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Guidelines for the acute care of severe limb trauma patients

dc.rights.licenseopenen_US
dc.contributor.authorPOTTECHER, Julien
dc.contributor.authorLEFORT, Hugues
dc.contributor.authorADAM, Philippe
dc.contributor.authorBARBIER, Olivier
dc.contributor.authorBOUZAT, Pierre
dc.contributor.authorCHARBIT, Jonathan
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorGALINSKI, Michel
dc.contributor.authorGARRIGUE, Delphine
dc.contributor.authorGAUSS, Tobias
dc.contributor.authorGEORG, Yannick
dc.contributor.authorHAMADA, Sophie
dc.contributor.authorHARROIS, Anatole
dc.contributor.authorKEDZIEREWICZ, Romain
dc.contributor.authorPASQUIER, Pierre
dc.contributor.authorPRUNET, Bertrand
dc.contributor.authorROGER, Claire
dc.contributor.authorTAZAROURTE, Karim
dc.contributor.authorTRAVERS, Stephane
dc.contributor.authorVELLY, Lionel
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorGIL-JARDINE, Cedric
dc.contributor.authorQUINTARD, Herve
dc.date.accessioned2021-08-24T07:48:43Z
dc.date.available2021-08-24T07:48:43Z
dc.date.issued2021-05-28
dc.identifier.issn2352-5568en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/110192
dc.description.abstractEnGOAL: To provide healthcare professionals with comprehensive multidisciplinary expert recommendations for the acute care of severe limb trauma patients, both during the prehospital phase and after admission to a Trauma Centre. DESIGN: A consensus committee of 21 experts was formed. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations remained non-graded. METHODS: The committee addressed eleven questions relevant to the patient suffering severe limb trauma: 1) What are the key findings derived from medical history and clinical examination which lead to the patient's prompt referral to a Level 1 or Level 2 Trauma Centre? 2) What are the medical devices that must be implemented in the prehospital setting to reduce blood loss? 3) Which are the clinical findings prompting the performance of injected X-ray examinations? 4) What are the ideal timing and modalities for performing fracture fixation? 5) What are the clinical and operative findings which steer the surgical approach in case of vascular compromise and/or major musculoskeletal attrition? 6) How to best prevent infection? 7) How to best prevent thromboembolic complications? 8) What is the best strategy to precociously detect and treat limb compartment syndrome? 9) How to best and precociously detect post-traumatic rhabdomyolysis and prevent rhabdomyolysis-induced acute kidney injury? 10) What is the best strategy to reduce the incidence of fat emboli syndrome and post-traumatic systemic inflammatory response? 11) What is the best therapeutic strategy to treat acute trauma-induced pain? Every question was formulated in a PICO (Patient Intervention Comparison Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS: The experts' synthesis work and the application of the GRADE method resulted in 19 recommendations. Among the formalised recommendations, 4 had a high level of evidence (GRADE 1+/-) and 12 had a low level of evidence (GRADE 2+/-). For 3 recommendations, the GRADE method could not be applied, resulting in an expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations. CONCLUSIONS: There was significant agreement among experts on strong recommendations to improve practices for severe limb trauma patients.
dc.language.isoENen_US
dc.subject.enGuidelines
dc.subject.enCompartment syndrome
dc.subject.enDamage control
dc.subject.enFat embolism syndrome
dc.subject.enRhabdomyolysis
dc.subject.enSevere limb trauma patient
dc.subject.enTourniquet
dc.title.enGuidelines for the acute care of severe limb trauma patients
dc.typeArticle de revueen_US
dc.identifier.doi10.1016/j.accpm.2021.100862en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed34059492en_US
bordeaux.journalAnaesthesia Critical Care & Pain Medicineen_US
bordeaux.page100862en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamIETOen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
bordeaux.identifier.funderIDSociété Française d’Anesthésie et de Réanimationen_US
bordeaux.identifier.funderIDSociété Française de Médecine d'Urgenceen_US
hal.identifierhal-03324847
hal.version1
hal.date.transferred2021-08-24T07:48:49Z
hal.exporttrue
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