Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.

Acute mesenteric ischemia (AMI) is a vascular emergency with a quite low incidence, but it is associated with disproportionately more severe morbidity and mortality. The aim of this study was to assess the current trend in the treatment of AMI and to see if endovascular intervention is an effective treatment modality in the selected group of patients. A retrospective review of patients admitted with AMI between 2007 and 2018 was performed. Outcome measures were length of stay (LOS) at hospital and intensive care unit (ICU), and post-treatment mortality. A total of 98 patients with AMI were admitted during the study period. Patients undergoing endovascular treatment compared with surgery were younger (62.9 ± 13.7 years vs. 69.5 ± 12.8 years; p = 0.01). Shorter LOS in hospital and ICU was observed for those treated with endovascular approach (6.8 ± 3.4 and 3.25 ± 0.5 days) compared to the surgical group (25 ± 8.6 and 12.8 ± 26.8 days; p < 0.001). Out of 39 patients requiring ICU admission, 48.7% were surgically treated and 10.2% underwent endovascular intervention (p < 0.001). Mortality associated with surgery was 30.6% compared to only 6.6% with endovascular intervention (p < 0.001). Between 2007 and 2012, only one patient underwent endovascular intervention and 20 underwent surgery compared to 14 patients treated with endovascular approach and 16 with surgery between 2013 and 2018. In this non-randomized, retrospective case series, patients with endovascular treatment fared clinically better and the intervention was found to be safe and feasible in the selected group of patients. We suggest a preference for this modality where possible. At our hospital, a trend favoring this approach is apparent during the last six years.

Management of patients after blunt splenic injury treated with Splenic Artery Embolisation (SAE) varies. This includes vaccination, post-procedure antibiotic use, and follow-up. This study aimed to assess current practice of management and infection prevention across Australia. A 29-question survey was sent via the Australian and New Zealand Trauma Registry to all 28 contributing trauma hospitals in Australia. Questions were based on data from the 2022 calendar year. Responses were received from 12 sites (43 %) including 6 of 8 Australian regions (75 %). Of responding sites, 10 (83 %) offer SAE via a 24-hour 7-day rostered service. Of a total 568 splenic injuries, there were 177 SAE treatments with a median of 8 per site (range 0-65). SAE constituted 31 % of all splenic management, conservative management in 65 %, and splenectomy in 4 %. 8 sites (67 %) had a protocol for splenic trauma. Prophylactic SAE was performed for AAST IV-V injuries at 8 sites (67 %), which included 80 % of adult hospitals. Distal SAE was the predominant treatment type (70 %). Patients were routinely admitted for median 4 days after SAE (range 2-5). Routine inpatient antibiotics were administered to SAE patients at 2 sites (17 %) while 1 site (8 %) routinely recommended lifelong antibiotics after SAE. Routine inpatient vaccinations were used by 4 of 11 sites (36 %), while 3 sites (25 %) recommend vaccinations in the future. 11 sites (92 %) follow-up patients post-discharge. Written information on SAE was given to patients at 9 hospitals (75 %) while splenic function testing was performed at 5 sites (42 %), mostly assessment for Howell-Jolly Bodies (80 %). 11 sites (92 %) would change clinical practice in the future if evidence on splenic immune function evolved. Across responding Australian hospitals, the use of vaccinations, antibiotics, and splenic function testing after SAE was low, which reflects existing evidence for preserved splenic function after SAE, plus unpublished experience of key stakeholders. Key societies should consider clinical practice guidelines that merge existing evidence with modern practice.

Purpose: This study investigated whether higher triage urgency according to the Australasian Triage Scale (ATS) is associated with reduced time to computed tomography (CT) in major trauma patients. Methods: A retrospective analysis was conducted on 621 patients with major trauma (ISS > 12) admitted to the state adult major trauma centre in Western Australia between September 2021 and August 2022. Demographic, injury, and clinical data were extracted from the state trauma registry. Time to CT was analysed using multivariate regression to assess the influence of ATS category and other clinical variables. Results: Median age was 50 years (range 14–103), and 75% were male. Nearly half of patients were triaged as ATS category 1. Higher urgency ATS category was independently associated with shorter time to CT: compared with ATS category 1, time to CT was delayed by 39 min in ATS 2 and 91 min in ATS 3 patients ( p < 0.001). Male sex was also associated with faster time to CT (− 27 min, p < 0.001). Longer time to CT correlated with increased time in the emergency department but was not associated with in-hospital mortality. Conclusion: Higher ATS urgency predicts faster access to CT in major trauma. Female patients experience longer delays, which may warrant targeted interventions. Time to CT was not associated with mortality in this cohort.

Introduction/background: Pelvic ring injuries (PRI) in traumatic shock are associated with over 30% mortality even in high income countries’ mature trauma systems, but recent Australian data showed no haemorrhage related mortality in this group. We aimed to describe the epidemiology, management and outcomes of PRI with haemodynamic instability managed in a state’s only Level 1 adult trauma centre. Design: We conducted a retrospective cohort study of all trauma patients with major PRI (Abbreviated Injury Scale (AIS) > 3) and hemodynamic instability (defined as systolic blood pressure (SBP) 0.7) presenting to the state adult trauma centre between 2013 and 2022. Data on demographics, injury patterns, management strategies, and outcomes were collected from the State Trauma Registry and hospital records. Results: Of 1369 patients with pelvic or acetabular fractures during the 10-year study period, 152 (11%) had major PRI with hemodynamic instability at presentation. Most were male (72%) with a median age of 35 years. Motor vehicle and motorbike crashes accounted for 52% of injuries. The median Injury Severity Score was 33. Massive transfusion protocols were activated in 45% of cases, while angioembolisation was utilised in 5.9%. Overall in-hospital mortality was 7.2% and mortality due to haemorrhage was 2%. Conclusions: In our mature trauma system, hemodynamically unstable PRI patients’ low mortality is consistent with the recently reported outcomes of best performing centres. Level of Evidence