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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Trampoline centre injuries in children and adolescents: a systematic review and meta-analysis.

Injury Prevention

No evidence-based review has compared injury risks sustained on trampolines at home and in trampoline centres.

To present pooled results for injury type, site and treatment from studies reporting injuries that occurred on trampolines at home and in trampoline centres.

Data were reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used to estimate effect.

There were 1 386 843 injuries (n=11 studies). There was an increased likelihood of musculoskeletal and/or orthopaedic injuries (OR 2.45, 95% CI 1.66 to 3.61, p<0.001), lower extremity injury (OR 2.81, 95% CI 1.99 to 3.97, p<0.001), sprains (OR 1.64, 95% CI 1.36 to 1.97, p<0.001) and a need for surgery (OR 1.89, 95% CI 1.37 to 2.60, p<0.001) at trampoline centres compared with home trampolines. Conversely, upper extremity injury (OR 0.49, 95% CI 0.25 to 0.95, p=0.03), concussion (OR 0.48, 95% CI 0.35 to 0.65, p<0.001) and lacerations (OR 0.46, 95% CI 0.35 to 0.59, p<0.001) were less likely to occur at trampoline centres than at home.

Children using trampoline centres are more likely to suffer severe trauma and require surgical intervention than children using home trampolines. Development and implementation of preventative strategies, public awareness, and mandatory safety standards are urgently required for trampoline centres.

Postconcussion discharge advice does not improve concussion knowledge in a community sample.

Injury Prevention

Poor concussion knowledge in the community has been linked to reduced injury identification. This study investigated if concussion knowledge could be improved by providing standard postinjury advice (written brochure).

This study was a prospective, controlled study, with random allocation of 199 Australian adults to receive either a concussion information (CI, n=101), or non-CI (n=98). All participants completed the Rosenbaum Concussion Knowledge and Attitudes Survey on three occasions: pre-education and posteducation, and 1 week later.

A 2 (condition) × 3 (occasion) mixed analysis of variance with concussion knowledge as the dependent variable did not find a statistically significant interaction (p>0.05). This result was unchanged: (1) with the covariate addition of background education and; (2) in a subgroup analysis (individuals with initially 'low' self-rated knowledge). Some key misconceptions about concussion were identified.

The community knowledge of concussion was not significantly improved by the concussion advice. Since injury recognition relies ton an extent on community knowledge, the identified misconceptions should be addressed. This could occur via public health messaging. In clinical settings and for future research, the next steps should also include regular updating of concussion information to keep pace with advances in the field.

Innovations in suicide prevention research (INSPIRE): a protocol for a population-based case-control study.

Injury Prevention

Suicide deaths have been increasing for the past 20 years in the USA resulting in 45 979 deaths in 2020, a 29% increase since 1999. Lack of data linkage between entities with potential to implement large suicide prevention initiatives (health insurers, health institutions and corrections) is a barrier to developing an integrated framework for suicide prevention.

Data linkage between death records and several large administrative datasets to (1) estimate associations between risk factors and suicide outcomes, (2) develop predictive algorithms and (3) establish long-term data linkage workflow to ensure ongoing suicide surveillance.

We will combine six data sources from North Carolina, the 10th most populous state in the USA, from 2006 onward, including death certificate records, violent deaths reporting system, large private health insurance claims data, Medicaid claims data, University of North Carolina electronic health records and data on justice involved individuals released from incarceration. We will determine the incidence of death from suicide, suicide attempts and ideation in the four subpopulations to establish benchmarks. We will use a nested case-control design with incidence density-matched population-based controls to (1) identify short-term and long-term risk factors associated with suicide attempts and mortality and (2) develop machine learning-based predictive algorithms to identify individuals at risk of suicide deaths.

We will address gaps from prior studies by establishing an in-depth linked suicide surveillance system integrating multiple large, comprehensive databases that permit establishment of benchmarks, identification of predictors, evaluation of prevention efforts and establishment of long-term surveillance workflow protocols.

Trends in data quality and quality indicators 5 years after implementation of the Dutch Hip Fracture Audit.

Eur J Trauma Emerg Surg

The Dutch Hip Fracture Audit (DHFA), a nationwide hip fracture registry in the Netherlands, registers hip fracture patients and aims to improve quality of care since 2016. This study shows trends in the data quality during the first 5 years of data acquisition within the DHFA, as well as trends over time for designated quality indicators (QI).

All patients registered in the DHFA between 1-1-2016 and 31-12-2020 were included. Data quality-registry case coverage and data completeness-and baseline characteristics are reported. Five QI are analysed: Time to surgery < 48 h, assessment for osteoporosis, orthogeriatric co-management, registration of functional outcomes at three months, 30-day mortality. The independent association between QI results and report year was tested using mixed-effects logistic models and in the case of 30-day mortality adjusted for casemix.

In 2020, the case capture of the DHFA comprised 85% of the Dutch hip fracture patients, 66/68 hospitals participated. The average of missing clinical values was 7.5% in 2016 and 3.2% in 2020. The 3 months follow-up completeness was 36.2% (2016) and 46.8% (2020). The QI 'time to surgery' was consistently high, assessment for osteoporosis remained low, orthogeriatric co-management scores increased without significance, registration of functional outcomes improved significantly and 30-day mortality rates remained unchanged.

The DHFA has successfully been implemented in the past five years. Trends show improvement on data quality. Analysis of several QI indicate points of attention. Future perspectives include lowering the burden of registration, whilst improving (registration of) hip fracture patients outcomes.

Development and Validation of a Bayesian Belief Network Predicting the Probability of Blood Transfusion after Pediatric Injury.

J Trauma Acute Care

Early recognition and intervention of hemorrhage is associated with decreased morbidity in children. Triage models have been developed to aid in the recognition of hemorrhagic shock after injury but require complete data and have limited accuracy. To address these limitations, we developed a Bayesian belief network, a machine learning model that represents the joint probability distribution for a set of observed or unobserved independent variables, to predict blood transfusion after injury in children and adolescents.

Level III, Prognostic.

The final model included 14 predictor variables and had excellent discrimination and calibration. The model achieved an AUC of 0.92 using emergency department data. When used as a binary predictor at an optimal threshold probability, the model had similar sensitivity, specificity, accuracy, and MCC compared to SIPA when only age, systolic blood pressure, and heart rate were observed. With the addition of the Glasgow Coma Scale score, the model has a higher accuracy and MCC than SIPA and rSIG.

A Bayesian belief network predicted blood transfusion after injury in children and adolescents better than SIPA and rSIG. This probabilistic model may allow clinicians to stratify hemorrhagic control interventions based upon risk.

Noninvasive Assessment of Intracranial Pressure Using Subharmonic-Aided Pressure Estimation: An Experimental Study in Canines.

J Trauma Acute Care

Intracranial hypertension is a common clinicopathological syndrome in neurosurgery, and a timely understanding of the intracranial pressure (ICP) may help guide clinical treatment. We aimed to investigate the correlation between subharmonic contrast-enhanced ultrasound (SHCEUS) parameters and ICP in experimental canines.

N/A laboratory and animal research.

The subharmonic amplitude of the basal vein was negatively correlated with the ICP (r = -0.798), and the SHAPE gradient was positively correlated with the ICP (r = 0.628). According to the guidelines for ICP monitoring in patients with traumatic brain injury, we defined 20 mmHg, 25 mmHg and 30 mmHg as the cutoff ICP levels. The area under the receiver operating characteristic curve (AUC) of the basal venous subharmonic amplitude for diagnosing intracranial hypertension ≥20 mmHg, ≥25 mmHg, and ≥ 30 mmHg was 0.867 (95% CI: 0.750-0.943), 0.884 (95% CI: 0.770-0.954), and 0.875 (95% CI: 0.759-0.948), respectively. The AUC of the SHAPE gradient for diagnosing intracranial hypertension ≥20 mmHg, ≥25 mmHg, and ≥ 30 mmHg was 0.839 (95% CI: 0.716-0.924), 0.842 (95% CI: 0.720-0.926), and 0.794 (95% CI: 0.665-0.890), respectively.

SHCEUS parameters are correlated with ICP. The SHAPE technique can assist in evaluating ICP changes in canines, which provides a new idea and method for evaluating ICP.

Tandem use of Gastroesophageal Resuscitative Occlusion of the Aorta followed by REBOA in a Lethal Liver Laceration Model.

J Trauma Acute Care

Therapeutic.

Injury resulted in onset of class IV shock in all animals with a mean arterial blood pressure ((MAP) (standard deviation)) of 24.5 (4.11) mmHg at the start of intervention. Nine of ten controls died during the intervention period with a median (interquartile) survival time of 8.5 minutes (9.25 minutes). All animals receiving the intervention survived both the 60-minute intervention period demonstrating a significant survival improvement (p = 0.0007). Transition from GROA to REBOA was successful in all animals with a transition time ranging from 30 to 90 seconds. MAP significantly improved in animals receiving GROA to REBOA for the duration of intervention, regardless of the method of aortic occlusion, with a range of 70.9 mmHg (16.04 mmHg) to 101.1 mmHg (15.3 mmHg). Additional Hemodynamics, metrics of shock, and oxygenation remained stable during intervention.

Less invasive technologies such as GROA may present an opportunity to control NCTH more rapidly, with a subsequent transition to more advanced care such as REBOA.

KABUL AIRPORT SUICIDE BOMBING ATTACK: MASS CASUALTY MANAGEMENT AT THE EMERGENCY'NGO HOSPITAL.

J Trauma Acute Care

Terrorist attacks with large numbers of civilian victims are not uncommon in war-torn countries, and present a unique challenge for health care facilities with limited resources. However, these events are largely under-reported and little is known about how the mass casualty events (MCE) are handled outside of a military setting.

Retrospective analysis/incident management.

Within six hours 93 causalities presented at our hospital. Out of them, 36 severe injured were admitted. Mean age was 30.8 years (SD 10.1). The most common injury mechanism was shell fragments. The most common injury site was head (63%; 23/36), followed by limbs (55.5%; 20/36) and thoracoabdominal region (30.5%; 11/36). Combined injuries occurred in 38.9% of cases. Patients receiving surgery presented more combined injuries in comparison with patients receiving only medical treatment (47.1% vs 31.6%). Thoraco-abdomen (25.0% vs 15.4%) and/or extremity injury (42.9% vs 28.6%) were more prevalent in the surgical group. Thirty major surgical procedures were carried out on 17 patients in the nine hours following the first arrival. The rate of Intensive Care Unit/High Dependency Unit admission was 36.1% and the 30-day in-hospital mortality was 16.6% (6/36). All deaths were recorded in the first 24 hours and none of them received surgery.

A large number of wounded patients must be anticipated after suicide bombing attacks. The authors report the challenges faced and key aspects of their management of MCEs.

EAST Evidence-Based Statement on "Stand Your Ground" Laws.

J Trauma Acute Care

Trauma surgeons have a mission to prevent injury as well as to treat it, and must address the underlying social and structural factors that expose ...

Accessibility of Level III Trauma Centers for Underserved Populations: A Cross-sectional Study.

J Trauma Acute Care

By providing definitive care for many, and rapid assessment, resuscitation, stabilization, and transfer to Level I/II centers when needed, Level III trauma centers can augment capacity in high resource regions and extend the geographic reach to lower resource regions. We sought to (1) characterize populations served principally by Level III trauma centers (2) estimate differences in time to care by trauma center level, and (3) update national estimates of trauma center access.

Level VI, descriptive study.

An estimated 22.8% of the US population (N = 76,119,228) lacked access to any level of trauma center care within 60 minutes, and 8.8% (N = 29,422,523) were principally served by Level III centers. Black and American Indian/Alaska Native (AIAN) populations were disproportionately represented among those principally served by Level III centers (39.1% and 12.2%, respectively). White and AIAN populations were disproportionately represented among those without access to any trauma center care (26.2% and 40.8%, respectively). Time to Level III care was shorter than Level I/II for 27.9% of the population, with a mean reduction in time to care of 28.9 minutes (SD = 31.4).

Level III trauma centers are a potential source of trauma care for underserved populations. While Black and AIAN disproportionately rely on Level III centers for care, most with access to Level III centers also have access to Level I/II centers. The proportion of the US population with timely access to trauma care has not improved since 2010.

Plasma-based assays distinguish hyperfibrinolysis and shutdown subgroups in trauma-induced coagulopathy.

J Trauma Acute Care

Trauma patients with abnormal fibrinolysis have increased morbidity and mortality. Knowledge of mechanisms differentiating fibrinolytic phenotypes is important to optimize treatment. We hypothesized that subjects with abnormal fibrinolysis identified by whole blood viscoelastometry can also be distinguished by plasma thrombin generation, clot structure, fibrin formation, and plasmin generation measurements.

Platelet-poor plasma (PPP) from an observational cross-sectional trauma cohort with fibrinolysis shutdown (% lysis at 30 minutes [LY30] < 0.9, N = 11) or hyperfibrinolysis (LY30 > 3%, N = 9) defined by whole blood thromboelastography were studied. Non-injured control subjects provided comparative samples. Thrombin generation, fibrin structure and formation, and plasmin generation were measured by fluorescence, confocal microscopy, turbidity, and a fluorescence-calibrated plasmin assay, respectively, in the absence/presence of tissue factor or tissue plasminogen activator (tPA).

Whereas spontaneous thrombin generation was not detected in PPP from control subjects, PPP from hyperfibrinolysis or shutdown patients demonstrated spontaneous thrombin generation, and the lag time was shorter in hyperfibrinolysis versus shutdown. Addition of tissue factor masked this difference but revealed increased thrombin generation in hyperfibrinolysis samples. Compared to shutdown, hyperfibrinolysis PPP formed denser fibrin networks. In the absence of tPA, the fibrin formation rate was faster in shutdown than hyperfibrinolysis, but hyperfibrinolysis clots lysed spontaneously; these differences were masked by addition of tPA. TPA-stimulated plasmin generation was similar in hyperfibrinolysis and shutdown samples. Differences in LY30, fibrin structure, and lysis correlated with pH.

This exploratory study using PPP-based assays identified differences in thrombin generation, fibrin formation and structure, and lysis in hyperfibrinolysis and shutdown subgroups. These groups did not differ in their ability to promote tPA-triggered plasmin generation. The ability to characterize these activities in PPP facilitates studies to identify mechanisms that promote adverse outcomes in trauma.

Impact of severe necrotizing fasciitis on quality of life in the Netherlands.

Eur J Trauma Emerg Surg

Necrotizing fasciitis (NF) is a severe soft-tissue infection which can leave survivors with big and multiple disfiguring alterations to their bodies, which can negatively affect the lives of patients by causing functional limitations and altered self-perception. In this study we aim to find if NF affect (self-reported) quality of life (QoL) in patients surviving NF.

All patients with (histopathological or surgical confirmed) NF who were admitted to the intensive care unit for 24 h or more between January 2003 and December 2017 in five hospitals from the Nijmegen teaching region were included. Quality of life was measured with the SF-36 and WHOQol-BREF. These results were compared to reference populations from the Netherlands and a Australian reference population.

44 out of 60 patients (73.3%) who were contacted returned the surveys and were eligible for analysis. These patients showed lowered levels of quality of life on multiple domains of the SF-36: physical functioning, role limitations due to physical health, vitality and general health. The physical domain of the WHOQol-BREF showed also significant lowered levels of quality of life.

NF is a severe illness with a high morbidity and mortality rate. This study shows that patients who do survive NF have decreased (self-reported) quality of life in multiple domains with a focus on decreased physical functioning. During and after admission realistic expectations should be discussed and there should be more attention to signs of permanent disability. That way extra support by a physiotherapist or social worker can be provided.