Detection of fractures of hand and forearm in whole-body CT for suspected polytrauma in intubated patients

Background: The aim of this study was to evaluate the potential of whole-body CT for diagnosis of hand and forearm fractures in intubated patients with suspected polytrauma. Methods: We performed a retrospective analysis on data collected from two trauma centres in Germany, including demographics, ISS, clinical symptoms, depiction in whole-body CT, and time to diagnosis. Results: Out of 426 patients included in the study, 66 (15.5%) suffered a hand or forearm fracture. The total number of fractures was 132, the whole-body CT report mentioned 98 (74.2%). 16 (12,1%) fractures of 12 patients were diagnosed later than 24 h after admission. Late diagnoses of fractures of the hand occurred more often if the hand was not fully included in the CT scan field. The sensitivity of whole-body CT for cases with fractures of hand and/or forearm with full inclusion of the corresponding area in the scan field was 80.2%. Conclusions: This study shows that whole-body CT is a valuable diagnostic tool for hand fractures in polytrauma patients. Hands should be evaluated regardless of clinical presentation in intubated patients after suspected polytrauma if they are included in the whole-body CT. © 2020 The Author(s)

Polytrauma: missed fractures hand/forearm

We wanted to assess how many fractures of hand and forearm, that were diagnosed 77 late (later than 24 h after admisison), were visible in the WBCT on retrospection. Additionally, the influence of the time of day of the WBCT and slice thickness on the occurrence of late diagnoses should be examined

Polytrauma: missed fractures hand/forearm

We wanted to assess how many fractures of hand and forearm, that were diagnosed 77 late (later than 24 h after admisison), were visible in the WBCT on retrospection. Additionally, the influence of the time of day of the WBCT and slice thickness on the occurrence of late diagnoses should be examined

Detection of missed fractures of hand and forearm in whole-body CT in a blinded reassessment

Background: We examined the visibility of fractures of hand and forearm in whole-body CT and its influence on delayed diagnosis. This study is based on a prior study on delayed diagnosis of fractures of hand and forearm in patients with suspected polytrauma. Methods: Two blinded radiologists examined CT-scans of patients with fractures of hand or forearm that were diagnosed later than 24 h after admission and control cases with unremarkable imaging of those areas. They were provided with clinical information that was documented in the admission report and were asked to examine forearm and hands. After unblinding, the visibility of fractures was determined. We examined if time of admission or slice thickness was a factor for late or missed diagnoses. Results: We included 72 known fractures in 36 cases. Of those 65 were visible. Sixteen visible fractures were diagnosed late during hospital stay. Eight more fractures were detected on revision by the radiologists. Both radiologists missed known fractures and found new fractures that were not reported by the other. Missed and late diagnoses of fractures occurred more often around 5 pm and 1 am. Slice thickness was not significantly different between fractures and cases with fractures found within 24 h and those found later. Conclusions: The number of late diagnosis or completely missed fractures of the hand and forearm may be reduced by a repeated survey of WBCT with focus on the extremities in patients with suspected polytrauma who are not conscious. Level of evidence: III © 2021, The Author(s)

A survey among physicians in surgery and anesthesiology departments after the first surge of SARS-CoV-2 infections in Germany : Preparing for further challenges ahead

BACKGROUND: The SARS-CoV‑2 pandemic has extensively challenged healthcare systems all over the world. Many elective operations were postponed or cancelled, changing priorities and workflows in surgery departments. AIMS: The primary aim of this cross-sectional study was to assess the workload and psychosocial burden of surgeons and anesthesiologists, working in German hospitals during the first wave of SARS-CoV‑2 infections in 2020. METHODS: Quantitative online survey on the workplace situation including psychosocial and work-related stress factors among resident and board-certified surgeons and anesthesiologists. Physicians in German hospitals across all levels of healthcare were contacted via departments, professional associations and social media posts. RESULTS: Among 154 total study participants, 54% of respondents stated a lack of personal protective equipment in their own wards and 56% reported increased staff shortages since the onset of the pandemic. While routine practice was reported as fully resumed in 71% of surgery departments at the time of the survey, work-related dissatisfaction among responding surgeons and anesthesiologists increased from 24% before the pandemic to 36% after the first wave of infections. As a countermeasure, 94% of participants deemed the establishment of action plans to increase pandemic preparedness and strengthening German public health systems a useful measure to respond to current challenges. CONCLUSION: The aftermath of the first wave of SARS-CoV‑2 infections in Germany has left the surgical staff strained, despite temporarily decreased workloads. Overall, a critical review of the altered conditions is indispensable to identify and promote effective solutions and prudent action plans required to address imminent challenges.Not heldaccepted version (12 month embargo

New features in the subsurface structure model of El Hierro island (Canaries) from low-frequency microseismic sounding: an insight into the 2011 seismo-volcanic crisis

To study the deep structure of El Hierro Island, Canarian Archipelago, we have used a microseismic sounding method (MSM) based on the fact that heterogeneities of the Earth's crust disturb the spectrum of the low-frequency microseismic field in their vicinity. So, at the Earth's surface, the spectral amplitudes of definite frequency f above the high-velocity heterogeneities are decreasing, and above the low-velocity ones they are increasing. Moreover, the frequency f is connected with the depth of a heterogeneity H and the velocity of the fundamental mode of Rayleigh waves V (R)(f) through the relation H a parts per thousand 0.4V (R)(f)/f. From these relations, the MSM lets us model the subsurface structure in a 3D context by inverting the amplitude-frequency spatial distribution of the microseismic field of low frequency. The validity of the method is shown through of numerical simulations and previous applications with known or verified solutions. This MSM is now used to invert the microseismic data registered in El Hierro Island. The obtained subsurface model reveals two large intrusive bodies beneath the island. Joint interpretation of microseismic and gravimetric data and their comparison with the available geological studies relate the central-eastern intrusive body to the early stage of the island formation. With respect to the western intrusive body, at the depths of 15-25 km, an area with lowest seismic velocities is identified, where we suggest that a modern magmatic reservoir is located. This reservoir could be associated with the recent submarine eruption in October 2011 and the accompanying seismic swarm, which started in July 2011. Several correlations between the shallowest structures identified by the gravity and MSM approaches are also found. Besides the numerical simulation and previous studies of this method, the correlation between gravity results, the MSM model, the geological information and the possible explanation of the features of the seismic swarm through the model obtained offer us a valid proof about the plausibility of the subsurface structures identified from MSM