General Surgery & Trauma | Links Medicus Content Curation & Alerts in Medicine

Summary: The PROCOAG Randomized Clinical Trial aimed to investigate the efficacy and safety of 4-factor prothrombin complex concentrate (4F-PCC) in trauma patients at risk of massive transfusion. Conducted in 12 French trauma centers, this double-blind, randomized, placebo-controlled superiority trial involved 324 patients. All patients were treated according to European traumatic hemorrhage guidelines and received early ratio-based transfusion (packed red blood cells:fresh frozen plasma ratio of 1:1 to 2:1). The primary outcome measured was 24-hour blood product consumption (efficacy), while arterial or venous thromboembolic events were assessed as a secondary outcome (safety).

The trial revealed no significant difference in 24-hour blood product consumption between the 4F-PCC and placebo groups, with median consumption of 12 units and 11 units, respectively. However, the study identified a statistically significant higher risk of thromboembolic events in the 4F-PCC group, with 35% of patients experiencing at least one event compared to 24% in the placebo group.

In conclusion, the study found no beneficial effect of incorporating 4F-PCC into a ratio-based transfusion strategy for patients with severe trauma at risk of massive transfusion. Furthermore, the higher rate of thromboembolic events in the 4F-PCC group indicated potential harm. The findings do not support the routine use of 4F-PCC in patients experiencing trauma who are at risk for extensive transfusion.

Article: Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients With Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial – JAMA (free for a limited period)

See also: Visual Abstract

Review | Neurogenic shock: definition, identification, and management in the ED

20 Mar, 2023 | 13:09h | UTC

Neurogenic Shock: Definition, Identification, and Management in the ED – emDocs

Review | Approach to the patient with adrenal hemorrhage

15 Mar, 2023 | 15:03h | UTC

Approach to the Patient With Adrenal Hemorrhage – The Journal of Clinical Endocrinology & Metabolism

Brief Review | Enhanced recovery after emergency laparotomy

13 Mar, 2023 | 14:37h | UTC

Enhanced recovery after emergency laparotomy – British Journal of Surgery

New WHO guidelines to boost the use of life-saving safety restraints in vehicles

10 Mar, 2023 | 14:40h | UTC

News Release: New global guidelines to boost the use of life-saving safety restraints in vehicles – World Health Organization

Guideline: Occupant Restraints: A Road Safety Manual for Decision-Makers and Practitioners – World Health Organization

Perspective | Dangerous selfies aren’t just foolish. We need to treat them like the public health hazard they really are

8 Mar, 2023 | 14:30h | UTC

Dangerous selfies aren’t just foolish. We need to treat them like the public health hazard they really are – The Conversation

E-Scooter users more likely to suffer serious trauma compared to bicycle users: a nationwide study in England and Wales

8 Mar, 2023 | 14:13h | UTC

Summary:
The study aimed to determine the incidence, demographics, and injury patterns involved in E-Scooter-related hospital admissions due to significant trauma compared with bicycle-related trauma within England and Wales. The retrospective cohort study was based on data submitted to the UK Trauma Audit and Research Network (TARN) registry between 1 January 2021 to 31 December 2021.

The study found that E-Scooter users were more likely to be admitted to a major trauma center or a critical care unit than bicycle users. Serious head and limb trauma occurred more frequently among E-Scooter users, while serious chest and pelvic trauma were greater among bicycle users. Over one-third of E-Scooter injuries were incurred outside the current legislation by patients who were intoxicated by alcohol and drugs or under the age of 17.

The study suggests a greater relative incidence of serious trauma and an alternative pattern of injury among E-Scooter users compared with bicycle users. The study concludes that further legislation and tighter regulation of E-Scooter rental are required to reduce the already significant burden of injury associated with this mode of transport.

Article: Major trauma among E-Scooter and bicycle users: a nationwide cohort study – Injury Prevention

News Release: Crashing an e-scooter likely to lead to more serious injuries than crashing a bike – British Medical Journal

Commentary: E-scooter riders more likely than cyclists to sustain serious injuries – BBC

The European guideline on management of major bleeding and coagulopathy following trauma

2 Mar, 2023 | 13:04h | UTC

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition – Critical Care

Guidelines | Efficacy and safety of non-steroidal anti-inflammatory drugs for the treatment of acute pain after orthopedic trauma

28 Feb, 2023 | 13:48h | UTC

Efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma and the Orthopedic Trauma Association – Trauma Surgery & Acute Care Open

RCT | Single chest tube superior to double chest tube post decortication in trauma/TB patients

27 Feb, 2023 | 12:53h | UTC

Effectiveness of Single Chest Tube vs Double Chest Tube Application Post Decortication: Prospective Randomized Controlled Study – Journal of the American College of Surgeons

Consensus Paper | Early management of isolated severe traumatic brain injury in a hospital without neurosurgical capabilities

24 Feb, 2023 | 13:49h | UTC

Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES) – World Journal of Emergency Surgery

Commentary from the author on Twitter

Great to see our consensus published. Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES).https://t.co/k9hwI82dOW pic.twitter.com/pIp5gFRnPa

— Deepak Sharma (@deepak_neuro) January 14, 2023

Review | Management of gastrointestinal foreign bodies with brief review of the guidelines

24 Feb, 2023 | 13:36h | UTC

Management of Gastrointestinal Foreign Bodies with Brief Review of the Guidelines – Pediatric Gastroenterology, Hepatology & Nutrition

Instant noodle burns common in pediatric scald injuries: Study highlights need for prevention efforts

21 Feb, 2023 | 11:50h | UTC

Summary: The study examined pediatric scald burns at the University of Chicago Burn Center between 2010 and 2020 and found that 31% of burns were attributed to instant noodles. Children with instant noodle burns were typically older, more likely to be Black/African American, and from lower socio-economic backgrounds. They were also more likely to be unsupervised at the time of the injury. While instant noodle burns were smaller and required less operative intervention than other scald burns, some still required hospitalization and were associated with complications. The study highlights the need for targeted burn prevention efforts to reduce the incidence of these common but serious injuries.

Article: Pediatric instant noodle burns: A ten-year single center retrospective study – Burns (link to abstract – $ for full-text)

Commentary: Why Instant Noodles Are a Danger to Your Kids – HealthDay

Consensus Paper | Pediatric traumatic hemorrhagic shock

17 Feb, 2023 | 13:15h | UTC

Pediatric traumatic hemorrhagic shock consensus conference recommendations – Journal of Trauma and Acute Care Surgery

Preface: Pediatric traumatic hemorrhagic shock consensus conference

Other articles in the supplement:

Pediatric traumatic hemorrhagic shock consensus conference research priorities

Building an optimal pediatric trauma program

Time is tissue: Barriers to timely transfusion after pediatric injury

Resuscitative practices and the use of low-titer group O whole blood in pediatric trauma

Tranexamic acid in pediatric hemorrhagic trauma

Blood banking considerations in pediatric trauma

Detecting traumatic brain injury–induced coagulopathy: What we are testing and what we are not

Consensus Statement | Development of an Enhanced Recovery After Surgery (ERAS) surgical safety checklist

10 Feb, 2023 | 14:03h | UTC

Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process – JAMA Network Open

Commentary from the author on Twitter (thread – click for more)

The @WHO Surgical Safety Checklist and the @ErasSociety guidelines come together.🔥
#ERAS teams can leverage 2 tools in 1 to improve care in critical perioperative communication moments https://t.co/EaXYyj7b56
via @JAMANetworkOpen part of @JAMANetwork pic.twitter.com/WHJMjThubO

— Mary Brindle (@MaryEBrindle) February 8, 2023