Dr Natalie Enninghorst

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.

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.

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.

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.

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.