A national survey on temporary and delayed abdominal closure in Norwegian hospitals

<p>Abstract</p> <p>Introduction</p> <p>Temporary abdominal closure (TAC) is included in most published damage control (DC) and abdominal compartment (ACS) protocols. TAC is associated with a range of complications and the optimal method remains to be defined. The aim of the present study was to describe the experience regarding TAC after trauma and ACS in all acute care hospitals in a sparsely populated country with long transportation distances.</p> <p>Material and methods</p> <p>A questionnaire was sent to all 50 Norwegian hospitals with acute care general surgical services.</p> <p>Results</p> <p>The response rate was 88%. A very limited number of hospitals had treated more than one trauma patient with TAC (5%) or one patient with ACS (14%) on average per year. Most hospitals preferred vacuum assisted techniques, but few reported having formal protocols for TAC or ACS. Although most hospitals would refer patients with TAC to a trauma centre, more than 50% reported that they would perform a secondary reconstruction procedure themselves.</p> <p>Conclusion</p> <p>This study shows that most Norwegian hospitals have limited experience with TAC and ACS. However, the long distances between hospitals mandate all acute care hospitals to implement formal treatment protocols including monitoring of IAP, diagnosing and decompression of ACS, and the use of TAC. Assuming experience leads to better care, the subsequent treatment of these patients might benefit from centralization to one or a few regional centers.</p

Abdominal injuries in a major Scandinavian trauma center – performance assessment over an 8 year period

INTRODUCTION: Damage control surgery and damage control resuscitation have reduced mortality in patients with severe abdominal injuries. The shift towards non-operative management in haemodynamically stable patients suffering blunt abdominal trauma has further contributed to the improved results. However, in many countries, low volume of trauma cases and limited exposure to trauma laparotomies constitute a threat to trauma competence. The aim of this study was to evaluate the institutional patient volume and performance for patients with abdominal injuries over an eight-year period. METHODS: Data from 955 consecutive trauma patients admitted in Oslo University Hospital Ulleval with abdominal injuries during the eight-year period 2002-2009 were retrospectively explored. A separate analysis was performed on all trauma patients undergoing laparotomy during the same period, whether abdominal injuries were identified or not. Variable life-adjusted display (VLAD) was used in order to describe risk-adjusted survival trends throughout the period and the patients admitted before (Period 1) and after (Period 2) the institution of a formal Trauma Service (2005) were compared. RESULTS: There was a steady increase in admitted patients with abdominal injuries, while the number of patients undergoing laparotomy was constant exposing the surgical trauma team leaders to an average of 8 trauma laparotomies per year. No increase in missed injuries or failures of non-operative management was detected. Unadjusted mortality rates decreased from period 1 to period 2 for all patients with abdominal injuries as well as for the patients undergoing laparotomy. However, this apparent decrease was not confirmed as significant in TRISS-based analysis of risk-adjusted mortality. VLAD demonstrated a steady performance throughout the study period. CONCLUSION: Even in a high volume trauma center the exposure to abdominal injuries and trauma laparotomies is limited. Due to increasing NOM, an increasing number of patients with abdominal injuries was not accompanied by an increase in number of laparotomies. However, we have demonstrated a stable performance throughout the study period as visualized by VLAD without an increase in missed injuries or failures of NOM

Markers of thrombin generation are associated with myocardial necrosis and left ventricular impairment in patients with ST-elevation myocardial infarction

Introduction Platelet activation, thrombin generation and fibrin formation play important roles in intracoronary thrombus formation, which may lead to acute myocardial infarction. We investigated whether the prothrombotic markers D-dimer, pro-thrombin fragment 1 + 2 (F1 + 2) and endogenous thrombin potential (ETP) are associated with myocardial necrosis assessed by Troponin T (TnT), and left ventricular impairment assessed by left ventricular ejection fraction (LVEF) and N-terminal pro b-type natriuretic peptide (NT-proBNP). Materials/Methods Patients (n = 987) with ST-elevation mycardial infarction (STEMI) were included. Blood samples were drawn at a median time of 24 h after onset of symptoms. Results Statistically significant correlations were found between both peak TnT and D-dimer (p < 0.001) and F1 + 2 (p < 0.001), and between NT-proBNP and D-dimer (p = 0.001) and F1 + 2 (p < 0.001). When dividing TnT and NT-proBNP levels into quartiles there were significant trends for increased levels of both markers across quartiles (all p < 0.001) D-dimer remained significantly associated with NT-proBNP after adjustments for covariates (p = 0.001) whereas the association between NTproBNP and F1 + 2 was no longer statistically significant (p = 0.324). A significant inverse correlation was found between LVEF and D-dimer (p < 0.001) and F1 + 2 (p = 0.013). When dichotomizing LVEF levels at 40 %, we observed significantly higher levels of both D-dimer (p < 0.001) and F1 + 2 (p = 0.016) in the group with low EF (n = 147). Summary/conclusion In our cohort of STEMI patients we demonstrated that levels of D-dimer and F1 + 2 were significantly associated with myocardial necrosis as assessed by peak TnT. High levels of these coagulation markers in patients with low LVEF and high NTproBNP may indicate a hypercoagulable state in patients with impaired myocardial function