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This document assesses the appropriateness of various imaging studies for acute penetrating trauma to the torso. Penetrating trauma most commonly occurs from gunshots and stabbings, although any object can impale the patient. Anatomic location, type of penetrating trauma, and hemodynamic status are among the many important factors when deciding upon if, what, and when imaging is needed to further evaluate the patient. Imaging plays a critical role in the management of these patients. CT, in particular, aids in identifying and predicting internal injuries based upon trajectory of the object. Clinical variants are distinguished by ballistic versus nonballistic injuries, hemodynamic status, and compartment of the body injured. Ballistic trauma trajectory is less predictable, and imaging recommendations are adjusted for this unpredictability. Excluded from this document are penetrating traumatic injuries to pediatric patients and specific recommendations when the genitourinary system is clinically suspected to be injured, the latter of which is more specifically discussed in other Appropriateness Criteria documents. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are documented annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer documented journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer documented literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Objective: To externally validate TRISS's probability of survival in a tertiary care hospital in northeastern Thailand. Materials and Methods: A retrospective cohort prognostic study included patients with significant injuries (ISS > 15) admitted to the hospital from 2011 to 2022 from the Khon Kaen trauma registry. Baseline characteristics were identified. AuROC presented the accuracy of the model. The age group was used as a subgroup analysis. The primary outcome was in-hospital mortality. Results: This retrospective cohort study was conducted at a tertiary care public hospital in northeastern Thailand. A total of 20,867 patients were included. Missing primary outcome data were excluded. Most patients were male (75.23%). The mean age was 38.19 ± 19.65 years. The mean ISS was 20.17 ± 5.28. The mortality rate was 15.33%. AuROC was 0.8388. Subgroup analysis by age group showed a statistically significant reduction in AuROC by increasing age. Conclusion: The accuracy of the TRISS model in a tertiary care hospital in Thailand was excellent, as close as MTOS. The accuracy was decreased by age. The TRISS model is applied to trauma quality improvement programs in Thailand. [ABSTRACT FROM AUTHOR]

Traumatic cardiac arrest is a rare and generally fatal complication of major trauma. The majority of cases result from potentially salvageable pathology such as exsanguinating haemorrhage or cardiac tamponade. Resuscitative thoracotomy is a rapid, straightforward, non-specialist procedure which can be lifesaving in appropriately selected trauma patients. This article provides a detailed review of the relevant pathophysiology, indications and contraindications, necessary equipment and techniques, and factors influencing patient outcomes. [ABSTRACT FROM AUTHOR]

Falls in older adults correlate with heightened morbidity and mortality. Assessing fall risk in the emergency department (ED) not only aids in identifying candidates for prevention interventions but may also offer insights into overall mortality risk. We sought to examine the link between fall risk and 30-day mortality in older ED adults. Observational cohort study of adults aged ≥ 75 years who presented to an academic ED and who were assessed for fall risk using the Memorial Emergency Department Fall Risk Assessment Tool (MEDFRAT), a validated, ED-specific screening tool. The fall risk was classified as low (0–2 points), moderate (3–4 points), or high (≥ 5) risk. The primary outcome was 30-day mortality. Hazard ratios (HR) with 95% confidence intervals (CIs) were calculated. A total of 941 patients whose fall risk was assessed in the ED were included in the study. Median age was 83.7 years; 45.6% were male, 75.6% lived in private residences, and 62.7% were admitted. Mortality at 30 days among the high fall risk group was four times that of the low fall risk group (11.8% vs 3.1%; HR 4.00, 95% CI 2.18 to 7.34, p < 0.001). Moderate fall risk individuals had nearly double the mortality rate of the low-risk group (6.0% vs 3.1%), but the difference was not statistically significant (HR 1.98, 95% CI 0.91 to 4.32, p = 0.087). ED fall risk assessments are linked to 30-day mortality. Screening may facilitate the stratification of older adults at risk for health deterioration. [ABSTRACT FROM AUTHOR]

Background: Most trauma-related studies are focused on short-term survival and complications within the index admission, and the long-term outcomes beyond discharge are mainly unknown. The purpose of this study was to analyze the data from the National Health Insurance Research Database (NHIRD) and to assess the long-term survival of major trauma patients after being discharged from the index admission. Material and methods: This retrospective, observational study included all patients with major trauma (injury severity score ≥16) in Taiwan from 2003 to 2007, and a 10-year follow-up was conducted on this cohort. Patients aged 18-70 who survived the index admission were enrolled. Patients who survived less than one year after discharge (short survival, SS) and those who survived for more than one year (long survival, LS) were compared. Variables, including preexisting factors, injury types, and short-term outcomes and complications, were analyzed, and the 10-year Kaplan--Meier survival analysis was conducted. Results: In our study, 9896 patients were included, with 2736 in the SS group and 7160 in the LS group. Age, sex, comorbidities, low income, cardiopulmonary resuscitation event, prolonged mechanical ventilation, prolonged ICU length of stay (LOS), and prolonged hospital LOS were identified as the independent risk factors of SS. The 10-year cumulative survival for major trauma patients was 63.71%, and the most mortality (27.64%) occurred within the first year after discharge. Conclusion: 27.64% of patients would die one year after being discharged from major trauma. Major trauma patients who survived the index admission still had significantly worse long-term survival than the general population, but the curve flattened and resembled the general population after one year. [ABSTRACT FROM AUTHOR]

Background: Prehospital (PH) tranexamic acid (TXA) improves survival from trauma haemorrhage. Injury mechanism, physiology, and sex demographics vary with patient age. The authors hypothesised that these factors influence TXA guideline compliance and examined national trends in PH use to identify any systematic biases in bleeding management. Materials and methods: The UK Trauma Audit and Research Network data for TXA eligible patients admitted to major trauma centres were divided into two cohorts: 2013-2015 (n =32 072) and 2017-2019 (n =14 974). Patients were stratified by PH, emergency department or no TXA use. Logistic regression models explored interaction between PH variables and TXA administration. Results are presented as odds ratios with a 95% CI. Results: PH TXA use increased from 8% to 27% over time (P<0.001). Only 3% of eligible patients who fell less than 2 m received PH TXA versus 63% with penetrating injuries (P< 0.001). Older patients eligible for PH TXA were less likely to receive it compared to younger patients [≥ 65 years old: 590 (13%) vs. <65 years old: 3361 (33%), P<0.001]. There was a significant interaction between age and sex with fewer older women receiving PH TXA. In shocked patients, one third of females compared to a fifth of men did not receive TXA (P <0.001). There was a decrease in PH TXA use as age increased (P<0.001). Conclusions: Despite a threefold increase in use, treatment guidance for PH TXA is not universally applied. Older people, women, and patients with low energy injury mechanisms appear to be systematically under treated. Training and education for PH providers should address these potential treatment biases. [ABSTRACT FROM AUTHOR]

Trauma is one of the leading cause of deaths in young adults in the UK, with a significant morbidity burden and economic impact. More significantly, is the increase in 'silver trauma' within the elderly population which now represents the typical major trauma patient. Despite the age differences, both groups have a similar injury severity and distribution. In the last two decades there have been changes in both the structure of trauma care across the UK, and in clinical aspects from pre-hospital care to rehabilitation. This article will review the major trauma network, a broad overview of the immediate management of the critically ill trauma patient and the ongoing rehabilitation of these patients. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of geriatrician review on 1-year mortality in older adults admitted with trauma. Background: Comprehensive geriatric assessment (CGA) has been associated with improved outcomes in older adults with hip fracture, but has not been evaluated in a broader trauma population. Methods: Trauma patients aged ≥ 65years admitted to an English Major Trauma Centre between November 2018 and September 2019 were included. Patients were divided into 3 cohorts: no geriatric assessment, reactive geriatric assessment, and proactive CGA. The primary outcome was time to mortality, secondary outcomes were time to discharge and frequency of complications. Analyses were adjusted for factors known to be associated with outcomes including age, frailty, injury severity, and complications. Results: Five hundred eighty-five patients were included (no geriatric assessment = 125; reactive geriatric assessment = 134; proactive CGA = 326): median age was 81 years (IQR 74-88); 326 (55.7%) were women; 297 (50.8%) were living with frailty (Clinical Frailty Scale ≥5). Median Injury Severity Score was 13 (IQR9-25). At 1-year follow-up, 147 (25.1%) patients had died. In multivariate analysis, both types of geriatric assessment were associated with reduced mortality [reactive aHR = 0.31, 95% CI 0.18–0.53; proactive adjusted hazard ratio (aHR) = 0.41, 95% CI 0.26–0.64]. There was no association between either type of geriatric assessment and length of stay (reactive aHR = 0.84, 95% CI 0.62–1.15; proactive aHR = 0.80, 95% CI 0.63–1.02). Conclusions: Geriatrician assessment is associated with reduced mortality in older adults admitted following trauma. Further research should focus on defining optimal models of geriatrician intervention. [ABSTRACT FROM AUTHOR]

Introduction: Following traumatic injury, occupational therapists (OTs) are pivotal in supporting people to return-to-work (RTW) and regain independence. Aim: to identify priorities for RTW after traumatic injury and highlight barriers hindering the process. Method: We recruited 17 participants with direct (i.e. trauma survivor [ n = 11]; OT trauma survivor [ n = 2]) or indirect (i.e. OT [ n = 4]) experience of returning to work following traumatic injury. Online consultations, lasting 60 min, were guided by a semi-structured script ensuring relevant topics were covered. An inductive approach was used for coding themes using thematic analysis. Findings: Sense of purpose, identity and social interaction were greater priorities for RTW, than financial stability. Major barriers were: pain and fatigue; adapting to physical changes; impacts on mental health; and lack of support (healthcare and the workplace). Participants (public and healthcare professionals) reported a lack of vocational rehabilitation in supporting trauma survivors RTW, but advocated occupational therapy for psychological recovery; purposeful engagement in occupations; and community support. Conclusion: Restoring an individual's self-identity and social connections, whilst helping control pain and fatigue, should be prioritised when planning occupational therapy for those returning to work after traumatic injury. This study was limited to 'returners', but can inform occupational therapy interventions for RTW. [ABSTRACT FROM AUTHOR]

Background: A key component of trauma system evaluation is the Injury Severity Score (ISS). The ISS is dependent on the AIS, and as AIS versions are updated this effects the number of patients within a health system which are considered severely injured (ISS >15). This study aims to analyse the changes comparing AIS1998 and AIS2015, and its impact on injury severity scoring and survival prediction model in a major trauma centre.Methods: This retrospective study reviewed all blunt trauma admissions from 1 January 2020 to 31 December 2020 from the trauma registry of Prince of Wales Hospital, Hong Kong. Patients were manually double coded with AIS1998 and AIS2015 by the same experienced trauma nurse who have completed both AIS 1998 and AIS 2015 Courses. AIS patterns and Injury Severity Scores (ISS) derived from AIS 1998 and 2015 were compared using the Wilcoxon Signed Rank Test. The area under the receiving operator curve (AUROC) was compared based on the Trauma and Injury Severity Score (TRISS) model using AIS 1998 and AIS 2015.Results: 739 patients were included. There were 34 deaths within 30 days (30-day mortality rate 4.6%). Patients coded with AIS2015 compared with AIS1998 had significant reductions in the classification of serious, severe and critical categories of AIS, with a substantial increase in the mild and moderate categories. The largest reduction was observed in the head and neck region (Z = -11.018, p < 0.001), followed by the chest (Z = -6.110, p < 0.001), abdomen (Z = -4.221, p < 0.001) and extremity regions (Z = -4.252, p < 0.001). There was a 27% reduction in number of cases with ISS >15 in AIS2015 compared with AIS1998. Rates of 30-day mortality, ICU admission, emergency operation and trauma team activation of ISS > 15 using AIS 1998 were similar to the cut off for New Injury Severity Score (NISS) >12 using AIS 2015. The AUROC from the TRISS (AIS2015) was 0.942, and not different from the AUROC for TRISS (AIS1998) of 0.936. The sensitivity and specificity were 93.9% and 82.1% for TRISS (AIS2015), and 93.9% and 76.0% for TRISS (AIS1998).Conclusion: Trauma centres should be aware of the impact of the AIS2015 update on the benchmarking of trauma care, and consider the need for updating the ISS cut off for major trauma definitions. [ABSTRACT FROM AUTHOR]

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Background: Major trauma has been one of the leading causes of morbidity, mortality, and functional disability, resulting in substantial societal burden. The aim of this study was to estimate the trends in burden of adult major trauma in Taiwan during 2003-2015.Methods: Adult patients with initial encounter of major trauma (injury severity score ≥ 16) were abstracted from the claim data of National Health Insurance (NHI) in Taiwan from January 2003 to December 2015. We explored the trends of incidence and mortality rates over time stratified by age and sex, as well as life expectancy (LE), loss-of-LE, lifetime healthcare expenditure and total loss-of-LE compared with age, sex and calendar-year matched referents simulated from the vital statistics of Taiwan.Results: A total of 71,731 cases of adult major trauma, and an estimated loss of 979,676 life-years were found with an increasing trend in cumulative incidence rate (CIR18-84) during 2003-2015. The incidence rates were significantly higher in men than women. For both sexes, the incidence rates for those aged 65 and above were about 2-3 times higher than those of all other age groups. The one-year case fatality rates among the elderly were about 31-61%, higher than all other ages. The lifetime healthcare expenditures per person were 47,616 USD in men and 43,416 USD in women.Conclusion: There is a consistently increasing trend in incidence and mortality of major trauma in Taiwan, especially among elderly people. For Taiwan, an aged society beginning since 2018, the challenge should be tackled more effectively in the coming decades. [ABSTRACT FROM AUTHOR]

Background: Electric scooters (e-scooters) have become a widespread method of transportation. The purpose of this study is to provide risk stratification tools for modifiable risk factors associated with e-scooter injury morbidity.Methods: Patients at an urban Level 1 Trauma center sustaining e-scooter injuries between November 2017 through March 2020 were identified. Primary outcomes of interest were major trauma, as defined by an Injury Severity Score (ISS) >15, or hospital admission.Results: A total of 442 patients sustained orthopaedic (51%), facial (31%), cranial (13%), and chest/abdominal injuries (4.5%). Rate of helmet use was 2.5%, hospital admission was 40.7%, and intensive care was 3%. Patients with facial injuries were half as likely to sustain major trauma as compared to orthopaedic injuries (p < 0.05). Factors with higher likelihood of hospital admission included age > 40 years (OR 4.20, p < 0.01), alcohol or other substance intoxication (OR 4.14 and 9.87, p < 0.001), loss of consciousness (OR 2.72, p < 0.003), or transport to the hospital by ambulance (OR 4.47, p < 0.001).Conclusions: There is a substantial proportion of major trauma within e-scooter injuries. Modifiable risk factors for hospital admission include use of head protection and substance use while riding e-scooters. [ABSTRACT FROM AUTHOR]

Traumatic cardiac arrest is a rare and generally fatal complication of major trauma. The majority of cases result from potentially salvageable pathology such as exsanguinating haemorrhage or cardiac tamponade. Resuscitative thoracotomy is a rapid, straightforward, non-specialist procedure which can be lifesaving in appropriately selected trauma patients. This article provides a detailed review of the relevant pathophysiology, indications and contraindications, necessary equipment and techniques, and factors influencing patient outcomes. [ABSTRACT FROM AUTHOR]

The 22 major trauma centres (MTCs) in England were appointed in 2012 to provide care to severely injured patients despite variation in existing infrastructure, resources, culture and skillset. Six MTCs remain unsupported by a co-located plastic surgery department. We describe the plastic surgical major trauma workload in England, the plastic surgical workforce and skillset available in each centre, and suggest what plastic surgical skills are required in an MTC. A multi-centre, prospective cohort study was performed to collect operative workload data. Eleven MTCs in England submitted complete datasets. Workforce data were provided by the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS). Fifty-three percent (n = 1582) of Trauma and Audit Research Network (TARN)-eligible patients admitted during the study period underwent at least one operation during their index admission. Of these, 14% (n = 227) required plastic surgery. The majority of plastic surgical operative work involved the extremities: 62% of index procedures involved the lower limb and 38% involved the upper limb. The number of full-time plastic surgical consultants per MTC ranged from 1 to 22. Only 10 MTCs had at least one plastic surgeon with a primary interest in lower limb trauma. Plastic surgery contributes substantially to major trauma care and the majority of this workload relates to extremity trauma. However, there is significant variability in the size, accessibility and skillset of the workforce available. On the basis of these data, we suggest a plastic surgical skillset which should be represented in plastic surgical departments supporting an MTC. [ABSTRACT FROM AUTHOR]

Temporary external fixation is frequently employed nowadays in the immediate management of orthopaedic trauma. It is particularly effective in major trauma and in open fractures or periarticular fractures of the lower limb with soft tissue compromise. In addition it is used for more recent indications such as intraoperative adjuncts to internal fixation. Despite the associated complications and pitfalls described, in most cases the benefits of temporary external fixation in the initial management of injured bones and soft tissues outweigh the risks, and facilitate the eventual definitive treatment. The application of a stable external fixator construct is an essential skill for any orthopaedic surgeon who manages trauma; despite this, the skill seems to be in decline outside major trauma centres in the UK. Inclusion of external fixation in the mandatory indicative procedures of the trauma and orthopaedic curriculum serves as a useful reminder of its value. [ABSTRACT FROM AUTHOR]

We investigated the predictors of mortality in major trauma patients using a trauma registry system database. Data were obtained from the trauma registry of a level I trauma center for all patients aged ≥18 years admitted to an intensive care unit (ICU) between January 1, 2006 and December 31, 2013. Models were adjusted for patient demographics, injury mechanism, preexisting comorbidity, Glasgow coma scale (GCS), injury severity score (ISS), emergency department (ED) and ICU procedures, surgical procedures, and complications. Multivariate logistic regression analysis was used to determine predictors of mortality and odds ratios of its associated factors. In total, 1561 patients met the inclusion criteria. The overall mortality rate was 13.4%. After controlling for all variables in a logistic regression model, the factors associated with increased mortality risk (P < 0.05) were age ≥ 45 years; ISS > 24; GCS score < 8 and 8–12; fall accident; preexisting comorbidity of renal insufficiency; ED cardiopulmonary resuscitation (CPR) procedures; ICU blood transfusion; and cardiovascular, respiratory, digestive system and infection complications. Our data showed some predictors of patient mortality after major trauma, most of which were determined during the trauma event. Only those treatment complications may be improved when performing the treatment procedures. [ABSTRACT FROM AUTHOR]

Background: Animal models of trauma have shown that females have better posttraumatic survival; however, results of previous studies on the influence of gender on major trauma patients have been controversial. This study aimed to evaluate the association between gender and survival in major trauma patients. Methods: We retrospectively analyzed patients registered in Taiwan's National Health Insurance Research Database between 2008 and 2012 with the diagnosis codes 800-939 and 950-957 (International Classification of Diseases, ninth revision, clinical modification). Data on gender, age, catastrophic illness, and new injury severity score (NISS) â¥16 were collected for comparing patients' mortality after trauma. Propensity score matching (PSM) was performed to eliminate dissimilarities in age, comorbidities, NISS, and primary traumatic regions between the genders. Results: Among 10 012 major trauma patients included in the study cohort, 28.8% (n = 2880) were women. The PSM patient group consisted of 50% (2876 of 5752) women. Women had a higher 30-day (15.4% of women vs 13.8% of men; p < 0.05) and hospital (16.1% of women vs 14.5% of men; p < 0.05) mortality and lower incidence rates of acute respiratory dysfunction (62.5% of women vs 65.9% of men; p < 0.005) and acute hepatic dysfunction (0.8% of women vs 2.1% of men; p < 0.001). However, the analysis of PSM patient groups showed lower mortality rates in women with moderate trauma (NISS 16-24) in the acute phase within three days (1.4% of women vs 2.7% of men, p = 0.03). Analysis of patients with an NISS of 16-24 who died within three days showed a higher NISS in women than in men (19.7 ± 2.3 vs 18.0 ±1.9, respectively, p <0.05). Conclusion: There is no gender difference in 30-day or hospital mortality among major trauma patients. However, women admitted for moderate major trauma had higher survival within three days of major trauma. [ABSTRACT FROM AUTHOR]

Après avoir disparu de la pratique transfusionnelle des pays développés, le sang total (ST) redevient une option thérapeutique pour les urgences hémorragiques en traumatologie dans la mesure où il offre des avantages pratiques dans la mise en œuvre du damage control resucitation. En effet, cette dernière se heurte principalement à des difficultés d'ordre logistique, comme la rapidité de mise à disposition du plasma et la disponibilité des plaquettes. Tout en permettant de n'avoir à manier qu'un seul produit à la fois, le ST permet de surmonter ces difficultés dès lors qu'on l'utilise sous forme de ST de groupe O déleucocyté (Stod). Cela expose une majorité des receveurs à recevoir du plasma ABO incompatible et des plaquettes conservées à 4 °C sans agitation, mais un robuste argumentaire clinique supporte l'innocuité de ces caractéristiques dans un contexte d'urgence traumatologique. Au-delà de cet avantage logistique, l'utilisation du ST semble assortie d'un bénéfice clinique dont l'ampleur et la réalité font l'objet de plusieurs essais randomisés. Although its use has disappeared from developing countries for years, whole blood (WB) is afresh a therapeutic option in the management of trauma-related massive hemorrhage as far as it provides useful benefits in the execution of the damage control resuscitation strategy. Indeed, this strategy has constraints that are mainly logistic due to the need of a quick availability of plasma and platelets units. As it is a "all-in-one" blood product, O-group WB provides red blood cells, platelets and plasma in a single unit instead of three and ease the transfusion in these situations. These O-group WB transfusion may expose recipients to ABO-incompatible plasma and provides unagitated cold-stored platelets, however a lot of evidences support the safety of this strategy in emergency situations. Beyond, the logistic benefit, use of WB is related to a clinical one which is currently evaluated in several clinical trials. [ABSTRACT FROM AUTHOR]

Polytrauma in children is rare; however, trauma is a leading cause of death in children. Clinicians with responsibility for management of the child suffering major trauma must recognize the conflict between these facts. Simulation and preparation can help to improve the quality of care at both individual and institutional levels. Children are not small adults, and their anatomical and physiological differences manifest themselves in different responses to major trauma than those seen in adults. This reality should be met with a tailored approach to assessment, investigation and management that accommodates the changes occurring from infancy, through childhood and adolescence to adulthood. This approach minimizes the risk of harm from inappropriate irradiation or intervention. Children have remarkable resilience and can make dramatic recoveries from seemingly irrecoverable situations. The comprehensive treatment of musculoskeletal injuries should therefore not be compromised in the setting of polytrauma, and attention must be given to the optimal time for treatment. Damage control resuscitation and early appropriate care facilitate an individualized response. Outcomes for paediatric polytrauma are improved by management in a specialist centre, with early aggressive management of injuries that require surgical treatment by an experienced multidisciplinary team. [ABSTRACT FROM AUTHOR]

Introduction: The American College of Surgeons Committee on Trauma (ACS-CoT) sets standards for appropriate trauma activation criteria. Overtriage and undertriage rates are traditionally determined by the Cribari matrix using the Injury Severity Score (ISS). In 2016, the Need for Trauma Intervention (NFTI) criteria were developed by Baylor University Medical Center to overcome weaknesses in the Cribari matrix methodology. Methods: A retrospective review of trauma triage rates was conducted from March 2018 to February 2019. Overtriage rates were calculated using the Cribari matrix and then further evaluated using modified NFTI (MNFTI) criteria. Overtriaged patients meeting MNFTI criteria were considered appropriately triaged and deleted from the overtriage category, and adjusted triage rates were determined. Demographic, injury, and outcome data were compared between MNFTI-positive and MNFTI-negative groups. A logistic regression analysis was performed to assess for predictors of patient mortality. Results: Using the Cribari matrix, 248 patients were identified as overtriaged. Of these, 133 (53.6%) were found to meet MNFTI criteria. The average monthly overtriage rate was reduced from 55% using the Cribari matrix to 26% after applying the MNFTI criteria. Within the Cribari overtriage patient group, MNFTI-positive patients had significantly longer hospital length of stay (LOS) (3.7 vs. 6.0 days, p = .016), intensive care unit LOS (1.2 vs. 4.2 days, p < .001), and ventilator days (0.6 vs. 1.6 days, p = .002) than MNFTI- negative patients. A multivariable logistic regression analysis found that meeting any of the MNFTI criteria significantly increased the odds of mortality (OR = 10.38; 95% CI [3.87, 27.84], p < .001). Conclusions: Discharge ISS may not accurately reflect the patient's acuity on presentation. Applying MNFTI criteria to the Cribari matrix improved overtriage rates and may more accurately reflect need for full trauma team activation. Patients meeting MNFTI criteria had worse outcomes overall and had a 10-fold increase in the odds of mortality. [ABSTRACT FROM AUTHOR]

Despite evidence of a lower risk of death, major trauma patients are not always transported to Trauma Centres. This study examines the characteristics and outcomes of major trauma patients between transport destinations. A retrospective cohort study of major trauma patients (Injury Severity Score >15) transported by ambulance was undertaken. Cases were divided into transport destination groups: (1) Direct, those transported to the Trauma Centre directly from the scene; (2) Indirect , those transported to another hospital prior to Trauma Centre transfer and (3) Non-transfers, those transported to a non-Trauma Centre and never subsequently transferred. Median and interquartile range (IQR) were used to describe the groups and differences were assessed using the Kruskal–Wallis test for continuous variables and Pearson chi-square for categorical. A total of 1625 patients were included. The median age was oldest in the non-transfers cohort (72 years IQR 46–84). This group had the highest proportion of falls from standing and head injuries (n = 298/400, 75%, p < 0.001). The non-transfers had the highest proportion of 30-day mortality (n = 134/400, 34%). There were significant differences between the groups with older adults, falls and head injuries over-represented in the non-transfer group. Considering the ageing population, trauma systems will need to adapt. [ABSTRACT FROM AUTHOR]

This review assesses the appropriateness of various imaging studies for adult major blunt trauma or polytrauma in the acute setting. Trauma is the leading cause of mortality for people in the United States <45 years of age, and the fourth leading cause of death overall. Imaging, in particular CT, plays a critical role in the management of these patients, and a number of indications are discussed in this publication, including patients who are hemodynamically stable or unstable; patients with additional injuries to the face, extremities, chest, bowel, or urinary system; and pregnant patients. Excluded from consideration in this review are penetrating traumatic injuries, burns, and injuries to pediatric patients. Patients with suspected injury to the head and spine are also discussed more specifically in other appropriateness criteria documents. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

This review assesses the appropriateness of various imaging studies for adult major blunt trauma or polytrauma in the acute setting. Trauma is the leading cause of mortality for people in the United States <45 years of age, and the fourth leading cause of death overall. Imaging, in particular CT, plays a critical role in the management of these patients, and a number of indications are discussed in this publication, including patients who are hemodynamically stable or unstable; patients with additional injuries to the face, extremities, chest, bowel, or urinary system; and pregnant patients. Excluded from consideration in this review are penetrating traumatic injuries, burns, and injuries to pediatric patients. Patients with suspected injury to the head and spine are also discussed more specifically in other appropriateness criteria documents. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Background and objective: Pneumothorax (PNX) detection is of the utmost clinical relevance because it may quickly progress to cause hemodynamic instability as a consequence of invasive ventilation. Radiography is characterized by a low sensitivity to detect this disease; in recent years, chest ultrasound (US) has gained increased visibility in the diagnosis of acute respiratory emergencies including PNX. The aim of this retrospective study was to evaluate the clinical impact of extended focused assessment with sonography in trauma (E-FAST) during the past 6 years of experience with this technique in our Level I trauma center. Methods: Between January 2013 and December 2018, we performed a retrospective case-series study including 3320 consecutive patients admitted to the emergency department of our hospital because of major trauma. Extended-US was always performed and reported immediately after FAST during primary survey and before multidetector computed tomography (MDCT) scans. The presence of PNX was determined using the well-known accepted US criteria. US findings were compared with computed tomography (CT) findings, the reference standard for PNX detection. Results: Of the 6640 lungs observed with E-FAST, there were 1244 PNX cases, while 1328 PNX cases were detected either on the basis of MDCT or on the basis of the presence of air flush during the thoracic decompression in the emergency room. Among the 84 false negatives, 12 patients had subcutaneous emphysema, 38 had a body mass index higher than 27, 6 had a thoracic wall hematoma, and 4 had chest penetrating trauma. There were 10 false positives in the diagnosis of PNX at US examination, with mild extension and not clinically significant. The overall sensitivity of E-FAST for PNX detection was 93.6% (1244/1328), the specificity of E-FAST was 99.8% (5312/5322), the negative predictive value (NPV) was 98.4% (5312/5396), and the positive predictive value (PPV) was 99.2% (1328/1338). Conclusion: Our results demonstrate that bedside thoracic US is characterized by a very good accuracy in the diagnostic work-up of major trauma patients, even in difficult conditions, allowing rapid diagnosis of PNX. Advances in knowledge: The novelty of this research lies in the possibility of diagnosing potential life-threatening conditions in a very short time by means of US, thus proposing a revision of the Advanced Trauma Life Support (ATLS) guidelines in order to incorporate it in the work-up of high-energy injured patients. [ABSTRACT FROM AUTHOR]

Polytrauma in children is rare, yet trauma is a leading cause of death in children. Clinicians with responsibility for the management of children suffering major trauma must recognise the conflict between these facts. Simulation and preparation can help to improve the quality of care at both individual and institutional levels. Children are not small adults, and their anatomic and physiological differences manifest themselves in different responses to major trauma than those seen in adults. This reality should be met with a tailored approach to assessment, investigation and management that accommodates the changes occurring from infancy, through childhood and adolescence to adulthood. This approach minimizes the risk of harm from inappropriate irradiation or intervention. Children have remarkable resilience and can make dramatic recoveries from seemingly irrecoverable situations. The appropriate treatment of musculoskeletal injuries should therefore not be compromised in the setting of polytrauma, and attention must be given to the optimal time for treatment. Damage control resuscitation and early appropriate care facilitate an individualised response. Outcomes for paediatric polytrauma are improved by management in a specialist centre, with early aggressive management of injuries that require surgical treatment by an experienced multidisciplinary team. [ABSTRACT FROM AUTHOR]

Trauma is one of the leading cause of deaths in those <35 years old in the UK. It also has a significant morbidity burden with a subsequent economic impact. There is also a realisation that trauma is having an increasing impact in the elderly population. In the last two decades there have been changes in both the structure of trauma care across the UK, and also in clinical aspects from pre-hospital care to rehabilitation. This article will review the changes that have occurred, including the reasons, and give a broad overview of the immediate management of the critically ill trauma patient. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is common and is associated with significant morbidity and mortality. The initial resuscitation and management of patients with traumatic brain injury is focused on limiting secondary brain injury and this may be complex in patients with significant injuries to other organ systems. The transport of critically ill brain injured patients for definitive treatment also carries significant risks which must be managed. This review describes the initial resuscitation and transfer of patients with traumatic brain injuries. [ABSTRACT FROM AUTHOR]

Abstract Polytrauma in children is rare, however trauma is a leading cause of death in children. Clinicians with responsibility for management of the child suffering major trauma must recognize the conflict between these facts. Simulation and preparation can help to improve the quality of care at both individual and institutional levels. Children are not small adults, and their anatomical and physiological differences manifest themselves in different responses to major trauma than those seen in adults. This reality should be met with a tailored approach to assessment, investigation and management that accommodates the changes occurring from infancy, through childhood and adolescence to adulthood. This approach minimizes the risk of harm from inappropriate irradiation or intervention. Children have remarkable resilience and can make dramatic recoveries from seemingly irrecoverable situations. The comprehensive treatment of musculoskeletal injuries should therefore not be compromised in the setting of polytrauma, and attention must be given to the optimal time for treatment. Damage control resuscitation and early appropriate care facilitate an individualized response. Outcomes for paediatric polytrauma are improved by management in a specialist centre, with early aggressive management of injuries that require surgical treatment by an experienced multidisciplinary team. [ABSTRACT FROM AUTHOR]

Background: Currently existing predictive models for massive blood transfusion in major trauma patients had limitations for sequential evaluation of patients and lack of dynamic parameters.Objective: To establish a predictive model for predicting the need of massive blood transfusion major trauma patients, integrating dynamic parameters.Design: Multi-center retrospective cohort study.Setting: Four designated trauma centers in Hong Kong.Methods: Trauma patients aged >12years were recruited from the trauma registries from 2005 to 2012. MBT was defined as delivery of ≥10units of packed red cells within 24h. Split sampling method was adopted for model building and validation. Multivariate logistic regression was adopted for model building, with weight assigned based on logarithmic of adjusted odds ratios. The performance of the dynamic MBT score (DMBT) was compared with the PWH score and the Trauma Associated Severe Hemorrhage (TASH) score in the validation data set.Results: 4991 patients were included in the study. The DMBT was established with 8 parameters: systolic blood pressure, heart rate, hemoglobin, hemoglobin drop within the first 2h, INR, base deficit, unstable pelvic fracture and hemoperitoneum in radiological imaging. At cut-off score of 6 the DMBT achieved sensitivity of 78.2% and specificity of 89.2%. In the validation set, the AUCs of the DMBT, PWH score, and TASH score were 0.907, 0.844, and 0.867 respectively.Conclusions: The DMBT score allows both snapshot and sequential activation along the trauma care pathway and has better performance than the PWH score and TASH score. [ABSTRACT FROM AUTHOR]

Many existing metrics, such as Injury Severity Score (ISS), cannot fully describe many trauma patients because of comorbidities. This study developed and evaluated the Need For Trauma Intervention (NFTI) metric as a novel indicator of major trauma. The NFTI metric was developed from an analysis of 2,396 trauma patients at a Level I trauma center. Six commonly recorded registry variables were found to be indicative of major trauma and comprised the NFTI criteria: receiving packed red blood cells within 4 hr; discharge from the emergency department (ED) to the operating room within 90 min; discharge from the ED to interventional radiology; discharge from the ED to the intensive care unit (ICU) with an ICU length of stay (LOS) of 3 or more days; mechanical ventilation outside of procedural anesthesia within 3 days; or death within 60 hr. Patients meeting any NFTI criteria are classified as having major traumas and, therefore, needing trauma activations (NFTI +). Need For Trauma Intervention was tested in an overlapping sample of 9,737 patients. Being NFTI + was associated with higher trauma activation levels, older age, higher ISS, worse ED vitals, longer hospital LOS, and mortality. Only 13 of 561 deaths were not NFTI + and all were in patients with do not resuscitate (DNR) orders; using ISS greater than 15 missed 73 mortalities, 46 with DNR orders. Results suggest that NFTI provides a comprehensive view of both anatomy and physiology in a manner that self-adjusts for age, frailty, and comorbidities as long as care teams adjust their treatments. Need For Trauma Intervention appears to be a unique, simple, and effective tool to retrospectively identify major trauma, regardless of ISS. [ABSTRACT FROM AUTHOR]

Summary Introduction The introduction of major trauma centres (MTCs) in England has led to 63% reduction in trauma mortality. 1 The role of plastic surgeons supporting these centres has not been quantified previously. This study aimed to quantify plastic surgical workload at an urban MTC to determine the contribution of plastic surgeons to major trauma care. Methods All Trauma Audit and Research Network (TARN)-recorded major trauma patients who presented to an urban MTC in 2013 and underwent an operation were identified retrospectively. Patients who underwent plastic surgery were identified and the type and date of procedure(s) were recorded. The trauma operative workload data of another tertiary surgical specialty and local historical plastics workload data from pre-MTC go-live were collected for comparison. Results Of the 416 major trauma patients who required surgical intervention, 29% ( n = 122) underwent plastic surgery. Of these patients, 43% had open lower limb fractures, necessitating plastic surgical involvement according to British Orthopaedic Association Standards for Trauma (BOAST) 4 guidance. The overall plastic surgery operative workload increased sevenfold post-MTC go-live. A similar proportion of the same cohort required neurosurgery ( n = 115; p = 0.589). Discussion This study quantifies plastic surgery involvement in major trauma and demonstrates that plastic surgical operative workload is at least on par with other tertiary surgical specialties. It also reports one centre's experience of a significant change in plastic surgery activity following designation of MTC status. The quantity of plastic surgical operative workload in major trauma must be considered when planning major trauma service design and workforce provision, and for plastic surgical postgraduate training. [ABSTRACT FROM AUTHOR]

Objective: To describe the long-term outcomes of major trauma patients and factors associated with the rate of recovery. Background: As injury-related mortality decreases, there is increased focus on improving the quality of survival and reducing nonfatal injury burden. Methods: Adult major trauma survivors to discharge, injured between July 2007 and June 2012 in Victoria, Australia, were followed up at 6, 12, and 24 months after injury to measure function (Glasgow Outcome Scale-- Extended) and return to work/study. Random-effects regression models were fitted to identify predictors of outcome and differences in the rate of change in each outcome between patient subgroups. Results: Among the 8844 survivors, 8128 (92%) were followed up. Also, 23% had achieved a good functional recovery, and 70% had returned to work/ study at 24 months. The adjusted odds of reporting better function at 12 months was 27% (adjusted odds ratio 1.27, 95% confidence interval [CI] 1.19-1.36) higher compared with 6 months, and 9% (adjusted odds ratio 1.09, 95% CI, 1.02-1.17) higher at 24 months compared with 12 months. The adjusted relative risk (RR) of returning to work was 14% higher at 12 months compared with 6 months (adjusted RR 1.14, 95% CI, 1.12-1.16) and 8% (adjusted RR 1.08, 95% CI, 1.06-1.10) higher at 24 months compared with 12 months. Conclusions: Improvement in outcomes over the study period was observed, although ongoing disability was common at 24 months. Recovery trajectories differed by patient characteristics, providing valuable information for informing prognostication and service planning, and improving our understanding of the burden of nonfatal injury. [ABSTRACT FROM AUTHOR]

To critically appraise available studies investigating the impact of alcohol outcomes in hospitalized patients after major trauma. Outcomes included injury severity, mortality, complications, and hospital/intensive care length of stay. Data were sourced from MEDLINE, CINAHL, and SCOPUS databases. Abstracts were screened for inclusion/exclusion criteria with 15 articles appraised and analyzed based on in-hospital outcomes. Although alcohol intoxication is associated with a marginal increase in the incidence of inhospital complications (sepsis and multiorgan failure), overall studies suggest it is not associated with longer intensive care or in-hospital length of stay. This literature review also demonstrated decreased mortality and injury severity in patients with traumatic brain injury. Further research is required to determine the reasons for these associations. [ABSTRACT FROM AUTHOR]

Pelvic and long bone fractures are common amongst major trauma patients. Rapid and safe skeletal stabilization is an important step in the early management of these patients, as part of systemic damage control as well as local fracture and soft tissue management. A clear understanding of the anatomy and biomechanics is required to carry out safe pin insertion and stable external fixator construction. [ABSTRACT FROM AUTHOR]

Introduction Following the introduction of the regional trauma system in 2012 the role of the trauma nurse coordinator (TNC) has been rolled out. This study aims to determine the demographic and practice profile of nurses performing the TNC role in England. Methods An electronic survey of TNCs across the 18 trauma networks in England was conducted. Results Fifty-three TNCs responded (62%) to the survey. Seventeen different role titles identified. The majority of TNCs had an emergency or trauma/orthopaedics clinical background. The largest proportion of time spent was clinical (38%). Least amount of time was spent in the education (7%), and research (3%). Nearly a quarter of respondents (23%) had some form of formal research training, nearly half (47%) were assisting others in research. Over half (55%) of respondents felt that they did not have adequate human resources to conduct their role. Discussion This research has provided baseline information about nurses in the role of TNC, their role titles and domains of the role 18 months after the formal introduction of trauma networks in England. There are some marked similarities and differences in the time spent in the different domains of the role between these findings and those published internationally. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is common and is associated with significant morbidity and mortality. The initial resuscitation and management of patients with TBI is focused on limiting secondary brain injury and this may be complex in patients with significant injuries to other organ systems. The transport of critically ill brain-injured patients for definitive treatment also carries significant risks which must be managed. This review describes the initial resuscitation and transfer of head-injured patients. [ABSTRACT FROM AUTHOR]

Summary: Background: Major trauma remains a significant medical concern, leading to about 10,000 deaths annually in Taiwan. Trauma system implementation has been shown to improve the outcomes in different countries. Using the National Health Insurance data, our study examined the influence of age and other factors on the outcomes of trauma patients. Materials and methods: We collected the original claim data of 1 million beneficiaries who enrolled in the National Health Insurance program from 2006 to 2008. ICDMAP-90 was used for calculating the Injury Severity Score (ISS), which was required for assessing the disease severity and implementing appropriate control measures. Other variables included age, sex, triage classifications, pre-existing comorbidities, and hospital levels. The Charlson Comorbidity Index for the year of admission was used for adjusting comorbid conditions. Results: A total of 2497 major trauma patients (ISS >15) were identified in our database. After controlling all the variables in a logistic regression model, for all the major trauma patients, a significant difference was observed between different hospital levels. Compared with the trauma centers, the risk of mortality in nontrauma centers was 1.58 times that in trauma centers (p = 0.004). In the younger groups (aged <40 and 41–60 years), hospital levels had no significant effect on mortality (p = 0.40, 0.41). However, the risk of mortality was 1.89 times in nontrauma centers, compared to that in trauma centers, in the oldest group (p = 0.005). Conclusion: Our study suggests that all major trauma patients should be sent to trauma centers, especially the older patients. [Copyright &y& Elsevier]

Abstract: Aim: To review the recent evidence that has resulted from experiences in and out of conflict in relation to improving imaging in cases of major trauma. Method: A search of electronic databases, the internet and Cochrane library was undertaken to identify relevant publications which were analysed in terms of quality. Evidence that has emerged from civilian and military practice that could influence the practice of major trauma imaging in future was discussed. Results: The importance of speed in assessing patients suffering major trauma is becoming more recognised. There is growing evidence that the use of portable ultrasound at the site of major trauma as first line investigation has potential. In more stable patients, the evidence for whole body CT at the expense of radiography is also growing. The concern regarding availability and radiation dose related to CT scanning remain significant but with the outcome of the recent Major Trauma Review and improvements in CT scanning techniques, such concerns are being addressed. There is limited research in the use of MRI in relation to major trauma. Conclusion: Ultrasound at the sight of major trauma has potential but further research will be needed. Factors such as operator training in particular need to be considered. CT scanning remains an important diagnostic tool for patients suffering major trauma and this is borne out by the Major Trauma Review and NICE guidelines. The availability of CT scanning in relation to accident and emergency scanning is a factor the Major Trauma Review has highlighted and the close proximity of new CT scanners to accident and emergency is a factor that will need to be taken into account in strategic planning. Given the growing evidence of CT involvement, the continued practice of cervical spine and pelvic radiography in cases of major trauma should be questioned. [Copyright &y& Elsevier]

Abstract: Patients with a severe trauma exhibit a strong oxidative stress, an intense inflammatory response, and long-lasting hypermetabolism, all of which are proportional to the severity of injury. In this study, we investigated the impact of trace element (TE) supplementation on the inflammatory response in an animal model of major trauma. New Zealand White rabbits were randomly assigned as a control group (n=5) and an experimental group (n=70) that, after receiving a major trauma, was subdivided into Trauma-Control (n=35) and Trauma-TE (n=35) groups. Systemic inflammatory response syndrome (SIRS) was observed in 40 out of 70 rabbits with a trauma, with a higher incidence in the Trauma-Control group (88.6%; 31/35) than the Trauma-TE group (28.6%; 10/35) (p<0.01). The mortality rate was significantly different between the Trauma-Control and the Trauma-TE groups; (34% vs. 8%; p<0.01). There were significant post-trauma alterations in the levels of (1) serum and spleen zinc (Zn), copper (Cu), selenium (Se), and manganese (Mn), (2) serum AST and ALT, (3) serum interleukin-6/10, and (4) nuclear factor kappa binding (NF-κB) activity and the expression. TE supplementation: (1) improved blood urea nitrogen (BUN), and creatinine (Cr) levels, (2) stabilized IL-6/10 production, (3) decreased NF-κB p65 production. Appropriate TE supplementation can improve the TE status, mitigate SIRS, and reduce the mortality due to multiple organ dysfunction syndromes (MODS)/multiple organ failure (MOF) after major trauma. [Copyright &y& Elsevier]

Point-of-care ultrasound is well suited for use in the emergency setting for assessment of the trauma patient. Currently, portable ultrasound machines with high-resolution imaging capability allow trauma patients to be imaged in the pre-hospital setting, emergency departments and operating theatres. In major trauma, ultrasound is used to diagnose life-threatening conditions and to prioritise and guide appropriate interventions. Assessment of the basic haemodynamic state is a very important part of ultrasound use in trauma, but is discussed in more detail elsewhere. Focussed assessment with sonography for Trauma (FAST) rapidly assesses for haemoperitoneum and haemopericardium, and the Extended FAST examination (EFAST) explores for haemothorax, pneumothorax and intravascular filling status. In regional trauma, ultrasound can be used to detect fractures, many vascular injuries, musculoskeletal injuries, testicular injuries and can assess foetal viability in pregnant trauma patients. Ultrasound can also be used at the bedside to guide procedures in trauma, including nerve blocks and vascular access. Importantly, these examinations are being performed by the treating physician in real time, allowing for immediate changes to management of the patient. Controversy remains in determining the best training to ensure competence in this user-dependent imaging modality. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Major trauma is the leading cause of death in children of developed countries. However, little is known about its long-term health consequences in survivors. Our aim was to describe the health condition in children at long-term after major trauma. Methods: Prospective cohort study of severely injured children (Injury Severity Score ≥16, age <16) admitted to a Dutch level I trauma center in 1999 to 2000 (N = 40). About 7 years after trauma (median, 7.3; range, 6.3-8.2 years), survivors'' health condition was assessed with the following: guides to the evaluation of permanent impairment of the American Medical Association (AMA-guides), Glasgow Outcome Scales (GOS/GOSE), Vineland Adaptive Behavior Scales (VABS), Child Behavior Checklist (CBCL), and Strengths and Difficulties Questionnaire (SDQ). Results: Of 40 children, 28 were followed up. Most (n = 16; 57%) had no impairments (AMA guides); minor to severe impairments were found in 12 of the respondents. About 80% (n = 22) had good recovery (GOS 5 and GOSE 7/8); the remaining had moderately disability (GOS 4 or GOSE 5/6). The mean scores on the VABS and the frequency of behavioral problems on the CBCL (24%) and the SDQ (20%) were comparable to healthy peers. Conclusions: This long-term follow-up study after major trauma revealed that most children had a health condition comparable to healthy peers; about 40% of the respondents was physically impaired or restricted in daily activities. Our experiences with different measures may be helpful to apply age-appropriate outcome measures for the clinical follow-up of children after major trauma and to design future longitudinal studies. [Copyright &y& Elsevier]

To examine the current evidence on the effect of education on intensive care unit nurses' knowledge and skills competence in caring for adult major trauma patients. A systematic review and meta-analysis was conducted to identify relevant studies through a comprehensive search, following strict eligibility criteria. Five databases were searched: MEDLINE, PubMed, CINAHL, Cochrane and Web of Science. A subsequent hand search was performed. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tool was used to assess methodological quality. Five eligible quantitative studies were identified and appraised. The overall results demonstrated that educational interventions have positive effects in improving intensive care nurses' knowledge and practice in managing major trauma patients. Meta-analysis was applied to three homogenous studies relating to knowledge outcome. Results demonstrated significant improvements immediately post-intervention and at one-to three-month follow-up [MD (mean difference) = 29.12, 95%CI (confidence interval) 10.29–47.95; P < 0.00001], and [MD = 23.70, 95%CI 8.84–38.56; P < 0.00001], respectively. A slight decrease in the knowledge and practice scores was noted from one- to three-month follow-up. This review demonstrated the significant effects of trauma education on improving intensive care nurses' knowledge and practices. Further research should develop valid competencies and policies to drive nurses' practice and potentially improve the safety and quality of care. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the experiences of long-distance visitors of major trauma patients admitted to intensive care units at a regional major trauma centre. Postal survey. Survey participants (n = 103) at a regional major trauma centre in England, United Kingdom, were identified from hospital records. Included were adult visitors (next of kin) of major trauma patients admitted to intensive care at the study site between January 2016 and July 2018, with ordinary residence located more than one hour's drive from the major trauma centre. Response rate was 45.6%. Median (range) driving distance between respondents' residence and the major trauma centre was 57.8 km (28.8–331.5). Median (range) number of days respondents visited at the major trauma centre was 18 (1–200). The quality of care at the centre was rated highly. Visitors described their often-challenging circumstances, negotiating the emotional, psychological, physical and financial impact of the situation. Suggested areas for improvement included car parking, signposting on and around the site, information provision, waiting areas and accommodation at or nearby the major trauma centre. This study has described experiences of long-distance visitors at one regional major trauma centre in England and identified opportunities to ameliorate visitors' stress points locally. Replication at other regional centres may be warranted. [ABSTRACT FROM AUTHOR]