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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Interobserver agreement for the Chest Wall Injury Society taxonomy of rib fractures using CT images.

J Trauma Acute Care

In 2020, a universal nomenclature for rib fractures was proposed by the international Chest Wall Injury Society taxonomy collaboration. The purpose of this study is to validate this taxonomy. We hypothesized that there would be at least moderate agreement, regardless of the observers' background.

level IV, diagnostic test.

A total of 90 observers participated, with 76 (84%) complete responses. Strong agreement was found for the classification of fracture location (κ 0.83; 95% CI 0.69-0.97 and AC1 0.84; 95% CI 0.81-0.88), moderate for fracture type (κ 0.46; 95% CI 0.32-0.59 and AC1 0.50; 95% CI 0.45-0.55), and fair for rib fracture displacement (κ 0.38; 95% CI 0.21-0.54 and AC1 0.38; 95% CI 0.34-0.42).

Agreement on rib fracture location was strong and moderate for fracture type. Agreement on displacement was lower than expected.. Evaluating strategies such as comprehensive education, additional imaging techniques, or further specification of the definitions will be needed to increase agreement on the classification of rib fracture type and displacement as defined by the CWIS taxonomy.

Use of Whole Blood Deployment Programs for Mass Casualty Incidents: South Texas Experience in Regional Response and Preparedness.

J Trauma Acute Care

Firearm-related deaths have become the leading cause of death in adolescents and children. Since the Sutherland Springs, TX mass casualty incident (MCI), the Southwest Texas Regional Advisory Council (STRAC) for trauma instituted a prehospital whole blood (WB) program and blood deployment program for MCI's.

Level VII.

On May 24, 2022, 19 children and 2 adults were killed at an MCI in Uvalde, TX. The MCI WB deployment protocol was initiated, and South Texas Blood and Tissue Center (STBTC) prepared 15 units of low titer O positive whole blood (LTO + WB) and 10 units of Leukoreduced O- packed cells (LPC). The deployed blood arrived at Uvalde Memorial Hospital within 67 minutes. One of the pediatric patients sustained multiple gunshots to the chest and extremities. The child was hypotensive and received 2 units of LPC, one at the initial hospital, and another during transport. On arrival, the patient required two units of LTO + WB and underwent a successful hemorrhage control operation. The remaining blood was returned to STBTC for distribution.

Multiple studies have shown the association of early blood product resuscitation and improved mortality, with WB being the ideal resuscitative product for a many. The ongoing efforts in South Texas serve as a model for development of similar programs throughout the country to reduce preventable deaths. This event represents the first ever successful deployment of WB to the site of a mass casualty incident related to a school shooting in the modern era.

Relationship among Child Maltreatment, Parental Conflict, and Mental Health of Children during the COVID-19 Lockdown in China.

Journal of Child and Adolescent Trauma

Children are more likely to experience maltreatment and parental conflict in a pandemic context, which can exacerbate their vulnerability to psycho...

The uniportal VATS in the treatment of stage II pleural empyema: a safe and effective approach for adults and elderly patients-a single-center experience and literature review.

World J Emerg Surg

Pleural empyema (PE) is a frequent disease, associated with a high morbidity and mortality. Surgical approach is the standard of care for most patients with II-III stage PE. In the last years, the minimally invasive surgical revolution involved also thoracic surgery allowing the same outcomes in terms of safety and effectiveness combined to better pain management and early discharge. The aim of this study is to demonstrate through our experience on uniportal-video-assisted thoracoscopy (u-VATS) the effectiveness and safety of its approach in treatment of stage II PE. As secondary endpoint, we will evaluate the different pattern of indication of u-VATS in adult and elderly patients with literature review.

We retrospectively reviewed our prospectively collected database of u-VATS procedures from November 2018 to February 2022, in our regional referral center for Thoracic Surgery of Regione Molise General Surgery Unit of "A. Cardarelli" Hospital, in Campobasso, Molise, Italy.

A total of 29 patients underwent u-VATS for II stage PE. Fifteen (51.72%) patients were younger than 70 years old, identified as "adults," 14 (48.28%) patients were older than 70 years old, identified as "elderly." No mortality was found. Mean operative time was 104.68 ± 39.01 min in the total population. The elderly group showed a longer operative time (115 ± 53.15 min) (p = 0.369). Chest tube was removed earlier in adults than in elderly group (5.56 ± 2.06 vs. 10.14 ± 5.58 p = 0.038). The Length of Stay (LOS) was shorter in the adults group (6.44 ± 2.35 vs. 12.29 ± 6.96 p = 0.033). Patients evaluated through Instrumental Activities of Daily Living (IADL) scale returned to normal activities of daily living after surgery.

In addition, the u-VATS approach seems to be safe and effective ensuring a risk reduction of progression to stage III PE with a lower recurrence risk and septic complications also in elderly patients. Further comparative multicenter analysis are advocated to set the role of u-VATS approach in the treatment of PE in adults and elderly patients.

Making Meaning of Disaster Experience in Highly Trauma-exposed Survivors of the Oklahoma City Bombing.

Traumatology

Survivors of disasters can be expected to form meaningful perspectives on their experiences that shape their trajectories of recovery; thus, these ...

Long-term outcomes after using retrievable vena cava filters in major trauma patients with contraindications to prophylactic anticoagulation.

Eur J Trauma Emerg Surg

To investigate the long-term outcomes of using vena cava filters to prevent symptomatic pulmonary embolism (PE) in major trauma patients who have contraindications to prophylactic anticoagulation.

This was an a priori sub-study of a randomized controlled trial (RCT) involving long-term outcome data of 223 patients who were enrolled in Western Australia. State-wide clinical information system, radiology database and death registry were used to assess long-term outcomes, including incidences of venous thromboembolism, venous injury and mortality beyond day-90 follow-up.

The median follow-up time of 198 patients (89%) who survived beyond 90 days was 65 months (interquartile range 59-73). Ten patients (5.1%) died after day-90 follow-up; and four patients developed venous thromboembolism, including two with symptomatic PE, all allocated to the control group (0 vs 4%, p = 0.043). Inferior vena cava injuries were not recorded in any patients. The mean total hospitalization cost, including the costs of the filter and its insertion and removal, to prevent one short- or long-term symptomatic PE was A$284,820 (€193,678) when all enrolled patients were considered. The number of patients needed to treat (NNT = 5) and total hospitalization cost to prevent one symptomatic PE (A$1,205 or €820) were, however, substantially lower when the filter was used only for patients who could not be anticoagulated within seven days of injury.

Long-term complications related to retrievable filters were rare, and the cost of using filters to prevent symptomatic PE was acceptable when restricted to those who could not be anticoagulated within seven days of severe injury.

The impact of low-dose aspirin in the Brain Injury Guidelines on outcomes in traumatic brain injury: A retrospective cohort study.

J Trauma Acute Care

Current Brain Injury Guidelines (BIG) characterize patients with intracranial hemorrhage taking antiplatelet or anticoagulant agents as BIG 3 (the most severe category) regardless of trauma severity. This study assessed the risk of in-hospital mortality or need for neurosurgery in patients taking low-dose aspirin who otherwise would be classified as BIG 1.

Class III.

A total of 1,520 patients met inclusion criteria. Median initial GCS was 14 (IQR 12, 15), injury severity scale score was 17 (IQR 10, 25) and abbreviated injury scale subscore head and neck (AISHead) was 3 (IQR 3, 4). The rate of the primary outcome for BIG 1, BIG 1 on aspirin, BIG 2, and BIG 3 was 1%, 2.2%, 1%, and 27%, respectively; the difference between BIG 1 on aspirin and BIG 3 was significant (p < 0.001).

Patients taking low-dose aspirin with otherwise BIG 1-grade injuries experienced mortality and required neurosurgery significantly less often than other patients categorized as BIG 3. Inclusion of low-dose aspirin in the BIG criteria should be re-evaluated.

TIMING OF VTE CHEMOPROPHYLAXIS WITH MAJOR SURGERY OF LOWER-EXTREMITY LONG BONE FRACTURES.

J Trauma Acute Care

There is debate on the need to withhold chemical VTE prophylaxis in patients requiring major orthopedic surgery. We hypothesized that the incidence of clinically significant hemorrhage (CSH) does not differ by the timing of prophylaxis in such patients.

III, therapeutic/care management.

There were 786 patients, and 65 (8.3%) developed a CSH within 24 hours postoperatively. Nineteen percent of patients received chemoprophylaxis preoperatively without interruption for surgery, 13% had preoperative initiation but dose(s) were held for surgery, 21% initiated within 12 hours postoperatively, and 47% initiated more than 12 hours postoperatively. The incidence and adjusted odds of CSH were similar across groups (11.3%, 9.1%, 7.1%, and 7.3% respectively; overall p = 0.60). The incidence of VTE was 0.9% and similar across groups (p = 0.47); however, 6 of 7 VTEs occurred when chemoprophylaxis was delayed or interrupted.

This study suggests early and uninterrupted VTE chemoprophylaxis is safe and effective in patients undergoing major orthopedic surgery for long bone fractures.

The Beirut Ammonium Nitrate Blast: A Multi-center Study to Assess Injury Characteristics and Outcomes.

J Trauma Acute Care

Blasts incidents impose catastrophic aftermaths on populations regarding casualties, sustained injuries and devastated infrastructure. Lebanon witnessed one of the largest non-nuclear chemical explosions in modern history - the August 2020 Beirut Port Blast. This study assesses the mechanisms and characteristics of blast morbidity and mortality and examines severe injury predictors through the Injury Severity Score.

Prognostic and Epidemiologic, Level III.

791 patients were included with a mean age of 42 years. The mean distance from the blast was 2.4 km (SD 1.9 km), 3.1% of victims were in the Beirut Port itself. The predominant mechanism of injury was being struck by an object (falling/projectile) (293, 37.0%) and the most frequent site of injury was the head/face (209, 26.4%). Injury severity was low for 548 (71.2%) patients, moderate for 62 (8.1%), and severe/critical for 27 (3.5%). Twenty-one deaths were recorded (2.7%). Significant serious injury predictors (ISS > 15) were sustaining multiple injuries (OR = 2.62, p = 0.005), a fracture (OR = 5.78, p < 0.001), primary blast injuries, specifically a blast lung (OR = 18.82, p = 0.001), concussion (OR = 7.17, p < 0.001), and eye injury (OR = 8.51, p < 0.001), and secondary blast injuries, particularly penetrating injuries (OR = 9.93, p < 0.001) and traumatic amputations (OR = 13.49, p = 0.01). 25.0% were admitted to the hospital, with 4.6% requiring the ICU. At discharge, 25 patients (3.4%) had recorded neurologic disability.

Most injuries sustained by the blast victims were minor. Serious injuries were mostly linked to blast overpressure and projectile fragments. Understanding blast injuries characteristics, their severity and management are vital to informing emergency services, disaster management strategies and hospital preparedness and consequently improving patient outcomes.

Surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures following cardiopulmonary resuscitation: an international, retrospective matched case-control study (CWIS-CPR).

J Trauma Acute Care

The presence of six or more rib fractures or a displaced rib fracture due to cardiopulmonary resuscitation (CPR) has been associated with longer hospital and intensive care unit (ICU) length of stay. Evidence on the effect of surgical stabilization of rib fractures (SSRF) following CPR is limited. This study aimed to evaluate outcomes after SSRF versus nonoperative management in patients with multiple rib fractures after CPR.

therapeutic study, level III.

Thirty-nine operatively treated patient were matched to 66 nonoperatively managed controls with comparable CPR-related characteristics. Patients who underwent SSRF more often had displaced rib fractures (n = 28, 72% vs. n = 31, 47%; p = 0.015) and a higher median number of displaced ribs (2, P25-P75 0-3 vs. 0, P25-P75 0-3; p = 0.014). SSRF was performed at a median of 5 days (P25-P75 3-8) after CPR. In the nonoperative group, a rib fixation specialist was consulted in 14 patients (21%). The ICU LOS was longer in the SSRF group (13 days, P25-P75 9-23 vs. 9 days, P25-P75 5-15; p = 0.004). Mechanical ventilator-free days, hospital LOS, thoracic complications, and mortality were similar.

Despite matching, those who underwent SSRF over nonoperative management for multiple rib fractures following CPR had more severe consequential chest wall injury and a longer ICU LOS. A benefit of SSRF on in-hospital outcomes could not be demonstrated.A low consultation rate for rib fixation in the nonoperative group indicates that the consideration to perform SSRF in this population might be associated with other non-radiographic or injury-related variables.

Does a reduced secondary operation rate offset higher implant charges when utilizing suture button fixation for syndesmotic injuries?

J Orthop Trauma

To determine if a reduced secondary operation rate offsets higher implant charges when utilizing suture button fixation for syndesmotic injuries.

Economic Level III. See Instructions for Authors for a complete description of levels of evidence.

Patients undergoing screw fixation were older (48.8 vs 39.6 years, p<0.01), had more ground level fall mechanisms (59.3% vs 51.1%, p =0.026), and sustained fewer 44C type injuries (34.7% vs 56.8%, p=0.01). Implant removal occurred at a higher rate in the screw fixation group (17.6% vs 5.7%, p=0.005). Binomial logistic regression identified non-smoker status (B=1.03, p=0.04) and implant type (B=1.41, p=0.008) as factors associated with implant removal. Adjusting for age, the NNT with a suture button construct to prevent one implant removal operation was 9, with mean resulting additional implant charges of $9747 ($1083/case). Backwards calculations using data from previous large studies estimated secondary operation charges at approximately $14220, suggesting a potential 31.5% cost savings for suture buttons when considering reduced secondary operation rates.

A reduced secondary operation rate may offset increased implant charges for suture button syndesmotic fixation when considering institutional implant removal rates for operations occurring in tertiary care settings. Given these offsetting charges, surgeons should utilize the syndesmotic fixation strategy they deem most appropriate in their practice setting.