Cause Of Death In Trauma Research Articles

Plasma treatment is associated with decreased brain lesion and resuscitation requirements after traumatic brain injury in a swine model of prolonged damage-control resuscitation

BACKGROUND Hemorrhage and traumatic brain injury (TBI) are the leading causes of death in trauma. Future military conflicts are likely to be in austere environments, where prolonged damage-control resuscitation (p-DCR) may be required for 72 hours before evacuation. Previous studies showed that early administration of fresh frozen plasma (FFP) during p-DCR can significantly decrease the volume of resuscitation required in models of hemorrhagic shock and also provide neuroprotection after TBI. In the current study, we hypothesized that the addition of FFP to p-DCR would decrease the resuscitation requirements and improve neurological outcomes in a large animal model of combined hemorrhagic shock and TBI. METHODS Yorkshire swine (40–45 kg; n = 10) were subjected to TBI (controlled cortical impact) and 40% blood volume hemorrhage. After 2 hours of shock, they were randomized to either: (1) p-DCR–normal saline or (2) p-DCR–FFP (250 mL). Prolonged damage-control resuscitation targeted a systolic blood pressure of 90% of baseline, in line with Tactical Combat Casualty Care principles. At 72 hours, animals were transfused 1 U of packed red blood cells, simulating evacuation to higher echelons of care. Brain lesion size, physiologic parameters, resuscitation fluid requirements, and neurological severity score were used to compare the clinical outcomes. RESULTS The p-DCR–FFP group required significantly less total volume (4,540.0 ± 151.7 mL vs. 974.0 ± 167.0 mL, p < 0.01) of resuscitation to maintain the target systolic blood pressure. Fresh frozen plasma–treated animals had significantly reduced brain lesion size (4,517.0 ± 180.0 mm3 vs. 2,477.0 ± 1,191.0 mm3, p < 0.01) and showed significantly decreased functional neurologic impairment. CONCLUSION In this exploratory study, treatment with FFP decreased resuscitation requirements, reduced brain lesion size, and improved neurological outcomes when added to prolonged DCR in a porcine model of combined hemorrhagic shock and TBI.

Stopping the bleed when tourniquets cannot: a technique for Foley catheter balloon compression in trauma.

Hemorrhage is a leading cause of death in trauma. Prehospital hemorrhage control techniques include tourniquet application for extremity wounds and direct compression; however, tourniquets are not effective in anatomic junctions, and direct compression is highly operator dependent. Balloon catheter compression has been employed previously in trauma care, but its use has been confined to the operating room and restricted to specific anatomic injuries. In a single-center retrospective review, we describe a technique for balloon catheter compression for hemorrhage control that can be employed across the continuum of trauma care, from the prehospital setting to the trauma bay, the operating room, and postoperative period. Of 18,303 trauma patients in Venezuela, 45% of the 1757 patients with vascular injuries received Foley catheter compression for hemorrhage control. Of these catheters, the majority (75%) were placed in the emergency department, 5% in the prehospital setting, and 20% in the operating room. Over half (53.2%) of the balloon catheters were placed for hemorrhage control in non-compressible anatomic junctions. Foley catheter balloon compression is a useful addition to a provider's arsenal of hemorrhage control techniques, as it is effective in anatomic junctions, preserves collateral circulation through focused compression, and requires minimal active physical attention to maintain hemostasis.

Safe and Efficacious Near Superhydrophobic Hemostat for Reduced Blood Loss and Easy Detachment in Traumatic Wounds.

Hemorrhage is the leading cause of trauma death, and innovation in hemostatic technology is important. The strongly hydrophobic carbon nanofiber (CNF) coating has previously been shown to have excellent hemostatic properties. However, the understanding of how CNF coating guides the coagulation cascade and the biosafety of CNF as hemostatic agents has yet to be explored. Here, our thrombin generation assay investigation showed that CNF induced fast blood coagulation via factor (F) XII activation of the intrinsic pathway. We further performed studies of a rat vein injury and demonstrated that the CNF gauze enabled a substantial reduction of blood loss compared to both the plain gauze and kaolin-imbued gauze (QuikClot). Analysis of blood samples from the model revealed no acute toxicity from the CNF gauze, with no detectable CNF deposition in any organ, suggesting that the immobilization of CNF on our gauze prevented the infiltration of CNF into the bloodstream. Direct injection of CNF into the rat vein was also investigated and found not to elicit overt acute toxicity or affect animal survival or behavior. Finally, toxicity assays with primary keratinocytes revealed minimal toxicity responses to CNF. Our studies thus supported the safety and efficacy of the CNF hemostatic gauze, highlighting its potential as a promising approach in the field of hemostatic control.

A new, deep learning-based method for the analysis of autopsy kidney samples used to study sex differences in glomerular density and size in a forensic population.

Artificial intelligence (AI) is increasingly used in forensic anthropology and genetics to identify the victim and the cause of death. The large autopsy samples from persons with traumatic causes of death but without comorbidities also offer possibilities to analyze normal histology with AI. We propose a new deep learning-based method to rapidly count glomerular number and measure glomerular density (GD) and volume in post-mortem kidney samples obtained in a forensic population. We assessed whether this new method detects glomerular differences between men and women without known kidney disease. Autopsies performed between 2009 and 2015 were analyzed if subjects were aged ≥ 18years and had no known kidney disease, diabetes mellitus, or hypertension. A large biopsy was taken from each kidney, stained with hematoxylin and eosin, and scanned. An in-house developed deep learning-based algorithm counted the glomerular density (GD), number, and size. Out of 1165 forensic autopsies, 86 met all inclusion criteria (54 men). Mean (± SD) age was 43.5 ± 14.6; 786 ± 277 glomeruli were analyzed per individual. There was no significant difference in GD between men and women (2.18 ± 0.49 vs. 2.30 ± 0.57 glomeruli/mm2, p = 0.71); glomerular diameter, area, and volume also did not differ. GD correlated inversely with age, kidney weight, and glomerular area. Glomerular area and volume increased significantly with age. In this study, there were no sex differences in glomerular density or size. Considering the size of the kidney samples, the use of the presented deep learning method can help to analyze large renal autopsy biopsies and opens perspectives for the histological study of other organs.

Prediction of outcomes of chest trauma using chest trauma scoring system at a rural tertiary health-care facility

Background: In India, trauma is the most common cause of death. The third most common cause of traumatic death is thoracic trauma. Thoracic trauma accounts for 10% of all trauma admissions, and the mortality rate is reported to range from 10% to 60%. Thoracic trauma patients are likely to be assessed and cared for consistently under a well-designed classification system. Aims: This study aims To investigate Chest Trauma Score (CTS)-based prognostic and predictive outcomes following chest trauma in the Indian subpopulation sustaining chest injuries. Setting and Design: This prospective observational study, Department of General Surgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, was included a total of 50 individuals with thoracic trauma. Materials and Methods: When a patient is admitted to the emergency department or trauma unit, a complete clinical assessment, detailed history, vital signs, and all appropriate investigations - including chest radiographs, computed tomography, or high-resolution computed tomography (HRCT) chest (if hemodynamics are stable on admission) - are performed. Age, pulmonary contusion (on HRCT chest), number of rib fractures, and presence of bilateral rib fracture were the four factors used to calculate the CTS. Statistical Analysis: Data were expressed as mean (standard deviation) and percentage (%). Chi-square, Student’s t-test, and analysis of variance were used to compare measured variables. Results: The mean pulse rate (beats/min) and respiratory rate (/min) of patients were significantly higher, and systolic blood pressure (mmHg) and diastolic blood pressure (mmHg) were significantly lower in the nonsurvivor group compared with the survivor group. More than 5 rib fractures and intubation were significantly found more in nonsurvivor group. The mean Glasgow Coma Scale (GCS) was significantly decreased in nonsurvivor group (11.67 ± 1.37) as compared to survivor group (14.55 ± 1.13). Conclusion: Traffic accidents were more frequently (60%) responsible for chest trauma. The mean GCS was significantly associated with patient mortality.

Using infrared cameras in drones to detect bleeding events

BackgroundHemorrhage is one of the main causes of death in trauma. Critical bleeding in patients needs to be detected as soon as possible to save the patient. Drones are gaining increasing importance in emergency services and can support rescue forces in accident scenarios such as a mass casualty incident.MethodsIn this study, a simulated pelvic hemorrhage was detected using a drone from 7 m above the ground over a time span of 30 s.ResultsThe results allow a good detection of the pelvic hemorrhage. Nevertheless, the simulated blood cools down quickly. After 30 s, there was no significant temperature difference compared to the rest of the body. At this point, further assessment is only possible via the RGB image.ConclusionThe findings suggest that bleeding from an open and continuously bleeding wound would most likely be detectable using the drone’s thermal imaging camera, even over a longer period of time.

Subdural hematoma, retinal hemorrhage, and fracture triad as a clinical predictor for the diagnosis of child abuse.

Nonaccidental trauma (NAT) is a major cause of traumatic death during infancy and early childhood. Several findings are known to raise the index of clinical suspicion: subdural hematoma (SDH), retinal hemorrhage (RH), fracture, and external trauma. Combinations of certain injury types, determined via statistical frequency associations, may assist clinical diagnostic tools when child abuse is suspected. The present study sought to assess the statistical validity of the clinical triad (SDH + RH + fracture) in the diagnosis of child abuse and by extension pediatric NAT. A retrospective review of The University of Arizona Trauma Database was performed. All patients were evaluated for the presence or absence of the components of the clinical triad according to specific International Classification of Diseases (ICD)-10 codes. Injury type combinations included some variation of SDH, RH, all fractures, noncranial fracture, and cranial fracture. Each injury type was then correlated with the ICD-10 codes for child abuse or injury comment keywords. Statistical analysis via contingency tables was then conducted for test characteristics such as sensitivity, specificity, positive predictive value, and negative predictive value. There were 3149 patients younger than 18 years of age included in the quantitative analysis, all of whom had at least one component of the clinical triad. From these, 372 patients (11.8%) had a diagnosis of child abuse. When compared to a single diagnosis of either SDH, RH, all fractures, noncranial fracture, or cranial fracture, the clinical triad had a significantly greater correlation with the diagnosis of child abuse (100% of cases) (p < 0.0001). The dyad of SDH + RH also had a significantly greater correlation with a child abuse diagnosis compared to single diagnoses (88.9%) (p < 0.0001). The clinical triad of SDH + RH + fracture had a sensitivity of 88.8% (95% CI 87.6%-89.9%), specificity of 100% (95% CI 83.9%-100%), and positive predictive value of 100% (95% CI 99.9%-100%). The dyad of SDH + RH had a sensitivity of 89.1% (95% CI 87.9%-90.1%), specificity of 88.9% (95% CI 74.7%-95.6%), and positive predictive value of 99.9% (95% CI 99.6%-100%). All patients with the clinical triad were younger than 3 years of age. When SDH, RH, and fracture were present together, child abuse and by extension pediatric NAT were highly likely to have occurred.

Speed kills? Quantifying the association between police traffic stops, types of stops, and motor vehicle collisions

BackgroundMotor vehicle crashes (MVCs) are a leading cause of traumatic death and injury. Police traffic stops (PTS) are a common approach to enforcing motor vehicle laws intended to prevent MVCs. However, it is unclear which types of PTS are most effective. This study examined the relationship of PTS subtypes among municipal police patrols on non-interstate roads and MVCs and MVC-related deaths. MethodsPTS subtype data were characterized from six North Carolina cities: Charlotte, Durham, Fayetteville, Greensboro, Raleigh, and Winston-Salem. The primary outcomes of this study were yearly non-interstate MVC and MVC-related death rates per 100 population. The data were analyzed as balanced time-series cross-sectional data. The statistical analysis accounted for time-dependent and city-dependent confounding. We used a two-way fixed effects model to analyze the relationship between PTS and MVC or MVC-related deaths. We also utilized the difference in difference (DID) analysis to analyze if the reduction of PTS following a 2012 policing administrative change in Fayetteville had an association with MVC or MVC-related deaths. ResultsWe found no significant overall association between non-interstate PTS and MVCs (Coeff: -0.00006; p = 0.43) or MVC-related deaths (Coeff: -0.00011; p = 0.15). Panel regression suggested no significant relationship between MVCs and MVC-related deaths and PTS related to driving while impaired (p = 0.36), safe movement violation (p = 0.43), or seatbelt violations (p = 0.17). However, speed limit violations (Coeff: -0.00025; p = 0.032) and stop-light/sign violations (Coeff: -0.00147; p = 0.017) related to PTS significantly reduced MVC-related deaths. The DID regression showed no significant impact on MVCs (p = 0.924) or MVC-related deaths (0.706) before and after the police reform period. ConclusionsThe evidence regarding the absence of an overall association and any association with most PTS subtypes suggest that PTS are not effective for MVC death prevention. Policymakers may proceed with exploring modifications to policing efforts without detriments to public safety as defined by MVC and MVC-related deaths. Level of evidenceRetrospective epidemiological study, level IV

A clinically-relevant mouse model that displays hemorrhage exacerbates tourniquet-induced acute kidney injury.

Hemorrhage is a leading cause of death in trauma. Tourniquets are effective at controlling extremity hemorrhage and have saved lives. However, tourniquets can cause ischemia reperfusion injury of limbs, leading to systemic inflammation and other adverse effects, which results in secondary damage to the kidney, lung, and liver. A clinically relevant animal model is critical to understanding the pathophysiology of this process and developing therapeutic interventions. Despite the importance of animal models, tourniquet-induced lower limb ischemia/reperfusion (TILLIR) models to date lack a hemorrhage component. We sought to develop a new TILLIR model that included hemorrhage and analyze the subsequent impact on kidney, lung and liver injuries. Four groups of mice were examined: group 1) control, group 2) hemorrhage, group 3) tourniquet application, and group 4) hemorrhage and tourniquet application. The hemorrhagic injury consisted of the removal of 15% of blood volume through the submandibular vein. The tourniquet injury consisted of orthodontic rubber bands applied to the inguinal area bilaterally for 80min. Mice were then placed in metabolic cages individually for 22h to collect urine. Hemorrhage alone did not significantly affect transcutaneous glomerular filtration rate (tGFR), blood urea nitrogen (BUN) or urinary kidney injury molecule-1 (KIM-1) levels. Without hemorrhage, TILLIR decreased tGFR by 46%, increased BUN by 162%, and increased KIM-1 by 27% (p < 0.05 for all). With hemorrhage, TILLIR decreased the tGFR by 72%, increased BUN by 395%, and increased urinary KIM-1 by 37% (p < 0.05 for all). These differences were statistically significant (p < 0.05). While hemorrhage had no significant effect on TILLIR-induced renal tubular degeneration and necrosis, it significantly increased TILLIR-induced lung total injury scores and congestion, and fatty liver. In conclusion, hemorrhage exacerbates TILLIR-induced acute kidney injury and structural damage in the lung and liver.

Biomechanical study on the effect of atherosclerosis on the vulnerability of thoracic aorta, and it's role in the development of traumatic aorta injury.

Traumatic aorta injury (TAI) is the second most common traumatic cause of death preceded only by head injuries, being responsible for 5% to 30% of all mortalities in high-speed deceleration injuries. Multiple external factors might play a role such as impact speed, impact direction, occupant location, and presence or lack of restraining safety mechanism. Apart from these external factors, also human biological factors can influence its development. Based on the data of scientific literature, age clearly plays a role in suffering TAI, but the role of atherosclerosis-as a disease affecting the structure of the aorta-is unknown. Biomechanical properties of tissue samples of 104 aorta specimens removed during the autopsy from the posterior (Group 'A') and lateral wall (Group 'B') of descending aorta were analyzed. Specimens were examined by a Zwick/Roell Z5.0 biaxial tester. The Young's modulus (E (MPa)) was calculated using a linear regression procedure where the base of the elongation was the parallel length of the sample, the achieved maximal force (Fmax (N)), the elongation at the time of Fmax (Lmax (mm)), the force at the beginning of rupture (Fbreak (N)), the elongation at the time of Fbreak (Lbreak (mm)) were registered. Specimens were categorized based on macroscopic and microscopic appearance. In the posterior (A) samples the difference between Lbreak (p<0.001) and Lmax (p<0.001) was significant between the macroscopic group. Lbreak (p = 0.009) and Lmax (p = 0.003) showed similar pattern in the lateral (B) samples. Comparing the histological groups by the measured parameters (Fmax, Lmax, Fbreak, Lbreak) showed a significant difference in the means (p<0.001, p = 0.003, p<0.001 respectively). The study demonstrated that atherosclerosis decreases the resistance of the aorta. The rupture occurs at lower force (Fmax and Fbreak), and at shorter elongation (Lmax and Lbreak) in case of the presence of atherosclerosis. This effect is most substantial if calcification is present: the resistance of aorta affected by calcification is only two-thirds on average compared to aorta affected by the early phase of atherosclerosis. This phenomenon can be clearly explained by the weakening structure of the tunica intima.

Audit of consecutive cases of mortality in emergency department of a tertiary hospital in south eastern Nigeria

Introduction: Too many avoidable deaths have been noted in Nigeria. The Emergency Department (ED) mortality rate is a good assessment of the adequacy of the clinical care state of any hospital and in turn the survival probability of any critical ill patient attending that ED. Materials and methods:This study was a retrospective one involving the review of records of all the one hundred consecutive deaths seen between June 2012 and February 2013 in the ED. All those brought in dead were excluded from the study. The data collected was simply analyzed. Results:There were 71 males (71%) and 29 females (29%) with ratio of 2.4: 1.0. The age range of dead subjects was 11 years and above. The major cause of deaths in the study was medical conditions (65%) with a preponderance of cardiovascular deaths (49.23%). Road traffic accident (RTA) was the major cause of trauma deaths (78.98%). Pedestrians and drivers were the most affected in RTA deaths (40% each). Deaths from malignancies constituted 43.75% of the non-traumatic surgical deaths. Majority of the deaths (74%) occurred within the first 24 hours of admission. Conclusion:The mortality rate in the ED is vital in predicting the survival chance of any critically ill- patient attending it. Pre- hospital care and establishment of trauma teams in the hospitals will go a long way in reducing deaths tolls in the ED. Also the ED should be prepared to cope with the challenges of cardiovascular emergencies.

Ultramassive Transfusion for Trauma in the Age of Hemostatic Resuscitation: A Retrospective Single-Center Cohort From a Large US Level-1 Trauma Center, 2011-2021.

Uncontrolled bleeding is a leading cause of death in trauma. In the last 40 years, ultramassive transfusion (UMT; ≥20 units of red blood cells [RBCs]/24 hours) for trauma has been associated with 50% to 80% mortality; the question remains as to whether the increasing number of units transfused in urgent resuscitation is a marker of futility. We asked whether the frequency and outcomes of UMT have changed in the era of hemostatic resuscitation. We performed a retrospective cohort study of all UMTs in the first 24 hours of care over an 11-year period at a major US level-1 adult and pediatric trauma center. UMT patients were identified, and a dataset was built by linking blood bank and trauma registry data, then reviewing individual electronic health records. Success in achieving hemostatic proportions of blood products was estimated as (units of plasma + apheresis-platelets-in-plasma + cryoprecipitate-pools + whole blood]/[all units given] ≥0.5. Demographics, injury type (blunt or penetrating), severity (Injury Severity Score [ISS]), severity pattern (Abbreviated Injury Scale score for head [AIS-Head] ≥4), admitting laboratory, transfusion, selected emergency department interventions, and discharge status were assessed using χ2 tests of categorical association, the Student t-test of means, and multivariable logistic regression. P <.05 was considered significant. Among 66,734 trauma admissions from April 6, 2011 to December 31, 2021, we identified 6288 (9.4%) who received any blood products in the first 24 hours, 159 of whom received UMT (0.23%; 154 aged 18-90 + 5 aged 9-17), 81% in hemostatic proportions. Overall mortality was 65% (n = 103); mean ISS = 40; median time to death, 6.1 hours. In univariate analyses, death was not associated with age, sex, or more RBC units transfused beyond 20 but was associated with blunt injury, increasing injury severity, severe head injury, and failure to receive hemostatic blood product ratios. Mortality was also associated with decreased pH and evidence of coagulopathy at admission, especially hypofibrinogenemia. Multivariable logistic regression showed severe head injury, admission hypofibrinogenemia and not receiving a hemostatic resuscitation proportion of blood products as independently associated with death. One in 420 acute trauma patients at our center received UMT, a historically low rate. A third of these patients lived, and UMT was not itself a marker of futility. Early identification of coagulopathy was possible, and failure to give blood components in hemostatic ratios was associated with excess mortality.

DISEASE PROCESSES IDENTIFIED IN CAPTIVE ARABIAN SAND CATS (FELIS MARGARITA HARRISONI).

The objective of this retrospective study is to identify common and significant causes of mortality and disease processes in the Arabian sand cat (Felis margarita harrisoni) captive population at Al Ain Zoo (Abu Dhabi, United Arab Emirates). Complete postmortem records of 25 Arabian sand cats, dead between 2009 and 2022, were reviewed retrospectively. A complete postmortem examination was done in all cases, and information was recorded in the Al Ain Zoo database and files. Out of 25 animals dead, 11 were adults (4-12 yr) and 12 were classified as geriatric animals (>12 yr), with only two neonatal (0-4 mon) deaths and no recorded deaths in juveniles (4 mon to 4 yr). Interestingly, but also expected because of the age range, 24% of the cases had concurrent pathologies at the time of death. As expected in adult and geriatric felines, more than half of the cases (60%) developed nephropathies that were either one of the most important contributors or the main cause of death of the animal. Different neoplastic lesions were described in four cases and reported for the first time in this subspecies: benign peripheral nerve sheath tumor, hepatobiliary carcinoma, and two different thyroid neoplasia. A vasculoproliferative disorder of the liver, peliosis hepatis, was described in one of the cases. Additionally, in at least four cases, hyperthyroidism was strongly suspected in connection with thyroid neoplasia and hyperplasia, clinical signs, and other observed postmortem lesions. Traumatic causes of death also were reported in six cases, including the only two neonates recorded dead. This information will contribute to Arabian sand cat improved veterinary care by identifying common pathologies in this species, potentially allowing earlier diagnosis and, ultimately, improving their management and husbandry in the captive breeding populations.

The pattern of Deaths in the Accident and Emergency Units of Ekiti State University Teaching Hospital

Background: Background: Death is common in accidents and emergency units (AEU), and its causes vary. Some are brought-in-dead (BID) with unknown causes and contribute to hospital mortality statistics. This study aimed to determine the causes and patterns of death in the AEU of the Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria Methods: This was a 5-year retrospective study of all patients who died in the AEU of Ekiti State University Teaching Hospital, including those brought in dead. The information needed was extracted from the case notes and entered into SPSS version 23 for analysis. Results: A total of 7,682 patients were observed during the study period, with 275 deaths repre-senting a mortality rate of 3.6%. One hundred and fifty-six (56.7%) patients were BID. The mean age was 50.8 years. Most deaths (n=233, 84.7%) were from non-traumatic causes, with stroke and heart failure being the most common causes. Head injury (3.3%) was the most common traumatic cause of death. The median interval from presentation to death was 5 hours (IQR 3 – 6). Most patients (n=54, 45.4%) died within the first 8 hours of admission. None of the patients underwent an autopsy. Hypertension and diabetes were the most common co-morbid conditions reported. Conclusion: Brought-in-dead patients were the most commonly recorded death pattern in AEU at the Ekiti State University Teaching Hospital, and the overall mortality rate was 3.6%. Non-traumatic causes are the leading causes of death.

Retrospective autopsy-based survey of fatal traumatic brain injuries in Benin City, Nigeria

Background: Traumatic brain injury (TBI) is major cause of death in young adults. It results from external force to the head causing injury to the contents of the skull with or without damage to the skull itself.&#x0D; Aims and objectives: To describe the autopsy findings in patients with Traumatic brain injuries.Materials and Methods: A Retrospective Study of findings in patients who suffered Traumatic Brain Injuries as seen at autopsy. The historical and autopsy data of all Traumatic brain injury patients whose bodies were received between 2011 and 2021 were analyzed.&#x0D; Results: TBIs account for 66.7% of traumatic deaths in our institution. Male to female ratio was 1:0.22, and mean age was 39.30±16.65 years. The most common cause of TBI was road traffic accidents (90.9%), with gunshots (5.6%) as a distant second. Intracranial hemorrhages were present in 99.6% of cases and almost all (98.8%) died as a result of Raised Intracranial pressure associated with intracranial hemorrhage. The most common pattern was Subdural hemorrhage (62.65%); followed by Subarachnoid hemorrhage (52.35%); Intraparenchymal hemorrhage (40.88%), Epidural hemorrhage (18.24%); and intraventricular hemorrhage (9.71%). Skull fractures were present in 41.6% of cases. &#x0D; Conclusion: RTA is the most common cause of traumatic brain injury in our study and the leading cause of traumatic deaths. Multiple injuries appears to contribute less to mortality amongst our TBI patients but this may be due to under reporting of injuries found in polytraumatized patients. Morbidity and mortality due to TBI, and trauma in general, will be reduced by improving road safety, and functional protocols for emergency and prehospital care of trauma patients.

EPIDEMIOLOGICAL ASPECTS OF POLYTRAUMATISM IN THE PEDIATRIC POPULATION

"Polytrauma" is a term frequently used in the practice and literature of trauma specialties. This term refers to a series of multiple injuries at the level of several organs or systems, in contrast to isolated traumatic injuries, where a single injury is encountered [Marsden NJ, 2022].Millions of patients with polytrauma require medical care, some of them suffering injuries that will lead to lifestyle changes with the limitation of multiple activities. Globally, road collision is the leading cause of traumatic death, followed by suicide and homicide [Marsden NJ, 2022]."Golden hour" expression coined by Professor Richard Cowley, concludes that most deaths due to polytrauma occur in the first 60 minutes after injury [Marsden NJ, 2022].Following the research carried out on deaths from traumatic causes, a trimodal distribution was highlighted from them: immediately, early and late. The first 2 represent 80% of all traumatic deaths, occurring in the first hours after the injury, either due to brain injuries or major exsanguination. On the other hand, late deaths occur within days to weeks of trauma, secondary to sepsis or multiple organ failure [Marsden NJ, 2022].

Validation of Prediction Rules for Computed Tomography Use in Children With Blunt Abdominal or Blunt Head Trauma: Protocol for a Prospective Multicenter Observational Cohort Study.

Traumatic brain injuries (TBIs) and intra-abdominal injuries (IAIs) are 2 leading causes of traumatic death and disability in children. To avoid missed or delayed diagnoses leading to increased morbidity, computed tomography (CT) is used liberally. However, the overuse of CT leads to inefficient care and radiation-induced malignancies. Therefore, to maximize precision and minimize the overuse of CT, the Pediatric Emergency Care Applied Research Network (PECARN) previously derived clinical prediction rules for identifying children at high risk and very low risk for IAIs undergoing acute intervention and clinically important TBIs after blunt trauma in large cohorts of children who are injured. This study aimed to validate the IAI and age-based TBI clinical prediction rules for identifying children at high risk and very low risk for IAIs undergoing acute intervention and clinically important TBIs after blunt trauma. This was a prospective 6-center observational study of children aged <18 years with blunt torso or head trauma. Consistent with the original derivation studies, enrolled children underwent routine history and physical examinations, and the treating clinicians completed case report forms prior to knowledge of CT results (if performed). Medical records were reviewed to determine clinical courses and outcomes for all patients, and for those who were discharged from the emergency department, a follow-up survey via a telephone call or SMS text message was performed to identify any patients with missed IAIs or TBIs. The primary outcomes were IAI undergoing acute intervention (therapeutic laparotomy, angiographic embolization, blood transfusion, or intravenous fluid for ≥2 days for pancreatic or gastrointestinal injuries) and clinically important TBI (death from TBI, neurosurgical procedure, intubation for >24 hours for TBI, or hospital admission of ≥2 nights due to a TBI on CT). Prediction rule accuracy was assessed by measuring rule classification performance, using standard point and 95% CI estimates of the operational characteristics of each prediction rule (sensitivity, specificity, positive and negative predictive values, and diagnostic likelihood ratios). The project was funded in 2016, and enrollment was completed on September 1, 2021. Data analyses are expected to be completed by December 2022, and the primary study results are expected to be submitted for publication in 2023. This study will attempt to validate previously derived clinical prediction rules to accurately identify children at high and very low risk for clinically important IAIs and TBIs. Assuming successful validation, widespread implementation is then indicated, which will optimize the care of children who are injured by better aligning CT use with need. RR1-10.2196/43027.

Effect of Head Trauma-Related Deaths on Corneal Endothelial Cell Loss in Eye Bank Donors.

The purpose of this study was to examine the effect of head trauma-related deaths on corneal endothelial cell density (ECD) in eye bank donors. This is a retrospective study of 287 corneas from donors with causes of death secondary to motor vehicle accident with sustained head trauma (n = 50), gunshot wound to the head (n = 138), fall with sustained head trauma (n = 2), and non-head-related traumatic causes of death (n = 97). Donors older than age 50 years were excluded due to concern for undiagnosed Fuchs endothelial dystrophy as a potential confounder for the cause of endothelial cell loss. Donor characteristics, ECD, and focal endothelial cell loss on specular microscopy were compared between the groups. Donors in the head trauma and nonhead trauma groups were matched by age; there were 42 age-matched donors in both groups. Age and ECD were negatively correlated (Pearson correlation coefficient = -0.57). Death-to-preservation time was not significantly different between the 2 groups ( P value = 0.59). The mean ECD in the head trauma group was 2859 ± 370 cells/mm 2 and 3041 ± 464 cells/mm 2 in the nonhead trauma group. The head trauma group had a lower ECD (178 ± 70 cells/mm 2 , P value = 0.013). After matching for age, the difference in ECD between the 2 groups was -94 ± 82 cells/mm 2 ( P value = 0.26). The adjusted odds of having focal endothelial cell loss was not statistically significant ( P value = 0.50) between the groups. After statistical adjustments, there were no differences between the head trauma and nonhead trauma groups.

High Intensity Focus Ultrasound Stimulation of Spleen Reduces Traumatic Bleeding in Mice

Introduction: Uncontrolled hemorrhage is the most common preventable cause of traumatic death. Direct pressure or tourniquets limit extremity bleeding, but non-compressible hemorrhage requires surgical control. Systemic hemostatic therapies are limited. In preclinical models of hemorrhage, electrical vagus nerve stimulation (VNS) accelerates thrombosis and decreases traumatic hemorrhage in a spleen-dependent manner. Here, we demonstrate that non-invasive high intensity focused ultrasound (HIFU) stimulation targeting the spleen significantly reduces bleeding in a murine tail transection model. Methods: Adult male C57BL/6J mice were anesthetized (ketamine/xylazine), placed in the right lateral decubitus position, and shaved after identifying the spleen by anatomical markers and palpation. The ultrasound probe was directed at the splenic hilum, followed by 1 min stimulation (1.1 MHz, 200 mV/pulse, 150 burst cycles, 500 μs burst period), a 30 s rest, and 1 min stimulation for a 5 min total stimulation. Animal tails were warmed in water (37°C, 5 min), transected 2 mm from the tip, and bled into water until hemorrhage stops for a minimum of 10 s to record the duration of bleeding (bleeding time). Results: Compared with sham stimulation, HIFU significantly reduces bleeding time after tail transection (Sham = 110.5 ± 7.7 s vs HIFU = 72.9 ± 6.6 s, Mean ± SEM, n = 10/group, p < 0.01 (two-tailed t-test). Conclusion: These data demonstrate that HIFU stimulation of the spleen provides a novel method to reduce traumatic hemorrhage. HIFU warrants additional study in traumatic and surgical bleeding, and as a treatment for bleeding disorders.

A feasibility study using sodium alginate injection for penetrating abdominal trauma in a swine model

Penetrating abdominal injury is a major cause of death in trauma. Sodium alginate hydrogel, a hemostatic agent, offers a platform for targeting both mechanical and biological injuries. The current study assessed the effect of Very Low Viscosity (high) G (VLVG) alginate following abdominal trauma in a swine model of penetrating abdominal injury. Seven anesthetized pigs were instrumented with invasive monitoring catheters and abdominal trauma was introduced by laparoscopic hepatectomy. Ten minutes after the induction of hypovolemic shock, three animals were intra-abdominally administered with VLVG alginate (study group) and four animals with saline (control group). During 8 h of continuous monitoring, various hemodynamic and biochemical variables were measured and liver biopsies for histological evaluation were taken. Hemodynamically, VLVG alginate-treated animals were more stable than controls, as reflected by their lower heart rate and higher blood pressure (p < 0.05 for both). They also had lower levels of liver enzymes and lactate, and less histopathological damage. We show that VLVG alginate might be a promising new agent for reducing penetrating intra-abdominal injury, with hemostatic and biocompatibility efficiency, and tissue preserving properties. Future effort of integrating it with a dispersal device may turn it into a valuable pre-hospital emergency tool to improve survival of trauma casualties.