Search

Nearly 10% of pregnant women suffer traumatic injury. Clinical outcomes for pregnant trauma patients (PTPs) with severe injuries have not been well studied. We sought to describe outcomes for PTPs presenting with severe injuries, hypothesizing that PTPs with severe injuries will have higher rates of complications and mortality compared to less injured PTPs. A post-hoc analysis of a multi-institutional retrospective study at 12 Level-I/II trauma centers was performed. Patients were stratified into severely injured (injury severity score [ISS] > 15) and not severely injured (ISS

Various scoring systems are utilized to assess severe trauma patients, with one of the most commonly used tools being the International Classification of Diseases Injury Severity Score (ICISS) criteria derived from the Survival Risk Ratio (SRR) calculated using diagnostic codes. This study aimed to redefine the severe trauma scoring system in Korea based on the SRR for diagnostic codes, and subsequently evaluate its performance in predicting survival outcomes for trauma patients. This study included trauma patients who visited Level 1 and 2 emergency departments (EDs) between January 2016 and December 2019, utilizing the Korean National Emergency Department Information System (NEDIS) database. The primary outcome of this study was in-hospital mortality. The new SRR-2020 value was calculated for each of the 865 trauma diagnosis codes (Korean Standard Classification of Diseases [KCD-7] codes, 4-digit format), and the patient-specific ICISS-2020 value was derived by multiplying the corresponding SRR-2020 value based on patient diagnosis. We compared the predictive performance for in-hospital mortality between severe trauma patients with an ICISS <0.9 based on the newly developed ICISS-2020 version and those defined by the previously used ICISS-2015 version. A total of 3,841,122 patients were enrolled, with an in-hospital mortality rate of 0.5 %. Severe trauma patients with ICISS-2020 < 0.9 accounted for 5.3 % (204,897 cases) that was lower than ICISS-2015 < 0.9 accounting for 15.3 % (587,801 cases). Among the 20,619 in-hospital mortality cases, 81.4 % had ICISS-2020 < 0.9, and 88.6 % had ICISS-2015 < 0.9. When comparing predictive performance for in-hospital mortality between the two ICISS versions, ICISS-2020 showed higher accuracy (0.95), specificity (0.95), positive predictive value (PPV) (0.08), positive likelihood ratio (LR+) (16.53), and area under the receiver operating characteristic curve (AUROC) (0.96) than ICISS-2015 for accuracy (0.85), sensitivity (0.88), specificity (0.85), PPV (0.03), LR+ (5.94), and AUROC (0.94). However, regarding sensitivity, ICISS-2020 < 0.9 showed a lower value of 0.81 compared to ICISS-2015 < 0.9, which was 0.88. The negative predictive value (NPV) was 1.00 for both versions. The newly developed ICISS-2020, utilizing a nationwide emergency patient database, demonstrated relatively good performance (accuracy, specificity, PPV, LR+, and AUROC) in predicting survival outcomes for patients with trauma. [ABSTRACT FROM AUTHOR]

Background: Traumatic rhabdomyolysis (RM) is common and associated with the development of acute kidney injury and potentially with other organ dysfunctions. Thus, RM may increase the risk of death. The primary objective was to assess the effect of severe RM (Creatine Kinase [CK] > 5000 U/L) on 30-day mortality in trauma patients using a causal inference approach. Methods: In this multicenter cohort study conducted in France using a national major trauma registry (Traumabase) between January 1, 2012, and July 1, 2023, all patients admitted to a participating major trauma center hospitalized in intensive care unit (ICU) and with CK measurement were included. Confounding variables for both 30-day mortality and exposure were used to establish a propensity score. A doubly robust approach with inverse treatment weighting enabled the calculation of the average treatment effect on the treated (ATT). Analyses were performed in the overall cohort as well as in two subgroups: hemorrhagic shock subgroup (HS) and traumatic brain injury subgroup (TBI). Sensitivity analyses were conducted. Results: Among the 8592 patients included, 1544 (18.0%) had severe RM. They were predominantly males (78.6%) with median [IQR] age of 41 [27–58] years and severely injured (ISS 20 [13 – 29]) mainly from blunt trauma (90.8%). In the entire cohort, the ATT, expressed as a risk difference, was 0.073 [-0.054 to 0.200]. Considering the 1311 patients in the HS subgroup, the ATT was 0.039 [0.014 to 0.063]. As in the overall cohort, there was no effect on mortality in the TBI subgroup. Severe RM was associated with greater severity of trauma and more complications (whether related to renal function or not) during the ICU stay. Mortality due to multiorgan failure (39.9% vs 12.4%) or septic shock (2.6% vs 0.8%) was more frequent among patients with severe RM. Conclusions: Severe RM was not associated with 30-day mortality considering the overall cohort. However, it was associated with a 4.0% increase in 30-day mortality among patients with concurrent hemorrhagic shock. Severe RM plays a significant role in ICU morbidity. [ABSTRACT FROM AUTHOR]

Background: Trauma represents a significant global health challenge.The development of an effective scoring tool capable of predicting mortality risk in trauma cases is essential. This study aimed to investigate the combined effects of quick sequential organ failure assessment (qSOFA) and hypothermia (H) along with prothrombin time (PT) in predicting the prognosis of patients with severe trauma. Methods: A retrospective cohort study was conducted to analyze data from severe trauma patients in the Trauma Database of the Trauma Center at the Second Affiliated Hospital of Soochow University between January 2017 and December 2021. Patients were categorized into survival and non-survival groups based on clinical outcomes. Baseline and clinical data were compared between the groups, and prognostic factors were explored using logistic regression analysis. Receiver operating characteristic (ROC) curves generated by 10-fold cross-validation using the caret in R programming language were used to assess the predictive efficacy of Injury Severity Score (ISS) and qSOFA + H + PT score for trauma patient mortality. Results: A total of 509 severe trauma patients (377 males and 132 females) were included, with a median age of 53 years (range: 42–65 years). The mortality rate was found to be 23.4%. Logistic regression analysis revealed that age, ISS, and qSOFA + H + PT were significant predictors of death in severe trauma patients, with odds ratios of 1.035 (95%CI:1.014–1.057), 1.052 (95%CI:1.017–1.090), and 6.124 (95%CI:3.107–12.072), respectively (P < 0.05). The predictive efficacy of ISS and qSOFA + H + PT for mortality prediction was 0.742 and 0.816, respectively.The predictive efficacy of qSOFA + H + PT for emergency blood transfusion and operation was 0.743 and 0.702. Conclusion: qSOFA + H + PT are identified as significant predictors to the death of severe trauma patients. They could be utilized as early intervention indicators in emergency departments, facilitating clinical management strategies such as emergency blood transfusion, emergency operation, and prognosis prediction. [ABSTRACT FROM AUTHOR]

Abstract Background Trauma represents a significant global health challenge.The development of an effective scoring tool capable of predicting mortality risk in trauma cases is essential. This study aimed to investigate the combined effects of quick sequential organ failure assessment (qSOFA) and hypothermia (H) along with prothrombin time (PT) in predicting the prognosis of patients with severe trauma. Methods A retrospective cohort study was conducted to analyze data from severe trauma patients in the Trauma Database of the Trauma Center at the Second Affiliated Hospital of Soochow University between January 2017 and December 2021. Patients were categorized into survival and non-survival groups based on clinical outcomes. Baseline and clinical data were compared between the groups, and prognostic factors were explored using logistic regression analysis. Receiver operating characteristic (ROC) curves generated by 10-fold cross-validation using the caret in R programming language were used to assess the predictive efficacy of Injury Severity Score (ISS) and qSOFA + H + PT score for trauma patient mortality. Results A total of 509 severe trauma patients (377 males and 132 females) were included, with a median age of 53 years (range: 42–65 years). The mortality rate was found to be 23.4%. Logistic regression analysis revealed that age, ISS, and qSOFA + H + PT were significant predictors of death in severe trauma patients, with odds ratios of 1.035 (95%CI:1.014–1.057), 1.052 (95%CI:1.017–1.090), and 6.124 (95%CI:3.107–12.072), respectively (P

Introduction: The association between elevated lactate levels and the development of disseminated intravascular coagulation (DIC) in patients with severe trauma remains unclear. Hence, this study aimed to explore the association between lactate and the development of DIC in patients with severe trauma. Methods: This prospective cohort study was conducted on consecutive patients with severe trauma who were hospitalized in the intensive care unit from January 2020 to January 2023. The primary outcome measured was the occurrence of DIC in patients in the emergency department or posthospitalization. Logistic regression analysis evaluating the risk values for lactate and DIC, the receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) examinations studying the predictive efficiency of lactate for DIC. The Kaplan–Meier survival curve was used to assess patient survival. Sensitivity robustness analysis included modified Poisson regression, E-value, subgroup analysis, and numerical variable transformation analysis. Results: Logistic regression analysis corrected for confounding factors showed that lactate was a risk factor for DIC in patients with severe trauma (adjusted odds ratio [OR]: 1.374, 95% confidence interval [CI]: 1.206–1.566). Lactate predicted DIC risk with a 0.8513 area under the ROC curve (95% CI: 0.7827–0.9199), 4.8 cutoff value, 0.8333 sensitivity, and 0.8014 specificity. DCA showed the correlation between lactate and DIC. The mortality rate of patients with a high risk of DIC was significantly higher than that of patients with a low risk (log-rank test, P < 0.001). The modified Poisson regression showed that lactate was a risk factor for DIC (risk ratio: 1.188, 95% CI: 1.140–1.237). E-value was 1.645, and the lower limit of 95% CI was 1.495. The logistic regression analysis after subgroup analysis and transformation of numerical variables showed that lactate remained a risk factor for DIC. Conclusions: Elevated lactate is closely associated with the occurrence of DIC in patients with severe trauma. Lactate seems to be a good predictive factor for DIC manifestation in patients with severe trauma.

Background and goal: The reverse shock index multiplied by the Glasgow Coma Scale score(rSIG)predicts trauma patient mortality, according to previous studies. It is unclear if rSIGCan predict massive transfusion (MT) in trauma patients. This study examines whether rSIG predicts MT in trauma patients. The study also tests whether rSIG can predict trauma patient's coagulopathy, in-hospital mortality, and 24-hour death, rSIG's prognostic value for MT in trauma patients is compared to TASH and ABC scores. Methods: This single -- center prospective observational study at B.L.D. E (DU), SHRI B.M. Patil medical college hospital and research center's emergency medicine department. In trauma patients, rSIG's prognostic value for MTP was compared to older scoring systems as TASH and ABC scores. Results: MT was given to 20 of 195 patients. MT, in-hospital mortality, 24-hour mortality, and coagulopathy are better predicted by rSIG than SI, SIA, and qSOFA. The in-hospital mortality AUROC for rSIG was 0.812, indicating its dependability. Prior study shows that rSIG can predict trauma patient's death and coagulopathy. All three tests are discriminatory, but evaluation assessment blood consumption is most accurate, followed by TASH score and rSIGusing ROC values. MT rSIG predicted better than SL, SLA, and qSOFA (AUROC=0.842). rSIG predicted coagulopathy, in-hospital, and 24-hour mortality better than SI, SIA and qSOFA. RSIG combines hemodynamic instability (reverse SI) and consciousness (GCS) for a more complete trauma patient evaluation. Detecting coagulopathy early with rSIG permits rewarming, acidosis correction, balanced transfusion and massive transfusion regimens. Conclusion: The study shows that rSIG can identify trauma patients at high risk for major transfusion, coagulopathy, and death. Assessment Blood consumption evaluation is most accurate, followed by TASH Score and rSIG, for managing severe trauma situations swiftly and effectively which could improve patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Traumas cause great casualties, accompanied by heavy economic burdens every year. The study aimed to use ML (machine learning) survival algorithms for predicting the 8-and 24-hour survival of severe traumas. Methods: A retrospective study using data from National Trauma Data Bank (NTDB) was conducted. Four ML survival algorithms including survival tree (ST), random forest for survival (RFS) and gradient boosting machine (GBM), together with a Cox proportional hazard model (Cox), were utilized to develop the survival prediction models. Following this, model performance was determined by the comparison of the C-index, integrated Brier score (IBS) and calibration curves in the test datasets. Results: A total of 191,240 individuals diagnosed with severe trauma between 2015 and 2018 were identified. Glasgow Coma Scale (GCS), trauma type, age, SaO2, respiratory rate (RR), systolic blood pressure (SBP), EMS transport time, EMS on-scene time, pulse, and EMS response time were identified as the main predictors. For predicting the 8-hour survival with the complete cases, the C-indexes in the test sets were 0.853 (0.845, 0.861), 0.823 (0.812, 0.834), 0.871 (0.862, 0.879) and 0.857 (0.849, 0.865) for Cox, ST, RFS and GBM, respectively. Similar results were observed in the 24-hour survival prediction models. The prediction error curves based on IBS also showed a similar pattern for these models. Additionally, a free web-based calculator was developed for potential clinical use. Conclusion: The RFS survival algorithms provide non-parametric alternatives to other regression models to be of clinical use for estimating the survival probability of severe trauma patients. [ABSTRACT FROM AUTHOR]

Introduction: The association between elevated lactate levels and the development of disseminated intravascular coagulation (DIC) in patients with severe trauma remains unclear. Hence, this study aimed to explore the association between lactate and the development of DIC in patients with severe trauma. Methods: This prospective cohort study was conducted on consecutive patients with severe trauma who were hospitalized in the intensive care unit from January 2020 to January 2023. The primary outcome measured was the occurrence of DIC in patients in the emergency department or posthospitalization. Logistic regression analysis evaluating the risk values for lactate and DIC, the receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) examinations studying the predictive efficiency of lactate for DIC. The Kaplan–Meier survival curve was used to assess patient survival. Sensitivity robustness analysis included modified Poisson regression, E -value, subgroup analysis, and numerical variable transformation analysis. Results: Logistic regression analysis corrected for confounding factors showed that lactate was a risk factor for DIC in patients with severe trauma (adjusted odds ratio [OR]: 1.374, 95% confidence interval [CI]: 1.206–1.566). Lactate predicted DIC risk with a 0.8513 area under the ROC curve (95% CI: 0.7827–0.9199), 4.8 cutoff value, 0.8333 sensitivity, and 0.8014 specificity. DCA showed the correlation between lactate and DIC. The mortality rate of patients with a high risk of DIC was significantly higher than that of patients with a low risk (log-rank test, P < 0.001). The modified Poisson regression showed that lactate was a risk factor for DIC (risk ratio: 1.188, 95% CI: 1.140–1.237). E -value was 1.645, and the lower limit of 95% CI was 1.495. The logistic regression analysis after subgroup analysis and transformation of numerical variables showed that lactate remained a risk factor for DIC. Conclusions: Elevated lactate is closely associated with the occurrence of DIC in patients with severe trauma. Lactate seems to be a good predictive factor for DIC manifestation in patients with severe trauma. [ABSTRACT FROM AUTHOR]

AIM: To evaluate the effectiveness of heparin-binding protein (HBP) in combination with organ function indicators for early diagnosis and prognosis prediction in patients with severe trauma complicated with sepsis. METHODS: A retrospective analysis was conducted on 184 patients with multiple injuries who were admitted to the Emergency Medicine Department of the Second Affiliated Hospital of Zhejiang University Medical College between January 2019 and September 2020 and underwent HBP testing. Patients were classified according to the SEPSIS 3. 0 diagnostic criteria into a sepsis group (n=89) and a non-sepsis group (n=95). Clinical outcomes were tracked, dividing patients into a deceased group (n=43) and a survival group (n=141). HBP levels were continuously measured, and the peak values of the two groups were compared to assess the efficacy of diagnosing sepsis. Further analysis on the correlation of HBP peak value median with clinical prognosis was conducted. The effectiveness of HBP alone and in combination with total bilirubin (TBil) and white blood cell (WBC) count in prognosis assessment was evaluated. RESULTS: (1) No significant difference was found in the peak level of HBP between the sepsis group (n=89) and the non-sepsis group (n=95) (71. 7± 68. 6 vs 52. 5±56. 1, P=0. 051). (2) Among the 184 patients, the peak level of HBP was positively correlated with WBC count (r=0. 244, P<0. 01) and TBil levels (r=0. 241, P<0. 01). (3) The area under curve (AUC) for independent diagnosis of sepsis using TBil levels, WBC count, and PCT levels were 0. 618, 0.631, and 0. 718, respectively, and the combined AUC was 0. 684, with a diagnostic sensitivity of 60. 7% and specificity of 71. 6% (P<0. 05). (4) Prognostic analysis of mortality showed that patients in the high HBP level group had a significantly higher mortality rate than those in the low-level group (30. 4% vs 16. 3%, P<0. 05). The WBC count was also significantly higher in the deceased group than in the survival group (17. 5±6. 9 vs 12. 8±4. 7, P<0. 01), especially in those with sepsis (P<0. 01). The AUCs for predicting sepsis mortality prognosis using HBP peak level, TBil levels, WBC count, SOFA score, and APACHE-II score were 0. 618, 0. 603, 0. 719, 0. 823, and 0. 811, respectively. The combined AUC of HBP with TBil and WBC for assessing sepsis prognosis was 0. 750, with a sensitivity of 74. 4% and specificity of 74. 5%, showing statistically significant differences (P<0. 05). (5) The combined assessment of these three indicators showed no statistically significant difference from artificial scoring systems in predicting sepsis prognosis (P>0. 05). CONCLUSION: The combination of HBP, TBil, and WBC is highly effective in predicting the risk of sepsis in patients with multiple injuries and has significant clinical value in predicting the mortality risk of trauma patients with sepsis. [ABSTRACT FROM AUTHOR]

Objective: To observe the application effect of damage control orthopaedics (DCO) combined with multidisciplinary team collaboration (MDT) trauma first aid mode in the treatment of severe traumatic fracture with massive bleeding. Methods: A total of 108 patients with severe traumatic fracture and massive bleeding who were admitted to the hospital from January to September 2023 were selected. They were divided into an observation group and a control group using the random number table method. The control group was given conventional treatment, and the observation group was given DCO combined with MDT trauma first aid mode. The preoperative injury severity score (ISS), treatment outcomes, perioperative heart rate (HR), systolic blood pressure, 24-hour urine volume, coagulation function [prothrombin time (PT) and activated partial thromboplastin time (APTT)], and inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6)] were compared between the two groups. Postoperative fracture healing, the incidence rates of complications, and in-hospital mortality rates in both groups were recorded. Results: The shock control time, intraoperative blood loss and hospital stay of the observation group were less than those of the control group (P<0.05). Six hours after surgery, HR of both groups decreased, and HR of the observation group was lower than that of the control group (P<0.05). Six hours after surgery, systolic blood pressure and 24-hour urine volume of both groups increased. Systolic blood pressure and 24-hour urine volume of the observation group were higher than those of the control group (P<0.05). There was no significant difference in PT or APTT in the two groups before surgery and at 6 hours after surgery (P>0.05). Perioperative TNF-α, IL-1 and IL-6 levels showed significant differences in terms of inter-group effect, time effect and interaction effect (P<0.05). The levels of TNF-α, IL-1 and IL-6 in both groups on day 3 and day 7 after surgery were lower than preoperative levels, and the observation group were lower (P<0.05). Compared with the control group, the observation group had a lower in-hospital mortality rate and better fracture healing (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). Conclusion: DCO combined with MDT trauma first aid mode can reduce intraoperative blood loss, shock duration and hospital stay of patients with severe traumatic fracture and massive bleeding. At the same time, it helps to improve perioperative hemodynamics and inflammatory response, promote fracture healing, and reduce mortality. [ABSTRACT FROM AUTHOR]

Objective To investigate the role of ultrasound-guided volume resuscitation in the treatment of severe trauma. Methods Sixty patients with severe trauma requiring surgical intervention were included and randomly assigned into the ultrasound-guided volume resuscitation group （group U， n = 30） and the empirical treatment group （group C， n = 30） using the random number table method. All patients underwent general anesthesia induction， central venous catheterization and subsequent surgery. In group U， ultrasound examination was conducted for assessing the inferior vena cava （IVC）， aortic root peak velocity variation （ΔVpeak） and time integral variation of aortic root velocity （ΔVTI） upon arrival at the operating room， after general anesthesia induction， at the end of operation and upon resuscitation， respectively. Fluid resuscitation therapy in group U was guided based on these results. In group C， patients were subjected to fluid resuscitation based on heart rate （HR）， mean arterial pressure （MAP）， central venous pressure （CVP）， fluid load test and blood gas analysis results， etc. Radial artery blood samples were collected from all patients immediately upon arrival at the OR （T0）， at 1 h （T1）， 2 h （T2）， 4 h （T3）， 6 h （T4）， and 24 h （T5） post-arrival， and lactate levels along with other blood gas analysis results were recorded accordingly. Additionally， the total amount of crystalloids and colloids administered from 0-0， lactate levels in group U exhibited an increase at T1 and T2， and followed by a return to normal levels at T4. In group C， an elevation in lactate levels was demonstrated at T1~T3， which subsequently decreased to normal levels at T5. Patients in group U displayed lower lactate levels at both T2 and T3 than those in group C. Additionally， patients in group U exhibited reduced overall usage of norepinephrine and a shorter duration of elevated lactate levels. Moreover， patients in group U received a higher volume of crystalloid fluids during the initial hour （0-P < 0.05）. However， no statistically significant differences were observed in the operation time， anesthesia duration， postoperative recovery time， extubation time， length of hospital stay， intraoperative blood loss， transfusion volume， oxygenation index， urine output or duration of hypotension between two groups （all P > 0.05）. Conclusion Ultrasound-guided volume resuscitation can be safely employed in severe trauma patients， which can reduce the total amount of transfusion， decrease the total dosage of vasoactive medications， and shorten the duration of elevated lactate levels.

Abstract Background For trauma patients with subsequent immediate surgery, it is unclear which surgical disciplines are most commonly required for treatment, and whether and to what extend this might depend on or change with “hypotension on arrival”. It is also not known how frequently damage control protocols are used in daily practice and whether this might also be related to “hypotension on arrival”. Methods A retrospective analysis of trauma patients from a German level 1 trauma centre and subsequent “immediate surgery” between 01/2017 and 09/2022 was performed. Patients with systolic blood pressure > 90 mmHg (group 1, no-shock) and thoracic surgery > vascular surgery > neurosurgery). Therefore, surgeons from these specialties must be available without delay to provide optimal trauma care.

Purpose: Scores are widely used for the assessment of injury severity and therapy guidance in severely injured patients. They differ vastly regarding complexity, applicability, and prognostic accuracy. The objective of this study was to compare well-established with more recently developed trauma scores as well as intensive care unit (ICU) scores. Methods: Retrospective analysis of severely injured patients treated at a level I trauma centre from 2010 to 2015. Inclusion criteria: Age ≥ 18 years, Injury Severity Score ≥ 16 and ICU treatment. Primary endpoint was in-hospital mortality. Several scores (ISS, APACHE II, RTS, Marshall Score, SOFA, NISS, RISC II, EAC and PTGS) were assessed to determine their predictive quality for mortality. Statistical analysis included correlation analysis and receiver operating characteristic (ROC). Results: 444 patients were included. 71.8% were males, mean age was 51 ± 20.26 years. 97.4% sustained a blunt trauma. The area under the ROC curve (AUROC) revealed RISC II (0.92) as strongest predictor regarding mortality, followed by APACHE II (0.81), Marshall score (0.69), SOFA (0.70), RTS (0.66), NISS (0.62), PTGS (0.61) and EAC (0.60). ISS did not reach statistical significance. Conclusions: RISC II provided the strongest predictive capability for mortality. In comparison, more simple scores focusing on injury pattern (ISS, NISS), physiological abnormalities (RTS, EAC), or a combination of both (PTGS) only provided inferior mortality prediction. Established ICU scores like APACHE II, SOFA and Marshall score were proven to be helpful tools in severely injured trauma patients. [ABSTRACT FROM AUTHOR]

Objective: To explore influencing factors of poor prognosis in patients with severe trauma, and to analyze distribution characteristics of adverse prognostic factors in patients with different early peripheral blood lymphocyte levels based on potential categories. Methods: A total of 174 patients with severe trauma treated in Mianyang Central Hospital from September 2020 to September 2022 were selected. According to condition of massive blood transfusion or death within 24 hours after admission, patients were divided into: good prognosis group (n=136) and poor prognosis group (n=38). Clinical data of two groups were compared, multivariate Logistic regression analysis was used to analyze factors affecting poor prognosis, and cluster analysis and potential classification were used to analyze distribution characteristics of adverse prognostic factors in patients with different early peripheral blood lymphocyte levels. Results: Multivariate Logistic regression analysis results showed decrease of Glasgow coma scale (GCS), prolongation of activated partial thromboplastin time (APTT), increase of D-dimer (D-D), decrease of fibrinogen (Fib), increase of fibrinogen degradation products (FDP), increase of neutrophil/lymphocyte ratio (NLR) and decrease of lymphocyte level were factors influencing poor prognosis (P<0.05). Cluster analysis results showed that risk of poor prognosis was obviously clustered, and patients could be divided into poor prognosis high risk group (lymphocyte level≤0.90x109 L-1, n=72) and low risk group (lymphocyte level>0.90x109 L-1, n=102). Incidence of poor prognosis in high risk group [33.33%(24/72) ] was significantly higher than that in low risk group [13.73% (14/102)] (P<0.05). Potential category analysis results showed that there were three potential category distribution patterns in poor prognosis high risk group and low risk group. Proportion of "unelevated distribution of D-D in patients with low GCS score" in high risk group was significantly higher than that in low risk group, and proportion of "distribution of less risk factors" in high risk group was significantly lower than that in low risk group (P<0.05). There was no significant difference in proportion of elevated D-D distribution in patients with low GCS score between two groups (P>0.05). Conclusion:Decrease of GCS score, prolongation of APTT and increase of D-D are all associated with poor prognosis in patients with severe trauma. Patients with lymphocyte level ≤0.90x109 L-1 have a higher risk of poor prognosis, and main influencing factors are "non-elevated distribution of D-D in patients with low GCS score". [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to find the factors that were associated with tracheostomy procedures in ventilated pediatric trauma patients. Methods: The Trauma Quality Improvement Program (TQIP) database of the calendar year 2017 through 2019 was accessed for the study. All patients <18 years old and who were on mechanical ventilation for more than 96 hours were included in the study. Multiple logistic regression analysis was performed to find the factors that were associated with a tracheostomy. Results: Out of 2653 patients, 1907 (71.88%) patients underwent tracheostomy. The patients who underwent tracheostomy had a lower median [IQR] of Glasgow Coma Scale (GCS) (3 [3-8] vs 5 [3-10], P <.001) and had a higher proportion of severe spine injury (On Abbreviated Injury Scale [AIS]≥3) (11.6% vs 8.8%, P =.044) when compared with patients who did not have tracheostomy. Lower GCS scores and severe spine injury were associated with higher odds of tracheostomy, with all P values <.05. Higher proportion of tracheostomy procedures were performed at level I pediatric trauma centers as compared to non-designated pediatric centers (odds ratio [95% CI]: 1.848 [1.524-2.242], P <.001). Conclusion: A lower GCS score, severe spine injury and highest level trauma centers were associated with a tracheostomy. [ABSTRACT FROM AUTHOR]

Objective To investigate the role of ultrasound-guided volume resuscitation in the treatment of severe trauma. Methods Sixty patients with severe trauma requiring surgical intervention were included and randomly assigned into the ultrasoundguided volume resuscitation group (group U，n = 30) and the empirical treatment group (group C，n = 30) using the random number table method. All patients underwent general anesthesia induction, central venous catheterization and subsequent surgery. In group U, ultrasound examination was conducted for assessing the inferior vena cava (IVC), aortic root peak velocity variation (ΔVpeak) and time integral variation of aortic root velocity (ΔVTI) upon arrival at the operating room, after general anesthesia induction, at the end of operation and upon resuscitation, respectively. Fluid resuscitation therapy in group U was guided based on these results. In group C, patients were subjected to fluid resuscitation based on heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), fluid load test and blood gas analysis results, etc. Radial artery blood samples were collected from all patients immediately upon arrival at the OR (T0), at 1 h (T1), 2 h (T2), 4 h (T3), 6 h (T4), and 24 h (T5) post-arrival, and lactate levels along with other blood gas analysis results were recorded accordingly. Additionally, the total amount of crystalloids and colloids administered from 0-<1 h, 1-<2 h, 2-<4 h, 4-6 h, and 0-6 h since arrival were documented. The operation time, anesthesia duration, postoperative recovery time, extubation time, blood loss volume, urine output, duration of hypotension, duration of elevated lactate levels, length of hospital stay, ICU transfer rate, 28-d mortality rate, and the total amount of norepinephrine use were recorded. Results Compared with T0, lactate levels in group U exhibited an increase at T1 and T2, and followed by a return to normal levels at T4. In group C, an elevation in lactate levels was demonstrated at T1~T3, which subsequently decreased to normal levels at T5. Patients in group U displayed lower lactate levels at both T2 and T3 than those in group C. Additionally, patients in group U exhibited reduced overall usage of norepinephrine and a shorter duration of elevated lactate levels. Moreover, patients in group U received a higher volume of crystalloid fluids during the initial hour (0-<1 h), and lesser amounts during 2-<4 h and 4-6 h as well as overall within 0-6 h, respectively. Furthermore, compared to the group C, there was less administration of colloid fluids during 2-<4 h and overall within 0-6 h in group U (all P < 0.05). However, no statistically significant differences were observed in the operation time, anesthesia duration, postoperative recovery time, extubation time, length of hospital stay, intraoperative blood loss, transfusion volume, oxygenation index, urine output or duration of hypotension between two groups (all P > 0.05). Conclusion Ultrasound-guided volume resuscitation can be safely employed in severe trauma patients, which can reduce the total amount of transfusion, decrease the total dosage of vasoactive medications, and shorten the duration of elevated lactate levels. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the effectiveness of an intensive care unit (ICU) round checklist, FAST HUGS BID (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, Ulcer prophylaxis, Glycemic control, Spontaneous breathing trial, Bowel regimen, Indwelling catheter removal, and De-escalation of antibiotics—abbreviated as FD hereafter), in improving clinical outcomes in patients with severe trauma. We included patients admitted to our trauma ICU from 2016 to 2020 and divided them into two groups: before (before-FD, 2016–2017) and after (after-FD, 2019–2020) implementation of the checklist. We compared patient characteristics and clinical outcomes, including ICU and hospital length of stay (LOS) and in-hospital mortality. Survival analysis was performed using Kaplan–Meier curves and multivariable logistic regression models; furthermore, multiple linear regression analysis was used to identify independent factors associated with ICU and hospital LOS. Compared with the before-FD group, the after-FD group had significantly lower in-hospital mortality and complication rates, shorter ICU and hospital LOS, and reduced duration of mechanical ventilation. Moreover, implementation of the checklist was a significant independent factor in reducing ICU and hospital LOS and in-hospital mortality. Implementation of the FD checklist is associated with decreased ICU and hospital LOS and in-hospital mortality. [ABSTRACT FROM AUTHOR]

Purpose: In the Netherlands, approximately 70% of severely injured patients (ISS ≥ 16) are transported directly to a Level I trauma center. This study compared the time needed to return to normal vital parameters and normal acid–base status in severely injured patients and some in-hospital processes in Level I versus Level II trauma centers. Methods: This retrospective cohort study included all adult severely injured patients or adult trauma patients admitted to the intensive care unit between 2015 and 2020 in a Dutch trauma region. The primary endpoint was time until normal vital parameters and acid–base status. Secondary endpoints were complication rate, hospital length of stay, emergency department length of stay, and time until a computed tomography (CT) scan. Results: A total of 2345 patients were included. Patients admitted to a Level I trauma center had a significantly higher rate of normalization of vital parameters over time (HR 1.51). There was no significant difference in normalization rate of the acid–base status over time (HR 1.10). In Level I trauma centers, time spent at the emergency department and time until the CT scan was significantly shorter (respectively, β − 38 min and β − 77 min), and the complication rate was significantly lower (OR 0.35). Conclusion: Severely injured patients admitted to a Level I trauma center require less time to normalize their vital functions. Level I centers are better equipped, resulting in better in-hospital processes with shorter time at the emergency department and shorter time until a CT scan. [ABSTRACT FROM AUTHOR]

Introduction: The rate of potentially preventable deaths (PPD) and preventable deaths (PD) can reach more than 20% of overall trauma mortality. Bleeding is the leading cause of preventable mortality. The aim of our study is to define the independent factors of preventable or potentially preventable mortality in our mature trauma system. Materials and methods: We conducted a single-center retrospective study in the Sainte Anne Military Teaching Hospital, Toulon, France, including all severe trauma patients admitted to our trauma center and discharged alive as well as all severe trauma patients who died with a death considered preventable or potentially preventable from January 2013 to December 2020. We matched the two groups using a propensity score and searched for independent factors using a generalized linear model. Results: 846 patients were included and analyzed. After matching, our cohort consisted of 245 patients in the survivor group and 49 patients in the preventable deaths group. Pre-hospital delays (73 min vs 54 min P = 0.003) as well as delays before incision in the operating room (80 min vs 52 min P < 0.001) were significantly longer in the PD group. These delays were independent factors of preventable mortality OR 10.35 (95% CI [3.44–31.11] P < 0.001) and OR 37.53 (95% CI [8.51–165.46] P < 0.001) as well as pelvic trauma OR 6.20 (95% CI [1.53–25.20] P = 0.011). Conclusion: Delays in pre-hospital care, delays in access to the operating room from arrival at the trauma center, and pelvic injuries are independent factors associated with an increased risk of preventable mortality in trauma. [ABSTRACT FROM AUTHOR]

Introduction: It is increasingly recognized that health-related quality of life (HRQoL) is a relevant outcome to study in populations comprising severely injured patients. Although some studies have readily demonstrated a compromised HRQoL in those patients, evidence regarding factors that predict HRQoL is scarce. This hinders attempts to prepare patient-specific plans that may aid in revalidation and improved life satisfaction. In this review, we present identified predictors of HRQoL in patients that have suffered severe trauma. Methods: The search strategy included a database search until the 1st of January 2022 in the Cochrane Library, EMBASE, PubMed, and Web of Science, and reference checking. Studies were eligible for inclusion when (HR)QoL was studied in patients with major, multiple, or severe injury and/or polytrauma, as defined by authors by means of an Injury Severity Score (ISS) cut-off value. The results will be discussed in a narrative manner. Results: A total of 1583 articles were reviewed. Of those, 90 were included and used for analysis. In total, 23 possible predictors were identified. The following parameters predicted reduced HRQoL in severely injured patients and came forward in at least more than three studies: higher age, female gender, lower extremity injuries, higher rate of injury severity, lower achieved educational level, presence of (pre-existing) comorbidities and mental illness, longer duration of hospital stay, and high level of disability. Conclusion: Age, gender, injured body region, and severity of injury were found to be good predictors of health-related quality of life in severely injured patients. A patient-centered approach, based on individual, demographic, and disease-specific predictors, is highly recommended. [ABSTRACT FROM AUTHOR]

To investigate the etiological characteristics of wound infection in severe trauma patients and logistic regression analysis of the influencing factors of infection. The 116 patients with severe trauma who were intervened in our hospital from 22 October 2017 to 9 September 2019 were selected as the subjects of this retrospective study and divided into a control group and an observation group according to whether they were infected or not, 58 cases each. Observe and compare the pathogenic characteristics (pathogen distribution and drug resistance) of the two groups of patients and logistic regression analysis of the influencing factors of infection. The gram‐positive bacteria in the observation group were mainly Staphylococcus aureus, accounting for 17.20%; the fungi were mainly Candida tropicalis, accounting for 17.20%; and the gram‐negative bacteria were mainly Acinetobacter baumannii, accounting for 20.39%; the control group was gram‐positive. The main bacteria are S. aureus, accounting for 8.60%; the fungi are mainly Candida albicans, accounting for 4.3%; and the gram‐negative bacteria, which are mainly Pseudomonas aeruginosa, accounting for 14.56%. Gram‐positive bacteria Enterococcus faecium, S. aureus, Enterococcus faecalis, Staphylococcus epidermidis. The highest drug resistance of other gram‐positive bacteria is penicillin and erythromycin at 85.00% and above. Fungi C. tropicalis, Candida parapsilosis, C. albicans, fluconazole and amphotericin B have the highest resistance to 80.00% and above. Gram‐negative bacteria A. baumannii, Ps. aeruginosa, Klebsiella pneumoniae, Escherichia coli, Proteus mirabilis, Enterobacter cloacae and other gram‐negative bacteria are the most resistant to ampicillin, and Piperacillin was 70.00% and above. The combined primary diseases of the two groups of patients, ventilator use ≧3 days, long‐term use of glucocorticoids, catheter use days ≧5 days, fever days ≧3 days and long‐term use of broad‐spectrum antimicrobial drugs, the difference is statistically significant academic significance (p < 0.05). Logistic analysis showed that combined with underlying diseases, fever days ≥3 days, long‐term use of glucocorticoids and catheter use days ≥5 days are the influencing factors for the occurrence of wound infections in patients with severe trauma. Trauma patients are prone to wound infections, and there are many influencing factors. Close observation of patients should be strengthened. Effective prevention and control measures should be taken for related influencing factors to reduce the incidence of infection. [ABSTRACT FROM AUTHOR]

Abstract Severe trauma is a critical aspect of medical practice, profoundly impacting patient care and outcomes. Over the past 20 years, advancements in trauma care concepts and the utilization of advanced technologies have led to substantial growth in severe trauma research, evidenced by a notable increase in research activity and subsequent publications. To understand the publication landscape in severe trauma, identify prevailing research trends, and highlight areas requiring further development for future insights, we conducted a bibliometric analysis. Our analysis indicates that there are 16,939 severe trauma‐related publications from the past 20 years, with a continuous increase in publication volume, particularly showing a rapid growth trend from 2018 to 2021. The United States leads in both volume and citation frequency. Moreover, we synthesized data on productive countries/regions and research institutions, showcasing extensive collaboration across diverse geographic locations and institutional affiliations. Substantial progress has been achieved in severe trauma research, particularly in clinical diagnosis, treatment, epidemiology, prevention, and pathogenesis. However, there is still a gap in adopting cutting‐edge interdisciplinary methodologies. This study provides a comprehensive overview of the current state of severe trauma research and suggests pathways for future advancement.

Objective To explore the value of thrombelastogram(TEG) on monitoring the coagulation function and guiding blood transfusion in admitted patients in early stage of severe trauma. Methods A total of 96 patients in early stage of severe trauma were selected from Ezhou Central Hospital, and were divided into two groups using a random number table method, with 48 patients in each group. The control group was guided by four routine coagulation tests for blood transfusion, while the observation group was guided by TEG.The detection rate of trauma-induced coagulopathy, detection duration, blood infusion volume within 24 hours of admission, coagulation index levels at different time points after blood transfusion, length of hospital stay, ICU stay, and mortality rate between the two groups were compared. Results The detection rate of trauma-induced coagulopathy was 72.9% in the control group and 93.8% in the observation group(P

Unstable U-shaped sacral fractures and vertical shear Tile C pelvic ring disruptions are characterized by rare lesions occurring in patients with severe trauma. Because the initial damage-control resuscitation primarily aims to stop life-threatening bleeding, emergency treatment often includes an anterior external pelvic fixator. Delayed surgery is mandatory to allow early mobilization, reduce mortality, and improve functional outcomes. Regarding U-shaped sacral fractures, although Roy-Camille type 1 U-shaped sacral fractures can be treated with iliosacral screws, types 2 (posteriorly displaced, equivalent to AO Spine C3) and 3 (anteriorly displaced, equivalent to AO Spine C3) fractures require spinopelvic triangular fixation. Besides, proper reduction of type 2 and some type 3 sacral fractures is mandatory to prevent wound complications. In patients with neurological deficits, the need for sacral laminectomy is left at the discretion of the surgeon, given the indirect decompression already obtained with fracture reduction. Tile C pelvic disruptions with posterior ring injury located lateral to the sacral foramen can be treated with either iliosacral screws or triangular spinopelvic fixation, combined with anterior pelvic fixation. Conversely, Tile C pelvic disruptions with posterior ring injury located at, or medial, to the sacral foramen (Denis zone II or III) induce vertical lumbosacral instability and thus require spinopelvic triangular fixation with anterior pelvic osteosynthesis. Although minimally invasive techniques have been developed, open surgeries are still required for inexperienced operators and in case of major displacement. The complication rate reaches approximately 33.33% of the cases, and complications include hardware malposition, wound infection or dehiscence, hardware prominence, and sometimes hardware failure.

Resumen: Antecedentes y objetivo: El aclaramiento renal aumentado o hiperfiltración glomerular (HFG) puede afectar significativamente a los resultados clínicos de los fármacos eliminados por vía renal al promover la exposición subterapéutica al fármaco. La agresión sufrida en los pacientes que presentan trauma grave supone un predisponente a manifestar HFG y la identificación de estos pacientes sigue siendo un desafío clínico. El objetivo principal de este estudio fue describir la prevalencia de HFG en una cohorte de pacientes críticos traumatizados en la primera semana de ingreso. Materiales y métodos: Estudio prospectivo observacional de una cohorte de pacientes adultos ingresados en la UCI de Anestesiología del Complejo Hospitalario Universitario de Albacete (España) tras sufrir un trauma grave o politraumatismo. Se calculó el aclaramiento de creatinina (ClCr) en muestra de recolección de orina 4 h a las 24, 72 y 168 h de ingreso aplicando la fórmula ClCr: [Diuresis en ml (orina/4 h) × Creatinina en orina (mg/dl)] ÷ [240 (minutos) × Creatinina en plasma (mg/dl)]. Un CrCl por encima de 130 ml/min fue considerado HFG. Los análisis se realizaron con el software estadístico R versión 4.0.4. Resultados: Se incluyeron 85 pacientes. La edad mediana de los pacientes fue de 51 años (RIQ 26); 68 pacientes fueron varones (78,82%). El 75,29% de los pacientes fueron politraumatizados; 61 pacientes (71,76%) presentaron HFG en algún momento de la determinación del ClCr. A las 24 h de ingreso el 56,34% de los pacientes presentaron HFG con ClCr medio de 195,8 ml/min, el 61,11% de los pacientes lo presentaban a las 72 h con ClCr medio de 186 ml/min y el 56,52% presentaban HFG a las 168 h de ingreso con ClCr medio de 207 ml/min. Se encontró una relación positiva importante (p = 0,07) entre la HFG manifestada a las 72 h y a las 168 h. Se observó relación estadísticamente significativa entre este fenómeno con edades más jóvenes, puntuaciones ISS más bajas y creatininas plasmáticas más bajas. Conclusiones: La HFG es una condición frecuente en los pacientes críticos ingresados por trauma grave. Recomendamos el uso del ClCr para evaluar la función renal y realizar ajustes posológicos. Se requieren estudios para comprender el impacto clínico de estos fenómenos sobre la eliminación de fármacos y poder establecer la dosificación ideal en tales casos. Abstract: Background and objective: Augmented renal clearance or glomerular hyperfiltration (GHF) can significantly affect the clinical outcomes of renally eliminated drugs by promoting subtherapeutic drug exposure. The aggression suffered in patients who suffer severe trauma is a predisposition to manifest GHF and the identification of these patients remains a clinical challenge. The main objective of this study was to describe the prevalence of GHF in a cohort of critically ill trauma patients. Materials and methods: Prospective observational study of a cohort of adult patients admitted after suffering severe trauma or polytrauma in the Anesthesiology ICU of the University Hospital of Albacete (Spain). Creatinine clearance (ClCr) was calculated in a 4-h urine collection sample at 24, 72 and 168 h after admission applying the formula: CrCl: [diuresis in ml (urine/4 h) × creatinine in urine (mg/dl)] ÷ [240 (min) × creatinine in plasma (mg/dl)]. A CrCl above 130 ml/min was considered GHF. The analyzes were performed with the statistical software R version 4.0.4. Results: Eighty-five patients were included. The median age of the patients was 51 years (IQR 26). Sixty-eight patients were male (78.82%). 75.29% of the patients were polytraumatized. Sixty-one patients (71.76%) presented GHF at some point in the CrCl determination. At 24 h of admission, 56.34% of the patients presented GHF with a mean CrCl of 195.8 ml/min, 61.11% of the patients presented it at 72 h with a mean CrCl of 186 ml/min and 56.52% presented GHF at 168 h of admission with a mean CrCl of 207 ml/min. A significant positive relationship (p = 0.07) was found between GHF manifested at 72 h and at 168 h. We observed a statistically significant relationship between this phenomenon with younger ages, lower ISS scores and lower plasma creatinines. Conclusions: GHF are a common condition in critically ill patients admitted for severe trauma. We recommend the use of CrCl to assess renal function and make dosage adjustments. Studies are required to understand the clinical impact of these phenomena on drug elimination and to be able to establish the ideal dosage in those cases.

Ulinastatin is mainly applied in the treatment of acute pancreatitis, but also in other common clinical critical illnesses such as shock, sepsis, evere pneumonia, cute respiratory distress syndrome, several acute poisoning, severe heat stroke, severe burns, severe trauma, and patients with sudden cardiac arrest for its roles in proteolytic enzymes inhibition and inflammatory responses regulation, which has been recommended by several guidelines/expert consensus on the diagnose and treatment of common clinical critical illness. However, there is currently a lack of consensus on the rational use of ulinastatin in terms of indications, usage, dosage, and others. Therefore, in order to promote the standardized application of ulinastatin, the expert group of expert consensus on the application of ulinastatin in common clinical critical illness summarized the mechanism, pharmacokinetics, indications of ulinastatin and its application methods in the treatment of common clinical critical illness, in order to provide a reference for the rational application of ulinastatin in clinical practice.

Biao Yang,1,&ast; Xiaoyong Wang,2,&ast; Zhaorui Liu,1,&ast; Zhengmao Lu,1 Guoen Fang,1 Xuchao Xue,1 Tianhang Luo1 1Department of General Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, People’s Republic of China; 2Department of Gastrointestinal Surgery, People’s Hospital of Haimen City, Nantong, Jiangsu Province, 226100, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Tianhang Luo, Department of General Surgery, Changhai Hospital, 168 Changhai Road, Yangpu District, Shanghai, 200433, People’s Republic of China, Tel +86-21-31161589, Fax +86-21-31161593, Email luotianhang78@126.comPurpose: This study aimed to investigate the changes in endothelial-related biomarkers and their relationship with the incidence and prognosis of patients with sepsis after severe trauma.Methods: A total of 37 severe trauma patients admitted to our hospital from Jan. to Dec. 2020 were enrolled in our research. All enrolled patients were divided into the sepsis and the non-sepsis groups. Endothelial progenitor cells (EPCs), circulating endothelial cells (CECs), and endothelial microparticles (EMPs) were detected on admission time; 24– 48 hours and 48– 72 hours after admission respectively. Demographic data, Acute Physiology, Chronic Health Evaluation (APACHE) II, and Sequential Organ Failure Assessment (SOFA) score were calculated every 24 h of admission to assess the severity of organ dysfunction. Receiver operating characteristic (ROC) curves were drawn to compare the areas under the curve (AUC) of endothelial-related biomarkers for the diagnosis of sepsis.Results: The incidence rate of sepsis was 45.95% in all patients. The SOFA score in the sepsis group was significantly higher than that in the non-sepsis group (2 points vs 0 points, P< 0.01). The number of EPCs, CECs, and EMPs all rose quickly in the early phase after trauma. The number of EPCs was similar in both groups, but the number of CECs and EMPs in the Sepsis Group was much higher than in the non-Sepsis Group (all P< 0.01). Logistic regression analysis showed that the occurrence of sepsis was closely related to the expression of 0– 24h CECs and 0– 24h EMPs. The AUC ROC for CECs in different time periods were 0.815, 0.877, and 0.882, respectively (all P< 0.001). The AUC ROC for EMPs in 0– 24h was 0.868 (P=0.005).Conclusion: The expression of EMPs was higher in early severe trauma, and high levels of EMPs were significantly higher in patients with early sepsis and poor prognosis.Keywords: sepsis, severe trauma, endothelial cell, biomarkers, prognosis

Unstable U-shaped sacral fractures and vertical shear Tile C pelvic ring disruptions are characterized by rare lesions occurring in patients with severe trauma. Because the initial damage-control resuscitation primarily aims to stop life-threatening bleeding, emergency treatment often includes an anterior external pelvic fixator. Delayed surgery is mandatory to allow early mobilization, reduce mortality, and improve functional outcomes. Regarding U-shaped sacral fractures, although Roy-Camille type 1 U-shaped sacral fractures can be treated with iliosacral screws, types 2 (posteriorly displaced, equivalent to AO Spine C3) and 3 (anteriorly displaced, equivalent to AO Spine C3) fractures require spinopelvic triangular fixation. Besides, proper reduction of type 2 and some type 3 sacral fractures is mandatory to prevent wound complications. In patients with neurological deficits, the need for sacral laminectomy is left at the discretion of the surgeon, given the indirect decompression already obtained with fracture reduction. Tile C pelvic disruptions with posterior ring injury located lateral to the sacral foramen can be treated with either iliosacral screws or triangular spinopelvic fixation, combined with anterior pelvic fixation. Conversely, Tile C pelvic disruptions with posterior ring injury located at, or medial, to the sacral foramen (Denis zone II or III) induce vertical lumbosacral instability and thus require spinopelvic triangular fixation with anterior pelvic osteosynthesis. Although minimally invasive techniques have been developed, open surgeries are still required for inexperienced operators and in case of major displacement. The complication rate reaches approximately 33.33% of the cases, and complications include hardware malposition, wound infection or dehiscence, hardware prominence, and sometimes hardware failure. [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.)

Copyright of Nefrologia is the property of Revista Nefrologia 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: Individual extracerebral organ dysfunction is common after severe traumatic brain injury (TBI) and impacts outcomes. However, multiorgan failure (MOF) has received less attention in patients with isolated TBI. Our objective was to analyze the risk factors associated with the development of MOF and its impact in clinical outcomes in patients with TBI. Methods: This was an observational, prospective, multicenter study using data from a nationwide registry that currently includes 52 intensive care units (ICUs) in Spain (RETRAUCI). Isolated significant TBI was defined as Abbreviated Injury Scale (AIS) ≥ 3 in the head area with no AIS ≥ 3 in any other anatomical area. Multiorgan failure was defined using the Sequential-related Organ Failure Assessment as the alteration of two or more organs with a score of ≥ 3. We analyzed the contribution of MOF to crude and adjusted mortality (age and AIS head) by using logistic regression analysis. A multiple logistic regression analysis was performed to analyze the risk factors associated with the development of MOF in patients with isolated TBI. Results: A total of 9790 patients with trauma were admitted to the participating ICUs. Of them, 2964 (30.2%) had AIS head ≥ 3 and no AIS ≥ 3 in any other anatomical area, and these patients constituted the study cohort. Mean age was 54.7 (19.5) years, 76% of patients were men, and ground-level falls were the main mechanism of injury (49.1%). In-hospital mortality was 22.2%. Up to 185 patients with TBI (6.2%) developed MOF during their ICU stay. Crude and adjusted (age and AIS head) mortality was higher in patients who developed MOF (odds ratio 6.28 [95% confidence interval 4.58–8.60] and odds ratio 5.20 [95% confidence interval 3.53–7.45]), respectively. The logistic regression analysis showed that age, hemodynamic instability, the need of packed red blood cells concentrates in the initial 24 h, the severity of brain injury, and the need for invasive neuromonitoring were significantly associated with MOF development. Conclusions: MOF occurred in 6.2% of patients with TBI admitted to the ICU and was associated with increased mortality. MOF was associated with age, hemodynamic instability, the need of packed red blood cells concentrates in the initial 24 h, the severity of brain injury, and the need for invasive neuromonitoring. [ABSTRACT FROM AUTHOR]

Mucormycosis is an opportunistic infection affecting mainly immunocompromised hosts. Infection in immunocompetent patients is rare, but may occur typically in trauma or burn victims. We report on a previously healthy young man suffering devastating trauma from an agricultural accident with the subsequent development of a multifocal mucormycosis. Diagnosis was achieved by cultures obtained from non-healing wounds, some of them even covered by a macroscopic mold formation. Specific treatment was initiated soon after the preliminary results indicated mucormycosis. Aggressive surgical therapy, with concomitant use of systemic posaconazole and topical amphotericin B in a combination treatment, led to the elimination of the fungal infection. The remaining deep tissue defects were consequently reconstructed by a muscle flap and skin graft autotransplantation with a good overall outcome, which would not have been possible without the complete remission of mucormycosis. This case study presents the successful use of a combination treatment with systemic posaconazole and topical amphotericin B and underlines the importance of timely and aggressive surgical therapy. [ABSTRACT FROM AUTHOR]

Abstract Background Veno-arterial carbon dioxide tension difference (ΔPCO2) and mixed venous oxygen saturation (SvO2) have been shown to be markers of the adequacy between cardiac output and metabolic needs in critical care patients. However, they have hardly been assessed in trauma patients. We hypothesized that femoral ΔPCO2 (ΔPCO2 fem) and SvO2 (SvO2 fem) could predict the need for red blood cell (RBC) transfusion following severe trauma. Methods We conducted a prospective and observational study in a French level I trauma center. Patients admitted to the trauma room following severe trauma with an Injury Severity Score (ISS) > 15, who had arterial and venous femoral catheters inserted were included. ΔPCO2 fem, SvO2 fem and arterial blood lactate were measured over the first 24 h of admission. Their abilities to predict the transfusion of at least one pack of RBC (pRBCH6) or hemostatic procedure during the first six hours of admission were assessed using receiver operating characteristics curve. Results 59 trauma patients were included in the study. Median ISS was 26 (22–32). 28 patients (47%) received at least one pRBCH6 and 21 patients (35,6%) had a hemostatic procedure performed during the first six hours of admission. At admission, ΔPCO2 fem was 9.1 ± 6.0 mmHg, SvO2 fem 61.5 ± 21.6% and blood lactate was 2.7 ± 1.9 mmol/l. ΔPCO2 fem was significantly higher (11.6 ± 7.1 mmHg vs. 6.8 ± 3.7 mmHg, P = 0.003) and SvO2 fem was significantly lower (50 ± 23 mmHg vs. 71.8 ± 14.1 mmHg, P

Abstract Background Fetal radiation exposure in pregnant women with trauma is a concern. The purpose of this study was to evaluate fetal radiation exposure with regard to the type of injury assessment performed. Methods It is a multicentre observational study. The cohort study included all pregnant women suspected of severe traumatic injury in the participating centres of a national trauma research network. The primary outcome was the cumulative radiation dose (mGy) received by the fetus with respect to the type of injury assessment initiated by the physician in charge of the pregnant patient. Secondary outcomes were maternal and fetal morbi-mortality, the incidence of haemorrhagic shock and the physicians’ imaging assessment with consideration of their medical specialty. Results Fifty-four pregnant women were admitted for potential major trauma between September 2011 and December 2019 in the 21 participating centres. The median gestational age was 22 weeks [12–30]. 78% of women (n = 42) underwent WBCT. The remaining patients underwent radiographs, ultrasound or selective CT scans based on clinical examination. The median fetal radiation doses were 38 mGy [23–63] and 0 mGy [0–1]. Maternal mortality (6%) was lower than fetal mortality (17%). Two women (out of 3 maternal deaths) and 7 fetuses (out of 9 fetal deaths) died within the first 24 h following trauma. Conclusions Immediate WBCT for initial injury assessment in pregnant women with trauma was associated with a fetal radiation dose below the 100 mGy threshold. Among the selected population with either a stable status with a moderate and nonthreatening injury pattern or isolated penetrating trauma, a selective strategy seemed safe in experienced centres.

Introduction: Massive hemorrhage (MH) is the second determinant of initial mortality in trauma patients. Its treatment requires aggressive resuscitation with blood or its components. New therapeutic schemes have been postulated, within which massive transfusion (MT) stands out. To analyze the initial experience with the application of the TM protocol in adult trauma patients admitted to the Emergency Department of the Hospital de Clínicas "Dr Manuel Quintela." Materials and methods: A retrospective, observational, and descriptive study was carried out at the Hospital de Clínicas in the period from 1st February 2018 to 2020. Inclusion and exclusion criteria were established. Results: If we only include patients who suffered some type of trauma, the percentage of correct activation rose to 81.6% of the cases. When evaluating the mortality associated with the use of the protocol, it was shown to be significantly lower than in those in which the protocol was used without a clear indication, with a calculated p-value of 0.009. This reflects that there is an association between the need for MT and death. An association was demonstrated between the value of the Assessment of Blood Consumption (ABC) score and death (p = 0.013). Conclusion: Decreases morbidity and mortality in patients who are candidates for MT. Organizes the work group, assigning roles and establishing therapies. Appropriate the rational use of blood components, a finite and scarce good in the world such as blood donation. [ABSTRACT FROM AUTHOR]

Purpose: The mitochondrial DNA (mtDNA) activated cyclic guanosine monophosphate–adenosine monophosphate synthase—stimulator of interferon genes (cGAS-STING) signaling pathway is a key player in mediating immune responses in autoimmune disorders and cancer. However, its role in severe trauma associated fracture healing is unknown. This study investigated if the cGAS-STING signaling pathway contributes to delayed bone healing in polytrauma (PT) fractures. Methods: For preliminary analyses, therapeutic dosage of RU.521 (cGAS inhibitor) (n = 2) was determined in C57BL/6 J mice by mass spectrometry, and IFNβ expression levels in serum and bronchioalveolar fluid (BALF) at 6 and 24 h (h) in RU.521/vehicle + mtDNA injected mice (n = 3/treatment and time point) was measured by ELISA. In the main study, plasma mtDNA was quantified by qPCR in a clinically relevant delayed fracture healing PT rat model with burn injury, blunt trauma, and a femoral fracture at 3 h post-trauma (hpt). Next, PT rats received either RU.521 (12 mg/kg in povidone; n = 8) or vehicle (povidone only; n = 5) immediately after injury and were followed up for 5 weeks post-trauma to assess bone regeneration by radiography and histology. Results: IFNβ levels were significantly decreased only at 24 h in BALF of RU.521 treated mice. At 3hpt mtDNA was significantly elevated in PT rats compared to rats without injury. When treated with RU.521, PT rats showed improvement in bone healing compared to vehicle control PT rats. Conclusions: These data reveal that the cGAS-STING signaling pathway influences trauma-induced delayed bone healing. However, further evaluation of this pathway at the cellular and molecular levels to augment PT associated detrimental effects is needed. [ABSTRACT FROM AUTHOR]

Objective To explore the present situation of nurses’ skills in pre-hospital treatment of severe trauma in Yunnan Province, and to provide reference for the construction of trauma centers at all levels in Yunnan province and the training of pre-hospital first aid skills of nurses. Methods Nine experts from the Yunnan Trauma Center Construction Expert Committee were interviewed in a semi-structured way, and the data were processed and analyzed by Giorgi phenomenological analysis. Results Four themes were extracted: Nurses were indispensable to the pre-hospital treatment team. Nurses were found with low level of pre-hospital treatment skills and unclear responsibilities; Give the poor emergency response capability, it was urgent to standardize the treatment process. It was an urgent to establish scientific, objective and quantitative evaluation standard to improve nurses' pre-hospital treatment ability. Conclusion The pre-hospital first aid ability of nurses in Yunnan province is at a low level, and there is a lack of objective evaluation criteria. It is necessary to strengthen the training of nurses' pre-hospital treatment skills, clarify their treatment responsibilities, and construct the evaluation index of nurses' pre-hospital treatment skills for severe trauma, so as to provide scientific and objective reference for standardizing the pre-hospital treatment process and nurse training. (目的 探究云南省护士严重创伤院前救治技能现状, 为云南省各级创伤中心的建设和护士院前救治技能培训提供参考。方法 对云南省创伤中心建设工作专家委员会的9名专家进行半结构式深入访谈, 运用Giorgi现象学分析法进行资料处理与分析。结果 提炼出4个主题: 护理人员是院前救治团队中不可或缺的团队成员; 护士院前救治技能水平低, 岗位职责不明确; 应急能力弱, 规范救治流程迫在眉睫; 建立科学、客观、量化的评估标准是提高护士救治能力的迫切需求。结论 云南省护士整体院前救治能力弱, 缺乏客观评估标准, 必须加强护士的院前救治技能培训、明确救治职责, 且有必要构建护士严重创伤院前创伤救治技能评估指标, 为规范护士院前救治流程和培训提供科学的、客观的参考依据。)

Background: Veno-arterial carbon dioxide tension difference (ΔPCO2) and mixed venous oxygen saturation (SvO2) have been shown to be markers of the adequacy between cardiac output and metabolic needs in critical care patients. However, they have hardly been assessed in trauma patients. We hypothesized that femoral ΔPCO2 (ΔPCO2 fem) and SvO2 (SvO2 fem) could predict the need for red blood cell (RBC) transfusion following severe trauma. Methods: We conducted a prospective and observational study in a French level I trauma center. Patients admitted to the trauma room following severe trauma with an Injury Severity Score (ISS) > 15, who had arterial and venous femoral catheters inserted were included. ΔPCO2 fem, SvO2 fem and arterial blood lactate were measured over the first 24 h of admission. Their abilities to predict the transfusion of at least one pack of RBC (pRBCH6) or hemostatic procedure during the first six hours of admission were assessed using receiver operating characteristics curve. Results: 59 trauma patients were included in the study. Median ISS was 26 (22–32). 28 patients (47%) received at least one pRBCH6 and 21 patients (35,6%) had a hemostatic procedure performed during the first six hours of admission. At admission, ΔPCO2 fem was 9.1 ± 6.0 mmHg, SvO2 fem 61.5 ± 21.6% and blood lactate was 2.7 ± 1.9 mmol/l. ΔPCO2 fem was significantly higher (11.6 ± 7.1 mmHg vs. 6.8 ± 3.7 mmHg, P = 0.003) and SvO2 fem was significantly lower (50 ± 23 mmHg vs. 71.8 ± 14.1 mmHg, P < 0.001) in patients who were transfused than in those who were not transfused. Best thresholds to predict pRBCH6 were 8.1 mmHg for ΔPCO2 fem and 63% for SvO2 fem. Best thresholds to predict the need for a hemostatic procedure were 5.9 mmHg for ΔPCO2 fem and 63% for SvO2 fem. Blood lactate was not predictive of pRBCH6 or the need for a hemostatic procedure. Conclusion: In severe trauma patients, ΔPCO2 fem and SvO2 fem at admission were predictive for the need of RBC transfusion and hemostatic procedures during the first six hours of management while admission lactate was not. ΔPCO2 fem and SvO2 fem appear thus to be more sensitive to blood loss than blood lactate in trauma patients, which might be of importance to early assess the adequation of tissue blood flow with metabolic needs. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the effects of antithrombin III administration on the prognosis of severe trauma patients with disseminated intravascular coagulation (DIC). Methods: Medical records of a total of 4023 patients who were admitted to the intensive care unit (ICU) at the single regional trauma center from January 2016 to December 2020 were retrospectively analyzed. After the exclusion of young patients (<15 years old), mild trauma (ISS < 16), non DIC, etc., a total of 140 patients were included in the study. These patients were classified into antithrombin III-administered and non-antithrombin III-administered groups. Clinical data, including laboratory findings, trauma- and ICU-related severity scores, prognosis (including length of hospital stay), and need for organ support, were retrospectively collected. We evaluated the characteristics of the two groups, and compared and analyzed the vital signs, laboratory findings, prognosis, and clinical outcomes of each group. With this, we analyzed the effect of antithrombin III administration in severe trauma patients with DIC. Results: Of the 140 patients, 61 were treated with antithrombin III. No significant difference was observed in the baseline characteristics between the two groups for initial laboratory results, initial vital signs, or trauma-related severity scores. The improvement of the sequential organ failure assessment (SOFA) score, a prognostic marker, was significantly greater in the administered group (p = 0.009). Additionally, the antithrombin-administered group showed a larger improvement in the SOFA score than the non-administered group (p = 0.002). However, there was no statistical difference between the two groups for the frequency or duration of organ support treatments (renal replacement therapy, mechanical ventilation), mortality, or length of hospital stay. Conclusion: Antithrombin III administration in severe trauma patients with DIC improved SOFA scores and aided in multi-organ dysfunction recovery. Appropriate indications should be studied to maximize the drug's improvement effect in patients with severe trauma in the future. [ABSTRACT FROM AUTHOR]

Background: Major bleeding is the leading cause of preventable mortality among trauma patients. Several studies have recently shown that prehospital plasma transfusion improves the outcomes of severely injured patients. Although no consensus has been reached, prehospital transfusion is regularly considered to reduce avoidable mortality. The objective was to assess the status of prehospital transfusion practices in France. Study Design and Methods: A national survey among the 378 advance life support emergency teams (SMURs) in metropolitan France was conducted from December 15, 2020 to October 31, 2021. A questionnaire was distributed by e‐mail to the physicians in charge of SMURs. The questions addressed the transfusion modalities, labile blood products (LBPs) used, and limitations encountered in implementing transfusion. Results: The response rate was 48%, and 82% of the respondents performed prehospital transfusions. A designated pack was used by 44% of the respondents. The LBPs used were packed red blood cells (100%), of which 95% were group 0 RH:‐1, fresh frozen plasma (27%), lyophilized plasma (7%), and platelets (1%). The LBPs were transported in isothermal boxes (97%) without temperature monitoring in 52% of the cases. Nontransfused LBPs were discarded in 43% of the cases. Reported limitations in implementing transfusion were the delivery time (45%), loss of LBPs (32%), and lack of evidence (46%). Discussion: Prehospital transfusion was developed in France but access to plasma remains difficult. Protocols allowing the reutilization of LBPs and improving conservation could limit the waste of a rare resource. Implementing the use of lyophilized plasma could facilitate prehospital transfusion. Future studies will need to specify the role of each LBP in the prehospital setting. [ABSTRACT FROM AUTHOR]

Background: Fetal radiation exposure in pregnant women with trauma is a concern. The purpose of this study was to evaluate fetal radiation exposure with regard to the type of injury assessment performed. Methods: It is a multicentre observational study. The cohort study included all pregnant women suspected of severe traumatic injury in the participating centres of a national trauma research network. The primary outcome was the cumulative radiation dose (mGy) received by the fetus with respect to the type of injury assessment initiated by the physician in charge of the pregnant patient. Secondary outcomes were maternal and fetal morbi-mortality, the incidence of haemorrhagic shock and the physicians' imaging assessment with consideration of their medical specialty. Results: Fifty-four pregnant women were admitted for potential major trauma between September 2011 and December 2019 in the 21 participating centres. The median gestational age was 22 weeks [12–30]. 78% of women (n = 42) underwent WBCT. The remaining patients underwent radiographs, ultrasound or selective CT scans based on clinical examination. The median fetal radiation doses were 38 mGy [23–63] and 0 mGy [0–1]. Maternal mortality (6%) was lower than fetal mortality (17%). Two women (out of 3 maternal deaths) and 7 fetuses (out of 9 fetal deaths) died within the first 24 h following trauma. Conclusions: Immediate WBCT for initial injury assessment in pregnant women with trauma was associated with a fetal radiation dose below the 100 mGy threshold. Among the selected population with either a stable status with a moderate and nonthreatening injury pattern or isolated penetrating trauma, a selective strategy seemed safe in experienced centres. [ABSTRACT FROM AUTHOR]

Purpose: Understanding epidemiological patterns in patients with severe sports-related injuries between children and adults is important for injury prevention. We ought to describe the characteristics and outcomes of patients with severe sports-related injuries and compare the characteristics between children and adults. Methods: We conducted a retrospective analysis of the Japan Trauma Data Bank (JTDB). We included patients with sports-related injury and an ISS of at least 16, who were admitted between 2004 and 2018. We compared characteristics between children (< 18 years) and adults (≥ 18 years). We performed a multivariable logistic regression analysis to compare in-hospital mortality. Results: We identified 1369 eligible patients (children, n = 326; adults, n = 1043). The most common season was April–June and July–September in children (28.5% and 27.9%) and January–March in adults (42.1%). Injuries to the head/neck (58.9% vs. 40.8%, p < 0.001) and abdomen (16.0% vs. 8.3%, p < 0.001) were significantly more frequent in children than adults, while injuries to the thorax (8.0% vs. 27.2%, p < 0.001), pelvis/lower extremity (0.6% vs. 6.0%, p < 0.001), and spine (23.9% vs. 35.3%, p < 0.001) were less frequent in children. We did not observe a statistically significant difference in in-hospital mortality between children and adults. Conclusions: We conducted a comprehensive analysis of severe sports-related injuries using a nationwide trauma database and demonstrated different patterns of severe sports-related injuries in children and adults. [ABSTRACT FROM AUTHOR]

Objective To explore the related risk factors of death in patients with severe trauma, and to establish a preliminary early warning scoring system for the prognosis of severe trauma (hereinafter referred to as the prediction model), so as to provide convenience for clinicians to judge the prognosis of patients early, timely and accurately. Methods The clinical data of 307 patients with severe trauma treated in the Emergency Department of the First Affiliated Hospital of Army Medical University from January 2019 to June 2021 were collected and retrospectively analyzed. They were divided into survival group (n=262) and death group (n=45) according to the outcomes. The age, sex, comorbidity, injury mechanism, number of injury sites, vital signs at admission, results of blood routine test, blood biochemistry test and blood coagulation test, blood gas analysis, endotracheal intubation at admission, emergency operation, use of vasoactive drugs and Glasgow coma score (GCS), injury severity score (ISS), and new injury severity score (NISS) were compared between the 2 groups with univariate analysis. The statistically significant indexes in univariate analysis were included in multivariate logistic regression analysis, and the risk factors affecting the prognosis of the patients were screened, and the prediction model was established according to the assignment of regression coefficient β, and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of the prediction model for the prognosis of patients with severe trauma. Results There were differences in injury mechanism, number of injury sites, comorbidity, endotracheal intubation on admission and use of vasoactive drugs between the 2 groups. The age, serum sodium, serum creatinine (Scr), lactic acid, blood glucose, fibrin degradation products and D-dimer were higher, while the body temperature, blood potassium, activated partial thrombin time, oxygenation index and GCS were lower in the death group than the survival group. The results of multivariate logistic regression analysis showed that age (≥62.5 years), Scr (≥77.37 mmol/L), GCS (≤12.5), oxygenation index (≤253.5 mmHg) and body temperature (≤36.25 ℃) were independent risk factors for death in the patients with severe trauma (P < 0.05). The above 5 variables were scored to form the prediction model, which divided severe trauma patients into low-risk, medium-risk and high-risk, and the incidence of death was 2.2%, 28.2% and 74.4%, respectively. When the cut-off value of the prediction model was 15.5, the sensitivity was 86.7%, the specificity was 89.4%, and the Yoden index was 0.764. Conclusion The prediction model is composed of age, Scr, GCS, oxygenation index and body temperature. Its predictive effect is better than those of the 5 indicators alone, and has more advantages than ISS, NISS, acute physiology and chronic health evaluation Ⅱ, sequential organ failure assessment and modified early warning score. It is more helpful to evaluate the prognosis of patients with severe trauma quickly and accurately.

Abstract Background This study aimed to review the impact of quality control management on the treatment of severely injured patients. Methods A retrospective analysis was conducted on patients with severe injury (injury severity score [ISS] ≥ 16) between January 1, 2018 and February 1, 2020. The selected patients were stratified as follows. The patients who were admitted prior to the implementation of quality control management—from January 1 to December 31, 2018—were assigned to the PRE group; the POST group included patients who were admitted after the implementation—from February 1, 2019 to February 1, 2020. Quality control management was implemented from January 1, 2019 to January 31, 2019. Parameters were compared to account for differences in terms of demographics, surgical procedures, results of process quality, and 72-h mortality. Results This study included 599 patients (PRE group: 212 males and 86 females; POST group: 228 males and 73 females; P = 0.20). The extent of document completion was 97.3 and 100% in the PRE and POST groups, respectively (P

Abstract Purpose The mitochondrial DNA (mtDNA) activated cyclic guanosine monophosphate–adenosine monophosphate synthase—stimulator of interferon genes (cGAS‐STING) signaling pathway is a key player in mediating immune responses in autoimmune disorders and cancer. However, its role in severe trauma associated fracture healing is unknown. This study investigated if the cGAS‐STING signaling pathway contributes to delayed bone healing in polytrauma (PT) fractures. Methods For preliminary analyses, therapeutic dosage of RU.521 (cGAS inhibitor) (n = 2) was determined in C57BL/6 J mice by mass spectrometry, and IFNβ expression levels in serum and bronchioalveolar fluid (BALF) at 6 and 24 h (h) in RU.521/vehicle + mtDNA injected mice (n = 3/treatment and time point) was measured by ELISA. In the main study, plasma mtDNA was quantified by qPCR in a clinically relevant delayed fracture healing PT rat model with burn injury, blunt trauma, and a femoral fracture at 3 h post‐trauma (hpt). Next, PT rats received either RU.521 (12 mg/kg in povidone; n = 8) or vehicle (povidone only; n = 5) immediately after injury and were followed up for 5 weeks post‐trauma to assess bone regeneration by radiography and histology. Results IFNβ levels were significantly decreased only at 24 h in BALF of RU.521 treated mice. At 3hpt mtDNA was significantly elevated in PT rats compared to rats without injury. When treated with RU.521, PT rats showed improvement in bone healing compared to vehicle control PT rats. Conclusions These data reveal that the cGAS‐STING signaling pathway influences trauma‐induced delayed bone healing. However, further evaluation of this pathway at the cellular and molecular levels to augment PT associated detrimental effects is needed.

BackgroundHaemorrhagic shock is the leading cause of early preventable death in severe trauma. Delayed treatment is a recognized prognostic factor that can be prevented by efficient organization of care. This study aimed to develop and validate Red Flag, a binary alert identifying blunt trauma patients with high risk of severe haemorrhage (SH), to be used by the pre-hospital trauma team in order to trigger an adequate intra-hospital standardized haemorrhage control response: massive transfusion protocol and/or immediate haemostatic procedures.MethodsA multicentre retrospective study of prospectively collected data from a trauma registry (Traumabase®) was performed. SH was defined as: packed red blood cell (RBC) transfusion in the trauma room, or transfusion ≥ 4 RBC in the first 6 h, or lactate ≥ 5 mmol/L, or immediate haemostatic surgery, or interventional radiology and/or death of haemorrhagic shock. Pre-hospital characteristics were selected using a multiple logistic regression model in a derivation cohort to develop a Red Flag binary alert whose performances were confirmed in a validation cohort.ResultsAmong the 3675 patients of the derivation cohort, 672 (18%) had SH. The final prediction model included five pre-hospital variables: Shock Index ≥ 1, mean arterial blood pressure ≤ 70 mmHg, point of care haemoglobin ≤ 13 g/dl, unstable pelvis and pre-hospital intubation. The Red Flag alert was triggered by the presence of any combination of at least two criteria. Its predictive performances were sensitivity 75% (72-79%), specificity 79% (77-80%) and area under the receiver operating characteristic curve 0.83 (0.81-0.84) in the derivation cohort, and were not significantly different in the independent validation cohort of 2999 patients.ConclusionThe Red Flag alert developed and validated in this study has high performance to accurately predict or exclude SH.