Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

European military surgical teams in combat theater:A survey study on deployment preparation and experience

Introduction: Adequate (predeployment) training of the nowadays highly specialized Western military surgical teams is vital to ensure a broad range of surgical skills to treat combat casualties. This survey study aimed to assess the self-perceived preparedness, training needs, deployment experience, and post-deployment impact of surgical teams deployed with the Danish, Dutch, or Finnish Armed Forces. Study findings may facilitate a customized predeployment training. Methods: A questionnaire was distributed among Danish, Dutch, and Finnish military surgical teams deployed between January 2013 and December 2020 (N = 142). The primary endpoint of self-perceived preparedness ratings, and data on the training needs, deployment experiences, and post-deployment impacts were compared between professions and nations. Results: The respondents comprised 35 surgeons, 25 anesthesiologists, and 39 supporting staff members, with a response rate of 69.7 % (99/142). Self-perceived deployment preparedness was rated with a median of 4.0 (IQR 4.0–4.0; scale: 1 [very unprepared]–5 [more than sufficient]). No differences were found among professions and nations. Skills that surgeons rated below average (median &lt;6.0; scale: 1 [low]–10 [high]) included tropical disease management and maxillofacial, neurological, gynecological, ophthalmic, and nerve repair surgery. The deployment caseload was most often reported as &lt;1 case per week (41/99, 41.4 %). The need for professional psychological help was rated at a median of 1.0 (IQR 1.0–1.0; scale: 1 [not at all]–5 [very much]). Conclusions: Military surgical teams report overall adequate preparedness for deployment. Challenges remain for establishing broadly skilled teams because of a low deployment caseload and ongoing primary specializations. Additional training and exposure were indicated for several specialism-specific skill areas. The need for specific training should be addressed through customized predeployment programs.</p

Epidemiology of penetrating injury in an urban versus rural level 1 trauma center in the Netherlands

Background: Penetrating injury can encompass a large spectrum of injuries dependent on the penetrating object, the location of entry, and the trajectory of the object through the human body. Therefore, the management of penetrating injuries can be challenging and often requires rapid assessment and intervention. No universal definition of penetrating injury exists in the literature and little is known about the demographics and outcome of penetrating injury in the Netherlands. Objective: A research was carried out to ascertain the size and outcome of penetrating injuries in two level-one trauma centers in the Netherlands. Methods: Using the trauma registry of the Radboud University Medical Center in Nijmegen and VU University Medical Center in Amsterdam, all patients with penetrating injury were identified who were admitted to these level 1 trauma centers in the period between January 1, 2009, and January 1, 2014. Penetrating injury was defined as an injury that caused disruption of the body surface and extended into the underlying tissue or into a body cavity. Data concerning age, gender, mechanism of injury, Glasgow Coma Scale, number of injuries, type of injury, and Injury Severity Score were collected and analyzed. Patient results were stratified by Injury Severity Score. Results: In total, 354 patients were identified, making up around 2% of all admitted trauma patients 3.1% (VU Medical Center) and 1.6% (Radboud Medical Center). Patients were overwhelmingly male (83.1%) and median age was 36 years (range = 1–88 years). Most injuries were caused by stabbings (51.1%) followed by shootings (26.3%). Admission to the intensive care unit occurred in 41.1% of all patients. Median stay in the intensive care unit was 5.1 days (range = 1–96 days) and median total hospital stay was 8 days (range = 1–95 days). Mortality among these patients was 7.1%, ranging from 0% among patients with Injury Severity Score 1–8 to 100% in patients with Injury Severity Score > 34. High mortality figures were associated with injuries caused by firearms (19.4%), injuries to the head (27.9%), and alleged assaults (10.9%). Differences in demographics between the two centers were not significant. Conclusion: Penetrating injury is a relative rare occurrence in the Netherlands compared with other countries. It is associated with high mortality and substantial hospital costs. The incidence of penetrating injuries is higher in metropolitan areas than in rural areas. A universal definition of penetrating trauma should be agreed upon in order to ensure that future studies remain free of bias, and also to ensure that data remain homogeneous

Self-perceived preparedness and training needs of healthcare personnel on humanitarian mission: a pre- and post-deployment survey

Background: Humanitarian healthcare workers are indispensable for treating weapon-wounded patients in armed conflict, and the international humanitarian community should ensure adequate preparedness for this task. This study aims to assess deployed humanitarian healthcare workers’ self-perceived preparedness, training requirements and mental support needs. Methods: Medical professionals deployed with the International Committee of the Red Cross (ICRC) between October 2018 and June 2020 were invited to participate in this longitudinal questionnaire. Two separate questionnaires were conducted pre- and post-deployment to assess respondents’ self-perceived preparedness, preparation efforts, deployment experiences and deployment influence on personal and professional development. Results: Response rates for the pre- and post-deployment questionnaires were 52.5% (114/217) and 26.7% (58/217), respectively. Eighty-five respondents (85/114; 74.6%) reported feeling sufficiently prepared to treat adult trauma patients, reflected by predeployment ratings of 3 or higher on a scale from 1 (low) to 5 (high). Significantly lower ratings were found among nurses compared to physicians. Work experience in a high-volume trauma centre before deployment was associated with a greater feeling of preparedness (mean rank 46.98 vs. 36.89; p = 0.045). Topics most frequently requested to be included in future training were neurosurgery, maxillofacial surgery, reconstructive surgery, ultrasound, tropical diseases, triage, burns and newborn noncommunicable disease management. Moreover, 51.7% (30/58) of the respondents regarded the availability of a mental health professional during deployment as helpful to deal with stress. Conclusion: Overall, deployed ICRC medical personnel felt sufficiently prepared for their missions, although nurses reported lower preparedness levels than physicians. Recommendations were made concerning topics to be covered in future training and additional preparation strategies to gain relevant clinical experience. Future preparatory efforts should focus on all medical professions, and their training needs should be continuously monitored to ensure the alignment of preparation strategies with preparation needs

Hoe stop je levensbedreigend uitwendig bloedverlies? Behandelopties in de prehospitale fase

3,500 people die of injuries in the Netherlands every year; 40% of the deaths are attributable to bleeding. Treatment of patients with lifethreatening blood loss is part of the trauma care continuum: all the way from incident to hospital treatment. This article presents an overview of all treatment options for stopping lifethreatening external blood loss, divided in medical assistance phases. It also makes a distinction between different types of care providers, based on the presence or absence of their medical skills

Self-efficacy and application of skills in the workplace after multidisciplinary trauma masterclass participation: a mixed methods survey and interview study

Purpose: The most complex injuries are usually least often encountered by trauma team members, limiting learning opportunities at work. Identifying teaching formats that enhance trauma skills can guide future curricula. This study evaluates self-assessed technical and nontechnical trauma skills and their integration into novel work situations for multidisciplinary trauma masterclass participants. Methods: This mixed methods study included participants of a multidisciplinary 3-day trauma masterclass. Ratings of trauma skills were collected through pre- and postcourse questionnaires with 1-year follow-up. Qualitative semi-structured interviews 9 months postcourse focused on the course format and self-perceived association with technical and nontechnical skills applied at work. Results: Response rates of pre- and postcourse questionnaires after 1 day, 3 months, and 1 year were respectively 72% (51/71), 85% (60/71), 34% (24/71), and 14% (10/71). Respondents were surgeons (58%), anesthesiologists (31%), and scrub nurses (11%). Self-efficacy in nontechnical (mean 3.4, SD 0.6 vs. mean 3.8, SD 0.5) and technical (mean 2.9, SD 0.6 vs. mean 3.6, SD 0.6) skills significantly increased postcourse (n = 40, p < 0.001). Qualitative interviews (n = 11) demonstrated that increased self-efficacy in trauma skills was the greatest benefit experienced at work. Innovative application of skills and enhanced reflection demonstrate adaptive expertise. Small-group case discussions and the operative porcine laboratory were considered the most educational working formats. The experienced faculty and unique focus on multidisciplinary teamwork were highly valued. Conclusion: Course participants’ self-assessed work performance mostly benefited from greater self-efficacy and nontechnical skills. Future trauma curricula should consider aligning the teaching strategies accordingly

The haemostatic effect of deep-frozen platelets versus room temperature-stored platelets in the treatment of surgical bleeding: MAFOD—study protocol for a randomized controlled non-inferiority trial

Background : The Netherlands Armed Forces have been successfully using deep-frozen (− 80 °C) thrombocyte concentrate (DTC) for the treatment of (massive) bleeding trauma patients in austere environments since 2001. However, high-quality evidence for the effectiveness and safety of DTCs is currently lacking. Therefore, the MAssive transfusion of Frozen bloOD (MAFOD) trial is designed to compare the haemostatic effect of DTCs versus room temperature-stored platelets (RSP) in the treatment of surgical bleeding. Methods : The MAFOD trial is a single-blinded, randomized controlled non-inferiority trial and will be conducted in three level 1 trauma centres in The Netherlands. Patients 12 years or older, alive at hospital presentation, requiring a massive transfusion including platelets and with signed (deferred) consent will be included. The primary outcome is the percentage of patients that have achieved haemostasis within 6 h and show signs of life. Haemostasis is defined as the time in minutes from arrival to the time of the last blood component transfusion (plasma/platelets or red blood cells), followed by a 2-h transfusion-free period. This is the first randomized controlled study investigating DTCs in trauma and vascular surgical bleeding. Discussion : The hypothesis is that the percentage of patients that will achieve haemostasis in the DTC group is at least equal to the RSP group (85%). With a power of 80%, a significance level of 5% and a non-inferiority limit of 15%, a total of 71 patients in each arm are required, thus resulting in a total of 158 patients, including a 10% refusal rate. The data collected during the study could help improve the use of platelets during resuscitation management. If proven non-inferior in civilian settings, frozen platelets may be used in the future to optimize logistics and improve platelet availability in rural or remote areas for the treatment of (massive) bleeding trauma patients in civilian settings. Trial registration: ClinicalTrials.gov NCT05502809. Registered on 16 August 2022