Acute Traumatic Injury Research Articles

The Effect of Hospital Transfer on Patient Outcomes After Rehabilitation for Spinal Injury

Spine fractures, including associated spinal cord injury, account for 3%-6% of all skeletal fractures annually in the United States. Patients who undergo interhospital transfer after injury may have a greater likelihood of nonroutine disposition, longer hospital stay, and higher cost. We evaluated the effects of patient transfer on functional outcomes after spine trauma. Patients were treated after acute traumatic spine injury at a rehabilitation hospital in 2011-2017. Compared patients were those directly admitted to the tertiary hospital or transferred from a community hospital. A total of 188 patients (mean age 46.1 ± 18.6 years, 77.1% men) were evaluated, including 130 (69.1%) directly admitted and 58 (30.9%) transferred patients. The most common levels of injury were at C5 (19.1%) and C6 (12.2%), and most injuries were American Spinal Injury Association injury severity score grade D (33.2%) or grade A (32.1%). No statistical difference in age, injury pattern, timing from injury to surgery, or rehabilitation length of stay was seen between admitted and transferred patients. A significant improvement in ambulation distances was seen at discharge for directly admitted compared with transferred patients (447.7 ± 724.9 vs. 159.9 ± 359.5 feet; P=0.005). However, no significant difference primary outcomes, namely American Spinal Injury Association injury severity score distribution (P= 0.2) or Functional Independence Measures (Δ30.9 ± 15.9 vs. 30.1 ± 17.1; P=0.7), were seen between admitted and transferred patients at time of rehabilitation discharge. Interhospital transfer status did not diminish time to rehabilitation after injury or reduce functional recovery, suggesting early surgical treatment in community settings may have merit prior to transfer.

Retrospective evaluation of serum/plasma iron, red blood cell distribution width, and nucleated red blood cells in dogs with acute trauma (2009-2015): 129 cases.

To compare the prognostic value of admission hematologic parameters serum/plasma iron, red blood cell distribution width (RDW), and nucleated red blood cells (nRBCs) in dogs presenting with acute traumatic injury. Retrospective observational study (2009-2015). University teaching hospital. One hundred and twenty-nine clinical dogs presenting within 24 hours of acute traumatic injury. None. One hundred and twenty-nine dogs met the inclusion criteria and 109 (84.5%) survived, while 20 (15.5%) died or were euthanized in hospital. Patients with blunt force trauma comprised 79.8% of the patient population; dogs with penetrating trauma comprised 20.2% of cases. Hypoferremia occurred in all nonsurvivors, and the median serum/plasma iron concentration was significantly lower in nonsurvivors than survivors (P = 0.028). Normal or increased serum/plasma iron had 100% specificity and 100% positive predictive value for survival. Red blood cell distribution width was not significantly different between groups (P = 0.417). The presence of nRBCs was significantly associated with nonsurvival (P = 0.030), although the absolute nRBC concentrations were not significantly different (P = 0.070). A multiple logistic regression model found age, type of injury, presence of nRBCs, and serum/plasma iron to be independent predictors of survival with an area under the receiver operator characteristic curve of 0.813. The presence of nRBCs and low serum/plasma iron are associated with mortality in patients with acute trauma; however, red blood cell distribution width was not associated with survival. Absence of hypoferremia was highly associated with a favorable prognosis in this patient population. These parameters may warrant inclusion in trauma scoring systems.

Clinical Outcomes After Spine Surgery for Traumatic Injury in the Octogenarian Population

To review the surgical outcomes of the octogenarian population at a single institution after spinal traumatic injury. Patients with both radiographic and clinical evidence of acute traumatic spine injury were reviewed using an institutional trauma survey to determine patient demographics and outcome data in a population of patients aged 80 years and older. Thirty-nine patients aged 80 years and older underwent surgical intervention for acute spinal trauma. There were 25 cases of cervical spine and 14 cases of thoracolumbar spine surgical intervention. Falls were the number one cause of acute spinal injury (31/39, 71%). Major respiratory disorders were the most common postoperative adverse event (12/39, 31%). Five patients experienced superficial wound dehiscence, fascial dehiscence, superficial infection, or delayed wound erosion. Patients were either discharged to home (10.5%), inpatient rehabilitation, (38.5%), skilled nursing facilities (17.9%), or long-term care facilities (17.9%). The postoperative mortality was 10.3%. Although the octogenarian population has increased risk for postoperative events after acute spinal injuries, surgical intervention may be worthwhile inthe elderly population. Although direct surgical complication rates are not higher, medical risks are significantly higher after surgery.

Metabolite profiles discriminate between acl injured cases and uninjured controls within the first year following injury and surgery

Purpose: Early biological changes at the metabolite level following acute traumatic knee joint injury may influence the initiation and progression of post-traumatic osteoarthritis. The overall objective of this study was to define the metabolite profile in young and physically active military service members following anterior cruciate ligament (ACL) rupture in comparison to uninjured matched controls. Methods: As part of a larger prospective cohort study we collected biospecimen samples (e.g., serum, plasma, etc.) at the time of ACL injury, the time of ACL reconstruction surgery, and at 6 months and 12 months post-surgery in ACL injured cases and at comparable time points in uninjured controls matched for sex, age (±2 years), height (±5.08 cm), and weight (±6.80 kg). We examined plasma samples from the first 30 ACL injured cases and 30 uninjured matched controls that had complete follow-up at all time points. All sample preparation was completed in batches of 20 samples to maintain sample extraction and derivatization stability prior to comprehensive two-dimensional gas chromatography coupled with time-of-flight mass spectrometry (GC×GC-TOFMS) analysis. Plasma samples at each time point were analyzed using the GC×GC-TOFMS method to identify important metabolites that might discriminate between ACL injured cases and uninjured matched controls. Fisher-Ratios were calculated as the group-to-group variance of the detected signal divided by the sum of the within-group variance of the signal and compared between groups at each time point to identify potentially important metabolites. Quantitative analysis for Fisher-Ratio selected metabolites was obtained via PARAFAC, a chemometric deconvolution algorithm, to obtain the metabolite peak areas. Testing for statistical significance of the concentration ratios using the peak areas for the key metabolites was based on t-tests with p-values using Microsoft Excel 365 ProPlus. Following metabolite quantification, the top 10 metabolites identified were carried forward and examined using principal component analysis on metabolite peak areas using PLS Toolbox 8.6. Results: Among the 30 ACL injured cases, 18 were males (60%) and the average age, height and weight was 19.35±1.22 years, 175.98±37.36 cm, and 78.93±16.95 kg. Uninjured controls for each case were matched for sex, age (±2 years), height (±5.08 cm), and weight (±6.80 kg). The top 10 metabolites identified via Fisher-Ratio analyses are presented in the table. Eight of the 10 metabolites were significantly different between ACL injured cases and uninjured matched controls at the time of injury, five were different at the time of ACL reconstruction surgery, six were different 6 months post-surgery, and eight were different 12 months-post surgery. L-methionine, Glyoxylic acid, and Malonic acid concentrations were significantly lower across all time points in ACL injured cases compared to uninjured matched controls. L-Lysine concentrations were significantly higher in ACL injured cases across all time points. Succinic acid concentrations were significantly higher in ACL injured cases at the time of injury and at 6 months and 12 months post-surgery. Arachidonic acid concentrations were significantly higher in ACL injured cases at the time of injury, the time of surgery, and 12 months post-surgery. The total percentage of explained variance by the first two principal components was 55.0% at the time of ACL injury, 58.0% at the time of ACL reconstruction surgery, 59.8% at 6 months post-surgery, and 56.6% 12 months post-surgery. As demonstrated in the figure, modest separation was observed between ACL injured cases and uninjured matched controls at the first two time points (time of injury and surgery) and notable separation was observed at the latter two time points (6 months and 12 months post-surgery). The proportion of cumulative explained variance with the first four principal components improved to 78.2% to 84.5% across all time points. Conclusions: Plasma concentrations for several metabolites appear to differentiate between ACL injured cases and uninjured controls matched for sex, age, height, and weight. This differentiation between groups appears to improve at 6 and 12 months following ACL reconstruction. The metabolites identified may provide insight into the pathways associated with the initiation and progression of post-traumatic osteoarthritis following ACL injury; however, further research and longer term follow-up in this cohort is needed to confirm this.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Clinical Trial to Evaluate the Efficacy and Safety of 'Pelubiprofen Controlled Released Tab.' in Acute Traumatic Injury

Clinical Trial to Evaluate the Efficacy and Safety of 'Pelubiprofen Controlled Released Tab.' in Acute Traumatic Injury

Expanding the injury definition: evidence for the need to include musculoskeletal conditions

ObjectivesThe objectives of the study are to quantify the proportion of cumulative microtraumatic overuse injuries in a physically active population, evaluate their impact in terms of lost work time, and link them to precipitating activities to inform prevention initiatives. Study designThe study design is retrospective cohort study. MethodsFor a population of U.S. Army Soldiers, diagnoses from medical records (International Classification of Diseases [ICD]-9 800–999 and selected ICD-9 710–739) were matched with self-reported injury information. Common diagnoses, limited duty days, and activities and mechanisms associated with the injuries were summarized. ResultsMost self-reported injuries (65%) were classified by providers with diagnoses that described cumulative microtraumatic tissue damage, and these injuries led to a higher incidence of limited duty (85%) than acute traumatic injury diagnoses. Reported mechanisms and activities often indicated repetitive physical training-related onset. ConclusionsBecause many diagnoses for cumulative microtraumatic musculoskeletal tissue damage are categorized as diseases to the musculoskeletal system in the International Classification of Diseases, they are often not included in definitions of injury. However, reported injury activities and mechanisms in this population provide evidence that cumulative microtraumatic injuries often arise from identifiable and preventable events. This finding confirms that these diagnoses should be classified as injuries in epidemiologic evaluations and surveillance to accurately represent injury burden.

Comparison between intravenous morphine versus fentanyl in acute pain relief in drug abusers with acute limb traumatic injury.

Rapid and effective pain relief in acute traumatic limb injuries (ATLI) is one of the most important roles of emergency physicians. In these situations, opioid addiction is an important concern because of the dependency on opioids. The study aims to compare the effectiveness of intravenous (IV) fentanyl versus morphine in reducing pain in patients with opioid addiction who suffered from ATLI. In this double-blind randomized clinical trial, 307 patients with ATLI, who presented to the emergency department (ED) from February 2016 to April 2016, were randomly divided into two groups. One group (152 patients) received 0.1 mg/kg IV morphine. The other group (155 patients) received 1 mcg/kg IV fentanyl. Patients' demographic data, pain score at specific intervals, vital signs, side effects, satisfaction and the need for rescue analgesia were recorded. Eight patients in the morphine group and five patients in the fentanyl group were excluded. Pain score in the fentanyl group had a significant decrease at 5-minute follow-up (P value=0.00). However, at 10, 30, and 60-minute follow-ups no significant differences were observed between the two groups in terms of pain score reduction. The rescue analgesia was required in 12 (7.7%) patients in the fentanyl group and in 48 (31.6%) patients in the morphine group (P value=0.00). No significant difference was observed regarding side effects, vital signs and patients' satisfaction between the two groups. Fentanyl might be an effective and safe drug in opioid addicts suffering from ATLI.

Acute traumatic cervical spinal cord injury in a third-trimester pregnant female with good maternal and fetal outcome: a case report and literature review.

The management of acute traumatic cervical spine injury in a third-trimester pregnancy is challenging with risks involved for both the mother and the fetus. We report one such case that was managed successfully with good maternal and fetal outcomes. A 30 years female, gravida 2, para 1, living 1 at 31 weeks 5 days of pregnancy, met with a RTA and was diagnosed with AIS B C4-C5 extension compression spinal cord injury (SCI) with a viable fetus. Closed reduction of C4-C5 dislocation was achieved through controlled cervical traction. Having involved the patient in informed decision-making, anterior cervical discectomy and fusion (ACDF) was performed under general anesthesia (GA), with obstetrician, as well as neonatologist available in the operation theater. The pregnancy was uneventful in the post-operative stage. A healthy baby was delivered at 36 weeks of gestation through cesarean section. At final follow-up review of 12 months the patient was ambulatory without support and was able to perform most of the regular activities independently. The significant risk of a spontaneous delivery with GA posed the dilemma of either managing the injury conservatively through bed rest, continuing the pregnancy till its term and then opting for surgical stabilization after delivery or opting for surgical stabilization of the spine immediately, with a view for early mobilization and rehabilitation. A successful outcome of traumatic cervical SCI in third-trimester pregnancy can be achieved by multi-disciplinary (anesthetist, obstetrician, neonatologist, spine surgeon, and physiatrist) team, and timely surgical spinal stabilization, followed by early comprehensive rehabilitation.

Prior CT imaging history for patients who undergo whole-body CT for acute traumatic injury and are discharged home from the emergency department

BackgroundRecurrent CT imaging is believed to significantly increase lifetime malignancy risk. We previously reported that high acuity, admitted trauma patients who received a whole-body CT in the emergency department (ED) had a history of prior CT imaging in 14% of cases. The primary objective of this study was to determine the CT imaging history for trauma patients who received a whole-body CT but were ultimately deemed safe for discharge directly home from the ED.MethodsThis was a retrospective cohort study conducted at an academic ED. All trauma patients who were discharged directly home from the ED after whole-body CT were analyzed. The decision to utilize whole-body CT was at the discretion of the caring physician during the study period. Clinical data for the most recent trauma visit was recorded in a structured fashion on a standardized data collection instrument utilizing the hospital system electronic medical record (EMR). Subsequently, study investigators reviewed a shared, electronic radiological archive for the 6-hospital system to evaluate prior CT exposure for each patient.Results165 patients were in the study group. The mean age of the study group was 39+/− 16 years old, 40% were female and 64% were Hispanic. The most common mechanism of injury in our study group was motor vehicle crash (MVC) (66%). In our study group, 25% had at least one prior CT. The most common prior studies performed were: CT abdomen/pelvis (13%), CT head (9.1%), CT face (6.7%), and CT chest (1.8%). Within a multivariate logistic regression model we found that the large majority of patient characteristics and mechanisms of injury were not associated with a positive prior CT imaging history.ConclusionWe found a positive history for prior CT for 25% of trauma patients who received whole-body CT scan but were discharged from the ED to home.

Cross-sectional imaging of thoracic traumatic aortic injury.

Aortic injury remains a major contributor to morbidity and mortality from acute thoracic trauma. While such injuries were once nearly uniformly fatal, the advent of cross-sectional imaging in recent years has facilitated rapid diagnosis and triage, greatly improving outcomes. In fact, cross-sectional imaging is now the diagnostic test of choice for traumatic aortic injury (TAI), specifically computed tomography angiography (CTA) in the acute setting and CTA or magnetic resonance angiography (MRA) in follow-up. In this review, we present an up-to-date discussion of acute traumatic thoracic aortic injury with a focus on optimal and emerging CT/MR techniques, imaging findings of TAI, and potential pitfalls.

Effect of emergency thoracic endovascular aortic repair in patients with acute traumatic thoracic aortic injury

Objective: To investigate the effect of emergency thoracic endovascular aortic repair (TEVAR) in patients with acute traumatic thoracic aortic injury. Method: From January 2014 to December 2016, a total of 35 patients with acute traumatic thoracic aortic injuries were treated with emergency TEVAR in our hospital, their clinical data were analyzed retrospectively in this study. Results: The patients were 42 (34, 55) years old,and there were 31 males.All cases were diagnosed by emergency aorta computed tomography angiography (CTA),and 5 cases were diagnosed as aortic transaction, 13 cases were diagnosed as aortic pseudoaneurysm, 7 cases were diagnosed as aortic dissection, and 10 cases were diagnosed as aortic intramural hematoma combined hemothorax.The concomitant injuries included cerebral contusion (3 cases, 8.6%), pulmonary contusion with rib fracture (31 cases, 88.5%), long bone fracture (7 cases, 22.5%), contusion of viscera or internal organs (3 cases, 8.6%).Emergency TEVAR were performed with vascular suture system preset under local anesthesia after diagnosis,and combined injury was treated in related departments.CTA was repeated after 1, 3 and 6 months and yearly thereafter. One patient died before transferring to catheter room,and 34 (97.1%) patients underwent TEVAR procedure successfully.Time from door to operating room was (88.6±26.6) minutes,and the procedure time was (52.0±9.4) minutes. A total of 69 Perclose Proglide vascular suture system were used,and 2 cases underwent surgical suture because of hematoma and pseudoaneurysm formation in femoral arteries.The involved length of thoracic aorta was (44.5±7.4)mm. A total of 46 stent-grafts were implanted, the length of stent-graft was (164.3±15.2)mm,and the proximal oversize rate was (22.3±8.6)%. The follow-up time was 24 (12,24) months, and there were no procedure related complication such as endoleak and paraplegia. Complete aortic remodeling was observed in 14 cases. Fully thrombolization at stent segments were observed in 7 cases. Fully thrombalization of pseudoaneurysms were observed in 13 cases. One patient complained mild left upper limb weakness due to left subclavian artery occlusion. Conclusion: Emergency TEVAR is safe and effective procedure for the treatment of patients with acute traumatic thoracic aortic injury.

Acute and chronic musculoskeletal injury in para-sport: A systematic review

The health benefits of sport are myriad, but sport also carries an inherent risk of injury. This systematic review summarizes musculoskeletal injury epidemiology in elite and recreational para-athletes, and highlights research gaps. Five electronic databases were searched for relevant articles: Ovid Medline, Ovid Medline In Process & Other Non-Indexed Citations, Ovid Embase, Cumulative Index to Nursing and Allied Health (CINAHL), and Web of Science. Evaluation and data extraction were performed by two independent examiners. Inclusion criteria were: (a) written in English; (b) published in a peer-reviewed journal between January 1975 and June 2017; (c) describe para-athletes participating in recreational or elite sport; and (d) describe sports-related, acute traumatic or chronic overuse musculoskeletal injury. Fifty full-text manuscripts were reviewed. Seated para-athletes sustain upper extremity injuries more commonly, while ambulant para-athletes frequently sustain lower extremity injuries. The upper extremity, including shoulder, elbow, wrist/hand, is the most commonly injured anatomical area in all para-athletes, unlike able-bodied athletes for whom lower extremity injuries predominate. Increased age and spinal cord injury may increase risk of upper extremity injury. Sprains, strains, blisters and lacerations are the most common injuries among paralympians, but winter paralympic sports carry higher risk of head injury, fracture and contusion, possibly due to the high-velocity elements. Male and female summer paralympic athletes have similar overall injury rates, and football 5-a-side, para-powerlifting, goalball, wheelchair fencing, and wheelchair rugby are consistently highest-risk sports. Para-ice hockey, alpine skiing, and snowboarding are highest-risk winter sports. Upper and lower extremity injury rates match in winter sport, unlike summer sport trends. Injury data for recreational and youth para-athletes are sparse. MSK injury epidemiology data continues to mature. Recreational and youth athletes remain under studied. Updating such data may accelerate the development of injury prevention strategies and lifetime injury models for para-athletes.

During Development NG2 Glial Cells of the Spinal Cord are Restricted to the Oligodendrocyte Lineage, but Generate Astrocytes upon Acute Injury

NG2 glia are self-renewal cells widely populating the entire central nervous system (CNS). The differentiation potential of NG2 glia in the brain has been systematically studied. However, the fate of NG2 glia in the spinal cord during development and after injury is still unclear. Here, we took advantage of faithful expression of Cre in NG2-CreERT2 knock-in mice to demonstrate that spinal NG2 glia remain committed to the oligodendrocyte (OL) lineage and generate OLs, but not astrocytes or neurons, during development.However, we found significant age- and region dependent differences in differentiation into OLs. Embryonic or neonatal NG2 glia generated more than 90% of the white matter OLs, but only 50% (embryonic) or 75% (neonatal) of gray matter OLs. Such differences disappeared after myelin completion coinciding with a decrease in the differentiation rate.While we never detected the generation of astrocytes from NG2 glia during spinal cord development, we found a small portion of NG2 glia could generate astrocytes in adult spinal cord upon acute traumatic injury.

Endovascular Management of Acute Traumatic Aortic Injury

Acute traumatic injury of the thoracic aorta is a highly lethal condition, with many afflicted patients expiring before hospital arrival. While previously these conditions were managed with open surgery, endovascular repair has rapidly evolved and is now considered the standard of care for certain patterns of aortic injury at centers with appropriate expertise. The development of newer branched devices has allowed these techniques to be utilized further and further proximally into the aorta. Through minimally invasive techniques, many aortic injuries can now be treated percutaneously with shorter recovery time and less perioperative complications.

LO48: Does FAST change management of blunt trauma patients?

Introduction: Despite widespread use of FAST in trauma, there is a lack of data supporting its usefulness. We sought to identify the impact of FAST on clinical management of blunt trauma patients. Methods: This health records review was conducted at a single large academic Level 1 trauma center emergency department. Patients with a suspicion of acute blunt traumatic abdominal injury were identified from our health records database. Data were collected regarding FAST utilization, CT scan utilization and timing, need for definitive management, disposition, and length of stay (LOS). Results: 285 patients were included, 152 (53.3%) received a FAST examination, with 33 (22%) having a direct impact on clinical management. CT was performed in 112 (73.6%) of the FAST group, with mean time to imaging of 147.4 minutes, time to trauma team assessment of 21.5 minutes, and ED-LOS of 8.6 hours. In the non-FAST group, 33 (24.8%) received a CT, with time to imaging of 133 minutes, time to trauma team assessment of 133 minutes, and ED-LOS of 13.8 hours. 75.6% of the FAST group required admission and 9.2% required definitive management; admission was needed for 38.3% of the non-FAST group and 2.2% required definitive management. Conclusion: This is the first study to assess patient outcomes with respect to FAST in the era of early whole body CT in trauma. Although FAST does not directly impact care for the majority of blunt trauma patients, it demonstrates usefulness in some patients by directing CT utilization and expediting disposition from the ED.

926 Innate antiviral immunity is activated upon skin injury via an IL-27/STAT1 axis

Activation of antimicrobial immunity is critical to control infection following skin injury. While the induction of antibacterial host defense molecules is relatively well-defined, regulation of antiviral proteins (AVPs) in the skin is largely unknown. Here, we show that AVPs are potently induced following acute traumatic skin injury in an IL-27-STAT1-dependent manner. Using human skin organ cultures and murine wound models, we discovered that excisional punch biopsy-induced wounding triggers production of multiple AVPs, including OAS1, OAS2, and OASL (p < 0.05). Since we previously reported that IL-27 plays a functional role in skin wound repair, we hypothesized that IL-27 may stimulate AVP expression in the skin. Indeed, IL-27 induced OAS2 both in vitro in human keratinocytes and in vivo upon s.c injection into mouse skin (p < 0.01) in a dose- and time-dependent manner. Addition of IL-27 neutralizing AB to wounds or genetic KO of the Il27 receptor significantly decreased OAS2 (p < 0.01), suggesting that IL-27 plays a critical role in injury-induced production of OAS2. IL-27 also suppresses viral infection in human keratinocytes and enhances dsRNA-induced AVP expression (p < 0.01) supporting the functional relevance of IL-27 in antiviral immunity. Using an siRNA screening approach, we demonstrate that OAS2 upregulation in response to IL-27 was IFNAR1-, TLR3-, MDA5-, MAVS-, RIGi-, TRAF6-, IkBe-, TBK1- and JAK1-independent, but STAT1- and IRF3-dependent (p < 0.001). In further support of this pathway, IL-27 was shown to cause rapid and transient nuclear translocation of p-STAT1 and IRF3, and IL-27 failed to induce OAS2 in a STAT1KO keratinocyte cell line. Together, our data suggest that IL-27 promotes skin antiviral competence through activation of AVPs upon cutaneous injury. New knowledge of the regulatory pathways of AVP induction following injury will aid in our understanding of cutaneous innate immunity and skin repair.

Imaging of Acute Traumatic Aortic Injury

This article aims to review the key aspects of the imaging evaluation of acute traumatic aortic injury (ATAI) with an emphasis on factors that affect management of these patients. In the setting of trauma, the chest radiograph typically serves as the initial imaging evaluation and can be useful in detecting signs of mediastinal hematoma. In the current era, definitive diagnosis of ATAI is made with computed tomography (CT), where indirect and direct findings of ATAI can enable a confident diagnosis. Knowledge of potential technical and anatomic CT imaging pitfalls can prevent misdiagnosis of ATAI. Diagnosis of ATAI in the setting of blunt or penetrating trauma relies heavily on timely and accurate imaging interpretation. Once the diagnosis is made, a meaningful report including appropriate descriptors of the characteristics and location of ATAI should be generated by the radiologist to help direct management.

Analysis of Prehospital Scene Times and Interventions on Mortality Outcomes in a National Cohort of Penetrating and Blunt Trauma Patients

Background: Recent studies have suggested improved outcomes in victims of penetrating trauma managed with shorter prehospital times and limited interventions. The purpose of the current study was to perform an outcome analysis of patients transported following penetrating and blunt traumatic injuries. Methods: We performed a descriptive retrospective analysis of the 2014 National Emergency Medical Services Information System (NEMSIS) public release research data set for patients presenting after acute traumatic injury. Results: A total of 2,018,141 patient encounters met criteria, of which 3.9% were penetrating trauma. Prehospital cardiac arrest occurred in 0.5% blunt and 4.2% penetrating trauma patients. Emergency department (ED) mortality was higher in penetrating than blunt trauma patients (4.1% vs. 0.8%). Scene times were 18.1 ± 36.5 minutes for blunt and 16.0 ± 45.3 minutes for penetrating trauma. Mean scene time for blunt trauma patients who died in the ED was 24.9 ± 58.0 minutes compared with 18.8 ± 38.5 minutes for those admitted; for penetrating trauma, scene times were 17.9 ± 23.5 and 13.4 ± 11.6 minutes, respectively. Mean number of procedures performed for blunt trauma patients who died in the ED was 6.5 ± 4.3 compared with 3.1 ± 2.3 for those who survived until admission; for penetrating trauma, the numbers of procedures performed were 5.7 ± 3.4 and 2.6 ± 2.0, respectively. Conclusions: Although less frequent than blunt trauma, penetrating trauma is associated with significantly higher prehospital and ED mortality. Increased scene time and number of procedures was associated with greater mortality for both blunt and penetrating trauma. Further study is required to better understand any causal relationships between prehospital times and interventions and patient outcomes.

Inflammatory and degenerative phases resulting from anterior cruciate rupture in a non-invasive murine model of post-traumatic osteoarthritis.

ABSTRACTJoint injury is the predominant risk factor for post‐traumatic osteoarthritis development (PTOA). Several non‐invasive mouse models mimicking human PTOA investigate molecular mechanisms of disease development; none have characterized the inflammatory response to this acute traumatic injury. Our aim was to characterize the early inflammatory phase and later degenerative component in our in vivo non‐invasive murine model of PTOA induced by anterior cruciate ligament (ACL) rupture. Right knees of 12‐week‐old C57Bl6 mice were placed in flexion at a 30° offset position and subjected to a single compressive load (12N, 1.4 mm/s) to induce ACL rupture with no obvious damage to surrounding tissues. Tissue was harvested 4 h post‐injury and on days 3, 14, and 21; contralateral left knees served as controls. Histological, immunohistochemical, and gene analyzes were performed to evaluate inflammatory and degenerative changes. Immunohistochemistry revealed time‐dependent expression of mature (F4/80 positive) and inflammatory (CD11b positive) macrophage populations within the sub‐synovial infiltrate, developing osteophytes, and inflammation surrounding the ACL in response to injury. Up‐regulation of genes encoding acute pro‐inflammatory markers, inducible nitric oxide synthase, interleukin‐6 and interleukin‐17, and the matrix degrading enzymes, ADAMTS‐4 and MMP3 was detected in femoral cartilage, concomitant with extensive cartilage damage and bone remodelling over 21‐days post‐injury. Our non‐invasive model describes pathologically distinct phases of the disease, increasing our understanding of inflammatory episodes, the tissues/cells producing inflammatory mediators and the early molecular changes in the joint, thereby defining the early phenotype of PTOA. This knowledge will guide appropriate interventions to delay or arrest disease progression following joint injury. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res 36:2118–2127, 2018.

Effects of enteral nutrition added with glutamine on gastrointestinal functions and prognosis of acute severe traumatic brain injury

Objective To investigate the effects of enteral nutrition added with glutamine on the incidences of gastrointestinal complications, intestinal mucosal barrier function and inflammatory responses in patients with acute severe traumatic brain injury (sTBI). Methods A prospective case control study was made on 107 patients with sTBI hospitalized from January 2016 to June 2017. The patients were divided into experimental group added with glutamine (n=54) and control group without glutamine (n=53) according to the random number table. The general data of the patients were recorded. After treatment, the incidences of gastrointestinal complications in both groups were compared. The serum levels of intestinal mucosal barrier function indices, namely, diamine oxidase (DAO), D-lactate acid, and intestinal fat acid binding protein (I-FABP) were evaluated by enzymology spectrophotometer method. Meanwhile, the serum levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were also tested with enzyme-linked immunosorbent assay (ELISA). Glasgow coma scale (GCS), acute physiology and chronic health evaluation II (APACHE II), and hospital stay in both groups were compared. Results The two group were comparable with respect to gender, age, injury reasons, body mass index, preoperative GCS, preoperative APACHE II, injury type and injury time (P>0.05). The experimental group had lower incidences of stress ulcer, gastric retention and diarrhea compared with the control group 14 days after treatment (P<0.05). Within 14 days after treatment, the serum levels of DAO, D-lactate acid and I-FABP were significantly decreased in the experimental group at days 7 and 14 after treatment (P<0.05). The serum levels of CRP, TNF-α and IL-6 in the experimental group were significantly decreased after treatment (P<0.05). The experimental group had better prognosis compared with the control group (P<0.05), with higher GCS scores [(9.3±0.7) points vs. (8.2±0.7) points], lower APACHE II scores [(15.3±1.1)points vs. (17.7±1.2) points] at day 14, and shorter hospital stay [(19.1±2.2)days vs. (25.3±2.4)days] (P<0.01). Conclusions Enteral nutrition added with glutamine can effectively reduce the incidence of gastrointestinal complications, as well as alleviate the intestinal mucosal barrier function damage and the inflammatory responses at early stage after sTBI, which possibly improves prognosis. Key words: Craniocerebral trauma; Enteral nutrition; Glutamine; Gastrointestinal tract; Prognosis