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Objectives: To describe rotational thromboelastometry (ROTEM) values (FIBTEM A5, EXTEM A5 and EXTEM CT) across age groups and assess for a statistical trend; and to determine whether any trend in ROTEM values is affected by severity of injury and packed red blood cells (PRBC) requirement. Methods: Retrospective observational study at a level 1 trauma centre in Queensland, Australia. A total of 1601 consecutive trauma patients presenting to the ED. ROTEM data described included FIBTEM A5, EXTEM A5 and EXTEM CT. These values are described by age group (≤30 years, 31–45 years, 46–60 years, 61–75 years and >75 years), Injury Severity Score (ISS) category (<12, ≥12, <25 and ≥25) and number of PRBCs transfused in the first 24 h of admission (0 units, 1–4 units, 5–9 units and ≥10 units). Results: The median age of participants was 37 years (interquartile range [IQR] 25–54 years), with 48.2% of patients had severe trauma (ISS >12) and 13.2% receiving at least one unit of PRBC in the first 24 h of admission. Median (IQR) values for FIBTEM A5, EXTEM A5 and EXTEM CT were 13 mm (10–16 mm), 45 mm (40–49 mm) and 62 s (56–71 s), respectively. A test for trend over progressive age groups showed an increase in FIBTEM A5 (P < 0.001) and EXTEM A5 values (P < 0.001) and a decrease in EXTEM CT values (P < 0.001). Conclusion: The present study demonstrated a pattern of increasing coagulability, as defined by ROTEM, with increasing age group in trauma patients, even among the severely injured. Further investigation is required to determine the clinical impact of these findings on both the ROTEM‐guided management and longitudinal outcomes of these patients and whether an age‐specific approach is beneficial. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the effect of age and collision direction on the severity of thoracic injuries based on a real-world crash database. Methods: This was a retrospective, observational study. We used the Korean In-Depth Accident Study (KIDAS) database, which was collected from crash injury patients who visited emergency medical centers between January 2011 and February 2022 in Korea. Among the 4520 patients enrolled in the database, we selected 1908 adult patients with abbreviated injury scale (AIS) scores between 0 and 6 in the thoracic region. We classified patients with an AIS score of 3 or higher into the severe injury group. Results: The incidence rate of severe thoracic injuries due to motor vehicle accidents was 16.4%. Between the severe and non-severe thoracic injury groups, there were significant differences in sex, age, collision direction, crash object, seatbelt use, and delta-V parameters. Among the age groups, over 55 years occupants had a higher risk in the thoracic regions than those under 54 years occupants. The risk of severe thoracic injury was highest in near-side collisions in all collision directions. Far-side and rear-end collisions showed a lower risk than frontal collisions. Occupants with unfastened seatbelts were at greater risk. Conclusions: The risk of severe thoracic injury is high in near-side collisions among elderly occupants. However, the risk of injury for elderly occupants increases in a super-aging society. To reduce thoracic injury, safety features made for elderly occupants in near-side collisions are required. [ABSTRACT FROM AUTHOR]

Purpose: Vascular injuries in lower extremity trauma, especially with involvement of the popliteal artery, are associated with considerably high rates of limb loss, especially with blunt trauma mechanisms. The aim of this study was to evaluate the risk of amputation in patients with traumatic popliteal artery lesions with special focus on the validity of the Mangled Extremity Severity Score (MESS). Methods: In this retrospective study, all patients treated for isolated lesions of the popliteal artery following trauma between January 1990 and December 2020 at a high-volume level I trauma center were included. Primary outcome was limb salvage dependent on MESS and the influence of defined parameters on limb salvage was defined as secondary outcome. The extent of trauma was assessed by the MESS. Results: A total of 50 patients (age 39.2 ± 18.6 years, 76% male) with most blunt injuries (n = 47, 94%) were included. None of the patients died within 30 days and revascularization was attempted in all patients with no primary amputation and the overall limb salvage rate was 88% (44 patients). A MESS ≥ 7 was observed in 28 patients (56%) with significantly higher rates of performed fasciotomies (92.9% vs. 59.1%; p < 0.01) in those patients. MESS did not predict delayed amputation within our patient cohort (MESS 8.4 ± 4.1 in the amputation group vs. 8.1 ± 3.8 in the limb salvage group; p = 0.765). Conclusion: Revascularization of limbs with isolated popliteal artery injuries should always be attempted. MESS did not predict delayed amputation in our cohort with fasciotomy being an important measure to increase limb salvage rates. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The COVID-19 pandemic has significantly affected societies worldwide, including the medical healthcare system and trauma care. This study explores the impact of COVID-19 infection on trauma patients in South Korea, a country with effective pandemic management. Methods: A retrospective cohort study of 4206 trauma patients from June 2020 to May 2022 was conducted. Patients were categorized into COVID-19-positive and COVID-19-negative groups. Various clinical parameters, complications, and mortality rates were analyzed. Results: COVID-19-positive patients exhibited higher rates of complications, such as pressure sores (8.8% vs. 2.3%, p < 0.001), surgical site infections (2.4% vs. 0.8%, p = 0.044), and pneumonia (8.8% vs. 4.1%, p = 0.007). There was no significant difference in mortality between COVID-19-positive and -negative groups (4% vs. 5.6%, p = 0.439). Factors influencing mortality included COVID-19 status, age, Glasgow Coma Scale, Injury Severity Score, and transfusion status. Conclusion: COVID-19 positivity may have adverse clinical effects on trauma patients, but the impact varies based on public health factors. Additional studies in different contexts are crucial to elucidate these complexities. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: measuring the severity of traumatic injuries is crucial for predicting clinical outcomes. Whereas the Injury Severity Score (ISS) has limitations in assigning scores to injuries at the same site, the New Injury Severity Score (NISS) corrects for this problem by taking into account the three most severe injuries regardless of the region of the body. This study seeks to comprehend the clinical and epidemiological profile of trauma patients while comparing the effectiveness of scales for predicting mortality. Methods: a descriptive, observational and retrospective study using records of patients who underwent thoracotomy at the Hospital das Clínicas of the Federal University of Triângulo Mineiro between 2000 and 2019. Demographic data, mechanisms of injury, affected organs, length of stay and mortality were analyzed. Injury severity was assessed using the ISS and NISS, and statistical analyses were conducted using MedCalc and SigmaPlot. Results: 101 patients were assessed, on average 29.6 years old, 86.13% of whom were men. The average duration of hospitalization was 10.9 days and the mortality rate was 28.7%. The ROC curve analysis revealed a sensitivity of 68.97%, specificity of 80.56% and area under the curve of 0.837 for the ISS, and 58.62%, 94.44% and 0.855 for the NISS, respectively. The Youden index was 0.49 for the ISS and 0.53 for the NISS. Conclusion: the study demonstrated comparable efficacy of NISS and ISS in predicting mortality. These findings hold significance in the hospital setting. Professionals must be familiar with these scales to utilize them competently for each patient.

ABSTRACT Purpose: to consolidate a Trauma Register (TR) trough REDCap data acquisition platform and to validate, in this context, local Quality Indicators (QI) as improvement opportunities in trauma management. Methods: continuous data acquisition of all patients admitted in Irmandade da Santa Casa de Misericórdia de São Paulo adult Trauma bay and it’s validation in REDCap platform; 6 months retrospective cohort of QI impact in length of hospitalar stay, complications and mortality. Fisher, Chi-squared, Wilcoxon and Kruskal-Wallis tests were used to correlate QIs fails with the endpoints, considering p

PurposeFunctional outcomes have been proposed for assessing quality of pediatric trauma care. Outcomes assessments often rely on Abbreviated Injury Scale (AIS) severity scores to adjust for injury characteristics, but the relationship between AIS severity and functional impairment is unknown. This study's primary aim was to quantify functional impairment associated with increasing AIS severity scores within body regions. The secondary aim was to assess differences in impairment between body regions based on AIS severity.MethodsChildren with serious (AIS≥ 3) isolated body region injuries enrolled in a multicenter prospective study were analyzed. The primary outcome was functional status at discharge measured using the Functional Status Scale (FSS). Discharge FSS was compared (1) within each body region across increasing AIS severity scores, and (2) between body regions for injuries with matching AIS scores.ResultsThe study included 266 children, with 16% having abnormal FSS at discharge. Worse FSS was associated with increasing AIS severity only for spine injuries. Abnormal FSS was observed in a greater proportion of head injury patients with a severely impaired initial Glasgow Coma Scale (GCS) (GCS

BackgroundRespiratory complications are associated with significant morbidity and mortality in trauma patients. The care transition from the intensive care unit (ICU) to the acute care ward is a vulnerable time for injured patients. There is a lack of knowledge about the epidemiology of respiratory events and their outcomes during this transition.MethodsRetrospective cohort study in a single Level I trauma center of injured patients 18 years and older initially admitted to the ICU from 2015 to 2019 who survived initial transfer to the acute care ward. The primary outcome was occurrence of a respiratory event, defined as escalation in oxygen therapy beyond nasal cannula or facemask for three or more consecutive hours. Secondary outcomes included unplanned intubation for a primary pulmonary cause, adjudicated via manual chart review, as well as in-hospital mortality and length of stay. Multivariable logistic regression was used to examine patient characteristics associated with posttransfer respiratory events.ResultsThere were 6,561 patients that met the inclusion criteria with a mean age of 52.3 years and median Injury Severity Score of 18 (interquartile range, 13-26). Two hundred and sixty-two patients (4.0%) experienced a respiratory event. Respiratory events occurred early after transfer (median, 2 days, interquartile range, 1-5 days), and were associated with high mortality (16% vs. 1.8%, p < 0.001), and ICU readmission rates (52.6% vs. 4.7%, p < 0.001). Increasing age, male sex, severe chest injury, and comorbidities, including preexisting alcohol use disorder, congestive heart failure, and chronic obstructive pulmonary disease, were associated with increased odds of a respiratory event. Fifty-eight patients experienced an unplanned intubation for a primary pulmonary cause, which was associated with an in-hospital mortality of 39.7%.ConclusionRespiratory events after transfer to the acute care ward occur close to the time of transfer and are associated with high mortality. Interventions targeted at this critical time are warranted to improve patient outcomes.Level of evidencePrognostic and Epidemiological study, level III.

BackgroundTrauma is the leading cause of death and disability in children in the USA. Tranexamic acid (TXA) reduces the blood transfusion requirements in adults and children during surgery. Several studies have evaluated TXA in adults with hemorrhagic trauma, but no randomized controlled trials have occurred in children with trauma. We propose a Bayesian adaptive clinical trial to investigate TXA in children with brain and/or torso hemorrhagic trauma.Methods/designWe designed a double-blind, Bayesian adaptive clinical trial that will enroll up to 2000 patients. We extend the traditional Emax dose-response model to incorporate a hierarchical structure so multiple doses of TXA can be evaluated in different injury populations (isolated head injury, isolated torso injury, or both head and torso injury). Up to 3 doses of TXA (15 mg/kg, 30 mg/kg, and 45 mg/kg bolus doses) will be compared to placebo. Equal allocation between placebo, 15 mg/kg, and 30 mg/kg will be used for an initial period within each injury group. Depending on the dose-response curve, the 45 mg/kg arm may open in an injury group if there is a trend towards increasing efficacy based on the observed relationship using the data from the lower doses. Response-adaptive randomization allows each injury group to differ in allocation proportions of TXA so an optimal dose can be identified for each injury group. Frequent interim stopping periods are included to evaluate efficacy and futility. The statistical design is evaluated through extensive simulations to determine the operating characteristics in several plausible scenarios. This trial achieves adequate power in each injury group.DiscussionThis trial design evaluating TXA in pediatric hemorrhagic trauma allows for three separate injury populations to be analyzed and compared within a single study framework. Individual conclusions regarding optimal dosing of TXA can be made within each injury group. Identifying the optimal dose of TXA, if any, for various injury types in childhood may reduce death and disability.

OBJECTIVE: Major negative life events, such as trauma exposure, can play a key role in igniting or exacerbating psychopathology. However, few disorders are diagnosed with respect to precipitating events, and the role of these events in the unfolding of new psychopathology is not well understood. The authors conducted a multisite transdiagnostic longitudinal study of trauma exposure and related mental health outcomes to identify neurobiological predictors of risk, resilience, and different symptom presentations. METHODS: A total of 146 participants (discovery cohort: N=69; internal replication cohort: N=77) were recruited from emergency departments within 72 hours of a trauma and followed for the next 6 months with a survey, MRI, and physiological assessments. RESULTS: Task-based functional MRI 2 weeks after a motor vehicle collision identified four clusters of individuals based on profiles of neural activity reflecting threat reactivity, reward reactivity, and inhibitory engagement. Three clusters were replicated in an independent sample with a variety of trauma types. The clusters showed different longitudinal patterns of posttrauma symptoms. CONCLUSIONS: These findings provide a novel characterization of heterogeneous stress responses shortly after trauma exposure, identifying potential neuroimaging-based biotypes of trauma resilience and psychopathology.

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Venous thromboembolic events (VTE) are a significant cause of morbidity and mortality following traumatic injury. We examined demographic characteristics, chemoprophylaxis, and outcomes of VTE patients with blunt trauma requiring hospitalization. Methods: A retrospective review of adult blunt trauma hospitalizations with and without VTE between 2012 and 2019 was conducted. Deaths in the emergency department were excluded. Univariate and multivariable analyses, including machine learning classification algorithms for VTE, were performed. Results: Of 10,926 admitted adult blunt trauma patients, 177 had VTE events. VTE events occurred at a median of 6 [IQR 3–11] days, with 7.3% occurring within 1 day of admission. VTE patients were more often male, and more often underwent surgery. They had higher injury severity as well as longer intensive care unit and hospital lengths of stay. While VTE occurred throughout the spectrum of injury severity, 27.7% had low injury severity (ISS < = 9). In multivariable analyses, both heparin and enoxaparin had reduced adjusted odds ratios for VTE. Conclusion: Approximately 7.3% of VTE events occurred within one day of admission. A substantial proportion of VTE events occurred in patients with low injury severity (ISS < = 9). Subcutaneous unfractionated heparin and enoxaparin chemoprophylaxis were both inversely associated with VTE. These findings underscore the need for vigilance for VTE identification in blunt trauma patients throughout their hospitalization and VTE prevention efforts. [ABSTRACT FROM AUTHOR]

Introduction: Trauma is a major cause of death worldwide, and prehospital care is critical to improve patient outcomes. However, there is controversy surrounding the effectiveness of limiting scene time to 10 min or less in the care of major trauma patients. This study aimed to investigate the association between scene time and mortality in major trauma patients. Methods: A retrospective cohort study was conducted on major trauma patients treated by the Thammasat University Hospital Emergency Medical Services (EMS) team from 2020 to 2022. We included traumatic adult patients who had an injury severity score (ISS) of 16 or higher. The primary outcome was 24-h mortality. Multivariable risk regression analysis was used to evaluate the independent effect of scene time on 24-h mortality. Results: A total of 104 patients were included, of whom 11.5% died within 24 h. After adjusting for age, systolic blood pressure, Glasgow Coma Scale, and ISS, patients who had a scene time over 10 min showed a significant association with mortality (33.3% vs. 8.7%, P = 0.031). Intravenous fluid administration at the scene showed a trend toward a significant association with mortality. Conclusions: This study provides evidence to support the importance of minimizing scene time for major trauma patients. The findings suggest that a balance between timely interventions and adequate resources should be considered to optimize patient outcomes. Further studies to investigate the impact of prehospital interventions on trauma patient outcomes are needed. [ABSTRACT FROM AUTHOR]

Trauma in pregnancy can range from a mild injury, such as a fall from standing height, to a major injury, involving a penetrating injury or a high force motor vehicle collision. Providing care to a pregnant patient with trauma presents a unique challenge as 2 patients are at risk for complications, that is, the mother and the fetus. both of whom require evaluation and management. Health care professionals should be aware of and be prepared to manage complications of trauma in pregnancy, given its significant associated morbidity and mortality This article details the epidemiology, etiology, assessment, diagnosis, and management of trauma in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Trauma is one of the important causes of disability, death and major health problem in the world. Various instruments are used to assess the clinical outcomes of trauma patients. Objectives: The aim of this study was to compare the Revised Trauma Score (RTS) with the MGAP score in determining the clinical outcomes. Methods: A retrospective cross-sectional analytical study was conducted on 1000 multiple trauma patients admitted to Poursina Hospital in Rasht. The data collection instruments included a three-part checklist of demographic and clinical characteristics, RTS and MGAP scores, and clinical outcomes (length of hospitalization and mortality). Data were analyzed using descriptive and non-parametric statistical tests by SPSS 21 software. To determine the predictive power of RTS and MGAP mortality using the ROC test, in addition to obtaining the area under the curve (AUC), the cut-off point, sensitivity, specificity, positive and negative predictive values (PPV and NPV) were obtained. Results: The findings showed that 3% of patients (CI: 95%) died and the length of hospitalization was 3.7±2 days. The mortality prediction level of RTS and MGAP instruments for trauma patients was significant (P<0.001) according to AUCs of 97.9% and 98.3%, respectively. Correlation between MGAP and RTS for the length of hospitalization were significant (r=-0.267and r=-0.274, p<0.001), but the intensity of correlation between MGAP and RTS was not significant. The best cut-off points for RTS and MGAP were equal to 7 and 22.5, respectively, with sensitivity rates of 98.1% and 92.3%., specificity rates of 96.7%, and 92.3%., PPV values of 97.7% and 92.3% and NPV values of 92.3% and 98.1%, respectively. Conclusion: MAGP and RTS instruments can predict the clinical outcomes of trauma patients well, but they did not have a significant superiority over each other. Therefore, the preferred choice of one of these agents requires multicenter studies. [ABSTRACT FROM AUTHOR]

Background: Trauma is one of the main causes of premature deaths worldwide. Improvements in hospital and pre-hospital care and procedures can reduce trauma-related deaths. Easy trauma scoring systems can help the doctors to adopt a specific and appropriate method of managing trauma patients. Objectives: This study aimed to compare the degree to which indicators of GCS, Age, and systolic blood pressure (GAP), New trauma score (NTS), Revised trauma score (RTS), and Kampala trauma score (KTS) predicted the hospital outcome of the multi-trauma patients. Methods: This descriptive-analytical study was conducted on 385 multi-trauma patients referred to the emergency department of Imam Khomeini hospital in Urmia (Iran). The data related to GAP, NTS, RTS, and KTS were collected using a checklist and then were analyzed using descriptive and analytical statistics by SPSS 18. Results: The mean RTS, NTS, KTS, GAP and GCS values were 6.71±0.47, 6.06±0.34, 8.25±0.96, 77.77±0.96, 22.20±2 and 13.90±1.8, respectively. Moreover, the deceased patients' averages of RTS, NTS and GAP were significantly lower than these averages in the discharged patients. Nonetheless, there was no significant difference between deceased and discharged patients in terms of their average KTS. Moreover, there was no statistically significant difference between the average RTS, NTS, KTS and GAP of the patients who needed surgery and the patients who did not need surgery. In addition, the averages RTS, NTS and GAP of the patients who needed ICU were significantly lower than these averages in patients who did not need ICU. However, there was no significant difference between the average KTS of the patients who needed ICU and the patients who did not need ICU. Conclusion: The findings of the study show that the deceased trauma patients' RTS, NTS, KTS and GAP were lower than the recovered patients' RTS, NTS, KTS and GAP. This problem can be a risk factor and shows that there is a need for faster treatment of these patients. [ABSTRACT FROM AUTHOR]

Asia is experiencing a demographic shift toward an aging population at an unrivaled rate. This can influence the characteristics and outcomes of trauma. We aim to examine different characteristics of older adult trauma patients compared to younger adult trauma patients and describe factors that affect the outcomes in Asian countries. This is a retrospective, international, multicenter study of trauma across participating centers in the Pan Asian Trauma Outcome Study (PATOS) registry, which included trauma cases aged ≥18 years, brought to the emergency department (ED) by emergency medical services (EMS) from October 2015 to November 2018. Data of older adults (≥65 years) and younger adults (<65 years) were analyzed and compared. The primary outcome measure was in-hospital mortality, and secondary outcomes were disability at discharge and hospital and intensive care unit (ICU) length of stays. Of 39,804 trauma patients, 10,770 (27.1%) were older adults. Trauma occurred more among older adult women (54.7% vs 33.2%, p < 0.001). Falls were more frequent in older adults (66.3% vs 24.9%, p < 0.001) who also had higher mean Injury Severity Score (ISS) compared to the younger adult trauma patient (5.4 ± 6.78 vs 4.76 ± 8.60, p < 0.001). Older adult trauma patients had a greater incidence of poor Glasgow Outcome Scale (GOS) (13.4% vs 4.1%, p < 0.001), higher hospital mortality (1.5% vs 0.9%, p < 0.001) and longer median hospital length of stay (12.8 vs 9.8, p < 0.001). Multiple logistic regression revealed age (adjusted odds ratio [AOR] 1.06, 95%CI 1.02–1.04, p < 0.001), male sex (AOR 1.60, 95%CI 1.04–2.46, p = 0.032), head and face injuries (AOR 3.25, 95%CI 2.06–5.11, p < 0.001), abdominal and pelvic injuries (AOR 2.78, 95%CI 1.48–5.23, p = 0.002), cardiovascular (AOR 2.71, 95%CI 1.40–5.22, p = 0.003), pulmonary (AOR 3.13, 95%CI 1.30–7.53, p = 0.011) and cancer (AOR 2.03, 95%CI 1.02–4.06, p = 0.045) comorbidities, severe ISS (AOR 2.06, 95%CI 1.23–3.45, p = 0.006), and Glasgow Coma Scale (GCS) ≤8 (AOR 12.50, 95%CI 6.95–22.48, p < 0.001) were significant predictors of hospital mortality. Older trauma patients in the Asian region have a higher mortality rate than their younger counterparts, with many significant predictors. These findings illustrate the different characteristics of older trauma patients and their potential to influence the outcome. Preventive measures for elderly trauma should be targeted based on these factors. [ABSTRACT FROM AUTHOR]

Aims: Major trauma patients need adequate nutrition for recovery. This study aimed to evaluate the adequacy of nutritional supply and the correlation between nutritional supply and clinical outcome. Methods: A single‐centre retrospective observational study was undertaken, describing the amounts of energy and proteins provided to 320 critically ill trauma patients during the first 10 days after admission. The data were collected from the electronic medical records of patients admitted to the trauma intensive care unit during the study period and descriptive statistical analyses were performed with the SPSS software. Results: The mean proportion of supplied energy to recommended energy during the first 10 days after admission was 57.5%, and the mean percentage of supplied protein to recommended protein intake was 51.3%. The patients were divided into those who received ≥70% (isocaloric nutrition group) and those who received <70% (hypocaloric nutrition group) of their estimated requirements. Both the duration of ventilator use (12.7 ± 10.5 vs. 16.0 ± 15.8 days, respectively, p = 0.009) and duration of parenteral nutrition (1.1 ± 1.4 vs. 2.0 ± 2.0 days, respectively, p = 0.001) were shorter in the isocaloric nutrition group (n = 83) than in the hypocaloric nutrition group (n = 237). Conclusion: Total energy and the amount of protein supplied were insufficient compared to the recommended amount. The duration of ventilator use was shorter in the isocaloric nutrition group than in the hypocaloric nutrition group. The association between shortened ventilator use and isocaloric nutrition requires further investigation as a potential intervention to reduce the risk of complications such as ventilator‐related pneumonia. [ABSTRACT FROM AUTHOR]

Severe trauma patients need immediate prehospital intervention and transfer to a specialised trauma hospital. In Norway, primary care doctors (PCDs) are an integrated part of the prehospital trauma care. The aim of this study was to investigate the degree to which PCDs were involved in prehospital care of severe trauma patients and how factors related to patients and doctors were associated with call-outs to these incidents. This was a registry-based study in Norway on severe trauma patients with acute hospital admission during the period 2012–2018. Data was obtained from three Norwegian official registries. By linking the registries, we studied the actions taken by the PCDs, whether they called out to severe trauma incidents. In multivariable regression models, we investigated whether factors related to the PCDs (age, sex, specialisation in general practice (GP)) and patients (age, sex, duration of hospital stay, type of injury) were associated with call-outs. Out of 4342 severe trauma incidents, PCDs had documented involvement in 1683 (39%) and called out to 644 (15%). Increased proportions of PCD call-outs to severe trauma incidents were significantly associated with lower age of PCD, being a GP specialist, lower patient age, being a male patient, increased length of hospital stay and injuries to the head and the neck. PCDs called out to a relatively low proportion of severe trauma patients. Several factors related to patients and doctors were associated with call-outs to severe trauma incidents in Norway. Factors related to doctors and patients affect the Primary Care Doctor's (PCD's) decision to call out to severe trauma incidents. PCDs were involved in 39% out of 4342 severe trauma incidents and called out to 15%. Increased proportion of PCD call-outs to severe trauma incidents was significantly associated with lower age of the PCD and being a GP specialist. Lower patient age, being a male patient, and injury to the head and the neck increased the likelihood of PCD call-outs. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objective of the study was to compare psychiatric outcomes in adults with and without history of pediatric traumatic brain injury (TBI). Youth ages 6 to 14 years hospitalized for TBI from 1992 to 1994 were assessed at baseline and at 3, 6, 12, and 24 months post-injury. In the current study, psychiatric assessments were repeated at 24 years post-injury with the same cohort, now adults ages 29 to 39 years. A control group of healthy adults also was recruited for one-time cross-sectional assessments. Outcome measures included: 1) presence of a psychiatric disorder since the 24-month assessment not present before the TBI ("novel psychiatric disorder," NPD), or in the control group, the presence of a psychiatric disorder that developed after the mean age of injury of the TBI group plus 2 years; and 2) Time-to-Event for onset of an NPD during the same time periods. In the TBI group, NPDs were significantly more common, and presence of a current NPD was significantly predicted by presence of a pre-injury lifetime psychiatric disorder and by abnormal day-of-injury computed tomography (CT) scan. Compared with controls, the TBI group also had significantly shorter Time-to-Event for onset of any NPD. These findings demonstrate that long-term psychiatric outcomes in adults previously hospitalized for pediatric TBI are significantly worse when compared with adult controls without history of pediatric TBI, both in terms of prevalence and earlier onset of NPD. Further, in the TBI group, long-term NPD outcome is predicted independently by presence of pre-injury psychiatric disorder and abnormal day-of-injury CT scan.

ObjectiveTo test the hypothesis that veterans with traumatic brain injury (TBI) have an increased subsequent risk of sleep disorders, we studied the longitudinal association between TBI and incident sleep disorders in nearly 200,000 veterans.MethodsWe performed a cohort study of all patients diagnosed with a TBI in the Veterans Health Administration system from October 1, 2001, to September 30, 2015, who were age-matched 1:1 to veterans without TBI. Veterans with prevalent sleep disorders at baseline were excluded. Development of sleep disorders was defined as any inpatient or outpatient diagnosis of sleep apnea, hypersomnia, insomnia, or sleep-related movement disorders based on ICD-9 codes after the first TBI diagnosis or the random selection date for those without TBI. We restricted the analysis to those with at least 1 year of follow-up. We used Cox proportional hazards models to examine the association between TBI and subsequent risk of sleep disorders.ResultsThe study included 98,709 veterans with TBI and 98,709 age-matched veterans without TBI (age 49 ± 20 years). After an average follow-up of 5 (1-14) years, 23,127 (19.6%) veterans developed sleep disorders. After adjustment for demographics, education, income, and medical and psychiatric conditions, those who had TBI compared to those without TBI were 41% more likely to develop any sleep disorders (hazard ratio 1.41 [95% confidence interval 1.37-1.44]), including sleep apnea (1.28 [1.24-1.32]), insomnia (1.50 [1.45-1.55]), hypersomnia (1.50 [1.39-1.61]), and sleep-related movement disorders (1.33 [1.16-1.52]). The association was stronger for mild TBIs, did not differ appreciably by presence of posttraumatic stress disorder, and remained after a 2-year time lag.ConclusionIn 197,418 veterans without sleep disorders, those with diagnosed TBI had an increased risk of incident sleep disorders over 14 years. Improved prevention and long-term management strategies for sleep are needed for veterans with TBI.

This study compared the predictive utility of Marshall, Rotterdam, Stockholm, Helsinki, and NeuroImaging Radiological Interpretation System (NIRIS) scorings based on early non-contrast brain computed tomography (CT) scans in patients with traumatic brain injury (TBI). The area under a receiver operating characteristic curve (AUROC) was used to determine the predictive utility of scoring systems. Subgroup analyses were performed among patients with head AIS scores > 1. A total of 996 patients were included, of whom 786 (78.9%) were males. In-hospital mortality, ICU admission, neurosurgical intervention, and prolonged total hospital length of stay (THLOS) were recorded for 27 (2.7%), 207 (20.8%), 82 (8.2%), and 205 (20.6%) patients, respectively. For predicting in-hospital mortality, all scoring systems had AUROC point estimates above 0.9 and 0.75 among all included patients and patients with head AIS > 1, respectively, without any significant differences. The Marshall and NIRIS scoring systems had higher AUROCs for predicting ICU admission and neurosurgery than the other scoring systems. For predicting THLOS ≥ seven days, although the NIRIS and Marshall scoring systems seemed to have higher AUROC point estimates when all patients were analyzed, five scoring systems performed roughly the same in the head AIS > 1 subgroup. [ABSTRACT FROM AUTHOR]

BACKGROUND: Low-titer group O whole blood (LTOWB) resuscitation is becoming common in both military and civilian settings and may represent the ideal resuscitation intervention. We sought to characterize the safety and efficacy of LTOWB resuscitation relative to blood component resuscitation. STUDY DESIGN: A prospective, multicenter, observational cohort study was performed using 7 trauma centers. Injured patients at risk of massive transfusion who required both blood transfusion and hemorrhage control procedures were enrolled. The primary outcome was 4-hour mortality. Secondary outcomes included 24-hour and 28-day mortality, achievement of hemostasis, death from exsanguination, and the incidence of unexpected survivors. RESULTS: A total of 1,051 patients in hemorrhagic shock met all enrollment criteria. The cohort was severely injured with >70% of patients requiring massive transfusion. After propensity adjustment, no significant 4-hour mortality difference across LTOWB and component patients was found (relative risk [RR] 0.90, 95% CI 0.59 to 1.39, p = 0.64). Similarly, no adjusted mortality differences were demonstrated at 24 hours or 28 days for the enrolled cohort. When patients with an elevated prehospital probability of mortality were analyzed, LTOWB resuscitation was independently associated with a 48% lower risk of 4-hour mortality (relative risk [RR] 0.52, 95% CI 0.32 to 0.87, p = 0.01) and a 30% lower risk of 28-day mortality (RR 0.70, 95% CI 0.51 to 0.96, p = 0.03). CONCLUSIONS: Early LTOWB resuscitation is safe but not independently associated with survival for the overall enrolled population. When patients were selected with an elevated probability of mortality based on prehospital injury characteristics, LTOWB was independently associated with a lower risk of mortality starting at 4 hours after arrival through 28 days after injury. [ABSTRACT FROM AUTHOR]

Purpose: To report the experience of treatment on blunt traumatic popliteal artery injury (PAI) combined orthopedic injuries and determine the amputation-associated factors. Methods: From January 2008 to December 2019, 55 patients in level I trauma center with traumatic blunt PAI were retrospectively reviewed. Variables were retrospectively collected and statistically analyzed. Patients with PAI with limb selvage, primary amputation, and secondary amputation were retrospectively grouped and compared. Results: A total of 55 patients with a median age of 41.4 years (range 18–70), of which 45 were males (81.8%) and 10 were females (18.2%), were enrolled. The overall amputation rate was 36.4% because 88.6% of patients faced more than 6 h of delay before treatment. The average injury severe score (ISS) and abbreviated injury score (AIS) were 10.4 (range 9–34) and 8.2 (range 5–16), respectively. Multivariate regression analysis showed that the number of hospitalization days was a significantly related factor to amputation. After a median follow-up of 56 months (range 12–132), no death, another limb loss, or claudication was found in all patients. Conclusions: Patients with PAI are commonly accompanied by multiple injuries that increase the risk of amputation; therefore, timely treatments are urgently required. Reducing the severity of ischemia by fasciotomy, not losing time by performing preoperative imaging or diagnostic tests, and repairing the associated venous injury can help to optimize the rates of limb salvage. However, impact factors, such as the gender and age of the patient, injured mechanisms, concomitant injuries, AIS, ISS, and surgical times, are not associated with the outcomes of amputation. Nonetheless, endeavors to salvage the limbs as far as possible should be made. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to verify the association between in-hospital complications and characterization and clinical variables including hospital care and trauma severity. Methods: This analysis with the prospective cohort data was conducted at a municipal hospital in São Paulo, Brazil, and included participants aged 14 years or older, with traumatic injuries from traffic accidents. Data was collected from January 2015 to July 2016 and included demographics variables, type of traumatic event, clinical parameters, length of stay in the Emergency department and in the Intensive Care Unit, length of hospital stay, survival probability, trauma severity and mortality. Results: Of the 327 patients, 25.1% had in-hospital complications and their occurrence was statistically associated with higher mean age, run-overs and higher trauma severity. The length of stay in the emergency room, hospital stay, ICU stay, percentage of deaths, and hospital readmission were higher in patients with complications. The number of complications was correlated with trauma severity, ICU stay, and mortality. Conclusion: Complications were associated with older age, run-overs, greater trauma severity, length of stay and readmission after hospital discharge. [ABSTRACT FROM AUTHOR]

The mangled extremity severity score (MESS) was established 28 years ago to decide performing an amputation in cases of limb trauma. It assigns points for 4 aspects of the injury: the extent of soft tissue and skeletal injury, limb ischemia and ischemic duration, shock, and age. A score of 7 or higher indicates that primary amputation is required. Thirty-one patients with MESS scores of 7 to 8 underwent limb salvage surgeries, with 13 limbs being saved and 18 limbs being amputated. Upper extremities trauma had a salvage rate of 62.5%, whereas lower extremity trauma had a salvage rate of 20%. MESS is not a sensitive predictor of amputation in upper limb trauma, but it is useful in lower limb injuries. [ABSTRACT FROM AUTHOR]

Background: The use of veno-venous extracorporeal membrane oxygenation (VV ECMO) remains controversial in trauma patients with acute respiratory distress syndrome (ARDS). Here, we aimed to investigate the therapeutic benefits of VV ECMO and the factors affecting patient outcomes. Methods: From 2017 to 2019, 21/1938 trauma patients (median age: 47 years; 18 men) at a level I trauma center received VV ECMO for post-traumatic ARDS. Demographic, injury-specific, ECMO, and outcome data were prospectively collected and retrospectively reviewed to analyze the factors affecting hospital mortality and ECMO results. Results: 19 patients (90.5%) were successfully weaned off ECMO; 16 patients (76.2%) survived to discharge. In univariate analysis, there was a significant difference in survival between the groups with a Trauma and Injury Severity Score (TRISS) ⩾0.5 and TRISS <0.5 (p = 0.05). The area under the receiver operating characteristic curve (AUC) for both TRISS and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) scores for death was 0.78. In those who failed ECMO weaning, the AUCs of the TRISS and RESP scores were 0.90 and 0.80, respectively. Conclusions: In patients with ARDS caused by severe trauma and supported by VV ECMO, survival is associated with TRISS; TRISS and RESP scores may be predictive of mortality and failure in ECMO weaning. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although the role of a dedicated trauma nurse has been implemented in an urban setting, it has not been studied in the rural trauma setting. We instituted a trauma resuscitation emergency care (TREC) nurse role to respond to trauma activations at our rural trauma center. OBJECTIVE: This study aims to determine the impact of TREC nurse deployment on the timeliness of resuscitation interventions in trauma activations. METHODS: This pre- and postintervention study at a rural Level I trauma center compared the time to resuscitation interventions before (August 2018 to July 2019) and after (August 2019 to July 2020) deploying TREC nurses to trauma activations. RESULTS: A total of 2,593 participants were studied, of which 1,153 (44%) were in the pre-TREC group and 1,440 (56%) in the post-TREC group. After TREC deployment, the median (interquartile range [IQR]) emergency department times within the first hour decreased from 45 (31.23–53) to 35 (16–51) min (p =.013). The median (IQR) time to the operating room within the first hour decreased from 46 (37–52) to 29 (12–46) min (p =.001), and within the first 2 hr, decreased from 59 (43.8–86) to 48 (23–72) min (p =.014). CONCLUSION: Our study found that TREC nurse deployment improved resuscitation intervention timeliness during the first 2 hr (early phase) of trauma activations. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic haemorrhagic shock can be difficult to diagnose. Models for predicting critical bleeding and massive transfusion have been developed to aid clinicians. The aim of this review is to outline the various available models and report on their performance and validation. Methods: A review of the English and non-English literature in Medline, PubMed and Google Scholar was conducted from 1990 to September 2015. We combined several terms for i) haemorrhage AND ii) prediction, in the setting of iii) trauma. We included models that had at least two data points. We extracted information about the models, their developments, performance and validation. Results: There were 36 different models identified that diagnose critical bleeding, which included a total of 36 unique variables. All models were developed retrospectively. The models performed with variable predictive abilities-the most superior with an area under the receiver operating characteristics curve of 0.985, but included detailed findings on imaging and was based on a small cohort. The most commonly included variable was systolic blood pressure, featuring in all but five models. Pattern or mechanism of injury were used by 16 models. Pathology results were used by 15 models, of which nine included base deficit and eight models included haemoglobin. Imaging was utilised in eight models. Thirteen models were known to be validated, with only one being prospectively validated. Conclusions: Several models for predicting critical bleeding exist, however none were deemed accurate enough to dictate treatment. Potential areas of improvement identified include measures of variability in vital signs and point of care imaging and pathology testing. [ABSTRACT FROM AUTHOR]

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Substantial difference in mortality following severe traumatic brain injury (TBI) across international trauma centers has previously been demonstrated. This could be partly attributed to variability in the severity coding of the injuries. This study evaluated the inter-rater and intra-rater reliability of Abbreviated Injury Scale (AIS) scores of patients with severe TBI across three international level I trauma centers. Methods: A total 150 patients (50 per center) were randomly selected from each respective trauma registry: University Medical Center Utrecht (UMCU), the Netherlands; John Hunter Hospital (JHH), Australia; and Harborview Medical Center (HMC), the United States. Reliability between coders and trauma centers was measured with the intraclass correlation coefficient (ICC). Results: The reliability between the coders and the original trauma registry scores was 0.50, 0.50, and 0.41 in, respectively, UMCU, JHH, and HMC. The AIS coders at UMCU scored the most AIS codes of ≥ 4. Reliability within the trauma centers was substantial in UMCU (ICC = 0.62) and HMC (ICC = 0.78) and almost perfect in JHH (ICC = 0.85). Reliability between trauma centers was 0.70 between UMCU and JHH, 0.70 between JHH and HMC, and 0.59 between UMCU and HMC. Conclusion: The results of this study demonstrated a substantial and almost perfect reliability of the AIS coders within the same trauma center, but variability across trauma centers. This indicates a need to improve inter-rater reliability in AIS coders and quality assessments of trauma registry data, specifically for patients with head injuries. Future research should study the effect of differences in AIS scoring on outcome predictions. [ABSTRACT FROM AUTHOR]

Pneumonectomy after traumatic lung injury (TLI) is associated with shock, increased pulmonary vascular resistance, and eventual right ventricular failure. Historically, trauma pneumonectomy (TP) mortality rates ranged between 53 and 100%. It is unclear if contemporary mortality rates have improved. Therefore, we evaluated outcomes associated with TP and limited lung resections (LLR) (i.e., lobectomy and segmentectomy) and aimed to identify predictors of mortality, hypothesizing that TP is associated with greater mortality versus LLR. We queried the Trauma Quality Improvement Program (2010-2016) and performed a multivariable logistic regression to determine the independent predictors of mortality in TLI patients undergoing TP versus LLR. TLI occurred in 287,276 patients. Of these, 889 required lung resection with 758 (85.3%) undergoing LLR and 131 (14.7%) undergoing TP. Patients undergoing TP had a higher median injury severity score (26.0 vs. 24.5, p = 0.03) but no difference in initial median systolic blood pressure (109 vs. 107 mmHg, p = 0.92) compared to LLR. Mortality was significantly higher for TP compared to LLR (64.9% vs 27.2%, p

ObjectiveTo determine the importance of preburn adjustment, injury-related variables, and selection of coping style in various outcome measures using a biopsychosocial model.DesignLongitudinal study.SettingOutpatient burn clinics.ParticipantsBurn survivors (N=231) who participated in this study as part of a larger burn model system study of 645 patients with major burn injuries.InterventionsNot applicable.Main outcome measuresThe 36-Item Short-Form Health Survey was used to assess preburn adjustment. Other outcome measures entered into the model included the Ways of Coping Checklist Revised, the Brief Symptom Inventory, the Beck Depression Inventory-II, and the Davidson Trauma Scale.ResultsCorrelational and mediational analyses revealed that preburn emotional health predicted better adjustment at year 1 and more posttraumatic stress disorder symptoms at year 2. Better preburn emotional health was also related to less use of avoidance coping strategies, which was found to be a mediator of the effect of preburn emotional health and posttraumatic stress disorder symptoms. Burn injury characteristics were not significantly associated with psychological adjustment at either year 1 or year 2.ConclusionsThe results indicate that there is a complex relation between premorbid mental health and the selection of coping strategies that affect long-term adjustment in persons recovering from a burn injury. This relation seems to have greater effect on long-term outcomes than does preburn emotional or physical health alone or the severity of the burn.

BackgroundTrauma prediction scores such as Revised Trauma Score (RTS) and Trauma and Injury Severity Score (TRISS)) are used to predict mortality, but do not include comorbidities. We analyzed the American Society of Anesthesiologists physical status (ASA PS) for predicting mortality in trauma patients undergoing surgery.MethodsThis multicenter, retrospective study compared the mortality predictive ability of ASA PS, RTS, Injury Severity Score (ISS), and TRISS using a complete case analysis with mixed effects logistic regression. Associations with mortality and AROC were calculated for each measure alone and tested for differences using chi-square.ResultsOf 3,042 patients, 230 (8%) died. The AROC for mortality for TRISS was 0.938 (95%CI 0.921, 0.954), RTS 0.845 (95%CI 0.815, 0.875), and ASA PS 0.886 (95%CI 0.864, 0.908). ASA PS + TRISS did not improve mortality predictive ability (p = 0.18).ConclusionsASA PS was a good predictor of mortality in trauma patients, although combined with TRISS it did not improve predictive ability.

Collaborative care is a multicomponent intervention delivered by frontline social work, nursing, and physician providers to address patients' physical, emotional, and social needs. We argued that collaborative care may particularly benefit patients with a violent victimization history because it practices three principles of trauma-informed care: patient–provider collaboration, preventing repeat trauma in clinical and community settings, and delivering comprehensive mental and physical healthcare. We conducted an exploratory secondary data analysis of a collaborative care randomized clinical trial involving patients who presented with traumatic physical injury at a Level I trauma center in Washington state between 2006 and 2009. We used random-effect linear regression models to estimate how histories of multiple violent traumas moderated the effects of the collaborative care intervention on Short Form-36 Mental Component Summary (MCS) and Physical Component Summary (PCS) T -scores over time. Collaborative care significantly improved follow-up MCS scores among patients who experienced three to four types of violent victimization in their lifetime. Additionally, intervention effects on MCS scores at the 3- and 6-month follow-up were clinically stronger for patients who reported three to four types of violent victimization (3-month = 7.5, 95% confidence level [CI] = 5.1 to 18.7; 6-month = 11.9, 95% CI = 5.1 to 18.7) than those without a history of violent victimization (3-month = 0.8, 95% CI = −5.1, 6.6; 6-month = 5.6, −2.4 to 13.5). We did not find that intervention effects on PCS scores differed between these groups at any wave. Collaborative care may be a promising approach to delivering trauma-informed mental healthcare to patients with histories of multiple types of violent victimization. [ABSTRACT FROM AUTHOR]

Hemorrhage is responsible for up to 40% of all traumatic deaths. The seminal CRASH-2 trial demonstrated a reduction in overall mortality following early tranexamic acid (TXA) administration to bleeding trauma patients. Following publication of the trial results, TXA has been incorporated into many prehospital trauma protocols. However, the cost-effectiveness of widespread TXA adoption by EMS is unknown. To estimate the cost-effectiveness of statewide implementation of a TXA protocol. The North Carolina Trauma Registry was queried to identify potential TXA patients using the a priori criteria of age ≥18 years, suspected hemorrhage, penetrating or blunt injury, and prehospital blood pressure <90 mmHg and heart rate >110 bpm. Using life tables adjusted for age, sex, and race, and the absolute risk reductions in mortality with early TXA administration reported in the literature, the life-years gained were calculated for each potential life saved. Implementation costs consisted of initial stocking, training, and replacement costs. Projected reduction in hospitalization costs were based on estimates reported in the literature. Economic analyses were conducted from societal and state EMS system perspectives. To assess the robustness of the model, univariate and bivariate sensitivity analyses were performed on selected input variables. Based on the TXA inclusionary criteria, 159 patients could potentially receive TXA per year. In the base-case scenario with a projected absolute mortality reduction of 3%, an additional 4.8 lives per year in NC would be saved, with an estimated 191 total life-years gained. The statewide implementation and operation cost was $305,122 in year 1, and continued operating costs were $6,042 in years 2 and 3, yielding a cost per life saved of $63,967 in year 1 and $1,267 in years 2 and 3. The cost per life-year gained was $1,595 in year 1 and $32 in years 2 and 3. Annual hospitalization costs would potentially be reduced by $1,828,072. Previous studies have demonstrated the clinical effectiveness of early TXA administration to patients with hemorrhage. Our modeling of the financial implications and clinical benefits of implementing a statewide TXA protocol suggests that prehospital TXA is a cost-effective treatment. [ABSTRACT FROM AUTHOR]

For the 30% of Australians who live in rural areas, access to rehabilitation services after sustaining a major traumatic injury can be challenging. This study aimed to explore the experience of rural major traumatic injury survivors accessing rehabilitation services. Semi-structured interviews were conducted with 21 rural major traumatic injury survivors (Mage = 47.86; SD = 11.35; Range: 21–61) who were an average of seven years post-injury (SD = 3.10; Range: 3.25–13.01). Transcribed interviews were thematically analysed. Four themes were identified: (1) Managing the transition back to local services, (2) Independence and determination to get better, (3) Rehabilitation is an ongoing process, and (4) Limited service access and quality. While injury-related symptoms persisted for many participants, they expressed strong determination for independence and self-management of their recovery. Barriers to accessing rehabilitation services included poor knowledge of local services, travel burden, financial costs, and a lack of local practitioners experienced in major traumatic injury rehabilitation. Facilitating factors included financial, psychological, community, and informal supports. To support recovery, future rural service models should improve consideration of factors resulting from living at a distance to services and harness independence to self-manage. Rural major traumatic injury survivors need support to navigate numerous barriers to accessing rehabilitation services. Rural participants expressed their preference for greater involvement in planning their transition back home following hospitalisation and help to link with available services in their local area. Specialist training and support for rural rehabilitation practitioners is needed, to effectively treat impairments related to major traumatic injury, particularly psychological and cognitive difficulties. Future service delivery models should incorporate methods to locate rural services; facilitate telehealth access and client self-management; and provide financial and mental health support to both rural survivors of major traumatic injury and their carers. [ABSTRACT FROM AUTHOR]

• This is the largest study to-date comparing the utility of CCI and CPS in predicting mortality and discharge outcomes in older trauma patients. • CCI, but not CPS, predicts mortality in older patients with trauma. • Increasing CCI decreased odds of discharge to care facilities. Predictive scoring system that incorporates injury severity, comorbidities and polypharmacy is needed. The Charlson Comorbidity Index (CCI) and Comorbidity Polypharmacy Score (CPS) may potentially risk-stratify older trauma patients more accurately than traditional trauma severity scores. We aim to evaluate if CCI or CPS are better predictors of mortality and discharge venue in such patients. We conducted a retrospective study using registry data from two tertiary trauma centres. Patients aged 65 years and above who presented to the emergency departments (EDs) between January 2011 and December 2015 with traumatic injuries were included. Charts were reviewed for demographics, injury mechanism and severity, discharge outcomes, and types of comorbidities and medications used. Primary outcome was overall mortality; secondary outcomes included ED disposition and hospital discharge venue. Discriminatory power of the score(s) were compared using area under the receiver operating characteristic (AUROC) curve. There were 2,750 patients, with overall female predominance (56.7%, 1,560/2,750) and median age of 78 years (interquartile range [IQR] 72 to 84 years). Median CCI score was 1 (IQR 0 to 2) and median CPS was 8 (IQR 4 to 12). Overall mortality was 9.4% (259/2,750). Every 1-point increase in CCI score resulted in increased odds of death by 16% (adjusted odds ratio 1.16, 95% confidence interval 1.07 to 1.26, p<0.001). Addition of CCI to the Injury Severity Score (ISS) increased the discriminatory power for mortality (AUROC for ISS = 0.832; AUROC for ISS with CCI = 0.843). Every 1-point increase in CCI was significantly associated with decreased odds of admission to a rehab facility by 8%. CPS did not predict mortality and discharge venue. CCI, but not CPS, was a predictor of mortality. A higher CCI was associated with decreased odds of discharge to a subacute facility, likely related to underlying rehabilitation potential. Further studies should be undertaken to explore an integrated scoring system that considers injury severity, comorbidities, and polypharmacy. [ABSTRACT FROM AUTHOR]

Background: There is limited literature of venovenous extracorporeal membrane oxygenation use in a community, non-university, setting in the trauma population. Methods: We reviewed our cases over 2 years from March 2018 to March 2020. This study was conducted in a community hospital with a General Surgery residency with no direct affiliation to a medical school. Primary outcome reviewed was survival to discharge. Secondary outcomes included duration of extracorporeal membranous oxygenation (ECMO) support, blood transfusion requirement, complications, and disposition. Results: Five patients were cannulated during this time period. All patients survived to discharge. Mean time on ECMO was 153.4 h or 6.4 days (range 60–216 h). All patients required a transfusion while cannulated, with a mean of 10 units PRBC transfused (range 3–24). One patient required CPR, one required cessation of heparin drip for bleeding, and one had clinical signs of a stroke. Three patients were discharged to long-term acute care facilities and the other two to acute rehab. Conclusions: Community level I trauma centers are capable of handling trauma patients requiring ECMO. It does require a multi-disciplinary team of surgical intensivists and cardiothoracic surgeons along with the support of nursing, respiratory therapists, and perfusionists. The outcomes in this limited series show that ECMO can be a tool utilized in the community setting. [ABSTRACT FROM AUTHOR]

Introduction: Hepatic pseudoaneurysm (HPA) is a rare but potentially life-threatening sequelae of blunt or penetrating liver trauma. At our institution, an imaging protocol for liver injury patients has been developed, with repeat computed tomographic (CT) angiography of the liver 48–72 h post-admission to assess for HPA. The purpose of this study was to evaluate the utility of this imaging pathway in liver trauma for the detection of HPAs. Methods: A retrospective analysis was performed on patients who were admitted to our institution between January 2014 and January 2018, found to have either blunt or penetrating liver injury on initial CT imaging. Data collection included mechanism of injury, injury severity score (ISS), American Association for the Surgery of Trauma (AAST) liver injury score, initial and follow-up CT findings and secondary intervention. Results: During the study period, 149 major trauma patients were admitted with liver injuries (mean age 35.6 years; 72% male, 28% female). Seventy two percent of patients suffered blunt (median ISS = 29; median AAST = 2.89) and 28% patients suffered penetrating injuries (median ISS = 16; median AAST = 2.88). The mean time to follow-up CT was 46.1 h. Follow-up CT identified 8 (5.4%) HPAs. 5 (62.5%) of these patients were treated with embolization. ISS and AAST were not associated with pseudoaneurysm formation according to logistic regression analysis; however, ISS (OR 1.06 [1.02, 1.09; p < 0.05]) and AAST (OR 2.24, [1.31, 3.83; p < 0.05]) were associated with requirement for embolization. Conclusion: Our experience indicates a role for early detection of HPAs using a dedicated trauma imaging pathway. [ABSTRACT FROM AUTHOR]

Purpose: The risk of infectious complications after trauma is determined by the amount of injury-related tissue damage and the resulting inflammatory response. Recently, it became possible to measure the neutrophil phenotype in a point-of-care setting. The primary goal of this study was to investigate if immunophenotype categories based on visual recognition of neutrophil subsets are applicable to interpret the inflammatory response to trauma. The secondary goal was to correlate these immunophenotype categories with patient characteristics, injury severity and risk of complications. Methods: A cohort study was conducted with patients presented at a level 1 trauma center with injuries of any severity, who routinely underwent neutrophil phenotyping. Data generated by automated point-of-care flow cytometry were prospectively gathered. Neutrophil phenotypes categories were defined by visual assessment of two-dimensional CD16/CD62L dot plots. All patients were categorized in one of the immunophenotype categories. Thereafter, the categories were validated by multidimensional analysis of neutrophil populations, using FlowSOM. All clinical parameters and endpoints were extracted from the trauma registry. Results: The study population consisted of 380 patients. Seven distinct immunophenotype Categories (0–6) were defined, that consisted of different neutrophil populations as validated by FlowSOM. Injury severity scores and risk of infectious complications increased with ascending immunophenotype Categories 3–6. Injury severity was similarly low in Categories 0–2. Conclusion: The distribution of neutrophil subsets that were described in phenotype categories is easily recognizable for clinicians at the bedside. Even more, multidimensional analysis demonstrated these categories to be distinct subsets of neutrophils. Identification of trauma patients at risk for infectious complications by monitoring the immunophenotype category is a further improvement of personalized and point-of-care decision-making in trauma care. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Emergency Trauma Score (EMTRAS), Revised Trauma Score (RTS) and Glasgow Age Pressure (GAP) are used to determine the patient status, and to predict the intervention and prognosis. Objectives: The aim of the present study was to evaluate the association between mortality and trauma severity scores (EMTRAS, RTS, and GAP) in multiple trauma patients. Methods: In this study, patients who had referred to the Emergency Department of Mustafa Kemal University Hospital due to multiple trauma within a one-year period were evaluated retrospectively. The hospital is located in the central district of Hatay, Antakya in the Republic of Turkey, 680 km from the capital, on the Syrian border. Its population is 1,5 million. Antakya is located as the central district of Hatay with population of 400,000. Demographic data, trauma type, nationality, vital parameters [pulse, peripheral oxygen saturation (SO2), respiratory count, systolic blood pressure (SBP), diastolic blood pressure (DBP)], physiological scoring systems (GCS, RTS, GAP and EMTRAS), and mortality states of the patients were reviewed. Data were analysed by SPSS 21, and the effect of current parameters on short-term (in the emergency service) and long-term (30 days) mortality was examined. Results: Three hundred and thirty-three multi-trauma patients were enrolled into the study. The median age of the patients was 31 (IQR: 22) years; 88.3% (294) of the patients were male. The exitus rate was detected as 7.8% in the emergency service and 26.4% within one month. GCS, RTS and GAP values of the patients who have died in the emergency service and within one month were significantly lower; however, the EMTRAS level was significantly higher in these patients (p<0.05). RTS and EMTRAS were detected as short- and long-term independent variables for mortality (p<0.05). After Receiver Operating Characteristic (ROC) analysis, the areas under the curve (AUC) of GCS, GAP, RTS and EMTRAS for short-term mortality were 0.861cm², 0.876 cm², 0.901cm² and 0,917cm², respectively; the AUC of such parameters for long-term mortality was detected 0.896cm², 0.904 cm², 0.914cm² and 0.899cm², respectively. Conclusion: EMTRAS values were detected more significant parameters for short-term mortality whereas RTS was more significant for long-term mortality in multiple trauma patients. Such two scores may be useful to predict the patient prognosis along with GCS or solely. [ABSTRACT FROM AUTHOR]

Background: Muscle-sparing thoracotomy (MST) has been proposed as an alternative to standard posterolateral thoracotomy (sPLT) for elective thoracic procedures with limited use in urgent thoracotomies. Objectives: The aim of this study was to compare the results of sPLT and MST during urgent thoracotomy for the treatment of chest trauma. Methods: This case series study included patients who underwent urgent thoracotomies within the first 48 hours of admission for treatment of chest trauma, from January 2019 to July 2022. Patients were divided into two groups: sPLT and MST groups. In addition, the MST group was divided into partial (pMST) or complete (cMST). Results: Seventy-five out of 1400 patients with chest trauma (5.3%) underwent urgent thoracotomy, and 30 of them (40%) had MST. Compared with the sPLT group, the MST group had a lower abbreviated injury scale (AIS) of the thoracic region, with a significant difference (4.09 ± 0.66 versus 3.77 ± 0.72, P = 0.052). There was no significant difference between the two groups with regard to the duration of tube drainage, ICU stay, hospital stay, and postoperative complications. The length of hospital stay was shorter in the MST group with no statistically significant difference (14.30 ± 3.01 vs. 15.5 ± 2.48, P = 0.08). The extent of MST, whether partial or complete, had no significant effect on postoperative outcomes. Conclusions: If it does not impede access or chest exposure, MST can be performed with early recovery and therefore a shorter hospital stay than sPLT. [ABSTRACT FROM AUTHOR]

The Westmead Post‐Traumatic Amnesia Scale (WPTAS) is routinely used for the assessment of post‐traumatic amnesia (PTA) in children who sustained traumatic brain injury (TBI). Yet, the WPTAS' predictive validity for functional outcomes is largely unknown. We aimed to determine whether PTA duration measured by the WPTAS (i) differentially predicts functional outcomes and (ii) contributes to predictions of outcomes beyond the Glasgow Coma Scale (GCS) in children who sustained TBI. Participants were children and adolescents with moderate‐to‐severe TBI (n = 55) aged 8–15 years. PTA duration was assessed with the WPTAS. Outcomes at the first outpatient follow‐up were scored on the Kings Outcome Scale for Childhood Head Injury (KOSCHI) and the TBI Outcome Domain Scale‐Extended (ODS‐E). Longer PTA and lower GCS were both significantly correlated with worse (i) global outcomes: presence of disability on the KOSCHI and lower score on the ODS‐E and (ii) select specific outcomes on the ODS‐E: mobility, mood and cognition. PTA duration predicted cognitive outcome on the ODS‐E independently, beyond GCS. Together, PTA duration and GCS, predicted the global KOSCHI outcome, as well as the ODS‐E mobility and mood outcomes. Neither GCS nor PTA duration correlated with the ODS‐E communication, impulsivity/disinhibition, headache, fatigue, sensory impairments or somatic complaints outcomes. PTA duration measured by the WPTAS is a significant unique predictor of functional cognitive outcomes in children who sustained moderate‐to‐severe TBI, and in combination with the GCS, a significant predictor of global, and several specific functional outcomes. [ABSTRACT FROM AUTHOR]

Background: A new, supposedly more reproducible radiographic classification, set to replace the Tönnis classification of hip dislocations, was proposed in 2015: the International Hip Dysplasia Institute (IHDI) classification. Purpose: To compare the IHDI classification with the Tönnis classification when evaluating the severity of hip dislocations as well as their respective inter- and intra-observer reliability. Material and Methods: Since January 2000, Swedish-born children with a hip dislocation were prospectively registered. From this registry, radiographs of 97 hips in 79 patients (91% girls; median age = 7 months), born in 2000–2009, were analyzed. Two observers, one consultant and one resident, classified each hip both by IHDI and Tönnis twice. Results: The IHDI classification had a more even distribution of grades with the majority in grade 2–3. The Tönnis classification graded the majority (77%) of the patients as grade 2 and equally among the other grades. There was moderate inter-observer agreement using both methods calculated with Kappa, 0.61 (95% confidence interval [CI] = 0.44–0.79) for Tönnis and 0.62 (95% CI = 0.49–0.74) for IHDI. The resident calculated Tönnis with weak intra-observer reliability of 0.57 (95% CI = 0.40–0.74) compared to high intra-observer reliability of 0.86 (95% CI = 0.74–0.98) for the consultant. Both observers graded IHDI with high intra-observer reliability. Conclusion: IHDI is more discriminative than the Tönnis classification when evaluating the severity of a hip dislocation in infants. [ABSTRACT FROM AUTHOR]

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