Guidelines for the acute care of severe limb trauma patients

Pottecher, Julien; Lefort, Hugues; Adam, P.; Barbier, Olivier; Bouzat, Pierre; Charbit, Jonathan; Galinski, Michel; Garrigue, Delphine; Gauss, Tobias; Georg, Yannick; Hamada, Sophie; Harrois, Anatole; Kedzierewicz, Romain; Pasquier, Pierre; Prunet, Bertrand; Roger, Claire; Tazarourte, Karim; Travers, Stéphane; Velly, Lionel; Gil‐Jardine, Cédric; Quintard, Hervé

doi:10.1016/j.accpm.2021.100862

Cited by 19 publications

(6 citation statements)

References 140 publications

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“…It is well known that severe trauma rescue is timedependent, and the concept of the "golden one hour" is proposed to emphasize the importance of time in trauma rescue [34,35], which was also demonstrated by our study. Based on this result, the treatment of severe trauma patients should be performed within 1 h, which is considered a key determinant of the outcomes of these patients [17,36].…”

Section: Discussionsupporting

confidence: 77%

Effects of the establishment of trauma centres on the mortality rate among seriously injured patients: a propensity score matching retrospective study

et al. 2023

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Background Little evidence suggests that trauma centres are associated with a lower risk of mortality in severely injured patients (Injury Severity Score (ISS) ≥16) with multiple injuries in China. The objective of this study was to determine the association between the establishment of trauma centres and mortality among severely injured patients with multiple injuries and to identify some risk factors associated with mortality. Methods A retrospective single-centre study was performed including trauma patients admitted to the First Affiliated Hospital of Nanchang University (FAHNU) between January 2016 and December 2021. To determine whether the establishment of a trauma centre was an independent predictor of mortality, logistic regression analysis and propensity score matching (PSM) were performed. Results Among 431 trauma patients, 172 were enrolled before the trauma centre was built, while 259 were included after the trauma centre was built. A higher frequency of older age and traffic accident injury was found in patients diagnosed after the trauma centre was built. The times for the completion of CT examinations, emergency operations and blood transfusions in the “after trauma centre” group were shorter than those in the “before trauma centre” group. However, the total expenditure of patients was increased. In the overall group, univariate and multivariate logistic regression analyses showed that a higher ISS was an independent predictor for worse mortality (OR = 17.859, 95% CI, 8.207–38.86, P < 0.001), while the establishment of a trauma centre was favourable for patient survival (OR = 0.492), which was also demonstrated by PSM. After determining the cut-off value of time for the completion of CT examination, emergency operation and blood transfusion, we found that the values were within the “golden one hour”, and it was better for patients when the time was less than the cut-off value. Conclusion Our study showed that for severely injured patients, the establishment of a trauma centre was favourable for a lower mortality rate. Furthermore, the completion of a CT examination, emergency surgery and blood transfusion in a timely manner and a lower ISS were associated with a decreased mortality rate.

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Section: Discussionsupporting

confidence: 77%

Effects of the establishment of trauma centres on the mortality rate among seriously injured patients: a propensity score matching retrospective study

et al. 2023

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“…Limb hemorrhage often occurs in both civilian and military trauma patients (Morsey et al, 2003;Arora et al, 2015;Chavez et al, 2016;De Rosa et al, 2018;Leurcharusmee et al, 2018;Kasepalu et al, 2020;BenÍtez et al, 2021;Pottecher et al, 2021;Hinojosa-Laborde et al, 2022;Paquette et al, 2022). Tourniquets are an Frontiers in Physiology frontiersin.org effective first-line therapy to stop extremity bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Chavez et al, 2016;De Rosa et al, 2018;Leurcharusmee et al, 2018;Kasepalu et al, 2020;BenÍtez et al, 2021). The incidences of acute kidney injury (AKI) associated with tourniquet use range from 0.8% to 17.2%, depending on whether patients are diabetic (Morsey et al, 2003;Arora et al, 2015;Chavez et al, 2016;De Rosa et al, 2018;Leurcharusmee et al, 2018;Kasepalu et al, 2020;BenÍtez et al, 2021;Pottecher et al, 2021;Paquette et al, 2022). There is no specific prevention or treatment for tourniquet-induced AKI or other organ injury (Zhou, 2023).…”

Section: Figurementioning

confidence: 99%

A clinically-relevant mouse model that displays hemorrhage exacerbates tourniquet-induced acute kidney injury

Packialakshmi,

Burmeister,

Anderson

et al. 2023

Front. Physiol.

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Hemorrhage is a leading cause of death in trauma. Tourniquets are effective at controlling extremity hemorrhage and have saved lives. However, tourniquets can cause ischemia reperfusion injury of limbs, leading to systemic inflammation and other adverse effects, which results in secondary damage to the kidney, lung, and liver. A clinically relevant animal model is critical to understanding the pathophysiology of this process and developing therapeutic interventions. Despite the importance of animal models, tourniquet-induced lower limb ischemia/reperfusion (TILLIR) models to date lack a hemorrhage component. We sought to develop a new TILLIR model that included hemorrhage and analyze the subsequent impact on kidney, lung and liver injuries. Four groups of mice were examined: group 1) control, group 2) hemorrhage, group 3) tourniquet application, and group 4) hemorrhage and tourniquet application. The hemorrhagic injury consisted of the removal of 15% of blood volume through the submandibular vein. The tourniquet injury consisted of orthodontic rubber bands applied to the inguinal area bilaterally for 80 min. Mice were then placed in metabolic cages individually for 22 h to collect urine. Hemorrhage alone did not significantly affect transcutaneous glomerular filtration rate (tGFR), blood urea nitrogen (BUN) or urinary kidney injury molecule-1 (KIM-1) levels. Without hemorrhage, TILLIR decreased tGFR by 46%, increased BUN by 162%, and increased KIM-1 by 27% (p < 0.05 for all). With hemorrhage, TILLIR decreased the tGFR by 72%, increased BUN by 395%, and increased urinary KIM-1 by 37% (p < 0.05 for all). These differences were statistically significant (p < 0.05). While hemorrhage had no significant effect on TILLIR-induced renal tubular degeneration and necrosis, it significantly increased TILLIR-induced lung total injury scores and congestion, and fatty liver. In conclusion, hemorrhage exacerbates TILLIR-induced acute kidney injury and structural damage in the lung and liver.

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“…The clinical status of each patient was determined using the grading of perioperative risks stratification for orthopedic surgery presented in Table 1 derived from Pape et al, 18 and extracted from the French orthopedic guidelines. 19 This grading considers mainly hemorrhagic shock, coagulopathy, respiratory failure, or severe extraspinal injuries. One only criterion allows classification in the most severe group.…”

Section: Study Definitionsmentioning

confidence: 99%

Injury characteristics, initial clinical status, and severe injuries associated with spinal fractures in a retrospective cohort of 506 trauma patients

Weber¹,

Breton²,

Cyteval³

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Our aim was to describe the characteristics of vertebral fractures, the presence of associated injuries, and clinical status within the first days in a severe trauma population. METHODS:All patients with severe trauma admitted to our level 1 trauma center between January 2015 and December 2018 with a vertebral fracture were analyzed retrospectively. The fractures were determined by the AO Spine classification as stable (A0, A1, and A2 types) or unstable (A3, A4, B, and C types). Clinical status was defined as stable, intermediate, or unstable based on clinicobiological parameters and anatomic injuries. Severe extraspinal injuries and emergent procedures were studied. Three groups were compared: stable fracture, unstable fracture, and spinal cord injury (SCI) group. RESULTS: A total of 425 patients were included (mean ± SD age, 43.8 ± 19.6 years; median Injury Severity Score, 22 [interquartile range, 17-34]; 72% male); 72 (17%) in the SCI group, 116 (27%) in the unstable fracture group, and 237 (56%) in the stable fracture group; 62% (95% confidence interval [CI], 57-67%) had not a stable clinical status on admission (unstable, 30%; intermediate, 32%), regardless of the group (p = 0.38). This decreased to 31% (95% CI, 27-35%) on day 3 and 23% (95% CI, 19-27%) on day 5, regardless of the group (p = 0.27 and p = 0.25). Progression toward stable clinical status between D1 and D5 was 63% (95% CI, 58-68%) overall but was statistically lower in the SCI group. Severe extraspinal injuries (85% [95% CI, 82-89%])and extraspinal emergent procedures (56% [95% CI, 52-61%]) were comparable between the three groups. Only abdominal injuries and hemostatic procedures significantly differed significantly (p = 0.003 and p = 0.009). CONCLUSION:More than the half of the patients with severe trauma had altered initial clinical status or severe extraspinal injuries that were not compatible with safe early surgical management for the vertebral fracture. These observations were independent of the stability of the fracture or the presence of an SCI.

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Guidelines for the acute care of severe limb trauma patients

Cited by 19 publications

References 140 publications

Effects of the establishment of trauma centres on the mortality rate among seriously injured patients: a propensity score matching retrospective study

Effects of the establishment of trauma centres on the mortality rate among seriously injured patients: a propensity score matching retrospective study

A clinically-relevant mouse model that displays hemorrhage exacerbates tourniquet-induced acute kidney injury

Injury characteristics, initial clinical status, and severe injuries associated with spinal fractures in a retrospective cohort of 506 trauma patients

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