Cover Page The handle http://hdl.handle.net/1887/22997 holds various files of this Leiden University dissertation Author: Wilden, Gwendolyn M. van der Title: The value of surgical treatment in abdominal emergencies : fulminant clostridium difficile colitis and severe abdominal trauma Issue Date: 2014-01-15 THE VALUE OF SURGICAL TREATMENT IN ABDOMINAL EMERGENCIES FULMINANT CLOSTRIDIUM DIFFICILE COLITIS AND SEVERE ABDOMINAL TRAUMA Gwendolyn M. van der Wilden This thesis was prepared at the Department of Surgery, Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, MA, United States of America and the Department of Trauma Surgery, Leiden University Medical Center & Leiden University, Leiden, the Netherlands. Author Coverphoto Cover design Printed by Gwendolyn M. van der Wilden Gwendolyn M. van der Wilden Optima Grafische Communicatie, Rotterdam The Netherlands Optima Grafische Communicatie, Rotterdam The Netherlands I would gratefully acknowledge the research support I received from the VSB Fonds, Minerva Scholarship Fund, Jo Keur Fonds, and the Bontius Stichting. This thesis has been sponsored by the Leiden University Fund/Melvin David Olin © G.M. van der Wilden, Leiden 2013 All rights reserved. No parts of this thesis may be reproduced, distributed, stored in a retrieval system or transmitted in any form or by any means, without permission of the author, or when appropriate, of the publisher of the publications. ISBN: 978-94-6169-449-2 THE VALUE OF SURGICAL TREATMENT IN ABDOMINAL EMERGENCIES FULMINANT CLOSTRIDIUM DIFFICILE COLITIS AND SEVERE ABDOMINAL TRAUMA Proefschrift ter verkrijging van de graad van Doctor aan de Universiteit Leiden, op gezag van Rector Magnificus prof.mr. C.J.J.M. Stolker, volgens besluit van het College voor Promoties te verdedigen op woensdag 15 januari 2014 klokke 15.00 uur door Gwendolyn Mariëtta van der Wilden geboren te Rotterdam in 1988 PROMOTIECOMMISSIE Promotores: Prof. Dr. I.B. Schipper Prof. Dr. G.C. Velmahos (Massachusetts General Hospital & Harvard Medical School) Overige Leden: Prof. Dr. J.C. Goslings (Academisch Medisch Centrum Amsterdam) Prof. Dr. E.J. Kuijper Prof. Dr. R.A.E.M. Tollenaar Medicine is a science of uncertainty and an art of probability (Sir William Osler, 1849-1919) Aan Opi en Omi Methorst Voor mijn ouders, Valerie en Julie LIST OF ABBREVIATIONS 25(OH)D 25(OH)D2 25(OH)D3 AAST ACS AIS aOR APACHE II BDI BLI BPI BRI CCI CDC CDI CDT CI CT EBL ED EIA ERCP FAST fCDC FFP f-NOM GCS GDH GU HCO3- HGB HLOS HR ICD-9 ICU IMT IO 25-hydroxyvitamin D ergocalciferol cholecalciferol American Association for the Surgery of Trauma American College of Surgeons abbreviated injury score adjusted odds ratio acute physiology and chronic health evaluation II blunt duodenal injury blunt liver injuries blunt pancreatic injury blunt renal injuries Charlson Comorbidity Index Clostridium difficile colitis Clostridium difficile infection Clostridium difficile transferase confidence interval computed tomography estimated blood loss emergency department enzyme immunoassay endoscopic retrograde cholangiopancreatography focused assessment with sonography for trauma fulminant Clostridium difficile colitis fresh frozen plasma failed non-operative management Glascow Coma Scale glutamate dehydrogenase genitourinary bicarbonate hemoglobin hospital length of stay heart rate international classification of diseases, 9th revision intensive care unit intestinal microbiota transplantation immediate operation IQ IQR ISS IV LOS MODS NL NOM NTDB OIS OR PCR PDT PO PR RBC ReCONECT SBP SD SIRS s-NOM SSI TAC TFB U.S. VDR WBC interquartiles interquartile range injury severity score intravenous length of stay multiple organ dysfunction syndrome the Netherlands non-operative management National Trauma Data Bank organ injury scale odds ratio polymerase chain reaction pancreatoduodenectomy for trauma per oral per rectum red blood cells Research COnsortium of New England Centers for Trauma systolic blood pressure standard deviation systemic inflammatory response syndrome successful non-operative management surgical site infection total abdominal colectomy total fluid balance United States of America vitamin D receptor white blood cells CONTENTS Introduction 11 Chapter 1 General introduction and outline of the thesis 13 Part I Fulminant Clostridium difficile colitis 33 Chapter 2 Fulminant Clostridium difficile colitis: prospective development of a risk scoring system 35 Chapter 3 Reduced mortality in patients with fulminant Clostridium difficile colitis due to a new hospital-wide protocol 51 Chapter 4 Antibiotic regimen after a total abdominal colectomy with ileostomy for fulminant Clostridium difficile colitis: a multicenter initiative 67 Chapter 5 Vitamin D status and the severity of Clostridium difficile infections in hospitalized adults 79 Part II Severe abdominal trauma 91 Chapter 6 Successful non-operative management of the most severe blunt kidney injuries: a multicenter study of the Research Consortium Of New England Centers for Trauma 93 Chapter 7 Successful non-operative management of the most severe blunt liver injuries: a multicenter study of the Research Consortium Of New England Centers for Trauma 107 Chapter 8 Trauma Whipple: Do or Don’t after severe pancreatoduodenal injuries? An Analysis of the National Trauma Data Bank (NTDB) 119 Discussion 133 Chapter 9 General discussion and future perspectives 135 Chapter 10 Summary 145 Appendices Summary in Dutch (Nederlandse samenvatting) 151 List of publications 157 Acknowledgements (Dankwoord) 159 Curriculum Vitae 163
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