Publications by authors named "Fikri Abu-Zidan"

265 Publications

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

World J Emerg Surg 2022 Jan 15;17(1). Epub 2022 Jan 15.

Department of Surgery, Texas Health Resources, Ft Worth, TX, USA.

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.
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http://dx.doi.org/10.1186/s13017-022-00406-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8761341PMC
January 2022

Kuala Lumpur train collision during the COVID-19 pandemic.

World J Emerg Surg 2022 Jan 11;17(1). Epub 2022 Jan 11.

Department of Emergency Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.

Background: Two city trains collided in an underground tunnel on 24 May 2021 at the height of COVID-19 pandemic near the Petronas Towers, Kuala Lumpur, Malaysia, immediately after the evening rush hours. We aim to evaluate the management of this mass casualty incident highlighting the lessons learned to be used in preparedness for similar incidents that may occur in other major cities worldwide.

Methods: Information regarding incident site and hospital management response were analysed. Data on demography, triaging, injuries and hospital management of patients were collected according to a designed protocol. Challenges, difficulties and their solutions were reported.

Results: The train's emergency response team (ERT) has shut down train movements towards the incident site. Red zone (in the tunnel), yellow zone (the station platform) and green zone (outside the station entrance) were established. The fire and rescue team arrived and assisted the ERT in the red zone. Incident command system was established at the site. Medical base station was established at the yellow zone. Two hundred and fourteen passengers were in the trains. Sixty-four of them were injured. They had a median (range) ISS of 2 (1-43), and all were sent to Hospital Kuala Lumpur (HKL). Six (9.4%) patients were clinically triaged as red (critical), 19 (29.7%) as yellow (semi-critical) and 39 (60.9%) as green (non-critical). HKL's disaster plan was activated. All patients underwent temperature and epidemiology link assessment. Seven (10.9%) patients were admitted to the hospital (3 to the ICU, 3 to the ward and 1 to a private hospital as requested by the patient), while the rest 56 (87.5%) were discharged home. Six (9.4%) needed surgery. The COVID-19 tests were conducted on seven patients (10.9%) and were negative. There were no deaths.

Conclusions: The mass casualty incident was handled properly because of a clear standard operating procedure, smooth coordination between multi-agencies and the hospitals, presence of a 'binary' system for 'COVID-risk' and 'non-COVID-risk' areas, and the modifications of the existing disaster plan. Preparedness for MCIs is essential during pandemics.
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http://dx.doi.org/10.1186/s13017-022-00405-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8748182PMC
January 2022

Risks for bicycle-related injuries in Al Ain city, United Arab Emirates: An observational study.

Medicine (Baltimore) 2021 Nov;100(44):e27639

Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.

Abstract: Traffic-related injuries are a serious health problem. Traffic safety is a priority reflected in the United Nations Sustainable Development Goals. Data on current hazards for bicycle-related injuries from the United Arab Emirates are lacking. The aim of our observational study was to assess the behavior of bicyclists on the roads in Al Ain City, United Arab Emirates and compare our current results with a previous study from 2004.We adapted and tested a structured data collection form. Different sectors of Al Ain were randomly selected to cover the whole city during different times. Bicyclists were observed without direct contact.Out of 1129 bicyclists, 97.6% were males and 13.2% children. 39.4% were cycling on main roads with high-density traffic, 33.1% were cycling against the traffic, 39.3% were cycling at night, and 96.8% of them were not using lights. Only 2.1% of the bicyclists used helmets. A higher proportion of female than male cyclists used helmets (25.9% vs 1.5%; P < .001, Fisher exact test). There was an increase in cycling with the traffic (P < .001) and in use of helmets (P < .025) compared with the previous study.Unsafe practices of bicyclists and low use of helmets despite legislation persist in Al Ain. There is a need to raise bicycle safety awareness and improve enforcement of bicycle helmet legislation. This should be directed toward expatriate workers, children, parents, and maids. Environmental changes, namely building separate bicycle lanes, can increase safety for cycling.
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http://dx.doi.org/10.1097/MD.0000000000027639DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8568463PMC
November 2021

Impact of the COVID-19 Pandemic on road traffic collision injury patterns and severity in Al-Ain City, United Arab Emirates.

World J Emerg Surg 2021 Nov 19;16(1):57. Epub 2021 Nov 19.

Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.

Background: The COVID-19 Pandemic lockdowns restricted human and traffic mobility impacting the patterns and severity of road traffic collisions (RTCs). We aimed to study the effects of the COVID-19 Pandemic on incidence, patterns, severity of the injury, and outcomes of hospitalized RTCs trauma patients in Al-Ain City, United Arab Emirates.

Methods: We compared the data of two cohorts of patients which were collected over two periods; the Pandemic period (28 March 2020 to 27 March 2021) and the pre-pandemic period (28 March 2019 to 27 March 2020). All RTCs trauma patients who were hospitalized in the two major trauma centers (Al-Ain and Tawam Hospitals) of Al-Ain City were studied.

Results: Overall, the incidence of hospitalized RTC trauma patients significantly reduced by 33.5% during the Pandemic compared with the pre-pandemic period. The mechanism of injury was significantly different between the two periods (p < 0.0001, Fisher's Exact test). MVCs were less during the Pandemic (60.5% compared with 72%), while motorcycle injuries were more (23.3% compared with 11.2%). The mortality of hospitalized RTC patients was significantly higher during the Pandemic (4.4% compared with 2.3%, p = 0.045, Fisher's Exact test). Logistic regression showed that the significant factors that predicted mortality were the low GCS (p < 0.0001), admission to the ICU (p < 0.0001), and the high ISS (p = 0.045). COVID-19 Pandemic had a very strong trend (p = 0.058) for increased mortality.

Conclusions: Our study has shown that the numbers of hospitalized RTC trauma patients reduced by 33.5% during the COVID-19 Pandemic compared with the pre-pandemic period in our setting. This was attributed to the reduced motor vehicle, pedestrian and bicycle injuries while motorcycle injuries increased. Mortality was significantly higher during the Pandemic, which was attributed to increased ISS and reduced GCS.
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http://dx.doi.org/10.1186/s13017-021-00401-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8602977PMC
November 2021

Global impact of COVID-19 pandemic on road traffic collisions.

World J Emerg Surg 2021 09 28;16(1):51. Epub 2021 Sep 28.

Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.

Background: Various strategies to reduce the spread of COVID-19 including lockdown and stay-at-home order are expected to reduce road traffic characteristics and consequently road traffic collisions (RTCs). We aimed to review the effects of the COVID-19 pandemic on the incidence, patterns, and severity of the injury, management, and outcomes of RTCs and give recommendations on improving road safety during this pandemic.

Methods: We conducted a narrative review on the effects of COVID-19 pandemic on RTCs published in English language using PubMed, Scopus, and Google Scholar with no date restriction. Google search engine and websites were also used to retrieve relevant published literature, including discussion papers, reports, and media news. Papers were critically read and data were summarized and combined.

Results: Traffic volume dropped sharply during the COVID-19 pandemic which was associated with significant drop in RTCs globally and a reduction of road deaths in 32 out of 36 countries in April 2020 compared with April 2019, with a decrease of 50% or more in 12 countries, 25 to 49% in 14 countries, and by less than 25% in six countries. Similarly, there was a decrease in annual road death in 33 out of 42 countries in 2020 compared with 2019, with a reduction of 25% or more in 5 countries, 15-24% in 13 countries, and by less than 15% in 15 countries. In contrast, the opposite occurred in four and nine countries during the periods, respectively. There was also a drop in the number of admitted patients in trauma centers related to RTCs during both periods. This has been attributed to an increase in speeding, emptier traffic lanes, reduced law enforcement, not wearing seat belts, and alcohol and drug abuse.

Conclusions: The COVID-19 pandemic has generally reduced the overall absolute numbers of RTCs, and their deaths and injuries despite the relative increase of severity of injury and death. The most important factors that affected the RTCs are decreased mobility with empty lines, reduced crowding, and increased speeding. Our findings serve as a baseline for injury prevention in the current and future pandemics.
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http://dx.doi.org/10.1186/s13017-021-00395-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8478263PMC
September 2021

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

World J Emerg Surg 2021 Sep 25;16(1):49. Epub 2021 Sep 25.

Department of general, Digestive and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal De Poissy/St Germain en Laye, Poissy, France.

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.
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http://dx.doi.org/10.1186/s13017-021-00387-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8467193PMC
September 2021

Anorectal emergencies: WSES-AAST guidelines.

World J Emerg Surg 2021 Sep 16;16(1):48. Epub 2021 Sep 16.

Department of Surgery, Fundacion Valle del Lili - Universidad del Valle, Cali, Colombia.

Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies.The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
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http://dx.doi.org/10.1186/s13017-021-00384-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8447593PMC
September 2021

Current changes in the epidemiology of fall-related injuries in Al Ain City, United Arab Emirates.

PLoS One 2021 16;16(9):e0257398. Epub 2021 Sep 16.

Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, Ain, United Arab Emirates.

Background: Falls in the Gulf countries are the second most common cause of injuries. The United Arab Emirates government implemented various preventive measures to decrease injuries in the country. We aimed to evaluate the changes in the epidemiology of fall-related injuries in Al-Ain City over the last decade.

Methods: Data of hospitalized patients who presented with fall-related injuries to the Al-Ain Hospital during the two periods of March 2003 to March 2006 and January 2014 to December 2017 were compared. This included patients' demographics, mechanism, location, anatomical distribution and parameters related to injury severity. Non-parametric tests were used for the statistical analysis.

Results: 882 in the first and 1358 patients in the second period were studied. The incidence of falls decreased by 30.5% over ten years. The number of elderly, female patients, and UAE nationals increased, (p < 0.001, p = 0.004, and p < 0.001). Falls from height decreased by 32.5% (p < 0.001) while fall on the same level increased by 22.5% (p < 0.001). Fall-related injuries at home have increased significantly by 22.6% (p <0.001), while falls in workplaces decreased by 24.4% (p <0.001).

Conclusions: Our study showed that the overall incidence of falls decreased compared to a decade ago. The preventive measures were effective in reducing falls from height and workplace injuries. Future preventive measures should target falls at the same level and homes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257398PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8445427PMC
November 2021

A pandemic recap: lessons we have learned.

World J Emerg Surg 2021 09 10;16(1):46. Epub 2021 Sep 10.

Division of Trauma, Emergency Surgery, and Surgical Critical Care, LAC+USC Medical Center, Los Angeles, USA.

On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.
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http://dx.doi.org/10.1186/s13017-021-00393-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430288PMC
September 2021

Point-of-care ultrasound (POCUS) practices in the helicopter emergency medical services in Europe: results of an online survey.

Scand J Trauma Resusc Emerg Med 2021 Aug 26;29(1):124. Epub 2021 Aug 26.

Department of Surgery, College of Medicine and Health Science, UAE University, Al-Ain, United Arab Emirates.

Background: The extent to which Point-of-care of ultrasound (POCUS) is used in different European helicopter EMS (HEMS) is unknown. We aimed to study the availability, perception, and future aspects of POCUS in the European HEMS using an online survey.

Method: A survey about the use of POCUS in HEMS was conducted by a multinational steering expert committee and was carried out from November 30, 2020 to December 30, 2020 via an online web portal. Invitations for participation were sent via email to the medical directors of the European HEMS organizations including two reminding notes.

Results: During the study period, 69 participants from 25 countries and 41 different HEMS providers took part in the survey. 96% (n = 66) completed the survey. POCUS was available in 75% (56% always when needed and 19% occasionally) of the responding HEMS organizations. 17% were planning to establish POCUS in the near future. Responders who provided POCUS used it in approximately 15% of the patients. Participants thought that POCUS is important in both trauma and non-trauma-patients (73%, n = 46). The extended focused assessment sonography for trauma (eFAST) protocol (77%) was the most common protocol used. A POCUS credentialing process including documented examinations was requested in less than one third of the HEMS organizations.

Conclusions: The majority of the HEMS organizations in Europe are able to provide different POCUS protocols in their services. The most used POCUS protocols were eFAST, FATE and RUSH. Despite the enthusiasm for POCUS, comprehensive training and clear credentialing processes are not available in about two thirds of the European HEMS organizations. Due to several limitations of this survey further studies are needed to evaluate POCUS in HEMS.
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http://dx.doi.org/10.1186/s13049-021-00933-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8390051PMC
August 2021

Invited Editorial. COVID-19 Vaccine: Hope and reality.

Afr Health Sci 2020 12;20(4):1507-1509

Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.

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http://dx.doi.org/10.4314/ahs.v20i4.3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351852PMC
December 2020

Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines.

World J Emerg Surg 2021 08 9;16(1):40. Epub 2021 Aug 9.

General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.

Immunocompromised patients are a heterogeneous and diffuse category frequently presenting to the emergency department with acute surgical diseases. Diagnosis and treatment in immunocompromised patients are often complex and must be multidisciplinary. Misdiagnosis of an acute surgical disease may be followed by increased morbidity and mortality. Delayed diagnosis and treatment of surgical disease occur; these patients may seek medical assistance late because their symptoms are often ambiguous. Also, they develop unique surgical problems that do not affect the general population. Management of this population must be multidisciplinary.This paper presents the World Society of Emergency Surgery (WSES), Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), and Global Alliance for Infection in Surgery (GAIS) joined guidelines about the management of acute abdomen in immunocompromised patients.
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http://dx.doi.org/10.1186/s13017-021-00380-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8352154PMC
August 2021

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy.

World J Emerg Surg 2021 06 10;16(1):30. Epub 2021 Jun 10.

Rothschild Hospital, AP-HP, Paris, and Université de Paris, Paris, France.

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.
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http://dx.doi.org/10.1186/s13017-021-00369-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190978PMC
June 2021

Epidemiological changes of geriatric trauma in the United Arab Emirates.

Medicine (Baltimore) 2021 Jun;100(22):e26258

Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.

Abstract: We aimed to study the epidemiological changes in geriatric trauma in Al-Ain City, United Arab Emirates, in the past decade to give recommendations on injury prevention.Trauma patients aged 65 years and above who were hospitalized at Al-Ain Hospital for more than 24 hours or died in the hospital after their arrival regardless of the length of stay were studied. Data were extracted from the Al-Ain Hospital trauma registry. Two periods were compared; March 2003 to March 2006 and January 2014 to December 2017. Studied variables which were compared included demography, mechanism of injury and its location, and clinical outcome.There were 66 patients in the first period and 200 patients in the second period. The estimated annual incidence of hospitalized geriatric trauma patients in Al-Ain City was 8.5 per 1000 geriatric inhabitants in the first period compared with 7.8 per 1000 geriatric inhabitants in the second period. Furthermore, mortality was reduced from 7.6% to 2% (P = 0.04). There was a significant increase in falls on the same level by14.9% (62.1%-77%, P = 0.02, Pearson χ2 test). This was associated with a significant increase of injuries occurring at home (55.4%-78.7% P = 0.0003, Fisher Exact test). There was also a strong trend in the reduction of road traffic collision injuries which was reduced by 10.8% (27.3%-16.5%, P = 0.07, Fisher Exact test).Although the incidence and severity of geriatric trauma did not change over the last decade, in-hospital mortality has significantly decreased over time. There was a significant increase in injuries occurring at homes and in falls on the same level. The home environment should be targeted in injury prevention programs so as to reduce geriatric injuries.
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http://dx.doi.org/10.1097/MD.0000000000026258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183772PMC
June 2021

Management of abdominal tuberculosis in a community-based hospital in a high-income developing country.

World J Emerg Surg 2021 05 26;16(1):25. Epub 2021 May 26.

Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE.

Background: The delayed diagnosis and management of abdominal tuberculosis increases its mortality. We aimed to study the clinical presentation, management, and outcome of patients who had abdominal tuberculosis and were treated at Al-Ain Hospital, Al-Ain City, United Arab Emirates.

Methods: All patients who had abdominal tuberculosis and were treated at Al-Ain Hospital between January 2011 and December 2018 were studied. Data were collected retrospectively using a structured protocol including demography, clinical presentation, diagnostic methods, management, and outcome.

Results: Twenty-four patients having a median age of 30 years were studied with an incidence of 0.6/100,000 population. The most common symptoms were abdominal pain (95.8%) and malaise (79.2%). Fever was present only in nine patients (37.5%). Laboratory investigations, except for polymerase chain reaction immunoassay, were not helpful. Chest X-ray was abnormal in three patients (12.5%). Ultrasound and abdominal CT scan were non-specific. Thirteen patients needed surgical intervention for diagnosis or therapy. Diagnosis was confirmed by histopathology in 15 patients (62.5%), immunological assays in 7 patients (29.2%), microbiological culture in 1 patient (4%), and therapeutic trial in 1 patient (4%). The most common type of abdominal tuberculosis was gastrointestinal in 13 patients (54.2%) followed by free wet peritonitis in 5 patients (20.8%). All patients had quadruple anti-tuberculous therapy for a minimum of 6 months. The median hospital stay was 6.5 days. None of our patients died.

Conclusions: Diagnosis of abdominal tuberculosis remains challenging despite advances in medical technology and diagnostic tools. The limited need for diagnostic therapy in our study supports the benefit of PCR assay. Surgery was mainly indicated as the last option to reach the diagnosis or to treat complications.
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http://dx.doi.org/10.1186/s13017-021-00370-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8153524PMC
May 2021

COVID-19 knowledge, attitudes, and practices of United Arab Emirates medical and health sciences students: A cross sectional study.

PLoS One 2021 12;16(5):e0246226. Epub 2021 May 12.

Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.

The COVID-19 pandemic is the largest viral pandemic of the 21st century. We aimed to study COVID-19 knowledge, attitudes, and practices (KAP) among medical and health sciences students in the United Arab Emirates (UAE). We performed a cross-sectional study between 2 June and 19 August 2020. The survey was distributed online using Survey Monkey. It was conducted in English and comprised two parts: socio-demographic characteristics, and KAP towards COVID-19. 712 responses to the questionnaire were collected. 90% of respondents (n = 695) were undergraduate students, while 10% (n = 81) were postgraduates. The majority (87%, n = 647) stated that they obtained COVID-19 information from multiple reliable sources. They were highly knowledgeable about the COVID-19 pandemic, but 76% (n = 539) did not recognize its routes of transmission. Medical students were significantly more knowledgeable compared with allied health students (P<0.0001, Mann Whitney U test) but there was no difference in knowledge between undergraduate and postgraduate students (P = 0.14, Mann Whitney U test). Medical students thought that more could be done to mitigate the COVID-19 situation compared with the allied health students (66.2% compared with 51.6%, p = 0.002 Fisher's Exact test). 63% (n = 431) were worried about getting COVID-19 infection, while 92% (n = 633)) were worried that a family member could be infected with the virus. 97% (n = 655) took precautions when accepting home deliveries, 94% (n = 637) had been washing their hands more frequently, and 95% (n = 643) had been wearing face masks. In conclusion, medical and health sciences students in the UAE showed high levels of knowledge and good attitudes and practices towards the COVID-19 pandemic. Nevertheless, they were worried about themselves or their family members becoming infected. Medical students had more knowledge about COVID-19 pandemic which was reflected in their opinion that more can be done to mitigate its effects.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246226PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115851PMC
June 2021

WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting.

World J Emerg Surg 2021 05 11;16(1):23. Epub 2021 May 11.

Department of Surgical Sciences, Policlinico Sant'Orsola Malpighi, Bologna, Italy.

Background: Despite the current therapeutic options for the treatment of inflammatory bowel disease, surgery is still frequently required in the emergency setting, although the number of cases performed seems to have decreased in recent years. The World Society of Emergency Surgery decided to debate in a consensus conference of experts, the main pertinent issues around the management of inflammatory bowel disease in the emergent situation, with the need to provide focused guidelines for acute care and emergency surgeons.

Method: A group of experienced surgeons and gastroenterologists were nominated to develop the topics assigned and answer the questions addressed by the Steering Committee of the project. Each expert followed a precise analysis and grading of the studies selected for review. Statements and recommendations were discussed and voted at the Consensus Conference of the 6th World Society of Emergency Surgery held in Nijmegen (The Netherlands) in June 2019.

Conclusions: Complicated inflammatory bowel disease requires a multidisciplinary approach because of the complexity of this patient group and disease spectrum in the emergency setting, with the aim of obtaining safe surgery with good functional outcomes and a decreasing stoma rate where appropriate.
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http://dx.doi.org/10.1186/s13017-021-00362-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111988PMC
May 2021

Is focused assessment with sonography for trauma useful in patients with pelvic fractures?

J Trauma Acute Care Surg 2021 07;91(1):e35-e36

Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.

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http://dx.doi.org/10.1097/TA.0000000000003221DOI Listing
July 2021

Disaster management of the psychological impact of the COVID-19 pandemic.

Int J Emerg Med 2021 Mar 24;14(1):19. Epub 2021 Mar 24.

Department of Psychiatry and Behavioral Sciences, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.

Background: The COVID-19 pandemic has exposed a suboptimal response to this threatening global disaster, including the response to the psychological impact. Both the economic hardship and the continuous media coverage of alarming news have exacerbated this effect which also includes increased domestic violence.

Aim: To address this important aspect of disaster management and provide recommendations on how to mitigate these effects.

Methods: This is a narrative review written by three experts in community medicine, disaster medicine and psychiatry reflecting the interdisciplinary approach in managing disasters. Selected important papers, personal published papers, PUBMED articles and media news related to the disaster management of the psychological effects of COVID-19 pandemic were collected over the last year, critically appraised and used in writing this manuscript.

Results: The COVID-19 pandemic causes major emotional distress. Lack of effective treatments and availability of the current vaccines for this virus increases the fear of being infected and infecting others. Negative emotions are common and are related to adjustment but may progress in the long term to anxiety, depression, and post-traumatic stress syndrome. The COVID-19 pandemic has a major impact on mental health. The most common distress reactions include anxiety, insomnia, perception of insecurity, anger, fear of illness, and risky behaviors. Patients having mental disorders are vulnerable during the pandemic because of (1) somatic vulnerability, (2) cognitive and behavioral vulnerability, (3) psychosocial vulnerability, and (4) disruption to psychiatric care. Psychiatric wards, which are commonly separate from main hospitals, should be included in the disaster management plans. Acute care physicians carry the psychological and ethical impact of difficult triage decisions when ending the support of some patients to save others. A combination of fear and guilt may overcome normal human tolerance levels in vulnerable health workers. The moral injuries can be carried for a long time.

Conclusions: Addressing the psychological effects is an essential component of disaster management of infectious pandemics. This should be implemented through the whole spectrum of disaster management including preparedness, mitigation, response, and recovery.
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http://dx.doi.org/10.1186/s12245-021-00342-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988636PMC
March 2021

The management of surgical patients in the emergency setting during COVID-19 pandemic: the WSES position paper.

World J Emerg Surg 2021 03 22;16(1):14. Epub 2021 Mar 22.

Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy.

Background: Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers.

Method: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology.

Results: Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts' opinion.

Conclusions: The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.
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http://dx.doi.org/10.1186/s13017-021-00349-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983964PMC
March 2021

A mandatory Emergency Medicine clerkship influences students' career choices in a developing system.

Afr J Emerg Med 2021 Mar 3;11(1):70-73. Epub 2020 Sep 3.

Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.

Background: Attracting medical students for a front-line specialty, Emergency Medicine, is challenging in many countries. The available literature is scarce and bounded to the mature emergency care and education systems. In the countries where emergency medicine is a new specialty and has different contextual needs, the perception of the students and their career interest in emergency medicine specialty is an unanswered question.

Objective: We aimed to study the effects of a mandatory Emergency Medicine (EM) clerkship on students' perceptions and their future career choice to be emergency physicians.

Methods: A voluntary de-identified survey was prospectively collected before and after the EM clerkship to capture students' perceptions in four domains (EM clerkship, EM physicians, EM patients, and EM specialty as a career choice). The survey included 24 statements having five-point Likert scale for each statement. Non-parametric Wilcoxon signed rank test was used for statistical analysis.

Results: Sixty-seven students responded to both surveys (response rate of 85%). Students' perceptions have significantly improved on the EM physicians, and their job after attending the clerkship ( < 0.001). They found EM a respected ( = 0.038), flexible ( < 0.001), secure (p < 0.001), satisfying, and prestigious ( = 0.006) job. They found EM physicians compassionate ( < 0.011), have adequate patient contact ( < 0.045) and control on their time (0.004). Choosing EM as a future career has significantly increased after clerkship (p < 0.001).

Conclusions: Our mandatory EM clerkship significantly improved students' perceptions on EM specialty as a future career choice. A well-structured and mandatory EM clerkship can attract more students to be trained in the EM.
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http://dx.doi.org/10.1016/j.afjem.2020.08.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910188PMC
March 2021

Trauma quality indicators: internationally approved core factors for trauma management quality evaluation.

World J Emerg Surg 2021 02 23;16(1). Epub 2021 Feb 23.

General Surgery, Brescia University Hospital, Brescia, Italy.

Introduction: Quality in medical care must be measured in order to be improved. Trauma management is part of health care, and by definition, it must be checked constantly. The only way to measure quality and outcomes is to systematically accrue data and analyze them.

Material And Methods: A systematic revision of the literature about quality indicators in trauma associated to an international consensus conference RESULTS: An internationally approved base core set of 82 trauma quality indicators was obtained: Indicators were divided into 6 fields: prevention, structure, process, outcome, post-traumatic management, and society integrational effects.

Conclusion: Present trauma quality indicator core set represents the result of an international effort aiming to provide a useful tool in quality evaluation and improvement. Further improvement may only be possible through international trauma registry development. This will allow for huge international data accrual permitting to evaluate results and compare outcomes.
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http://dx.doi.org/10.1186/s13017-021-00350-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901006PMC
February 2021

Revised Injury Severity Classification II (RISC II) is a predictor of mortality in REBOA-managed severe trauma patients.

PLoS One 2021 10;16(2):e0246127. Epub 2021 Feb 10.

Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

The evidence supporting the use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in severely injured patients is still debatable. Using the ABOTrauma Registry, we aimed to define factors affecting mortality in trauma REBOA patients. Data from the ABOTrauma Registry collected between 2014 and 2020 from 22 centers in 13 countries globally were analysed. Of 189 patients, 93 died (49%) and 96 survived (51%). The demographic, clinical, REBOA criteria, and laboratory variables of these two groups were compared using non-parametric methods. Significant factors were then entered into a backward logistic regression model. The univariate analysis showed numerous significant factors that predicted death including mechanism of injury, ongoing cardiopulmonary resuscitation, GCS, dilated pupils, systolic blood pressure, SPO2, ISS, serum lactate level and Revised Injury Severity Classification (RISCII). RISCII was the only significant factor in the backward logistic regression model (p < 0.0001). The odds of survival increased by 4% for each increase of 1% in the RISCII. The best RISCII that predicted 30-day survival in the REBOA treated patients was 53.7%, having a sensitivity of 82.3%, specificity of 64.5%, positive predictive value of 70.5%, negative predictive value of 77.9%, and usefulness index of 0.385. Although there are multiple significant factors shown in the univariate analysis, the only factor that predicted 30-day mortality in REBOA trauma patients in a logistic regression model was RISCII. Our results clearly demonstrate that single variables may not do well in predicting mortality in severe trauma patients and that a complex score such as the RISC II is needed. Although a complex score may be useful for benchmarking, its clinical utility can be hindered by its complexity.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246127PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875379PMC
July 2021

Eye injuries caused by date palm thorns and leaves.

Saudi J Ophthalmol 2020 Jan-Mar;34(1):13-17. Epub 2020 Nov 22.

Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box: 17666, Al-Ain, United Arab Emirates.

Purpose: To describe the clinical presentation, management, and outcome of hospitalized patients having date palm tree eye injuries.

Methods: This is a retrospective study of consecutive patients who were admitted to Al-Ain hospital following date palm tree eye injuries between 2012 and 2017. Patients' demography, symptoms and signs at presentation, surgical intervention, visual acuity (VA) before and after treatment, hospital stay, and causes for VA limitation were studied.

Results: Sixteen patients were studied. Their median (range) age was 38.5 (7-58) years, all were males. Majority (87.5%) were from the Indian subcontinent and had their injuries at farms. Eye pain (94 %) was the most common presenting symptom while keratitis (62.5%) and corneal perforation (43.8%) were the most common physical findings. Vision showed a statistical trend for improvement after treatment ( = 0.1, Wilcoxon singed rank test). Five patients (31%) were blind in the injured eye.

Conclusion: Palm date tree eye injuries which mainly occur at farms are a significant cause for visual loss at United Arab Emirates (UAE). Use of eyes protective goggles combined with legislative eye safety regulations will reduce palm tree eye injuries.
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http://dx.doi.org/10.4103/1319-4534.301296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849857PMC
November 2020

Do young patients with high clinical suspicion of appendicitis really need cross-sectional imaging? Proceedings from a highly controversial debate among the experts' panel of 2020 WSES Jerusalem guidelines.

J Trauma Acute Care Surg 2021 05;90(5):e101-e107

From the Department of Emergency Surgery (M.P., A.P.), Azienda Ospedaliero-Universitaria di Cagliari, University Hospital Policlinico Duilio Casula, Cagliari, Italy; Department of Surgery (R.A.), Linkoping University, Linkoping, Sweden; Department of Surgery (M.B.), University of Amsterdam, Amsterdam, The Netherlands; General, Emergency and Trauma Surgery (F.C.), Pisa University Hospital, Pisa, Italy; Department of Surgery (M.S.), Macerata Hospital, Macerata, Italy; Denver Health System-Denver Health Medical Center (E.E.M.), Denver, Colorado; Department of Surgery (M.S.), Letterkenny Hospital, Donegal, Ireland; Department of Surgery (F.A.-Z.), College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates; Department of Abdominal Surgery (M.T., A.L.), Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Department of Upper GI Surgery (D.D.), Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom; Division of General Surgery (Y.K.), Rambam Health Care Campus, Haifa, Israel; Department of Gastrointestinal Surgery (K.S.), Stavanger University Hospital, Stavanger, Norway; Department of Surgery (G.A.), University Hospital Centre of Zagreb, Zagreb, Croatia; Section of Acute Care Surgery, Westchester Medical Center, Department of Surgery (R.L.), New York Medical College, Valhalla, New York; Acute Surgical Unit (M.K.), Canberra Hospital, ACT, Canberra, Australia; Faculdade de Ciências Médicas (FCM)-Unicamp, Campinas (G.P.F.), SP, Brazil; Department of Surgery (R.T.B., E.T., H.V.G.), Radboud University Medical Center, Nijmegen, The Netherlands; Niguarda Hospital Trauma Center (O.C.), Milan, Italy; Department of Surgery (R.V.M.), University of Washington, Harborview Medical Center, Seattle, Washington; Department of Surgery (F.P.), Nicola Giannettasio Hospital, Corigliano-Rossano, and La Sapienza University o Rome, Rome, Italy; Department of Visceral Surgery (B.D.S.), Centre Hospitalier Intercommunal Poissy/Saint-Germain-en-Laye, Poissy, France; Division of Trauma and Acute Care Surgery, Department of General Surgery (C.A.O.), Fundación Valle del Lili, Cali, Colombia; Department of General Surgery and Trauma (L.A.), Bufalini Hospital, Cesena, Italy; Emergency and Trauma Surgery Department (F.C.), Maggiore Hospital of Parma, Parma, Italy; and Department of General Surgery (S.D.S.), University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Varese, Italy.

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http://dx.doi.org/10.1097/TA.0000000000003097DOI Listing
May 2021

Establishment of an Undergraduate FOAM Initiative: International Emergency Medicine (iEM) Education Project for Medical Students.

West J Emerg Med 2020 Dec 16;22(1):63-70. Epub 2020 Dec 16.

United Arab Emirates University, College of Medicine and Health Sciences, Department of Surgery, Al Ain, United Arab Emirates.

Introduction: Our goal was to describe the structure, process, platforms, and piloting period activities of the International Emergency Medicine (iEM) Education Project, which is a Free Open Access Medical Education (FOAM) initiative designed for medical students.

Methods: This was a descriptive study. We analyzed the activity data of iEM Education Project platforms (website and image, video, audio archives) in the piloting period (June 1, 2018-August 31, 2018). Studied variables included the total and monthly views, views by country and continents, the official languages of the countries where platforms were played, and their income levels.

Results: Platforms were viewed or played 38,517 times by users from 123 countries. The total views and plays were 8,185, 11,896, and 18,436 in June, July, and August, respectively. We observed a monthly increasing trend in all platforms. Image archive and website were viewed the most. All platforms were dominantly viewed from Asia and North America, high- and upper-middle-income countries, and non-English speaking countries. However, there were no statistically significant differences between continents, income levels, or language in platforms, except for the website, the project's main hub, which showed a strong trend for difference between income levels (Kruskal-Wallis, P = 0.05). Website views were higher in high-income countries compared with low- and lower-middle income countries (Mann Whitney U test, P = 0.038 and P = 0.021, respectively).

Conclusion: The iEM Education Project was successfully established. Our encouraging initial results support the international expansion and increased collaboration of this project. Despite targeting developing countries with limited resources in this project, their engagement was suboptimal. Solutions to reach medical students in these countries should be investigated.
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http://dx.doi.org/10.5811/westjem.2020.10.48385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7806331PMC
December 2020

Primary Reattachment of Near-Complete Ear Amputation: A Successful Outcome.

Ear Nose Throat J 2020 Dec 15:145561320982170. Epub 2020 Dec 15.

Department of Surgery, 62776College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates.

Objectives: Traumatic amputation of the ear constitutes a great aesthetic deformity that can have a tremendous negative impact. Reports describing the survival of near-complete ear amputation using non-microsurgical replantation are scarce. We aimed to study the surgical outcome of patients with near-complete ear amputations supplied by small pedicle bridges that were treated with primary reattachment.

Methods: We retrospectively studied patients with near-complete ear amputation who were admitted at Al Ain Hospital from January 2016 to December 2019.

Results: Five patients were studied. The most common mechanism of injury was motor vehicle injury, followed by cutting injury. The skin pedicle was inferior in 3 (60%) patients of patients. The median width of the skin pedicles was 8.5 mm. The median interval between the injury and the surgical management was 4 hours. All patients underwent primary reattachment of the ear without microsurgery. One patient developed a small area of necrosis of the ear lobe. All patients recovered with a completely healed pinna and satisfactory overall appearance.

Conclusions: Primary reattachment without microsurgery of the near-complete ear amputation can be safely performed in the presence of an intact skin pedicle. It can achieve an aesthetically satisfactory outcome without severe complications.
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http://dx.doi.org/10.1177/0145561320982170DOI Listing
December 2020

American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of abdominal vascular injuries.

J Trauma Acute Care Surg 2020 12;89(6):1197-1211

From the Division of Trauma (L.K., J.S.), Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego, San Diego; Comparative Effectiveness and Clinical Outcomes Research Center (R.C.), Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, California; Vascular and Trauma Surgery (A.M.O.G. Jr.), Universidade Federal do Pará/Centro Universitário do Estado do Pará, Belém, PA, Brazil; Department of War Surgery (V.R.), Kirov Military Medical Academy, Saint Petersburg, Russia; Department of Surgery (E.E.M.), Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, Colorado; Division Chief Trauma and Acute Care Surgery (J.M.G.), Department of Surgery, University of California Davis, Sacramento, California; Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates; Division of Trauma and Acute Care Surgery, Department of Surgery (A.B.P.), University of Pittsburgh School of Medicine, Pittsburg, Pennsylvania; Division of Trauma and Acute Care Surgery, Department of Surgery (C.A.O.), Fundación Valle del Lili, Universidad del Valle, Cali, Colombia; Department of Surgery (R.V.M.), University of Washington, Seattle, Washington; Department of Surgery (S.D.S.), University Hospital of Varese, University of Insubria, Italy; Division of Acute Care Surgery, Department of Surgery (R.I.), Virginia Commonwealth University Richmond, Virginia; Unit of Digestive and HPB Surgery (N.D.A.), CARE Department, Henri Mondor University Hospital (AP-HP) and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France; R. Adams Cowley Shock Trauma Center (T.S.), University of Maryland, Baltimore, Maryland; Emergency Surgery Department (F.C.), Parma University Hospital, Parma, Italy; Department of Surgery and Critical Care Medicine (A.K.), University of Calgary, Calgary, Alberta, Canada; Department of Emergency Surgery (V.K.), City Hospital, Mozyr, Belarus; Departments of Surgery and Medicine (N.P.), Schulich School of Medicine and Dentistry, Western University London Health Sciences Centre, London, Ontario, Canada; Trauma Services (I.C.), Auckland City Hospital, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Abdominal Center, Department of Surgery (A.L., M.S.), University Hospital Meilahti, Helsinki, Finland; Department of Digestive Surgery (M. Chirica), Grenoble University Hospital, Grenoble, France; 3rd Department of Surgery (E.P.), Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece; Division of Trauma/Acute Care Surgery and Surgical Critical Care (G.P.F.), University of Campinas, Campinas, Brazil; General, Emergency Surgery, and Trauma Center (M. Chiarugi), University of Pisa, Pisa, Italy; Department of General and Upper GI Surgery (D.D.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Dipartimento di Scienze Clinico Chirurgiche (E.C.), Diagnostiche e Pediatriche, University of Pavia, Pavia; General and Emergency Surgery Department (M. Ceresoli), School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy; Service de Chirurgie Generale, Digestive, Metabolique Centre Hospitalier de Poissy (B.D.S.), St Germain en Laye, France; Departamento de Cirugía (F.V.-R.), Hospital Angeles Lomas, Curso Universitario Posgrado de Cirugía, Universidad Nacional Autónoma de México, Mexico, Mexico; Department of Surgery (M.S.), Macerata Hospital (ASUR Marche), Macerata, Italy; Trauma Surgery Department (W.B.), Scripps Memorial Hospital, La Jolla, California; General Surgery Department (L.A.), Bufalini Hospital, Cesena, Italy; and Trauma Service, Department of General Surgery (D.G.W.), Royal Perth Hospital, The University of Western Australia, Perth, Australia.

Abdominal vascular trauma accounts for a small percentage of military and a moderate percentage of civilian trauma, affecting all age ranges and impacting young adult men most frequently. Penetrating causes are more frequent than blunt in adults, while blunt mechanisms are more common among pediatric populations. High rates of associated injuries, bleeding, and hemorrhagic shock ensure that, despite advances in both diagnostic and therapeutic technologies, immediate open surgical repair remains the mainstay of treatment for traumatic abdominal vascular injuries. Because of their devastating nature, abdominal vascular injuries remain a significant source of morbidity and mortality among trauma patients. The American Association for the Surgery of Trauma in conjunction with the World Society of Emergency Surgery seek to summarize the literature to date and provide guidelines on the presentation, diagnosis, and treatment of abdominal vascular injuries. LEVEL OF EVIDENCE: Review study, level IV.
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December 2020

American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines on diagnosis and management of peripheral vascular injuries.

J Trauma Acute Care Surg 2020 12;89(6):1183-1196

From the Division of Trauma (L.K., J.S.), Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego, San Diego, California; Comparative Effectiveness and Clinical Outcomes Research Center (R.C.), Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, California; Vascular and Trauma Surgery (A.M.O.G. Jr.), Universidade Federal do Pará/Centro Universitário do Estado do Pará, Belém, PA, Brazil; Department of War Surgery (V.R.), Kirov Military Medical Academy, Saint Petersburg, Russia; Department of Surgery (E.E.M.), Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, Colorado; Division Chief Trauma and Acute Care Surgery (J.G.), Department of Surgery. University of California Davis, Sacramento, California; Department of Surgery (F.A.-Z.), College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates; Division of Trauma and Acute Care Surgery, Department of Surgery (A.B.P.), University of Pittsburgh School of Medicine, Pittsburg, Pennsylvania; Division of Trauma and Acute Care Surgery, Department of Surgery (C.O.), Fundación Valle del Lili, Universidad del Valle, Cali, Colombia; Department of Surgery (R.V.M.), University of Washington, Seattle, Washington; Department of Surgery (S.D.S.), University Hospital of Varese, University of Insubria, Varese, Italy; Division of Acute Care Surgery, Department of Surgery (R.I.), Virginia Commonwealth University Richmond, Virginia; Unit of Digestive and HPB Surgery (N.D.A.), CARE Department, Henri Mondor University Hospital (AP-HP) and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France; R. Adams Cowley Shock Trauma Center (T.S.), University of Maryland, Baltimore, Maryland; Emergency Surgery Department (F.C.), Parma University Hospital, Parma, Italy; Department of Surgery and Critical Care Medicine (A.K.), University of Calgary, Calgary, Alberta, Canada; Department of Emergency Surgery (V.K.), City Hospital, Mozyr, Belarus; Departments of Surgery and Medicine (N.P.), Schulich School of Medicine and Dentistry, Western University London Health Sciences Centre, London, Ontario, Canada; Trauma Services (I.C.), Auckland City Hospital, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Abdominal Center, Department of Surgery (A.L.), University Hospital Meilahti, Helsinki, Finland; Department of Digestive Surgery (M. Chirica), Grenoble University Hospital, Grenoble, France; 3rd Department of Surgery (E.P.), Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece; Division of Trauma/Acute Care Surgery and Surgical Critical Care (G.P.F.), University of Campinas, Campinas, Brazil; General, Emergency Surgery, and Trauma Center (M. Chiarugi, F.C.), University of Pisa, Pisa, Italy; Department of General and Upper GI Surgery (D.D.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; Dipartimento di Scienze Clinico Chirurgiche (E.C.), Diagnostiche e Pediatriche, University of Pavia, Pavia; General and Emergency Surgery Department (M. Ceresoli), School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy; Service de Chirurgie Generale, Digestive, Metabolique Centre Hospitalier de Poissy (B.D.S.), St Germain en Laye, France; Universidad Nacional Autónoma de México, Curso Universitario Posgrado de Cirugía, Departamento de Cirugía (F.V.-R.), Hospital Angeles Lomas, Mexico, Mexico; Department of Surgery (M.S.), Macerata Hospital (ASUR Marche), Macerata, Italy; Trauma Surgery Department (W.B.), Scripps Memorial Hospital, La Jolla, California; General Surgery Department (L.A.), Bufalini Hospital, Cesena, Italy; and Trauma Service, Department of General Surgery (D.G.W.), Royal Perth Hospital, The University of Western Australia, Perth, Australia.

The peripheral arteries and veins of the extremities are among the most commonly injured vessels in both civilian and military vascular trauma. Blunt causes are more frequent than penetrating except during military conflicts and in certain geographic areas. Physical examination and simple bedside investigations of pulse pressures are key in early identification of these injuries. In stable patients with equivocal physical examinations, computed tomography angiograms have become the mainstay of screening and diagnosis. Immediate open surgical repair remains the first-line therapy in most patients. However, advances in endovascular therapies and more widespread availability of this technology have resulted in an increase in the range of injuries and frequency of utilization of minimally invasive treatments for vascular injuries in stable patients. Prevention of and early detection and treatment of compartment syndrome remain essential in the recovery of patients with significant peripheral vascular injuries. The decision to perform amputation in patients with mangled extremities remains difficult with few clear indicators. The American Association for the Surgery of Trauma in conjunction with the World Society of Emergency Surgery seeks to summarize the literature to date and provide guidelines on the presentation, diagnosis, and treatment of peripheral vascular injuries. LEVEL OF EVIDENCE: Review study, level IV.
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December 2020
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