Result Of Trauma Research Articles

Association between nutritional status, injury severity, and physiological responses in trauma patients

PurposeTo evaluate the predictive value of the Controlling Nutritional Status (CONUT) score and Injury Severity Score (ISS) in assessing physiological abnormalities and outcomes in trauma patients.MethodsA retrospective analysis was conducted on 354 trauma patients. Physiological parameters were assessed, including cardiovascular function, inflammatory response, liver and kidney function, and nutritional status. The CONUT score and ISS were calculated for each patient. Binary logistic regression was used to identify independent predictors of trauma severity. Receiver operating characteristic (ROC) curve analysis evaluated the predictive accuracy of the CONUT and ISS scores for adverse outcomes.ResultsSeverely injured patients exhibited more significant abnormalities in cardiovascular function, inflammatory response, liver and kidney function, and nutritional status compared to those with minor injuries. These patients had significantly higher CONUT scores. Logistic regression analysis identified white blood cell count, hemoglobin, and CONUT score as independent predictors of trauma severity. ROC analysis showed that both CONUT and ISS scores effectively predicted adverse outcomes, with ISS demonstrating better specificity.ConclusionThe CONUT and ISS scores are effective tools for predicting physiological abnormalities and adverse outcomes in trauma patients. Incorporating these scores into clinical practice may enhance prognostic assessments and improve management strategies for trauma patients.

RSNA 2023 Abdominal Trauma AI Challenge Review and Outcomes Analysis.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Purpose To evaluate the performance of the winning machine learning (ML) models from the 2023 RSNA Abdominal Trauma Detection Artificial Intelligence Challenge. Materials and Methods The competition was hosted on Kaggle and took place between July 26, 2023, to October 15, 2023. The multicenter competition dataset consisted of 4,274 abdominal trauma CT scans in which solid organs (liver, spleen and kidneys) were annotated as healthy, low-grade or high-grade injury. Studies were labeled as positive or negative for the presence of bowel/mesenteric injury and active extravasation. In this study, performances of the 8 award-winning models were retrospectively assessed and compared using various metrics, including the area under the receiver operating characteristic curve (AUC), for each injury category. The reported mean values of these metrics were calculated by averaging the performance across all models for each specified injury type. Results The models exhibited strong performance in detecting solid organ injuries, particularly high-grade injuries. For binary detection of injuries, the models demonstrated mean AUC values of 0.92 (range:0.91-0.94) for liver, 0.91 (range:0.87-0.93) for splenic, and 0.94 (range:0.93-0.95) for kidney injuries. The models achieved mean AUC values of 0.98 (range:0.96-0.98) for high-grade liver, 0.98 (range:0.97-0.99) for high-grade splenic, and 0.98 (range:0.97-0.98) for high-grade kidney injuries. For the detection of bowel/mesenteric injuries and active extravasation, the models demonstrated mean AUC values of 0.85 (range:0.74-0.73) and 0.85 (range:0.79-0.89) respectively. Conclusion The award-winning models from the AI challenge demonstrated strong performance in the detection of traumatic abdominal injuries on CT scans, particularly high-grade injuries. These models may serve as a performance baseline for future investigations and algorithms. ©RSNA, 2024.

Take Two: Second Systolic Blood Pressure Provides Prognostic Information in Trauma

Abstract Introduction: An initial systolic blood pressure (SBP1) of <110 mmHg has been shown to predict mortality. However, SBP1 may not reflect hemodynamic changes during initial resuscitation. We aimed to determine if the second recorded blood pressure (SBP2) could provide additional prognostic value. Methods: An 8-year retrospective chart review was performed including patients who underwent trauma activations at a single institution. The initial systolic blood pressure (SBP 1) and second systolic blood pressure (SBP 2) were analyzed. Difference between the first and second systolic blood pressure (ΔSBP) was defined as SBP2 − SBP1. The primary outcome was inhospital mortality, and the secondary outcome was receipt of ≥2 units of blood in the first 4 h of admission. Univariable analysis and logistic regression analysis were performed to assess the relationship of SBP2 and ΔSBP with the study outcomes. Regression model fit was assessed by the likelihood ratio test and Akaike information criterion. Results: Eight thousand seven hundred and ninety-eight patients were included with 12% and 13% presenting with SBP1 <110 mmHg and SBP2 <110 mmHg, respectively. Four hundred and six (5%) died and 327 (4%) received ≥2 units of blood in the first 4 h. The addition of ΔSBP to regression models improved model fit in explaining the primary and secondary outcomes. Subgroup analysis found that the addition of ΔSBP improved model fit for those with penetrating mechanism of injury and those with Injury Severity Score of ≥9, but not for those with blunt moderate or severe traumatic brain injury. Conclusion: SBP2 offers additional prognostic value in predicting trauma outcomes. Incorporating subsequent hemodynamic data during resuscitation beyond the initial SBP in trauma databases should be considered.

099. Artificial Intelligence and Machine Learning in Trauma Outcome Prediction: A Literature Review

Introduction: Trauma remains a leading cause of mortality and disability globally, particularly among young adults. Despite advancements, accurate prediction of trauma outcomes remains challenging. Artificial intelligence (AI) and machine learning (ML) has the potential to detect patterns and analyzing complex relationship of data from trauma patients to support decision making in the management of trauma. This study aims to explore the potential of AI and ML to enhance trauma outcome prediction in order to healthcare workers with basic understanding of AI and ML and the potential for them to utilize it management of trauma patients. Methods: A literature review was conducted using studies from PubMed, SCOPUS, Cochrane, EBSCOHost, and ScienceDirect database using PRISMA protocol. Data extraction focused on study design, population, interventions, outcomes, and methodological quality using the Oxford Centre for Evidence-Based Medicine levels of evidence. Results: From the literature review, 15 studies from total of 585 studies were included in this literature review. XGBoost and Neural Networks were the most common algorithms (60%). While six studies predicted mortality, others focused on length of stay and discharge outcomes. Overall, ML significantly improved trauma diagnosis by enhancing predictive models for injury severity and mortality. Conclusions: Machine learning models have shown superior performance compared to traditional scoring systems in their ability to predict trauma outcomes and could effectively forecast critical outcomes and guide treatment decisions. Subsequent studies should concentrate on creating more resilient models based on prospectively gathered data to enhance the performance of created algorithms.

Sexual Trauma, Polygenic Scores, and Mental Health Diagnoses and Outcomes

Leveraging real-world clinical biobanks to investigate the associations between genetic and environmental risk factors for mental illness may help direct clinical screening efforts and evaluate the portability of polygenic scores across environmental contexts. To examine the associations between sexual trauma, polygenic liability to mental health outcomes, and clinical diagnoses of schizophrenia, bipolar disorder, and major depressive disorder in a clinical biobank setting. This genetic association study was conducted using clinical and genotyping data from 96 002 participants across hospital-linked biobanks located at Vanderbilt University Medical Center (VUMC), Nashville, Tennessee (including 58 262 individuals with high genetic similarity to the 1000 Genomes Project [1KG] Northern European from Utah reference population [1KG-EU-clustered] and 11 047 with high genetic similarity to the 1KG African-ancestry reference population of Yoruba in Ibadan, Nigeria [1KG-YRI-clustered]), and Mass General Brigham (MGB), Boston, Massachusetts (26 693 individuals with high genetic similarity to the combined European-ancestry superpopulation [1KG-EU-clustered]). Clinical data analyzed included diagnostic billing codes and clinical notes spanning from 1976 to 2023. Data analysis was performed from 2022 to 2024. Clinically documented sexual trauma disclosures and polygenic scores for schizophrenia, bipolar disorder, and major depressive disorder. Diagnoses of schizophrenia, bipolar disorder, and major depressive disorder, determined by aggregating related diagnostic billing codes, were the dependent variables in logistic regression models including sexual trauma disclosure status, polygenic scores, and their interactions as the independent variables. Across the VUMC and MGB biobanks, 96 002 individuals were included in analyses (VUMC 1KG-EU-clustered: 33 011 [56.7%] female; median [range] age, 56.8 [10.0 to >89] years; MGB 1KG-EU-clustered: 14 647 [54.9%] female; median [range] age, 58.0 [10.0 to >89] years; VUMC 1KG-YRI-clustered: 6961 [63.0%] female; median [range] age, 44.6 [10.1 to >89] years). Sexual trauma history was associated with all mental health conditions across institutions (ORs ranged from 8.83 [95% CI, 5.50-14.18] for schizophrenia in the VUMC 1KG-YRI-clustered cohort to 17.65 [95% CI, 12.77-24.40] for schizophrenia in the VUMC 1KG-EU-clustered cohort). Sexual trauma history and polygenic scores jointly explained 3.8% to 8.8% of mental health phenotypic variance. Schizophrenia and bipolar disorder polygenic scores had greater associations with mental health outcomes in individuals with no documented disclosures of sexual trauma (schizophrenia interaction: OR, 0.70 [95% CI, 0.56-0.88]; bipolar disorder interaction: OR, 0.83 [95% CI, 0.74-0.94]). Sexual trauma and mental health polygenic scores, while correlated with one another, were independent and joint risk factors for severe mental illness in a large, diverse hospital biobank population. Furthermore, associations of schizophrenia and bipolar disorder polygenic scores with respective diagnoses were greater in those without disclosures, suggesting that genetic predisposition to mental illness as measured by polygenic scores may be less impactful in the presence of this severe environmental risk factor.

Multiple organ failure following severe battle injuries during recent conflicts: a French retrospective cohort study.

Improvements in combat casualty care have increased survival rates, but these patients are at particular risk of developing multiple organ failure (MOF). We investigated the incidence and severity of MOF in a cohort of severe combat casualties. This retrospective study included all on-duty French land army war casualties with a severe combat injury requiring intensive care unit admission during 2009-2023. Demographic data, advanced life support interventions, and outcomes were collected. Each organ failure was then analyzed during a 7-day trauma course according to the Sequential Organ Failure Assessment (SOFA) score. Of the 100 patients who met the inclusion criteria, those with persistent MOF at day 4 (MOF group) represented 22% of the total population (median SOFA score 6.0 [5.3-8.0]). Compared to those without persistent MOF, these patients were more severely injured (median Military Injury Severity Score 38.0 [interquartile range 33.0-56.8] vs 26.5 [20.0-34.0], p < 0.001) by an explosive mechanism (68.2%) and sustained more traumatic brain injury (TBI; 40.9% vs 14.1%, p = 0.013). The MOF group also received significantly more blood units (median 14.0 [8.3-24.8] vs 6.0 [0.0-12.0], p < 0.001) and massive transfusions (68.2% vs 32.1%, p = 0.002). Pulmonary and cardiovascular dysfunction were the most frequently observed trauma outcomes. A multivariable logistic regression model showed that MOF persistence at day 4 was significantly associated (odds ratios [95% confidence intervals]) with severe injuries (1.5 [1-2.3], p = 0.042). A high number of severe lesions significantly and independently increased risk of MOF persistence at day 4 after combat-related trauma. These findings are particularly relevant to current and anticipated large-scale combat operations that will challenge battlefield casualty care and evacuation.

The influence of socioeconomic status on management and outcomes in major trauma: A systematic review and meta-analysis.

Major trauma is a leading cause of death and disability in younger individuals and poses a significant public health concern. There is a growing interest in understanding the complex relationships between socioeconomic deprivation and major trauma. Anecdotal evidence suggests that deprivation is associated with more violent and debilitating injuries. There remains a paucity in literature evaluating major trauma outcomes in relation to socioeconomic deprivation. A comprehensive search of MEDLINE, Embase, and CENTRAL databases was performed to identify studies from 1947 to March 2024. The primary outcome was to establish the distribution of injuries based on deprivation, with secondary outcomes evaluating surgical intervention rates, length of stay, and mortality. Quantitative pooling of data was based on the random-effects model. Fourteen studies and 878,872 trauma patients were included. A substantial proportion (28%) of trauma incidents occurred in the most deprived group. Patients from the lowest socioeconomic group were considerably younger (weighted mean difference [WMD] -9.85years and 95% confidence intervals [CI] -9.99 to -9.70) and more likely to be male (odds ratio [OR] 1.36 and 95% CI 1.14-1.63). There were no differences in surgical intervention (OR 1.74 and 95% CI 0.97-3.13), length of stay (WMD 1.15days and 95% CI -0.32-2.62), and mortality (OR 1.04 and 95% CI 0.95-1.14) regardless of background. Major trauma is prevalent in deprived areas and in younger individuals, with an increasing trend of deprivation in male patients. Although the rates of surgery, length of stay, and mortality did not differ between groups, planning of public health interventions should target areas of higher deprivation.

TOMM40-APOE chimera linking Alzheimer's highest risk genes: a new pathway for mitochondria regulation and APOE4 pathogenesis.

The patho-mechanism of apolipoprotein variant, APOE4, the strongest genetic risk for late-onset Alzheimer's disease (AD) and longevity, remains unclear. APOE's neighboring gene, TOMM40 (mitochondria protein transport channel), is associated with brain trauma outcome and aging-related cognitive decline, however its role in AD APOE4-independently is controversial. We report that TOMM40 is prone to transcription readthrough into APOE that can generate spliced TOMM40-APOE mRNA chimera (termed T9A2) detected in human neurons and other cells and tissues. T9A2 translation tethers APOE (normal APOE3 or APOE4) to near-full-length TOM40 that is targeted to mitochondria. Importantly, T9A2-APOE3 boosts mitochondrial bioenergetic capacity and decreases oxidative stress significantly more than T9A2-APOE4 and APOE3, and lacking in APOE4. We describe detailed interactomes of these actors that may inform about the activities and roles in pathogenesis. T9A2 uncovers a new candidate pathway for mitochondria regulation and oxidative stress-protection that are impaired in APOE4 genotypes and could initiate neurodegeneration.

Demographics, management and outcomes of major trauma in older patients at an Irish trauma unit.

Major trauma data in the developed world trends towards increased rates of lower energy mechanism in an older cohort. This study examines how the mechanism of trauma, injury pattern and outcomes differ between a younger and older cohorts in an Irish trauma unit. In this retrospective study, all entries to the Trauma Audit and Research Network (TARN) database from Tallaght University Hospital, between January 1st 2016 and 31st December 2021, were interrogated. Differences between injury severity, 30-day mortality, and hospital length of stay in younger and older patients were also examined. Older patients (≥ 65years) had a similar severity of injury to younger patients (< 65years); however, they had longer stays in hospital (18.8 versus 9.5days, p < 0.001). Older patients (≥ 65years) were more likely to have head (16.1% versus 11.3%, p < 0.05) and cervical spine (21.4% versus 11.2%, p < 0.05) injuries as their primary injury compared with younger patients. Older patients (≥ 65years) are less likely to have limb (33.3% versus 45.6%, p < 0.05). Fall from a height less than 2m was more likely to be the mechanism of injury in the older cohort compared with the younger cohort (77.3% versus 36.3%, p < 0.05). This study highlights the increased mortality and morbidity experienced by older trauma patients compared with a younger cohort. The findings support the development of "silver trauma" care pathways and directing resources to meet the needs of older trauma patients and optimize clinical outcomes.

Urban-rural disparities in fatal and non-fatal paediatric injuries after trauma – A national retrospective cohort study

IntroductionPaediatric trauma is a leading cause of death, with correlations between trauma outcomes and geographical locations. Certain rural regions of Norway face a higher risk of trauma-related fatalities compared to the nationwide population. Among adults, the risk of both fatal and non-fatal injuries rises with increased rurality. The study aimed to investigate whether there is an increased risk of fatal and non-fatal injuries for children in rural areas across the entire country, as well as any changes over two decades. Materials and methodsWe conducted a retrospective cohort study of fatal and non-fatal paediatric injuries by accessing two national registries for all trauma-related patients under the age of 18. All cases were stratified into six groups according to level of centrality based on a national index used as a proxy for rurality. For inter-group comparison, urban-rural disparities were evaluated using Pearson`s Chi-square test, linear regression, and relative risk (RR). Result1,059 paediatric deaths were included in the study period from 2002 to 2021. The mortality rate increased linearly with increased rurality (r = 0.985, p < .001). The overall mortality risk was 2.4 times higher in the most rural group compared to the most urban (RR = 2.37, 95 %CI 1.78 – 3.14, p < .001). Most deaths occurred pre-hospital (73 %), the total number of fatalities was highest in the age group 16 to 17 (42 %), and transport-related injury (32 %) was the most common cause of death. The relative risk of non-fatal injury was significantly higher for all centrality groups compared to most urban, and the highest rate was seen in sub-rural areas (RR = 1.39, 95 %CI 1.37 - 1.42, p < .001). ConclusionThe mortality rate increased linearly across all levels of centrality, and the relative risk was 2.4 times higher in the most rural population compared to the most urban population. To effectively target primary prevention and enhance trauma care for paediatric patients in rural areas, a deeper epidemiological understanding and more comprehensive studies are essential.

Temporal differential effects of post-injury alcohol consumption in a mouse model of blast-induced traumatic brain injury

Traumatic brain injury is a prevalent condition that affects millions worldwide with no clear understanding or effective therapeutic management available. Military soldiers have a high risk of exposure to blast-induced traumatic brain injury (bTBI). Furthermore, alcohol drinking is common in this population, and studies have shown that post-TBI alcohol exposure can result in memory loss. Hence, it is possible that alcohol could contribute to the overall pathological outcome of brain trauma. However, such a possibility has not been explored in detail. Here, we combined a mild bTBI (mbTBI) model with the drinking-in-the-dark (DID) paradigm to investigate the pathological synergy between mbTBI and alcohol consumption by examining brain oxidative stress levels and behavioral alterations in mice. The results revealed the anxiolytic and short-term memory improvement effects of post-trauma alcohol drinking examined at an early timepoint post mbTBI. However, extended alcohol drinking for up to three weeks post mbTBI impaired long-term memory and was accompanied by intensified oxidative stress in brain regions associated with memory and anxiety. These findings, as well as those from previous in vitro TBI/alcohol studies, suggest a pathological synergy of physical force and post-impact alcohol exposure. This knowledge could potentially aid in establishing guidelines for TBI victims to avoid further injury to their brains as well as to help maximize their recovery following TBI.

Magnitude, mechanism and outcome of pediatric trauma at university of gondar comprehensive specialized hospital, 2023

IntroductionTrauma is the leading cause of mortality among children older than one year. In fact, injuries alone account for a greater number of deaths in children than all other causes combined. Among children under the age of 19, accidental injuries contribute to 65 % of all injury-related deaths. Limited research on childhood trauma in Ethiopia makes it difficult to fully understand its processes, patterns, and effects. In this research, we thoroughly examine the mechanisms, patterns, and outcomes of pediatric trauma cases at the University of Gondar Comprehensive Specialized Hospital, located in Northwest Ethiopia, in the year 2023. MethodsThis cross-sectional study was conducted on a randomly selected sample of 405 pediatric patients who visited the University of Gondar Comprehensive Specialized Hospital between January 1, 2023, and December 30, 2023. Data were extracted from each medical chart using a structured checklist. The collected data were entered into Epi-data 3.1 for cleaning and analyzed using SPSS version 25. The results were reported using tables and text. ResultsA total of 405 patients, consisting of 265 males (65.4 %) and 140 females (34.6 %), were included in this study. The patients had a mean age of 7.1 years and a standard deviation of 4.3. The majority of the patients, 303 (74 %), were under the age of 10. More than half of the trauma cases, 222 (54.8 %), occurred in children from rural areas. Fall-down accidents accounted for 187 (46.2 %) of the cases. The second most common cause of trauma was road traffic incidents with collisions, accounting for 53 (13.1 %) cases. In terms of anatomical location, face and head trauma were the most common, accounting for 165 (40.7 %) cases. This was followed by extremity trauma (upper and lower extremities) in 159 (39.3 %) cases and abdomen and pelvic trauma in 103 (25.4 %) cases. The majority of children, specifically 373 (92.1 %), were discharged with improvement. ConclusionPediatric trauma continues to be a significant issue of public health importance. It is predominantly observed in boys residing in rural areas, with fall-related injuries being the most prevalent cause. Moreover, a majority of the affected individuals experience trauma to the head and face. Therefore, it is imperative to emphasize the necessity of educating the general population about the potential risks associated with pediatric trauma, especially concerning incidents involving falls and motor vehicle collisions. Educating children about the potential hazards linked to activities like climbing trees, crossing roads, and interacting with animals is of utmost importance.

Investigation of treatment outcomes for severe extremity trauma in an independent orthopedic trauma center: A case series

BackgroundSevere extremity trauma is one of the most challenging injuries to treat. Limb salvage after severe extremity trauma requires rapid revascularization, accurate and appropriate bone and soft tissue reconstruction, and appropriate management to address critical complications. The purpose of this study was to report the treatment outcomes for severe extremity trauma injuries at our independent orthopedic trauma center. MethodsThis study included patients with severe extremity trauma who underwent major vascular repair or soft tissue reconstruction. Bone reconstruction method, presence or absence of revascularization, and flap type were investigated. Complications were investigated, including revascularization failure, flap failure, infection, and ultimately, whether amputation was required. Additionally, we investigated the number of surgeries performed on each patient at the time of initial hospitalization. ResultsThirty-five patients who underwent revascularization or soft tissue reconstruction were included in this study. Plate fixation was performed in 18 patients, intramedullary nail fixation in 8, screw fixation in 1, pinning in 4, and without implant fixation in 4. Revascularization was performed in six patients, and no vascular complications occurred. Pedicled and free flaps were used in 17 and 16 patients, respectively. Partial flap necrosis occurred in four patients, and arterial occlusion occurred in one. Infection occurred in 10 patients who were treated with frequent irrigation and high-concentration antibiotics local infusion therapy. None of the 35 patients required limb amputation. Mean number of surgeries was 12.5. ConclusionsThe limb of all the 35 patients with severe extremity trauma treated at our independent orthopedic trauma center were salvaged.

Outcomes following intensive allied health therapy in the acute hospital for trauma patients

The majority of patients hospitalised for trauma survive their injuries, with the quality of the survival potentially influenced by early acute hospital rehabilitation. The aim of this study was to review the outcomes of patients managed under an intensive Allied Health Model of Care (AHMOC) compared to a baseline cohort.Methods: The AHMOC was commenced in February 2020 on the Trauma ward at Alfred Health for 12 months. The baseline group included patients admitted to the trauma ward in 2019. All patients who were registered by either the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) or the Victorian State Trauma Registry (VSTR). The association between the groups (AHMOC and baseline) and outcomes were assessed using logistic (discharge destination, 12-month return to work) and linear (length of stay (LOS)) regression.Results: There were 1644 in the baseline group and 1732 in the AHMOC group, of which 70% and 76% respectively were discharged directly home from the acute hospital (p value <0.001). The trauma ward LOS was 4.0 days for each group (p value 0.77). After accounting for confounders, the adjusted odds of discharge home and RTW at 12 months were 53% (AOR 1.53 95% CI 1.29, 1.82) and 65% (AOR 1.65 95% CI 1.24) higher for the AHMOC group compared to baseline, respectively. There was also a 6% reduction in the LOS in the AHMOC group compared to baseline (Adjusted mean difference 6%; 95% CI (0.881, 0.999) p value = 0.050).Conclusion: This study shows an association between an AHMOC for trauma patients with a focus on early and intensive therapy and improved odds of discharge directly home, as well as improved 12 month return to work outcomes.

The double 90 rule: A new strategy for resuscitation in non-academic level II trauma centers

BackgroundEfficient resuscitation after trauma and shorter time to definitive hemorrhage control help improve trauma outcomes. We aimed to improve the speed and efficiency of resuscitation for critically ill trauma patients in the emergency department by involving interventional radiology and a second surgeon. Study designIn 2017 our community, non-academic level II trauma center implemented the Double 90 rule—for trauma patients with 2 confirmed systolic blood pressures <90 mm Hg—which involves a second activation including the interventional radiology team, backup trauma surgeon, and operating room charge nurse. We retrospectively reviewed our trauma registry to compare data for high-level trauma patients before (2016, “Pre-Dbl90”) and 3 consecutive years after intervention (2018–2020, “Dbl90”). ResultsAmong 613 patients who met criteria for our highest level of trauma activation, 100 either had activation of the Double 90 rule (Dbl90 patients, n = 76) or met Double 90 rule criteria (Pre-Dbl90 patients, n = 24). The groups were similar in age, sex, injury severity score, penetrating trauma incidence, and admission vitals. Median time to computed tomography decreased throughout the study period, from 34 min in 2016 to 18 min in 2020 (P < .001). Median time to first hemorrhage control procedure decreased from 118 min (2016) to 43 min (2020), (P = .013).Mean packed red blood cell transfusion decreased from 9.1 to 4.8 units (P = .016). Mortality rates were similar between groups. ConclusionThe Double 90 rule is effective for expediting trauma care starting in the emergency department, shortening the times to computed tomography, hemorrhage control intervention, and decreasing packed red blood cell transfusion.

Разработка прогностической математической модели травматических повреждений печени

Intra-abdominal bleeding is a leading cause of adverse outcomes in liver trauma, underscoring the critical importance of timely surgical intervention and optimal hemostasis strategies. This study investigates the impact of liver model segmentation on the distribution of mechanical stresses during impact simulation using the finite element method. By discretizing a computer-aided design (CAD) model into finite elements of two types – 4-node linear isoparametric elements for the parenchyma and 3-node Kirchhoff plate elements for intersegmental partitions – we developed a computational liver model adequately captures the organ's anatomy. Our results show that incorporating segmentation significantly affects the simulation outcomes, enabling a more realistic assessment of tissue damage patterns upon impact. This approach facilitates the simulation of a wide range of real-world traumatic effects, allowing for arbitrary specification of impact direction, speed, and affected area. By accounting for liver segmentation, our study provides a more accurate and comprehensive understanding of traumatic liver injuries, ultimately informing clinical decision-making and improving patient outcomes.

Association Between Admission Systolic Blood Pressure and Outcomes in Patients with Isolated Traumatic Brain Injury: A Cross-National Multicenter Cohort Study.

The optimal prehospital blood pressure in patients following traumatic brain injury (TBI) remains controversial. We aimed to assess the association between the systolic blood pressure (SBP) at emergency department triage and patient outcomes following isolated moderate-to-severe TBI. We conducted a cross-national multicenter retrospective cohort study using the Pan-Asia Trauma Outcomes Study database from January 1, 2016, to November 30, 2018. The enrollees were adult patients with isolated moderate-to-severe TBI defined by the International Classification of Diseases code, a Glasgow Coma Scale (GCS) <13 at triage, and a nonhead Abbreviated Injury Scale ≤3. The studied variables were SBPs at triage categorized into different ranges. The primary outcome was 30-day mortality, and the secondary outcome was poor functional status at hospital discharge defined by the modified Rankin Scale ≥4. Multivariable logistic regression was applied to adjust for confounders including country, sex, age, mechanism of injury, prehospital vascular access, respiratory rate, GCS, oxygen saturation, intubation, Injury Severity Score, head surgery, intensive care unit admission, and length of hospital stay. Subgroup analyses were performed on different severity of TBI. A total of 785 patients (median age, 42 years; male patients 77.5%; mean SBP at triage, 136.3 ± 33.1 mmHg) were included in the primary analysis. The lowest 30-day mortality rate existed in patients with SBP of 100-119 mmHg. Taking it as baseline, the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of SBP <100 mmHg, 120-139 mmHg, 140-159 mmHg, and ≥160 mmHg were 7.05 (2.51-19.78), 3.14 (1.14-8.65), 2.91 (1.04-8.17), and 3.28 (1.14-9.42). As for the secondary outcome, the aORs and 95% CIs were 1.36 (0.68-2.68) of <100 mmHg, 0.99 (0.57-1.70) of 120-139 mmHg, 1.23 (0.67-2.25) of 140-159 mmHg, and 1.52 (0.78-2.95) of ≥160 mmHg. Subgroup analyses revealed trends of the best outcomes in both moderate and severe TBI patients with SBP 100-119 mmHg, whereas statistical significance appeared only in patients with severe TBI. SBP of 110-119 mmHg at triage is associated with the lowest 30-day mortality in patients following isolated moderate-to-severe TBI and possibly related to a better functional outcome.

Evaluation of the Geriatric Trauma Outcome Score (GTOS) as a Prognostic Tool in Intensive Care Unit Trauma Patients.

Existing prognostic scoring systems for intensive care unit (ICU) trauma patients require extensive data collection. The Geriatric Trauma Outcome Score (GTOS), which is based on age, injury severity, and transfusion need, has been validated for predicting mortality in elderly patients with trauma; however, its utility in the general ICU trauma population remains unexplored. This retrospective study included 2952 adult ICU trauma patients admitted between 2016 and 2021. The GTOS was calculated as follows: age + (Injury Severity Score × 2.5) + 22 (if transfused within 24 h). The area under the receiver operating characteristic curve (AUROC) was used to assess GTOS's ability to predict mortality. The optimal GTOS cutoff was determined using Youden's index. Mortality rates were compared between the high and low GTOS groups, including a propensity score-matched analysis adjusted for baseline characteristics. This study included 2952 ICU trauma patients, with an overall mortality rate of 11.0% (n = 325). GTOS demonstrated good predictive accuracy for mortality (AUROC 0.80). The optimal cutoff was 121.8 (sensitivity, 0.791; specificity, 0.685). Despite adjustments, patients with GTOS ≥ 121.8 had significantly higher mortality (17.4% vs. 6.2%, p < 0.001) and longer hospital stays (20.3 vs. 15.3 days, p < 0.001) compared to GTOS < 121.8. GTOS showed a reasonable ability to predict mortality in ICU trauma patients across all ages, although not as accurately as more complex ICU-specific models. With its simplicity, the GTOS may serve as a rapid screening tool for risk stratification in acute ICU trauma settings when combined with other data.

Posttraumatic Growth in War Captives

Numerous studies have investigated the various consequences of traumatic experiences during the war. The most significant disorder that occurs as a result of war traumatization is posttraumatic stress disorder, in addition to which other psychological disorders often can occur. In the last few decades, the number of studies researching the occurrence of posttraumatic growth as a positive outcome of trauma, including that of war veterans, has been growing. Among war veterans, prisoners of war stand out for the intensity of their traumatic experience but also for the appearance and intensity of the pathological outcomes of the trauma. Studies show that in this group of veterans, posttraumatic stress disorder and comorbidity disorders often persist for decades after their release from captivity.There is not much research about the positive outcomes of trauma in these particularly vulnerable populations, and this paper is a review of several different studies, the results of which show that posttraumatic growth is possible even after challenging traumatic experiences such as war captivity.

Management of neonatal head injuries: A retrospective cohort study

AbstractAimThe aim of this study is to describe circumstances, management and short‐term outcomes of neonatal head trauma, and adherence to the Paediatric Emergency Care Applied Research Network (PECARN) head trauma prediction rule for children under 2 years.MethodsMulticentre retrospective cohort study of neonates (&lt;29 days) with head trauma across 25 emergency departments (ED) from January 2017 to June 2021.ResultsA total of 492 neonates (median age 17 days, range 0–28 days) with non‐trivial head trauma were enrolled. Falls were the most common injury mechanism (375/492, 76.2%). Imaging was performed in 150/492 (30.5%) neonates.Clinically important traumatic brain injury (ciTBI), defined as death, neurosurgery, prolonged intubation, or extended hospitalisation from injury, occurred in 7/492 (1.4%) cases. Notably, 286/492 (58.1%) neonates were managed by short‐term observation (&lt;48 h), and 126/492 (25.6%) were admitted.Among high‐risk neonates per PECARN criteria, 17/21 (80.9%) did not undergo recommended head CT scans but were observed within ED short observation units or underwent alternative imaging, with no ciTBI diagnoses among those discharged without CT.ConclusionSevere neonatal head injuries are rare, and most neonatal head injuries have a favourable outcome, making observation a suitable approach, while remaining vigilant for signs of non‐accidental injuries.