Background
Electric scooters (e‐Scooters) are a form of motorized vehicle that offers cheap, efficient and environmentally friendly transportation. Increased e‐Scooter utilization has been ...accompanied by increases in e‐Scooter related injuries in multiple countries. This project describes the incidence, injury pattern, injury severity and patient factors associated with e‐Scooter use from the Western Australian State Trauma Registry.
Methods
Retrospective cohort of all trauma patients captured by the Western Australian State Trauma Registry between 01 July 2017 and 30 June 2022 were analysed. Patient demographics, helmet use, reported drug use, and injury details (including principal and additional diagnoses, ISS) were collected.
Results
Eighty‐one patients sustained e‐Scooter related injuries between 2017 and 2022. Fifty‐four (66%) of hospital admissions were recorded in 2021–2022, an annual percent change of 385.7% from the previous year. Most patients were male (80%). Median age was 40 years (IQR: 32–50). Helmet use was reported in 43% of patients. Helmet use was associated with a significantly lower odds of head injury (OR = 4.42, CI: 1.38–14.21; P = 0.01). Thirty‐five percent of patients were intoxicated with either alcohol or drugs. Forty‐four (54%) patients required surgery.
Conclusion
E‐Scooter crashes are a new mechanism of injury affecting patients captured by the Western Australian State Trauma Registry. Helmet use correlated with a reduced risk of head injury.
Background
Despite the negative effect of sarcopenia on postoperative outcomes being well recognized in the elective setting, there remains a paucity of studies describing this phenomenon in the ...emergency laparotomy (EL) setting. This systematic review and meta‐analysis aimed to compare short‐ and long‐term postoperative outcomes following EL in patients with and without sarcopenia.
Methods
A systematic review using PRISMA guidelines was used to identify studies comparing perioperative outcomes following EL for patients with and without sarcopenia. A subsequent meta‐analysis was conducted. The following data were extracted from the included studies: patient demographics, pathology or type of operation performed for EL, post‐operative mortality at inpatient, 30‐day, 90‐day and 1‐year, and functional outcomes. A quality assessment of included studies was undertaken.
Results
Twelve studies reporting the outcomes of sarcopenia following EL were identified. Sarcopenia was significantly associated with higher 30‐day and 1‐year mortality rates following EL (OR 3.50, P < 0.01; OR 3.49, P < 0.01, respectively). Additionally, sarcopenia was significantly associated with unfavourable functional outcomes at discharge following emergency laparotomy (OR 2.44, p < 0.01).
Conclusion
Opportunistically identified on cross‐sectional imaging, sarcopenia is a valuable predictor of short‐ and long‐term morbidity and mortality following EL. Further studies are required to identify the most appropriate diagnostic criteria of sarcopenia and better define this physiological phenomenon.
Forest plot of 30‐day mortality (a), 1‐year mortality (b), and discharge outcome (c) following emergency laparotomy in sarcopenic and non‐sarcopenic patients.
Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current ...update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC.
The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see https://www.gradeworkinggroup.org/ ). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached.
The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal.
ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.
Background
Analyse admissions to Royal Perth Hospital (RPH) with acute small bowel obstruction (SBO), and identify trends between outcomes and management.
Methods
Retrospective, single‐centre review ...of patients admitted to RPH with acute SBO, between May 2017 and May 2018.
Results
A total of 251 admissions met inclusion criteria. Increasing age correlated with increasing total length of stay (LOS) (r = 0.134, P = 0.033) and post‐operative LOS (r = 0.349, P < 0.0001). Increasing age led to poorer outcomes (P < 0.0001). Diagnoses were most commonly adhesions (167/251 = 66.5%), hernias (47/251 = 18.7%) and inflammatory bowel diseases (11/251 = 4.4%).
Operation rate for adhesional SBO was 24.6% (41/167) and non‐adhesional SBO 54.8% (46/84). Median total LOS for operative versus conservative management was 9 days (interquartile range (IQR) 8) versus 3 days (IQR 3) (P < 0.0001). Median time to surgery was 1 day (IQR 2). Increased time from admission to theatre led to increasing post‐operative LOS (r = 0.398, P = 0.0013). Median post‐operative LOS for bowel resection versus no resection was 9 days (IQR 4.5) versus 6 days (IQR 4) (P = 0.0128).
Of 101, 81 (80.2%) adhesional SBO resolved non‐operatively after receiving Gastrografin, compared to 45 of 66 (68.2%) of those who did not (P = 0.07). It did not significantly alter total or post‐operative LOS (P = 0.65 and P = 0.96), patient outcome (P = 0.26), or need for bowel resection (P = 0.63).
Conclusions
Operative management, bowel resection, older age and increasing time from admission to surgery increase LOS. Trial of Gastrografin in non‐operative management of adhesion type small bowel obstructions does not significantly affect outcomes but tends to reduce operative rates.
This is a retrospective single centre review of patient admissions over a 1‐year period, using electronic patient records and imaging. Using data from the 251 total admissions fitting inclusion criteria, we found that length of stay was increased with operative management, older age and with increasing time from admission to surgery. The trial of Gastrografin in non‐operative management of adhesion type small bowel obstructions did not significantly affect outcomes but tended to reduce operative rates.
Background
The COVID‐19 pandemic led to a global shortage of iodinated contrast media (ICM) in early 2022. ICM is used in more than half of the computed tomography of the abdomen and pelvis (CTAP) ...performed to diagnose an acute abdomen (AA). In response to the shortage, the RANZCR published contrast‐conserving recommendations. This study aimed to compare AA diagnostic outcomes of non‐contrast CTs performed before and during the shortage.
Methods
A single‐centre retrospective observational cohort study of all adult patients presenting with an AA who underwent a CTAP was conducted during the contrast shortage period from May to July 2022. The pre‐shortage control comparison group was from January to March 2022; key demographics, imaging modality indication and diagnostic outcomes were collected and analysed using SPSS v27.
Results
Nine hundred and sixty‐two cases met the inclusion criteria, of which n = 502, 52.2% were in the shortage period group. There was a significant increase of 464% in the number of non‐contrast CTAPs performed during the shortage period (P < 0.001). For the six AA pathologies, only n = 3, 1.8% of non‐contrast CTAPs had equivocal findings requiring further imaging with a contrast CTAP. Of the total CTs performed, n = 464, 48.2% were negative.
Conclusion
This study showed that when non‐contrast CTs are selected appropriately, they appear to be non‐inferior to contrast‐enhanced CTAPs in diagnosing acute appendicitis, colitis, diverticulitis, hernia, collection, and obstruction. This study highlights the need for further research into utilizing non‐contrast scans for assessing the AA to minimize contrast‐associated complications.
The utilization of non‐contrast computer tomography imaging to diagnose the acute abdomen during the global contrast shortage.
Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1-0.3% per year. Despite a sharp reduction in incidence and rates of hospital ...admission and mortality over the past 30 years, complications are still encountered in 10-20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment.
The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached.
The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with ...laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.
Abstract Background The incidence of Blunt Carotid Artery and Vertebral Artery Injury (BCVI) is relatively low in modern trauma practice. However, these injuries may be associated with severe ...neurological consequences. Following the introduction of a Diagnostic Imaging Pathway in Department of Health of Western Australia, we hypothesized that this injury would be less likely to be missed, and accordingly diagnosed more frequently. Method A review of all major trauma (Injury Severity Scale > 15) admissions at the State Major Trauma Centre in Royal Perth Hospital was undertaken from 1995 until 2013. BCVI was identified from the hospital’s trauma registry. The medical records of these patients were then reviewed. Result 58 of 7451 (0.78%) major trauma patients were diagnosed of BCVI during the study period. An increased incidence, from 0.52% (20/3880) to 1.06% (38/3571), was seen after the introduction of the Diagnostic Imaging Pathway in 2007 (p = 0.010). The majority of the cases were caused by motor vehicle crashes, with 66% (n = 38) of the cases sustaining concomitant head or cervical spine injury. Other commonly associated injuries included chest, extremity and thoracic spine injury. Conclusion Our study reports a significant increase in the diagnosis of BCVI among major traumas after the introduction of a Diagnostic Imaging Pathway for the screening of this injury in 2007. The previously low incidence of BCVI compared with other centres’ reports indicated possible previous under-screening and diagnosis of this injury.
The peripheral arteries and veins of the extremities are among the most commonly injured vessels in both civilian and military vascular trauma. Blunt causes are more frequent than penetrating except ...during military conflicts and in certain geographic areas. Physical examination and simple bedside investigations of pulse pressures are key in early identification of these injuries. In stable patients with equivocal physical examinations, computed tomography angiograms have become the mainstay of screening and diagnosis. Immediate open surgical repair remains the first-line therapy in most patients. However, advances in endovascular therapies and more widespread availability of this technology have resulted in an increase in the range of injuries and frequency of utilization of minimally invasive treatments for vascular injuries in stable patients. Prevention of and early detection and treatment of compartment syndrome remain essential in the recovery of patients with significant peripheral vascular injuries. The decision to perform amputation in patients with mangled extremities remains difficult with few clear indicators. The American Association for the Surgery of Trauma in conjunction with the World Society of Emergency Surgery seeks to summarize the literature to date and provide guidelines on the presentation, diagnosis, and treatment of peripheral vascular injuries. LEVEL OF EVIDENCE: Review study, level IV.
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