Depacked patients who underwent a shortened perihepatic packing for severe blunt liver trauma have a high survival rate: 20 years of experience in a level I trauma center.

INTRODUCTION: Non-operative management is currently the preferred approach in blunt liver trauma, including high grade liver lesions. However, hemodynamic instability imposes the need for an emergency laparotomy, with a perihepatic packing (PHP) to control liver bleeding in most cases. Our retrospective study aimed to assess the outcomes of liver trauma patients who underwent a shortened PHP. METHODS: All consecutive patients who underwent PHP for blunt liver trauma from 1998 to 2019 in our Level I trauma center were included in the study. Unstable patients with severe liver trauma were transferred to the operating room without any delay, and a collective decision was made to perform abbreviated laparotomy to pack the liver. Demographics, perioperative data, postoperative outcomes, and mortality were retrospectively collected, and survivors and deceased patients were compared with a paired t-test. RESULTS: Fifty-nine patients of 206 patients admitted with severe liver injuries were treated with shortened PHP. Thirty-four (57.6%) patients died, including 26 (76.5%) within the first 24 h. Twelve (20.3%) patients had a selective hepatic embolization and eight (13.6%) had an extrahepatic embolization. Forty-eight patients had an extra abdominal associated injury. This was not a predictive factor of mortality. The removal of packing was performed in 24 patients within 72 h after laparotomy, with an 80% survival rate in these patients. CONCLUSION: Shortened PHP is an effective strategy for controlling liver bleeding in severe hepatic trauma. The mortality rate of these patients is high, but after the removal of packing, the survival is good.

Correlation between students' and trainers' evaluations while learning delegated surgical procedures: A prospective cohort study.

BACKGROUND: The delegation of procedures within the medical competence to the nurses can increase the effectiveness of the healthcare provided. The objectives of the study are (1) to assess the quality of training courses for delegated surgical procedures through implementation for graduate scrub nursing ("students") (2) and to evaluate the correlation between the evaluation of this training carried out by students and the self-assessment conducted by the faculty ("trainers"). MATERIALS AND METHODS: We set up a 49-h training for five groups of 10 students from July 2016 to July 2017 in our tertiary academic hospital. The course consisted mostly in simulations based on the "Zwisch" model and focused on acquiring the control of the gesture as well as on the development of critical reasoning. An evaluation of the training by the students but also a self-assessment of trainers were prospectively collected using the SFDP26 questionnaire. RESULTS: 52 active scrub nursing students and 21 trainers were included. 96% of students and 86% of trainers evaluated the training from "good" to "very good". Progress was observed for 41 (79%) of the students and 18 (86%) of the trainers, and 98% of students felt able to put their new skills into clinical practice after training. There was no difference between the total scores of students and teachers (p = 0.153). A statistically significant difference between the evaluations produced by the students and the self-evaluations produced by the trainers was observed for 8 of the 26 items of assessment. In case of inadequacy, the trainers' scores were always lower than those of the students. CONCLUSIONS: Training in performing delegated surgical procedures by mixed cognitive and motor gestures learning, based on the development of critical thinking and simulations seems to be effective, with a significant improvement in students' knowledge and skills. Expectations of students and trainers are well correlated.