Alexander Hönning

Background/Objectives: Road traffic accidents represent the leading cause of death in children and adolescents in Brazil. In the state of Piauí, non-specialized facilities frequently manage critically injured pediatric patients. Targeted training programs are considered a key strategy for improving outcomes. This study assessed the feasibility of adapting a pediatric trauma course developed in a high-income setting for medical first responders in both pre-hospital and in-hospital settings in a resource-limited environment in northeastern Brazil. Methods: This prospective non-randomized mixed-methods feasibility-oriented implementation and educational evaluation study involved the design of a simulation-based course based on a literature review by a German interprofessional and interdisciplinary team. Local adaptation was achieved through a needs assessment, field visits, and stakeholder collaboration. Implementation included the training of Brazilian instructor candidates, who subsequently delivered the course under supervision. Data were collected using study-specific, non-validated questionnaires at two timepoints and analyzed descriptively and exploratively. Results: A total of 98 healthcare professionals participated in the needs assessment (mean experience 9.7 ± 6.3 years; 62.2% nursing staff); 66 completed the pediatric trauma management section. Although familiarity with the ABCDE approach was high (86%), confidence in pediatric trauma management was significantly lower than management in adults (47% vs. 68%, p = 0.0018), particularly for invasive procedures. During implementation, 38 participants completed the course, with a 100% recommendation rate; approximately 80% felt prepared to teach independently. However, participants and instructors highlighted the need for more practical training, longer course duration, and follow-up instructor training. Conclusions: A context-adapted, simulation-based pediatric trauma training program was feasibly implemented and well accepted in a resource-limited region of Brazil. The train-the-trainer approach shows promise for strengthening local pediatric trauma capacity, but sustained implementation requires continued instructor development, supervised teaching, and long-term evaluation of educational and clinical outcomes.

Treatment of severely injured patients is challenging, and timely reading of whole-body computed tomography (WBCT) images therefore crucial. Artificial intelligence is increasingly used to prioritize and detect acute injuries in this context. Algorithms focusing on the cervical spine and compression fractures have been deployed successfully. However, tools for whole spine assessment and the entirety of fracture morphologies are lacking. We aimed to investigate the capabilities of an algorithm to detect spine fractures on WBCTs and factors contributing to the difficulties in its development. A version 1.0 (v1) of the algorithm was previously trained with 454 cervical spine fractures using a U-Net via four-fold cross-validation to segment spine fractures and the spine via a multi-task loss. Further training expanded towards whole spine assessment with additional annotated fractures (Cohort 1) of the cervical (n = 50), thoracic (n = 30), and lumbar spine (n = 20), resulting in version 2.0 (v2). Baseline was set to reach the highest sensitivity at a maximum of five false positives per case. Version 1.0 was tested on Cohort 1 and both versions were compared on prospectively collected real-world data (Cohort 2, n = 712 WBCTs). An additional systematic review served to compare the algorithmic performance against the state-of-the-art. Version 1.0 showed promising performance not only for the cervical but also the thoracic and lumbar spine due to generalization (sensitivities ranging between 60% and 87%). Version 2.0 also achieved decent sensitivities for Cohort 2 (sensitivities ranging between 77% and 85%) but generated an abundance of false positives. Various reasons led to false positive results; for Version 2.0, the trabecular structure itself provoked false alerts. Variances in training and test data (image quality, dose, reconstructions), heterogeneity of fractures and anatomies, plus the size of training sets explain some difficulties during algorithm development. Only five other groups described their work on whole-spine fracture detection, encountered similar difficulties, and have also failed to develop a clinically deployable tool. Spine fracture detection on WBCT is feasible, but multiple factors hinder the development of commercially available AI tools. Expansion and the improved design of training cohorts are necessary for further development and simulation of real-life conditions.

Background: In the past ten years, the number of publications on injuries associated with electric scooters (e-scooters) has been increasing continuously. The aim of this systematic review and meta-analysis was to synthesize the original study results on injury types, injury severity, clinical care, accident mechanisms, risk factors, and patient characteristics associated with e-scooter accidents. Methods: The literature search was conducted in PubMed, EMBASE and Medline. We included quantitative clinical studies published between 07/2019 and 07/2024 that report e-scooter-associated injuries in patients who presented to an emergency department. Variables that were reported as proportions (e.g., frequency of extremity fractures) were summarized using a proportional meta-analysis. Parameters on a continuous scale were combined using a meta-analysis of the arithmetic means. Results: Among 524 unique records, 149 articles met the inclusion criteria, and 68 were eligible for quantitative analyses. Most e-scooter patients sustained injuries to the head and face with a pooled frequency of 42.1% (95% CI 38.7–45.4). Injuries of the upper extremities were estimated at 40.1% of patients (95% CI 35.8–44.4). Fractures of the extremities occurred with a pooled frequency of 25.7% (95% CI 22.5–28.9). An estimated proportion of 2.3% (95% CI 1.6–3.0) sustained severe traumatic brain injuries. Determined by the Injury Severity Score (ISS), 2.8% (95% CI 1.5–4.1) of the e-scooter patients were severely injured (ISS ≥ 16). Conclusions: Injuries to the head and face as well as the upper extremities are the most common causes for emergency department visits following e-scooter accidents. One in four patients presented with extremity fractures. Severe injuries, however, affect less than three percent of e-scooter patients.

Background and Objectives: Severe burn injuries are still associated with high mortality. The length of intensive care stay is strongly influenced by the severity of organ failure, with multi-organ failure being the main cause of death in up to 40% of cases. Liver dysfunction is the second most common organ failure. Conventional diagnosis relies on static laboratory parameters that reflect damage already caused. Measuring the hepatic clearance of indocyanine green (LiMON^®) offers a dynamic, bedside method for detecting liver dysfunction early, enabling timely therapy adjustments. Materials and Methods: In this prospective single-centre observational study, all patients admitted to the Unfallkrankenhaus Berlin Burns Centre from October 2022 to September 2024 with ≥30% TBSA burns were included. Liver function was assessed via LiMON^® within 24 h post-injury and every 48 h until day 14 or ICU discharge. Static liver parameters were measured in parallel. Results: We included a total of 23 patients. An initial measurement was only successful in 18 cases. On admission, six patients (33%) had normal liver function with a plasma duration rate (PDR) > 18% (PDR 30.9 ± 7.3%), while 12 (67%) showed reduced clearance (PDR 14.5 ± 2.6%). In 75% of cases (n = 9), function recovered within 48 h. Based on PDR progression, four liver function patterns were defined: “stable”, “recovery”, “late insufficiency”, and “failure”; a fifth pattern included all patients who were deceased during this study (“death”). These groups differed in fluid therapy, plasma transfusion, and catecholamines administered. PDR correlated well with aminotransferase levels. Conclusions: Dynamic liver function monitoring enables earlier detection of impairment than static markers. Early identification of at-risk patients could guide fluid management and improve outcomes. LiMON^® is a valuable tool in burn care, though alternative methods may be needed in patients with severe systemic hypoperfusion.

Objectives This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: The primary objective of this review is to determine the diagnostic accuracy of any form of ML algorithm for detecting ICH in participants who underwent hCT. We will assess diagnostic accuracy by individual and pooled indicators such as sensitivity and specificity with 95% confidence intervals, positive and negative likelihood ratios, and the summary receiver operating characteristic curve. Secondary objectives To investigate the following potential sources of heterogeneity in the diagnostic accuracy of ML: type of ML algorithm; year of development of the ML algorithm; certification of ML algorithm (Yes/No); type of reference standard; participant age (adults only/children only/mixed); hCT quality; hCT protocol; type of study (retrospective cohort study/prospective cohort study/RCT).

Spondylodiscitis is a rather rare condition with an annual incidence of 1–7 per 100,000. Thus, empirical data on the treatment of this disease are limited. In 2020, the first German guideline for the diagnosis and treatment of spondylodiscitis was published. In a 5-year retrospective analysis, we examined the patient collective, the current diagnosis and treatment strategy, and the effect of Magnetic Resonance Imaging (MRI) diagnostics on therapeutic decisions of a consecutive monocentric cohort of 66 patients without neurological symptoms. The majority of the patients were male (55%) with a mean age of 74 years. Non-operative therapy was found to be associated with short-term treatment success in 54 (82%) of the patients. In 12 patients, who underwent surgical therapy, MRI diagnostics and clinical findings were equally important for the decision to perform a surgery. Patients treated operatively stayed for an average of 33.6 (±12.9) days in the hospital and thus significantly longer than non-operatively treated patients with 22.2 (±8.0) days. The in-house standard of care did not essentially deviate from the guideline’s recommendations. Future research should address early detection of the need for surgical therapy, and immediate anti-infective treatment appropriate to the detected pathogen.

Background: Studies have shown that Omicron breakthrough infections can occur at higher SARS-CoV-2 antibody levels compared to previous variants. Estimating the magnitude of immunological protection induced from COVID-19 vaccination and previous infection remains important due to varying local pandemic dynamics and types of vaccination programmes, particularly among at-risk populations such as health care workers (HCWs). We analysed a follow-up SARS-CoV-2 serological survey of HCWs at a tertiary COVID-19 referral hospital in Germany following the onset of the Omicron variant. Methods: The serological survey was conducted in January 2022, one year after previous surveys in 2020 and the availability of COVID-19 boosters including BNT162b2, ChAdOx1-S, and mRNA-1273. HCWs voluntarily provided blood for serology and completed a comprehensive questionnaire. SARS-CoV-2 serological analyses were performed using an Immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA). Antibody levels were reported according to HCW demographic and occupational characteristics, COVID-19 vaccination and SARS-CoV-2 infection history, and multivariate linear regression was used to evaluate these associations. Results: In January 2022 (following the fourth COVID-19 wave in Germany including the onset of the Omicron variant), 1482/1517 (97.7%) HCWs tested SARS-CoV-2 seropositive, compared to 4.6% in December 2020 (second COVID-19 wave). Approximately 80% had received three COVID-19 vaccine doses and 15% reported a previous laboratory-confirmed SARS-CoV-2 infection. SARS-CoV-2 IgG geometric mean titres ranged from 335 (95% Confidence Intervals [CI]: 258–434) among those vaccinated twice and without previous infection to 2204 (95% CI: 1919–2531) among those vaccinated three times and with previous infection. Heterologous COVID-19 vaccination combinations including a mRNA-1273 booster were significantly associated with the highest IgG antibody levels compared to other schemes. There was an 8-to 10-fold increase in IgG antibody levels among 31 HCWs who reported a SARS-CoV-2 infection in May 2020 to January 2022 after COVID-19 booster vaccination. Conclusions: Our findings demonstrate the importance of ongoing COVID-19 booster vaccination strategies in the context of variants such as Omicron and despite hybrid immunity from previous SARS-CoV-2 infections, particularly for at-risk populations such as HCWs. Where feasible, effective types of booster vaccination, such as mRNA vaccines, and the appropriate timing of administration should be carefully considered.

Low-to-moderate quality meta-analytic evidence shows that motor control stabilisation exercise (MCE) is an effective treatment of non-specific low back pain. A possible approach to overcome the weaknesses of traditional meta-analyses would be that of a prospective meta-analyses. The aim of the present analysis was to generate high-quality evidence to support the view that motor control stabilisation exercises (MCE) lead to a reduction in pain intensity and disability in non-specific low back pain patients when compared to a control group. In this prospective meta-analysis and sensitivity multilevel meta-regression within the MiSpEx-Network, 18 randomized controlled study arms were included. Participants with non-specific low back pain were allocated to an intervention (individualized MCE, 12 weeks) or a control group (no additive exercise intervention). From each study site/arm, outcomes at baseline, 3 weeks, 12 weeks, and 6 months were pooled. The outcomes were current pain (NRS or VAS, 11 points scale), characteristic pain intensity, and subjective disability. A random effects meta-analysis model for continuous outcomes to display standardized mean differences between intervention and control was performed, followed by sensitivity multilevel meta-regressions. Overall, 2391 patients were randomized; 1976 (3 weeks, short-term), 1740 (12 weeks, intermediate), and 1560 (6 months, sustainability) participants were included in the meta-analyses. In the short-term, intermediate and sustainability, moderate-to-high quality evidence indicated that MCE has a larger effect on current pain (SMD = −0.15, −0.15, −0.19), pain intensity (SMD = −0.19, −0.26, −0.26) and disability (SMD = −0.15, −0.27, −0.25) compared with no exercise intervention. Low-quality evidence suggested that those patients with comparably intermediate current pain and older patients may profit the most from MCE. Motor control stabilisation exercise is an effective treatment for non-specific low back pain. Sub-clinical intermediate pain and middle-aged patients may profit the most from this intervention.