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Article ; Online: From numbers to meaningful change: Minimal important change by using PROMIS in a cohort of fracture patients.

Houwen, Thymen / Theeuwes, Hilco P / Verhofstad, Michael H J / de Jongh, Mariska A C

2023 Volume 54 Suppl 5, Page(s) 110882

Abstract: Introduction: use of the Patient-Reported Outcomes measurement Information System (PROMIS®) is slowly increasing in patients with a fracture. Yet, minimal important change of PROMIS in patients with fractures has been addressed in a very limited number ... ...

Abstract	Introduction: use of the Patient-Reported Outcomes measurement Information System (PROMIS®) is slowly increasing in patients with a fracture. Yet, minimal important change of PROMIS in patients with fractures has been addressed in a very limited number of studies. As the minimal important change (MIC) is important to interpret PROMIS-scores, the goal is to estimate the MIC for PROMIS physical function (PF), PROMIS pain interference (PI) and PROMIS ability to participate in social roles and activities (APSRA) in patients with a fracture. Secondly, the smallest detectable change was determined. Materials and methods: A longitudinal cohort study on patients ≥ 18 years receiving surgical or non-surgical care for fractures was conducted. Patients completed PROMIS PF V1.1, PROMIS PI V1.1 and PROMIS APSRA V2.0. For follow-up, patients completed three additional anchor questions evaluating patient-reported improvement on a seven point rating scale. The predictive modeling method was used to estimate the MIC value of all three PROMIS questionnaires. Results: Hundred patients with a mean age of 55.4 ± 12.6 years were included of which sixty (60%) were female. Seventy-two (72%) patients were recovering from a surgical procedure. PROMIS-CAT T-scores of all PROMIS measures showed significant correlations with their anchor questions. The predictive modeling method showed a MIC value of +2.4 (n = 98) for PROMIS PF, -2.9 (n = 96) for PROMIS PI and +3.2 (n = 91) for PROMIS APSRA. Conclusion: By using the anchor based predictive modeling method, PROMIS MIC-values for improvement of respectively +2.4 points on a T-score metric for PROMIS-PF, -2.9 for PROMIS-PI and +3.2 for PROMIS APSRA give the impression of being meaningful to patients. These values can be used in clinical practice for managing patient expectations; to inform on treatment results; and to assess if patients experience significant change. This in order to encourage patient centered care.
MeSH term(s)	Humans ; Female ; Adult ; Middle Aged ; Aged ; Male ; Longitudinal Studies ; Patient Reported Outcome Measures ; Cohort Studies ; Fractures, Bone ; Surveys and Questionnaires
Language	English
Publishing date	2023-10-12
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2023.110882
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Zs.A 778: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Experiences of recovery and posthospital care needs of working-age adults after physical trauma: a qualitative focus group study.

Roodbeen, Ruud T J / Lugtenberg, Marjolein / Pöstges, Heide / Lansink, Koen W W / Theeuwes, Hilco P / de Jongh, Mariska A C / Joosen, Margot C W

BMJ open

2022 Volume 12, Issue 4, Page(s) e053330

Abstract: Objective: To explore experiences of recovery after physical trauma and identify long-term needs for posthospital care.: Design, participants and setting: A qualitative study was conducted consisting of seven online focus groups among working-age ... ...

Abstract	Objective: To explore experiences of recovery after physical trauma and identify long-term needs for posthospital care. Design, participants and setting: A qualitative study was conducted consisting of seven online focus groups among working-age adults who sustained their injury between 9 months and 5 years ago. Trauma patients discharged from a level 1 trauma centre in the Netherlands were divided into three groups based on the type of their physical trauma (monotrauma, polytrauma and traumatic brain injury). Group interviews were transcribed verbatim, and thematic analysis was conducted. Results: Despite differences in type and severity of their injuries, participants all struggled with the impact that trauma had on various aspects of their lives. They experienced recovery as an unpredictable and inconstant process aimed at resuming a meaningful life. Work was often perceived as an important part of recovery, though the value attributed to work could change over time. Participants struggled to bring the difficulties they encountered in their daily lives and at work to the attention of healthcare professionals (HCPs). While posthospital care needs varied between and across groups, all people stressed the need for flexible access to person-centred, multidisciplinary care and support after hospital discharge. Conclusions: This study reveals that people with a broad variety of injury experience recovery as a process towards resuming a meaningful life and report the need to expand trauma care to include comprehensive support to live well long term. Person-centred care might be helpful to enable HCPs to take people's individual long-term needs and life situations into account. Furthermore, providing timely access to coordinated, multidisciplinary care after discharge is advocated. Integrated care models that span a network of multidisciplinary support around the person may help align existing services and may facilitate easy and timely access to the most suitable support for injured people and their loved ones.
MeSH term(s)	Adult ; Focus Groups ; Humans ; Infant ; Palliative Care ; Patient Discharge ; Qualitative Research ; Trauma Centers
Language	English
Publishing date	2022-04-20
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-053330
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Article ; Online: Developing mHealth to the Context and Valuation of Injured Patients and Professionals in Hospital Trauma Care: Qualitative and Quantitative Formative Evaluations.

Houwen, Thymen / Vugts, Miel A P / Lansink, Koen W W / Theeuwes, Hilco P / Neequaye, Nicky / Beerekamp, M Susan H / Joosen, Margot C W / de Jongh, Mariska A C

JMIR human factors

2022 Volume 9, Issue 2, Page(s) e35342

Abstract: Background: Trauma care faces challenges to innovating their services, such as with mobile health (mHealth) app, to improve the quality of care and patients' health experience. Systematic needs inquiries and collaborations with professional and patient ... ...

Abstract	Background: Trauma care faces challenges to innovating their services, such as with mobile health (mHealth) app, to improve the quality of care and patients' health experience. Systematic needs inquiries and collaborations with professional and patient end users are highly recommended to develop and prepare future implementations of such innovations. Objective: This study aimed to develop a trauma mHealth app for patient information and support in accordance with the Center for eHealth Research and Disease Management road map and describe experiences of unmet information and support needs among injured patients with trauma, barriers to and facilitators of the provision of information and support among trauma care professionals, and drivers of value of an mHealth app in patients with trauma and trauma care professionals. Methods: Formative evaluations were conducted using quantitative and qualitative methods. Ten semistructured interviews with patients with trauma and a focus group with 4 trauma care professionals were conducted for contextual inquiry and value specification. User requirements and value drivers were applied in prototyping. Furthermore, a complementary quantitative discrete choice experiment (DCE) was conducted with 109 Dutch trauma surgeons, which enabled triangulation on value specification results. In the DCE, preferences were stated for hypothetical mHealth products with various attributes. Panel data from the DCE were analyzed using conditional and mixed logit models. Results: Patients disclosed a need for more psychosocial support and easy access to more extensive information on their injury, its consequences, and future prospects. Health care professionals designated workload as an essential issue; a digital solution should not require additional time. The conditional logit model of DCE results suggested that access to patient app data through electronic medical record integration (odds ratio [OR] 3.3, 95% CI 2.55-4.34; P<.001) or a web viewer (OR 2.3, 95% CI 1.64-3.31; P<.001) was considered the most important for an mHealth solution by surgeons, followed by the inclusion of periodic self-measurements (OR 2, 95% CI 1.64-2.46; P<.001), the local adjustment of patient information (OR 1.8, 95% CI 1.42-2.33; P<.001), local hospital identification (OR 1.7, 95% CI 1.31-2.10; P<.001), complication detection (OR 1.5, 95% CI 1.21-1.84; P<.001), and the personalization of rehabilitation through artificial intelligence (OR 1.4, 95% CI 1.13-1.62; P=.001). Conclusions: In the context of trauma care, end users have many requirements for an mHealth solution that addresses psychosocial functioning; dependable information; and, possibly, a prediction of how a patient's recovery trajectory is evolving. A structured development approach provided insights into value drivers and facilitated mHealth prototype enhancement. The findings imply that iterative development should move on from simple and easily implementable mHealth solutions to those that are suitable for broader innovations of care pathways that most-but plausibly not yet all-end users in trauma care will value. This study could inspire the trauma care community.
Language	English
Publishing date	2022-06-20
Publishing country	Canada
Document type	Journal Article
ISSN	2292-9495
ISSN (online)	2292-9495
DOI	10.2196/35342
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Article ; Online: Prevalence of inflicted and neglectful femur shaft fractures in young children in national level I trauma centers.

Loos, Marie-Louise H J / Bakx, Roel / Allema, J H / Bloemers, Frank W / Ten Bosch, Jan A / Edwards, Michael J R / Hulscher, Jan B F / Keyzer-Dekker, Claudia M G / Krug, Egbert / de Ridder, Victor A / Spanjersberg, W Richard / Teeuw, Arianne H / Theeuwes, Hilco P / de Vries, Selena / de Wit, Ralph / van Rijn, Rick R

Pediatric radiology

2022 Volume 52, Issue 12, Page(s) 2359–2367

Abstract: Background: The prevalence of inflicted femur fractures in young children varies (1.5-35.2%), but these data are based on small retrospective studies with high heterogeneity. Age and mobility of the child seem to be indicators of inflicted trauma.: ... ...

Abstract	Background: The prevalence of inflicted femur fractures in young children varies (1.5-35.2%), but these data are based on small retrospective studies with high heterogeneity. Age and mobility of the child seem to be indicators of inflicted trauma. Objective: This study describes other factors associated with inflicted and neglectful trauma that can be used to distinguish inflicted and neglectful from accidental femur fractures. Materials and methods: This retrospective study included children (0-6 years) who presented with an isolated femur fracture at 1 of the 11 level I trauma centers in the Netherlands between January 2010 and January 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect teams or the court. Cases in which conclusions were unavailable and there was no clear accidental cause were reviewed by an expert panel. Results: The study included 328 children; 295 (89.9%) cases were classified as accidental trauma. Inflicted trauma was found in 14 (4.3%), while 19 (5.8%) were cases of neglect. Indicators of inflicted trauma were age 0-5 months (29%, positive likelihood ratio [LR +] 8.35), 6-12 months (18%, LR + 5.98) and 18-23 months (14%, LR + 3.74). Indicators of neglect were age 6-11 months (18%, LR + 4.41) and age 18-23 months (8%, LR + 1.65). There was no difference in fracture morphology among groups. Conclusion: It is unlikely that an isolated femur fracture in ambulatory children age > 24 months is caused by inflicted trauma/neglect. Caution is advised in children younger than 24 months because that age is the main factor associated with inflicted trauma/neglect and inflicted femur fractures.
MeSH term(s)	Child ; Humans ; Infant ; Child, Preschool ; Infant, Newborn ; Trauma Centers ; Femoral Fractures/diagnostic imaging ; Femoral Fractures/epidemiology ; Retrospective Studies ; Prevalence ; Femur/injuries ; Child Abuse/diagnosis
Language	English
Publishing date	2022-05-07
Publishing country	Germany
Document type	Journal Article
ZDB-ID	124459-0
ISSN	1432-1998 ; 0301-0449
ISSN (online)	1432-1998
ISSN	0301-0449
DOI	10.1007/s00247-022-05378-8
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Zs.A 927: Show issues

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Article ; Online: The prevalence of non-accidental trauma among children with polytrauma: A nationwide level-I trauma centre study.

Loos, Marie-Louise H J / van Rijn, Rick R / Krug, Egbert / Bloemers, Frank W / Ten Bosch, Jan A / Bossuyt, P M M / Edwards, Michael J R / Greeven, Alexander P A / Hulscher, Jan B F / Keyzer-Dekker, Claudia M G / de Ridder, Victor A / Spanjersberg, W Richard / Teeuw, Arianne H / Theeuwes, Hilco P / de Vries, Selena / de Wit, Ralph / Bakx, Roel

Journal of forensic and legal medicine

2022 Volume 90, Page(s) 102386

Abstract: Objective: We aimed to investigate the prevalence and characteristics of non-accidental trauma (NAT) in children with polytrauma treated at level-I trauma centres (TC).: Summary of background: Data 6-10% Of children who present at the emergency ... ...

Abstract	Objective: We aimed to investigate the prevalence and characteristics of non-accidental trauma (NAT) in children with polytrauma treated at level-I trauma centres (TC). Summary of background: Data 6-10% Of children who present at the emergency department with injuries, sustain polytrauma. Polytrauma may result from either accidental (AT) or NAT, i.e. inflicted or neglect. The prevalence of NAT among children with polytrauma is currently unclear. Methods: This is a retrospective study that included children (0-18 years) with an Injury Severity Score >15, who presented at one of the 11 Level-I trauma centers (TC) in the Netherlands between January 1, 2010 and January 1, 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect-team. Cases in which conclusions were unavailable and there was no clear accidental cause of injuries were reviewed by an expert panel. Results: The study included 1623 children, 1452 (89%) were classified as AT, 171 (11%) as NAT; 39 (2,4%) inflicted and 132 (8,1%) neglect. Of pre-school aged children (<5 years) 41% sustained NAT (OR26.73, 95%CI 17.70-40.35), 35/342 (10%) inflicted and 104/342 (31%) neglect. Admission due to 'cardiopulmonary arrest' was the result of inflicted trauma (30% vs 0%,p < 0.001). NAT had a higher mortality rate (16% vs 10%, p = 0.006). Indicators of NAT were: (near-)drowning (OR10.74, 95%CI 5.94-19.41), burn (OR8.62, 95%CI 4.08-18.19) and fall from height (OR2.18, 95%CI 1.56-3.02). Conclusions: NAT was the cause of polytrauma in 11% of children in our nationwide level-I TC study; 41% of these polytrauma were the result of NAT experienced by preschool-aged children. Our data show the importance of awareness for NAT.
MeSH term(s)	Child ; Child Abuse ; Child, Preschool ; Humans ; Infant ; Injury Severity Score ; Multiple Trauma/epidemiology ; Prevalence ; Retrospective Studies ; Trauma Centers
Language	English
Publishing date	2022-06-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2268721-X
ISSN	1878-7487 ; 1752-928X
ISSN (online)	1878-7487
ISSN	1752-928X
DOI	10.1016/j.jflm.2022.102386
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Article ; Online: Training for endoscopic surgical procedures should be performed in the dissection room: a randomized study.

Klitsie, Pieter J / Ten Brinke, Bart / Timman, Reinier / Busschbach, Jan J V / Theeuwes, Hilco P / Lange, Johan F / Kleinrensink, Gert-Jan

Surgical endoscopy

2017 Volume 31, Issue 4, Page(s) 1754–1759

Abstract: Background: Laparoscopic surgery is associated with a shallow learning curve. AnubiFiX embalming technique enables laparoscopic surgical training on supple embalmed and hence insufflatable human specimens in the dissection room. Aim of the present trial ...

Abstract	Background: Laparoscopic surgery is associated with a shallow learning curve. AnubiFiX embalming technique enables laparoscopic surgical training on supple embalmed and hence insufflatable human specimens in the dissection room. Aim of the present trial is to test whether dissection-based anatomy education is superior to classical frontal classroom education on the short and long term. Methods: A total of 112 medical students were randomized in three groups. Group I attended classroom education, group II laparoscopic dissection-based education and group III received both. All groups completed an anatomy test on human specimens before, immediately after and 3 weeks after the anatomy training. Results: Group II and III scored significantly better compared to group I immediately after the anatomy training (p I-II < 0.001, p I-III < 0.001). This difference was still significant after 3 weeks (p I-II < 0.001, p I-III < 0.001). No significant difference was found between group II and group III immediately after the course (p = 0.86), nor at the follow-up (p = 0.054). Conclusions: The AnubiFiX™ embalming technique enables laparoscopic anatomy education in human specimens, with superior outcomes on the short and long term, as compared to classical frontal classroom education.
MeSH term(s)	Anatomy/education ; Dissection/education ; Education, Medical, Undergraduate/methods ; Embalming/methods ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/education ; Learning Curve ; Male ; Netherlands
Language	English
Publishing date	2017-04
Publishing country	Germany
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-016-5168-3
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Zs.A 2214: Show issues

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Article ; Online: Training in laparoscopic colorectal surgery: a new educational model using specially embalmed human anatomical specimen.

Slieker, Juliette C / Theeuwes, Hilco P / van Rooijen, Göran L / Lange, Johan F / Kleinrensink, Gert-Jan

Surgical endoscopy

2012 Volume 26, Issue 8, Page(s) 2189–2194

Abstract: Background: With an increasing percentage of colorectal resections performed laparoscopically nowadays, there is more emphasis on training “before the job” on operative skills, including the comprehension of specific laparoscopic surgical anatomy. As ... ...

Abstract	Background: With an increasing percentage of colorectal resections performed laparoscopically nowadays, there is more emphasis on training “before the job” on operative skills, including the comprehension of specific laparoscopic surgical anatomy. As integration of technical skills with correct interpretation of the anatomical image must be incorporated in laparoscopic training, a human specimen training model with special emphasis on surgical anatomy was developed. Methods: The new embalming method Anubifix™ combines long-term high-quality embalming of human bodies with almost normal flexibility and plasticity, and the body can be kept operational as long as conventionally embalmed human specimens. A colorectal training model was created in a specimen in which anatomical landmarks of colorectal anatomy were permanently colored to explore laparoscopic colorectal anatomy in a skills training setting. Airtight closure of the abdominal wall permits the creation of pneumoperitoneum. Residents were asked to test the model by mobilizing the small and large bowels and expose the central vessels and ureters. Afterward they were asked to fill out an eight-item questionnaire about the model. Results: Eleven surgical residents in their first and second year of training participated. Responses to the questionnaire showed that a majority of residents considered the model to be representative of the real situation and superior to animal models or virtual reality simulators, and helped to improve the knowledge of three-dimensional anatomy and laparoscopic skills. Conclusion: The new training model for laparoscopic colorectal surgery proved to be a high-quality tool, concentrating on laparoscopic colorectal anatomy in a skills training setting. We believe it may be a valuable adjunct to residency training programs based on the principle of “training before the job.”
MeSH term(s)	Anatomic Landmarks/anatomy & histology ; Anatomy/education ; Attitude of Health Personnel ; Colorectal Surgery/education ; Embalming/methods ; Equipment Design ; Humans ; Internship and Residency ; Laparoscopy/education ; Medical Illustration ; Models, Educational ; Surveys and Questionnaires ; Teaching Materials
Language	English
Publishing date	2012-01-29
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-012-2158-y
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Article ; Online: An anatomical study of the length of the neural pedicle after the bifurcation of the thoracodorsal nerve: implications for innervated free partial latissimus dorsi flaps.

Theeuwes, Hilco P / Gosselink, Martijn P / Bruynzeel, Hanna / Kleinrensink, Gert-Jan / Walbeehm, Erik T

Plastic and reconstructive surgery

2010 Volume 127, Issue 1, Page(s) 210–214

Abstract: Background: For innervated functional muscle transplant procedures, it is essential to have knowledge about the length of nerve pedicles available for nerve anastomosis. For the latissimus dorsi muscle, the thoracodorsal nerve divides into two funicles ... ...

Abstract	Background: For innervated functional muscle transplant procedures, it is essential to have knowledge about the length of nerve pedicles available for nerve anastomosis. For the latissimus dorsi muscle, the thoracodorsal nerve divides into two funicles that separately innervate the medial and lateral portions of the muscle. This suggests the possibility of a multiple, segmentally innervated latissimus dorsi muscle transfer. The branching and length of the thoracodorsal nerve distal to the bifurcation have not been described. This surgical-anatomical study presents anatomical data on these practical/clinical issues. Methods: Eleven latissimus dorsi muscles were dissected in eight adult embalmed human specimens. The thoracodorsal neurovascular bundle was dissected from insertion to proximal of the bifurcation. Measurements were taken indirectly from standardized photographic images and analyzed with ImageJ and standard spreadsheet software. Results: The mean age of the specimens was 66 years. The median pedicle length of the lateral part of the muscle was 3.8 cm (range, 2.41 to 5.93 cm). The median length of the medial branch was 3.49 cm (range, 1.7 to 5.12 cm). Proximal branching of the medial pedicle of the bifurcation was identified in approximately two-thirds of the specimens and had a median of 3.55 cm (range, 2.54 to 4.68 cm). The veins and arteries showed a similar pattern, with a median length slightly less than that of the thoracodorsal nerve. Conclusion: The separate neurovascular branches and its minimal pedicle length make the latissimus dorsi muscle very suitable for single functional free muscle transfer, using only the lateral part of the latissimus dorsi muscle, and double functional free muscle transfer using only one vascular pedicle.
MeSH term(s)	Aged ; Aged, 80 and over ; Back ; Cadaver ; Female ; Free Tissue Flaps/innervation ; Humans ; Male ; Middle Aged ; Muscle, Skeletal/innervation ; Peripheral Nerves/anatomy & histology
Language	English
Publishing date	2010-12-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	208012-6
ISSN	1529-4242 ; 0032-1052 ; 0096-8501
ISSN (online)	1529-4242
ISSN	0032-1052 ; 0096-8501
DOI	10.1097/PRS.0b013e3181f95a8e
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Article ; Online: High prevalence of non-accidental trauma among deceased children presenting at Level I trauma centers in the Netherlands.

Loos, Marie-Louise H J / Bakx, Roel / Duijst, Wilma L J M / Aarts, Francee / de Blaauw, Ivo / Bloemers, Frank W / Ten Bosch, Jan A / Evers, Martina / Greeven, Alexander P A / Hondius, Marie-Josée / van Hooren, Roland L J H / Huisman, Erik / Hulscher, Jan B F / Keyzer-Dekker, Claudia M G / Krug, Egbert / Menke, Jack / Naujocks, Tatjana / Reijnders, Udo J L / de Ridder, Victor A /

Spanjersberg, W Richard / Teeuw, Arianne H / Theeuwes, Hilco P / Vervoort-Steenbakkers, Will / de Vries, Selena / de Wit, Ralph / van Rijn, Rick R

Forensic science, medicine, and pathology

2021 Volume 17, Issue 4, Page(s) 621–633

Abstract: Purpose: Between 0.1-3% of injured children who present at a hospital emergency department ultimately die as a result of their injuries. These events are typically reported as unnatural causes of death and may result from either accidental or non- ... ...

Abstract	Purpose: Between 0.1-3% of injured children who present at a hospital emergency department ultimately die as a result of their injuries. These events are typically reported as unnatural causes of death and may result from either accidental or non-accidental trauma (NAT). Examples of the latter include trauma that is inflicted directly or resulting from neglect. Although consultation with a forensic physician is mandatory for all deceased children, the prevalence of fatal inflicted trauma or neglect among children is currently unclear. Methods: This is a retrospective study that included children (0-18 years) who presented and died at one of the 11 Level I trauma centers in the Netherlands between January 1, 2014, and January 1, 2019. Outcomes were classified based on the conclusions of the Child Abuse and Neglect team or those of forensic pathologists and/or the court in cases referred for legally mandated autopsies. Cases in which conclusions were unavailable and there was no clear accidental cause of death were reviewed by an expert panel. Results: The study included 175 cases of childhood death. Seventeen (9.7%) of these children died due to inflicted trauma (9.7%), 18 (10.3%) due to neglect, and 140 (80%) due to accidents. Preschool children (< 5 years old) were significantly more likely to present with injuries due to inflicted trauma and neglect compared to older children (44% versus 6%, p < 0.001, odds ratio [OR] 5.80, 95% confidence interval [CI] 2.66-12.65). Drowning accounted for 14 of the 18 (78%) pediatric deaths due to neglect, representing 8% of the total cases. Postmortem radiological studies and autopsies were performed on 37 (21%) of all cases of childhood death. Conclusion: One of every five pediatric deaths in our nationwide Level I trauma center study was attributed to NAT; 44% of these deaths were the result of trauma experienced by preschool-aged children. A remarkable number of fatal drownings were due to neglect. Postmortem radiological studies and autopsies were performed in only one-fifth of all deceased children. The limited use of postmortem investigations may have resulted in missed cases of NAT, which will result in an overall underestimation of fatal NAT experienced by children.
MeSH term(s)	Accidents ; Adolescent ; Child ; Child Abuse/diagnosis ; Child, Preschool ; Humans ; Infant ; Netherlands/epidemiology ; Prevalence ; Retrospective Studies ; Trauma Centers ; Wounds and Injuries
Language	English
Publishing date	2021-11-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2195904-3
ISSN	1556-2891 ; 1547-769X
ISSN (online)	1556-2891
ISSN	1547-769X
DOI	10.1007/s12024-021-00416-7
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Article ; Online: The surgical anatomy of the small saphenous vein and adjacent nerves in relation to endovenous thermal ablation.

Kerver, Anton L A / van der Ham, Arie C / Theeuwes, Hilco P / Eilers, Paul H C / Poublon, Alex R / Kerver, Albertus J H / Kleinrensink, Gert-Jan

Journal of vascular surgery

2012 Volume 56, Issue 1, Page(s) 181–188

Abstract: Background: Thermal damage to peripheral nerves is a known complication of endovenous thermal ablation (EVA) of the small saphenous vein (SSV). Therefore, the main objective of this anatomic study was to define a safe zone in the lower leg where EVA of ... ...

Abstract	Background: Thermal damage to peripheral nerves is a known complication of endovenous thermal ablation (EVA) of the small saphenous vein (SSV). Therefore, the main objective of this anatomic study was to define a safe zone in the lower leg where EVA of the SSV can be performed safely. Methods: The anatomy of the SSV and adjacent nerves was studied in 20 embalmed human specimens. The absolute distances between the SSV and the sural nerve (SN) (closest/nearest branch) were measured over the complete length of the leg (>120 data points per leg), and the presence of the interlaying deep fascia was mapped. The distance between the SSV and the tibial nerve (TN) and the common peroneal nerve was assessed. A new analysis method, computer-assisted surgical anatomy mapping, was used to visualize the gathered data. Results: The distance between the SSV and the SN was highly variable. In the proximal one-third of the lower leg, the distance between the vein and the nerve was <5 mm in 70% of the legs. In 95%, the deep fascia was present between the SSV and the SN. In the distal two-thirds of the lower leg, the distance between the vein and the nerve was <5 mm in 90% of the legs. The deep fascia was present between both structures in 15%. In 19 legs, the SN partially ran beneath the deep fascia. In the saphenopopliteal region, the average shortest distance between the SSV and the TN was 4.4 mm. In 20%, the distance was <1 mm. The average, shortest distance between the SSV and the common peroneal nerve was 14.2 mm. The distance was <1 mm in one leg. Conclusions: At the saphenopopliteal region, the TN is at risk during EVA. In the distal two-thirds of the lower leg, the SN is at risk for (thermal) damage due to the small distance to the SSV and the absence of the deep fascia between both structures. The proximal one-third of the lower leg is the optimal region for EVA of the SSV to avoid nerve damage; the fascia between the SSV and the SN is a natural barrier in this region that could preclude (thermal) damage to the nerve.
MeSH term(s)	Cadaver ; Catheter Ablation/adverse effects ; Humans ; Leg/blood supply ; Leg/innervation ; Peripheral Nervous System/anatomy & histology ; Saphenous Vein/anatomy & histology ; Saphenous Vein/surgery ; Software ; Sural Nerve/anatomy & histology
Language	English
Publishing date	2012-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2011.11.127
Database	MEDical Literature Analysis and Retrieval System OnLINE

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