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Introduction: There remains a significant morbidity and mortality in young pedestrians hit by motor vehicles, even in the era of pedestrian crossings and speed limits. The aim of this study was to compare the incidence and injury severity of motor vehicle-related pedestrian trauma according to time of day and season in a young population, based on the supposition that injuries would be more prevalent during dusk and dawn and during autumn and winter. Methods: Data were retrieved from the National Trauma Audit and Research Network (TARN) database for patients between 10 and 25 years old who had been involved as pedestrians in road traffic collisions between 2013 and 2020. The incidence of injuries, their severity (using the injury severity score (ISS)) and mortality were analysed according to the hours of daylight, darkness and season. Results: The study identified a seasonal pattern, highlighting that injuries were most prevalent during autumn (34.9% of injuries). Prevalence decreased throughout the year from winter (25.4%) to spring (21.4%), to summer (18.3%). The greatest incident rate (number of incidents/hour) occurred between 1500-1630 h, correlating to school pick up times, but overall there was no significant difference in injury prevalence between hours of darkness (47.3%) and daylight (52.7%). However, a significant relationship between ISS and daylight hours was demonstrated (p-value = 0.0124), whereby moderate injuries (ISS score: 9-15) were more likely during the day (72.7%), while severe injuries (ISS score > 15) were more likely at night (55.8%). Conclusion:We identified a relationship between the time of day and the frequency and severity of pedestrian trauma in young people. In addition, particular time groupings correspond to the greatest incidents rate, suggesting that reduced visibility coupled with school pick up times play a significant role. We recommend targeted public health measures to improve road safety that focus on these high-risk times of the day. [ABSTRACT FROM AUTHOR]

Background: Traumatic injuries are common amongst working-age adults. Survivors often experience physical and psychological problems, reduced quality of life and difficulty returning to work. Vocational rehabilitation improves work outcomes for a range of conditions but evidence of effectiveness for those with traumatic injuries is lacking. This study assesses feasibility of delivering a vocational rehabilitation intervention to enhance return to work and improve quality of life and wellbeing in people with at least moderate trauma to inform design of a definitive randomised controlled trial (RCT). Methods: Non-randomised, single-arm, multi-centre mixed-methods feasibility study with nested case studies and qualitative study. The case studies comprise interviews, observations of clinical contacts and review of clinical records. The qualitative study comprises interviews and/or focus groups. Participants will be recruited from two UK major trauma centres. Participants will comprise 40 patients aged 16–69 with an injury severity score of > 8 who will receive the intervention and complete questionnaires. Interviews will be conducted with 10 patients and their occupational therapists (OTs), clinical psychologists (CPs), employers and commissioners of rehabilitation services. Fidelity will be assessed in up to six patients by observations of OT and CP—patient contacts, review of patient records and intervention case report forms. OT and CP training will be evaluated using questionnaires and competence to deliver the intervention assessed using a team objective structured clinical examination and written task. Patients participating in and those declining participation in the study will be invited to take part in interviews/focus groups to explore barriers and facilitators to recruitment and retention. Outcomes include recruitment and retention rates, intervention fidelity, OT and CP competence to deliver the intervention, experiences of delivering or receiving the intervention and factors likely to influence definitive trial delivery. Discussion: Effective vocational rehabilitation interventions to enhance return to work amongst trauma patients are urgently needed because return to work is often delayed, with detrimental effects on health, financial stability, healthcare resource use and wider society. This protocol describes a feasibility study delivering a complex intervention to enhance return to work in those with at least moderate trauma. Trial registration: ISRCTN: 74668529. Prospectively registered on 23 January 20 [ABSTRACT FROM AUTHOR]

It is more than 20 years since the term ‘Damage control’ was introduced to describe an emerging surgical strategy of abbreviated laparotomy for exsanguinating trauma patients. This strategy of temporisation and prioritisation of physiological recovery over completeness of anatomical repair was associated with improved survival in a subset of patients with combined major vascular and multiple visceral injuries. The ensuing years saw the rapid adoption of these principles as standard of care for massively injured and physiologically exhausted patients. Resuscitation of severely injured patients has changed significantly in the last decade with the emergence of a new resuscitation paradigm termed ‘damage control resuscitation’. Originating in combat support hospitals, damage control resuscitation emphasises the primacy of haemorrhage control while directly targeting the ‘lethal triad’ of coagulopathy, acidosis, and hypothermia. Integral to damage control resuscitation is the appropriate application of damage control surgery and together they constitute the modern damage control paradigm. This review aims to discuss the modern application of damage control resuscitation and damage control surgery and to review the evidence supporting its constituent components, as well as considering deficiencies in current knowledge and areas for future research. [ABSTRACT FROM AUTHOR]

To assesses the feasibility of delivering a telehealth vocational rehabilitation (VR) intervention to enhance return to work and improve quality of life and wellbeing in people post-trauma. Non-randomised single-arm mixed-methods feasibility study. Participants were recruited from two UK major trauma centres (MTCs). The intervention was delivered virtually (or face-to-face where necessary) in participants' homes. Adult patients (n=10) 16-69 years, admitted to participating UK MTCs with Injury Severity Score (ISS) >8, recruited ≤12 weeks post-injury. Eligible participants were employed (paid or unpaid) or in full-time education at injury onset. Treating occupational therapists (OTs) and clinical psychologists (CPs) (n=6) trained in ROWTATE VR. ROWTATE is an individually-tailored job retention intervention, delivered by OTs, who act as case-coordinators, and CPs. It commences 12-weeks post-injury and is delivered for up to 12 months. It involves: assessing impact of injury; work-focused rehabilitation; planning/monitoring phased return-to-work; liaising with employers/healthcare team; educating patients/employers about injury impact; early identification, monitoring and support for psychological problems. Due to COVID-19, the intervention was adapted for remote delivery (video/phone call) and OTs/CPs trained in remote delivery. Study completion. Intervention fidelity, barriers and enablers to delivery, acceptability and usefulness; acceptability of remote intervention training. At 6 months: 90% started intervention ≤12 weeks post-injury, 103 OT sessions (M=10.3, range 5-19); 99% OT sessions delivered remotely, 6 patients referred to CP; 22 sessions (M=3.7, range 1-5), 100% remote. Fidelity: OT: 90%-100% across patients, CP: 82%-100% across patients. No participant withdrawals. Treating therapists and all participants found the intervention acceptable. Remote VR training and delivery is feasible and acceptable to OTs/CPs and trauma survivors. Findings have informed a definitive randomised controlled trial. No conflicting interests. [ABSTRACT FROM AUTHOR]

Summary: Objective:: To determine opportunities for improvement (OI) in the critical care management of severely injured patients in a general adult intensive care unit through a performance improvement (PI) process. Methods:: Retrospective review of patient records from intensive care patients who had sustained traumatic injuries, except isolated head injury, over a 1-year period. Three assessors independently audited the notes using performance improvement methodology to determine complications, errors in management and preventability. Complications were included when two or more assessors independently detected the complication. Measurements and results:: Records from 90 patients with a diagnosis of ‘trauma’ were reviewed, 14 patients with isolated head injury were excluded. The mean injury severity score was 23 (range 4–43). No complications or errors of management were identified from 41 patients, including ten patients who died. Seventy-two complications were identified in 35 patients including 15 pneumonias, 6 cases of peri-operative hypothermia and 5 recurrent pneumothoraces. Fourteen preventable complications were identified. Conclusions:: The PI OI process highlighted specific opportunities for the improvement of critical care management of trauma patients in our unit. These will be addressed through the introduction of formal tertiary surveys and clinical management guidelines addressing hypothermia and management of coagulopathy. [Copyright &y& Elsevier]

Objectives: To determine the incidence, aetiology and contributing factors to injuries being missed during the primary and secondary surveys in patients with major trauma managed on a general Adult Intensive Care Unit (AICU). Methods: The records for patients admitted to the AICU following severe injury (defined as injury severity score (ISS) >16) over a 1-year period were reviewed. Diagnostic imaging performed during the resuscitation was reviewed in cases where missed injuries were discovered. Results: Forty-five patients with a median injury severity score of 26 were included in the study. Twelve missed injuries were discovered in 10 patients during the intensive care admission; three required an additional surgical procedure. There was no significant difference in Glasgow Coma Score, revised trauma score, ISS or admission systolic blood pressure between patients with missed injuries and those patients where all injures were found at resuscitation (P>0.05). Three quarters of the undetected injuries were orthopaedic. Conclusions: Significant injuries can be missed during the primary and secondary surveys in severely injured patients. A tertiary survey should be completed in all trauma patients admitted to an intensive care unit. [Copyright &y& Elsevier]

Major hemorrhage is often associated with trauma-induced coagulopathy. Targeted blood product replacement could achieve faster hemostasis and reduce mortality. This study aimed to investigate whether thromboelastography (TEG®) goal-directed transfusion improved blood utilization, reduced mortality, and was cost effective. Data were prospectively collected in a U.K. level 1 trauma center, in patients with major hemorrhage one year pre- and post-implementation of TEG® 6s Hemostasis Analyzers. Mortality, units of blood products transfused, and costs were compared between groups. Patient demographics in pre-TEG (n = 126) and post-TEG (n = 175) groups were similar. Mortality was significantly lower in the post-TEG group at 24 h (13% vs. 5%; p = 0.006) and at 30 days (25% vs. 11%; p = 0.002), with no difference in the number or ratio of blood products transfused. Cost of blood products transfused was comparable, with the exception of platelets (average £38 higher post-TEG). Blood product wastage was significantly lower in the post-TEG group (1.8 ± 2.1 vs. 1.1 ± 2.0; p = 0.002). No statistically significant difference in cost was observed between the two groups (£753 ± 651 pre-TEG; £830 ± 847 post-TEG; p = 0.41). These results demonstrate TEG 6s-driven resuscitation algorithms are associated with reduced mortality, reduced blood product wastage, and are cost neutral compared to standard coagulation tests. [ABSTRACT FROM AUTHOR]

Abstract: In year 2000, there were approximately 4600 reported firearm injuries in the UK. Most large urban Accident & Emergency Departments can expect to manage at least 5-10 gunshot injuries per year. In the UK, these injuries tend to involve handguns or shotguns (rather than military-style weapons) and occur in inner-city areas, often being gang- or drug-related. The steady increase in the incidence of gun-associated violence in the UK has occurred despite the alteration in gun legislation that was introduced following a multiple shooting incident in Dunblane, UK, in 1996. The UK, however, remains towards the bottom of the ‘league’ of firearm deaths, with a rate of 0.3 per 100,000 population. In comparison, South Africa, with an estimated 8 million weapons in circulation, has a murder rate of 56 per 100,000, and the USA has a value of 10.6. Explosives cause unique injury patterns, devastating multiple wounds, and trauma to many body systems. The recognition, resuscitation and appropriate management of these injuries is vital. A wide range of weapons can be responsible for ballistic-type injuries, including handguns, automatic assault rifles, bombs, mines and fragments. Whilst it is important to ‘treat the wound and not the weapon’, an understanding of ballistics and injury patterns is valuable, as these wounds can be complex and involve multiple body systems. [Copyright &y& Elsevier]