February 2009 airplane crash at Amsterdam Schiphol Airport: an overview of injuries and patient distribution

The objective of this study was to describe the injuries and distribution of casualties resulting from the crash of Turkish Airlines flight TK 1951 near Schiphol Airport in the Netherlands on 25 of February 2009. This was a retrospective, descriptive study. Based on a review of the hospital records for all casualties of the airplane crash, triage at the scene, time to emergency department, Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS), mortality, length of hospital stay and surgical procedures were abstracted. Of the 135 passengers, nine died on-scene. A total of 126 survivors were examined in 15 hospitals; data for all survivors were available for the study. Median time between crash and arrival at an emergency department was 3.5 hours (range 1.25-5.5 hours). Six passengers were uninjured and 66 were admitted to hospital. A total of 305 injuries were recorded. The majority were head and facial injuries (92), spinal injuries (35), and fractures of extremities (38). Eighteen percent of the patients had a spinal injury. The mean ISS was 6.3 (range = 1-57). The ISS score was >15 for 13 patients. Surgical procedures (80) were necessary in 23 patients. There was no in-hospital mortality. Although the accident was in an urban area, there was a significant delay between the time of the accident and the arrival of the casualties at hospital emergency departments. The Turkish Airlines crash provides extensive information for research into mass-casualty or disaster management, triage, plane crash injuries, and survivability. The "Medical Research Turkish Airlines Crash" (MOTAC) study group currently is investigating several of these issue

The role of plain radiography in paediatric wrist trauma

Acute wrist trauma in children is one of the most frequent reasons for visiting the emergency department (ED). Radiographic imaging in children with wrist trauma is mostly performed routinely to confirm or rule out a fracture. The aim of this study was to determine how many radiographs of the wrist show a fracture in children following wrist trauma. A retrospective cohort study was performed in three Dutch hospitals from 2009-2010. Data were extracted from patient records and radiographic reports. Of the 1,223 children who presented at the ED after a wrist trauma, 51 % had a wrist fracture. The peak incidence of having a wrist fracture was at the age of 10 years; 65 % of the children younger than 10 years of age had a wrist fracture. Of all the patients without a wrist fracture, 74 % were older than 10 years of age. Almost half of the paediatric patients with a trauma of the wrist had normal radiographs. The development of a clinical decision rule to determine when a radiograph of the wrist is indicated following acute wrist trauma is needed. This could likely reduce the number of radiographs. MAIN MESSAGES: • Fifty-one percent of the children with wrist trauma have a wrist fracture. • Peak incidence of having a wrist fracture is at the age of 10 years. • Sixty-five percent of the children younger than 10 years of age had a wrist fracture. • Of all the patients without a wrist fracture, 74 % were older than 10 years of age. • The development of a clinical decision rule to reduce the number of radiographs is neede

Predictive scoring systems to differentiate between simple and complex appendicitis in children (PRE-APP study)

Background: Several clinical prediction rules have been developed for preoperative differentiation between simple and complex appendicitis in children, as potential treatment strategies differ. This study aimed to externally validate applicable clinical prediction rules that could be used to differentiate between simple and complex appendicitis in children. Methods: Potential clinical prediction rules were identified by a scoping review of the literature. Clinical prediction rules applicable in our daily practice were subsequently externally validated in a multicenter historical cohort consisting of 1 tertiary center and 1 large teaching hospital. All children (0.7 were considered acceptable and potentially useful. Results: In total, 31 clinical prediction rules were identified, of which 12 could be evaluated in our cohort consisting of 550 children. The main reason to exclude clinical prediction rules was the use of variables that were not routinely measured in our cohort. In our cohort, 208/550 (38%) were diagnosed with complex appendicitis according to the gold standard. Clinical prediction rules with areas under the receiver operating characteristic curve >0.7 were: Gorter (0.81), Bogaard (0.79), Bröker (0.79), Graham (0.77), Hansson (0.76), BADCF (0.76), and Eddama (0.75). Conclusion: In this study, clinical prediction rules consisting of a combination of clinical and objective variables had the highest discriminative ability. External validation showed that 7 clinical prediction rules were potentially useful. Integration of these clinical prediction rules in daily practice is proposed to guide decision making regarding treatment strategies

Correction: Amsterdam Wrist Rules: a clinical decision aid

The name of one of the authors of this manuscript (1) was misspelled. The correct name is: J. Carel Goslings. We regret any inconvenience this error has caused. (1) Bentohami A, Walenkamp MM, Slaar A, Beerekamp MS, de Groot JA, Verhoog EM, et al. Amsterdam wrist rules: a clinical decision aid. BMC Musculoskelet Disord 2011 Oct 17;12:23

The Management of Post-appendectomy Abscess in Children; A Historical Cohort Study and Update of the Literature

Introduction: Recent studies have shown that specific cases of post-appendectomy abscess (PAA) in children could be treated conservatively. However, due to the lack of high-quality evidence, choice of treatment still depends on preferences of the treating surgeon, leading to heterogeneity in clinical practice. Therefore, we aimed to provide an update of recent literature on the management of PAA in children and subsequently evaluate the outcomes of a large multicenter cohort of children treated for PAA. Methods: A literature search was performed in Pubmed and Embase, selecting all randomized controlled trials, prospective and retrospective cohort studies, and case series published from 2014 and onward and reporting on children (<18 years) treated for a PAA. Subsequently, a historical cohort study was performed, including all children (<18 years) treated for a radiologically confirmed PAA between 2014 and 2021 in a tertiary referral center and two large peripheral centers. Medical charts were reviewed to compare non-invasive (i.e., antibiotics) and invasive (i.e., drainage procedures) treatment strategies. Primary outcome was the success rate of treatment, defined as no need for further interventions related to PAA or its complications. Results: The search yielded 1,991 articles, of which three were included. Treatment success ranged between 69–88% and 56–100% for non-invasive and invasive strategies, respectively. Our multicenter cohort study included 70 children with a PAA, of which 29 (41%) were treated non-invasively and 41 (59%) invasively. In the non-invasive group, treatment was effective in 21 patients (72%) compared to 25 patients (61%) in the invasive group. Non-invasive treatment was effective in 100% of unifocal small (<3 cm) and 80% of unifocal medium size PAA (3–6 cm), but not effective for multiple abscesses. Conclusion: Non-invasive treatment of especially unifocal small and medium size (<6 cm) PAA in children seems to be safe and effective. Based on these results, a standardized treatment protocol was developed. Prospective validation of this step-up approach-based treatment protocol is recommended

Amsterdam wrist rules:A clinical decision aid

<p>Background: Acute trauma of the wrist is one of the most frequent reasons for visiting the Emergency Department. These patients are routinely referred for radiological examination. Most X-rays however, do not reveal any fractures. A clinical decision rule determining the need for X-rays in patients with acute wrist trauma may help to percolate and select patients with fractures.</p><p>Methods/Design: This study will be a multi-center observational diagnostic study in which the data will be collected cross-sectionally. The study population will consist of all consecutive adult patients (>= 18 years) presenting with acute wrist trauma at the Emergency Department in the participating hospitals.</p><p>This research comprises two components: one study will be conducted to determine which clinical parameters are predictive for the presence of a distal radius fracture in adult patients presenting to the Emergency Department following acute wrist trauma. These clinical parameters are defined by trauma-mechanism, physical examination, and functional testing. This data will be collected in two of the three participating hospitals and will be assessed by using logistic regression modelling to estimate the regression coefficients after which a reduced model will be created by means of a log likelihood ratio test. The accuracy of the model will be estimated by a goodness of fit test and an ROC curve. The final model will be validated internally through bootstrapping and by shrinking it, an adjusted model will be generated.</p><p>In the second component of this study, the developed prediction model will be validated in a new dataset consisting of a population of patients from the third hospital. If necessary, the model will be calibrated using the data from the validation study.</p><p>Discussion: Wrist trauma is frequently encountered at the Emergency Department. However, to this date, no decision rule regarding this type of trauma has been created. Ideally, radiographs are obtained of all patients entering one of the participating hospitals with trauma to the wrist. However, this is ethically and logistically not feasible and one could argue that patients, for whom no radiography is required according to their physician, are not suspected of having a distal radius fracture and thus are not part of the domain.</p>