. Furthermore, there is no high-level scientific evidence to support or reject immobilisation in blunt injury. Since evidence in favour and against prehospital immobilization is equally divided, the present situation appears to have reached something of a deadlock. These slides can be retrieved under Electronic Supplementary Material.
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Lang P, Kulla M, Kerwagen F, Lefering R, Friemert B, Palm HG. The role of whole-body computed tomography in the diagnosis of thoracic injuries in severely injured patients - a retrospective multi-centre study based on the trauma registry of the German trauma society (TraumaRegister DGU ®). Scand J Trauma Resusc Emerg Med 2017; 25:82. [PMID: 28810921 PMCID: PMC5558663 DOI: 10.1186/s13049-017-0427-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/07/2017] [Indexed: 12/14/2022] Open
Abstract
Background Thoracic injuries are a leading cause of death in polytrauma patients. Early diagnosis and treatment are of paramount importance. Whole-body computed tomography (WBCT) has largely replaced traditional imaging techniques such as conventional radiographs and focused computed tomography (CT) as diagnostic tools in severely injured patients. It is still unclear whether WBCT has led to higher rates of diagnosis of thoracic injuries and thus to a change in outcomes. Methods In a retrospective study based on the trauma registry of the German Trauma Society (TraumaRegister DGU®), we analysed data from 16,545 patients who underwent treatment in 59 hospitals between 2002 and 2012 (ISS ≥ 9). The 3 years preceding and the 3 years following the introduction of WBCT as a standard imaging modality for the investigation of severely injured patients were assessed for every hospital. Accordingly, patients were assigned to either the pre-WBCT or the WBCT group. We compared the numbers of thoracic injuries and the outcomes of patients before and after the routine use of WBCT. Results A total of 13,564 patients (pre-WBCT: n = 5005, WBCT: n = 8559) were included. Relevant thoracic injuries were detected in 47.8%. There were no major differences between the patient groups in injury severity (pre-WBCT: median ISS 21; WBCT: median ISS 22), injury patterns and demographics. After the introduction of WBCT, only minor changes were observed regarding the rates of most thoracic injuries. Clinically relevant injuries were pulmonary contusions (pre-WBCT: 18.5%; WBCT: 28.7%), injuries to the lung parenchyma (pre-WBCT: 12.6%; WBCT: 5.9%), multiple rib fractures (pre-WBCT: 10.6%; WBCT: 21.6%), and pneumothoraces (pre-WBCT: 17.3%; WBCT: 21.6%). The length of stay in the intensive care unit (pre-WBCT: 10.8 days; WBCT: 9.7 days) and in hospital (pre-WBCT: 26.2 days; WBCT: 23.3 days) decreased. There was no difference in overall mortality (pre-WBCT: 15.5%; WBCT: 15.6%). Conclusions The routine use of WBCT in the trauma room setting has led to changes in patient management that are not reflected in the rates of diagnosis of severe thoracic injuries (e.g. tension pneumothoraces, cardiac injuries, arterial injuries). By contrast, there was a relevant increase in the rates of diagnosis of minor thoracic injuries, which, however, did not result in an improvement in survival prognosis.
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Affiliation(s)
- Patricia Lang
- Trauma Research Group, Department of Orthopaedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, German Armed Forces Hospital of Ulm, Ulm, Germany
| | - Martin Kulla
- Department of Anaesthesiology and Intensive Care Medicine, German Armed Forces Hospital of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
| | - Fabian Kerwagen
- Trauma Research Group, Department of Orthopaedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, German Armed Forces Hospital of Ulm, Ulm, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Benedikt Friemert
- Trauma Research Group, Department of Orthopaedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, German Armed Forces Hospital of Ulm, Ulm, Germany
| | - Hans-Georg Palm
- Trauma Research Group, Department of Orthopaedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, German Armed Forces Hospital of Ulm, Ulm, Germany
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