Les urgences chirurgicales représentent 30 % des actes chirurgicaux réalisés en France. Ces interventions sont par définition imprévues, difficiles à organiser et source d’une morbi-mortalité majorée par rapport aux chirurgies programmées. Différents types d’organisation existent selon le volume des urgences prises en charges dans les différents plateaux techniques. Les anesthésistes-réanimateurs sont fréquemment les régulateurs de l’accès au bloc opératoire des urgences chirurgicales et interventionnelles, a fortiori sur les périodes de permanence des soins. Ils centralisent les demandes des spécialités chirurgicales et/ou interventionnelles et priorisent les patients en tenant compte de multiples facteurs. Il s’agit d’un exercice difficile qui peut avoir des conséquences sur le devenir des patients. En effet, le retard de prise en charge est l’un des facteurs aggravant la morbi-mortalité des patients opérés en urgence. À l’heure actuelle, il n’existe pas de recommandation ou d’aide cognitive pouvant simplifier la pratique de la régulation. L’objectif de cet article est de faire le point sur l’organisation de la chirurgie d’urgence en France et sur les différents facteurs à intégrer lorsque l’on est amené à réguler l’activité chirurgicale en urgence.

The respective weights of head and extra-head injuries to the occurrence of coagulopathy following traumatic brain injury (TBI) remain unclear. We hypothesized that the severity of extra-head injuries would be the main contributor to coagulopathy following TBI. This was a retrospective study from a multicenter, prospective trauma registry. All adult patients directly admitted following TBI (Abbreviated Injury Score [AIS]) head ≥1) from 2012 to 2021 were included. Coagulopathy was defined as a prothrombin time ratio (PTr) >1.2, platelets <100 G.L-1, or fibrinogen level <1.5 g.L-1 on hospital admission. TBI severity was assessed by the Glasgow Coma Scale (GCS). Severe extracranial injuries were defined by at least one of the extra-head AIS scores ≥3 (AISextra-head ≥3). Incidences of coagulopathy were determined and compared according to TBI severity in patients with or without severe extracranial injuries. Risk factors for coagulopathy were identified using bivariate analysis and then multivariable analysis. In 9,610 TBI patients analyzed, the overall incidence of coagulopathy was 28.5% (n = 2,738). The incidence of coagulopathy increased gradually with TBI severity, from 8% for GCS 14-15% to 42% for GCS 3 in patients without severe extracranial injuries, and from 27% for GCS 14-15% to 70% for GCS 3 in patients with severe extracranial injuries. In multivariable analysis, AISextra-head ≥3 (odds ratio = 2 [1.8-2.3], p < 0.001) and GCS ≤8 (odds ratio = 1.3 [1.1-1.6], p = 0.001) were independent risk factors for coagulopathy. Coagulopathy was associated with both head and extra-head injury severities, yet to a greater extent with severe extracranial injuries.

Abstract Background In severe trauma 30% of the patients develop a trauma-induced coagulopathy (TIC), which is associated with higher mortality, massive transfusion and prolonged intensive care stay. Conventional coagulation assays present limitations to detect TIC, primarily due to delayed turnaround time. To enhance early management of TIC viscoelastic tests have been included into guidelines as a standard of care. The Quantra device, based on sonorheometry analysis, offers a rapid bedside assessment of coagulation but lacks validation in a trauma population. The aim of this study was to validate Quantra to detect TIC compared with standard blood coagulation test in severe trauma patients. Methods We performed a multicenter analysis of prospectively collected data (January 1, 2022–December 31, 2024) across four level-1 trauma centers. Trauma patients > 16 years underwent simultaneous Quantra and standard laboratory testing at hospital admission. Diagnostic performance for prespecified thresholds—activated partial thromboplastin time (aPTT) ratio > 1.5, prothrombin time ratio (PTr) > 1.5, fibrinogen ≤ 1.5 g/L, and platelet concentration ≤ 50, ≤ 100, and ≤ 150 G/L—was assessed by receiver operating characteristic curves in a derivation cohort, with Youden-optimized cutoffs applied to an external validation cohort to determine their specific positive and negative predictive values. Results The derivation and validation cohorts included 285 and 219 patients, respectively. In the derivation cohort, the areas under the curve (AUCs) were 0.91 [0.84–0.98] for clot time to predict an aPTT ratio > 1.5 with a best cutoff of 144.5s; 0.82 [0.75–0.90] for clot stiffness to predict a PTr > 1.5 (best cutoff 15.4hPa); 0.87 [0.81–0.93] for fibrinogen contribution to clot stiffness to predict a fibrinogen concentration < 1.5g/L (best cutoff 1.1hPa); 0.90 [0.84–0.95] for platelet contribution to clot stiffness to predict a platelets count ≤ 100G/L (best cutoff 12.4hPa). In the validation cohort, positive predictive and negative predictive values for best cutoffs were 0.67 [0.50–0.80] and 1.00 [0.98–1.00] for clot time, 0.50 [0.39–0.61] and 0.88 [0.80–0.93] for clot stiffness, 0.58 [0.44–0.70] and 0.91 [0.85–0.95] for fibrinogen contribution to clot stiffness, 0.13 [0.24–0.99] and 0.99 [0.96–1.00] for platelets contribution to clot stiffness. Conclusion Early Quantra analysis seems to provide rapid and reliable exclusion of TIC. Prospective investigations remain required to determine usefulness in TIC management.

INTRODUCTION:The specialized care of acute trauma patients is increasingly organized within networks, with the most critical patients referred to level 1 trauma centers (TC1). This French national survey aimed to evaluate the organizational and structural characteristics of these centers. MATERIAL AND METHODS:A 195-item survey was conducted across 40 centers classified as TC1 according to consensual criteria. It included a general analysis of the hospital, followed by an internal analysis of each department, specifically admitting severe acute trauma patients. The survey collected data on the architectural, human, and functional organization, activity, and general satisfaction regarding each department. RESULTS:All surveyed centers responded, 65% (26/40) of them were integrated into a trauma network. These TC1 admitted 409 (±332) severe trauma patients/year, including 90 (±75) grade A/very severe and 138 (±120) grade B/severe. Across the 40 TC1, a total of 46 reception areas were identified with a mean of 2.9 (±1.7) beds/area, and a surface of 20.4 (±8.9) m²/area. Their distances from the CT-scanner and operating room were 81 (±90) and 82 (±76) m, respectively. For grade A (unstable despite prehospital medical care) and B (stabilized after prehospital medical care and/or specific anatomic lesion) patients, the trauma team leader was an anesthesiologist-intensivist in 97.5% and 90.5% of admissions, respectively. Eleven (23.9%) reception areas reported multiple medical specialties involved in the admission of severe trauma patients, and 19 (41.3%) reported having dedicated nurses. CONCLUSION:This survey highlights the variability of the functional, architectural, and human resource organization of French TC1.

OBJECTIVE:The Société Française de Médecine d'Urgence (SFMU), the Société Française d'Anesthésie et de Réanimation (SFAR), the Groupe d'Intérêt en Hémostase Péri-opératoire (GIHP) and the Société Française de Thrombose et d'Hémostase (SFHT) have collaborated to propose a set of guidelines on the management of anticoagulants in an emergency setting. DESIGN:A group of French and Belgian experts from the French Societies of Emergency Medicine (SFMU), Anaesthesia and Intensive Care (SFAR), the working group on Perioperative Haemostasis (GIHP) and the French Society of Thrombosis and Haemostasis (SFHT) was convened. Any potential conflicts of interest were officially declared at the start of the recommendation development process, which was conducted independently of any industry funding. The authors used the GRADE ("Grading of Recommendations Assessment, Development and Evaluation") methodology to assess the level of evidence in the literature. METHODS:Five areas were defined: (1) The role of laboratory testing in determining anticoagulant use and the level of anticoagulation; (2) Management of anticoagulant-associated bleeding; (3) Management of asymptomatic overdoses; (4) Management of non-elective invasive procedures on anticoagulants; and (5) Thrombolysis for acute ischaemic stroke on anticoagulants. For each field, the aim of the recommendations was to answer a certain number of questions formulated by the experts according to the PICO model ("Population, Intervention, Comparison, Outcome"). Based on these questions, an extensive bibliographic search from 1990 onwards was carried out using predefined key words according to the PRISMA recommendations. Data quality was analysed using the GRADE method. Recommendations were formulated using the GRADE method and then voted on by all the experts using the GRADE grid method. RESULTS:The experts' summary work and application of the GRADE method resulted in 103 recommendations concerning 21 questions. After two rounds of voting and several amendments, strong agreement was reached on 97 recommendations. Out of these recommendations, 19 have a high level of evidence (19 GRADE 1), 35 have a low level of evidence (35 GRADE 2), and 48 are expert opinions. Finally, for one question, no recommendation could be made. CONCLUSIONS:There was strong agreement among the experts to provide recommendations for clinicians to provide up-to-date management of patients on anticoagulants in an emergency setting.

To reduce the number of deaths caused by exsanguination, the initial management of severe trauma aims to prevent, if not limit, the lethal triad, which consists of acidosis, coagulopathy, and hypothermia. Recently, several studies have suggested adding hypocalcemia to the lethal triad to form the lethal diamond, but the evidence supporting this change is limited. Therefore, the aim of this study was to compare the lethal triad and lethal diamond for their respective associations with 24-h mortality in severe trauma patients receiving transfusion. We performed a multicenter retrospective analysis of patients in TraumaBase®, a French database (2011–2023). The patients included in this study were all trauma patients who had received transfusions of at least 1 unit of red blood cells (RBCs) within the first 6 h of hospital admission and for whom ionized calcium measurements were available. Hypocalcemia was defined as an ionized calcium level < 1.1 mmol/L. A total of 2141 severe trauma patients were included (median age: 39, interquartile range [IQR]: 26–57; median injury severity score: 27, IQR: 17–41). Patients primarily presented with blunt trauma (81.7

BACKGROUND:As the demand for high-quality healthcare grows, there is a pressing need for comprehensive methods to assess the quality of hospital care. Lack of standardization makes it difficult to compare urgent surgical outcomes across studies. Our group used a modified Delphi methodology to define the outcomes that should be reported or compared when evaluating urgent surgical care. METHODS:This three-round Delphi process took place from May to October 2024. It was conducted with an international panel of medico-surgical experts from 16 countries. We aimed to select, based on a 2-level consensus assessment, reporting outcomes for urgent surgical pathways. RESULTS:Initially, 87 items were classified under 8 headings. 26 outcomes were selected after the second Delphi round. A third round was required to validate 3 additional outcomes. Among the selected outcomes were in-hospital or 30-day mortality, 15 items addressing perioperative morbidity, as well as factors related to the patient journey: preoperative (surgical waiting time), intraoperative (surgical bleeding), and postoperative aspects (9 items selected). Notably, no items from the 'patient satisfaction' and 'medico-economics' headings were retained. Panelists deemed it essential to use multi-criteria outcomes (i.e., combining items from the 8 headings) to evaluate urgent surgical care pathways. CONCLUSIONS:A set of 29 relevant outcomes will help to develop a more comprehensive approach for urgent surgical care evaluation. It enables the development of new prioritization policies and a better study of outcomes for urgent surgeries. It is worth noting the lack of economic criteria and patient satisfaction measures.

Background To reduce the number of deaths caused by exsanguination, the initial management of severe trauma aims to prevent, if not limit, the lethal triad, which consists of acidosis, coagulopathy, and hypothermia. Recently, several studies have suggested adding hypocalcemia to the lethal triad to form the lethal diamond, but the evidence supporting this change is limited. Therefore, the aim of this study was to compare the lethal triad and lethal diamond for their respective associations with 24-hour mortality in transfused severe trauma patients. Methods We performed a multicenter retrospective analysis of patients in TraumaBase®, a French database (2011–2023). The patients included in this study were all trauma patients who had received transfusions of at least 1 unit of packed red blood cells (RBCs) within the first 6 hours of hospital admission and for whom ionized calcium measurements were available. Hypocalcemia was defined as an ionized calcium level < 1.1 mmol/L. Results A total of 2141 severe trauma patients were included (median age: 39, interquartile range [IQR]: 26–57; median injury severity score [ISS]: 27, IQR: 17–41). Patients primarily presented with blunt trauma (81.7%), and a 24-hour mortality rate of 16.1% was observed. Receiver operating characteristic (ROC) curve analysis revealed no significant difference in the association with 24-hour mortality between the lethal diamond (area under the curve [AUC]: 0.71) and the lethal triad (AUC: 0.72) (p = 0.26). The strength of the association with 24-hour mortality was similar between the lethal triad and the lethal diamond, with Cramer’s V values of 0.29 and 0.28, respectively. Conclusions This study revealed no significant difference between the lethal triad and the lethal diamond in terms of their respective associations with 24-hour mortality in severe trauma patients requiring transfusion. These results raise questions about the independent role of hypocalcemia in early mortality.

The aging population in France and Western Europe is on the rise, particularly among individuals aged 65 years and older. Although older adults are susceptible to traumatic injuries, they constitute a minority of trauma center admissions especially those aged 85 and above. The aim of our study was to investigate the prognostic factors for mortality among the older old population (aged 85 years and above) managed in ICU of Traumabase group trauma centers. This retrospective observational cohort study, conducted from 2013 to 2022, analyzed all severely injured older patients (aged ≥ 85 years) managed in 14 ICU trauma centers enrolled in the Traumabase registry. The study examined sociodemographic, clinical, and outcome variables. Frailty was assessed using the Clinical Frailty Scale. Among the 365 older trauma patients, 190 (52.1

PURPOSE:The 5th edition of The European recommendations for the management of major bleeding and coagulopathy following trauma leaves room for various coagulation factor administration strategies. The present study examines these strategies reporting prevalence and timing of administration, quantity dispensed, and transfusion ratios in French trauma centers and their compliance with recommendations alongside associated mortality data.METHODS:All adult patients, admitted directly to participating centers between 2011 and 2019, were extracted from a trauma registry. Two subpopulations were studied: severe hemorrhage (SH) and massive transfusion (MT) groups.RESULTS:A total of 19,396 patients were included, among whom 8.4% (1630) experienced SH and 3% (579) received MT. Within the first 24 hours, 10% received fresh frozen plasma (FFP), rising to 93% and 99% in the subgroups of patients experiencing SH and MT respectively. Only, 8% received fibrinogen concentrate (FC), increasing to 75% and 92% in subgroups SH and MT respectively. Co-administration of FFP and FC became the dominant strategy with 68% of patients at 6 h and 72% at 24 h in SH subgroup. In unadjusted data, mortality was systematically lower in groups that complied with recommendations, a lower mortality than expected was mostly observed in contrast to non-compliant subgroups. The per-patient compliance to studied recommendations was 21% and 22% in SH and MT subgroups.CONCLUSION:The main hemostatic strategy for major bleeding combined the administration of both FFP and FC, favoring an early additional supply of fibrinogen. Compliance with the recommendations was low in SH and MT subgroups.

ImportanceDelayed admission of patients with surgical emergencies to the operating room occurs frequently and is associated with poor outcomes. In France, where 3 distinct organizational pathways in hospitals exist (a dedicated emergency operating room and team [DET], a dedicated operating room in a central operating theater [DOR], and no dedicated structure or team [NOR]), neither the incidence nor the influence of delayed urgent surgery is known, and no guidelines are available to date.ObjectiveTo examine the overall frequency of delayed admission of patients with surgical emergencies to the operating room across the 3 organizational pathways in hospitals in France.Design, Setting, and ParticipantsThis prospective multicenter cohort study was conducted in 10 French tertiary hospitals. All consecutive adult patients admitted for emergency surgery from October 5 to 16, 2020, were included and prospectively monitored. Patients requiring pediatric surgery, obstetrics, interventional radiology, or endoscopic procedures were excluded.ExposuresEmergency surgery.Main Outcomes and MeasuresThe main outcome was the global incidence of delayed emergency surgery across 3 predefined organizational pathways: DET, DOR, and NOR. The ratio between the actual time to surgery (observed duration between surgical indication and incision) and the ideal time to surgery (predefined optimal duration between surgical indication and incision according to the Non-Elective Surgery Triage classification) was calculated for each patient. Surgery was considered delayed when this ratio was greater than 1.ResultsA total of 1149 patients were included (mean [SD] age, 55 [21] years; 685 [59.9%] males): 649 in the DET group, 320 in the DOR group, and 171 in the NOR group (missing data: n = 5). The global frequency of surgical delay was 32.5% (95% CI, 29.8%-35.3%) and varied across the 3 organizational pathways: DET, 28.4% (95% CI, 24.8%-31.9%); DOR, 32.2% (95% CI, 27.0%-37.4%); and NOR, 49.1% (95% CI, 41.6%-56.7%) (P < .001). The adjusted odds ratio for delay was 1.80 (95% CI, 1.17-2.78) when comparing NOR with DET.Conclusions and RelevanceIn this cohort study, the frequency of delayed emergency surgery in France was 32.5%. Reduced delays were found in organizational pathways that included dedicated theaters and teams. These preliminary results may pave the way for comprehensive large-scale studies, from which results may potentially inform new guidelines for quicker and safer access to emergency surgery.

Importance Electric scooter (e-scooter) use is increasing in France and in many urban environments worldwide. Yet little is known about injuries associated with use of e-scooters. Objective To describe characteristics and outcomes of major trauma involving e-scooters. Design, Setting, and Participants A multicenter cohort study was conducted in France using the national major trauma registry between January 1, 2019, and December 20, 2022. All patients admitted to a participating major trauma center following a road traffic crash (RTC) involving an e-scooter, a bicycle, or a motorbike were included. Exposure Included patients were compared according to the 3 mechanisms. Main Outcomes and Measures The primary outcome was trauma severity as defined by the Injury Severity Score (ISS). Secondary outcomes included the trends of the number of patients per year, a comparison of the RTC epidemiologic factors, injury severity, resources used, and in-hospital outcomes. Results A total of 5233 patients involved in RTCs were admitted (median age, 33 [IQR, 24-48] years; 4629 [88.5%] men; median ISS, 13 [IQR, 8-22]). The population included 229 e-scooter RTCs (4.4%), 4094 motorbike RTCs (78.2%), and 910 bicycle RTCs (17.4%). The number of patients treated following e-scooter RTCs increased by 2.8-fold in 4 years (from 31 in 2019 to 88 in 2022), while bicycle RTCs increased by 1.2-fold and motorbike RTCs decreased by 0.9-fold. At admission, 36.7% of e-scooter users had a blood alcohol content higher than the legal threshold (n = 84) and 22.5% wore a protective helmet (n = 32). Among e-scooter RTCs, 102 patients (45.5%) had an ISS of 16 or higher. This proportion was similar for patients with motorbike RTCs (1557 [39.7%]; P = .10) and bicycle RTCs (411 [47.3%]; P = .69). With a proportion of 25.9% (n = 50), patients with e-scooter RTCs had twice as many severe traumatic brain injuries (Glasgow Coma Scale ≤8) as motorbike RTCs (445 [11.8%]) and a proportion comparable to bicycle RTCs (174 [22.1%]). The mortality of e-scooter RTCs was 9.2% (n = 20), compared with 5.2% (n = 196) ( P = .02) for motorbikes and 10.0% (n = 84) ( P = .82) for bicycles. Conclusions and Relevance The findings of this study suggest that trauma involving e-scooters in France has significantly increased over the past 4 years. These patients presented with injury profiles as severe as those of individuals who experienced bicycle or motorbike RTCs, with a higher proportion of severe traumatic brain injury.

Abstract Background Following traumatic brain injury (TBI), coagulopathy on hospital admission is reported in 25–35% of patients and associated with increased morbimortality. The respective contributions of intracranial injury and concomitant extracranial lesions to coagulopathy have been poorly investigated. We hypothesized that the occurrence of post-TBI coagulopathy would not only be related to head injury severity, but also and to a greater extent to the presence and severity of the associated extra-cranial injuries.Methods Observational study from a multicenter prospective French trauma registry (Traumabase®). All adult patients directly admitted to one of the participating centers from January 2012 to December 2021 following TBI (AIS (Abbreviated Injury score) head ≥ 1) were included. Post-TBI coagulopathy was defined by at least 1 of the following criteria: prothrombin ratio (Quick %) < 70% or platelet count < 100 G.L− 1 or fibrinogenemia < 1.5 g.L− 1 on hospital admission. Severe associated extracranial lesions were defined by at least 1 of the extra-head AIS scores ≥ 3.Results Among 33875 patients admitted to 22 trauma centers, 9610 patients had TBI and were analyzed. The overall incidence of admission coagulopathy was 28.5%. Coagulopathic patients were significantly more severely injured and especially more severely head-injured, when compared to non-coagulopathic patients. The higher the AIShead, the higher the proportion of patients exhibiting coagulopathy (P < 0.001), whatever the presence of extracranial lesions. When compared to patients with AIShead = 1, the increased incidence of coagulopathy with TBI severity was observed at an earlier stage of TBI severity when severe extracranial lesions were present. In multivariable analysis, severe extracranial injury was independently associated with the risk of post-TBI coagulopathy (OR 2.0 (1.8–2.3), P < 0.001).Conclusions A continuously graded association between the severity of head injury and coagulopathy at hospital admission was observed, and this increased incidence of coagulopathy was observed at an earlier stage of TBI severity when severe extracranial lesions were present. The presence of severe extracranial injuries was one of the most important risk factors for coagulopathy following TBI. Intracranial and extra-cranial injury severity could be used to timely identify TBI patients most likely to present post-traumatic coagulopathy, that could benefit from early specific hemostatic resuscitation.

Importance Optimal transfusion strategies in traumatic hemorrhage are unknown. Reports suggest a beneficial effect of 4-factor prothrombin complex concentrate (4F-PCC) on blood product consumption. Objective To investigate the efficacy and safety of 4F-PCC administration in patients at risk of massive transfusion. Design, Setting, and Participants Double-blind, randomized, placebo-controlled superiority trial in 12 French designated level I trauma centers from December 29, 2017, to August 31, 2021, involving consecutive patients with trauma at risk of massive transfusion. Follow-up was completed on August 31, 2021. Interventions Intravenous administration of 1 mL/kg of 4F-PCC (25 IU of factor IX/kg) vs 1 mL/kg of saline solution (placebo). Patients, investigators, and data analysts were blinded to treatment assignment. All patients received early ratio-based transfusion (packed red blood cells:fresh frozen plasma ratio of 1:1 to 2:1) and were treated according to European traumatic hemorrhage guidelines. Main Outcomes and Measures The primary outcome was 24-hour all blood product consumption (efficacy); arterial or venous thromboembolic events were a secondary outcome (safety). Results Of 4313 patients with the highest trauma level activation, 350 were eligible for emergency inclusion, 327 were randomized, and 324 were analyzed (164 in the 4F-PCC group and 160 in the placebo group). The median (IQR) age of participants was 39 (27-56) years, Injury Severity Score was 36 (26-50 [major trauma]), and admission blood lactate level was 4.6 (2.8-7.4) mmol/L; prehospital arterial systolic blood pressure was less than 90 mm Hg in 179 of 324 patients (59%), 233 patients (73%) were men, and 226 (69%) required expedient hemorrhage control. There was no statistically or clinically significant between-group difference in median (IQR) total 24-hour blood product consumption (12 [5-19] U in the 4F-PCC group vs 11 [6-19] U in the placebo group; absolute difference, 0.2 U [95% CI, -2.99 to 3.33]; P = .72). In the 4F-PCC group, 56 patients (35%) presented with at least 1 thromboembolic event vs 37 patients (24%) in the placebo group (absolute difference, 11% [95% CI, 1%-21%]; relative risk, 1.48 [95% CI, 1.04-2.10]; P = .03). Conclusions and Relevance Among patients with trauma at risk of massive transfusion, there was no significant reduction of 24-hour blood product consumption after administration of 4F-PCC, but thromboembolic events were more common. These findings do not support systematic use of 4F-PCC in patients at risk of massive transfusion. Trial Registration ClinicalTrials.gov Identifier: NCT03218722.

We aimed to develop and validate a Portuguese version of the Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese) patient-reported outcome measure and evaluate its psychometric properties.After ethical approval, we recruited term pregnant women undergoing uncomplicated elective cesarean delivery in a single Brazilian institution. Women were invited to complete the translated ObsQoR-10-Portuguese and EuroQoL (EQ-5D) questionnaires (including a global health visual analog scale [GHVAS]) at 24 h (±6 h) following delivery, and a subset of women an hour later. We assessed validity and reliability of ObsQoR-10-Portuguese.One hundred thirteen enrolled women completed the surveys at 24 h and 29 women at 25 h (100% response rate). Validity: (i) convergent validity: ObsQoR-10-Portuguese correlated moderately with EuroQoL score (r = −0.587) and GHVAS score (r = 0.568) at 24 h. (ii) Discriminant validity: ObsQoR-10 discriminated well between good versus poor recovery (GHVAS score ≥ 70 versus < 70; difference in mean scores 14.2; p < 0.001). (iii) Hypothesis testing: 24-h ObsQoR-10-Portuguese scores correlated with gestational age (r = 0.191; p = 0.043). (iv) Cross-cultural validity: differential item functioning analysis suggested bias in 2 items. Reliability: (i) internal consistency was good (Cronbach’s alpha = 0.82 and inter-item correlation = 0.31). (ii) Split-half reliability was very good (Spearman–Brown Prophesy Reliability Estimate = 0.80). (iii) Test re-test reliability was excellent (intra-class correlation coefficient = 0.87). (iv) Floor and ceiling effects: < 5% women scored either 0 or 100 (lowest and highest scores, respectively).ObsQoR-10-Portuguese is valid and reliable, and should be considered for use in Portuguese-speaking women to assess their quality of inpatient recovery following cesarean delivery.

BACKGROUND Optimal management of community-acquired intra-abdominal infections (IAI) requires timely surgical source control and adequate anti-infective treatment. OBJECTIVE To describe the initial management of community-acquired IAI admitted to the emergency department and assess the association between the length of time to either diagnosis or therapeutic procedures and patient outcomes. DESIGN A prospective, multicentre, observational study. SETTING Thirteen teaching hospitals in France between April 2018 and February 2019. PATIENTS Two hundred and five patients aged at least 18 years diagnosed with community-acquired IAI. MAIN OUTCOME MEASURES The primary outcome was hospital length of stay. The secondary outcome was hospital mortality. RESULTS Patients had a mean age of 56 (± 21) years and a median [interquartile] SAPS II of 26 [17 to 34]. Among the study cohort, 18% were postoperatively transferred to intensive care unit and 7% had died by day 28. Median [IQR] time to imaging, antibiotic therapy and surgery were 4 [2 to 6], 7.5 [4 to 12.5] and 9 [5.5 to 17] hours, respectively. The length of time to surgical source control [0.99, 95% confidence interval (CI), 0.98 to 0.99], SOFA greater than 2 [0.36 (95% CI, 0.26 to 0.651)], age greater than 60 years [0.65 (95% CI, 0.45 to 0.94)], generalized peritonitis [0.7 (95% CI, 0.56 to 0.89)] and laparotomy surgery [0.657 (95% CI, 0.42 to 0.78)] were associated with longer hospital length of stay. The duration of time to surgical source control [1.02 (95% CI, 1.01 to 1.04)], generalized peritonitis [2.41 (95% CI, 1.27 to 4.61)], and SOFA score greater than 2 [6.14 (95% CI, 1.40 to 26.88)] were identified as independent risk factors for 28-day mortality. CONCLUSION This multicentre observational study revealed that the time to surgical source control, patient severity and generalized peritonitis were identified as independent risk factors for increased hospital LOS and mortality in community-acquired IAI. Organisational strategies to reduce the time to surgical management of intra-abdominal infections should be further evaluated. STUDY REGISTRATION ClinicalTrials.gov on 1 April 2018, NCT03544203.

Background Trauma-induced coagulopathy includes thrombocytopenia and platelet dysfunction that impact patient outcome. Nevertheless, the role of platelet transfusion remains poorly defined. The aim of the study was 1/ to evaluate the impact of early platelet transfusion on 24-h all-cause mortality and 2/ to describe platelet count at admission (PCA) and its relationship with trauma severity and outcome. Methods Observational study carried out on a multicentre prospective trauma registry. All adult trauma patients directly admitted in participating trauma centres between May 2011 and June 2019 were included. Severe haemorrhage was defined as ≥ 4 red blood cell units within 6 h and/or death from exsanguination. The impact of PCA and early platelet transfusion (i.e. within the first 6 h) on 24-h all-cause mortality was assessed using uni- and multivariate logistic regression. Results Among the 19,596 included patients, PCA (229 G/L [189,271]) was associated with coagulopathy, traumatic burden, shock and bleeding severity. In a logistic regression model, 24-h all-cause mortality increased by 37% for every 50 G/L decrease in platelet count (OR 0.63 95% CI 0.57–0.70; p < 0.001). Regarding patients with severe hemorrhage, platelets were transfused early for 36% of patients. Early platelet transfusion was associated with a decrease in 24-h all-cause mortality (versus no or late platelets): OR 0.52 (95% CI 0.34–0.79; p < 0.05). Conclusions PCA, although mainly in normal range, was associated with trauma severity and coagulopathy and was predictive of bleeding intensity and outcome. Early platelet transfusion within 6 h was associated with a decrease in mortality in patients with severe hemorrhage. Future studies are needed to determine which doses of platelet transfusion will improve outcomes after major trauma.