Injury Morbidity Research Articles

Idiopathic Proximal Tibiofibular Joint Laxity in a Collegiate Baseball Player: A Case Report

Objective: Present a clinical case detailing the assessment and management of a collegiate baseball player suffering from symptomatic laxity of the proximal tibiofibular joint. Background: Injuries to the proximal tibiofibular joint are rare, and generally accompanied by some form of trauma. Typically, dislocations of the proximal tibiofibular joint occur in an anterior direction, and require reduction and possible fixation as a first course of treatment. Treatment: A 20-year-old collegiate baseball player reported to the athletic training clinic complaining of idiopathic lateral right knee pain. The patient could not recall a mechanism, but recalled an insidious onset of pain that had begun two months prior to reporting to the athletic training staff. There has been some documentation of patients presenting with congenitally lax proximal tibiofibular ligaments, but at this time there is no demographic information on this patient population. Uniqueness: Most cases of proximal tibiofibular laxity occur as a result of trauma. In this patient’s case, there was no specific mechanism of injury or site morbidity to suggest an injury had occurred. Additionally, the patient was able to develop dynamic, and functional stability before regaining static stability. Conclusion: Anatomical abnormalities offer clinicians a unique opportunity to explore multiple levels of problem solving and patient assessment. Further research needs to be conducted to provide demographic data and treatment options for patients suffering from proximal tibiofibular joint laxity.

Functional outcomes in pelvic fractures and the factors affecting them– A short term, prospective observational study at a tertiary care hospital

BackgroundPelvic fractures are markers of high energy trauma and are associated with significant morbidity and mortality. With evolution of modern diagnostic tools and intervention their management has come a long way. Research questionWhether or not modern healthcare could provide the victims of such high energy trauma with a good functional outcome and optimal quality of life, such that they are able to perform their activities of daily living independently? ObjectivesTo evaluate the functional outcomes in pelvic fractures and to find out factors that could indicate the prognosis. MethodologyOurs is a prospective observational study with 75 patients at a tertiary care hospital between September 2015 to December 2016. The minimum duration of follow up was six months. Patients' demographic profile, mode and pattern of injury, associated injuries, management and subsequent complications, if any were recorded prospectively. Functional outcomes were assessed using the Majeed score. All preoperative parameters were correlated statistically with the Majeed score to find out their association. ResultsMajeed scores were excellent in 27 patients, good in 29 patients, fair in 12 patients and poor in 7 patients. Overall functional outcome were good due to availability of sophisticated diagnostic tools, dedicated trauma management team and experienced pelvi-acetabular surgeon. Poorer outcomes were seen in male gender, associated urogenital injuries, associated acetabulum and sacrum fractures, associated nerve injuries and bedsore. No association were seen with age, fracture pattern, treatment modality and timing of surgery. ConclusionWith modern day diagnostic and therapeutic modalities the functional outcome a patient could achieve is promising. With associated risk factors guiding the outcome, the health care provider can individualise the management and decrease the overall morbidity and mortality of such high energy injuries.

Elaborated plan for incoming surgical emergency management in Sub-Saharan Africa.

BackgroundGlobally, there has been an increase in injuries as a major cause of death. This burden is mainly due to an increase in road traffic injuries, and it poses an enormous burden in low- and middle-income countries. Musculoskeletal and head injuries are the most prevalent ones, which has led to an overcrowding of traumatic surgical emergencies.MethodologyAn unrestricted search was done in different research databases for articles published in English between January 2005 and November 2017 focusing on traumatic surgical emergencies.ResultsThe past several decades on the global health landscape are notable for increases in traumatic surgical emergencies. Although this burden of surgical emergencies is universal, high-income countries have implemented measures including mass casualty incident management, which continuously reduces the mortality and morbidity of trauma-related injuries. Nonindustrialized countries are facing almost the same burden, but there is still a lack of enough sustainable measures for combating this burden. Nevertheless, the Rwandan pre-hospital emergency care service (SAMU) which integrate pre-hospital services, has contributed a lot in the management of emergencies in Rwanda. Limb and head injuries are increasing, and there is a trend that this would continue.ConclusionA global upward shift in traumatic surgical emergencies was noted for the past several decades. This trend will continue, and it poses a significant burden in Sub-Saharan Africa, along with worldwide. The Sub-Saharan African mortality and morbidity rates are increasing in regard to traumatic surgical emergencies. Task shifting, initiation of similar systems such as SAMU, increase in workforce, conducting enough research, mass casualty incident protocols implementation, and zero tolerance in regard to alcohol or psychoactive substances by road users are recommendations from this review.

Research round-up

The effects of co-occurring mental illness and substance use disorder on injury in recently released prisoners is highlighted in a study by Young and colleagues. Researchers analysed data for 1307 adults (median follow-up 495 days [IQR 163–958]) released from prison in Queensland, Australia. The crude rate for hospital contact for injury was 996 per 1000 person-years (95% CI 893–1112) in individuals with co-occurring mental illness and substance use disorder compared with 275 (247–307) in individuals with no mental illness. Relative to recently released prisoners without mental illness, individuals with both mental illness and substance use disorder had increased risk for injury (adjusted hazard rate ratio 3·27, 95% CI 2·30–4·64; p<0·0001), as did individuals with mental illness alone (1·87, 1·19–2·95; p=0·0071). Dual diagnosis of mental illness and substance use disorder and injury in adults recently released from prison: a prospective cohort studyPeople released from prison experience high rates of injury compared with the general population. Among people released from prison, dual diagnosis is associated with an increased risk of injury. Contact with the criminal justice system is a key opportunity to prevent subsequent injury morbidity in people with co-occurring mental health disorders. Engagement with integrated psychiatric and addiction treatment delivered without interruption during the transition from prison into the community might prevent the injury-related disparities experienced by this vulnerable group. Full-Text PDF Open Access

Characteristics of sports and recreation-related emergency department visits among school-age children and youth in North Carolina, 2010\u20132014

BackgroundSports and recreational activities are an important cause of injury among children and youth, with sports-related traumatic brain injuries (TBIs) being of particular concern given the developing brain. This paper reports the characteristics of sport and recreation-related (SR) emergency department (ED) visits among school-age children and youth in a statewide population.MethodsThis study included all injury-related visits made to all North Carolina 24/7 acute-care civilian hospital-affiliated EDs by school-age youth, 5–18 years of age, during 2010–2014 (N = 918,662). Population estimates were based on US decennial census data. Poisson regression methods were used to estimate incidence rates and rate ratios.ResultsDuring the five-year period, there were 767,075 unintentional injury-related ED visits among school-age youth, of which 213,518 (27.8%) were identified as SR injuries. The average annual absolute number and incidence rate (IR) of SR ED visits among school-age youth was 42,704 and 2374.5 ED visits per 100,000 person-years (95% confidence interval [CI], 2364.4–2384.6), respectively. In comparison to other unintentional injuries among school-age youth, SR ED visits were more likely to be diagnosed with an injury to the upper extremity (Injury Proportion Ratio [IPR] = 1.28; 95% CI, 1.27–1.29), the lower extremity (IPR = 1.14; 95% CI, 1.13–1.15), and a TBI or other head/neck/facial injury (IPR = 1.12; 95% CI, 1.11–1.13).Among ED visits made by school-age youth, the leading cause of SR injury was sports/athletics played as a group or team. The leading cause of team sports/athletics injury was American tackle football among boys and soccer among girls. The proportion of ED visits diagnosed with a TBI varied by age and sex, with 15–18 year-olds and boys having the highest population-based rates.ConclusionsSports and recreational activities are an important component of a healthy lifestyle, but they are also a major source of injury morbidity among school-age youth. Physical activity interventions should take into account sex and age differences in SR injury risk.

Dual diagnosis of mental illness and substance use disorder and injury in adults recently released from prison: a prospective cohort study

People with mental illness and substance use disorder are over-represented in prisons. Injury-related mortality is elevated in people released from prison, and both mental illness and substance use disorder are risk factors for injury. Effective care coordination during the transition between criminal justice and community service providers improves health outcomes for people released from prison. However, the health outcomes and support needs of people with dual diagnosis (co-occurring mental illness and substance use disorder) released from prison are poorly understood. Here we aim to examine the association between dual diagnosis and non-fatal injury in adults released from prison. Pre-release interview data collected between Aug 1, 2008, and July 31, 2010, from a representative sample of sentenced adults (≥18 years) in Queensland, Australia, were linked, retrospectively and prospectively, to person-level, state-wide emergency department and hospital records. We identified dual diagnoses from inpatient, emergency department, and prison medical records. We modelled the association between mental health status and all injury resulting in hospital contact by fitting a multivariate Cox regression, adjusting for sociodemographic, health, and criminogenic covariates, and replacing missing covariate data by multiple imputation. In 1307 adults released from prison, there were 2056 person-years of follow-up (median 495 days, IQR 163-958). The crude injury rates were 996 (95% CI 893-1112) per 1000 person-years for the dual diagnosis group, 538 (441-657) per 1000 person-years for the mental illness only group, 413 (354-482) per 1000 person-years for the substance use disorder only group, and 275 (247-307) per 1000 person-years for the no mental disorder group. After adjusting for model covariates, the dual diagnosis (adjusted hazard rate ratio 3·27, 95% CI 2·30-4·64; p<0·0001) and mental illness only (1·87, 1·19-2·95; p=0·0071) groups were at increased risk of injury after release from prison compared with the group with no mental health disorders. People released from prison experience high rates of injury compared with the general population. Among people released from prison, dual diagnosis is associated with an increased risk of injury. Contact with the criminal justice system is a key opportunity to prevent subsequent injury morbidity in people with co-occurring mental health disorders. Engagement with integrated psychiatric and addiction treatment delivered without interruption during the transition from prison into the community might prevent the injury-related disparities experienced by this vulnerable group. The development of targeted injury prevention strategies for people with dual diagnosis released from prison is warranted. National Health and Medical Research Council.

The Epidemiology of Unintentional and Violence-Related Injury Morbidity and Mortality among Children and Adolescents in the United States.

Injuries and violence among young people have a substantial emotional, physical, and economic toll on society. Understanding the epidemiology of this public health problem can guide prevention efforts, help identify and reduce risk factors, and promote protective factors. We examined fatal and nonfatal unintentional injuries, injuries intentionally inflicted by other (i.e., assaults and homicides) among children ages 0–19, and intentionally self-inflicted injuries (i.e., self-harm and suicides) among children ages 10–19. We accessed deaths (1999–2015) and visits to emergency departments (2001–2015) for these age groups through the Centers for Disease Control and Prevention’s (CDC) Web-based Injury Statistics Query and Reporting System (WISQARS), and examined trends and differences by age, sex, race/ethnicity, rural/urban status, and injury mechanism. Almost 13,000 children and adolescents age 0–19 years died in 2015 from injury and violence compared to over 17,000 in 1999. While the overall number of deaths has decreased over time, there were increases in death rates among certain age groups for some categories of unintentional injury and for suicides. The leading causes of injury varied by age group. Our results indicate that efforts to reduce injuries to children and adolescents should consider cause, intent, age, sex, race, and regional factors to assure that prevention resources are directed at those at greatest risk.

Trends in injury morbidity in China, 1993–2013: A longitudinal analysis of population-based survey data

Understanding long-term trends in injury morbidity is critical to prevention and intervention planning. The aim of this study was to assess long-term trends in injury morbidity rates in China from 1993 to 2013. Using data from the National Health Service Survey (NHSS), which is conducted every five years, crude and age-standardized prevalence during the previous two weeks and hospitalization rates in the last 12 months with 95% confidence intervals (CI) were calculated. The Rao-Scott Chi-square test examined injury morbidity differences across the five survey years by location (urban/rural), sex, age group, and household income. Percent changes in morbidity rate were approximated using logistic regressions. Sampling weights were applied to all analyses. In 2013, crude two-week injury prevalence in China was 0.46% (95% CI: 0.40%, 0.52%) and 12-month crude hospitalization rate was 0.70% (95% CI: 0.63%, 0.77%). Age-standardized injury prevalence increased 31.4% (95% CI: 7.6%, 60.6%) between 1993 and 2013 (29.4%, 95% CI: 6.7%, 56.9% from 1993–2003; 1.6%, 95% CI: -14.8%, 21.0% from 2003–2013), and age-standardized hospitalization rates rose 107.2% (95% CI: 75.1%, 145.2%) from 1993 to 2013 (-9.5%, 95% CI: -24.6%, 8.6% from 1993–2003 and 129.0%, 95% CI: 93.9%, 170.4% from 2003–2013). Subgroup analyses showed similar trends over time. The leading cause of injury was dislocation, sprain or strain for prevalence, and fractures for hospitalization. In conclusion, injury morbidity increased substantially from 1993 to 2013 in China. Inconsistent changes in two-week prevalence and 12-month hospitalization rate merit attention from researchers and policy-makers.

Chronic Neurological Morbidities and Elevated Hippocampal Calcium Levels in a DFP-Based Rat Model of Gulf War Illness

Over 20 yr have elapsed since the end of the First Gulf War, yet approximately one-third of the veterans exhibit Gulf War Illness (GWI) symptoms, particularly depression and memory impairments. Exposure to organophosphate (OP) compounds is implicated for GWI development. The role of calcium (Ca2+) signaling in learning, memory, and mood is well established and disruptions in Ca2+ homeostasis are observed in many neurological disorders. However, the status of Ca2+ homeostasis in the development of GWI behavioral impairments is not known. Male Sprague-Dawley rats were exposed to OP agent diisopropyl fluorophosphate (DFP; 0.5 mg/kg, s.c. 5 days), and at 6 mo post-DFP exposure, rats were subjected to behavioral assays for the determination of GWI neurological morbidities. Fura-2AM loaded acutely isolated hippocampal neurons were used for [Ca2+]i estimations. We observed chronic depressive symptoms and cognitive deficits in rats exposed to repeated low-dose DFP. The GWI rats also manifested elevations in hippocampal [Ca2+]i along with a significant increase in the number of neurons displaying these elevations. As Ca2+ is a major second-messenger molecule, such sustained increases in its levels could activate multiple signaling cascades and alter gene expression of proteins involved in synaptic plasticity and possibly underlie the neuronal injury and chronic morbidities in GWI.

The Public Health Challenge of Consumer Non-Compliance to Toy Product Recalls and Proposed Solutions.

This paper addresses the public health issue of toy product recalls in the United States, an under-addressed topic in scholarly literature, yet highly relevant to the prevention of pediatric injuries. Toy-related injuries led to 274,000 emergency room visits and seven fatalities in 2016 in the United States, and toy-related injury rates have remained stable over the last five years despite declining incidences of recalls. While dangerous toys not being recalled and the misuse of “safe” products are possible contributing factors, consumer non-response to recall notices also contributes to unintentional child injury from dangerous toys. We discuss the process of recalling toys, and the role of the U.S. Consumer Product Safety Commission in that process. We also review potential factors behind significant consumer non-response to recall notifications, citing economic and psychological theories as explanations for the actions of multiple stakeholders in the recall process. We close by proposing reforms at the regulatory, consumer, and retailer levels that might boost compliance with recall notifications and ultimately reduce injury morbidity and mortality.

Ecological study of road traffic injuries in the eastern Mediterranean region: country economic level, road user category and gender perspectives

BackgroundThe Eastern Mediterranean region has the second highest number of road traffic injury mortality rates after the African region based on 2013 data, with road traffic injuries accounting for 27% of the total injury mortality in the region. Globally the number of road traffic deaths has plateaued despite an increase in motorization, but it is uncertain whether this applies to the Region. This study investigated the regional trends in both road traffic injury mortality and morbidity and examined country-based differences considering on income level, categories of road users, and gender distribution.MethodsRegister-based ecological study linking data from Global Burden of Disease Study with the United Nations Statistics Division for population and World Bank definition for country income level. Road traffic injury mortality rates and disability-adjusted life years were compiled for all ages at country level in 1995, 2005, 2015 and combined for a regional average (n = 22) and a global average (n = 122). The data were stratified by country economic level, road user category and gender.ResultsRoad traffic injury mortality rates in the Region were higher than the global average for all three reference years but suggest a downward trend. In 2015 mortality rates were more than twice as high in low and high income countries compared to global income averages and motor vehicle occupants had a 3-fold greater mortality than the global average. Severe injuries decreased by more than half for high/middle income countries but remained high for low income countries; three times higher for males than females.ConclusionDespite a potential downward trend, inequalities in road traffic injury mortality and morbidity burden remain high in the Eastern Mediterranean region. Action needs to be intensified and targeted to implement and enforce safety measures that prevent and mitigate severe motor vehicle crashes in high income countries especially and invest in efforts to promote public, active transport for vulnerable road users in the resource poor countries of the Region.

Mechanistic Differences in Neuropathic Pain Modalities Revealed by Correlating Behavior with Global Expression Profiling

SUMMARYChronic neuropathic pain is a major morbidity of neural injury, yet its mechanisms are incompletely understood. Hypersensitivity to previously non-noxious stimuli (allodynia) is a common symptom. Here, we demonstrate that the onset of cold hypersensitivity precedes tactile allodynia in a model of partial nerve injury, and this temporal divergence was associated with major differences in global gene expression in innervating dorsal root ganglia. Transcripts whose expression change correlates with the onset of cold allodynia were nociceptor related, whereas those correlating with tactile hypersensitivity were immune cell centric. Ablation of TrpV1 lineage nociceptors resulted in mice that did not acquire cold allodynia but developed normal tactile hypersensitivity, whereas depletion of macrophages or T cells reduced neuropathic tactile allodynia but not cold hypersensitivity. We conclude that neuropathic pain incorporates reactive processes of sensory neurons and immune cells, each leading to distinct forms of hypersensitivity, potentially allowing drug development targeted to each pain type.

Determination of the burden of spinal cord injury and limb amputation as a result of the bam earthquake in 2004

Background and Objectives: This study aimed at investigating the burden of injuries, including spinal cord injuries and limb amputation, caused by the Bam earthquake. Materials and Methods: The data related to morbidity of spinal cord injuries were collected from records provided by State Welfare Organization of Iran. Then, morbidity and mortality data for amputation and also mortality of spinal cord injuries were obtained from a previous study using the network scale-up method. Then, we followed the World Health Organization guidelines to assess the burden of this disease, and then years of life lost (YLL) and years of life lost due to disability (YLD) were calculated. Results: The disability-adjusted life years (DALYs) caused by the spinal cord injury were 15,435 years. YLL due to premature mortality was 13,134 and YLD was 2301 years and the number of DALY caused by limb amputation was equal to 2184, all of which were due to YLD. Conclusions: According to the results of the present study, spinal cord injuries and amputations resulting from the earthquake impose many burdens on society. This provides outcomes and evidence for policymaking and planning in the field of health care for policymakers.

A Study of Systemic Factors Affecting Mortality and Morbidity of Traumatic Brain Injury

A Study of Systemic Factors Affecting Mortality and Morbidity of Traumatic Brain Injury

Successful non-operative management of blunt abdominal trauma in highly selective cases: A safe and effective choice.

The non-operative management (NOM) of abdominal injuries has gained wide acceptance over the last few decades. The present study evaluated the efficacy of NOM in blunt abdominal trauma (BAT) at a regional Hellenic hospital. We analyzed the results of a pre-decided treatment protocol, which was applied to all patients hospitalized for BAT, from 2008 to 2015. The protocol proposed NOM in hemodynamically stable patients with no signs of peritonitis. The demographic characteristics, type of injury, injured organ(s), type of management (operative vs. non-operative), Injury Severity Score (ISS), morbidity, mortality rates, and health costs were evaluated. One hundred and forty-six patients hospitalized for BAT at our department were included. Among them, 49 were operated and 97 were subjected to NOM. Although ISS was significantly higher in the surgical group, the severity of injuries in liver, spleen, and kidneys was not different between the two groups. Surprisingly, no case subjected to NOM required a conversion to operative management, which may probably be because of the strict inclusion criteria for NOM. Patients with hemodynamic stability and normal physical examination may be non-operatively treated, independent of the grade of injury, in highly selective cases. ISS score is an independent risk factor for surgical treatment.

Development of the International Alcohol Policy and Injury Index

ABSTRACTObjectiveTo develop a new index to measure the effectiveness of alcohol control policies on selected indicators of alcohol-related injuries.MethodsWe used the World Health Organization Global Information System on Alcohol and Health (GISAH) for cross-sectional data from 156 countries for this analysis. Five policy domains were selected: physical availability, drinking context, pricing, advertising, and vehicular. Injury mortality and alcohol-attributable fractions (AAFs) for vehicular deaths were also used for the same countries. We created a new composite indicator, the International Alcohol Policy Injury Index (IAPII), in order to assess the association between policy and deaths due to alcohol-related injury.ResultsAfter we controlled for per-capita alcohol consumption, we found that injury deaths and AAF deaths were inversely associated with four of the five policy domains. The domains were weighted according to effectiveness and used to construct the IAPII, which produced acceptable sensitivity and specificity. Regression results, controlling for consumption, demonstrated that the IAPII was significantly associated with AAF vehicular injury death for males, AAF vehicular injury death for females, and overall injury death at p < 0.01.ConclusionsOur findings support the IAPII as a reliable indicator of the relationship between alcohol policies and injury deaths: the stronger the policy, the less the likelihood of both overall and vehicular injury death. Future work should test the effectiveness of the IAPII in reducing alcohol-related injury morbidity, which accounts for a larger share of the global burden of disease than alcohol-related injury mortality does.

Isolated iliac vascular injuries and outcome of repair versus ligation of isolated iliac vein injury

ObjectiveThe incidence of morbidity and mortality for iliac vascular injuries in the literature are likely overestimated owing to associated injuries. Data for isolated iliac vascular injuries are very limited. No large studies have reported the incidence of morbidity for repair versus ligation of isolated iliac vein injuries. MethodsPatients in the National Trauma Data Bank (NTDB; 2007-2012) with at least one iliac vascular injury were analyzed. Isolated iliac vessels were defined as cases with Abbreviated Injury Scale severity score of greater than 3 for extraabdominal injuries and an Organ Injury Scale grade of greater than 3 for intraabdominal injuries. ResultsOverall, 6262 iliac vascular injuries (2809 penetrating, 3453 blunt) were identified in 271,076 patients with abdominal trauma (2.3%). There were 3379 patients (1841 penetrating, 1538 blunt) with isolated iliac vascular injuries (1.2%) and 557 patients (514 penetrating, 43 blunt) with combined iliac artery and vein injuries (0.2%). The 30-day mortality rate was 16.5% for isolated iliac vein injury, 19.3% for isolated iliac artery injury, and 48.7% for combined isolated iliac artery and vein injury. The 30-day mortality rate was 23.4% for isolated iliac vascular injuries compared with 39.0% for nonisolated iliac vascular injuries (P < .001). Patients with isolated iliac vein injuries had morbidity rates of deep venous thrombosis (repair, 14.6%; ligation, 14.1%; P = .875), pulmonary embolism (repair, 1.8%; ligation, 0.5%; P = .38), fasciotomy (repair, 9.3%; ligation, 14.6%; P = .094), amputation (repair, 1.8%; ligation, 2.6%; P = .738), acute kidney injury (repair, 5.8%; ligation, 4.7%; P = .627). Multivariate logistic regression demonstrated that ligation of isolated iliac vein injuries had an odds ratio of 2.2 for mortality compared with repair (95% confidence interval, 1.08-4.66). ConclusionsIsolated iliac vascular injuries are associated with a high incidence of mortality, especially for combined venous and arterial injury, but mortality is significantly lower than in patients with nonisolated iliac vascular injuries. In patients with isolated iliac vein injuries, mortality was higher in patients who underwent ligation compared with repair; however, the rates of deep venous thrombosis, pulmonary embolism, fasciotomy, amputation, and acute kidney injury were not different between the treatment groups. These data lend credence to the assessment that repair of iliac vein injuries is preferable to ligation whenever feasible.

Geospatial relationship of road traffic crashes and healthcare facilities with trauma surgical capabilities in Nairobi, Kenya: defining gaps in coverage

BackgroundRoad traffic injuries (RTIs) are a cause of significant morbidity and mortality in low- and middle-income countries. Access to timely emergency services is needed to decrease the morbidity and mortality...

Treatment strategies for carotid artery penetrating injury: a case report and literature review

BackgroundThe carotid artery is an important blood vessel in the human body. Its ruptures caused by accidents can be lethal cases without timely treatment. Currently, successful rescue cases have rarely been reported, hence we present the following case.Case presentationA patient who was a 46-year-old male admitted due to left neck trauma that lasted almost a day. The CT angiography (CTA) of the neck showed two pseudoaneurysms: one on the anterior wall and one on the posterior wall of the carotid artery. In our case, we considered an open approach to reconstruct the carotid artery. After excision of the aneurysm, the internal carotid artery was stitched. Electrophysiological monitoring and shunt were used during the operation. The postoperative course was uneventful, and the patient remains free of symptoms.ConclusionsMany departments jointly and positive and effective surgical intervention are the key to reduce morbidity and mortality of carotid artery penetrating injury.

Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta‐Analysis

The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR]=0.72 [0.65-0.80]) and helicopter transport (OR=0.70 [0.55-0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD]=5.7 [4.4-7.0]) but a nonsignificant reduction in mortality (OR=0.78 [0.44-1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD=0.58 [-0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR=0.76 [0.68-0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.