Differences In Injury Severity Research Articles

The impact of post-operative enteral nutrition on duodenal injury outcomes: A post hoc analysis of an EAST multicenter trial.

Leak following surgical repair of traumatic duodenal injuries results in prolonged hospitalization and oftentimes nil per os(NPO) treatment. Parenteral nutrition(PN) has known morbidity; however, duodenal leak(DL) patients often have complex injuries and hospital courses resulting in barriers to enteral nutrition(EN). We hypothesized EN alone would be associated with 1)shorter duration until leak closure and 2)less infectious complications and shorter hospital length of stay(HLOS) compared to PN. This was a post-hoc analysis of a retrospective, multicenter study from 35 Level-1 trauma centers, including patients >14 years-old who underwent surgery for duodenal injuries(1/2010-12/2020) and endured post-operative DL. The study compared nutrition strategies: EN vs PN vs EN + PN using Chi-Square and Kruskal-Wallis tests; if significance was found pairwise comparison or Dunn's test were performed. There were 113 patients with DL: 43 EN, 22 PN, and 48 EN + PN. Patients were young(median age 28 years-old) males(83.2%) with penetrating injuries(81.4%). There was no difference in injury severity or critical illness among the groups, however there were more pancreatic injuries among PN groups. EN patients had less days NPO compared to both PN groups(12 days[IQR23] vs 40[54] vs 33[32],p = <0.001). Time until leak closure was less in EN patients when comparing the three groups(7 days[IQR14.5] vs 15[20.5] vs 25.5[55.8],p = 0.008). EN patients had less intra-abdominal abscesses, bacteremia, and days with drains than the PN groups(all p < 0.05). HLOS was shorter among EN patients vs both PN groups(27 days[24] vs 44[62] vs 45[31],p = 0.001). When controlling for predictors of leak, regression analysis demonstrated EN was associated with shorter HLOS(β -24.9, 95%CI -39.0 to -10.7,p < 0.001). EN was associated with a shorter duration until leak closure, less infectious complications, and shorter length of stay. Contrary to some conventional thought, PN was not associated with decreased time until leak closure. We therefore suggest EN should be the preferred choice of nutrition in patients with duodenal leaks whenever feasible. IV.

Injury Pattern and Current Early Clinical Care of Pediatric Polytrauma Comparing Different Age Groups in a Level I Trauma Center.

Introduction: Pediatric polytrauma is a complex condition with unique characteristics and requirements for early clinical care. This study aimed to analyze the injury patterns, early clinical care, and outcomes of pediatric polytrauma patients in a Level I trauma center. The focus was on evaluation between different age groups and the recognition of injuries as potential factors influencing outcomes. Methods: A prospective cohort study model of pediatric polytrauma patients (ISS ≥ 16) was conducted over a 13-year period, stratified by age groups (Group A: 0-5 years; Group B: 6-10 years; Group C: 11-15 years; and Group D: 16-18 years). A comparison of the groups was conducted to examine variations in early clinical care, trauma mechanisms, distribution of affected body regions (as per AIS and ISS criteria), and trauma-related mortality. Additionally, factors contributing to mortality were evaluated. Results: The median age of patients was 16 years, with a male predominance (64.7%). The Injury Severity Score (ISS) varied across age groups, with no significant difference. The 30-day mortality rate was 19.0%, with no significant age-related differences. Trauma mechanisms varied across age groups, with motor vehicle accidents being the most common mechanism in all age groups except 0-5 years, where falls were prevalent. Analysis of injury patterns by AIS body regions indicated that head trauma was a significant predictor of mortality (Hazard Ratio 2.894, p < 0.001), while chest, abdominal, and extremity trauma showed no significant association with mortality. Multiple regression analysis identified the ISS and preclinical GCS as valid predictors of mortality (p < 0.001 and p = 0.006, respectively). Conclusions: While age-related differences in injury severity and clinical interventions were limited, head trauma emerged as a critical predictor of mortality. Early recognition and management of head injuries are crucial in improving outcomes. Additionally, the ISS and preclinical GCS were identified as valid predictors of mortality, emphasizing the importance of early assessment and resuscitation. A tailored approach to pediatric polytrauma care, considering both age and injury patterns, might contribute to survival benefits in this vulnerable population.

Injuries Among Hispanic/Latinx Agricultural Workers Seen in Illinois Hospitals

ABSTRACT Objective Agriculture is a dangerous industry, with evidence indicating a disproportionate burden among Hispanic/Latinx workers. There is a need to expand the utilization of different data systems to improve the surveillance of precarious workers within agriculture. This analysis describes inclusion criteria to identify farm-related injuries and illnesses in hospital data utilizing ICD-10 codes to better assess health equity issues involving Hispanic/Latinx workers and their associated costs. Methods Discharge data of agriculture-related injuries and illnesses treated in Illinois hospitals and emergency departments from 2018 to 2021 were extracted using ICD-10 diagnosis and location of injury codes. Injury cause, nature, severity, and course of clinical care are stratified by ethnicity. Multivariable models were developed to assess differences in injury severity, level of care required, and cost of care. Results We identified 3,745 farm-related injuries and illnesses treated in Illinois hospitals between 2018 and 2021, of which 196 involved Hispanic/Latinx individuals. Hispanic/Latinx patients were substantially younger and disproportionately covered by workers’ compensation insurance or uninsured. Compared to non-Hispanic/Latinx individuals, Hispanic/Latinx patients suffered injuries from different mechanisms, particularly involving animals and cutting/piercing instruments. While non-Hispanic/Latinx individuals demonstrated more severe injuries based on the descriptive statistics, after controlling for confounding (particularly age), we did not observe ethnic disparities in injury severity or level of care required. However, the cost of care was equivalent to or higher among Hispanic/Latinx persons. Conclusion The case definition used for this analysis identified agriculture-related cases and provided insights on the course of clinical care by ethnicity. This strategy would likely yield valuable information in states with larger and more diverse agricultural workforces. More targeted research to appropriately scope the issue and inform interventions is needed to understand differential exposure and reduce agricultural workplace hazards and address the financial burden resulting from farm-related injuries.

Exploring differences in injury severity between occupant groups involved in fatal rear-end crashes: a correlated random parameter logit model with mean heterogeneity

ABSTRACT Rear-end crashes are one of the most common crash types. Passenger cars involved in rear-end crashes frequently produce severe outcomes. However, no study investigated the differences in the injury severity of occupant groups when cars are involved as following and leading vehicles in rear-end crashes. Therefore, the focus of this investigation is to compare the key factors affecting the injury severity between the front- and rear-car occupant groups in rear-end crashes. First, data is extracted from the Fatality Analysis Reporting System (FARS) for two types of rear-end crashes, including passenger cars as rear-end and rear-ended vehicles. Significant injury severity difference between front- and rear-car occupant groups is found by conducting likelihood ratio test. Moreover, the front- and rear-car occupant groups are modeled by the correlated random parameter logit model with heterogeneity in means (CRPLHM) and the random parameter logit model with heterogeneity in means (RPLHM), respectively. This study provides an insightful knowledge of mechanism of occupant injury severity in rear-end crashes.

Screening for Intimate Partner Violence in Trauma: Results of a Quality Improvement Project

IntroductionIntimate partner violence (IPV) is common, especially among patients presenting with traumatic injury. We implemented an IPV screening program for patients admitted after trauma. We sought to determine whether specific demographic or clinical characteristics were associated with being screened or not screened for IPV and with IPV screen results. MethodsRetrospective cohort study evaluating all patients admitted after trauma from July 2020-July 2022 in an Adult Level 1 Trauma Center. ResultsThere were 4147 admissions following traumatic injury, of which 70% were men and 30% were women. The cohort was 46% White, 20% Asian, 15% Black, and 17% other races. Twenty-three percent were Hispanic or Latino/a. Seventy-seven percent were admitted for blunt injuries and 16% for penetrating injuries. Thirteen percent (n = 559) of the cohort was successfully screened for IPV. Screening rates did not differ by gender, race, or ethnicity. After adjustment for demographic and clinical factors, patients admitted to the intensive care unit were significantly less likely to be screened. Of the screened patients, 30% (165) screened positive. These patients were more commonly Hispanic or Latino/a, insured by Medicaid and presented with a penetrating injury. There were no differences in injury severity in patients who screened positive versus those who screened negative. ConclusionsThere are significant barriers to universal screening for IPV, including injury acuity, in patients admitted following trauma. However, the 30% rate of positive screens for IPV in patients admitted following trauma highlights the urgent need to understand and address barriers to screening in trauma settings to enable universal screening.

A comparative analysis of tranexamic acid dosing strategies in traumatic major hemorrhage.

Tranexamic acid (TXA) is a life-saving treatment for traumatic hemorrhage, but the optimal dosing regimen remains unknown. Different doses and treatment strategies have been proposed, including single bolus, repeated bolus, or bolus plus infusion. The aim of this study was to determine the effect of different TXA dosing strategies on clinical outcomes in bleeding trauma patients. Secondary analysis of a perpetual cohort study from a UK Level I trauma center. Adult patients who activated the local major hemorrhage protocol and received TXA were included. The primary outcome was 28-day mortality. Secondary outcomes were 24-hour mortality, multiple organ dysfunction syndrome, venous thromboembolism, and rotational thromboelastometry fibrinolysis. Over an 11-year period, 525 patients were included. Three dosing groups were identified: 1 g bolus only (n = 317), 1 g bolus +1 g infusion over 8 hours (n = 80), and 2 g bolus (n = 128). Demographics and admission physiology were similar, but there were differences in injury severity (median Injury Severity Score, 25, 29, and 25); and admission systolic blood pressure (median Systolic Blood Pressure, 99, 108, 99 mm Hg) across the 1-g, 1 g + 1 g, and 2-g groups. 28-day mortality was 21% in each treatment group. The incidence of multiple organ dysfunction syndrome was significantly higher in the bolus plus infusion group (84%) vs. 1 g bolus (64%) and 2 g bolus (62%) group, p = 0.002, but on multivariable analysis was nonsignificant. Venous thromboembolism rates were similar in the 1-g bolus (4%), 2 g bolus (8%) and bolus plus infusion groups (7%). There was no difference in rotational thromboelastometry maximum lysis at 24 hours: 5% in both the 1-g and 2-g bolus groups vs. 4% in bolus plus infusion group. Clinical outcomes and 24-hour fibrinolysis state were equivalent across three different dosing strategies of TXA. Single bolus administration is likely preferable to a bolus plus infusion regimen. Therapeutic/Care Management; Level III.

Temporal Instability Analysis of Injury Severities for Angle and Non-Angle Crashes at Roundabouts

Roundabout crashes are common worldwide but have received little attention. In particular, the investigation remains relatively understudied in distinct collision modes of roundabout crashes, including angle and non-angle crashes. This study investigates differences in factors affecting injury severity between angle and non-angle crashes and how these differences change over time. Random parameter logit models with heterogeneity in mean and variance were estimated using 2012–2019 Florida crash data. Variables considered for the modeling include temporal characteristics, environmental characteristics, road characteristics, spatial characteristics, vehicle characteristics, crash characteristics, and human characteristics. In addition, likelihood ratio tests were used to investigate the temporal instabilities of the models and differences in collision modes. The results showed that only a few variables demonstrated temporally stable effects for angle collisions (weekend and dark-lighted) and non-angle collisions (paved shoulders and cyclists), respectively. Unique influencing factors of injury severity were identified for different collision modes, such as dark-lighted, straight alignment, merge, lane departure, the disabled driver for angle collisions, and clear, fog, commercial vehicles, and aggressive driving for non-angle collisions. The results of the out-of-sample prediction simulations further demonstrate the difference in injury severity over time for angle and non-angle collisions. Overall results suggest that countermeasures can be implemented to reduce the injury severity of angle crashes/non-angle crashes based on the significant variables identified. This study may be used to improve roundabout safety by considering different collision modes.

Disadvantaged Neighborhoods Continue to Bear the Burden of Gun Violence

IntroductionGun violence is a pervasive and dynamic public health crisis causing substantial burden on communities and healthcare systems in the United States. Risk factor and outcome analyses are crucial to develop effective interventions. The aim of this study was to assess firearm injury in a diverse community setting as it relates to neighborhood socioeconomic disadvantage and changes over time following large-scale local interventions. MethodsAll county residents with firearm injury presenting to a Level 1 Trauma Center from January 2012 to December 2021 were retrospectively reviewed. Area Deprivation Index (ADI) was used to measure neighborhood socioeconomic disadvantage based on a nine-digit zip code at patients’ home address. Injuries were also stratified by 5-year time periods, 2012-2016 and 2017-2021. Demographics and clinical data were analyzed including injury severity, hospital course, and discharge location. Data were compared by ADI quintile and between time periods using chi-squared, one-way analysis of variance, and Cochran-Armitage test. ResultsA total of 1044 injuries were evaluated. Patients were 93% male with mean age of 29 y (standard deviation 10.2) and were concentrated in the most disadvantaged neighborhoods (74% ADI Q5). Black or African American race was greater in the most disadvantaged ADI groups (76% versus 47%-66%; P <0.001). Percentage of total injuries in the most disadvantaged ADI group rose from 71% to 78% over time (P = 0.006). Mortality occurred in 154 (15%) patients overall, while most (71%) were discharged to home. Mortality declined from 18% to 11% over time (P <0.001). Medicaid utilization rose from 42% to 77% alongside a decrease in self-pay status from 44% to 4% (P <0.001). There were no clinically significant group differences in injury severity or clinical characteristics. ConclusionsFirearm injury remains concentrated in the most socioeconomically disadvantaged neighborhoods, and this disparity is increasing over time. Medicaid utilization rose and mortality decreased in this population over time. This research presents a method to inform and monitor local gun violence interventions using ADI to address public health equity.

Principal component analysis of a swine injury model identifies multiple phenotypes in trauma.

Trauma is the third leading cause of death in the United States and the primary cause of death for people between the ages of 1 year and 44 years. In addition to tissue damage, trauma may also activate an inflammatory state known as trauma-induced coagulopathy (TIC) that is associated with clotting malfunctions, acidemia, and end-organ dysfunction. Prior work has also demonstrated benefit to acknowledging the type and severity of endothelial injury, coagulation derangements, and systemic inflammation in the management of trauma patients. This study builds upon prior work by combining laboratory, metabolic, and clinical metrics into an analysis of trauma phenotypes, evolution of phenotypes over time after trauma, and significance of trauma phenotype on mortality. Seventy 3-month-old female Yorkshire crossbred swine were randomized to injury and resuscitation groups. Principal component analysis (PCA) of longitudinal swine TEG data (Reaction time, Alpha-Angle, Maximum Amplitude, and Clot Lysis at 30 minutes), pH, lactate, and MAP was completed in R at baseline, 1 hour postinjury, 3 hours postinjury, 6 hours postinjury, and 12 hours postinjury. Subjects were compared by principal component factor scores to assess differences in survival, injury severity, and treatment group. Among injured animals, three phenotypes were observed at each time point. Five phenotypes were associated with differences in survival, and of these, four were associated with differences in injury severity. Phenotype alignment was not significantly different by treatment group. This application of PCA to a set of coagulation, hemodynamic, and organ perfusion variables has identified multiple evolving phenotypes after trauma. Some of these phenotypes may correlate with injury severity and may have implications for survival. Next steps include validating these findings over greater numbers of subjects and exploring other machine-learning techniques for phenotype identification. Level IV, Therapeutic/Care Management.

Temporal instability and differences in injury severity between restrained and unrestrained drivers in speeding-related crashes

Upon detecting a crash impact, the vehicle restraint system locks the driver in place. However, external factors such as speeding, crash mechanisms, roadway attributes, vehicle type, and the surrounding environment typically contribute to the driver being jostled within the vehicle. As a result, it is crucial to model unrestrained and restrained drivers separately to reveal the true impact of the restraint system and other factors on driver injury severities. This paper aims to explore the differences in factors affecting injury severity for seatbelt-restrained and unrestrained drivers involved in speeding-related crashes while accounting for temporal instability in the investigation. Utilizing crash data from Thailand between 2012 and 2017, mixed logit models with heterogeneity in means and variances were employed to account for multi-layered unobserved heterogeneity. For restrained drivers, the risk of fatal or severe crashes was positively associated with factors such as male drivers, alcohol influence, flush/barrier median roadways, sloped roadways, vans, running off the roadway without roadside guardrails, and nighttime on unlit or lit roads. For unrestrained drivers, the likelihood of fatal or severe injuries increased in crashes involving older drivers, alcohol influence, raised or depressed median roadways, four-lane roadways, passenger cars, running off the roadway without roadside guardrails, and crashes occurring in rainy conditions. The out-of-sample prediction simulation results are particularly significant, as they show the maximum safety benefits achievable solely by using a vehicle's seatbelt system. Likelihood ratio test and predictive comparison findings highlight the considerable combined impact of temporal instability and the non-transferability of restrained and unrestrained driver injury severities across the periods studied. This finding also demonstrates a potential reduction in severe and fatal injury rates by simply replicating restrained driver conditions. The findings should be of value to policymakers, decision-makers, and highway engineers when developing potential countermeasures to improve driver safety and reduce the frequency of severe and fatal speeding-related single-vehicle crashes.

Early Tracheostomy in Older Trauma Patient Is Associated With Comparable Outcomes to Younger Cohort

IntroductionEarly tracheostomy (ET) is associated with a lower incidence of pneumonia (PNA) and mechanical ventilation duration (MVD) in hospitalized patients with trauma. The purpose of this study is to determine if ET also benefits older adults compared to the younger cohort. MethodsAdult hospitalized trauma patients who received a tracheostomy as registered in The American College of Surgeons Trauma Quality Improvement Program from 2013 to 2019 were analyzed. Patients with tracheostomy prior to admission were excluded. Patients were stratified into 2 cohorts consisting of those aged ≥65 and those aged <65. These cohorts were analyzed separately to compare the outcomes of ET (<5 d; ET) versus late tracheostomy (LT) (≥5 d; LT). The primary outcome was MVD. Secondary outcomes were in-hospital mortality, hospital length of stay (HLOS), and PNA. Univariate and multivariate analyses were performed with significance defined as P value < 0.05. ResultsIn patients aged <65, ET was performed within a median of 2.3 d (interquartile range, 0.47-3.8) after intubation and a median of 9.9 d (interquartile range, 7.5-13) in the LT group. The ET group's Injury Severity Score was significantly lower with fewer comorbidities. There were no differences in injury severity or comorbidities when comparing the groups. ET was associated with lower MVD (d), PNA, and HLOS on univariate and multivariate analyses in both age cohorts, although the degree of benefit was higher in the less than 65 y cohort [ET versus LT MVD: 5.08 (4.78-5.37), P < 0.001; PNA: 1.45 (1.36-1.54), P < 0.001; HLOS: 5.48 (4.93-6.04), P < 0.001]. Mortality did not differ based on time to tracheostomy. ConclusionsET is associated with lower MVD, PNA, and HLOS in hospitalized patients with trauma regardless of age. Age should not factor into timing for tracheostomy placement.

Drug and alcohol intoxication in major trauma: Associations, trends and outcomes over a decade.

Drug and alcohol intoxication is common among injured patients altering trauma presentation and characteristics. However, uncertainty exists regarding the effect of intoxication on injury severity, as well as outcomes. The present study aims to provide an update on substance-use patterns and their association with traumatic presentation and outcome within a contemporary Australian context. All major trauma patients captured in our centre's Trauma Registry between July 2010 and June 2020 were included. Demographic, injury characteristic, outcome and substance-use data were collected. Differences in injury severity and characteristics were explored using χ2 tests, while outcomes were modelled using adjusted binomial logistic regression. Among 9700 patients, 9% were drug-intoxicated prior to injury, while 9.4% were alcohol-intoxicated. Drug use almost tripled between 2010 (4.8%) and 2020 (13.3%), while alcohol intoxication fell, from 11.7% to 7.3%, over the same period. Although there were significant differences in trauma mechanism among intoxicated patients, group comparison found no difference in Injury Severity Score for any group. Regarding outcomes, all intoxication resulted in significantly greater odds (odds ratio 1.62-2.41) of ICU admission. No difference in mortality was found among individual substance-use groups; however, polysubstance-intoxicated patients had 3.52 times greater odds of dying (95% confidence interval 1.21-10.23) compared to non-intoxicated patients. Within this contemporary Australian population, we demonstrate escalating rates of drug intoxication and declining rates of alcohol intoxication prior to trauma. Intoxication was associated with more frequent violent and non-accidental injury, and despite no difference in severity, it was associated with worse outcomes.

Transfusion-related cost comparison of trauma patients receiving whole blood versus component therapy.

With the emergence of whole blood (WB) in trauma resuscitation, cost-related comparisons are of significant importance to providers, blood banks, and hospital systems throughout the country. The objective of this study was to determine if there is a transfusion-related cost difference between trauma patients who received low titer O+ whole blood (LTO+WB) and component therapy (CT). A retrospective review of adult and pediatric trauma patients who received either LTO+WB or CT from time of injury to within 4 hours of arrival was performed. Annual mean cost per unit of blood product was obtained from the regional blood bank supplier. Pediatric and adult patients were analyzed separately and were compared on a cost per patient (cost/patient) and cost per patient per milliliter (cost/patient/mL) basis. Subgroup analysis was performed on severely injured adult patients (Injury Severity Score, >15) and patients who underwent massive transfusion. Prehospital LTO+WB transfusion began at this institution in January 2018. After the initiation of the WB transfusion, the mean annual cost decreased 17.3% for all blood products, and the average net difference in cost related to component blood products and LTO+WB was more than $927,000. In adults, LTO+WB was associated with a significantly lower cost/patient and cost/patient/mL compared with CT at 4 hours ( p < 0.001), at 24 hours ( p < 0.001), and overall ( p < 0.001). In the severely injured subgroup (Injury Severity Score, >15), WB was associated with a lower cost/patient and cost/patient/mL at 4 hours ( p < 0.001), 24 hours ( p < 0.001), and overall ( p < 0.001), with no difference in the prehospital setting. Similar findings were true in patients meeting massive transfusion criteria, although differences in injury severity may account for this finding. With increased use of LTO+WB for resuscitation, cost comparison is of significant importance to all stakeholders. Low titer O+ WB was associated with reduced cost in severely injured patients. Ongoing analyses may improve resource utilization and benefit overall healthcare cost. Therapeutic/Care Management; Level IV.

Abstract 189: Resuscitative Endovascular Balloon Occlusion Of The Aorta In The Obese Patient

Objectives: Perceptions of difficulty in obtaining arterial access in obese patients may impact the rate of resuscitative endovascular balloon occlusion of the aorta (REBOA) use in clinical practice. Excess adipose tissue can obstruct palpation of anatomic landmarks, limit sonographic visualization, and potentially increase difficulty of REBOA placement. We aimed to examine the association between obesity and REBOA placement, hypothesizing that increased body habitus would decrease success and increase time to successful aortic occlusion (AO). Methods: A retrospective analysis of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry was performed on REBOA patients (2013-2022). Patients with systolic blood pressure &gt; 0mmHg admission were included. Patients requiring CPR on arrival to the ED were excluded. Body mass index (BMI) categorized obesity subgroups as follows: non-obese (&lt;30), mildly obese (30-34.9), moderately obese (35-39.9), and severely obese (40+). Results: Inclusion criteria was met by 410 patients. There was no statistical difference in injury severity or admission systolic blood pressure (SBP) among the subgroups. At initiation of AO, moderately and severely obese patients had higher median SBP compared to non- and mildly obese patients (p=0.03). On multivariate analysis, BMI did not significantly impact the success of REBOA placement or time to successful AO. When stratified by arterial access technique, there was no difference in success rates, time to successful AO, or mortality between groups. Overall time to successful AO, response SBP, and mortality did not differ across subgroups. Conclusion: Following traumatic injury in obese patients, REBOA placement is a feasible intervention. Despite differences in patient body habitus, ultrasound guidance was not superior to landmark palpation for acquiring arterial access. Placement of REBOA is equally effective in obese patients and severe obesity should not impede REBOA use.

Comparative analysis of all-terrain vehicles, motorcycle and automobile-related trauma in a rural border community of the USA

IntroductionThere is widespread use of all-terrain vehicles (ATVs) in the USA for both work-related and recreational activities. In this study, we aimed to determine the difference in injury severity, Glasgow...

Myristoylated Protein Kinase C Beta II Inhibitor Attenuates Renal Injury in Mice Subjected to Severe Bilateral Ischemia‐Reperfusion

Acute kidney injury (AKI) due to ischemia‐reperfusion (I/R) insult involves oxidative stress and inflammation leading to rapid renal decline and remains a significant cause of post‐operative mortality. Myristoylated protein kinase C beta II peptide inhibitor (N‐myr‐SLNPEWNET; myr‐PKCβII‐) is known to attenuate myocardial I/R injury in ex vivo rat hearts. We hypothesized that myr‐PKCβII‐ would attenuate severe renal I/R injury that is characterized by elevated serum creatinine (Cr) and a decrease in glomerular filtration rate (GFR). We predict that treatment with myr‐PKCβII‐ will improve these indices of kidney function compared to a scrambled control peptide (N‐myr‐WNPESLNTE; myr‐PKCβII‐scram).Renal pedicles of anesthetized male C57BL/6J mice (25–30g) were clamped bilaterally for 20 min or 19 min. Five minutes before unclamping, 2.0 mg/kg (20 µM serum) myr‐PKCβII‐ or myr‐PKCβII‐scram were given i.v. into the tail vein. Cr (mg/dL) was measured at baseline, 24h, 72h, and 96h post‐injury. GFR (µl/min) was determined with fluorescein‐isothiocyanate (FITC)‐Sinistrin renal clearance. Data were evaluated by unpaired Student’s t‐test.Following 20‐min renal ischemia (Fig 1.), myr‐PKCβII‐ (n=9) significantly reduced Cr at 24h and 72h post‐injury compared to myr‐PKCβII‐scram control (n=8, p&lt;0.05). However, there were three fatalities prior to 96h. In 19‐min ischemia, there were no fatalities up to 96h post‐injury. However, Cr levels of the myr‐PKCβII‐scram control (n=8) in 19‐min I/R were significantly lower than 20‐min I/R at all time points post‐injury (all p&lt;0.01): 24h (0.54 ± 0.10 vs 1.59 ± 0.06 mg/dL), 72h (0.24 ± 0.06 vs 1.28 ± 0.25 mg/dL), and 96h (0.17 ± 0.03 vs 0.72 ± 0.15 mg/dL). Myr‐PKCβII‐ did not significantly reduce Cr (Fig. 1) nor improve GFR (Fig. 2) following 19‐min I/R.Results suggest that 20‐min renal ischemia was more severe, which was indicated by a 5‐fold increase of peak Cr levels at 72h post‐injury compared to 19‐min ischemia and the unanticipated fatalities of three mice. Myr‐PKCβII‐ attenuated renal injury following 20‐min renal ischemia, but not at the milder 19‐min model in which peak Cr levels were too low to detect therapeutic benefit. The large difference in injury severity between 20‐min and 19‐min renal ischemia emphasizes the temporal relationship between renal function and ischemic duration.Future studies will characterize myr‐PKCβII‐ protection against AKI in 19‐min bilateral renal ischemia based on biomarkers indicating proximal renal tubule damage (e.g. NGAL and Kim‐1). A more optimal ischemic duration between 19 min and 20 min will be investigated for future experiments.

Mortality of adolescents with isolated traumatic brain injury does not vary with type of level I trauma center.

Pediatric patients with isolated severe traumatic brain injury (TBI) treated at pediatric trauma centers (PTCs) have lower mortality than those treated at adult trauma centers (ATCs) or mixed trauma centers (MTCs). The primary objective of this study was to determine if adolescent patients (15-17 years) with isolated severe TBI also benefited from treatment at PTCs. This was a cross-sectional analysis using a national sample of adolescent trauma patients obtained from the American College of Surgeons' Trauma Quality Program Participant Use Files for 2013 to 2017 (n = 3,524). Mortality, the primary outcome variable, was compared between Level I PTCs, ATCs, and MTCs using multiple logistic regression controlling for patient characteristics and injury severity. Secondary outcomes included discharge disposition, utilization of craniotomy, intensive care unit (ICU) utilization, ICU length of stay (LOS), and hospital LOS. Prior to adjustment, patients treated at ATCs (odds ratio [OR], 2.76; p = 0.032) and MTCs (OR, 2.36; p = 0.070) appeared to be at greater risk of mortality than those treated at PTCs. However, after adjustment, this difference disappeared (ATC OR, 1.21; p = 0.733; MTC OR, 0.95; p = 0.919). Patients treated at ATCs and MTCs were more severely injured than those treated at PTCs and more likely to be admitted to an ICU (ATC OR, 2.12; p < 0.001; MTC OR, 1.91; p < 0.001). No other secondary outcome differed between center types. Adolescent patients with isolated severe TBI treated at ATCs and MTCs had similar mortality risk as those treated at PTCs. The difference in injury severity across center types warrants additional research. Prognostic/Epidemiological; Level III.

CPR-related injuries after non-traumatic out-of-hospital cardiac arrest: Survivors versus non-survivors

AimThere have been no direct comparisons of cardiopulmonary resuscitation (CPR)-related injuries between those who die during CPR and those who survive to intensive care unit (ICU) admission. This study aimed to compare the incidence, severity, and impact on survival rate of these injuries and potential influencing factors. MethodThis retrospective multicenter study analyzed autopsy reports of patients who experienced out-of-hospital cardiac arrest (OHCA) and were not admitted to hospital. CPR-related injuries were compared to OHCA patients with clinical suspicion of CPR-related injury confirmed on imaging when admitted to the ICU. ResultsA total of 859 out-of-hospital cardiac arrests (OHCA) were divided into 2 groups: those who died during CPR and underwent autopsy (DEAD [n = 628]); and those who experienced return of spontaneous circulation and admitted to the ICU (ICU [n = 231]). Multivariable analyses revealed that independent factors of 30-day mortality included no bystander arrest, cardiac etiology, no shockable rhythm, and CPR-related injury. Trauma was independently associated with older age, bystander CPR, cardiac etiology, duration of CPR, and no defibrillation. CPR-related injury occurred in 30 (13%) patients in the ICU group and 547 (87%) in the DEAD group (p < 0.0001). Comparison of injuries revealed that those in the DEAD group experienced more thoracic injuries, rib(s) and sternal fractures, and fewer liver injuries compared to those in the ICU group, without differences in injury severity. ConclusionCPR-related injuries were observed more frequently in those who died compared with those who survived to ICU admission. Injury was an independent factor of 30-day mortality.

Injured cyclists with focus on single-bicycle crashes and differences in injury severity in Sweden

While cycling is promoted as a clean, energy-efficient mode of transport generating physical activity, the number of injured cyclists must decrease to achieve traffic safety goals. The extent of the single bicycle crashes (SBCs) and crash causes are rather well studied. This study expands this knowledge by focusing on differences in injury severity. The aim of the study is to investigate the relationship between injury severity and characteristics of the crash and the cyclist with focus on SBCs. Furthermore, injury risk is calculated for different age classes and sexes, as well as for different purposes of the trip.The results are based on injured cyclists in Sweden (N = 105,836) registered in STRADA, 2010–2019, by both the police and accident and emergency departments (A&Es), with a special focus on injury severity reported by the A&Es. Binary logistic regression was applied to analyse how the odds of being severely injured differed for different cyclists and situations. Results from of the National Travel Survey, 2011–2016, were used to study differences in distance travelled with respect to sex, age group and purpose of the trip.Given that the cyclist is injured in an SBC, the results show a higher probability of being severely injured (maximal AIS 3 or more) for cyclists 45 years or older compared to younger cyclists, for males compared to females and for cyclists not wearing a helmet compared to cyclists wearing a helmet. A higher probability for severe injury was also found for crashes occurring during leisure trips compared to work/school trips, crashes occurring during weekdays compared to weekends and crashes at intersections and road stretches compared to pedestrian and cycle paths. Furthermore, the risk of being severely injured in an SBC per km travelled was higher for cyclists aged 45 and older and during a leisure trip.

A comparative study of the midfoot structure of humans and mice by CT measurement: Implications for employing a mouse model to study Lisfranc injury

Although midfoot injury, especially Lisfranc sprain, is a relative rare traumatic pathology, if overlooked or treated incorrectly, the damage will develop into chronic Lisfranc injury, which is characterized by lifelong residual symptoms. The differences in injury severity, healing rates, treatment plans, and patient adherence make prospective investigations of the pathogenesis of Lisfranc injury very difficult to conduct. The development of an animal model that mimics the symptoms of humans with chronic Lisfranc injury has the potential to lessen the challenges associated with prospective human research. Previous research has successfully used a mouse model to explore the biomechanics of the human ankle joint. However, it remains to be determined if the mouse model can mimic human midfoot functions based on their similarities in anatomical structure. In this study, the anatomical structure of the mouse and human midfoot were compared by CT scan. The animal image data were obtained from 10 male C57BL/6J mice (20 feet) by micro-CT. The human data were obtained from six volunteers (six feet) by CT scanning. The three-dimensional skeletal structure of the midfoot was reconstructed, and the morphological parameters were measured by a plane projection method. There were no significant differences among the hindfoot adductus angle (mice: 28.86 ​± ​6.27°; human: 25.45 ​± ​2.70°), metatarsus adductus angle (mice: 11.34 ​± ​2.95°; human: 11.48 ​± ​3.97°), or the transverse arch angle (mice: 111.77 ​± ​4.70°; human: 111.84 ​± ​6.34°) between the mice and humans. The mice had a comparable Lisfranc joint complex architecture compared to humans in both coronal and transverse planes. The lateral cuneiform was fused with the navicular bone in mice, which would provide better intrinsic stability than in humans. Future research is necessary to evaluate the mouse midfoot injury model and the similarities of their neuro-musculo-skletal systems with humans.