Tobias Gauss

Tobias Gauss
Déchocage - Bloc des urgences Pole Anesthésie-Réanimation CHU Grenoble Alpes Traumabase.eu

MD, Dr. med.

About

134
Publications
21,939
Reads
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1,270
Citations
Additional affiliations
September 2021 - present
Centre Hospitalier Universitaire de Grenoble
Position
  • Consultant
September 2016 - August 2017
East Anglian Air Ambulance
Position
  • Doctor
November 2006 - May 2007
Hôpital Universitaire Robert Debré
Position
  • Intern

Publications

Publications (134)
Article
Full-text available
Background Trauma-induced coagulopathy includes thrombocytopenia and platelet dysfunction that impact patient outcome. Nevertheless, the role of platelet transfusion remains poorly defined. The aim of the study was 1/ to evaluate the impact of early platelet transfusion on 24-h all-cause mortality and 2/ to describe platelet count at admission (PCA...
Article
Full-text available
Background: Delaying time to prone positioning (PP) may be associated with higher mortality in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). We evaluated the use and the impact of early PP on clinical outcomes in intubated patients hospitalized in intensive care units (ICUs) for COVID-19. Methods: All int...
Conference Paper
Full-text available
Objective. To provide guidelines to define the place of human factors in the management of critical situations in anesthesia and critical care. Design. A committee of nineteen experts from SFAR and FHS group learned societies has been set up. A policy of declaration of links of interest was applied and respected throughout the whole process of prod...
Article
Full-text available
Background Rapid referral of traumatic brain injury (TBI) patients requiring emergency neurosurgery to a specialized trauma center can significantly reduce morbidity and mortality. Currently, no model has been reported to predict the need for acute neurosurgery in severe to moderate TBI patients. This study aims to evaluate the performance of Machi...
Article
Full-text available
PurposeThe bacterial ecology involved in early pneumonia of severe trauma patients is mostly commensal and would allow wide use of narrow-spectrum antibiotics. We describe risk factors for treatment failure of severe trauma patients’ pneumonia with the use of narrow-spectrum antimicrobial therapy in order to develop a score that could help clinicia...
Article
Full-text available
Purpose Blunt cerebrovascular injuries (BCVI) are a rare but serious complication after trauma. Among patients with BCVI, neurological status is altered in 30% of cases and the prognosis seems to be associated with ischemic complications. The aim of this study was to assess the long-term outcome of BCVI-associated ischemic events. Methods This ret...
Article
Full-text available
Purpose Traumatic hemorrhagic shock (THS) is a complex, dynamic process and, no consensual definition of THS is available. This study aims (1) to explore existing definitions of traumatic hemorrhagic shock (THS), (2) to identify essential components of these definitions and (3) to illustrate in a pragmatic way the consequences of applying five of t...
Preprint
Background : Rapid referral of traumatic brain injury (TBI) patients requiring emergency neurosurgery to a specialized trauma center can significantly reduce morbidity and mortality. Currently, no model has been reported to predict the need for acute neurosurgery in severe to moderate TBI patients. This study aims to evaluate the performance of Mac...
Preprint
Background: Rapid referral of traumatic brain injury (TBI) patients requiring emergency neurosurgery to a specialized trauma center can significantly reduce morbidity and mortality. Currently, no model has been reported to predict the need for acute neurosurgery in severe to moderate TBI patients. This study aims to evaluate the performance of Mach...
Article
Full-text available
PurposeThe aim of this work is to study a cohort of patients of ISS < 15 admitted to a TC, and to determine the number of patients that ultimately benefited from the skills and resources specific of a level 1 trauma center.Methods Retrospective study from a prospective cohort of patients admitted to TC (Beaujon Hospital, APHP) for suspected severe...
Article
Full-text available
Purposes External ventricular drainage (EVD) is frequently used to control raised intracranial pressure after traumatic brain injury. However, the available evidence about its effectiveness in this context is limited. The aim of this study is to evaluate the effectiveness of EVD to control intracranial pressure and to identify the clinical and radi...
Preprint
Full-text available
Purpose: Fetal radiation exposure in pregnant women with trauma is a concern. The purpose of this study was to evaluate fetal radiation exposure with regard to the type of injury assessment performed. Methods: It is a multicentre observational study. The cohort study included all pregnant women suspected of severe traumatic injury in the participat...
Article
Full-text available
Background Emerging evidence suggests that the reallocation of health care resources during the COVID-19 pandemic negatively impacts health care system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. Methods This retrospective observationa...
Article
Full-text available
As emerging countries, China, Russia, and South Africa are establishing and/or improving their trauma systems. China has recently established a trauma system named “the Chinese Regional Trauma Care System” and covered over 200 million populations. It includes paramedic-staffed pre-hospital care, in-hospital care in certified trauma centers, trauma...
Article
Full-text available
Rational To evaluate the respective impact of standard oxygen, high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) on oxygenation failure rate and mortality in COVID-19 patients admitted to intensive care units (ICUs). Methods Multicenter, prospective cohort study (COVID-ICU) in 137 hospitals in France, Belgium, and Switzerland. Demog...
Article
Full-text available
Background Predicting outcomes of critically ill intensive care unit (ICU) patients with coronavirus-19 disease (COVID-19) is a major challenge to avoid futile, and prolonged ICU stays. Methods The objective was to develop predictive survival models for patients with COVID-19 after 1-to-2 weeks in ICU. Based on the COVID–ICU cohort, which prospect...
Article
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Background Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring intensive care unit (ICU) have a high incidence of hospital-acquired infections; however, data regarding hospital acquired bloodstream infections (BSI) are scarce. We aimed to investigate risk factors and outcome of BSI in critically ill...
Article
Background Reports published directly after terrorist mass casualty incidents frequently fail to capture difficulties that may have been encountered. An anonymised consensus-based platform may enable discussion and collaboration on the challenges faced. Our aim was to identify where to focus improvement for future responses. Methods We conducted a...
Article
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A considerable amount of literature has nurtured the idea that massive transfusion is an independent trauma disease and therapeutic tool. In this opinion paper, the authors expose the evolution and challenge the classic paradigm and historic definition of massive transfusion. Based on current evidence the elements of an evolving strategy in transfu...
Preprint
Full-text available
Background: The CRASH-3 trial provides a high level of evidence on the question whether to administer Tranexamic Acid (TXA) for Traumatic brain injury (TBI). For numerous other research questions, the available evidence will not correspond to such a level of evidence and will rely on observational evidence only. The development of methodological al...
Article
Goal To provide healthcare professionals with comprehensive multidisciplinary expert recommendations for the acute care of severe limb trauma patients, both during the prehospital phase and after admission to a Trauma Centre. Design A consensus committee of 21 experts was formed. A formal conflict-of-interest (COI) policy was developed at the onse...
Article
Full-text available
Vasopressor use in severely injured trauma patients is discouraged due to concerns that vasoconstriction will worsen organ perfusion and result in increased mortality and organ failure in hypotensive trauma patients. Hypotensive resuscitation is advocated based on limited data that lower systolic blood pressure and mean arterial pressure will resul...
Article
Full-text available
Objective: To assess the feasibility and reproducibility of pancreatic surface lobularity (PSL) quantification derived from abdominal computed tomography (CT) in a population of patients free from pancreatic disease. Materials and methods: This retrospective study included 265 patients free from pancreatic disease who underwent contrast-enhanced...
Article
Blunt cerebrovascular injury is a very rare complication of blunt trauma and a diagnostic challenge. A 14 year old male fell 10 m sustaining multi system trauma. The atypical Glasgow Coma Score was six with a fully preserved eye component. Initial whole-body CT scanning demonstrated multiple injuries but no obvious brain injury. Trauma management i...
Preprint
Full-text available
Background Evidence increases to suggest that the reallocation of health care resources during considerable the COVID-19 pandemic impacts considerably any health system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. Methods This retrospect...
Technical Report
Objectif : Élaborer un référentiel français multidisciplinaire qui aborde la prise en charge initiale, pré- et intra-hospitalière, d’un patient victime de traumatisme sévère de membre(s). Conception : Un comité de consensus de 21 experts a été constitué. Une politique de déclaration et de suivi des liens d’intérêts a été appliquée et respectée dura...
Article
Résumé La transfusion massive reste un élément important dans l’arsenal thérapeutique de la prise en charge des patients traumatisés graves en choc hémorragique. La transfusion massive peut être définie comme l’administration rapide d’un volume important de PSL sur une unité de temps pour intégrer la nature évolutive et dynamique d’une hémorragie e...
Article
Full-text available
Purpose: To describe acute respiratory distress syndrome (ARDS) severity, ventilation management, and the outcomes of ICU patients with laboratory-confirmed COVID-19 and to determine risk factors of 90-day mortality post-ICU admission. Methods: COVID-ICU is a multi-center, prospective cohort study conducted in 138 hospitals in France, Belgium, a...
Article
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Missing attributes are ubiquitous in causal inference, as they are in most applied statistical work. In this paper, we consider various sets of assumptions under which causal inference is possible despite missing attributes and discuss corresponding approaches to average treatment effect estimation, including generalized propensity score methods an...
Article
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Objective. To identify predictive factors of unfavourable outcome among patients hospitalized for COVID-19. Methods. We conducted a monocentric retrospective cohort study ofCOVID-19 patients hospitalized in Paris area. An unfavourable outcome was defined as the need for artificial ventilation and/or death. Characteristics at admission were analysed...
Article
Full-text available
The first wave of the SARS-CoV-2 pandemic required an unprecedented and historic increase in critical care capacity on a global scale in France. Authors and members from the ACUTE and REANIMATION committees of the French Society of Anaesthesiology and Critical Care (SFAR) wished to share experience and insights gained during the first weeks of this...
Article
Objective: Hemorrhage is the leading cause of death after terrorist attack and the immediacy of labile blood product (LBP) administration has a decisive impact on patients' outcome. The main objective of this study was to evaluate the transfusion patterns of the Paris terrorist attack victims, 2015, November 13. Methods: We performed a retrospec...
Article
Objective: Identify issues that are important to severe trauma survivors up to 3 years after the trauma. Background: Severe trauma is the first cause of disability-adjusted life years worldwide, yet most attention has focused on acute care and the impact on long-term health is poorly evaluated. Method: We conducted a large-scale qualitative st...
Article
Full-text available
Objectives To update the French guidelines on the management of trauma patients with spinal cord injury or suspected spinal cord injury. Design A consensus committee of 27 experts was formed. A formal conflict-of-interest (COI) policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted in...
Article
In Reply We thank Vivien et al for their interest in our study¹ and thank the editor for the opportunity to reply. Indeed, it would have been preferable to analyze the complete time frame including time on scene and dispatch. However, only the total prehospital time was consistently available for this study. Any further steps to evaluate all steps...
Chapter
The administration of vasopressors to trauma patients in hemorrhagic shock is challenged primarily on the conceptual basis of “permissive hypotension” or “hypotensive resuscitation.” The phrase “pop the clot” is also frequently referenced to discourage targeting a physiologically appropriate blood pressure to minimize any disruption of hemostasis t...
Article
Full-text available
Background: Fibrinogen concentrate is widely used in traumatic hemorrhagic shock despite weak evidence in the literature. The aim of the study was to evaluate the effect of fibrinogen concentrate administration within the first 6 hours on 24-hour all-cause mortality in traumatic hemorrhagic shock using a causal inference approach. Methods: Obser...
Article
To the Editor The work of Sims et al¹ on low-dose supplementation of arginine vasopressin in patients with trauma and hemorrhagic shock has gained our greatest interest. We applaud the authors for their work, which we consider an important contribution to the trauma community and ongoing controversy on the use of vasopressors in hemorrhagic shock a...
Article
Full-text available
Objective: To develop French guidelines on the management of patients with severe abdominal trauma Design: A consensus committee of 20 experts from the French Society of Anaesthesiology and Critical Care Medicine (Société française d'anesthésie et de réanimation, SFAR), the French Society of Emergency Medicine (Société française de médecine d'urge...
Article
Full-text available
Background Transporting a severely injured patient directly to a trauma center (TC) is consensually considered optimal. Nevertheless, disagreement persists regarding the association between secondary transfer status and outcome. The aim of the study was to compare adjusted mortality between road traffic trauma patients directly or secondarily trans...
Preprint
Full-text available
Missing attributes are ubiquitous in causal inference, as they are in most applied statistical work. In this paper, we consider various sets of assumptions under which causal inference is possible despite missing attributes and discuss corresponding approaches to average treatment effect estimation, including generalized propensity score methods an...
Article
Résumé Objectif En France, la prise en charge des urgences vitales intra-hospitalières (UVIH) est peu connue malgré des recommandations d’experts de 2004. Cette étude visait à décrire l’organisation de leur prise en charge dans les hôpitaux universitaires (HU). Méthodes En 2017, une enquête descriptive, multicentrique, basée sur un questionnaire...
Article
Full-text available
Background: Haemorrhagic shock is the leading cause of early preventable death in severe trauma. Delayed treatment is a recognized prognostic factor that can be prevented by efficient organization of care. This study aimed to develop and validate Red Flag, a binary alert identifying blunt trauma patients with high risk of severe haemorrhage (SH),...
Article
Full-text available
Background: The diagnostic value of hemoglobin (Hb) for detecting a significant hemorrhage (SH) in the early phase of trauma remains controversial. The present study aimed to assess the abilities of Hb measurements taken at different times throughout trauma management to identify patients with SH. Methods: All consecutive adult trauma patients d...
Article
Full-text available
Background: Organ failure, including acute kidney injury (AKI), is the third leading cause of death after bleeding and brain injury in trauma patients. We sought to assess the prevalence, the risk factors and the impact of AKI on outcome after trauma. Methods: We performed a retrospective analysis of prospectively collected data from a multicent...
Article
Objective: Pelvic fractures represent 5% of all traumatic fractures and 30% are isolated pelvic fractures. Pelvic fractures are found in 10 to 20% of severe trauma patients and their presence is highly correlated to increasing trauma severity scores. The high mortality of pelvic trauma, about 8 to 15%, is related to actively bleeding pelvic injuri...
Preprint
Full-text available
Logistic regression is a common classification method in supervised learning. Surprisingly, there are very few solutions for performing it and selecting variables in the presence of missing values. We propose a stochastic approximation version of the EM algorithm based on Metropolis-Hasting sampling, to perform statistical inference for logistic re...