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1. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

Author

ten Broek, Richard PG, Krielen, Pepijn, Di Saverio, Salomone, Coccolini, Federico, Biffl, Walter L, Ansaloni, Luca, Velmahos, George C, Sartelli, Massimo, Fraga, Gustavo P, Kelly, Michael D, Moore, Frederick A, Peitzman, Andrew B, Leppaniemi, Ari, Moore, Ernest E, Jeekel, Johannes, Kluger, Yoram, Sugrue, Michael, Balogh, Zsolt J, Bendinelli, Cino, Civil, Ian, Coimbra, Raul, De Moya, Mark, Ferrada, Paula, Inaba, Kenji, Ivatury, Rao, Latifi, Rifat, Kashuk, Jeffry L, Kirkpatrick, Andrew W, Maier, Ron, Rizoli, Sandro, Sakakushev, Boris, Scalea, Thomas, Søreide, Kjetil, Weber, Dieter, Wani, Imtiaz, Abu-Zidan, Fikri M, De’Angelis, Nicola, Piscioneri, Frank, Galante, Joseph M, Catena, Fausto, and van Goor, Harry

Subjects
Patient Safety, Prevention, Digestive Diseases, Clinical Research, Evaluation of treatments and therapeutic interventions, 7.3 Management and decision making, 6.4 Surgery, Management of diseases and conditions, Oral and gastrointestinal, Disease Management, General Surgery, Guidelines as Topic, Humans, Intestinal Obstruction, Tissue Adhesions, Treatment Outcome, Small bowel obstruction, Adhesions, Surgery, Laparoscopy, Laparotomy
Abstract

BackgroundAdhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups.MethodsThe guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion.RecommendationsAdhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO.Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention.DiscussionThis guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.

Published
2018

2. Splenic trauma: WSES classification and guidelines for adult and pediatric patients

Author

Coccolini, Federico, Montori, Giulia, Catena, Fausto, Kluger, Yoram, Biffl, Walter, Moore, Ernest E, Reva, Viktor, Bing, Camilla, Bala, Miklosh, Fugazzola, Paola, Bahouth, Hany, Marzi, Ingo, Velmahos, George, Ivatury, Rao, Soreide, Kjetil, Horer, Tal, ten Broek, Richard, Pereira, Bruno M, Fraga, Gustavo P, Inaba, Kenji, Kashuk, Joseph, Parry, Neil, Masiakos, Peter T, Mylonas, Konstantinos S, Kirkpatrick, Andrew, Abu-Zidan, Fikri, Gomes, Carlos Augusto, Benatti, Simone Vasilij, Naidoo, Noel, Salvetti, Francesco, Maccatrozzo, Stefano, Agnoletti, Vanni, Gamberini, Emiliano, Solaini, Leonardo, Costanzo, Antonio, Celotti, Andrea, Tomasoni, Matteo, Khokha, Vladimir, Arvieux, Catherine, Napolitano, Lena, Handolin, Lauri, Pisano, Michele, Magnone, Stefano, Spain, David A, de Moya, Marc, Davis, Kimberly A, De Angelis, Nicola, Leppaniemi, Ari, Ferrada, Paula, Latifi, Rifat, Navarro, David Costa, Otomo, Yashuiro, Coimbra, Raul, Maier, Ronald V, Moore, Frederick, Rizoli, Sandro, Sakakushev, Boris, Galante, Joseph M, Chiara, Osvaldo, Cimbanassi, Stefania, Mefire, Alain Chichom, Weber, Dieter, Ceresoli, Marco, Peitzman, Andrew B, Wehlie, Liban, Sartelli, Massimo, Di Saverio, Salomone, and Ansaloni, Luca

Subjects
Physical Injury - Accidents and Adverse Effects, Childhood Injury, Emergency Care, Patient Safety, Pediatric, Hematology, Injuries and accidents, Abdominal Injuries, Adult, Conservative Treatment, Guidelines as Topic, Hemodynamics, Humans, Spleen, Wounds and Injuries, Trauma, Classification, Guidelines, Embolization, Surgery, Non-operative, Conservative
Abstract

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.

Published
2017

3. Development and Validation of the Air Medical Prehospital Triage Score for Helicopter Transport of Trauma Patients

Author

Brown, Joshua B, Gestring, Mark L, Guyette, Francis X, Rosengart, Matthew R, Stassen, Nicole A, Forsythe, Raquel M, Billiar, Timothy R, Peitzman, Andrew B, and Sperry, Jason L

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Adult, Aged, Air Ambulances, Female, Humans, Injury Severity Score, Male, Middle Aged, Patient Selection, Reproducibility of Results, Retrospective Studies, Survival Rate, Triage, Wounds and Injuries, Young Adult, air medical, emergency medical services, helicopter, injury, prehospital, scene, transport, trauma, triage, Medical and Health Sciences, Surgery, Clinical sciences
Abstract

ObjectiveThe aim of this study was to develop and internally validate a triage score that can identify trauma patients at the scene who would potentially benefit from helicopter emergency medical services (HEMS).Summary background dataAlthough survival benefits have been shown at the population level, identification of patients most likely to benefit from HEMS transport is imperative to justify the risks and cost of this intervention.MethodsRetrospective cohort study of subjects undergoing scene HEMS or ground emergency medical services (GEMS) in the National Trauma Databank (2007-2012). Data were split into training and validation sets. Subjects were grouped by triage criteria in the training set and regression used to determine which criteria had a survival benefit associated with HEMS. Points were assigned to these criteria to develop the Air Medical Prehospital Triage (AMPT) score. The score was applied in the validation set to determine whether subjects triaged to HEMS had a survival benefit when actually transported by helicopter.ResultsThere were 2,086,137 subjects included. Criteria identified for inclusion in the AMPT score included GCS 29, flail chest, hemo/pneumothorax, paralysis, and multisystem trauma. The optimal cutoff for triage to HEMS was ≥2 points. In subjects triaged to HEMS, actual transport by HEMS was associated with an increased odds of survival (AOR 1.28; 95% confidence interval [CI] 1.21-1.36, P

Published
2016

4. Helicopter transport improves survival following injury in the absence of a time-saving advantage

Author

Brown, Joshua B, Gestring, Mark L, Guyette, Francis X, Rosengart, Matthew R, Stassen, Nicole A, Forsythe, Raquel M, Billiar, Timothy R, Peitzman, Andrew B, and Sperry, Jason L

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Air Ambulances, Ambulances, Cohort Studies, Emergency Medical Services, Female, Humans, Injury Severity Score, Logistic Models, Male, Multiple Trauma, Odds Ratio, Propensity Score, Quality Improvement, Retrospective Studies, Risk Assessment, Survival Analysis, Time Factors, Time-to-Treatment, Transportation of Patients, Surgery, Clinical sciences
Abstract

BackgroundAlthough survival benefits have been shown at the population level, it remains unclear what drives the outcome benefits for helicopter emergency medical services (HEMS) in trauma. Although speed is often cited as the vital factor of HEMS, we hypothesized a survival benefit would exist in the absence of a time savings over ground emergency medical services (GEMS). The objective was to examine the association of survival with HEMS compared with GEMS transport across similar prehospital transport times.MethodsWe used a retrospective cohort of scene HEMS and GEMS transports in the National Trauma Databank (2007-2012). Propensity score matching was used to match HEMS and GEMS subjects on the likelihood of HEMS transport. Subjects were stratified by prehospital transport times in 5-minute increments. Conditional logistic regression determined the association of HEMS with survival across prehospital transport times strata controlling for confounders. Transport distance was estimated from prehospital transport times and average HEMS/GEMS transport speeds.ResultsThere were 155,691 HEMS/GEMS pairs matched. HEMS had a survival benefit over GEMS for prehospital transport times between 6 and 30 minutes. This benefit ranged from a 46% increase in odds of survival between 26 and 30 minutes (adjusted odds ratio [AOR], 1.46; 95% CI, 1.11-1.93; P < .01) to an 80% increase in odds of survival between 16 and 20 minutes (AOR, 1.80; 95% CI, 1.51-2.14; P < .01). This prehospital transport times window corresponds to estimated transport distance between 14.3 and 71.3 miles for HEMS and 3.3 and 16.6 miles for GEMS.ConclusionWhen stratified by prehospital transport times, HEMS had a survival benefit concentrated in a window between 6 and 30 minutes. Because there was no time-savings advantage for HEMS, these findings may reflect care delivered by HEMS providers.

Published
2016

5. Geographic Variation in Outcome Benefits of Helicopter Transport for Trauma in the United States

Author

Brown, Joshua B, Gestring, Mark L, Stassen, Nicole A, Forsythe, Raquel M, Billiar, Timothy R, Peitzman, Andrew B, and Sperry, Jason L

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Physical Injury - Accidents and Adverse Effects, Clinical Research, Good Health and Well Being, Adolescent, Adult, Aged, Aged, 80 and over, Air Ambulances, Databases, Factual, Female, Healthcare Disparities, Humans, Logistic Models, Male, Middle Aged, Outcome Assessment, Health Care, Propensity Score, Retrospective Studies, United States, Wounds and Injuries, Young Adult, geographic, helicopter, outcome, trauma, variation, Medical and Health Sciences, Surgery, Clinical sciences
Abstract

ObjectiveEvaluate the effect of US geographic region on outcomes of helicopter transport (HT) for trauma.BackgroundHT is an integral component of trauma systems. Evidence suggests that HT is associated with improved outcomes; however, no studies examine the impact of geographic variation on outcomes for HT.MethodsRetrospective cohort study of patients undergoing scene HT or ground transport in the National Trauma Databank (2009-2012). Subjects were divided by US census region. HT and ground transport subjects were propensity-score matched based on prehospital physiology and injury severity. Conditional logistic regression was used to evaluate the effect of HT on survival and discharge to home in each region. Region-level characteristics were assessed as potential explanatory factors.ResultsA total of 193,629 pairs were matched. HT was associated with increased odds of survival and discharge to home; however, the magnitude of these effects varied significantly across regions (P

Published
2016

6. Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

Author

Brown, Joshua B, Cohen, Mitchell J, Minei, Joseph P, Maier, Ronald V, West, Michaela A, Billiar, Timothy R, Peitzman, Andrew B, Moore, Ernest E, Cuschieri, Joseph, and Sperry, Jason L

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Physical Injury - Accidents and Adverse Effects, Clinical Research, Good Health and Well Being, Adult, Blood Coagulation Disorders, Emergency Medical Services, Endopeptidase Clp, Erythrocyte Transfusion, Female, Heat-Shock Proteins, Humans, Injury Severity Score, Male, Middle Aged, Propensity Score, Prospective Studies, Protozoan Proteins, Shock, Hemorrhagic, Treatment Outcome, Wounds, Nonpenetrating, blood, prehospital, resuscitation, trauma, transfusion, Inflammation and the Host Response to Injury Investigators, Medical and Health Sciences, Surgery, Clinical sciences
Abstract

ObjectiveTo evaluate the association of pretrauma center (PTC) red blood cell (RBC) transfusion with outcomes in severely injured patients.BackgroundHemorrhage remains a major driver of mortality. Little evidence exists supporting PTC interventions to mitigate this.MethodsBlunt injured patients in shock arriving at a trauma center within 2 hours of injury were included from the Glue Grant database. Subjects were dichotomized by PTC RBC transfusion. Outcomes included 24-hour mortality, 30-day mortality, and trauma-induced coagulopathy [(TIC), admission international normalized ratio >1.5]. Cox regression and logistic regression determined the association of PTC RBC transfusion with outcomes. To address baseline differences, propensity score matching was used.ResultsOf 1415 subjects, 50 received PTC RBC transfusion. Demographics and injury severity score were similar. The PTC RBC group received 1.3 units of RBCs (median), and 52% were scene transports. PTC RBC transfusion was associated with a 95% reduction in odds of 24-hour mortality [odds ratio (OR) = 0.05; 95% confidence interval (CI), 0.01-0.48; P < 0.01], 64% reduction in the risk of 30-day mortality [hazard ratio = 0.36; 95% CI, 0.15-0.83; P = 0.02], and 88% reduction in odds of TIC (OR = 0.12; 95% CI, 0.02-0.79; P = 0.03). The matched cohort included 113 subjects (31% PTC RBC group). Baseline characteristics were similar. PTC RBC transfusion was associated with a 98% reduction in odds of 24-hour mortality (OR = 0.02; 95% CI, 0.01-0.69; P = 0.04), 88% reduction in the risk of 30-day mortality (hazard ratio = 0.12; 95% CI, 0.03-0.61; P = 0.01), and 99% reduction in odds of TIC (OR = 0.01; 95% CI, 0.01-0.95; P = 0.05).ConclusionsPTC RBC administration was associated with a lower risk of 24-hour mortality, 30-day mortality, and TIC in severely injured patients with blunt trauma, warranting further prospective study.

Published
2015

7. Prehospital Use of Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Is Associated With a Reduced Incidence of Trauma-Induced Coagulopathy

Author

Neal, Matthew D, Brown, Joshua B, Moore, Ernest E, Cuschieri, Joseph, Maier, Ronald V, Minei, Joseph P, Billiar, Timothy R, Peitzman, Andrew B, Cohen, Mitchell J, and Sperry, Jason L

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Physical Injury - Accidents and Adverse Effects, Aetiology, 2.1 Biological and endogenous factors, Adult, Anti-Inflammatory Agents, Non-Steroidal, Blood Coagulation Disorders, Blood Transfusion, Comorbidity, Female, Humans, Incidence, International Normalized Ratio, Male, Middle Aged, Risk Assessment, Risk Factors, Trauma Severity Indices, Wounds and Injuries, acute coagulopathy of trauma, Glue Grant, inflammation, NSAID, trauma, Inflammation and Host Response to Injury Investigators, Medical and Health Sciences, Surgery, Clinical sciences
Abstract

ObjectiveTo determine whether prehospital nonsteroidal anti-inflammatory drug (NSAID) use may lead to a reduced incidence of trauma-induced coagulopathy (TIC) in severely injured patients.BackgroundTIC is present in up to a quarter of severely injured trauma patients and is linked to worse outcomes after injury. Evidence linking TIC to inflammation has emerged; however, the mechanism behind this association is still under investigation. NSAIDs are commonly used anti-inflammatory drugs, but their effects on TIC and outcomes after injury are largely unexplored.MethodsWe performed a secondary analysis of the Inflammation and the Host Response to Injury Large Scale Collaborative Program (Glue Grant) data set. Prehospital medications and comorbidities were analyzed by logistic regression analysis for association with TIC as defined by laboratory (international normalized ratio >1.5) or clinical (transfusion >2 units of fresh frozen plasma or >1 pack of platelets in 6 hours) parameters.ResultsPrehospital NSIAD use was independently associated with a 72% lower risk of TIC and was the only medication among 15 analyzed to retain significance in the model. Stepwise logistic regression also demonstrated that preadmission use of NSAIDs was independently associated with a 66% lower risk of clinically significant coagulopathy. These findings were independent of comorbid conditions linked to NSAID use.ConclusionsNSAID use before admission for severe injury is associated with a reduced incidence of TIC. These findings provide further evidence to a potential leak between TIC and inflammation.

Published
2014

8. Prehospital low titer group O whole blood is feasible and safe: Results of a prospective randomized pilot trial

Author

Guyette, Frank X., Zenati, Mazen, Triulzi, Darrell J., Yazer, Mark H., Skroczky, Hunter, Early, Barbara J., Adams, Peter W., Brown, Joshua B., Alarcon, Louis, Neal, Matthew D., Forsythe, Raquel M., Zuckerbraun, Brian S., Peitzman, Andrew B., Billiar, Timothy R., and Sperry, Jason L.

Subjects
Surgery, Critical Care and Intensive Care Medicine, Article
Abstract

INTRODUCTION: Low titer group O whole blood (LTOWB) resuscitation is increasingly common in both military and civilian settings. Data regarding the safety and efficacy of prehospital LTOWB remains limited. METHODS: We performed a single center, prospective, cluster randomized, prehospital thru in-hospital whole blood pilot trial for injured air medical patients. We compared standard prehospital air medical care including red cell transfusion and crystalloids followed by in-hospital component transfusion to prehospital and in-hospital LTOWB resuscitation. Prehospital vital signs were used as inclusion criteria (SBP ≤ 90 mmHg and HR ≥ 108 bpm) or (SBP ≤ 70 mmHg) for patients at risk of hemorrhage. Primary outcome was feasibility. Secondary outcomes included 28-day and 24 hour mortality, multiple organ failure, nosocomial infection, 24hr transfusion requirements and arrival coagulation parameters. RESULTS: Between November 2018 thru October 2020, 86 injured patients were cluster randomized by helicopter base. The trial has halted early at 77% enrollment. Overall, 28-day mortality for the cohort was 26%. Injured patients randomized to prehospital LTOWB (n=40) relative to standard care (n=46) were similar in demographics and injury characteristics. Intent to treat Kaplan-Meier survival analysis demonstrated no statistical mortality benefit at 28 days (25.0% vs. 26.1%, p= 0.85). Patients randomized to prehospital LTOWB relative to standard care had lower red cell transfusion requirements at 24 hours (p

Published
2022
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9. Diagnosis and management of small bowel obstruction in virgin abdomen : a WSES position paper

Author

Amara, Yousef, Leppaniemi, Ari, Catena, Fausto, Ansaloni, Luca, Sugrue, Michael, Fraga, Gustavo P., Coccolini, Federico, Biffl, Walter L., Peitzman, Andrew B., Kluger, Yoram, Sartelli, Massimo, Moore, Ernest E., Di Saverio, Salomone, Darwish, Esfo, Endo, Chikako, van Goor, Harry, ten Broek, Richard P., HUS Abdominal Center, and II kirurgian klinikka

Subjects
operative management, ADHESIONS, SURGERY, Small bowel obstruction, NEED, Virgin abdomen, 3126 Surgery, anesthesiology, intensive care, radiology, Immediate intervention, SOLUBLE CONTRAST AGENT, ETIOLOGY, RELIABILITY, Conservative management, LAPAROTOMY, COMPUTED-TOMOGRAPHY SCAN, METAANALYSIS, INTESTINAL-OBSTRUCTION
Abstract

Background Small bowel obstruction (SBO) is a common surgical emergency, causing high morbidity and healthcare costs. The majority of SBOs are caused by adhesions that result from previous surgeries. Bowel obstruction, however, also occurs in patients without previous operation or known pathology, a so called virgin abdomen. It is unknown if small bowel obstruction in the virgin abdomen (SBO-VA) can be managed according to the same principles as other cases of small bowel obstruction. The aim of this position paper is to evaluate the available evidence on etiology and management of small bowel obstruction in the virgin abdomen. Methods This is a narrative review with scoping aspects. Clinical topics covered in this review include epidemiology and etiology of SBO-VA, diagnosis and imaging, initial assessment, the role of surgical management in SBO-VA, and the role of non-operative management in SBO-VA. Results Our scoping search revealed seven original studies reporting original patient data related to SBO-VA. All the included studies are retrospective cohorts, with populations ranging between 44 and 103 patients with SBO-VA. Adhesions were found to be the cause of the obstruction in approximately half of the reported cases of SBO-VA. A relatively high number of cases of SBO-VA were managed surgically with studies reporting 39-83%. However, in cases where a trial of non-operative management was started, this was generally successful. Conclusion The data available suggest that etiology and treatment results for patients with SBO-VA are largely comparable to the results in patients with SBO after previous abdominal surgery. We therefore propose that patients with a virgin abdomen could be treated according to existing guidelines for SBO and adhesive small bowel obstruction.

Published
2021

10. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO) : 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

Author

Ten Broek, Richard P. G., Krielen, Pepijn, Di Saverio, Salomone, Coccolini, Federico, Biffl, Walter L., Ansaloni, Luca, Velmahos, George C., Sartelli, Massimo, Fraga, Gustavo P., Kelly, Michael D., Moore, Frederick A., Peitzman, Andrew B., Leppaniemi, Ari, Moore, Ernest E., Jeekel, Johannes, Kluger, Yoram, Sugrue, Michael, Balogh, Zsolt J., Bendinelli, Cino, Civil, Ian, Coimbra, Raul, De Moya, Mark, Ferrada, Paula, Inaba, Kenji, Ivatury, Rao, Latifi, Rifat, Kashuk, Jeffry L., Kirkpatrick, Andrew W., Maier, Ron, Rizoli, Sandro, Sakakushev, Boris, Scalea, Thomas, Soreide, Kjetil, Weber, Dieter, Wani, Imtiaz, Abu-Zidan, Fikri M., De'Angelis, Nicola, Piscioneri, Frank, Galante, Joseph M., Catena, Fausto, van Goor, Harry, II kirurgian klinikka, Department of Surgery, Clinicum, and HUS Abdominal Center

Subjects
Laparotomy, Adhesions, GENERAL-SURGERY, ICODEXTRIN 4-PERCENT SOLUTION, Small bowel obstruction, POSTOPERATIVE ADHESIONS, LAPAROSCOPIC MANAGEMENT, 3126 Surgery, anesthesiology, intensive care, radiology, SOLUBLE CONTRAST AGENT, QUALITY-OF-LIFE, LOWER ABDOMINAL-SURGERY, SURGICAL-TREATMENT, RISK-FACTORS, Surgery, Laparoscopy, INTESTINAL-OBSTRUCTION
Abstract

Background: Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups. Methods: The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion. Recommendations: Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO. Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention. Discussion: This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.

Published
2018

11. WSES SM (World Society of Emergency Surgery Summer Meeting) highlights: emergency surgery around the world (Brazil, Finland, USA)

Author

Catena Fausto, Ansaloni Luca, Peitzman Andrew B, Puyana Juan, Ferrada Paula, Leppanemi Ari, Poggetti Renato, Pinna Antonio D, and Moore Ernest E

Subjects
Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Emergency surgery is performed in every hospital with a A and E unit all around the world. However it is organized in different ways with different results. Aim of this paper is to present history, current scope, current training program and new politics for training national program of 3 countries of different continents. Brazil, Finland and US emergency surgery models are presented discussing all criticisms showed during the WSES Summer Meeting 2008.

Published
2009
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12. Pre-hospital Use of Non-steroidal Anti-inflammatory Drugs (NSAIDs) is Associated with a Reduced Incidence of Trauma-Induced Coagulopathy

Author

Neal, Matthew D., Brown, Joshua B., Moore, Ernest E., Cuschieri, Joseph, Maier, Ronald V., Minei, Joseph P., Billiar, Timothy R., Peitzman, Andrew B., Cohen, Mitchell J., Sperry, Jason L., and Inflammation, The

Subjects
Adult, Male, medicine.medical_specialty, Blood transfusion, medicine.medical_treatment, Comorbidity, Logistic regression, Lower risk, Risk Assessment, Article, Risk Factors, Internal medicine, mental disorders, medicine, Coagulopathy, Humans, Blood Transfusion, International Normalized Ratio, Trauma Severity Indices, business.industry, Incidence (epidemiology), Incidence, Anti-Inflammatory Agents, Non-Steroidal, Blood Coagulation Disorders, Middle Aged, medicine.disease, Surgery, Wounds and Injuries, Female, Fresh frozen plasma, business, Risk assessment
Abstract

OBJECTIVE To determine whether prehospital nonsteroidal anti-inflammatory drug (NSAID) use may lead to a reduced incidence of trauma-induced coagulopathy (TIC) in severely injured patients. BACKGROUND TIC is present in up to a quarter of severely injured trauma patients and is linked to worse outcomes after injury. Evidence linking TIC to inflammation has emerged; however, the mechanism behind this association is still under investigation. NSAIDs are commonly used anti-inflammatory drugs, but their effects on TIC and outcomes after injury are largely unexplored. METHODS We performed a secondary analysis of the Inflammation and the Host Response to Injury Large Scale Collaborative Program (Glue Grant) data set. Prehospital medications and comorbidities were analyzed by logistic regression analysis for association with TIC as defined by laboratory (international normalized ratio >1.5) or clinical (transfusion >2 units of fresh frozen plasma or >1 pack of platelets in 6 hours) parameters. RESULTS Prehospital NSIAD use was independently associated with a 72% lower risk of TIC and was the only medication among 15 analyzed to retain significance in the model. Stepwise logistic regression also demonstrated that preadmission use of NSAIDs was independently associated with a 66% lower risk of clinically significant coagulopathy. These findings were independent of comorbid conditions linked to NSAID use. CONCLUSIONS NSAID use before admission for severe injury is associated with a reduced incidence of TIC. These findings provide further evidence to a potential leak between TIC and inflammation.

Published
2014

13. Damage control operations in non-trauma patients: defining criteria for the staged rapid source control laparotomy in emergency general surgery.

Author

Becher, Robert D., Peitzman, Andrew B., Sperry, Jason L., Gallaher, Jared R., Neff, Lucas P., Sun, Yankai, Miller, Preston R., and Chang, Michael C.

Subjects
*ABDOMINAL surgery, *ACIDOSIS, *COMPARATIVE studies, *EMERGENCY medical services, *LACTATES, *PATIENTS, *SEPTIC shock, *SEPSIS, *SURGEONS, *SURGERY, *OPERATIVE surgery, *SURVIVAL analysis (Biometry), *MATHEMATICAL variables, *COMORBIDITY, *LOGISTIC regression analysis
Abstract

Background: The staged laparotomy in the operative management of emergency general surgery (EGS) patients is an extension of trauma surgeons operating on this population. Indications for its application, however, are not well defined, and are currently based on the lethal triad used in physiologically-decompensated trauma patients. This study sought to determine the acute indications for the staged, rapid source control laparotomy (RSCL) in EGS patients. Methods: All EGS patients undergoing emergent staged RSCL and non-RSCL over 3 years were studied. Demographics, physiologic parameters, perioperative variables, outcomes, and survival were compared. Logistic regression models determined the influence of physiologic parameters on mortality and postoperative complications. EGS-RSCL indications were defined. Results: 215 EGS patients underwent emergent laparotomy; 53 (25 %) were staged RSCL. In the 53 patients who underwent a staged RSCL based on the lethal triad, adjusted multivariable regression analysis shows that when used alone, no component of the lethal triad independently improved survival. Staged RSCL may decrease mortality in patients with preoperative severe sepsis / septic shock, and an elevated lactate (≥3); acidosis (pH ≤ 7.25); elderly (≥70); male gender; and multiple comorbidities (≥3). Of the 162 non-RSCL emergent laparotomies, 27 (17 %) required unplanned re-explorations; of these, 17 (63 %) had sepsis preoperatively and 9 (33 %) died. Conclusions: The acute physiologic indicators that help guide operative decisions in trauma may not confer a similar survival advantage in EGS. To replace the lethal triad, criteria for application of the staged RSCL in EGS need to be defined. Based on these results, the indications should include severe sepsis / septic shock, lactate, acidosis, gender, age, and pre-existing comorbidities. When correctly applied, the staged RSCL may help to improve survival in decompensated EGS patients. [ABSTRACT FROM AUTHOR]

Published
2016
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14. Liver trauma: WSES position paper.

Author

Coccolini, Federico, Montori, Giulia, Catena, Fausto, Di Saverio, Salomone, Biffl, Walter, Moore, Ernest E., Peitzman, Andrew B., Rizoli, Sandro, Tugnoli, Gregorio, Sartelli, Massimo, Manfredi, Roberto, and Ansaloni, Luca

Subjects
LIVER surgery, LIVER injuries, DIAGNOSIS of abdominal injuries, ABDOMINAL injuries, ANGIOGRAPHY, BLUNT trauma, COMPUTED tomography, HEMODYNAMICS, HEMORRHAGE, LIVER transplantation, POSTOPERATIVE care, THERAPEUTIC embolization, SEVERITY of illness index, TRAUMA severity indices, DIAGNOSIS
Abstract

The liver is the most injured organ in abdominal trauma. Road traffic crashes and antisocial, violent behavior account for the majority of liver injuries. The present position paper represents the position of the World Society of Emergency Surgery (WSES) about the management of liver injuries. [ABSTRACT FROM AUTHOR]

Published
2015
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15. Defining geriatric trauma: When does age make a difference?

Author

Goodmanson, Nicholas W., Rosengart, Matthew R., Barnato, Amber E., Sperry, Jason L., Peitzman, Andrew B., and Marshall, Gary T.

Subjects
OLDER people's injuries, TRAUMA centers, MEDICAL triage, AGING, HOSPITAL mortality, SURGERY
Abstract

Background: Injured elderly patients experience high rates of undertriage to trauma centers (TCs) whereas debate continues regarding the age defining a geriatric trauma patient. We sought to identify when mortality risk increases in injured patients as the result of age alone to determine whether TC care was associated with improved outcomes for these patients and to estimate the added admissions burden to TCs using an age threshold for triage. Methods: We performed a retrospective cohort study of injured patients treated at TCs and non-TCs in Pennsylvania from April 1, 2001, to March 31, 2005. Patients were included if they were between 19 and 100 years of age and had sustained minimal injury (Injury Severity Score < 9). The primary outcome was in-hospital mortality. We analyzed age as a predictor of mortality by using the fractional polynomial method. Results: A total of 104,015 patients were included. Mortality risk significantly increased at 57 years (odds ratio 5.58; 95% confidence interval 1.07–29.0; P = .04) relative to 19-year-old patients. TC care was associated with a decreased mortality risk compared with non-TC care (odds ratio 0.83; 95% confidence interval 0.69–0.99; P = .04). Using an age of 70 as a threshold for mandatory triage, we estimated TCs could expect an annual increase of approximately one additional admission per day. Conclusion: Age is a significant risk factor for mortality in trauma patients, and TC care improves outcomes even in older, minimally injured patients. An age threshold should be considered as a criterion for TC triage. Use of the clinically relevant age of 70 as this threshold would not impose a substantial increase on annual TC admissions. [ABSTRACT FROM AUTHOR]

Published
2012
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16. Technical Challenges and Utility of Anterior Exposure for Thoracic Spine Pathology.

Author

Pettiford, Brian L., Schuchert, Matthew J., Jeyabalan, Geetha, Landreneau, James R., Kilic, Arman, Landreneau, Joshua P., Awais, Omar, Kent, Michael S., Ferson, Peter F., Luketich, James D., Peitzman, Andrew B., and Landreneau, Rodney J.

Subjects
THORACIC vertebrae, LUMBAR vertebrae, OPERATIVE surgery, DEATH rate, THORACIC surgeons, SCOLIOSIS, SURGEONS, SURGERY
Abstract

Background: Thoracic surgeons are frequently called upon to provide exposure to the anterior cervicothoracic, thoracic, and proximal lumbar spine. We reviewed our surgical experience and the perioperative outcomes of these spinal approaches. Relevant technical and anatomic considerations of each procedure are highlighted. Methods: A total of 213 patients (116 female, 97 male) undergoing anterior thoracic spinal exposures over an 11-year period at a single institution were analyzed. Primary endpoints include morbidity, mortality, and perioperative outcomes. Results: Mean age was 53.7 years. Surgical approaches were determined based on the location and length of spinal involvement, and included cervicothoracic (5), thoracotomy (117), and thoracoabdominal (91) techniques. Malignant etiologies were associated with the highest perioperative mortality (6.7%, p = 0.08). Procedures for infection were associated with a significantly higher complication rate (p = 0.041) and length of stay (p = 0.033). Correction of scoliosis required longer operative times (p < 0.001) and resulted in a trend toward higher blood loss (p = 0.16). Thoracoabdominal approaches were associated with increased operative times (386 vs 316 minutes) and length of stay (8 vs 6 days) compared with thoracotomy. Conclusions: The increased use of anterior approaches to spinal pathology necessitates greater involvement by thoracic surgeons. Familiarity with the anatomic and technical features of the anterior spinal exposure is required by thoracic surgeons to optimize surgical outcomes. [Copyright &y& Elsevier]

Published
2008
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17. The Department of Surgery at the School of Medicine at the University of Pittsburgh, Pittsburgh, Pa.

Author

Billiar, Timothy R. and Peitzman, Andrew B.

Subjects
MEDICAL education, SURGERY, PHYSICIANS, TEACHING, UNIVERSITY faculty
Abstract

The article presents information about the department of surgery at the School of Medicine at the University of Pittsburgh, Pittsburgh, Pennsylvania. The School of Medicine at the University began as the Western Pennsylvania Medical College and graduated its first class of physicians in 1887. In the 1890s, the medical college became affiliated with the Western University of Pennsylvania, which had originated as the Pittsburgh Academy in 1787. Thus, roots of the School of Medicine at the University of Pittsburgh make it one of the nation's oldest academic institutions. Most of the clinical teaching in the first half of the 20th century was provided by volunteer or part-time faculty

Published
2004
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18. Kidney and uro-trauma: WSES-AAST guidelines.

Author

Coccolini, Federico, Moore, Ernest E., Kluger, Yoram, Biffl, Walter, Leppaniemi, Ari, Matsumura, Yosuke, Kim, Fernando, Peitzman, Andrew B., Fraga, Gustavo P., Sartelli, Massimo, Ansaloni, Luca, Augustin, Goran, Kirkpatrick, Andrew, Abu-Zidan, Fikri, Wani, Imitiaz, Weber, Dieter, Pikoulis, Emmanouil, Larrea, Martha, Arvieux, Catherine, and Manchev, Vassil

Subjects
GENITOURINARY organ injuries, KIDNEY disease diagnosis, KIDNEY disease treatments, KIDNEY injuries, URINARY organ disease diagnosis, ENDOVASCULAR surgery, UROLOGICAL surgery, HEALTH care teams, HEMODYNAMICS, HOMEOSTASIS, INTENSIVE care units, MEDICAL protocols, PEDIATRICS, PROFESSIONAL associations, SURGICAL stents, SURGEONS, URINARY organ diseases, UROLOGISTS, THERAPEUTIC embolization, SYSTEMATIC reviews
Abstract

Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines. [ABSTRACT FROM AUTHOR]

Published
2019
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19. WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections

Author

Massimo Sartelli, Federico Coccolini, Yoram Kluger, Ervis Agastra, Fikri M. Abu-Zidan, Ashraf El Sayed Abbas, Luca Ansaloni, Abdulrashid Kayode Adesunkanmi, Goran Augustin, Miklosh Bala, Oussama Baraket, Walter L. Biffl, Marco Ceresoli, Elisabetta Cerutti, Osvaldo Chiara, Enrico Cicuttin, Massimo Chiarugi, Raul Coimbra, Daniela Corsi, Francesco Cortese, Yunfeng Cui, Dimitris Damaskos, Nicola de’Angelis, Samir Delibegovic, Zaza Demetrashvili, Belinda De Simone, Stijn W. de Jonge, Stefano Di Bella, Salomone Di Saverio, Therese M. Duane, Paola Fugazzola, Joseph M. Galante, Wagih Ghnnam, George Gkiokas, Carlos Augusto Gomes, Ewen A. Griffiths, Timothy C. Hardcastle, Andreas Hecker, Torsten Herzog, Aleksandar Karamarkovic, Vladimir Khokha, Peter K. Kim, Jae Il Kim, Andrew W. Kirkpatrick, Victor Kong, Renol M. Koshy, Kenji Inaba, Arda Isik, Rao Ivatury, Francesco M. Labricciosa, Yeong Yeh Lee, Ari Leppäniemi, Andrey Litvin, Davide Luppi, Ronald V. Maier, Athanasios Marinis, Sanjay Marwah, Cristian Mesina, Ernest E. Moore, Frederick A. Moore, Ionut Negoi, Iyiade Olaoye, Carlos A. Ordoñez, Mouaqit Ouadii, Andrew B. Peitzman, Gennaro Perrone, Tadeja Pintar, Giuseppe Pipitone, Mauro Podda, Kemal Raşa, Julival Ribeiro, Gabriel Rodrigues, Ines Rubio-Perez, Ibrahima Sall, Norio Sato, Robert G. Sawyer, Vishal G. Shelat, Michael Sugrue, Antonio Tarasconi, Matti Tolonen, Bruno Viaggi, Andrea Celotti, Claudio Casella, Leonardo Pagani, Sameer Dhingra, Gian Luca Baiocchi, Fausto Catena, Sartelli, M, Coccolini, F, Kluger, Y, Agastra, E, Abu-Zidan, F, Abbas, A, Ansaloni, L, Adesunkanmi, A, Augustin, G, Bala, M, Baraket, O, Biffl, W, Ceresoli, M, Cerutti, E, Chiara, O, Cicuttin, E, Chiarugi, M, Coimbra, R, Corsi, D, Cortese, F, Cui, Y, Damaskos, D, De'Angelis, N, Delibegovic, S, Demetrashvili, Z, De Simone, B, de Jonge, S, Di Bella, S, Di Saverio, S, Duane, T, Fugazzola, P, Galante, J, Ghnnam, W, Gkiokas, G, Gomes, C, Griffiths, E, Hardcastle, T, Hecker, A, Herzog, T, Karamarkovic, A, Khokha, V, Kim, P, Kim, J, Kirkpatrick, A, Kong, V, Koshy, R, Inaba, K, Isik, A, Ivatury, R, Labricciosa, F, Lee, Y, Leppaniemi, A, Litvin, A, Luppi, D, Maier, R, Marinis, A, Marwah, S, Mesina, C, Moore, E, Moore, F, Negoi, I, Olaoye, I, Ordonez, C, Ouadii, M, Peitzman, A, Perrone, G, Pintar, T, Pipitone, G, Podda, M, Rasa, K, Ribeiro, J, Rodrigues, G, Rubio-Perez, I, Sall, I, Sato, N, Sawyer, R, Shelat, V, Sugrue, M, Tarasconi, A, Tolonen, M, Viaggi, B, Celotti, A, Casella, C, Pagani, L, Dhingra, S, Baiocchi, G, Catena, F, Sartelli, Massimo, Coccolini, Federico, Kluger, Yoram, Agastra, Ervi, Abu-Zidan, Fikri M, Abbas, Ashraf El Sayed, Ansaloni, Luca, Adesunkanmi, Abdulrashid Kayode, Augustin, Goran, Bala, Miklosh, Baraket, Oussama, Biffl, Walter L, Ceresoli, Marco, Cerutti, Elisabetta, Chiara, Osvaldo, Cicuttin, Enrico, Chiarugi, Massimo, Coimbra, Raul, Corsi, Daniela, Cortese, Francesco, Cui, Yunfeng, Damaskos, Dimitri, De'Angelis, Nicola, Delibegovic, Samir, Demetrashvili, Zaza, De Simone, Belinda, de Jonge, Stijn W, Di Bella, Stefano, Di Saverio, Salomone, Duane, Therese M, Fugazzola, Paola, Galante, Joseph M, Ghnnam, Wagih, Gkiokas, George, Gomes, Carlos Augusto, Griffiths, Ewen A, Hardcastle, Timothy C, Hecker, Andrea, Herzog, Torsten, Karamarkovic, Aleksandar, Khokha, Vladimir, Kim, Peter K, Kim, Jae Il, Kirkpatrick, Andrew W, Kong, Victor, Koshy, Renol M, Inaba, Kenji, Isik, Arda, Ivatury, Rao, Labricciosa, Francesco M, Lee, Yeong Yeh, Leppäniemi, Ari, Litvin, Andrey, Luppi, Davide, Maier, Ronald V, Marinis, Athanasio, Marwah, Sanjay, Mesina, Cristian, Moore, Ernest E, Moore, Frederick A, Negoi, Ionut, Olaoye, Iyiade, Ordoñez, Carlos A, Ouadii, Mouaqit, Peitzman, Andrew B, Perrone, Gennaro, Pintar, Tadeja, Pipitone, Giuseppe, Podda, Mauro, Raşa, Kemal, Ribeiro, Julival, Rodrigues, Gabriel, Rubio-Perez, Ine, Sall, Ibrahima, Sato, Norio, Sawyer, Robert G, Shelat, Vishal G, Sugrue, Michael, Tarasconi, Antonio, Tolonen, Matti, Viaggi, Bruno, Celotti, Andrea, Casella, Claudio, Pagani, Leonardo, Dhingra, Sameer, Baiocchi, Gian Luca, Catena, Fausto, HUS Abdominal Center, II kirurgian klinikka, and University of Helsinki

Subjects
MESH, FOURNIERS GANGRENE, RD1-811, Soft Tissue Infections / surgery, Necrotizing infections, Necrotizing soft-tissue infections, Skin and soft-tissue infections, Critical Pathways, Humans, United States, Soft Tissue Infections, Review, DIAGNOSIS, NECROTIZING FASCIITIS, Skin and soft-tissue infection, MANAGEMENT, INTRAVENOUS IMMUNOGLOBULIN, RISK, HERNIA REPAIR, RC86-88.9, RESISTANT STAPHYLOCOCCUS-AUREUS, Medical emergencies. Critical care. Intensive care. First aid, Necrotizing infection, 3126 Surgery, anesthesiology, intensive care, radiology, ENDOSONOGRAPHY, Necrotizing soft-tissue infection, Emergency Medicine, Surgery
Abstract

Skin and soft-tissue infections (SSTIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections.Together, the World Society of Emergency Surgery, the Global Alliance for Infections in Surgery, the Surgical Infection Society-Europe, The World Surgical Infection Society, and the American Association for the Surgery of Trauma have jointly completed an international multi-society document to promote global standards of care in SSTIs guiding clinicians by describing reasonable approaches to the management of SSTIs.An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting evidence was shared by an international task force with different clinical backgrounds.

Published
2022

20. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections

Author

Cristian Mesina, Oussama Baraket, Arda Isik, Iyiade Olaoye, Tadeja Pintar, Wagih Ghnnam, Andreas Hecker, Ionut Negoi, Andrey Litvin, A R K Adesunkanmi, Julival Ribeiro, Stijn W. de Jonge, Norio Sato, Carlos Augusto Gomes, Manos Pikoulis, Federico Coccolini, Yeong Yeh Lee, Frederick A. Moore, Gustavo M. Machain, Francesco Cortese, Elif Colak, Luca Ansaloni, Daniela Corsi, Enrico Cicuttin, Fikri M. Abu-Zidan, Fausto Catena, Andrew W. Kirkpatrick, Raul Coimbra, I. A. Kryvoruchko, Chiara Gurioli, Paola Fugazzola, Gabriele Sganga, András Vereczkei, Sanjay Marwah, Kenji Inaba, Agron Dogjani, Antonio Tarasconi, Elisabetta Cerutti, Rao R. Ivatury, Ibrahima Sall, Michael Sugrue, Francesco M. Labricciosa, Marco Ceresoli, Renol M. Koshy, Jae Il Kim, Goran Augustin, Mauro Podda, Therese M. Duane, Katia Iskandar, Osvaldo Chiara, Dimitris Damaskos, Timothy Craig Hardcastle, Yunfeng Cui, Vishal G Shelat, Joel Noutakdie Tochie, Andrew B. Peitzman, Sameer Dhingra, Miklosh Bala, Ashraf Abbas, Samir Delibegovic, Leonardo Pagani, George Gkiokas, Claudio Casella, Mahir Gachabayov, Gabriel Rodrigues, Stefano Di Bella, Vladimir Khokha, Kemal Rasa, Nicola de’ Angelis, Ernest E. Moore, Robert G. Sawyer, Ronald V. Maier, Yoram Kluger, Ines Rubio-Perez, Victor Y. Kong, Gennaro Perrone, Francesco Di Marzo, Jan Ulrych, Gian Luca Baiocchi, Matti Tolonen, Athanasios Marinis, Cristina Marmorale, G. Tomadze, Peter K. Kim, Belinda De Simone, Aleksandar Karamarkovic, Ian Stephens, Mouaqit Ouadii, Massimo Sartelli, Davide Luppi, Boyko Atanasov, Helmut Alfredo Segovia Lohse, Ervis Agastra, Syed Mohammad Umar Kabir, Massimo Chiarugi, Carlos A. Ordoñez, Giuseppe Pipitone, Bruno Viaggi, Joseph M. Galante, Suman Baral, Ewen A. Griffiths, Mushira Enani, Marja A. Boermeester, Zaza Demetrashvili, Ari Leppäniemi, Torsten Herzog, Walter L. Biffl, Salomone Di Saverio, Sartelli, Massimo, Coccolini, Federico, Kluger, Yoram, Agastra, Ervi, Abu-Zidan, Fikri M, Abbas, Ashraf El Sayed, Ansaloni, Luca, Adesunkanmi, Abdulrashid Kayode, Atanasov, Boyko, Augustin, Goran, Bala, Miklosh, Baraket, Oussama, Baral, Suman, Biffl, Walter L, Boermeester, Marja A, Ceresoli, Marco, Cerutti, Elisabetta, Chiara, Osvaldo, Cicuttin, Enrico, Chiarugi, Massimo, Coimbra, Raul, Colak, Elif, Corsi, Daniela, Cortese, Francesco, Cui, Yunfeng, Damaskos, Dimitri, De' Angelis, Nicola, Delibegovic, Samir, Demetrashvili, Zaza, De Simone, Belinda, de Jonge, Stijn W, Dhingra, Sameer, Di Bella, Stefano, Di Marzo, Francesco, Di Saverio, Salomone, Dogjani, Agron, Duane, Therese M, Enani, Mushira Abdulaziz, Fugazzola, Paola, Galante, Joseph M, Gachabayov, Mahir, Ghnnam, Wagih, Gkiokas, George, Gomes, Carlos Augusto, Griffiths, Ewen A, Hardcastle, Timothy C, Hecker, Andrea, Herzog, Torsten, Kabir, Syed Mohammad Umar, Karamarkovic, Aleksandar, Khokha, Vladimir, Kim, Peter K, Kim, Jae Il, Kirkpatrick, Andrew W, Kong, Victor, Koshy, Renol M, Kryvoruchko, Igor A, Inaba, Kenji, Isik, Arda, Iskandar, Katia, Ivatury, Rao, Labricciosa, Francesco M, Lee, Yeong Yeh, Leppäniemi, Ari, Litvin, Andrey, Luppi, Davide, Machain, Gustavo M, Maier, Ronald V, Marinis, Athanasio, Marmorale, Cristina, Marwah, Sanjay, Mesina, Cristian, Moore, Ernest E, Moore, Frederick A, Negoi, Ionut, Olaoye, Iyiade, Ordoñez, Carlos A, Ouadii, Mouaqit, Peitzman, Andrew B, Perrone, Gennaro, Pikoulis, Mano, Pintar, Tadeja, Pipitone, Giuseppe, Podda, Mauro, Raşa, Kemal, Ribeiro, Julival, Rodrigues, Gabriel, Rubio-Perez, Ine, Sall, Ibrahima, Sato, Norio, Sawyer, Robert G, Segovia Lohse, Helmut, Sganga, Gabriele, Shelat, Vishal G, Stephens, Ian, Sugrue, Michael, Tarasconi, Antonio, Tochie, Joel Noutakdie, Tolonen, Matti, Tomadze, Gia, Ulrych, Jan, Vereczkei, Andra, Viaggi, Bruno, Gurioli, Chiara, Casella, Claudio, Pagani, Leonardo, Baiocchi, Gian Luca, Catena, Fausto, Sartelli, M, Coccolini, F, Kluger, Y, Agastra, E, Abu-Zidan, F, Abbas, A, Ansaloni, L, Adesunkanmi, A, Atanasov, B, Augustin, G, Bala, M, Baraket, O, Baral, S, Biffl, W, Boermeester, M, Ceresoli, M, Cerutti, E, Chiara, O, Cicuttin, E, Chiarugi, M, Coimbra, R, Colak, E, Corsi, D, Cortese, F, Cui, Y, Damaskos, D, de' Angelis, N, Delibegovic, S, Demetrashvili, Z, De Simone, B, de Jonge, S, Dhingra, S, Di Bella, S, Di Marzo, F, Di Saverio, S, Dogjani, A, Duane, T, Enani, M, Fugazzola, P, Galante, J, Gachabayov, M, Ghnnam, W, Gkiokas, G, Gomes, C, Griffiths, E, Hardcastle, T, Hecker, A, Herzog, T, Kabir, S, Karamarkovic, A, Khokha, V, Kim, P, Kim, J, Kirkpatrick, A, Kong, V, Koshy, R, Kryvoruchko, I, Inaba, K, Isik, A, Iskandar, K, Ivatury, R, Labricciosa, F, Lee, Y, Leppaniemi, A, Litvin, A, Luppi, D, Machain, G, Maier, R, Marinis, A, Marmorale, C, Marwah, S, Mesina, C, Moore, E, Moore, F, Negoi, I, Olaoye, I, Ordonez, C, Ouadii, M, Peitzman, A, Perrone, G, Pikoulis, M, Pintar, T, Pipitone, G, Podda, M, Rasa, K, Ribeiro, J, Rodrigues, G, Rubio-Perez, I, Sall, I, Sato, N, Sawyer, R, Segovia Lohse, H, Sganga, G, Shelat, V, Stephens, I, Sugrue, M, Tarasconi, A, Tochie, J, Tolonen, M, Tomadze, G, Ulrych, J, Vereczkei, A, Viaggi, B, Gurioli, C, Casella, C, Pagani, L, Baiocchi, G, Catena, F, HUS Abdominal Center, II kirurgian klinikka, and University of Helsinki

Subjects
Review, DAMAGE CONTROL LAPAROTOMY, Intra-abdominal infections, Peritonitis, Sepsis, Anti-Bacterial Agents, Critical Pathways, Humans, Treatment Outcome, Anti-Infective Agents, Intraabdominal Infections, 0302 clinical medicine, PERFORATED DIVERTICULITIS, Medicine, LAPAROSCOPIC CHOLECYSTECTOMY, Surgical approach, Iais, biology, Peritoniti, Anti-Infective Agents / therapeutic use, Medical emergencies. Critical care. Intensive care. First aid, 3. Good health, SURGICAL-TREATMENT, 030220 oncology & carcinogenesis, embryonic structures, Emergency Medicine, 030211 gastroenterology & hepatology, KLEBSIELLA-PNEUMONIAE, medicine.medical_specialty, RD1-811, Sepsi, MEDLINE, ANTIBIOTIC-THERAPY, 03 medical and health sciences, Intra-abdominal infection, Emergency surgery, Effective treatment, COMPUTED-TOMOGRAPHY, Intensive care medicine, Anti-Bacterial Agents / therapeutic use, Task force, business.industry, RC86-88.9, Abdominal Infection, SEPTIC SHOCK, Intraabdominal Infections / surgery, 3126 Surgery, anesthesiology, intensive care, radiology, biology.organism_classification, Review article, PRIMARY RESECTION, ACUTE COLONIC DIVERTICULITIS, Surgery, business, Intraabdominal Infections / drug therapy
Abstract

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The cornerstones of effective treatment of IAIs include early recognition, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using a critical care environment, combined with an optimal surgical approach. Together, the World Society of Emergency Surgery (WSES), the Global Alliance for Infections in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) have jointly completed an international multi-society document in order to facilitate clinical management of patients with IAIs worldwide building evidence-based clinical pathways for the most common IAIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting information was shared by an international task force from 46 countries with different clinical backgrounds. The aim of the document is to promote global standards of care in IAIs providing guidance to clinicians by describing reasonable approaches to the management of IAIs.

Published
2021

21. Pelvic trauma: WSES classification and guidelines

Author

Raul Coimbra, George C. Velmahos, Rao R. Ivatury, Giulia Montori, Osvaldo Chiara, Catherine Arvieux, Ernest E. Moore, Luca Ansaloni, Fausto Catena, Andrew B. Peitzman, Zsolt J. Balogh, Sandro Rizoli, Philip F. Stahel, Ari Leppäniemi, Yoram Kluger, Stefano Magnone, Federico Coccolini, Leonardo Solaini, Fikri M. Abu-Zidan, Tal M. Hörer, Andrew W. Kirkpatrick, Marco Ceresoli, Roberto Manfredi, Noel Naidoo, Niccolò Allievi, Massimo Sartelli, Bruno Pereira, Walter L. Biffl, Dieter G. Weber, Gustavo Pereira Fraga, Coccolini, Federico, Stahel, Philip F, Montori, Giulia, Biffl, Walter, Horer, Tal M, Catena, Fausto, Kluger, Yoram, Moore, Ernest E, Peitzman, Andrew B, Ivatury, Rao, Coimbra, Raul, Fraga, Gustavo Pereira, Pereira, Bruno, Rizoli, Sandro, Kirkpatrick, Andrew, Leppaniemi, Ari, Manfredi, Roberto, Magnone, Stefano, Chiara, Osvaldo, Solaini, Leonardo, Ceresoli, Marco, Allievi, Niccolò, Arvieux, Catherine, Velmahos, George, Balogh, Zsolt, Naidoo, Noel, Weber, Dieter, Abu-Zidan, Fikri, Sartelli, Massimo, Ansaloni, Luca, Coccolini, F, Stahel, P, Montori, G, Biffl, W, Horer, T, Catena, F, Kluger, Y, Moore, E, Peitzman, A, Ivatury, R, Coimbra, R, Fraga, G, Pereira, B, Rizoli, S, Kirkpatrick, A, Leppaniemi, A, Manfredi, R, Magnone, S, Chiara, O, Solaini, L, Ceresoli, M, Allievi, N, Arvieux, C, Velmahos, G, Balogh, Z, Naidoo, N, Weber, D, Abu-Zidan, F, Sartelli, M, and Ansaloni, L

Subjects
medicine.medical_treatment, Injury, Review, Guideline, External fixation, Fractures, Bone, 0302 clinical medicine, Injury Severity Score, Pelvic ring, Fracture Fixation, Fracture fixation, Medicine, Pelvic ring fracture, 030222 orthopedics, Angiography, Disease Management, 3. Good health, Management, medicine.anatomical_structure, Blunt trauma, Mechanic, Evidence-Based Practice, Emergency Medicine, medicine.medical_specialty, ABO, Guidelines as Topic, REBOA, Guidelines, Trauma, Pelvis, X-ray, 03 medical and health sciences, Internal fixation, Pelvic, Pelvic ring fractures, Preperitoneal pelvic packing, Hemodynamics, Humans, Wounds and Injuries, Bone, business.industry, General surgery, 030208 emergency & critical care medicine, Surgery, Pelvic trauma, body regions, business, Fractures
Abstract

Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

Published
2017

22. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

Author

Michael Sugrue, George C. Velmahos, Ferdinando Agresta, Kurinchi Selvan Gurusamy, Ari Leppäniemi, Walter L. Biffl, Arianna Birindelli, Steve De Castro, Ewen A. Griffiths, Massimo Sartelli, Zsolt J. Balogh, M. D. Kelly, Roberto Persiani, Mark De Moya, Frederick A. Moore, Cino Bendinelli, Gustavo Pereira Fraga, Fausto Catena, Aneel Bhangu, Kjetil Søreide, Fabio Cesare Campanile, Manne Andersson, Luca Ansaloni, Rao R. Ivatury, Jeffry L. Kashuk, Salomone Di Saverio, Elio Jovine, Antonio Biondi, David W da Costa, Carlos Augusto Gomes, Osvaldo Chiara, Sandro Rizoli, Gregorio Tugnoli, Roberto Cirocchi, Ronald V. Maier, Thomas M. Scalea, Dieter G. Weber, Andrew B. Peitzman, Valeria Tonini, Philip F. Stahel, Yoram Kluger, Roland Andersson, Federico Coccolini, Alice Piccinini, Raul Coimbra, Ernest E. Moore, Di Saverio, Salomone, Birindelli, Arianna, Kelly, Micheal D, Catena, Fausto, Weber, Dieter G, Sartelli, Massimo, Sugrue, Michael, De Moya, Mark, Gomes, Carlos Augusto, Bhangu, Aneel, Agresta, Ferdinando, Moore, Ernest E, Soreide, Kjetil, Griffiths, Ewen, De Castro, Steve, Kashuk, Jeffry, Kluger, Yoram, Leppaniemi, Ari, Ansaloni, Luca, Andersson, Manne, Coccolini, Federico, Coimbra, Raul, Gurusamy, Kurinchi S, Campanile, Fabio Cesare, Biffl, Walter, Chiara, Osvaldo, Moore, Fred, Peitzman, Andrew B, Fraga, Gustavo P, Costa, David, Maier, Ronald V, Rizoli, Sandro, Balogh, Zsolt J, Bendinelli, Cino, Cirocchi, Roberto, Tonini, Valeria, Piccinini, Alice, Tugnoli, Gregorio, Jovine, Elio, Persiani, Roberto, Biondi, Antonio, Scalea, Thoma, Stahel, Philip, Ivatury, Rao, Velmahos, George, and Andersson, Roland

Subjects
medicine.medical_specialty, Settore MED/18 - CHIRURGIA GENERALE, Non-operative management, MEDLINE, Review, Complicated appendiciti, 030230 surgery, Guidelines, Guideline, Acute Appendiciti, law.invention, 03 medical and health sciences, 0302 clinical medicine, Phlegmon, Acute Appendicitis, Guidelines, Consensus Conference, Alvarado Score, Appendicitis diagnosis score, Non-operative management, Antibiotics, Complicated appendicitis, Appendectomy, Laparoscopic appendectomy, Phlegmon, Appendiceal abscess, Randomized controlled trial, Laparoscopic appendectomy, law, Acute Appendicitis, Antibiotics, medicine, Appendectomy, Abscess, Appendiceal abscess, Appendicitis diagnosis score, Appendiceal absce, Complicated appendicitis, business.industry, General surgery, Kirurgi, Antibiotic, medicine.disease, Alvarado Score, Consensus Conference, Appendicitis, 3. Good health, Surgery, Alvarado score, 030220 oncology & carcinogenesis, Acute appendicitis, Emergency Medicine, business
Abstract

Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.

Published
2016

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