The latest medical research on Trauma

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about trauma gathered by our medical AI research bot.

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Comparison of CATCH, PECARN, and CHALICE clinical decision rules in pediatric patients with mild head trauma.

Eur J Trauma Emerg Surg

The present study compares the most frequently used the CATCH, PECARN, and CHALICE clinical decision protocols with an aim to evaluate their effectiveness from the population perspective.

This study included all patients under 18 years of age presenting with blunt head trauma and a Glasgow Coma Scale score of 13 and higher for whom the attending physician decided to order head computed tomography scans, and the legal representative provided an informed consent for inclusion in the study. The PECARN, CATCH, and CHALICE clinical decision rules were applied to the participating patients, and the data for each of the three international clinical decision rules were recorded. These data were then compared to head CT results.

Based on the head CT positivity, the sensitivity and specificity values for the PECARN were 82.76 and 45.03%; the sensitivity and specificity values for CATCH were 89.29 and 47.44%, showing statistical significance in predicting CT positivity; the CHALICE did not show statistical significance in detecting a pathological CT result. In terms of evaluating the need for hospitalization, the PECARN had a sensitivity of 83.87% and a specificity of 45.12%; the CATCH had a sensitivity of 90% and a specificity of 47.54%, showing statistical significance while the CHALICE did not significantly detect the need for hospitalization.

The present study found that the PECARN and CATCH rules in children with minor head injury were significantly sensitive in detecting CT positivity and the need for hospitalization.

Risk and prognostic factors of replantation failure in patients with severe traumatic major limb mutilation.

Eur J Trauma Emerg Surg

Traumatic mutilation of major limbs can result in limb loss, motor disability, or death. Patients who had replantation failure needed to undergo additional surgeries (even amputation) and had a longer length of hospital stay. Here, we determined the risk and prognostic factors of replantation failure in patients with traumatic major limb mutilation.

This retrospective study included adult inpatients with severed traumatic major limb mutilation who underwent replantation from Suzhou Ruixing Medical Group from October 18, 2016 to July 31, 2020. Demographic, and clinical characteristics including traumatic conditions, laboratory findings, mangled extremity severity scores (MESS), treatments, and outcomes of the patients were collected. Data were used to analyze predictors and risk factors for replantation failure.

Among the 66 patients, 48 (72.7%) were males, the median age was 47.0 years old. Replantation failure occurred in 48 patients (72.7%). The area under the curve of the joint prediction of lactic acid on admission, 72-h cumulative fluid balance, and albumin level immediately postoperatively was 0.838 (95% confidence interval [CI], 0.722-0.954; P < 0.001) with a sensitivity of 89.7% and a specificity of 69.2%. Lower limb trauma (odds ratio [OR] 8.65, 95% CI 1.64-45.56, P = 0.011), mangled extremity severity scores (OR 2.24, 95% CI 1.25-4.01, P = 0.007), and first 72-h cumulative fluid balance > 4885.6 mL (OR 10.25, 95% CI 1.37-76.93, P = 0.024) were independent risk factors for replantation failure.

Lower limb trauma, mangled extremity severity scores, and cumulative water balance were associated with replantation failure, implying that fluid management is necessary for major limb salvage. More studies are needed to explore the predictive power of indicators related to tissue oxygenation and wound healing for replantation failure.

The ARISCAT score is a promising model to predict postoperative pulmonary complications after major emergency abdominal surgery: an external validation in a Danish cohort.

Eur J Trauma Emerg Surg

Postoperative pulmonary complications (PPCs) occur in up to 30% of patients undergoing surgery and are a significant contributor to the overall risk of surgery. A preoperative risk prediction tool for postoperative pulmonary complications could succour clinical identification of patients at increased risk and support clinical decision making. This original study aimed to externally validate a risk model for predicting postoperative pulmonary complications (ARISCAT) in a cohort of patients undergoing major emergency abdominal surgery at a Danish University Hospital.

ARISCAT was validated prospectively in a cohort of patients undergoing major emergency abdominal surgery between March 2017 and January 2019. Predicted PPCs by ARISCAT were compared with observed PPCs. ARISCAT was validated with calibration, discrimination and accuracy and in adherence to the TRIPOD statement.

The study included a total of 585 patients with a median age of 70 years. The majority of patients underwent emergency laparotomy without bowel resection. The predicted PPC frequency by ARISCAT was 24.9%, while the observed frequency of PPCs in the cohort was 36.1%. The slope of the calibration plot was 0.9546, the y axis interception was 0.1269 and the plot was well fitted to a linear slope. The Hosmer Lemeshow goodness-of-fit analysis showed good calibration (p > 0.25). ARISCAT showed good discrimination with AUC 0.83 (95% CI 0.79-0.86) on a receiver-operating characteristics curve and the accuracy was also good with a Brier score of 0.19.

ARISCAT was a promising tool to predict PPCs in a high-risk surgical population undergoing major emergency abdominal surgery.

BETABLOCKADE IN TBI: DOSE DEPENDENT REDUCTIONS IN BBB LEUKOCYTE MOBILIZATION AND PERMEABILITY IN VIVO.

J Trauma Acute Care

Traumatic brain injury (TBI) is accompanied by a hyperadrenergic catecholamine state that can cause penumbral neuroinflammation. Prospective human studies demonstrate improved TBI survival with beta blockade (bb), although mechanisms remain unclear. We hypothesized that deranged post-TBI penumbral blood brain barrier (BBB) leukocyte mobilization and permeability are improved by beta-blockade.

Level II Evidence (Therapeutic / care management).

Propranolol after TBI reduced both in vivo LEU rolling and BBB permeability in a dose-dependent fashion compared to no treatment (p < 0.001). Propranolol reduced cerebral edema (p < 0.001) and hastened recovery of lost body weight at 48 hours (p < 0.01). Compared to no treatment (14.9 + 0.2), 24-hour GNT scores were improved with 2 (15.8 + 0.2, p = 0.02) and 4 (16.1 + 0.1, p = 0.001) but not with 1 mg/kg propranolol.

Propranolol administration reduces post-TBI LEU mobilization and microvascular permeability in the murine penumbral neurovasculature and leads to reduced cerebral edema. This is associated with hastened recovery of post-TBI weight loss and neurologic function with bb treatment. Dose-dependent effects frame a mechanistic relationship between beta blockade and improved human outcomes after TBI.

It's Time to Look in the Mirror: Individual Surgeon Outcomes After Emergent Trauma Laparotomy.

J Trauma Acute Care

Multiple quality indicators are utilized by trauma programs to decrease variation and improve outcomes. However, little if any provider level outcomes related to surgical procedures are reviewed. Emergent trauma laparotomy (ETL) is arguably the signature case that trauma surgeons perform on a regular basis, but few data exist to facilitate benchmarking of individual surgeon outcomes. As part of our comprehensive performance improvement program, we examined outcomes by surgeon for those who routinely perform ETL.

Level III, Therapeutic/Care Management.

There were 242 ETL ((7-32 ETL)/surgeon) performed by 14 faculty. Resuscitative thoracotomy was performed in 7.0% (n = 17) prior to ETL. Six patients without resuscitative thoracotomy died intraoperatively and damage control laparotomy was performed on 31.9% (n = 72/226). Mortality was 4.0% (n = 9) at 24 hours and 7.1% (n = 16) overall. Median ISS (p = 0.21), NISS (p = 0.21), and time in ED were similar overall among surgeons (p = 0.15) while operative time varied significantly (40-469 minutes; p = 0.005). There were significant differences between rates of individual surgeon's mortality (Range (Hospital Mortality): 0-25%) and damage control laparotomy (Range: 14-63%) in ETL.

Significant differences exist in outcomes by surgeon after ETL. Benchmarking surgeon level performance is a necessary natural progression of quality assurance programs for individual trauma centers. Additional data from multiple centers will be vital to allow for development of more granular quality metrics to foster introspective case review and quality improvement.

DIRECT TO OR RESUSCITATION OF ABDOMINAL TRAUMA: AN NTDB PROPENSITY MATCHED OUTCOMES STUDY.

J Trauma Acute Care

Direct to operating room resuscitation (DOR) is employed by some trauma centers for severely injured trauma patients as an approach to minimize time to hemorrhage control. It is unknown whether this strategy results in favorable outcomes. We hypothesized that utilization of an emergency department operating room (EDOR) for resuscitation of patients with abdominal trauma at an urban Level I trauma center would be associated with decreased time to laparotomy and improved outcomes.

Therapeutic Level IV.

240 patients were included (120 institutional, 120 national). Both samples were well-balanced and 83.3% sustained penetrating trauma. 84.2% were young adults between the ages of 15 and 47, 91.7% were male, 47.5% Black/African American, with a median ISS of 14 (IQR: 8-29), GCS 15 (IQR: 13-15), 71.7% had an SBP of >90 mmHg, and had a shock index of 0.9 (IQR: 0.7-1.1) which did not differ between groups (p > 0.05). Treatment in the EDOR was associated with decreased time to incision (25.5 vs. 40 min; p ≤ 0.001), ICU LOS (1 vs. 3.1 days; p < 0.001), transfusion requirement within 24 hours (3 vs. 5.8 units packed red blood cells; p = 0.025), hospital LOS (5 vs 8.5 days, p = 0.014) and ventilator days (1 vs. 2 days; p ≤ 0.001). There were no significant differences in in-hospital mortality (22.5% vs 15.0%; p = 0.14) or outcome-free days (4.9 vs. 4.5 days, p = 0.55).

The use of an EDOR is associated with decreased time to hemorrhage control as evidenced by the decreased time to incision, blood transfusion requirement, ICU LOS, hospital LOS, and ventilator days. These findings support DOR for patients sustaining operative abdominal trauma.

Functional outcomes and perceived quality of life following fixation of femoral neck fractures in adults from 18 to 69 years using dynamic hip screw (DHS) and an additional anti-rotation screw- a retrospective analysis of 53 patients after a mean follow-up time of 4 years.

Eur J Trauma Emerg Surg

The purpose of the study was to explore the functional outcome after osteosynthesis with dynamic hip screw (DHS) for adults up to 69 years, and identify potential predictive indicators of either positive impact on quality of life or increase the incidence of complications.

Out of 85 patients 53 could be contacted, 36 were followed up clinically and radiologically, 17 patients could be interviewed by phone. All fractures have been treated by osteosynthesis with DHS and one additional anti-rotation screw. Functional outcome and quality of life were measured with use of Harris Hip Score (HHS) and Short Form 12 Health Survey (SF 12). The mean values were compared to two random sample t tests and ANOVA for independent random samples. The connection between an aim variable and selected variables of influence was examined by regression analysis.

The mean HHS showed good functional results with 88 points (median 95.6). Good or excellent results were achieved in 80.4% of cases. The current investigation also delivers promising results with regard to the complication rate: avascular femoral head necrosis (AVN) in 11.3% of cases (n = 6), 9.4% showed non-union (n = 5) and cut out (n = 3) occurred in 5.7%. A secondary conversion to hip arthroplasty (n = 7) had a strong negative impact on everyday life (HHS = 63.3 points, Physical Health Summary Score SF-12 = 34.9 points).

The results of this study are promising showing uncomplicated fracture healing in 84.9% of intracapsular femoral neck fractures and a low incidence of complications after osteosynthesis with DHS in patients aged up to 69 years. The quality of the fracture reduction achieved in the axial view and a small tip apex index after an osteosynthetically treated femoral neck fracture with DHS are significant predictive indicators for complications. Diabetes, age > 65 years, osteoporosis, ASA III may also be significant factors for worse results, but showed no statistical significance in our analysis.

Maximum movement and cumulative movement (travel) to inform our understanding of secondary spinal cord injury and its application to collar use in self-extrication.

Scandinavian Journal of

Motor vehicle collisions remain a common cause of spinal cord injury. Biomechanical studies of spinal movement often lack "real world" context and applicability. Additional data may enhance our understanding of the potential for secondary spinal cord injury. We propose the metric 'travel' (total movement) and suggest that our understanding of movement related risk of injury could be improved if travel was routinely reported. We report maximal movement and travel for collar application in vehicle and subsequent self-extrication.

Biomechanical data on application of cervical collar with the volunteer sat in a vehicle were collected using Inertial Measurement Units on 6 healthy volunteers. Maximal movement and travel are reported. These data and a re-analysis of previously published work is used to demonstrate the utility of travel and maximal movement in the context of self-extrication.

Data from a total of 60 in-vehicle collar applications across three female and three male volunteers was successfully collected for analysis. The mean age across participants was 50.3 years (range 28-68) and the BMI was 27.7 (range 21.5-34.6). The mean maximal anterior-posterior movement associated with collar application was 2.3 mm with a total AP travel of 4.9 mm. Travel (total movement) for in-car application of collar and self-extrication was 9.5 mm compared to 9.4 mm travel for self-extrication without a collar.

We have demonstrated the application of 'travel' in the context of self-extrication. Total travel is similar across self-extricating healthy volunteers with and without a collar. We suggest that where possible 'travel' is collected and reported in future biomechanical studies in this and related areas of research. It remains appropriate to apply a cervical collar to self-extricating casualties when the clinical target is that of movement minimisation.

Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest.

Scandinavian Journal of

A favorable neurological outcome is closely related to patient characteristics and total cardiopulmonary resuscitation (CPR) duration. The total CPR duration consists of pre-hospital and in-hospital durations. To date, consensus is lacking on the optimal total CPR duration. Therefore, this study aimed to determine the upper limit of total CPR duration, the optimal cut-off time at the pre-hospital level, and the time to switch from conventional CPR to alternative CPR such as extracorporeal CPR.

We conducted a retrospective observational study using prospective, multi-center registry of out-of-hospital cardiac arrest (OHCA) patients between October 2015 and June 2019. Emergency medical service-assessed adult patients (aged ≥ 18 years) with non-traumatic OHCA were included. The primary endpoint was a favorable neurological outcome at hospital discharge.

Among 7914 patients with OHCA, 577 had favorable neurological outcomes. The optimal cut-off for pre-hospital CPR duration in patients with OHCA was 12 min regardless of the initial rhythm. The optimal cut-offs for total CPR duration that transitioned from conventional CPR to an alternative CPR method were 25 and 21 min in patients with initial shockable and non-shockable rhythms, respectively. In the two groups, the upper limits of total CPR duration for achieving a probability of favorable neurological outcomes < 1% were 55-62 and 24-34 min, respectively, while those for a cumulative proportion of favorable neurological outcome > 99% were 43-53 and 45-71 min, respectively.

Herein, we identified the optimal cut-off time for transitioning from pre-hospital to in-hospital settings and from conventional CPR to alternative resuscitation. Although there is an upper limit of CPR duration, favorable neurological outcomes can be expected according to each patient's resuscitation-related factors, despite prolonged CPR duration.

Assessing spinal movement during four extrication methods: a biomechanical study using healthy volunteers.

Scandinavian Journal of

Motor vehicle collisions are a common cause of death and serious injury. Many casualties will remain in their vehicle following a collision. Trapped patients have more injuries and are more likely to die than their untrapped counterparts. Current extrication methods are time consuming and have a focus on movement minimisation and mitigation. The optimal extrication strategy and the effect this extrication method has on spinal movement is unknown. The aim of this study was to evaluate the movement at the cervical and lumbar spine for four commonly utilised extrication techniques.

Biomechanical data was collected using inertial Measurement Units on 6 healthy volunteers. The extrication types examined were: roof removal, b-post rip, rapid removal and self-extrication. Measurements were recorded at the cervical and lumbar spine, and in the anteroposterior (AP) and lateral (LAT) planes. Total movement (travel), maximal movement, mean, standard deviation and confidence intervals are reported for each extrication type.

Data from a total of 230 extrications were collected for analysis. The smallest maximal and total movement (travel) were seen when the volunteer self-extricated (AP max = 2.6 mm, travel 4.9 mm). The largest maximal movement and travel were seen in rapid extrication extricated (AP max = 6.21 mm, travel 20.51 mm). The differences between self-extrication and all other methods were significant (p < 0.001), small non-significant differences existed between roof removal, b-post rip and rapid removal. Self-extrication was significantly quicker than the other extrication methods (mean 6.4 s).

In healthy volunteers, self-extrication is associated with the smallest spinal movement and the fastest time to complete extrication. Rapid, B-post rip and roof off extrication types are all associated with similar movements and time to extrication in prepared vehicles.

Biomechanical comparison of acetabular fracture fixation with stand-alone THA or in combination with plating.

Eur J Trauma Emerg Surg

A common surgical treatment in anterior column acetabular fractures with preexisting osteoarthritis is THA, which is commonly combined with plate osteosynthesis. Implantation of a solitary revision cup cranially fixed to the os ilium is less common. The purpose of this study was to compare the stabilization of anterior column acetabular fractures fixed with a cranial socket revision cup with flange and iliac peg or with a suprapectineal plate osteosynthesis combined with an additional revision cup.

In 20 human hemipelves, an anterior column fracture was stabilized by either a cranial socket revision cup with integrated flange (CF = Cup with Flange) or by a suprapectineal plate combined with a revision cup (CP = Cup and Plate). Each specimen was loaded under a stepwise increasing dynamic load protocol. Initial construct stiffness, interfragmentary movements along the fracture line, as well as femoral head movement in relation to the acetabulum were analyzed.

Both groups showed comparable initial construct stiffness (CP: 3180 ± 1162 N/mm and CF: 3754 ± 668 N/mm; p = 0.158). At an applied load of 1400 N, interfragmentary movements at the acetabular (p = 0.139) and the supraacetabular region (p = 0.051) revealed comparable displacement for both groups and remained below 1 mm. Femoral head movement in relation to the acetabulum also remained below 1 mm for both test groups (p = 0.260).

From a biomechanical point of view, both surgical approaches showed comparable fracture reduction in terms of initial construct stiffness and interfragmentary movement. The potential benefit of the less-invasive cranial socket revision cup has to be further investigated in clinical studies.

Residential Out-of-Home Care Staff Perceptions of Implementing a Trauma-Informed Approach: The Sanctuary Model.

Journal of Child and Adolescent Trauma

The aim of this study was to explore and better understand the enablers and barriers of implementation and how these impact on the organisational s...