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Willinge GJA, Spierings JF, Weert T, Twigt BA, Goslings JC, van Veen RN. Efficiency of a virtual fracture care protocol in non-operative treatment of adult patients with a distal radial fracture. J Hand Surg Eur Vol 2024; 49:341-349. [PMID: 37458134 DOI: 10.1177/17531934231187830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
This study aimed to determine the effects of virtual fracture care (VFC) on secondary healthcare utilization in non-operative treatment of adult patients with a distal radial fracture. A retrospective cohort study was performed, including those who received non-operative treatment without VFC (pre-VFC) and with VFC (VFC). Outcomes included secondary healthcare utilization, calculated treatment costs, emergency department (ED) reattendances and complication rates. In total, 88 pre-VFC and 99 VFC patients were included. Pre-VFC patients had more follow-up appointments, with a median of 4 (IQR: 3) versus a median of 4 (IQR: 1) in VFC patients. In addition, 3% of follow-up appointments for pre-VFC patients were performed remotely compared to 18% for VFC patients. Complications and ED reattendances were comparable between groups. In this study, non-operative treatment of adult patients with a distal radial fracture through VFC reduced secondary healthcare utilization, with similar reported complication and ED reattendance rates compared with treatment without VFC.Level of evidence: III.
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Affiliation(s)
- Gijs J A Willinge
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Jelle F Spierings
- Department of Trauma Surgery, St. Antonius Hospital Utrecht, Nieuwegein, the Netherlands
| | - Ton Weert
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Bas A Twigt
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Ruben N van Veen
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
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Tol MCJM, Willigenburg NW, Rasker AJ, Willems HC, Gosens T, Heetveld MJ, Schotanus MGM, Eggen B, Kormos M, van der Pas SL, van der Vaart AW, Goslings JC, Poolman RW. Posterolateral or Direct Lateral Surgical Approach for Hemiarthroplasty After a Hip Fracture: A Randomized Clinical Trial Alongside a Natural Experiment. JAMA Netw Open 2024; 7:e2350765. [PMID: 38206628 PMCID: PMC10784859 DOI: 10.1001/jamanetworkopen.2023.50765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024] Open
Abstract
Importance Hip fractures in older adults are serious injuries that result in disability, higher rates of illness and death, and a substantial strain on health care resources. High-quality evidence to improve hip fracture care regarding the surgical approach of hemiarthroplasty is lacking. Objective To compare 6-month outcomes of the posterolateral approach (PLA) and direct lateral approach (DLA) for hemiarthroplasty in patients with acute femoral neck fracture. Design, Setting, and Participants This multicenter, randomized clinical trial (RCT) comparing DLA and PLA was performed alongside a natural experiment (NE) at 14 centers in the Netherlands. Patients aged 18 years or older with an acute femoral neck fracture were included, with or without dementia. Secondary surgery of the hip, pathological fractures, or patients with multitrauma were excluded. Recruitment took place between February 2018 and January 2022. Treatment allocation was random or pseudorandom based on geographical location and surgeon preference. Statistical analysis was performed from July 2022 to September 2022. Exposure Hemiarthroplasty using PLA or DLA. Main Outcome and Measures The primary outcome was health-related quality of life 6 months after surgery, quantified with the EuroQol Group 5-Dimension questionnaire (EQ-5D-5L). Secondary outcomes included dislocations, fear of falling and falls, activities of daily living, pain, and reoperations. To improve generalizability, a novel technique was used for data fusion of the RCT and NE. Results A total of 843 patients (542 [64.3%] female; mean [SD] age, 82.2 [7.5] years) participated, with 555 patients in the RCT (283 patients in the DLA group; 272 patients in the PLA group) and 288 patients in the NE (172 patients in the DLA group; 116 patients in the PLA group). In the RCT, mean EQ-5D-5L utility scores at 6 months were 0.50 (95% CI, 0.45-0.55) after DLA and 0.49 (95% CI, 0.44-0.54) after PLA, with 77% completeness. The between-group difference (-0.04 [95% CI, -0.11 to 0.04]) was not statistically significant nor clinically meaningful. Most secondary outcomes were comparable between groups, but PLA was associated with more dislocations than DLA (RCT: 15 of 272 patients [5.5%] in PLA vs 1 of 283 patients [0.4%] in DLA; NE: 6 of 113 patients [5.3%]) in PLA vs 2 of 175 patients [1.1%] in DLA). Data fusion resulted in an effect size of 0.00 (95% CI, -0.04 to 0.05) for the EQ-5D-5L and an odds ratio of 12.31 (95% CI, 2.77 to 54.70) for experiencing a dislocation after PLA. Conclusions and Relevance This combined RCT and NE found that among patients treated with a cemented hemiarthroplasty after an acute femoral neck fracture, PLA was not associated with a better quality of life than DLA. Rates of dislocation and reoperation were higher after PLA. Randomized and pseudorandomized data yielded similar outcomes, which suggests a strengthening of these findings. Trial Registration ClinicalTrials.gov Identifier: NCT04438226.
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Affiliation(s)
- Maria C. J. M. Tol
- Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands
| | - Nienke W. Willigenburg
- Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands
| | - Ariena J. Rasker
- Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands
| | - Hanna C. Willems
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Amsterdam, the Netherlands
| | - Taco Gosens
- Department of Orthopedics and Trauma Surgery, ETZ, Tilburg, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Martin J. Heetveld
- Department of Trauma Surgery, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Martijn G. M. Schotanus
- Department of Orthopedic Surgery & Traumatology, Zuyderland Medical Center, Heerlen, Sittard-Geleen, the Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Science, Maastricht University, the Netherlands
| | - Bart Eggen
- Delft University of Technology, Electrical Engineering, Mathematics and Computer Science, Delft, the Netherlands
| | - Mate Kormos
- Delft University of Technology, Electrical Engineering, Mathematics and Computer Science, Delft, the Netherlands
| | - Stéphanie L. van der Pas
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, the Netherlands
| | - Aad W. van der Vaart
- Delft University of Technology, Electrical Engineering, Mathematics and Computer Science, Delft, the Netherlands
| | - J. Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Rudolf W. Poolman
- Department of Orthopedic Surgery, Joint Research, OLVG Hospital, Amsterdam, the Netherlands
- Department of Orthopedic Surgery, LUMC, Leiden, the Netherlands
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Meijer HA, Obdeijn MC, van Loon J, van den Heuvel SB, van den Brink LC, Schijven MP, Goslings JC, Schepers T. Rehabilitation after Distal Radius Fractures: Opportunities for Improvement. J Wrist Surg 2023; 12:460-473. [PMID: 37841352 PMCID: PMC10569825 DOI: 10.1055/s-0043-1769925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/09/2023] [Indexed: 10/17/2023]
Abstract
Background Exercises are frequently prescribed to regain function; yet there is no consensus on a standardized protocol, and adherence is low. Smart technology innovations, such as mobile applications, may be useful to provide home-based patient support in rehabilitation after distal radius fractures. Purposes Our purpose was to establish the potential of digital innovations for support and monitoring of patients and treatment adherence in rehabilitation programs, and additionally, to compare the current practice among physiotherapists to the various wrist exercise regimens and their effectiveness as described in the literature. Methods Standard practice, including the use of support tools for treatment adherence, was evaluated using a nationwide survey. Then, scientific databases were searched using "distal radius fracture" and "physiotherapy" or "exercise therapy," and related search terms, up until 23 March 2023. Results of the survey and literature review were compared. Results The survey was completed by 92 therapists. Nonstandardized support tools were used by 81.6% of respondents; 53.2% used some form of technology, including taking photos on the patients' smartphone for home reference. In the literature review, 23 studies were included, of which five described an exercise protocol. Treatment adherence was not reported in any of the included studies. Two studies described the use of smart technology or support tools. Conclusions There is no consensus on a standardized exercise protocol for rehabilitation after distal radius fractures, neither from a systematic literature search nor from a nationwide survey. Smart technology may facilitate monitoring of patients and exercise adherence, hereby supporting self-efficacy and improving adherence and outcomes.
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Affiliation(s)
- Henriëtte A.W. Meijer
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Miryam C. Obdeijn
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Justin van Loon
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | | | - Lianne C. van den Brink
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies P. Schijven
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam, The Netherlands
| | - J. Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, The Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Kuypers MI, Veldhuis LI, Mencl F, van Riel A, Thijssen WAHM, Tromp E, Goslings JC, Plötz FB. Procedural sedation and analgesia versus nerve blocks for reduction of fractures and dislocations in the emergency department: A systematic review and meta-analysis. J Am Coll Emerg Physicians Open 2023; 4:e12886. [PMID: 36704208 PMCID: PMC9867878 DOI: 10.1002/emp2.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/27/2022] [Accepted: 12/15/2022] [Indexed: 01/23/2023] Open
Abstract
Background Procedural sedation and analgesia (PSA) and peripheral nerve blocks (NBs) are techniques to manage pain and facilitate reduction of dislocated joints or fractures. However, it is unclear if either approach provides any distinct advantage in the emergency department (ED). The aim of this systematic review is to compare these 2 techniques on pain scores, adverse events, patient satisfaction, and length of stay (LOS) in the ED. Methods We performed an electronic search of MEDLINE, EMBASE, and the Cochrane Library, and references were hand-searched. Randomized controlled trials (RCTs) comparing PSA with NBs for orthopedic reductions in the ED were included. Outcomes of interest included pain scores, adverse events, patient satisfaction, and LOS in the ED. A total of 2 reviewers independently screened abstracts and extracted data into a standardized form. The Cochrane risk-of-bias tool was used to evaluate study quality. The Grading of Recommendation Assessment Development and Evaluation approach was used to assess the certainty and strength of the evidence. Data on pain scores were pooled using a random-effects model and are reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results A total of 6 RCTs (n = 256) were included in a qualitative review, and 4 RCTs (n = 101) were included in the meta-analysis. There was no significant difference in pain scores between the PSA and NB groups (P = 0.47; SMD, 0.45; 95% CI, -0.78 to 1.69; I2 = 0.94). There were less adverse events in the NB group (0%-3.3%) compared with the PSA group (0%-20%; n = 256). LOS times were consistently shorter in the NB group (n = 215). Patient satisfaction was comparable in both groups (n = 196). Conclusion Based on the available evidence, NBs performed by emergency physicians are as effective as PSA in managing pain during orthopedic reductions in the ED. NBs are associated with fewer adverse events and shorter LOS in the ED. The quality of evidence is low.
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Affiliation(s)
- Maybritt I. Kuypers
- Department of Emergency MedicineAmsterdam University Medical Center location Academisch Medisch CentrumAmsterdamthe Netherlands
| | - Lars I. Veldhuis
- Department of AnesthesiologyAmsterdam University Medical Center location Academisch Medisch CentrumAmsterdamthe Netherlands
| | - Francis Mencl
- Department of Emergency MedicinePenn State University Milton Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Anne van Riel
- Department of Emergency MedicineCatharina ZiekenhuisEindhoventhe Netherlands
| | | | - Ellen Tromp
- Department of Epidemiology and StatisticsSint Antonius ZiekenhuisNieuwegeinthe Netherlands
| | - J. Carel Goslings
- Department of TraumatologyOnze Lieve Vrouwe GasthuisAmsterdamthe Netherlands
| | - Frans B. Plötz
- Department of PediatricsTergooi ZiekenhuisBlaricumthe Netherlands,Department of PediatricsAmsterdam UMC, Emma Children's HospitalAmsterdamthe Netherlands
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5
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Bruinsma WE, Goslings JC, Schep NW, Ring D. Nonoperatively Treated Proximal Humerus Fractures: Randomized Trial of Immediate Versus Delayed Initiation of Exercises. Arch Bone Jt Surg 2023; 11:672-676. [PMID: 38058967 PMCID: PMC10697187 DOI: 10.22038/abjs.2023.50201.2493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/26/2023] [Indexed: 12/08/2023]
Abstract
Objectives There is debate about when to start exercises in the nonoperative treatment of a proximal humerus fracture. This randomized trial compared immediate and one-month delayed shoulder exercises in the nonoperative treatment of fractures of the proximal humerus. Methods Twenty-six patients with a fracture of the proximal humerus who chose nonoperative treatment were randomized to start pendulum exercises within a few days and 24 were randomized to delayed exercises and started with active self-assisted stretching 1 month after fracture. Three and six months after the injury, patients completed the Disabilities of the Arm Shoulder and Hand questionnaire to measure capability, a measure of pain intensity, and had motion measurements. Results There was no significant difference in forward flexion (primary outcome) six months after injury between patients that started motion exercises immediately compared to 1 month after injury (p = 0.85). There was no difference in any motion measurement, pain intensity, upper extremity specific disability (DASH score) three or six months after injury. Conclusion Delaying exercises for a month does not affect recovery from nonoperative treatment of a fracture of the proximal humerus. People can choose whether to start exercises immediately or wait until they feel comfortable.
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Affiliation(s)
| | | | | | - David Ring
- Dell Medical School--The University of Texas at Austin, USA
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6
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Augustinus S, Mulders MAM, Gardenbroek TJ, Goslings JC. Tranexamic acid in hip hemiarthroplasty surgery: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2022; 49:1247-1258. [DOI: 10.1007/s00068-022-02180-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
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Ter Meulen DP, Mulders MAM, Kruiswijk AA, Kret EJ, Slichter ME, van Dongen JM, Kerkhoffs GMMJ, Goslings JC, Kleinlugtenbelt YV, Willigenburg NW, Schep NWL, Poolman RW. Effectiveness and cost-effectiveness of surgery versus casting for elderly patients with Displaced intra- Articular type C distal Radius fractures: protocol of a randomised controlled Trial with economic evaluation (the DART study). BMJ Open 2022; 12:e051658. [PMID: 35365511 PMCID: PMC8977782 DOI: 10.1136/bmjopen-2021-051658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Current literature is inconclusive about the optimal treatment of elderly patients with displaced intra-articular distal radius fractures. Cast treatment is less invasive and less expensive than surgical treatment. Nevertheless, surgery is often the preferred treatment for this common type of distal radius fracture. Patients with a non-acceptable position after closed reduction are more likely to benefit from surgery than patients with an acceptable position after closed reduction. Therefore, this study aims to assess non-inferiority of functional outcomes after casting versus surgery in elderly patients with a non-acceptable position following a distal radius fracture. METHODS AND ANALYSIS This study is a multicentre randomised controlled trial (RCT) with a non-inferiority design and an economic evaluation alongside. The population consists of patients aged 65 years and older with a displaced intra-articular distal radius fracture with non-acceptable radiological characteristics following either inadequate reduction or redisplacement after adequate reduction. Patients will be randomised between surgical treatment (open reduction and internal fixation) and non-operative treatment (closed reduction followed by cast treatment). We will use two age strata (65-75 and >75 years of age) and a web-based mixed block randomisation. A total of 154 patients will be enrolled and evaluated with the patient-rated wrist evaluation as the primary outcome at 1-year follow-up. Secondary outcomes include the Disabilities of the Arm, Shoulder and Hand questionnaire, quality of life (measured by the EQ-5D), wrist range of motion, grip strength and adverse events. In addition, we will perform a cost-effectiveness and cost-utility analysis from a societal and healthcare perspective. Incremental cost-effectiveness ratios, cost-effectiveness planes and cost-effectiveness acceptability curves will be presented. ETHICS AND DISSEMINATION The Research and Ethics Committee approved this RCT (NL56858.100.16). The results of this study will be reported in a peer-reviewed journal. We will present the results of this study at (inter)national conferences and disseminate the results through guideline committees. TRIAL REGISTRATION NUMBER Clinicaltrials.gov (NCT03009890). Dutch Trial Registry (NTR6365).
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Affiliation(s)
- D P Ter Meulen
- Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
- Orthopedic Surgery, LUMC, Leiden, The Netherlands
| | - M A M Mulders
- Trauma Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - A A Kruiswijk
- Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
| | - E J Kret
- Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
| | - M E Slichter
- Orthopedic Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - J M van Dongen
- Department of Health Sciences, Faculty of Science, and the Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G M M J Kerkhoffs
- Orthopedic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - J C Goslings
- Trauma Surgery, OLVG, Amsterdam, The Netherlands
| | | | | | - N W L Schep
- Trauma Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - R W Poolman
- Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
- Orthopedic Surgery, LUMC, Leiden, The Netherlands
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8
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Wirtz MR, Roelofs JJ, Goslings JC, Juffermans NP. Treatment with ddAVP improves platelet-based coagulation in a rat model of traumatic hemorrhagic shock. Trauma Surg Acute Care Open 2022; 7:e000852. [PMID: 35340703 PMCID: PMC8905935 DOI: 10.1136/tsaco-2021-000852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/16/2022] [Indexed: 11/03/2022] Open
Abstract
Objectives Trauma-induced hemorrhagic shock is characterized by increased endothelial permeability and coagulopathy. Vasopressin analog ddAVP (desmopressin) acts by reorganizing and redistributing adhesive and tight junction molecules, enhancing endothelial barrier function. Furthermore, ddAVP increases von Willebrand factor (vWF) plasma levels and thereby potentially enhances platelet-based coagulation. The objective of this study was to assess whether the use of ddAVP results in improvement of both endothelial barrier function and platelet-based coagulation, thereby improving shock reversal and reduce organ failure in a rat model of trauma and transfusion. Methods Blood products were prepared from syngeneic rat blood according to blood bank standards. Polytrauma was induced in Sprague Dawley rats by a fractured femur and crush injury to the intestines and liver. The rats were hemorrhaged until a mean arterial pressure of 40 mm Hg and transfused with RBCs, fresh frozen plasmas and platelets in a 1:1:1 ratio, and randomized to receive a single dose of ddAVP (n=7 per group). Blood samples were taken up to 6 hours after trauma to assess biochemistry, markers of endothelial injury and coagulation status by rotational thromboelastometry (ROTEM). Organ damage was assessed by histopathology. Results Rats receiving ddAVP showed significantly better shock reversal compared with controls. Also, coagulation parameters remained stable in the ddAVP treated group, whereas rats in the control group showed deterioration of coagulation parameters, including decreased clot strength and decreased platelet functioning (89% (IQR 82% to 92%) of baseline values). Platelet count and vWF antigen levels at exsanguination did not differ between groups. ddAVP did not reduce markers of endothelial dysfunction nor markers of organ injury. Conclusions The use of ddAVP in a rat trauma-transfusion model improved shock parameters and ROTEM parameters of clot formation. However, this did not abrogate the amount of organ failure. Level of evidence Level III.
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Affiliation(s)
- Mathijs R Wirtz
- Department of Intensive Care Medicine, Amsterdam University Medical Centres, Amsterdam, Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Joris J Roelofs
- Department of Pathology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care Medicine, Amsterdam University Medical Centres, Amsterdam, Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centres, Amsterdam, Netherlands
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Selles CA, Mulders MAM, Winkelhagen J, van Eerten PV, Goslings JC, Schep NWL. Volar Plate Fixation Versus Cast Immobilization in Acceptably Reduced Intra-Articular Distal Radial Fractures: A Randomized Controlled Trial. J Bone Joint Surg Am 2021; 103:1963-1969. [PMID: 34314402 DOI: 10.2106/jbjs.20.01344] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evidence for the treatment of acceptably reduced intra-articular distal radial fractures remains inconclusive. We therefore compared the functional outcomes of cast immobilization (nonoperative) and volar plate fixation (operative) for patients with these fractures. METHODS This multicenter randomized controlled trial enrolled patients between 18 and 75 years old with an acceptably reduced intra-articular distal radial fracture. Patients were randomized to nonoperative treatment or to operative treatment. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE) score after 12 months. Secondary outcome measures were the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; the Short Form-36 (SF-36) questionnaire; a visual analog scale for pain; range of motion; grip strength; radiographic parameters; and complications. Analyses followed the intention-to-treat principle. RESULTS A total of 96 patients were randomized, and 90 (46 in the nonoperative group and 44 in the operative group) were included in the analysis. Patients treated in the operative group had significantly better functional outcomes measured with the PRWE at 6 weeks, 3 months, 6 months, and 1 year. Additionally, a 28% rate of subsequent surgery was identified in the nonoperative group. CONCLUSIONS Adult patients with an acceptably reduced intra-articular distal radial fracture have better functional outcomes for 12 months when treated operatively instead of nonoperatively. We therefore recommend surgical treatment for patients with these fractures. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- C A Selles
- Trauma Unit, Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.,Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - M A M Mulders
- Trauma Unit, Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - J Winkelhagen
- Department of Surgery, Dijklander Ziekenhuis, Hoorn, the Netherlands
| | - P V van Eerten
- Department of Surgery, Maxima Medical Center, Veldhoven, the Netherlands
| | - J C Goslings
- Department of Surgery, OLVG, Amsterdam, the Netherlands
| | - N W L Schep
- Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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Selles CA, Mulders MAM, van Dieren S, Goslings JC, Schep NWL. Cost Analysis of Volar Plate Fixation Versus Plaster Cast Immobilization for Intra-Articular Distal Radial Fractures. J Bone Joint Surg Am 2021; 103:1970-1976. [PMID: 34314400 DOI: 10.2106/jbjs.20.01345] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to compare the cost-effectiveness and cost-utility between plaster cast immobilization and volar plate fixation for acceptably reduced intra-articular distal radial fractures. METHODS A cost-effectiveness analysis was conducted as part of a randomized controlled trial comparing operative (volar plate fixation) with nonoperative (plaster cast immobilization) treatment in patients between 18 and 75 years old with an acceptably reduced intra-articular distal radial fracture. Health-care utilization and use of resources per patient were documented prospectively and included direct medical costs, direct non-medical costs, and indirect costs. All analyses were performed according to the intention-to-treat principle. RESULTS The mean total cost per patient was $291 (95% bias-corrected and accelerated confidence interval [bcaCI] = -$1,286 to $1,572) higher in the operative group compared with the nonoperative group. The mean total number of quality-adjusted life-years (QALYs) gained at 12 months was significantly higher in the operative group than in the nonoperative group (mean difference = 0.15; 95% bcaCI = 0.056 to 0.243). The difference in the cost per QALY (incremental cost-effectiveness ratio [ICER]) was $2,008 (95% bcaCI = -$9,608 to $18,222) for the operative group compared with the nonoperative group, which means that operative treatment is more effective but also more expensive. Subgroup analysis including only patients with a paid job showed that the ICER was -$3,500 per QALY for the operative group with a paid job compared with the nonoperative group with a paid job, meaning that operative treatment is more effective and less expensive for patients with a paid job. CONCLUSIONS The difference in QALYs gained for the operatively treated group was equivalent to an additional 55 days of perfect health per year. In adult patients with an acceptably reduced intra-articular distal radial fracture, operative treatment is a cost-effective intervention, especially in patients with paid employment. Operative treatment is slightly more expensive than nonoperative treatment but provides better functional results and a better quality of life. LEVEL OF EVIDENCE Economic and Decision Analysis Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- C A Selles
- Trauma Unit, Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.,Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - M A M Mulders
- Trauma Unit, Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - S van Dieren
- Trauma Unit, Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - J C Goslings
- Department of Surgery, OLVG, Amsterdam, the Netherlands
| | - N W L Schep
- Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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11
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Sanders FRK, Birnie MF, Dingemans SA, van den Bekerom MPJ, Parkkinen M, van Veen RN, Goslings JC, Schepers T. Functional outcome of routine versus on-demand removal of the syndesmotic screw: a multicentre randomized controlled trial. Bone Joint J 2021; 103-B:1709-1716. [PMID: 34719269 PMCID: PMC8528163 DOI: 10.1302/0301-620x.103b11.bjj-2021-0348.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aims The aim of this study was to investigate whether on-demand removal (ODR) is noninferior to routine removal (RR) of syndesmotic screws regarding functional outcome. Methods Adult patients (aged above 17 years) with traumatic syndesmotic injury, surgically treated within 14 days of trauma using one or two syndesmotic screws, were eligible (n = 490) for inclusion in this randomized controlled noninferiority trial. A total of 197 patients were randomized for either ODR (retaining the syndesmotic screw unless there were complaints warranting removal) or RR (screw removed at eight to 12 weeks after syndesmotic fixation), of whom 152 completed the study. The primary outcome was functional outcome at 12 months after screw placement, measured by the Olerud-Molander Ankle Score (OMAS). Results There were 152 patients included in final analysis (RR = 73; ODR = 79). Of these, 59.2% were male (n = 90), and the mean age was 46.9 years (SD 14.6). Median OMAS at 12 months after syndesmotic fixation was 85 (interquartile range (IQR) 60 to 95) for RR and 80 (IQR 65 to 100) for ODR. The noninferiority test indicated that the observed effect size was significantly within the equivalent bounds of -10 and 10 scale points (p < 0.001) for both the intention-to-treat and per-protocol, meaning that ODR was not inferior to RR. There were significantly more complications in the RR group (12/73) than in the ODR group (1/79) (p = 0.007). Conclusion ODR of the syndesmotic screw is not inferior to routine removal when it comes to functional outcome. Combined with the high complication rate of screw removal, this offers a strong argument to adopt on demand removal as standard practice of care after syndesmotic screw fixation. Cite this article: Bone Joint J 2021;103-B(11):1709–1716.
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Affiliation(s)
- Fay R K Sanders
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Merel F Birnie
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Siem A Dingemans
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Markus Parkkinen
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | | | - Tim Schepers
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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12
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Geerdink TH, Geerdink NJ, van Dongen JM, Haverlag R, Goslings JC, van Veen RN. Cost-effectiveness of direct discharge from the emergency department of patients with simple stable injuries in the Netherlands. Trauma Surg Acute Care Open 2021; 6:e000763. [PMID: 34722930 PMCID: PMC8549675 DOI: 10.1136/tsaco-2021-000763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/01/2021] [Indexed: 11/03/2022] Open
Abstract
Background Approximately one-third of musculoskeletal injuries are simple stable injuries (SSIs). Direct discharge (DD) from the emergency department (ED) of patients with SSIs reduces healthcare utilization, without compromising patient outcome and experience, when compared with "traditional" care with routine follow-up. This study aimed to determine the cost-effectiveness of DD compared with traditional care from a societal perspective. Methods Societal costs, including healthcare, work absenteeism, and travel costs, were calculated for patients with an SSI, 6 months before (pre-DD cohort) and after implementation of DD (DD cohort). The pre-DD cohort was treated according to local protocols. The DD cohort was treated using orthoses, discharge leaflet, smartphone application, and telephone helpline, without scheduling routine follow-up. Effect measures included generic health-related quality of life (HR-QoL; EuroQol Five-Dimensional Questionnaire); disease-specific HR-QoL (functional outcome, different validated questionnaires, converted to 0-100 scale); treatment satisfaction (Visual Analog Scale (VAS), 1-10); and pain (VAS, 1-10). All data were assessed using a 3-month postinjury survey and electronic patient records. Incremental cost-effectiveness ratios were calculated and uncertainty was assessed using bootstrapping techniques. Results Before DD, 144 of 348 participants completed the survey versus 153 of 371 patients thereafter. There were no statistically significant differences between the pre-DD cohort and the DD cohort for generic HR-QoL (0.03; 95% CI -0.01 to 0.08), disease-specific HR-QoL (4.4; 95% CI -1.1 to 9.9), pain (0.08; 95% CI -0.37 to 0.52) and treatment satisfaction (-0.16; 95% CI -0.53 to 0.21). Total societal costs were lowest in the DD cohort (-€822; 95% CI -€1719 to -€67), including healthcare costs (-€168; 95% CI -€205 to -€131) and absenteeism costs (-€645; 95% CI -€1535 to €100). The probability of DD being cost-effective was 0.98 at a willingness-to-pay of €0 for all effect measures, remaining high with increasing willingness-to-pay for generic HR-QoL, disease-specific HR-QoL, and pain, and decreasing with increasing willingness-to-pay for treatment satisfaction. Discussion DD from the ED of patients with SSI seems cost-effective from a societal perspective. Future studies should test generalizability in other healthcare systems and strengthen findings in larger injury-specific cohorts. Level of evidence II.
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Affiliation(s)
- Thijs H Geerdink
- Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Niek J Geerdink
- Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Robert Haverlag
- Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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13
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Geerdink TH, Salentijn DA, de Vries KA, Noordman PCW, van Dongen JM, Haverlag R, Goslings JC, van Veen RN. Optimizing orthopedic trauma care delivery during the COVID-19 pandemic. A closed-loop audit of implementing a virtual fracture clinic and fast-track pathway in a Dutch level 2 trauma center. Trauma Surg Acute Care Open 2021; 6:e000691. [PMID: 34632079 PMCID: PMC8491002 DOI: 10.1136/tsaco-2021-000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 09/01/2021] [Indexed: 11/05/2022] Open
Abstract
Background Guidelines concerning outpatient management of patients during the coronavirus pandemic required minimized face-to-face follow-up and increased remote care. In response, we established a virtual fracture clinic (VFC) review for emergency department (ED) patients with musculoskeletal injuries, meaning patients are reviewed ‘virtually’ the next workday by a multidisciplinary team, instead of routine referral for face-to-face fracture clinic review. Patients wait at home and are contacted afterwards to discuss treatment. Based on VFC review, patients with minor injuries are discharged, while for other patients an extensive treatment plan is documented using injury-specific care pathways. Additionally, we established an ED orthopedic trauma fast-track to reduce waiting time. This study aimed to evaluate the extent to which our workflow supported adherence to national coronavirus-related guidelines and effects on ED waiting time. Methods A closed-loop audit was performed during two 4-week periods using predefined standards: (1) all eligible ED orthopedic trauma patients are referred for VFC review; (2) reached afterwards; and follow-up is (3) patient initiated, or (4) performed remotely, whenever possible. Total ED waiting time, time to review, time for review, and time after review were assessed during both audit periods and compared with previous measurements. Results During both audits, the majority of eligible ED patients were referred for VFC review (1st: n=162 (88.0%); 2nd: n=302 (98.4%)), and reached afterwards (1st: 98.1%; 2nd: 99.0%). Of all referred patients, 17.9% and 13.6% were discharged ‘virtually’ during first and second audits, respectively, while 45.0% and 41.1% of scheduled follow-up appointments were remote. Median total ED waiting time was reduced (1st: −36 minutes (p<0.001); 2nd: −33 minutes (p<0.001)). During the second audit, median ED time to review was reduced by −13 minutes (p<0.001), as well as time for review: −10 minutes (p=0.019). Discussion In line with national guidelines, our VFC review allowed time-effective review and triage of the majority of ED orthopedic trauma patients, supporting patient-initiated and remote follow-up, whenever possible. ED waiting time was reduced after implementing the VFC review and orthopedic trauma fast-track. Level of evidence IV.
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Affiliation(s)
- Thijs H Geerdink
- Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | | | | | - Johanna M van Dongen
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Robert Haverlag
- Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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14
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Geerdink TH, Verbist J, van Dongen JM, Haverlag R, van Veen RN, Goslings JC. Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature. Eur J Trauma Emerg Surg 2021; 48:2589-2605. [PMID: 34529086 PMCID: PMC9360121 DOI: 10.1007/s00068-021-01784-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE There is growing evidence that patients with certain simple stable musculoskeletal injuries can be discharged directly from the Emergency Department (ED), without compromising patient outcome and experience. This study aims to review the literature on the effects of direct discharge (DD) of simple stable musculoskeletal injuries, regarding healthcare utilization, costs, patient outcome and experience. METHODS A systematic review was performed in Medline, Embase, CINAHL, Cochrane Library and Web of Science using PRISMA guidelines. Comparative and non-comparative studies on DD of simple stable musculoskeletal injuries from the ED in an adult/paediatric/mixed population were included if reporting ≥ 1 of: (1) logistic outcomes: DD rate (proportion of patients discharged directly); number of follow-up appointments; DD return rate; (2) costs; (3) patient outcomes/experiences: functional outcome; treatment satisfaction; adverse outcomes; other. RESULTS Twenty-six studies were included (92% conducted in the UK). Seven studies (27%) assessed functional outcome, nine (35%) treatment satisfaction, and ten (38%) adverse outcomes. A large proportion of studies defined DD eligibility criteria as injuries being minor/simple/stable, without further detail. ED DD rate was 26.7-59.5%. Mean number of follow-up appointments was 1.00-2.08 pre-DD, vs. 0.00-0.33 post-DD. Return rate was 0.0-19.4%. Costs per patient were reduced by €69-€210 (ranging from - 38.0 to - 96.6%) post-DD. Functional outcome and treatment satisfaction levels were 'equal' or 'better' (comparative studies), and 'high' (non-comparative studies), post-DD. Adverse outcomes were low and comparable. CONCLUSIONS This systematic review supports the idea that DD of simple stable musculoskeletal injuries from the ED provides an opportunity to reduce healthcare utilization and costs without compromising patient outcomes/experiences. To improve comparability and facilitate implementation/external validation of DD, future studies should provide detailed DD eligibility criteria, and use a standard set of outcomes. Systematic review registration number: 120779, date of first registration: 12/02/2019.
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Affiliation(s)
- T H Geerdink
- Department of Trauma Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
| | - J Verbist
- Department of Trauma Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - J M van Dongen
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - R Haverlag
- Department of Trauma Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - R N van Veen
- Department of Trauma Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - J C Goslings
- Department of Trauma Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
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15
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Kleinveld DJB, van Amstel RBE, Wirtz MR, Geeraedts LMG, Goslings JC, Hollmann MW, Juffermans NP. Platelet-to-red blood cell ratio and mortality in bleeding trauma patients: A systematic review and meta-analysis. Transfusion 2021; 61 Suppl 1:S243-S251. [PMID: 34269443 PMCID: PMC8362120 DOI: 10.1111/trf.16455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND In traumatic bleeding, transfusion practice has shifted toward higher doses of platelets and plasma transfusion. The aim of this systematic review was to investigate whether a higher platelet-to-red blood cell (RBC) transfusion ratio improves mortality without worsening organ failure when compared with a lower ratio of platelet-to-RBC. METHODS Pubmed, Medline, and Embase were screened for randomized controlled trials (RCTs) in bleeding trauma patients (age ≥16 years) receiving platelet transfusion between 1946 until October 2020. High platelet:RBC ratio was defined as being the highest ratio within an included study. Primary outcome was 24 hour mortality. Secondary outcomes were 30-day mortality, thromboembolic events, organ failure, and correction of coagulopathy. RESULTS In total five RCTs (n = 1757 patients) were included. A high platelet:RBC compared with a low platelet:RBC ratio significantly improved 24 hour mortality (odds ratio [OR] 0.69 [0.53-0.89]) and 30- day mortality (OR 0.78 [0.63-0.98]). There was no difference between platelet:RBC ratio groups in thromboembolic events and organ failure. Correction of coagulopathy was reported in five studies, in which platelet dose had no impact on trauma-induced coagulopathy. CONCLUSIONS In traumatic bleeding, a high platelet:RBC improves mortality as compared to low platelet:RBC ratio. The high platelet:RBC ratio does not influence thromboembolic or organ failure event rates.
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Affiliation(s)
- Derek J B Kleinveld
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rombout B E van Amstel
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mathijs R Wirtz
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Leo M G Geeraedts
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands
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16
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Treskes K, Sierink JC, Edwards MJR, Beuker BJA, Van Lieshout EMM, Hohmann J, Saltzherr TP, Hollmann MW, Van Dieren S, Goslings JC, Dijkgraaf MGW. Cost-effectiveness of immediate total-body CT in patients with severe trauma (REACT-2 trial). Br J Surg 2021; 108:277-285. [PMID: 33793734 PMCID: PMC10364909 DOI: 10.1093/bjs/znaa091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/05/2020] [Accepted: 10/22/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The effect of immediate total-body CT (iTBCT) on health economic aspects in patients with severe trauma is an underreported issue. This study determined the cost-effectiveness of iTBCT compared with conventional radiological imaging with selective CT (standard work-up (STWU)) during the initial trauma evaluation. METHODS In this multicentre RCT, adult patients with a high suspicion of severe injury were randomized in-hospital to iTBCT or STWU. Hospital healthcare costs were determined for the first 6 months after the injury. The probability of iTBCT being cost-effective was calculated for various levels of willingness-to-pay per extra patient alive. RESULTS A total of 928 Dutch patients with complete clinical follow-up were included. Mean costs of hospital care were €25 809 (95 per cent bias-corrected and accelerated (bca) c.i. €22 617 to €29 137) for the iTBCT group and €26 155 (€23 050 to €29 344) for the STWU group, a difference per patient in favour of iTBCT of €346 (€4987 to €4328) (P = 0.876). Proportions of patients alive at 6 months were not different. The proportion of patients alive without serious morbidity was 61.6 per cent in the iTBCT group versus 66.7 per cent in the STWU group (difference -5.1 per cent; P = 0.104). The probability of iTBCT being cost-effective in keeping patients alive remained below 0.56 for the whole group, but was higher in patients with multiple trauma (0.8-0.9) and in those with traumatic brain injury (more than 0.9). CONCLUSION Economically, from a hospital healthcare provider perspective, iTBCT should be the diagnostic strategy of first choice in patients with multiple trauma or traumatic brain injury.
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Affiliation(s)
- K Treskes
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
| | - J C Sierink
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
| | - M J R Edwards
- Trauma Unit, Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - B J A Beuker
- Trauma Unit, Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - E M M Van Lieshout
- Trauma Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - J Hohmann
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - T P Saltzherr
- Department of Surgery, Haaglanden Medical Centre, Den Haag, the Netherlands
| | - M W Hollmann
- Department of Anaesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - S Van Dieren
- Department of Surgery, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
| | - J C Goslings
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands.,Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - M G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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17
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Mulders MAM, Schep NWL, de Muinck Keizer RJO, Kodde IF, Hoogendoorn JM, Goslings JC, Eygendaal D. Operative vs. nonoperative treatment for Mason type 2 radial head fractures: a randomized controlled trial. J Shoulder Elbow Surg 2021; 30:1670-1678. [PMID: 33753275 DOI: 10.1016/j.jse.2021.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal treatment of isolated displaced partial articular radial head fractures remains controversial. The aim of this randomized controlled trial was to compare the functional outcome of operative treatment with nonoperative treatment in adults with an isolated Mason type 2 radial head fractures. METHODS In this multicenter randomized controlled trial, patients from 18 years of age with an isolated partial articular fracture of the radial head were randomly assigned to operative treatment by means of open reduction and screw fixation or nonoperative treatment with a pressure bandage. The primary outcome was function assessed with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Questionnaires and clinical follow-up was conducted at admission and at 3, 6, and 12 months. RESULTS In total, 45 patients were randomized, 23 patients to open reduction and screw fixation and 22 patients to nonoperative treatment with a pressure bandage. At 3, 6, and 12 months, patients treated operatively had similar functional outcomes compared to patients treated nonoperatively (DASH score at 12 months: 0.0 [0.0-4.2] vs. 1.7 [0.0-8.5]; P = .076). CONCLUSIONS Nonoperatively treated adults with an isolated Mason type 2 radial head fracture have similar functional results after 1 year compared with operatively treated patients. In addition, complication rates were low for both operative and nonoperative treatment.
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Affiliation(s)
- Marjolein A M Mulders
- Trauma Unit, Department of Surgery, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands.
| | - Niels W L Schep
- Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Izaäk F Kodde
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands; Department of Orthopedic Surgery, Deventer Hospital, Deventer, the Netherlands
| | | | - J Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands; Department of Orthopedic Surgery, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
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18
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Meijer HAW, Graafland M, Obdeijn MC, Schijven MP, Goslings JC. Validity and reliability of a wearable-controlled serious game and goniometer for telemonitoring of wrist fracture rehabilitation. Eur J Trauma Emerg Surg 2021; 48:1317-1325. [PMID: 33885912 PMCID: PMC9001232 DOI: 10.1007/s00068-021-01657-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/21/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the validity of wrist range of motion (ROM) measurements by the wearable-controlled ReValidate! wrist-rehabilitation game, which simultaneously acts as a digital goniometer. Furthermore, to establish the reliability of the game by contrasting ROM measurements to those found by medical experts using a universal goniometer. METHODS As the universal goniometer is considered the reference standard, inter-rater reliability between surgeons was first determined. Internal validity of the game ROM measurements was determined in a test-retest setting with healthy volunteers. The reliability of the game was tested in 34 patients with a restricted range of motion, in whom the ROM was measured by experts as well as digitally. Intraclass-correlation coefficients (ICCs) were determined and outcomes were analyzed using Bland-Altman plots. RESULTS Inter-rater reliability between experts using a universal goniometer was poor, with ICCs of 0.002, 0.160 and 0.520. Internal validity testing of the game found ICCs of - 0.693, 0.376 and 0.863, thus ranging from poor to good. Reliability testing of the game compared to medical expert measurements, found that mean differences were small for the flexion-extension arc and the radial deviation-ulnar deviation arc. CONCLUSION The ReValidate! game is a reliable home-monitoring device digitally measuring ROM in the wrist. Interestingly, the test-retest reliability of the serious game was found to be considerably higher than the inter-rater reliability of the reference standard, being healthcare professionals using a universal goniometer. TRIAL REGISTRATION NUMBER (internal hospital registration only) MEC-AMC W17_003 #17.015.
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Affiliation(s)
- Henriëtte A W Meijer
- Department of Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Maurits Graafland
- Department of Surgery, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Miryam C Obdeijn
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
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19
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Gardenbroek TJ, Oud S, Formijne Jonkers HA, Goslings JC. Supporting the medial hinge in proximal humerus fractures with an intramedullary plate. Trauma Case Rep 2021; 33:100474. [PMID: 33997224 PMCID: PMC8102799 DOI: 10.1016/j.tcr.2021.100474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 11/19/2022] Open
Abstract
Proximal humerus fractures are common and approximately 20% of displaced fractures may benefit from surgery. A lack of medial support is found to be a predictor of failure after surgical fixation of proximal humerus fractures. The optimal technique for restoring the medial hinge is unclear. We describe two cases of patients with a dislocated 4-part humerus fracture treated with a locking plate and an additional small intramedullary plate to support the medial hinge. This technique is simple and allows for an enhanced stability of the medial hinge during and after surgery.
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Affiliation(s)
| | - Sharon Oud
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | | | - J Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
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20
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Geerdink TH, Augustinus S, Groen JJ, van Dongen JM, Haverlag R, van Veen RN, Goslings JC. Direct discharge from the emergency department of simple stable injuries: a propensity score-adjusted non-inferiority trial. Trauma Surg Acute Care Open 2021; 6:e000709. [PMID: 33928193 PMCID: PMC8054190 DOI: 10.1136/tsaco-2021-000709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Recent studies suggest a large proportion of musculoskeletal injuries are simple stable injuries (SSIs). The aim of this study was to evaluate whether direct discharge (DD) from the emergency department (ED) of SSIs is non-inferior to 'traditional care' regarding treatment satisfaction and functional outcome, and to compare other patient-reported outcomes (PROMs), patient-reported experiences (PREMs), resource utilization, and adverse outcomes before and after DD. Methods This trial compared outcomes for 11 SSIs 6 months before and after the implementation of DD protocols. Pre-DD, patients were treated according to local protocols. Post-DD, patients were discharged directly using removable orthoses, discharge leaflets, smartphone application, and telephone helpline. Participants received a 3-month postinjury PROM/PREM survey to assess treatment satisfaction (Visual Analog Scale, VAS), pain (VAS), functional outcome (four validated questionnaires), and health-related quality of life (HR-QoL; EuroQol-5D). Resource utilization included general practitioner (GP) visit (yes/no), physiotherapist visit (yes/no), return to work/school/sports (days), work/school absenteeism to visit hospital (yes/no), number of hospital visits, and follow-up X-rays. Other outcomes included missed injuries (additionally to SSI) and adverse outcomes (delayed union, non-union). Between-group differences were assessed using propensity score-adjusted regression analyses. Non-inferiority was assessed for satisfaction and functional outcome using predefined margins. Results 348 (pre-DD) and 371 (post-DD) patients participated; 144 (41.4%) and 153 (41.2%) patients completed the survey. Satisfaction and functional outcome post-DD were non-inferior to traditional care. Mean satisfaction was 8.13 pre-DD and 7.95 post-DD (mean difference: -0.16, p=0.408). Pain, HR-QoL, GP/physiotherapist visits, and return to work/school/sports were comparable before and after DD. Work absenteeism was higher pre-DD (OR 0.110, p<0.001), as well as school absenteeism (OR 0.084, p<0.001). Post-DD, the mean number of hospital visits and X-rays reduced: -1.68 (p<0.001) and -0.26 (p<0.001). Missed injuries occurred once pre-DD versus twice post-DD. There were no adverse outcomes. Discussion The results of this study confirm several SSIs can be discharged directly from the ED without compromising patient outcome/experience. Future injury-specific trials are needed to conclusively assess non-inferiority of DD. Level of evidence II.
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Affiliation(s)
| | | | - Jasper J Groen
- Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Robert Haverlag
- Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands
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Geerdink TH, Uijterwijk BA, Meijer DT, Sierevelt IN, Mallee WH, van Veen RN, Goslings JC, Haverlag R. Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons. Injury 2021; 52:774-779. [PMID: 33276960 DOI: 10.1016/j.injury.2020.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The importance of routine follow-up of several relatively simple stable injuries (SSIs) is questionable. Multiple studies show that direct discharge (DD) of patients with SSIs from the Emergency Department results in patient outcomes and experiences comparable to 'standard care' with outpatient follow-up. The purpose of this study was to evaluate to which extent DD of SSIs has been adopted amongst trauma and orthopedic surgeons internationally, and to assess the variation in the management of these common injuries. METHODS An online survey was sent to members of an international trauma- and orthopaedic surgery collaboration. Participants, all trauma- or orthopaedic surgeons, were presented with eleven hypothetical cases of patients with simple stable injuries in which they were asked to outline their treatment plan regarding number of follow-up appointments and radiographs, physiotherapy and when to start functional movement. The primary outcome was the proportion of surgeons selecting direct discharge (i.e. zero scheduled appointments), per injury. Secondary outcomes included clinical agreement (>80% of respondents answering similarly) on total number of follow-up appointments (0, 1 or ≥2), radiographs (0, 1 or ≥2), routine physiotherapy referral (yes/no) and when to start functional movement (weeks). RESULTS 138 of 667 (20.7%) surgeons completed the survey. Adoption of direct discharge ranged from 4-45% of case examples. In 10 out of 11 cases, less than 25% of surgeons selected direct discharge. Clinical agreement regarding number of appointments and when to start functional movement was not reached for any of the injuries. There was clinical agreement on number of radiographs for one injury and for four injuries regarding routine referral to a physiotherapist. DISCUSSION Despite available evidence, DD of SSIs has not been widely adopted worldwide. Practice variation still exists even for these common injuries. This variation suggests inefficiency and consequently unnecessarily high healthcare costs. (Orthopaedic) trauma surgeons are encouraged to evaluate their current treatment protocols of SSIs.
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Affiliation(s)
- T H Geerdink
- Trauma Surgery, OLVG Amsterdam, The Netherlands.
| | | | - D T Meijer
- Resident Orthopaedic Surgery, Amsterdam UMC - Location AMC, The Netherlands
| | | | - W H Mallee
- Orthopaedic Surgery, OLVG Amsterdam, The Netherlands
| | | | | | - R Haverlag
- Trauma Surgery, OLVG Amsterdam, The Netherlands
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22
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Meijer HAW, Graafland M, Obdeijn MC, van Dieren S, Goslings JC, Schijven MP. Serious game versus standard care for rehabilitation after distal radius fractures: a protocol for a multicentre randomised controlled trial. BMJ Open 2021; 11:e042629. [PMID: 33785488 PMCID: PMC8030479 DOI: 10.1136/bmjopen-2020-042629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Distal radius fractures are among the most prevalent traumatic injuries worldwide. These injuries are associated with high healthcare-related and socioeconomic costs, mainly resulting from loss of productivity. To optimise recovery and return to work, wrist exercises are recommended. However, adherence to standard exercise regimens is low. Serious games provide a treatment platform for standardised postoperative care, uniting meaningful recovery with entertainment. Also, mobile serious games, for example, smartphone or tablet applications, are able to send practice reminders believed to improve self-efficacy. METHODS AND ANALYSIS To test the effectiveness of a mobile serious game for distal radius fracture rehabilitation compared with standard care, a multicentre, randomised controlled clinical trial was designed. Primary outcome will be the Patient-Rated Wrist Evaluation (PRWE) score after 6 weeks of treatment. Secondary outcomes are range of motion, grip strength, pain scores, and self-reported treatment adherence after 2, 6 and 12 weeks of treatment.Adult patients with any type of closed distal radius fracture are included directly after non-operative or operative fracture treatment. Patients are recruited in the outpatient clinics of four teaching hospitals. The intended sample size is 92 patients, based on the minimal clinically important difference of the PRWE score at 6 weeks, using a superiority model.Patients are randomised between using the wearable-controlled mobile serious game ReValidate! (intervention group) and standard care consisting of unsupervised exercises and a referral for physiotherapy or exercise therapy upon request or recommendation by the treating clinician (control group). ETHICS AND DISSEMINATION The protocol has been approved by the Medical Ethical Review Board of the Amsterdam University Medical Centres, location Academic Medical Centre in Amsterdam, the Netherlands. Results will be made available to involved healthcare providers, funders, and to the general public including patients via peer-reviewed academic journals and international conferences. TRIAL REGISTRATION NUMBER Dutch Trial Registry (NTR), NL6140, protocol V.2.
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Affiliation(s)
- Henriëtte A W Meijer
- Department of Surgery, Amsterdam Movement Sciences, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Maurits Graafland
- Department of Surgery, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Miryam C Obdeijn
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Susan van Dieren
- Department of Surgery, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
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23
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Sanders FRK, Penning D, Backes M, Dingemans SA, van Dieren S, Eskes AM, Goslings JC, Kloen P, Mathôt RAA, Schep NWL, Spijkerman IJB, Schepers T. Wound infection following implant removal of foot, ankle, lower leg or patella; a protocol for a multicenter randomized controlled trial investigating the (cost-)effectiveness of 2 g of prophylactic cefazolin compared to placebo (WIFI-2 trial). BMC Surg 2021; 21:69. [PMID: 33522909 PMCID: PMC7849087 DOI: 10.1186/s12893-020-01024-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Elective implant removal (IR) after fracture fixation is one of the most common procedures within (orthopedic) trauma surgery. The rate of surgical site infections (SSIs) in this procedure is quite high, especially below the level of the knee. Antibiotic prophylaxis is not routinely prescribed, even though it has proved to lower SSI rates in other (orthopedic) trauma surgical procedures. The primary objective is to study the effectiveness of a single intravenous dose of 2 g of cefazolin on SSIs after IR following fixation of foot, ankle and/or lower leg fractures. Methods This is a multicenter, double-blind placebo controlled trial with a superiority design, including adult patients undergoing elective implant removal after fixation of a fracture of foot, ankle, lower leg or patella. Exclusion criteria are: an active infection, current antibiotic treatment, or a medical condition contraindicating prophylaxis with cefazolin including allergy. Patients are randomized to receive a single preoperative intravenous dose of either 2 g of cefazolin or a placebo (NaCl). The primary analysis will be an intention-to-treat comparison of the proportion of patients with a SSI at 90 days after IR in both groups. Discussion If 2 g of prophylactic cefazolin proves to be both effective and cost-effective in preventing SSI, this would have implications for current guidelines. Combined with the high infection rate of IR which previous studies have shown, it would be sufficiently substantiated for guidelines to suggest protocolled use of prophylactic antibiotics in IR of foot, ankle, lower leg or patella. Trial registration Nederlands Trial Register (NTR): NL8284, registered on 9th of January 2020, https://www.trialregister.nl/trial/8284
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Affiliation(s)
- Fay R K Sanders
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Diederick Penning
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Manouk Backes
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Siem A Dingemans
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Susan van Dieren
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Anne M Eskes
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J Carel Goslings
- Trauma Surgery, OLVG, Loc. West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Peter Kloen
- Orthopedic Surgery, Amsterdam UMC, Loc. AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Ron A A Mathôt
- Hospital Pharmacy, Amsterdam UMC, Loc. AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Niels W L Schep
- Trauma Surgery, Maasstad Ziekenhuis, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - Ingrid J B Spijkerman
- Medical Microbiology, Amsterdam UMC, Loc. AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Ten Brinke JG, Slinger G, Slaar A, Saltzherr TP, Hogervorst M, Goslings JC. Correction to: Increased and unjustified CT usage in paediatric C‑spine clearance in a level 2 trauma centre. Eur J Trauma Emerg Surg 2021; 47:791-794. [PMID: 33462647 PMCID: PMC8187194 DOI: 10.1007/s00068-020-01557-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The original version of this article unfortunately contained mistakes.
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Affiliation(s)
- Joost G Ten Brinke
- Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands. .,Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, The Netherlands.
| | | | - Annelie Slaar
- Department of Radiology, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | | | - Mike Hogervorst
- Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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25
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Baksaas-Aasen K, Gall LS, Stensballe J, Juffermans NP, Curry N, Maegele M, Brooks A, Rourke C, Gillespie S, Murphy J, Maroni R, Vulliamy P, Henriksen HH, Pedersen KH, Kolstadbraaten KM, Wirtz MR, Kleinveld DJB, Schäfer N, Chinna S, Davenport RA, Naess PA, Goslings JC, Eaglestone S, Stanworth S, Johansson PI, Gaarder C, Brohi K. Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial. Intensive Care Med 2021; 47:49-59. [PMID: 33048195 PMCID: PMC7550843 DOI: 10.1007/s00134-020-06266-1] [Citation(s) in RCA: 133] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 09/20/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Contemporary trauma resuscitation prioritizes control of bleeding and uses major haemorrhage protocols (MHPs) to prevent and treat coagulopathy. We aimed to determine whether augmenting MHPs with Viscoelastic Haemostatic Assays (VHA) would improve outcomes compared to Conventional Coagulation Tests (CCTs). METHODS This was a multi-centre, randomized controlled trial comparing outcomes in trauma patients who received empiric MHPs, augmented by either VHA or CCT-guided interventions. Primary outcome was the proportion of subjects who, at 24 h after injury, were alive and free of massive transfusion (10 or more red cell transfusions). Secondary outcomes included 28-day mortality. Pre-specified subgroups included patients with severe traumatic brain injury (TBI). RESULTS Of 396 patients in the intention to treat analysis, 201 were allocated to VHA and 195 to CCT-guided therapy. At 24 h, there was no difference in the proportion of patients who were alive and free of massive transfusion (VHA: 67%, CCT: 64%, OR 1.15, 95% CI 0.76-1.73). 28-day mortality was not different overall (VHA: 25%, CCT: 28%, OR 0.84, 95% CI 0.54-1.31), nor were there differences in other secondary outcomes or serious adverse events. In pre-specified subgroups, there were no differences in primary outcomes. In the pre-specified subgroup of 74 patients with TBI, 64% were alive and free of massive transfusion at 24 h compared to 46% in the CCT arm (OR 2.12, 95% CI 0.84-5.34). CONCLUSION There was no difference in overall outcomes between VHA- and CCT-augmented-major haemorrhage protocols.
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Affiliation(s)
| | - L S Gall
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - J Stensballe
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - N P Juffermans
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - N Curry
- Oxford University Hospital NHS Trust, Oxford, UK
| | - M Maegele
- Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany
| | - A Brooks
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Rourke
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - S Gillespie
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - J Murphy
- Queen Mary University of London, London, UK
| | - R Maroni
- Queen Mary University of London, London, UK
| | - P Vulliamy
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - H H Henriksen
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K Holst Pedersen
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - M R Wirtz
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - D J B Kleinveld
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - N Schäfer
- Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany
| | - S Chinna
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R A Davenport
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - P A Naess
- Oslo University Hospital & University of Oslo, Oslo, Norway
| | - J C Goslings
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - S Eaglestone
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - S Stanworth
- Oxford University Hospital NHS Trust, Oxford, UK.,NHS Blood and Transplant, Bristol, UK
| | - P I Johansson
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - C Gaarder
- Oslo University Hospital & University of Oslo, Oslo, Norway
| | - K Brohi
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK.
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Wirtz MR, van den Brink DP, Roelofs JJTH, Goslings JC, Juffermans NP. Therapeutic application of recombinant human ADAMTS-13 improves shock reversal and coagulation status in a trauma hemorrhage and transfusion rat model. Intensive Care Med Exp 2020; 8:42. [PMID: 33336308 PMCID: PMC7746419 DOI: 10.1186/s40635-020-00328-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION In hemorrhaging trauma patients, the endothelium is activated, resulting in excessive endothelial synthesis of von Willebrand Factor (vWF), which may enhance micro-thrombi formation, resulting in obstruction of the microcirculation and endothelial injury, aggravating bleeding, as well as contributing to organ failure. Under normal conditions, vWF is cleaved by the metalloprotease ADAMTS-13. After trauma, ADAMTS-13 levels are reduced. OBJECTIVES To assess whether recombinant human ADAMTS-13 inhibits endothelial injury and organ failure in a rat trauma-transfusion model. METHODS Blood products were prepared from syngeneic rat blood according to blood bank standards. Polytrauma was induced in rats by crush injury to the intestines and liver and by fracture of the femur. The rats were hemorrhaged until a mean arterial pressure (MAP) of 40 mmHg was reached. Rats were randomized to receive transfusion of RBCs, FFPs, and platelets in a 1:1:1 ratio to achieve a MAP of 70 mmHg, with or without the addition of ADAMTS-13 (50 μg/kg). Blood samples were assessed for biochemistry and rotational thromboelastometry (ROTEM). Syndecan-1 and VE-cadherin levels were measured as a reflection of endothelial integrity. The amount of leakage of dextran-FITC from the vascular system to the parenchyma in lungs was quantified. To assess inflammation, IL-6 and IL-8 levels were determined. Organ damage was assessed by histopathology. RESULTS All rats were severely shocked, with no significant differences in shock parameters between groups. Rats treated with ADAMTS-13 showed signs of a more effective shock reversal (higher blood pressure, lower lactate levels) compared to controls. Also, ROTEM parameters of clot formation in rats receiving ADAMTS-13 improved compared to controls, which was mainly platelet-dependent. Syndecan-1 levels relative to baseline trended to be lower in ADAMTS-13 treated rats compared to controls (107 vs 149%, p = 0.08). ADAMTS-13 reduced albuminuria (1.7 vs 4.4 g/L, p < 0.01) and organ-specific inflammation (pulmonary IL-6 243 vs 369 pg/mL, p = 0.08; splenic IL-6 253 vs 307, p = 0.03) compared to controls, but did not improve histopathological scores. CONCLUSIONS The use of ADAMTS-13 in a rat trauma-transfusion model improves parameters of shock, platelet-driven coagulation, endothelial damage, and organ inflammation. These results suggest that ADAMTS-13 is important in mediating outcome of trauma. Whether ADAMTS-13 can be used as a therapeutic adjunct to treat bleeding trauma patients remains to be determined.
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Affiliation(s)
- Mathijs R Wirtz
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands. .,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands. .,Department of Trauma Surgery, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.
| | - Daan P van den Brink
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.,Department of Trauma Surgery, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Joris J T H Roelofs
- Department of Pathology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
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Salentijn DA, Mulders MAM, van Veen RN, Goslings JC, Schep NWL. [The Amsterdam Wrist Rules app: An aid for the triage of patients with wrist trauma]. Ned Tijdschr Geneeskd 2020; 164:D5198. [PMID: 33651504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the safety of implementing the Amsterdam Wrist Rules (AWR) during Emergency Department (ED) nurse triage, and to assess the potential reduction of radiographic images. DESIGN Prospective cohort study METHODS: Based on patient characteristics and clinical variables the AWR-application advised triage nurses if radiographic imaging was necessary of patients (>3 years) presenting with trauma of the wrist. The triage nurse was allowed to perform radiographic imaging if the advice was negative. Safety was assessed by the number of missed clinically relevant distal radius fractures (DRFs) when the AWR advised not to perform imaging. The potential reduction of radiographic images was assessed by the proportion of patients in whom the AWR-application advised not to perform imaging. Compliance was defined as following this advice. Patient satisfaction was assessed if no radiographic imaging was performed. RESULTS The AWR-application advised not to perform imaging in 18% of children (n=153) and in 9% of adults (n=204). In children, one clinically relevant DRF was missed (sensitivity 99%, specificity 33%) and none in adults (sensitivity 100%, specificity 19%). The compliance was 22% in children and 32% in adults. If no radiographic imaging was performed, 100% of children and 75% of adults were satisfied. CONCLUSION Implementation of the AWR during ED nurse triage of patients presenting with wrist trauma can safely contribute to reducing unnecessary radiographic imaging. If other injuries than a clinically relevant DRF are suspected based on triage, an ED physician should decide if imaging is necessary.
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Affiliation(s)
- Dorien A Salentijn
- Maasstad Ziekenhuis, afd. Chirurgie, Rotterdam
- Contact: Dorien A. Salentijn
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Wirtz MR, Moekotte J, Balvers K, Admiraal MM, Pittet JF, Colombo J, Wagener BM, Goslings JC, Juffermans N. Autonomic nervous system activity and the risk of nosocomial infection in critically ill patients with brain injury. Intensive Care Med Exp 2020; 8:69. [PMID: 33237337 PMCID: PMC7688871 DOI: 10.1186/s40635-020-00359-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/13/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Nosocomial infection contributes to adverse outcome after brain injury. This study investigates whether autonomic nervous system activity is associated with a decreased host immune response in patients following stroke or traumatic brain injury (TBI). METHODS A prospective study was performed in adult patients with TBI or stroke who were admitted to the Intensive Care Unit of our tertiary university hospital between 2013 and 2016. Heart rate variability (HRV) was recorded daily and assessed for autonomic nervous system activity. Outcomes were nosocomial infections and immunosuppression, which was assessed ex vivo using whole blood stimulations with plasma of patients with infections, matched non-infected patients and healthy controls. RESULTS Out of 64 brain injured patients, 23 (36%) developed an infection during their hospital stay. The ability of brain injured patients to generate a host response to the bacterial endotoxin lipopolysaccharides (LPS) was diminished compared to healthy controls (p < 0.001). Patients who developed an infection yielded significantly lower TNF-α values (86 vs 192 pg/mL, p = 0.030) and a trend towards higher IL-10 values (122 vs 84 pg/mL, p = 0.071) following ex vivo whole blood stimulations when compared to patients not developing an infection. This decreased host immune response was associated with altered admission HRV values. Brain injured patients who developed an infection showed increased normalized high-frequency power compared to patients not developing an infection (0.54 vs 0.36, p = 0.033), whereas normalized low-frequency power was lower in infected patients (0.46 vs 0.64, p = 0.033). CONCLUSION Brain injured patients developing a nosocomial infection show parasympathetic predominance in the acute phase following brain injury, reflected by alterations in HRV, which parallels a decreased ability to generate an immune response to stimulation with LPS.
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Affiliation(s)
- Mathijs R Wirtz
- Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis and Amsterdam University Medical Centers, Amsterdam, The Netherlands. .,Laboratory of Experimental Intensive Care and Anesthesiology of the Amsterdam University Medical Center, Amsterdam, The Netherlands. .,Trauma Unit, Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Jiri Moekotte
- Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis and Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology of the Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Kirsten Balvers
- Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis and Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology of the Amsterdam University Medical Center, Amsterdam, The Netherlands.,Trauma Unit, Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Marjolein M Admiraal
- Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis and Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology of the Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jean-Francois Pittet
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joe Colombo
- Department of Cardiology, Drexel University College of Medicine, and ANSAR Medical Technologies, Inc., Philadelphia, PA, USA
| | - Brant M Wagener
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Nicole Juffermans
- Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis and Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology of the Amsterdam University Medical Center, Amsterdam, The Netherlands
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Ten Brinke JG, Slinger G, Slaar A, Saltzherr TP, Hogervorst M, Goslings JC. Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre. Eur J Trauma Emerg Surg 2020; 47:781-789. [PMID: 33108476 PMCID: PMC8187214 DOI: 10.1007/s00068-020-01520-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/26/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Cervical spine injury after blunt trauma in children is rare but can have severe consequences. Clear protocols for diagnostic workup are, therefore, needed, but currently not available. As a step in developing such a protocol, we determined the incidence of cervical spine injury and the degree of protocol adherence at our level 2 trauma centre. METHODS We analysed data from all patients aged < 16 years suspected of cervical spine injury after blunt trauma who had presented to our hospital during two periods: January 2010 to June 2012, and January 2017 to June 2019. In the intervening period, the imaging protocol for diagnostic workup was updated. Outcomes were the incidence of cervical spine injury and protocol adherence in terms of the indication for imaging and the type of imaging. RESULTS We included 170 children in the first study period and 83 in the second. One patient was diagnosed with cervical spine injury. Protocol adherence regarding the indication for imaging was > 80% in both periods. Adherence regarding the imaging type decreased over time, with 45.8% of the patients receiving a primary CT scan in the second study period versus 2.9% in the first. CONCLUSION Radiographic imaging is frequently performed when clearing the paediatric cervical spine, although cervical spine injury is rare. Particularly CT scan usage has wrongly been emerging over time. Stricter adherence to current protocols could limit overuse of radiographic imaging, but ultimately there is a need for an accurate rule predicting which children really are at risk of injury.
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Affiliation(s)
- Joost G Ten Brinke
- Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands. .,Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, The Netherlands.
| | | | - Annelie Slaar
- Department of Radiology, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | | | - Mike Hogervorst
- Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Abstract
AIMS The primary aim of this study was to address the hypothesis that fracture morphology might be more important than posterior malleolar fragment size in rotational type posterior malleolar ankle fractures (PMAFs). The secondary aim was to identify clinically important predictors of outcome for each respective PMAF-type, to challenge the current dogma that surgical decision-making should be based on fragment size. METHODS This observational prospective cohort study included 70 patients with operatively treated rotational type PMAFs, respectively: 23 Haraguchi Type I (large posterolateral-oblique), 22 Type II (two-part posterolateral and posteromedial), and 25 (avulsion-) Type III. There was no standardized protocol on how to address the PMAFs and CT-imaging was used to classify fracture morphology and quality of postoperative syndesmotic reduction. Quantitative 3D-CT (Q3DCT) was used to assess the quality of fracture reduction, respectively: the proportion of articular involvement; residual intra-articular: gap, step-off, and 3D-displacement; and residual gap and step-off at the fibular notch. These predictors were correlated with the Foot and Ankle Outcome Score (FAOS) at two-years follow-up. RESULTS Bivariate analyses revealed that fracture morphology (p = 0.039) as well as fragment size (p = 0.007) were significantly associated with the FAOS. However, in multivariate analyses, fracture morphology (p = 0.001) (but not fragment size (p = 0.432)) and the residual intra-articular gap(s) (p = 0.009) were significantly associated. Haraguchi Type-II PMAFs had poorer FAOS scores compared with Types I and III. Multivariate analyses identified the following independent predictors: step-off in Type I; none of the Q3DCT-measurements in Type II, and quality of syndesmotic reduction in small-avulsion Type III PMAFs. CONCLUSION PMAFs are three separate entities based on fracture morphology, with different predictors of outcome for each PMAF type. The current debate on whether or not to fix PMAFs needs to be refined to determine which morphological subtype benefits from fixation. In PMAFs, fracture morphology should guide treatment instead of fragment size. Cite this article: Bone Joint J 2020;102-B(9):1229-1241.
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Affiliation(s)
- Robin P Blom
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, Netherlands.,Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Batur Hayat
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - Rami M A Al-Dirini
- College of Science and Engineering, Flinders University, Adelaide, Australia
| | - Inger Sierevelt
- Specialized Center of Orthopaedic Research and Education (SCORE), Amsterdam, Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, Netherlands.,University of Amsterdam, Amsterdam, Netherlands.,Academic Centre for Evidence based Sports medicine (ACES), Amsterdam, Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, Netherlands.,IOC Research Centre, Amsterdam, Netherlands
| | - J Carel Goslings
- University of Amsterdam, Amsterdam, Netherlands.,Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Ruurd L Jaarsma
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia.,Flinders University, Adelaide, Australia
| | - Job N Doornberg
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, Netherlands.,Flinders Medical Centre, Adelaide Australia
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Dingemans SA, Birnie MFN, Sanders FRK, van den Bekerom MPJ, Backes M, van Beeck E, Bloemers FW, van Dijkman B, Flikweert E, Haverkamp D, Holtslag HR, Hoogendoorn JM, Joosse P, Parkkinen M, Roukema G, Sosef N, Twigt BA, van Veen RN, van der Veen AH, Vermeulen J, Winkelhagen J, van der Zwaard BC, van Dieren S, Goslings JC, Schepers T. Correction to: Routine versus on demand removal of the syndesmotic screw; a protocol for an international randomised controlled trial (RODEO-trial). BMC Musculoskelet Disord 2020; 21:520. [PMID: 32758205 PMCID: PMC7409494 DOI: 10.1186/s12891-020-03516-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S A Dingemans
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M F N Birnie
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - F R K Sanders
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M P J van den Bekerom
- Department of Orthopedic Surgery, OLVG, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - M Backes
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - E van Beeck
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - F W Bloemers
- Department of Surgery, Trauma Unit, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - B van Dijkman
- Department of Surgery, Flevo Hospital, P.O. Box 3005, 1300 EG, Almere, The Netherlands
| | - E Flikweert
- Department of Surgery, Deventer Hospital, P.O. Box 5001, 7400 GC, Deventer, The Netherlands
| | - D Haverkamp
- Department of Surgery, Slotervaart Hospital, P.O. Box 90440, 1006 BK, Amsterdam, The Netherlands
| | - H R Holtslag
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J M Hoogendoorn
- Department of Surgery, Haaglanden MC, P.O. Box 432, 2501 CK, The Hague, The Netherlands
| | - P Joosse
- Department of Surgery, Noordwest Hospital Group, P.O. Box 501, 1815 JD, Alkmaar, The Netherlands
| | - M Parkkinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - G Roukema
- Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC, Rotterdam, The Netherlands
| | - N Sosef
- Department of Surgery, Spaarne Hospital, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands
| | - B A Twigt
- Department of Surgery, BovenIJ Hospital, P.O. Box 37610, 1030 BD, Amsterdam, The Netherlands
| | - R N van Veen
- Department of Surgery, OLVG, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - A H van der Veen
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, The Netherlands
| | - J Vermeulen
- Department of Surgery, Spaarne Hospital, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands
| | - J Winkelhagen
- Department of Surgery, Westfries Hospital, P.O. Box 600, 1620 AR, Hoorn, The Netherlands
| | - B C van der Zwaard
- Department of Orthopaedics, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME, 's-Hertogenbosch, The Netherlands
| | - S van Dieren
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J C Goslings
- Department of Orthopedic Surgery, OLVG, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - T Schepers
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Halm JA, Beerekamp MSH, de Muinck-Keijzer RJ, Beenen LFM, Maas M, Goslings JC, Schepers T. Intraoperative Effect of 2D vs 3D Fluoroscopy on Quality of Reduction and Patient-Related Outcome in Calcaneal Fracture Surgery. Foot Ankle Int 2020; 41:954-963. [PMID: 32517492 PMCID: PMC7406967 DOI: 10.1177/1071100720926111] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Three-dimensional (3D) fluoroscopy is thought to be advantageous in the open reduction and internal fixation (ORIF) of calcaneal fractures. The goal of this multicenter randomized controlled trial was to investigate the clinical effect of additional intraoperative 3D fluoroscopy on postoperative quality of reduction and fixation and patient-reported outcome as compared to conventional 2-dimensional (2D) fluoroscopy in patients with intra-articular fractures of the calcaneus. METHODS Patients were randomized to 3D or conventional 2D fluoroscopy during operative treatment of calcaneal fractures. Primary outcome was the difference in quality of fracture reduction and implant position on postoperative computed tomography (CT). Secondary endpoints included intraoperative corrections (prior to wound closure), complications, and revision surgery (after wound closure). Function and patient-reported outcome were evaluated after surgery and included range of motion, Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) score, Short-Form 36 (SF-36) questionnaires, and Kellgren-Lawrence posttraumatic osteoarthritis classification. A total of 102 calcaneal fractures were included in the study in 100 patients. Fifty fractures were randomized to the 3D group and 52 to the 2D group. RESULTS There was a statistically significant difference in duration of surgery between the groups (2D 125 min vs 3D 147 min; P < .001). After 3D fluoroscopy, a total of 57 intraoperative corrections were performed in 28 patients (56%). The postoperative CT scan revealed an indication for additional revision of reduction or implant position in 69% of the 3D group vs 60% in the 2D fluoroscopy group. At 2 years, there was no difference in number of revision surgery, complications, FAOS, AOFAS score, SF-36 score, or posttraumatic osteoarthritis. CONCLUSION The use of intraoperative 3D fluoroscopy in the treatment of intra-articular calcaneal fractures prolongs the operative procedures without improving the quality of reduction and fixation. There was no benefit of intraoperative 3D fluoroscopy with regard to postoperative complications, quality of life, functional outcome, or posttraumatic osteoarthritis.Level of Evidence: Level I, prospective randomized controlled study.
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Affiliation(s)
- Jens A. Halm
- Trauma Unit, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands,Jens A. Halm, MD, PhD, Trauma Unit, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
| | - M. Suzan H. Beerekamp
- Trauma Unit, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | | | - Ludo F. M. Beenen
- Department of Radiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Mario Maas
- Department of Radiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - J. Carel Goslings
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Unit, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
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van Meijel EPM, Gigengack MR, Verlinden E, van der Steeg AFW, Goslings JC, Bloemers FW, Luitse JSK, Boer F, Grootenhuis MA, Lindauer RJL. Long-Term Posttraumatic Stress Following Accidental Injury in Children and Adolescents: Results of a 2-4-Year Follow-Up Study. J Clin Psychol Med Settings 2020; 26:597-607. [PMID: 30924029 PMCID: PMC6851392 DOI: 10.1007/s10880-019-09615-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In this study, we determined the long-term prevalence of posttraumatic stress disorder (PTSD) in children and adolescents after accidental injury and gained insight into factors that may be associated with the occurrence of PTSD. In a prospective longitudinal study, we assessed diagnosed PTSD and clinically significant self-reported posttraumatic stress symptoms (PTSS) in 90 children (11–22 years of age, 60% boys), 2–4 years after their accident (mean number of months 32.9, SD 6.6). The outcome was compared to the first assessment 3 months after the accident in 147 children, 8–18 years of age. The prevalence of PTSD was 11.6% at first assessment and 11.4% at follow-up. Children with PTSD or PTSS reported significantly more permanent physical impairment than children without. Children who completed psychotherapy had no symptoms or low levels of symptoms at follow-up. Given the long-term prevalence of PTSD in children following accidents, we recommend systematic monitoring of injured children. The role of possible associated factors in long-term PTSS needs further study.
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Affiliation(s)
- Els P M van Meijel
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands. .,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
| | - Maj R Gigengack
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Eva Verlinden
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Alida F W van der Steeg
- Pediatric Surgical Center of Amsterdam, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam & VU University, Amsterdam, The Netherlands
| | - J Carel Goslings
- Trauma Unit Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Jan S K Luitse
- Emergency Department, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frits Boer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Pediatric Psychology Department of the Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Princess Maxima Center for Pediatric Oncology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
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Mulders MAM, Walenkamp MMJ, Sosef NL, Ouwehand F, van Velde R, Goslings JC, Schep NWL. The Amsterdam Wrist Rules: how much money can they save? Eur J Health Econ 2020; 21:745-750. [PMID: 32185523 PMCID: PMC7366574 DOI: 10.1007/s10198-020-01168-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/10/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE To allow physicians to be more selective in their request for a radiograph of the wrist and to potentially reduce costs, the Amsterdam Wrist Rules (AWR) have been developed, externally validated, and recently also implemented. The aim of this study was to conduct an incremental cost analysis and budget impact analysis of the implementation of the AWR at the emergency department (ED) in the Netherlands. METHODS A cost-minimisation analysis to determine the expected cost savings for implementation of the Amsterdam Wrist Rules. The incremental difference in costs before and after implementation of the AWR was based on the reduction in costs for radiographs, the cost savings due to reduction of ED consultation times and the costs of a re-evaluation appointment by a physician. RESULTS In the Netherlands, implementation of the AWR could potentially result in 6% cost savings per patient with a wrist injury. In addition, implementation of the AWR resulted in €203,510 cost savings annually nationwide. In the sensitivity analysis, an increase in physician compliance to 100% substantially increased the potential total amount of annual cost savings to €610,248, which is 6% of total costs before implementation. Variation in time spent at the ED, a decrease and increase in costs and patients presenting annually at the ED did not change the cost savings substantially. CONCLUSION Implementation of the AWR has been shown to reduce direct and indirect costs and can, therefore, result in considerable savings of healthcare consumption and expenditure.
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Affiliation(s)
- Marjolein A M Mulders
- Trauma Unit, Department of Surgery, Amsterdam UMC, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Monique M J Walenkamp
- Trauma Unit, Department of Surgery, Amsterdam UMC, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Nico L Sosef
- Department of Surgery, Spaarne Gasthuis, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands
| | - Frank Ouwehand
- Emergency Department, Amsterdam UMC, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Romuald van Velde
- Department of Surgery, Tergooi Hospitals, P.O. Box 10016, 1201 DA, Hilversum, The Netherlands
| | - J Carel Goslings
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - Niels W L Schep
- Department of Trauma and Hand Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC, Rotterdam, The Netherlands
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Langerhuizen DWG, Bergsma M, Selles CA, Jaarsma RL, Goslings JC, Schep NWL, Doornberg JN. Diagnosis of dorsal screw penetration after volar plating of a distal radial fracture. Bone Joint J 2020; 102-B:874-880. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1489.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to investigate whether intraoperative 3D fluoroscopic imaging outperforms dorsal tangential views in the detection of dorsal cortex screw penetration after volar plating of an intra-articular distal radial fracture, as identified on postoperative CT imaging. Methods A total of 165 prospectively enrolled patients who underwent volar plating for an intra-articular distal radial fracture were retrospectively evaluated to study three intraoperative imaging protocols: 1) standard 2D fluoroscopic imaging with anteroposterior (AP) and elevated lateral images (n = 55); 2) 2D fluoroscopic imaging with AP, lateral, and dorsal tangential views images (n = 50); and 3) 3D fluoroscopy (n = 60). Multiplanar reconstructions of postoperative CT scans served as the reference standard. Results In order to detect dorsal screw penetration, the sensitivity of dorsal tangential views was 39% with a negative predictive value (NPV) of 91% and an accuracy of 91%; compared with a sensitivity of 25% for 3D fluoroscopy with a NPV of 93% and an accuracy of 93%. On the postoperative CT scans, we found penetrating screws in: 1) 40% of patients in the 2D fluoroscopy group; 2) in 32% of those in the 2D fluoroscopy group with AP, lateral, and dorsal tangential views; and 3) in 25% of patients in the 3D fluoroscopy group. In all three groups, the second compartment was prone to penetration, while the postoperative incidence decreased when more advanced imaging was used. There were no penetrating screws in the third compartment (extensor pollicis longus groove) in the 3D fluoroscopy groups, and one in the dorsal tangential views group. Conclusion Advanced intraoperative imaging helps to identify screws which have penetrated the dorsal compartments of the wrist. However, based on diagnostic performance characteristics, one cannot conclude that 3D fluoroscopy outperforms dorsal tangential views when used for this purpose. Dorsal tangential views are sufficiently accurate to detect dorsal screw penetration, and arguably more efficacious than 3D fluoroscopy. Cite this article: Bone Joint J 2020;102-B(7):874–880.
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Affiliation(s)
- David W. G. Langerhuizen
- Department of Orthopaedic Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Minke Bergsma
- Department of Orthopaedic Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Caroline A. Selles
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Ruurd L. Jaarsma
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre, Adelaide, Australia
| | - J. Carel Goslings
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Niels W. L. Schep
- Department of Surgery, Maasstad ziekenhuis, Rotterdam, The Netherlands
| | - Job N. Doornberg
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre, Adelaide, Australia
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Wirtz MR, Schalkers DV, Goslings JC, Juffermans NP. The impact of blood product ratio and procoagulant therapy on the development of thromboembolic events in severely injured hemorrhaging trauma patients. Transfusion 2020; 60:1873-1882. [PMID: 32579252 PMCID: PMC7497022 DOI: 10.1111/trf.15917] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Transfusion therapy in hemorrhaging trauma patients is associated with the development of thromboembolic events. It is unknown whether current resuscitation strategies, including large volumes of plasma and early administration of procoagulant therapy, increases this risk. METHODS A systematic search was conducted in MEDLINE, PubMed, and Embase. Studies were screened by two independent reviewers and included if they reported on thromboembolic events in patients with severe trauma (injury severity score ≥16) who received transfusion of at least 1 unit of red blood cells. The ratio by which blood products were transfused, as well as use of procoagulant or antifibrinolytic medication, was recorded. RESULTS A total of 40 studies with 11.074 bleeding trauma patients were included, in which 1.145 thromboembolic events were reported, yielding an incidence of 10% thromboembolic events. In studies performing routine screening for thromboembolic complications, the incidence ranged from 12% to 23%. The risk of thromboembolic events was increased after administration of tranexamic acid (TXA; odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7-4.1; p < 0.001) and fibrinogen concentrate (OR, 2.1; 95% CI, 1.0-4.2; p = 0.04). Blood product ratio, the use of prothrombin complex concentrate or recombinant factor VIIa were not associated with thromboembolic events. CONCLUSION This systematic review identified an incidence of thromboembolic events of 10% in severely injured bleeding trauma patients. The use of TXA and fibrinogen concentrate was associated with the development of thromboembolic complications.
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Affiliation(s)
- Mathijs R Wirtz
- Department of Intensive Care, Amsterdam University Medical Centers, location Academic Medical Centre, Amsterdam, The Netherlands.,Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, location Academic Medical Centre, Amsterdam, The Netherlands
| | - Daisy V Schalkers
- Department of Intensive Care, Amsterdam University Medical Centers, location Academic Medical Centre, Amsterdam, The Netherlands
| | - J Carel Goslings
- Trauma Unit, Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care, Amsterdam University Medical Centers, location Academic Medical Centre, Amsterdam, The Netherlands
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van der Sluijs R, Fiddelers AAA, Waalwijk JF, Reitsma JB, Dirx MJ, den Hartog D, Evers SMAA, Goslings JC, Hoogeveen WM, Lansink KW, Leenen LPH, van Heijl M, Poeze M. The impact of the Trauma Triage App on pre-hospital trauma triage: design and protocol of the stepped-wedge, cluster-randomized TESLA trial. Diagn Progn Res 2020; 4:10. [PMID: 32566758 PMCID: PMC7302135 DOI: 10.1186/s41512-020-00076-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/22/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Field triage of trauma patients is crucial to get the right patient to the right hospital within a particular time frame. Minimization of undertriage, overtriage, and interhospital transfer rates could substantially reduce mortality rates, life-long disabilities, and costs. Identification of patients in need of specialized trauma care is predominantly based on the judgment of Emergency Medical Services professionals and a pre-hospital triage protocol. The Trauma Triage App is a smartphone application that includes a prediction model to aid Emergency Medical Services professionals in the identification of patients in need of specialized trauma care. The aim of this trial is to assess the impact of this new digital approach to field triage on the primary endpoint undertriage. METHODS The Trauma triage using Supervised Learning Algorithms (TESLA) trial is a stepped-wedge cluster-randomized controlled trial with eight clusters defined as Emergency Medical Services regions. These clusters are an integral part of five inclusive trauma regions. Injured patients, evaluated on-scene by an Emergency Medical Services professional, suspected of moderate to severe injuries, will be assessed for eligibility. This unidirectional crossover trial will start with a baseline period in which the default pre-hospital triage protocol is used, after which all clusters gradually implement the Trauma Triage App as an add-on to the existing triage protocol. The primary endpoint is undertriage on patient and cluster level and is defined as the transportation of a severely injured patient (Injury Severity Score ≥ 16) to a lower-level trauma center. Secondary endpoints include overtriage, hospital resource use, and a cost-utility analysis. DISCUSSION The TESLA trial will assess the impact of the Trauma Triage App in clinical practice. This novel approach to field triage will give new and previously undiscovered insights into several isolated components of the diagnostic strategy to get the right trauma patient to the right hospital. The stepped-wedge design allows for within and between cluster comparisons. TRIAL REGISTRATION Netherlands Trial Register, NTR7243. Registered 30 May 2018, https://www.trialregister.nl/trial/7038.
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Affiliation(s)
- Rogier van der Sluijs
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Surgery, Utrecht University Medical Center, Utrecht, The Netherlands
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Audrey A. A. Fiddelers
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Job F. Waalwijk
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Surgery, Utrecht University Medical Center, Utrecht, The Netherlands
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Johannes B. Reitsma
- Department of Epidemiology, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Miranda J. Dirx
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dennis den Hartog
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Silvia M. A. A. Evers
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - J. Carel Goslings
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Surgery, Onze Lieve Vrouwe Hospital, Amsterdam, The Netherlands
| | | | - Koen W. Lansink
- Department of Surgery, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
| | - Luke P. H. Leenen
- Department of Surgery, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Mark van Heijl
- Department of Surgery, Utrecht University Medical Center, Utrecht, The Netherlands
- Department of Surgery, Diakonessenhuis Utrecht/Zeist/Doorn, Utrecht, The Netherlands
| | - Martijn Poeze
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
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van Meijel EPM, Gigengack MR, Verlinden E, van der Steeg AFW, Goslings JC, Bloemers FW, Luitse JSK, Boer F, Grootenhuis MA, Lindauer RJL. Short and Long-Term Parental Posttraumatic Stress After a Child's Accident: Prevalence and Associated Factors. Child Psychiatry Hum Dev 2020; 51:200-208. [PMID: 31494749 PMCID: PMC7067753 DOI: 10.1007/s10578-019-00924-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Studies on the long-term prevalence of parental posttraumatic stress symptoms (PTSS) following child accidental injury are scarce, and findings on risk factors vary. In this follow-up study (T2, n = 69) we determined the prevalence of parental PTSS 2-4 years after accidental injury of their child, compared with 3 months after the accident (T1, n = 135). Additionally, we examined the association between parental and child factors and PTSS severity. Children were 8-18 years old at the time of the accident. Parent and child PTSS was assessed by self-report. Other data were retrieved from medical records and a telephone interview. Parental PTSS was 9.6% at T1 and 5.8% at T2. Acute parental stress as measured within 2 weeks of the child's accident was significantly associated with parental PTSS severity (T1 and T2), as was the child's hospitalization of more than 1 day at T1 and the child's permanent physical impairment at T2. To prevent adverse long-term psychological consequences we recommend identifying and monitoring parents at risk and offering them timely treatment.
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Affiliation(s)
- Els P M van Meijel
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands. .,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
| | - Maj R Gigengack
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Eva Verlinden
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Alida F W van der Steeg
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & VU University, Amsterdam, The Netherlands.,Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - J Carel Goslings
- Trauma Unit Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Jan S K Luitse
- Emergency Department, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frits Boer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Pediatric Psychology Department of the Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
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Mulders MAM, Walenkamp MMJ, van Dieren S, Goslings JC, Schep NWL. Volar Plate Fixation in Adults with a Displaced Extra-Articular Distal Radial Fracture Is Cost-Effective. J Bone Joint Surg Am 2020; 102:609-616. [PMID: 32079885 DOI: 10.2106/jbjs.19.00597] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To our knowledge, a health economic evaluation of volar plate fixation compared with plaster immobilization in patients with a displaced extra-articular distal radial fracture has not been previously conducted. METHODS A cost-effectiveness analysis of a multicenter randomized controlled trial was performed. Ninety patients were randomly assigned to volar plate fixation or plaster immobilization. The use of resources per patient was documented prospectively for up to 12 months after randomization and included direct medical, direct non-medical, and indirect non-medical costs due to the distal radial fracture and the received treatment. RESULTS The mean quality-adjusted life-years (QALYs) at 12 months were higher in patients treated with volar plate fixation (mean QALY difference, 0.16 [bias-corrected and accelerated 95% confidence interval (CI), 0.07 to 0.27]). (The 95% CIs throughout are bias-corrected and accelerated.) In addition, the mean total costs per patient were lower in patients treated with volar plate fixation (mean difference, -$299 [95% CI, -$1,880 to $1,024]). The difference in costs per QALY was -$1,838 (95% CI, -$12,604 to $9,787), in favor of volar plate fixation. In a subgroup analysis of patients who had paid employment, the difference in costs per QALY favored volar plate fixation by -$7,459 (95% CI, -$23,919 to $3,233). CONCLUSIONS In adults with a displaced extra-articular distal radial fracture, volar plate fixation is a cost-effective intervention, especially in patients who had paid employment. Besides its better functional results, volar plate fixation is less expensive and provides a better quality of life than plaster immobilization. LEVEL OF EVIDENCE Economic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Marjolein A M Mulders
- Trauma Unit (M.A.M.M. and M.M.J.W.), Department of Surgery (S.v.D.), Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Monique M J Walenkamp
- Trauma Unit (M.A.M.M. and M.M.J.W.), Department of Surgery (S.v.D.), Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Susan van Dieren
- Trauma Unit (M.A.M.M. and M.M.J.W.), Department of Surgery (S.v.D.), Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J Carel Goslings
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Niels W L Schep
- Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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Selles CA, Beerekamp MSH, Leenhouts PA, Segers MJM, Goslings JC, Schep NWL, Ubbink D, Blokhuis T, Kloen P, van den Berg R, van Dijkman B, Luitse J, Maas M, Peters R, Twigt B, Winkelhagen J. The Value of Intraoperative 3-Dimensional Fluoroscopy in the Treatment of Distal Radius Fractures: A Randomized Clinical Trial. J Hand Surg Am 2020; 45:189-195. [PMID: 31955998 DOI: 10.1016/j.jhsa.2019.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 09/18/2019] [Accepted: 11/06/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This study attempted to determine the clinical effectiveness of the intraoperative use of 3-dimensional fluoroscopy compared with conventional 2-dimensional fluoroscopy in patients with distal radius fractures. METHODS We performed a multicenter randomized clinical trial in which 206 patients were randomized between the use of 3-dimensional fluoroscopy or not during operative treatment of the distal radius fracture. The primary outcome was the quality of fracture reduction and fixation assessed on a postoperative computed tomography scan with a dichotomous outcome: indication for revision, yes or no. RESULTS There was no significant difference in whether the fracture required revision surgery: 31% (2-dimensional group) versus 24% (3-dimensional group). In 11% of distal radius fractures allocated to the 3-dimensional group, additional intraoperative corrections (screw replacements) were performed. CONCLUSIONS Compared with 2-dimensional fluoroscopy, the use of intraoperative 3-dimensional fluoroscopy does not appear to improve the quality of reduction and fixation in the management of patients with a distal radius fracture. However, the use of 3-dimensional fluoroscopy appears to have advantages such as more intraoperative revisions and less revision surgeries that this study could not clearly demonstrate. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- C A Selles
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Nieuwegein, The Netherlands.
| | - M S H Beerekamp
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Nieuwegein, The Netherlands
| | - P A Leenhouts
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Nieuwegein, The Netherlands
| | - M J M Segers
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J C Goslings
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Nieuwegein, The Netherlands
| | - N W L Schep
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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Geerdink TH, Haverlag R, van Veen RN, Bouwmeester OVA, Goslings JC. [Direct discharge from the ED for patients with simple stable injuries: a Dutch pilot study]. Ned Tijdschr Geneeskd 2020; 164:D4604. [PMID: 32391996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To describe and study (a) the implementation of direct discharge from a Dutch Emergency Department (ED) for patients with relatively simple stable injuries (SSIs), (b) preliminary logistical and financial effects, and (c) patients' experiences. DESIGN Prospective cohort study. METHOD Following the example of a healthcare reorganisation in the United Kingdom, in May 2019 we changed the treatment protocols of eleven SSIs. Since that time, no standard follow-up appointment has been scheduled for these patients. Patients are given information about treatment and the recovery period, and a form of immobilization is applied which can easily be removed at home. This information is summarised in a discharge leaflet and a smartphone application. A telephone helpline is available for any concerns or questions. During the implementation phase we determined compliance with, and deviation from, the protocol daily for 3 months. To determine the logistical and financial effects we compared the healthcare utilization of all patients with SSIs three months before and after implementation. Patient satisfaction and the shift in treatment towards primary care were determined by means of questionnaires. RESULTS In the three months before implementation 275 patients with an SSI presented to our ED, compared with 318 in the same period after implementation; 304 of the 318 patients were directly discharged (protocol compliance 95.6%). We found a significant reduction in follow-up appointments (-91%), radiological imaging (-72%), and costs. Patient satisfaction was comparable. There was no shift towards primary care in healthcare utilisation. CONCLUSION In the Netherlands, direct discharge from the ED seems to be an effective and safe alternative to traditional treatment with outpatient follow-up. Further studies on patient-reported outcomes should determine if this process is in concordance with the principle of Value Based Health Care.
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Treskes K, Russchen MJAM, Beenen LFM, de Jong VM, Kolkman S, de Bruin IGJM, Dijkgraaf MGW, Van Lieshout EMM, Saltzherr TP, Goslings JC. Early detection of severe injuries after major trauma by immediate total-body CT scouts. Injury 2020; 51:15-19. [PMID: 31493846 DOI: 10.1016/j.injury.2019.08.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/15/2019] [Accepted: 08/27/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Evaluation of immediate total-body CT (iTBCT) scouts during primary trauma care could be clinically relevant for early detection and treatment of specific major injuries. The aim of this study was to determine the diagnostic usefulness of TBCT scouts in detecting life-threatening chest and pelvic injuries. METHODS All patients who underwent an iTBCT during their primary trauma assessment in one trauma center between April 2011 and November 2014 were retrospectively included. Two experienced trauma surgeons and two emergency radiologists evaluated iTBCT scouts with structured questionnaires. Inter-observer agreement and diagnostic properties were calculated for endotracheal tube position and identification of pneumo- and/or hemothorax and pelvic fractures. Diagnostic properties of iTBCT scouts for indication for chest tube placement and pelvic binder application were calculated in comparison to decision based on iTBCT. RESULTS In total 220 patients with a median age of 37 years (IQR 26-59) were selected with a median Injury Severity Score of 18 (IQR 9-27). There was moderate to substantial inter-observer agreement and low false positive rates for pneumo- and/or hemothorax and for severe pelvic fractures by iTBCT scouts. For 19.8%-22.5% of the endotracheal intubated patients trauma surgeons stated that repositioning of the tube was indicated. Positive predictive value and sensitivity were respectively 100% (95%CI 52%-100%) and 50% (95%CI 22%-78%) for decisions on chest tube placement by trauma surgeon 1 and 67% (95%CI 13%-98%) and 22% (95%CI 4%-60%) for decisions by trauma surgeon 2. Only in one of 14 patients the pelvic binder was applied after iTBCT acquisition. CONCLUSIONS iTBCT scouts can be useful for early detection of pneumo- and/or hemothorax and severe pelvic fractures. Decision for chest tube placement based on iTBCT scouts alone is not recommended.
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Affiliation(s)
- K Treskes
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - M J A M Russchen
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - L F M Beenen
- Department of Radiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - V M de Jong
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - S Kolkman
- Department of Radiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - I G J M de Bruin
- Trauma Unit, Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - M G W Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - E M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - T P Saltzherr
- Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, Den Haag, the Netherlands
| | - J C Goslings
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
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Ridderikhof ML, Lodder DV, Van Dieren S, Lirk P, Goddijn H, Goslings JC, Hollmann MW. The relationship between patient factors and the refusal of analgesics in adult Emergency Department patients with extremity injuries, a case-control study. Scand J Pain 2019; 20:87-94. [PMID: 31536036 DOI: 10.1515/sjpain-2019-0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/16/2019] [Indexed: 11/15/2022]
Abstract
Background and aims Previous studies have described the phenomenon of oligo-analgesia in Emergency Department patients with traumatic injuries, despite the high prevalence of pain among these patients. Besides aspects related to health care staff, patient related factors might also play a role in suboptimal pain treatment, however evidence is scarce. Therefore, the objective of the current study was to evaluate patient related factors in adult patients refusing offered analgesics during an Emergency Department presentation with extremity injuries. Methods This was a case control study in the Emergency Department of a level 1 Trauma Centre. Cases were defined as adult patients with an extremity injury who declined analgesia, when offered. They were matched to controls from the same population, who accepted analgesics, in a 1:2 ratio using gender as matching variable. Primary outcome was difference in NRS pain score. Secondary outcomes were the relationship between categorical severity of pain scores and refusal of analgesics, exploration of independent predictors of analgesia refusal utilizing multivariate logistic regression and the evaluation of eight beliefs among patients who refuse analgesics. Results Between August 1st and 31st 2016, a total of 253 patients were eligible for inclusion of whom 55 declined analgesic treatment. They were included as cases and matched to 110 controls. Difference in median NRS pain score was significant between the groups: 5.0 (IQR 3.0-8.0) vs. 8.0 (IQR 6.0-9.0), respectively (p < 0.01). Nearly 20% of patients with severe pain declined analgesics, compared to 41% with moderate and 69% with mild pain (p < 0.01). The NRS pain score was the only independent predictor of refusal of analgesic treatment with a mean Odds Ratio of 0.67 (95%-CI 0.54-0.83). Most common patients' beliefs were that pain medication should be used in extreme pain only, fear of decreasing the doctor's ability to judge the injury and fear of addiction to analgesics. Conclusions Pain severity is the single independent predictor of refusal of analgesia, however the following patient beliefs are important as well: pain medication should be used in extreme pain only; fear of decreasing the doctor's ability to judge the injury and the fear of becoming addicted to pain medication. Implications In case patients refuse offered analgesics, the health care provider should actively address patient beliefs that might exist and lead to suboptimal pain treatment.
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Affiliation(s)
- Milan L Ridderikhof
- Department of Emergency Medicine, Amsterdam UMC - Location AMC, Amsterdam, The Netherlands
| | - Donica V Lodder
- Department of Emergency Medicine, Amsterdam UMC - Location AMC, Amsterdam, The Netherlands
| | - Susan Van Dieren
- Clinical Research Unit, Amsterdam UMC - Location AMC, Amsterdam, The Netherlands
| | - Philipp Lirk
- Department of Anaesthesiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Helma Goddijn
- Department of Emergency Medicine, Amsterdam UMC - Location AMC, Amsterdam, The Netherlands
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam UMC - Location AMC, Amsterdam, The Netherlands
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Mulders MAM, Walenkamp MMJ, Sosef NL, Ouwehand F, van Velde R, Goslings JC, Schep NWL. Correction to: The Amsterdam Wrist Rules to reduce the need for radiography after a suspected distal radius fracture: an implementation study. Eur J Trauma Emerg Surg 2019; 46:583. [PMID: 31705168 DOI: 10.1007/s00068-019-01256-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The original version of this article unfortunately contained a mistake. The spelling of the J. Carel Goslings' name was incorrect. The correct information is given above.
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Affiliation(s)
- Marjolein A M Mulders
- Trauma Unit, Department of Surgery, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Monique M J Walenkamp
- Trauma Unit, Department of Surgery, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Nico L Sosef
- Department of Surgery, Spaarne Gasthuis, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands
| | - Frank Ouwehand
- Emergency Department, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Romuald van Velde
- Department of Surgery, Tergooi Hospitals, P.O. Box 10016, 1201 DA, Hilversum, The Netherlands
| | - J Carel Goslings
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - Niels W L Schep
- Department of Trauma and Hand Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC, Rotterdam, The Netherlands
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Nosewicz TL, Dingemans SA, Backes M, Luitse JSK, Goslings JC, Schepers T. A systematic review and meta-analysis of the sinus tarsi and extended lateral approach in the operative treatment of displaced intra-articular calcaneal fractures. Foot Ankle Surg 2019; 25:580-588. [PMID: 30321924 DOI: 10.1016/j.fas.2018.08.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 06/26/2018] [Accepted: 08/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal surgical approach for displaced intra-articular calcaneal fractures (DIACF) is subject of debate. The primary aim of this systematic review and meta-analysis was to assess wound-healing complications following the sinus tarsi approach (STA) compared to the extended lateral approach (ELA). Secondary aims were to assess time to surgery, operative time, calcaneal anatomy restoration, functional outcome, implant removal and injury to the peroneal tendons and sural nerve. METHODS MEDLINE, EMBASE and Cochrane databases were searched for clinical studies comparing the STA and the ELA (until September 2017). RESULTS Nine studies were included (two randomized controlled trials; seven comparative studies). 326 patients (331 fractures) were treated by the STA and 383 patients (390 fractures) by ELA. Ninety-nine per cent were Sanders type II/III fractures. Wound healing complications in the STA and ELA occurred in 11/331 and 82/390 fractures, respectively. Weighted means were 4.9% and 24.9%, respectively. Meta-analysis showed significantly less wound healing complications in the STA compared to ELA (risk ratio 0.20; 95% CI 0.11-0.36; P<0.00001; I2=0%). In general, time to surgery and operative time were shorter in the STA. Meta-analysis was not possible due to heterogeneity between studies. No differences were found in remaining secondary outcomes. CONCLUSIONS The STA is associated with significantly less wound healing complications. With similar functional outcome and calcaneal anatomy restoration, the STA may be the preferred approach in the operative treatment of Sanders type II/III DIACF.
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Affiliation(s)
- Tomasz L Nosewicz
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Siem A Dingemans
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Manouk Backes
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Jan S K Luitse
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Tim Schepers
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Meijer HA, Graafland M, Obdeijn MC, Goslings JC, Schijven MP. Face Validity and Content Validity of a Game for Distal Radius Fracture Rehabilitation. J Wrist Surg 2019; 8:388-394. [PMID: 31579548 PMCID: PMC6773587 DOI: 10.1055/s-0039-1688948] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 04/09/2019] [Indexed: 10/26/2022]
Abstract
Background Patients recovering from a variety of wrist injuries are frequently advised to exercise to regain lost wrist and hand function. Treatment regimens to regain motion in the wrist are highly variable, and adherence to exercise protocols is known to be low. A serious game ReValidate! incorporating standardized exercise regimens was developed to motivate patients. In this study, the game is evaluated regarding its face validity and content validity. Methods In this cross-sectional study, a mixed group of "users" ( n = 53) including patients currently recovering from wrist injury, and a mixed group of "experts" ( n = 46) including professionals advising patients on therapy regimen after wrist injury played at least one complete level of the serious game. Players evaluated the game by means of a structured questionnaire regarding its content, clinical applicability, and user experience. Questions were answered on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Results All groups valued the game as being able to support wrist rehabilitation and being of use to patients recovering from a distal radius fracture (users: median 4, P25-P75 3-4 vs. experts: median 4, P25-P75 3.50-5; p = not significant). The types of exercises performed during the game were considered to be both realistic and complete compared with regular physiotherapy exercises (users: median 4, P25-P75 3-4 vs. experts: median 4, P25-P75 3-5, p = not significant). Conclusions The ReValidate! serious game can be regarded as a valid tool for patients to regain their wrist function after injury. Level of evidence This is a Level II study.
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Affiliation(s)
- Henriëtte A.W. Meijer
- Department of Surgery, Academic Medical Center, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maurits Graafland
- Department of Surgery, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Miryam C. Obdeijn
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J. Carel Goslings
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Marlies P. Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam UMC, AMC, University of Amsterdam, Amsterdam, the Netherlands
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Königs M, Pouwels PJW, Ernest van Heurn LW, Bakx R, Jeroen Vermeulen R, Goslings JC, Poll-The BT, van der Wees M, Catsman-Berrevoets CE, Oosterlaan J. Correction to: Relevance of neuroimaging for neurocognitive and behavioral outcome after pediatric traumatic brain injury. Brain Imaging Behav 2019; 13:1183. [DOI: 10.1007/s11682-018-9930-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kleinveld DJB, Wirtz MR, van den Brink DP, Maas MAW, Roelofs JJTH, Goslings JC, Hollmann MW, Juffermans NP. Use of a high platelet-to-RBC ratio of 2:1 is more effective in correcting trauma-induced coagulopathy than a ratio of 1:1 in a rat multiple trauma transfusion model. Intensive Care Med Exp 2019; 7:42. [PMID: 31346913 PMCID: PMC6658636 DOI: 10.1186/s40635-019-0242-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/07/2019] [Indexed: 12/16/2022] Open
Abstract
Background Platelet dysfunction importantly contributes to trauma-induced coagulopathy (TIC). Our aim was to examine the impact of transfusing platelets (PLTs) in a 2:1 PLT-to-red blood cell (RBC) ratio versus the standard 1:1 ratio on transfusion requirements, correction of TIC, and organ damage in a rat multiple trauma transfusion model. Methods Mechanically ventilated male Sprague Dawley rats were traumatized by crush injury to the small intestine and liver and a fracture of the femur, followed by exsanguination until a mean arterial pressure (MAP) of 40 mmHg. Animals were randomly assigned to receive resuscitation in a high PLT dose (PLT to plasma to RBC in a ratio of 2:1:1) or a standard PLT dose (ratio of 1:1:1) until a MAP of 60 mmHg was reached (n = 8 per group). Blood samples were taken for biochemical and thromboelastometry (ROTEM) assessment. Organs were harvested for histopathology.Outcome measures were transfusion requirements needed to reach a pretargeted MAP, as well as ROTEM correction and organ failure. Results Trauma resulted in coagulopathy as assessed by deranged ROTEM results. Mortality rate was 19%, with all deaths occurring in the standard dose group. The severity of hypovolemic shock as assessed by lactate and base excess was not different in both groups. The volume of transfusion needed to reach the MAP target was lower in the high PLT dose group compared to the standard dose, albeit not statistically significant (p = 0.054). Transfusion with a high PLT dose resulted in significant stronger clot firmness compared to the standard dose at all time points following trauma, while platelet counts were similar. Organ failure as assessed by biochemical analysis and histopathology was not different between groups, nor were there any thromboembolic events recorded. Conclusions Resuscitation with a high (2:1) PLT-to-RBC ratio was more effective compared to standard (1:1) PLT-to-RBC ratio in treating TIC, with a trend towards reduced transfusion volumes. Also, high PLT dose did not aggravate organ damage. Transfusion strategies using higher PLT dose regiments might be a feasible treatment option in hemorrhaging trauma patients for the correction of TIC.
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Affiliation(s)
- Derek J B Kleinveld
- Department of Intensive Care Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Trauma Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mathijs R Wirtz
- Department of Intensive Care Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Trauma Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Daan P van den Brink
- Department of Intensive Care Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M Adrie W Maas
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - J Carel Goslings
- Department of Trauma Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands.
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Blom RP, Meijer DT, de Muinck Keizer RJO, Stufkens SAS, Sierevelt IN, Schepers T, Kerkhoffs GMMJ, Goslings JC, Doornberg JN. Posterior malleolar fracture morphology determines outcome in rotational type ankle fractures. Injury 2019; 50:1392-1397. [PMID: 31176480 DOI: 10.1016/j.injury.2019.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/23/2019] [Accepted: 06/02/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Rotational type ankle fractures with a concomitant fracture of the posterior malleolus are associated with a poorer clinical outcome as compared to ankle fractures without. However, clinical implications of posterior malleolar (PM) fracture morphology and pattern have yet to be established. Many studies on this subject report on fragment size, rather than fracture morphology based on computed tomography (CT). The overall purpose of the current study was to elucidate the correlation of PM fracture morphology and functional outcome, assessed with CT imaging and not with -unreliable- plain radiographs. METHODS Between January 2010 and May 2014, 194 patients with an operatively (ORIF) treated ankle fracture, were prospectively included in the randomized clinical EF3X-trial at our Level-I trauma center. The current study retrospectively included 73 patients with rotational type ankle fractures and concomitant fractures of the posterior malleolus. According to the CT-based Haraguchi fracture morphology, all patients were divided into three groups: 20 Type I (large posterolateral-oblique), 21 Type II (transverse medial-extension) and 32 Type III (small-shell fragment). At 12 weeks, 1 year and 2 years postoperatively the Foot and Ankle Outcome Scores (FAOS) and SF-36 scores were obtained, with the FAOS domain scores at two years postoperative as primary study outcome. Statistical analysis included a multivariate regression and secondary a mixed model analysis. RESULTS Haraguchi Type II PM ankle fractures demonstrated significantly poorer outcome scores at two years follow-up compared to Haraguchi Types I and III. Mean FAOS domain scores at two years follow-up showed to be significantly worse in Haraguchi Type II as compared to Type III, respectively: Symptoms 48.2 versus 61.7 (p = 0.03), Pain 58.5 versus 84.4 (p < 0.01), Activities of Daily Living (ADL) 64.1 versus 90.5 (p < 0.01). CONCLUSION Posterior malleolar ankle fractures with medial extension of the fracture line (i.e. Haraguchi Type II) are associated with significantly poorer functional outcomes. The current dogma to fix PM fractures that involve at least 25-33% of the tibial plafond may be challenged, as posterior malleolar fracture pattern and morphology - rather than fragment size - seem to determine outcome.
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Affiliation(s)
- R P Blom
- Department of Orthopaedic Surgery, Amsterdam UMC, location AMC. University of Amsterdam. Amsterdam, the Netherlands; Amsterdam Movement Sciences, Amsterdam, the Netherlands; Academic Center for Evidence-based Sports medicine (ACES).
| | - D T Meijer
- Department of Orthopaedic Surgery, Amsterdam UMC, location AMC. University of Amsterdam. Amsterdam, the Netherlands; Trauma Unit, Department of Surgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - R-J O de Muinck Keizer
- Trauma Unit, Department of Surgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - S A S Stufkens
- Department of Orthopaedic Surgery, Amsterdam UMC, location AMC. University of Amsterdam. Amsterdam, the Netherlands; Amsterdam Movement Sciences, Amsterdam, the Netherlands; Academic Center for Evidence-based Sports medicine (ACES)
| | - I N Sierevelt
- Specialized Centre of Orthopedic Research and Education (SCORE). Amsterdam, the Netherlands
| | - T Schepers
- Trauma Unit, Department of Surgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - G M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, location AMC. University of Amsterdam. Amsterdam, the Netherlands; Amsterdam Movement Sciences, Amsterdam, the Netherlands; Academic Center for Evidence-based Sports medicine (ACES); Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center, Amsterdam, the Netherlands
| | - J C Goslings
- Trauma Unit, Department of Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands
| | - J N Doornberg
- Department of Orthopaedic Surgery, Amsterdam UMC, location AMC. University of Amsterdam. Amsterdam, the Netherlands; Department of Orthopaedics and Trauma Surgery, Flinders Medical Centre and Flinders University. Adelaide, South Australia, Australia
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Ridderikhof ML, Saanen J, Goddijn H, Van Dieren S, Van Etten-Jamaludin F, Lirk P, Goslings JC, Hollmann MW. Paracetamol versus other analgesia in adult patients with minor musculoskeletal injuries: a systematic review. Emerg Med J 2019; 36:493-500. [DOI: 10.1136/emermed-2019-208439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 12/26/2022]
Abstract
ObjectivesPain treatment in acute musculoskeletal injuries usually consists of paracetamol, non-steroidal antiinflammatory drugs (NSAIDs) or opioids. It would be beneficial to determine whether paracetamol is as effective as other analgesics. The objective of this study was to evaluate available evidence regarding efficacy of paracetamol in these patients.MethodsEmbase, MEDLINE, Cochrane and relevant trial registers were searched from inception to 14 February 2018 by two independent reviewers to detect all randomised studies with adult patients with acute minor musculoskeletal injuries treated with paracetamol as compared with other analgesics. There were no language or date restrictions. Two independent reviewers evaluated risk of bias and quality of evidence. Primary outcome was decrease in pain scores during the first 24 hours, and secondary outcomes included pain decrease beyond 24 hours, need for additional analgesia and occurrence of adverse events.ResultsSeven trials were included, evaluating 2100 patients who were treated with paracetamol or NSAIDs or the combination of both as comparisons, of which only four studies addressed the primary outcome. No studies were found comparing paracetamol with opioids. There were no differences in analgesic effectiveness within and beyond 24 hours, nor in need for additional analgesia and occurrence of adverse events. Overall, quality of evidence was low. Because of methodological inconsistencies, a meta-analysis was not possible.ConclusionsBased on available evidence, paracetamol is as effective as NSAIDs or the combination of both in treating pain in adult patients with minor musculoskeletal injuries in the acute setting. The quality of evidence is low.
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