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Polytrauma Management under Special Circumstances: Pediatric Trauma, Trauma in Pregnancy and Geriatric Trauma

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (20 September 2024) | Viewed by 4056

Special Issue Editors

Dr. Kai Oliver Jensen

E-Mail Website
Guest Editor
Department of Traumatology, University Hospital Zürich, Zürich, Switzerland
Interests: multiple trauma; geriatric trauma; acute care & emergency surgery; polytrauma & orthopedic trauma; registries
Prof. Dr. Arnold J. Suda

E-Mail Website
Guest Editor
Department of Orthopaedics and Trauma Surgery, AUVA Trauma Center Salzburg, Salzburg, Austria
Interests: polytrauma; prosthesis

Special Issue Information

Dear Colleagues,

In recent decades, there have been improvements made in the field of traumatology and orthopaedics thanks to scientific research findings following major trauma. While the mean age of trauma patients is increasing, there is just a small amount of knowledge about different treatment algorithms for this population.

Within the broad spectrum of patients treated in traumatology, injured children and pregnant women suffering from polytrauma need interdisciplinary treatment strategies and require specific treatment.

Therefore, this Special Issue focuses on the trauma within these special groups of patients, aiming to provide a selection of current scientific and surgical recommendations for clinical practice. The researchers in this field are encouraged to submit an original article or review to this Special Issue.

Dr. Kai Oliver Jensen
Prof. Dr. Arnold J. Suda
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • polytrauma
  • geriatric
  • pregnancy
  • children
  • severely injured
  • orthogeriatric
  • paediatric
  • trauma
  • outcome

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Published Papers (3 papers)

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Research

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8 pages, 771 KiB  
Article
NIpple Position to Pinpoint Localization of Chest Drain Insertion in FEmale Trauma Patients: The NIPPLE-Trial—A Landmark Study
by Paula Beck, Mila M. Paul, Helena Düsing, Johanna C. Wagner, Sebastian Künle and Sebastian Imach
J. Clin. Med. 2024, 13(21), 6458; https://doi.org/10.3390/jcm13216458 - 28 Oct 2024
Viewed by 1638
Abstract
Background: The insertion of chest drains (CD) in trauma patients is a lifesaving, albeit high-risk intervention. Safe insertion of CD in settings where aids like ultrasound are not available relies on a landmark technique defining the so-called triangle of safety. The inferior [...] Read more.
Background: The insertion of chest drains (CD) in trauma patients is a lifesaving, albeit high-risk intervention. Safe insertion of CD in settings where aids like ultrasound are not available relies on a landmark technique defining the so-called triangle of safety. The inferior margin of this triangle is identified by nipple height, which is thought to correspond to the fifth intercostal space (ICS). Training manikins are modeled after a lean male body and oftentimes insinuating jokes fuel uncertainty about the height of the nipple as a reliable landmark in female trauma patients. This study aims to prove that the nipple can be considered a safe landmark for CD insertion in women: even if larger breasts follow the force of gravity, it should not act towards the direction of the feet, but to the sides of the thorax in a flat-lying trauma patient. Methods: An online questionnaire was designed and distributed amongst female surgeons. Epidemiological data (age, nr of pregnancies, history of breastfeeding) was collected. Height, weight, and body mass index (BMI) were reported. Chest circumference and underbust girth were self-measured. The nipple position in relation to the ICS was measured by the women while lying in a supine position. Results: 237 female surgeons completed the questionnaire. Nine questionnaires were excluded due to incomplete data sets. 20 women were excluded due to previous breast surgery. Thus, 208 participants (or 416 nipples) were included in analysis. In supine position, both nipples were located in the 5th (±0.8) intercostal space. Age, BMI, height, weight, and status post-pregnancy had no significant impact on nipple position. Interestingly, a history of breastfeeding correlated with lower nipple position. Conclusions: The nipple is a safe landmark for identifying the correct insertion position of chest drains in supine-lying female trauma patients. Full article
(This article belongs to the Special Issue Polytrauma Management under Special Circumstances: Pediatric Trauma, Trauma in Pregnancy and Geriatric Trauma)
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13 pages, 401 KiB  
Article
The Road to Sepsis in Geriatric Polytrauma Patients—Can We Forecast Sepsis in Trauma Patients?
by Cédric Niggli, Philipp Vetter, Jan Hambrecht, Hans-Christoph Pape and Ladislav Mica
J. Clin. Med. 2024, 13(6), 1570; https://doi.org/10.3390/jcm13061570 - 9 Mar 2024
Viewed by 999
Abstract
Background: Sepsis is a leading cause of mortality in polytrauma patients, especially beyond the first week, and its management is vital for reducing multiorgan failure and improving survival rates. This is particularly critical in geriatric polytrauma patients due to factors such as age-related [...] Read more.
Background: Sepsis is a leading cause of mortality in polytrauma patients, especially beyond the first week, and its management is vital for reducing multiorgan failure and improving survival rates. This is particularly critical in geriatric polytrauma patients due to factors such as age-related physiological alterations and weakened immune systems. This study aimed to investigate various clinical and laboratory parameters associated with sepsis in polytrauma patients aged < 65 years and ≥65 years, with the secondary objective of comparing sources of infection in these patient groups. Methods: A retrospective cohort study was conducted at the University Hospital Zurich from August 1996 to December 2012. Participants included trauma patients aged ≥16 years with an Injury Severity Score (ISS) ≥ 16 who were diagnosed with sepsis within 31 days of admission. Patients in the age groups < 65 and ≥65 years were compared in terms of sepsis development. The parameters examined included patient and clinical data as well as laboratory values. The statistical methods encompassed group comparisons with Welch’s t-test and logistic regression. Results: A total of 3059 polytrauma patients were included in the final study. The median age in the group < 65 years was 37 years, with a median ISS of 28. In the patient group ≥ 65 years, the median age was 75 years, with a median ISS of 27. Blunt trauma mechanism, ISS, leucocytosis at admission, and anaemia at admission were associated with sepsis in younger patients but not in geriatric patients, whereas sex, pH at admission, lactate at admission, and Quick values at admission were not significantly linked with sepsis in either age group. Pneumonia was the most common cause of sepsis in both age groups. Conclusions: Various parameters linked to sepsis in younger polytrauma patients do not necessarily correlate with sepsis in geriatric individuals with polytrauma. Hence, it becomes critical to recognize imminent danger, particularly in geriatric patients. In this context, the principle of “HIT HARD and HIT EARLY” is highly important as a proactive approach to effectively address sepsis in the geriatric trauma population, including the preclinical setting. Full article
(This article belongs to the Special Issue Polytrauma Management under Special Circumstances: Pediatric Trauma, Trauma in Pregnancy and Geriatric Trauma)
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Review

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13 pages, 1517 KiB  
Review
Pediatric Carotid Injury after Blunt Trauma and the Necessity of CT and CTA—A Narrative Literature Review
by Lukas Krüger, Oliver Kamp, Katharina Alfen, Jens Theysohn, Marcel Dudda and Lars Becker
J. Clin. Med. 2024, 13(12), 3359; https://doi.org/10.3390/jcm13123359 - 7 Jun 2024
Viewed by 900
Abstract
Background: Blunt carotid injury (BCI) in pediatric trauma is quite rare. Due to the low number of cases, only a few reports and studies have been conducted on this topic. This review will discuss how frequent BCI/blunt cerebrovascular injury (BCVI) on pediatric patients [...] Read more.
Background: Blunt carotid injury (BCI) in pediatric trauma is quite rare. Due to the low number of cases, only a few reports and studies have been conducted on this topic. This review will discuss how frequent BCI/blunt cerebrovascular injury (BCVI) on pediatric patients after blunt trauma is, what routine diagnostics looks like, if a computed tomography (CT)/computed tomography angiography (CTA) scan on pediatric patients after blunt trauma is always necessary and if there are any negative health effects. Methods: This narrative literature review includes reviews, systematic reviews, case reports and original studies in the English language between 1999 and 2020 that deal with pediatric blunt trauma and the diagnostics of BCI and BCVI. Furthermore, publications on the risk of radiation exposure for children were included in this study. For literature research, Medline (PubMed) and the Cochrane library were used. Results: Pediatric BCI/BCVI shows an overall incidence between 0.03 and 0.5% of confirmed BCI/BCVI cases due to pediatric blunt trauma. In total, 1.1–3.5% of pediatric blunt trauma patients underwent CTA to detect BCI/BCVI. Only 0.17–1.2% of all CTA scans show a positive diagnosis for BCI/BCVI. In children, the median volume CT dose index on a non-contrast head CT is 33 milligrays (mGy), whereas a computed tomography angiography needs at least 138 mGy. A cumulative dose of about 50 mGy almost triples the risk of leukemia, and a cumulative dose of about 60 mGy triples the risk of brain cancer. Conclusions: Given that a BCI/BCVI could have extensive neurological consequences for children, it is necessary to evaluate routine pediatric diagnostics after blunt trauma. CT and CTA are mostly used in routine BCI/BCVI diagnostics. However, since radiation exposure in children should be as low as reasonably achievable, it should be asked if other diagnostic methods could be used to identify risk groups. Trauma guidelines and clinical scores like the McGovern score are established BCI/BCVI screening options, as well as duplex ultrasound. Full article
(This article belongs to the Special Issue Polytrauma Management under Special Circumstances: Pediatric Trauma, Trauma in Pregnancy and Geriatric Trauma)
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