2024 |
Meakes S, Enninghorst N, Weaver N, Hardy BM, Balogh ZJ, 'Long-term functional outcomes in polytrauma: a fundamentally new approach is needed in prediction', European Journal of Trauma and Emergency Surgery, (2024)
Purpose: Modern trauma care has reduced mortality but poor long-term outcomes with low follow-up rates are common with limited recommendations for improvements. The aim of this st... [more]
Purpose: Modern trauma care has reduced mortality but poor long-term outcomes with low follow-up rates are common with limited recommendations for improvements. The aim of this study was to describe the impact of severe injury on the health-related quality of life, specifically characterise the non-responder population and to identify modifiable predictors of poorer outcomes. Methods: Five-year (2012¿2016) prospective cohort study was performed at a level 1 trauma centre. Baseline Short-Form Health Survey (SF36) was collected at admission, and at 6 and 12¿months postinjury together with demographics, injury mechanism and severity, psychosocial wellbeing, and return to work capacity. Results: Of the 306 consecutive patients [age 52 ± 17¿years, male 72%, ISS 21 (17, 29), mortality 5%], 195 (64%) completed questionnaires at baseline, and at 12¿months. Preinjury physical health scores were above the general population (53.1 vs. 50.3, p < 0.001) and mental health component was consistent with the population norms (51.7 vs. 52.9, p = 0.065). One year following injury, both physical health (13.2, 95% CI 14.8, 11.6) and mental health scores (6.0, 95% CI 8.1, 3.8) were significantly below age- and sex-adjusted preinjury baselines. Non-responders had similar ISS but with a lower admission GCS, and were more likely to be younger, and without comorbidities, employment, or university education. Conclusion: Contrary to their better than population norm preinjury health status, polytrauma patients remain functionally impaired at least 1¿year after injury. The identified high risk for non-responding group needs more focused efforts for follow-up. A fundamentally different approach is required in polytrauma research which identify modifiable predictors of poor long-term outcomes.
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2024 |
Hardy BM, Enninghorst N, King KL, Balogh ZJ, 'The most critically injured polytrauma patient mortality: should it be a measurement of trauma system performance?', EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY, 50 115-119 (2024) [C1]
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Nova |
2024 |
Meakes S, Enninghorst N, Weaver N, Hardy BM, Balogh ZJ, 'Long-term functional outcomes in polytrauma: a fundamentally new approach is needed in prediction', EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY, [C1]
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2023 |
Bunjo Z, Gill TK, Enninghorst N, McGonagle L, Tudor F, Bollman J, et al., 'Australian medical students report poor confidence managing common orthopaedic sports-related injuries: findings of a multi-site survey', ANZ JOURNAL OF SURGERY, 93 462-465 (2023) [C1]
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Nova |
2023 |
Cobianchi L, Piccolo D, Dal Mas F, Agnoletti V, Ansaloni L, Balch J, et al., 'Correction: Surgeons perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey (World Journal of Emergency Surgery, (2023), 18, 1, (1), 10.1186/s13017-022-00467-3)', World Journal of Emergency Surgery, 18 (2023)
Following publication of the original article [1], in Pub-Med the author name Daniele Bissacco under Team Dynamics Study Group has not been tagged and now it has been rectified.... [more]
Following publication of the original article [1], in Pub-Med the author name Daniele Bissacco under Team Dynamics Study Group has not been tagged and now it has been rectified.
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2023 |
Cobianchi L, Piccolo D, Dal Mas F, Agnoletti V, Ansaloni L, Balch J, et al., 'Surgeons perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey', World Journal of Emergency Surgery, 18 (2023) [C1]
Background: Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analyt... [more]
Background: Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons¿ knowledge and perception of using AI-based tools in clinical decision-making processes. Methods: An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society¿s website and Twitter profile. Results: 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons¿ preference toward more classical decision-making aids like clinical guidelines, traditional training, and the support of their multidisciplinary colleagues. A lack of knowledge about several AI-related aspects emerges and is associated with mistrust. Discussion: The trauma and emergency surgical community is divided into those who firmly believe in the potential of AI and those who do not understand or trust AI-enabled surgical decision-making aids. Academic societies and surgical training programs should promote a foundational, working knowledge of clinical AI.
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Nova |
2023 |
Cobianchi L, Dal Mas F, Agnoletti V, Ansaloni L, Biffl W, Butturini G, et al., 'Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey', World Journal of Emergency Surgery, 18 (2023) [C1]
Background: Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in ... [more]
Background: Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods: Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society¿s website, and shared on the society¿s Twitter profile. Results: A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. Discussion: Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions.
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Nova |
2023 |
Hardy BM, Varghese A, Adams MJ, Enninghorst N, Balogh ZJ, 'The outcomes of the most severe polytrauma patients: a systematic review of the use of high ISS cutoffs for performance measurement.', Eur J Trauma Emerg Surg, (2023) [C1]
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2022 |
Sivam A, Enninghorst N, 'The Dilemma of Reconstructive Material Choice for Orbital Floor Fracture: A Narrative Review.', Medicines (Basel, Switzerland), 9 6 (2022) [C1]
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Nova |
2022 |
Hardy BM, King KL, Enninghorst N, Balogh ZJ, 'Trends in polytrauma incidence among major trauma admissions', EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY, (2022) [C1]
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2020 |
Wheeler JA, Weaver N, Balogh ZJ, Drobetz H, Kovendy A, Enninghorst N, 'Radiation Exposure in Patients with Isolated Limb Trauma: Acceptable or Are We Imaging Too Much?', JOURNAL OF CLINICAL MEDICINE, 9 (2020) [C1]
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Nova |
2018 |
Ghoshal A, Enninghorst N, Sisak K, Balogh ZJ, 'An interobserver reliability comparison between the Orthopaedic Trauma Association's open fracture classification and the Gustilo and Anderson classification', Bone and Joint Journal, 100B 242-246 (2018) [C1]
Aims To evaluate interobserver reliability of the Orthopaedic Trauma Association's open fracture classification system (OTA-OFC). Patients and Methods Patients of any age wit... [more]
Aims To evaluate interobserver reliability of the Orthopaedic Trauma Association's open fracture classification system (OTA-OFC). Patients and Methods Patients of any age with a first presentation of an open long bone fracture were included. Standard radiographs, wound photographs, and a short clinical description were given to eight orthopaedic surgeons, who independently evaluated the injury using both the Gustilo and Anderson (GA) and OTA-OFC classifications. The responses were compared for variability using Cohen's kappa. Results The overall interobserver agreement was ¿ = 0.44 for the GA classification and ¿ = 0.49 for OTA-OFC, which reflects moderate agreement (0.41 to 0.60) for both classifications. The agreement in the five categories of OTA-OFC was: for skin, ¿ = 0.55 (moderate); for muscle, ¿ = 0.44 (moderate); for arterial injury, ¿ = 0.74 (substantial); for contamination, ¿ = 0.35 (fair); and for bone loss, ¿ = 0.41 (moderate). Conclusion Although the OTA-OFC, with similar interobserver agreement to GA, offers a more detailed description of open fractures, further development may be needed to make it a reliable and robust tool.
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Nova |
2014 |
Neptune D, Bonevski B, Enninghorst N, Balogh ZJ, 'The prevalence of smoking and interest in quitting among surgical patients with acute extremity fractures', Drug and Alcohol Review, (2014) [C1]
Introduction and Aims: We studied the prevalence of smoking, the effect of hospital stay on motivation to quit and the exposure to smoking cessation advice in orthopaedic patients... [more]
Introduction and Aims: We studied the prevalence of smoking, the effect of hospital stay on motivation to quit and the exposure to smoking cessation advice in orthopaedic patients who required surgical intervention for acute extremity fractures. Design and Methods: This cross-sectional study involved a self-administered pen-and-paper survey assessing smoking status, interest and motivation to quit smoking, and current advice to quit among a consecutive cohort of patients aged 18-65 years old with acute extremity fractures. These patients were admitted to the John Hunter Hospital Level 1 trauma facility in New South Wales, Australia, for surgical intervention over a three month period. Results: A total of 183 patients (response rate 98%) completed the survey. Sixty-eight patients (37.2%) reported a current smoking habit. The prevalence of smoking was 42.2% among males and 25.5% among females. A total of 40% of smokers reported that they had not received advice to quit from medical staff during hospital admission. Prior to admission, 12.1% of smokers were interested in smoking cessation; this percentage increased to 26.8% post-admission. Discussion and Conclusions: The prevalence of smoking among surgical patients with extremity fractures was found to be more than twice the prevalence of the population of New South Wales. Hospital admission had a positive impact on the patient's interest in smoking cessation. Our study suggests that the identification of orthopaedic patients who smoke is suboptimal, and the opportunity to encourage smoking cessation during hospital admission is currently being overlooked. © 2014 Australasian Professional Society on Alcohol and other Drugs.
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Nova |
2013 |
Lumsdaine W, Enninghorst N, Hardy BM, Balogh ZJ, 'Patterns of CT use and surgical intervention in upper limb periarticular fractures at a level-1 trauma centre', INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 44 471-474 (2013) [C1]
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Nova |
2013 |
Sisak K, Manolis M, Hardy BM, Enninghorst N, Bendinelli C, Balogh ZJ, 'Acute transfusion practice during trauma resuscitation: Who, when, where and why?', INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 44 581-586 (2013) [C1]
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Nova |
2013 |
Soederlund T, Yoshino O, Bendinelli C, Enninghorst N, Balogh ZJ, 'Acute repair of traumatic abdominal muscle avulsion from iliac crest: A mesh-free technique using suture anchors', INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 44 1257-1259 (2013) [C3]
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Nova |
2013 |
Sisak K, Manolis M, Hardy BM, Enninghorst N, Balogh ZJ, 'Epidemiology of Acute Transfusions in Major Orthopaedic Trauma', JOURNAL OF ORTHOPAEDIC TRAUMA, 27 413-418 (2013) [C1]
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Nova |
2013 |
Williams N, Hardy BM, Tarrant S, Enninghorst N, Attia J, Oldmeadow C, Balogh ZJ, 'Changes in hip fracture incidence, mortality and length of stay over the last decade in an Australian major trauma centre.', Archives of Osteoporosis, 8 (2013) [C1]
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Nova |
2013 |
Enninghorst N, Hardy BM, Sisak K, Lott N, Balogh ZJ, 'Tissue oxygen saturation changes during intramedullary nailing of lower-limb fractures', JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 74 123-127 (2013) [C1]
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Nova |
2013 |
Butcher NE, Enninghorst N, Sisak K, Balogh ZJ, 'The definition of polytrauma: Variable interrater versus intrarater agreement-A prospective international study among trauma surgeons', JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 74 884-889 (2013) [C1]
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Nova |
2013 |
Enninghorst N, McDougall D, Evans JA, Sisak K, Balogh ZJ, 'Population-based epidemiology of femur shaft fractures', Journal of Trauma and Acute Care Surgery, 74 1516-1520 (2013) [C1]
BACKGROUND: Themanagement of patientswith femoral shaft fractures (FSFs) is often a decisionmaking dilemma (damage-control orthopedics vs. early total care), with equivocal eviden... [more]
BACKGROUND: Themanagement of patientswith femoral shaft fractures (FSFs) is often a decisionmaking dilemma (damage-control orthopedics vs. early total care), with equivocal evidence. The comprehensive, population-based epidemiology of patients with FSF is unknown. The purpose of this prospective study was to describe the epidemiology of patientswith FSF, with special focus on patient physiology and timing of surgery. METHODS: A 12-month prospective population-based study was performed on consecutive patients with FSF in an area with 850,000 population including all ages and prehospital deaths. Patient demographics, mechanism, Injury Severity Score (ISS), shock parameters (systolic blood pressure, base deficit and lactate), transfusion requirement, fracture type [Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification (OA/OTA)], comorbidities, procedures, and outcomes were recorded. Patients hemodynamic status was described as stable, borderline, unstable, and "in extremis." RESULTS: Atotal of 126 patients (21 per 100,000 per year)with 136 femur fractures (62%male; age, 38 [28] years; ISS, 20 [19]; 51%multiple injuries) were identified in the region. Sixty patients (48.4%) sustained a high-energy injury with 19 (31.1%) of these being polytrauma patients (ISS, 28 [12]; systolic blood pressure, 98 [39]; base deficit, 6.5 [5.8]; lactate 4 [2]).Fifteen polytrauma patients (94%) required massive transfusion (12 [12] U of packed red blood cells, 8 [5] fresh frozen plasma, 1 [0.4] platelet, 13 [8] cryoprecipitate). Twenty-one patients (16.7%) died at the prehospital setting (3.5 per 100,000 per year). From the 105 hospital admissions, 68.3% was stable (14.3 per 100,000 per year), 8.7% was borderline (1.8 per 100,000 per year), 4.0% was unstable (0.8 per 100,000 per year) and 2.4%(0.5 per 100,000 per year)was in extremis. Six patients (5.7%) died. The length of stay (LOS) was 18 (15) days, and the intensive care unit LOS was 5 (6) days. Fourty-five patients sustained a low-energy injury that had in 85%of casesmultiple comorbidities. Eight low-energy patients needed 3 (1) transfusions, and none of the patients died. The LOS was 15 (11) days. CONCLUSION: Patients with low-energy FSF have a hospital admission rate similar to the patients with high-energy FSF. Sixty-eight percent of patients with FSF are complicated (open, compromised physiology, multiple injuries, bilateral, elderly with comorbidities, etc.), requiring major resources and highly specialized care. LEVEL OF EVIDENCE: Epidemiology study, level III. Copyright © 2013 Lippincott Williams & Wilkins.
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Nova |
2012 |
Easton RM, Bendinelli C, Sisak K, Enninghorst N, Regan D, Evans J, Balogh ZJ, 'Recalled pain scores are not reliable after acute trauma', Injury: International Journal of the Care of the Injured, 43 1029-1032 (2012) [C1]
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Nova |
2012 |
Puchwein P, Enninghorst N, Sisak K, Ortner T, Schildhauer TA, Balogh ZJ, Pichler W, 'Percutaneous fixation of acetabular fractures: Computer-assisted determination of safe zones, angles and lengths for screw insertion', Archives of Orthopaedic and Trauma Surgery, 132 805-811 (2012) [C1]
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Nova |
2012 |
Sisak K, Soeyland K, McLeod MG, Jansen M, Enninghorst N, Martin A, Balogh ZJ, 'Massive transfusion in trauma: Blood product ratios should be measured at 6 hours', ANZ Journal of Surgery, 82 161-167 (2012) [C1]
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Nova |
2012 |
Alrahbi R, Easton RM, Bendinelli C, Enninghorst N, Sisak K, Balogh ZJ, 'Intercostal catheter insertion: Are we really doing well?', ANZ Journal of Surgery, 82 392-394 (2012) [C1]
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Nova |
2012 |
Easton RM, Bendinelli C, Sisak K, Enninghorst N, Balogh ZJ, 'Prehospital nausea and vomiting after trauma: Prevalence, risk factors, and development of a predictive scoring system', Journal of Trauma and Acute Care Surgery, 72 1249-1253 (2012) [C1]
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Nova |
2011 |
Enninghorst N, Peralta R, Yoshino O, Pfeifer R, Pape HC, Hardy BM, et al., 'Physiological assessment of the polytrauma patient: initial and secondary surgeries', European Journal of Trauma and Emergency Surgery, 37 559-566 (2011) [C1]
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Nova |
2011 |
Beilman G, Enninghorst N, 'Open Tibia Fractures: Timely Debridement Leaves Injury Severity as the Only Determinant of Poor Outcome DISCUSSION', JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 70 356-357 (2011) [C3]
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2011 |
Enninghorst N, McDougall D, Hunt JJ, Balogh ZJ, 'Open tibia fractures: Timely debridement leaves injury severity as the only determinant of poor outcome', Journal of Trauma-Injury Infection and Critical Care, 70 352-356 (2011) [C1]
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Nova |
2011 |
Nicholas B, Toth L, Van Wessem K, Evans J, Enninghorst N, Balogh ZJ, 'Borderline femur fracture patients: Early total care or damage control orthopaedics?', ANZ Journal of Surgery, 81 148-153 (2011) [C1]
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Nova |
2010 |
Enninghorst N, Toth L, King KL, McDougall D, Mackenzie S, Balogh ZJ, 'Acute definitive internal fixation of pelvic ring fractures in polytrauma patients: A feasible option', Journal of Trauma - Injury, Infection and Critical Care, 68 935-939 (2010) [C1]
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Nova |
2003 |
Liener UC, Enninghorst N, Hogel J, Kinzl L, Suger G, 'Quality of life after surgical treatment of osteitis', UNFALLCHIRURG, 106 456-460 (2003)
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