Result Of Trauma Research Articles

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 (<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 (<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.

Associations between avoidant/restrictive food intake disorder profiles and trauma exposure in veteran men and women.

Trauma exposure, particularly interpersonal trauma, is prevalent among individuals with eating disorders (EDs), and trauma exposure and the subsequent development of posttraumatic stress disorder have been associated with poorer outcomes for ED treatment. To our knowledge, there are no published investigations of trauma exposure among individuals with avoidant/restrictive food intake disorder (ARFID), a new diagnosis introduced by the Diagnostic and Statistical Manual of Mental Disorders-5. We investigated associations between trauma exposure and ARFID profiles in a sample of U.S. military veteran men and women. Participants in this cross-sectional study included 1494 veterans randomly selected from the population of post-9/11 veterans who had separated from military service within the previous 18 months. They completed a survey assessing EDs, including the Nine Item ARFID Screen and trauma exposure. Results revealed that 9.8% of the sample exceeded cutoffs for any ARFID profile, with the picky eating profile being the most common. Trauma exposure was prevalent among participants who exceeded cutoffs for ARFID, particularly the picky eating profile. Findings highlight the importance of addressing EDs, including ARFID, in veterans. It will be important to examine the extent to which trauma and trauma-related disorders impact treatment outcomes for individuals with ARFID.

Advancing the science of adverse childhood experiences and resilience: A case for global and ecological perspectives

Research on adverse childhood experiences and resilience (the process of overcoming trauma) has been dominated by studies originating in wealthy democracies of the global north. We call for more global and ecological approaches not only for documenting the true global burden of childhood adversity, but also for advancing the science of resilience and understanding pathways to overcoming trauma. We identify several forms of trauma that need better consideration in prevalence estimates, including state, political, and institutional violence, crisis migration, climate change and related natural disasters, and global health crises such as the COVID-19 pandemic. We also need more nuanced analyses of culture and place and to recognize that the global south and global north are not monolithic concepts. We offer illustrative examples of how more global, ecological approaches can enhance our understanding of pathways to overcoming even high dosages of childhood adversity. One of the key insights of ACEs research, the dose-response relationship between trauma burden and outcomes, has been extended to research on resilience. Concepts that capture the total “dose” of positive assets and resources (people's resilience portfolios) are showing how people might overcome even high doses of trauma. This work can become more global by including incorporating strengths and healing processes common in collectivist, versus individualistic, cultures. It can become more ecological by recognizing that physical environments—both natural and human-made built aspects—play key roles in resilience. Recognizing the intersectionality among these elements can take us to the next generation of trauma and resilience science.

ThP7.1 - The effect of socioeconomic status on outcomes in major trauma: a systematic review and meta-analysis

Abstract Background Major trauma poses a significant public health concern, with survivors often suffering long-term disability. There is growing interest in understanding the complex relationships between socioeconomic deprivation and major trauma in recent years. Anecdotal evidence suggests that social deprivation leads to more violent and debilitating injuries. There remains, however, a paucity in literature evaluating major trauma outcomes in relation to socioeconomic deprivation. Methods A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was performed to identify eligible studies from 1947 to March 2024. The primary outcome is to establish the proportion of patients with the highest socioeconomic deprivation, with secondary outcomes evaluating surgical intervention rates, length of stay, and mortality. Quantitative pooling of data was based on the random effects model. Results Fourteen studies reporting on 878,872 major trauma patients were included. A substantial proportion of major trauma incidents occurred in the most deprived group at 28%. There were more male patients in the most deprived compared to the least deprived group (OR 1.36, 95% CI 1.14-1.63, I2=99%). There were no differences in surgical intervention (OR 1.74, 95% CI 0.97-3.13, I2=0%) and length of stay (WMD 1.15 days, 95% CI -0.32-2.62, I2=82%) regardless of background. Interestingly, mortality was higher in the most deprived group (OR 2.02, 95% CI 1.14-3.57, I2=80%). Conclusion Major trauma is more prevalent in deprived areas. Although rates of surgery and length of stay did not differ, mortality is higher in the most deprived group. The planning of public health interventions should target areas of higher deprivation.

The role of maternal postmigration living difficulties in intergenerational trauma transmission among asylum-seeker mother-child dyads: Exploring complex posttraumatic stress disorder as a mechanism.

Among forcibly displaced people, maternal trauma and stress have been implicated in poor child socioemotional outcomes via intergenerational trauma transmission. This study explored the role of maternal postmigration living difficulties (PMLD) in the pathway linking maternal trauma, trauma-related psychopathology, and child socioemotional outcomes among mother-child dyads seeking asylum in a high-risk urban setting. Participants were East African (Eritrean) mothers (N = 127) of preschool-aged children seeking asylum in Israel. Using moderated mediation analysis, we tested whether and how PMLD may moderate the mediating role of current maternal International Classification of Diseases, 11th revision (ICD-11) posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder disturbances in self-organization (DSO) symptoms between past maternal trauma exposure and current postdisplacement child internalizing and externalizing difficulties. Children's direct exposure to adverse life experiences was controlled for. Maternal PTSD symptoms mediated the association between past maternal trauma exposure and child internalizing difficulties, but not externalizing difficulties, across all levels of current maternal PMLD. However, maternal DSO symptoms mediated internalizing and externalizing child outcomes, but only among mothers reporting high levels of current PMLD. This study provides novel evidence that PMLD may amplify the toxicity of past maternal trauma exposure for poor child socioemotional outcomes via ICD-11 DSO symptoms. The intergenerational transmission pathway via the narrower fear-based ICD-11 PTSD, however, is independent of the degree of maternal PMLD. Findings suggest that policies designed to buffer intergenerational trauma transmission among forcibly displaced people may need to consider the toxicity of PMLD as well as enable mothers to heal from PTSD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Serum Interleukin-6 as an Early Indicator of Trauma Complications.

Trauma is a major global health issue, associated with high mortality and complications like inapparent hypoxia, fat embolism syndrome (FES), sepsis, and multiple organ dysfunction syndrome (MODS). Early identification of high-risk patients is crucial but challenging. Serum interleukin-6 (IL-6), a key inflammatory cytokine, has shown potential as a biomarker for predicting adverse outcomes in trauma. IL-6 levels typically increase rapidly following trauma, peaking within 12 to 24 hours. Despite its potential role, there is limited research on the effectiveness of IL-6 as an early marker for trauma-related complications. This study aims to assess whether monitoring serum IL-6 levels at specific intervals after trauma can aid in early risk assessment and predict the development of these complications. This prospective observational cohort study at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) included 119 trauma patients aged 19-65 years, admitted within 12 hours of injury. Venous blood samples (5 mL each) were collected at 12 and 24 hours for IL-6 and C-reactive protein (CRP) analysis. Injury severity score (ISS) was assessed for all the patients upon arrival to the emergency department at NEIGRIHMS and was categorized as mild, moderate, severe, and very severe. Inapparent hypoxia, FES, sepsis, and MODS were assessed using pulse oximetry, Gurd's criteria, quick sequential organ failure assessment (qSOFA) score, and Marshall's multiple organ dysfunction score, respectively. Among the participants, 21.85% developed complications; primarily inapparent hypoxia. Serum IL-6 levels were significantly elevated in individuals with complications at both 12 hours (p < 0.001) and 24 hours (p < 0.001) post-trauma. At the 12-hour mark, serum IL-6 demonstrated a sensitivity of 92.3% and a specificity of 78.5%, with a cut-off value of 37.26 pg/mL. By 24 hours, the sensitivity increased to 96.2% and the specificity to 87.1%, with a cut-off value of 55.08 pg/mL. Patients with MODS had the highest IL-6 levels, with medians of 270.87 pg/mL at 12 hours and 826.10 pg/mL at 24 hours. A strong correlation was observed between serum IL-6 at 24 hours and the ISS(rs = 0.725, p < 0.001). At 12 hours, there was a moderate correlation between serum IL-6 and CRP (rs = 0.488, p < 0.001). By 24 hours, this correlation strengthened to a strong level (rs = 0.749, p < 0.001). The significant association of serum IL-6 levels with both ISSand CRP highlights its potential role in assessing trauma severity. The high sensitivity and specificity of IL-6 at the 24-hour make it a valuable biomarker for the early detection of trauma-related complications.

Shifts in Paediatric Road Trauma Dynamics Pre- vs. Post-COVID-19 Lockdown: Insights from a Major Trauma Centre.

The COVID-19 pandemic has brought unprecedented changes globally, significantly affecting public health sectors, including paediatric road trauma. This study aims to explore the changes in paediatric road trauma presentations and outcomes before and after the COVID-19 lockdown. This retrospective study analysed paediatric trauma data from the Saudi TraumA Registry (STAR) from August 2017 to December 2022, comparing pre- and post-COVID-19 lockdown periods (August 2017-March 2020 and July 2020-December 2022, respectively). The study analysed demographic data, mechanism of injury, severity, ICU admissions, and mortality rates using multivariate logistic regression models. Out of 950 paediatric trauma cases analysed, there was an 44.2 [561/389 = 1.442] % increase in the number of cases post-lockdown. A significant shift was noted in the age group of 5-9 years, with cases increasing from post-lockdown. Head injuries were the most prevalent type of injury, with their proportion slightly increasing from 163 (20.5%) pre-lockdown to 248 (23.2%) post-lockdown. The ICU admission were consistent across both periods, while the definitive care mode of arrival post-lockdown showed a notable shift towards private or government ambulances. Our study provides critical insights into the significant impact of the COVID-19 on paediatric road trauma. The observed increase in trauma cases post-pandemic, particularly among younger children and a notable rise in driver-related injuries among adolescents, underscores the profound effect of lockdown measures and subsequent societal changes on paediatric health. Efforts to reduce paediatric traffic injuries require collaboration among parents, educators, healthcare professionals, policymakers, and the community at large.

The negative effect of preexisting cirrhosis on blunt liver trauma patients: a multifaceted approach from the trauma quality improvement program database.

To assess the impact of pre-existing cirrhosis on the outcomes of non-operatively managed blunt liver trauma within the Trauma Quality Improvement Program (TQIP) database. A study of non-operatively managed blunt liver injury patients from 2016 to 2019 was conducted. Propensity score matching analyzed mortality, complications, and hospital length of stay (LOS) for patients with and without cirrhosis. The effect of transcatheter arterial embolization (TAE) was determined using multivariate logistic regression. Out of 63,946 patients, 767 (1.2%) had pre-existing cirrhosis. Following 1:1 matching, those with cirrhosis experienced more hemorrhage (TAE need: 5.7% vs. 2.7%; transfusion volume: 639.1 vs. 259.3ml), complications (acute kidney injury: 5.1% vs. 2.8%; sepsis: 2.4% vs. 1.0%), and poorer outcomes (mortality: 19.5% vs. 10.2%; hospital LOS: 11.6 vs. 8.4 days; ICU LOS: 12.1 vs. 7.4 days; ventilator days: 7.6 vs. 1.6). Notably, TAE was associated with increased mortality in cirrhotic patients (odds ratio: 4.093) but did not significantly affect mortality in patients without cirrhosis. Within TQIP, pre-existing cirrhosis is a significant negative determinant for outcomes in blunt liver trauma. Cirrhotic patients undergoing TAE for hemostasis face greater mortality risk than non-cirrhotic counterparts.

Traumatic Dental Injuries among Adolescents and Young Adults in Iași, Romania: Legal and Medical Perspectives.

This study aims to assess the etiology, frequency, and localization of dental and periodontal trauma in adolescents and young adults, along with these individuals' predisposition based on age, gender, and residence. Materials and Methods This retrospective study included 109 adolescents and young adults from a database of the Emergency and Oral and Maxillofacial Surgery department at "Sf. Spiridon" Hospital, Iasi, Romania. The collected data included demographic details, mechanisms of dental and periodontal trauma, treatment approaches, and clinical outcomes. Statistical analysis was performed using SPSS 26.0, with comparisons based on age, gender, and residence. Enamel fractures (23.9%) and enamel-dentin fractures without pulp exposure (20.2%) were the most frequent dental injuries. Concussion (58.7%), subluxation (21.1%), luxation, avulsion (7.3%), and extrusion (5.5%) were common periodontal injuries. The anterior region of the dental arch accounted for the majority (60.6%) of injuries. Adolescents under 17 years were more prone to enamel-dentin fractures without pulp exposure (23.8%), enamel-dentin fractures with pulp exposure (20.6%), and root fractures (20.6%), while young adults over 18 years had a higher incidence of enamel fractures (32.6%) and crown-root fractures (30.4%). Falls (66.7%) were the predominant cause of trauma for female patients, whereas male patients were more often injured during sports activities (49.3%). The younger age group was 0.29 times more likely to sustain enamel-dentin fractures without pulp exposure (p = 0.049, OR = 0.291) and root fractures (p = 0.047, OR = 0.241). Traumatic dental injuries are more prevalent in young adults compared to adolescents, with falls and sports activities being the most common causes, particularly among males. These findings emphasize the need for targeted preventive programs aimed at reducing the incidence of dento-periodontal trauma in these age groups.

Trauma Centre admission criteria for elderly patients

Introduction:Injuries are among three most common causes of sudden death in Poland, and patient particularly at risk of fatal outcome of trauma are elderly. Geriatric age is associated with pathological changes that determine worse response to trauma. In order to improve treatment outcomes of elderly trauma patients it is essential for them to have access to specialized healthcare units i.e. Trauma Centers (TC).In Poland, admission criteria for TC are determined in the Regulation of the Ministry of Health published in 2010. Those criteria do not include age. According to recent research, such admission criteria lead to undertriage i.e., underestimation of injuries of elderly trauma patients and referred to a healthcare unit of lower reference level.Aim: Analyze the current national admission criteria of elderly trauma patients admitted to TCs.Materials and methods:TC admission criteria were subject to analysis in referral to available scientific publications in the field of medical segregation of elderly trauma patients, available in: PubMed, Medline-EBSCO.Results:TS admission criteria in current form are fulfilled only by elderly patients with minimal survival chance. As a result, majority of elderly trauma patients are referred to healthcare units of lower reference level. Those patients are deprived of professional trauma care in TC. Such discrepancies in medical segregation often stem from lack of anatomical changes or shifts in physiological parameters typically observed in trauma patients.ConclusionsIt is essential to develop national research to find the optimal system of triage for elderly trauma patient and an adequate tool for appropriate admitted them to TC.

Evaluating the Impact of Nutritional Risk on Stress-Induced Hyperglycemia and Trauma Patient Outcomes.

Stress-induced hyperglycemia (SIH) and malnutrition are common in trauma patients and are linked to worse outcomes. This study examined the influence of nutritional status, determined by the Geriatric Nutritional Risk Index (GNRI), on the incidence of SIH in trauma patients. A retrospective analysis was conducted on adult trauma patients admitted to a Level I trauma center from 1 January 2009 to December 31, 2021. Patients were categorized into four groups: SIH, diabetic hyperglycemia (DH), diabetic normoglycemia (DN), and non-diabetic normoglycemia (NDN). Nutritional status was assessed using GNRI: high risk (GNRI < 82), moderate risk (82 ≤ GNRI < 92), low risk (92 ≤ GNRI ≤ 98), and no risk (GNRI > 98). Incidence of SIH and outcomes were analyzed across GNRI groups. SIH was associated with higher mortality across all GNRI groups compared to NDN, with the highest rate (45.7%) in the high-risk group. Mortality decreased as GNRI increased in all glucose groups. NDN patients had the lowest mortality rates across GNRI groups. There was no correlation between GNRI and SIH incidence (p = 0.259). SIH significantly influenced mortality across all nutritional status groups, with the highest impact in malnourished patients. Although malnutrition did not affect SIH incidence, both SIH and poor nutritional status independently contributed to worse trauma outcomes. Targeted management of hyperglycemia and nutritional deficiencies is crucial for improving survival.

Uptake of telehealth services by people recovering from road trauma in Victoria, Australia

Introduction In recent years, injury insurers in Australia have introduced compensation cover for services delivered via telehealth. The aim of this study was to investigate the uptake of telehealth services by people recovering from road trauma in Victoria, Australia, and the characteristics of participants accessing these services. Methods All Victorian State Trauma Registry and Victorian Orthopaedic Trauma Outcomes Registry cases, aged ≥16 years, who sustained transport-related injury from March to August 2020, and were linked with the Transport Accident Commission claims dataset, were included in this registry-based cohort study. The primary outcome was the uptake of services accessed in-person and via telehealth. Results Within 12 months of injury, 413 participants accessed 93,035 services, with 1432 of these via telehealth (1.5%). Seventy-five percent of family counselling, 26% of psychology and 7% of medical consultations were accessed via telehealth. For telehealth users, a greater proportion had worked/studied prior to injury, met major trauma criteria, and were discharged to inpatient rehabilitation, compared to non-users. For participants with no telehealth use, a greater proportion were discharged home, and were classified as ‘rapid recovery’ clients. Conclusions While telehealth uptake was low during the study period, it was accessed by people with more severe injuries. There was also greater telehealth uptake during some of Victoria's strictest COVID-19 lockdowns. Telehealth may continue to be an appealing option for medical and psychological services into the future, and may assist with return to work following transport injury.

Prevalence of Vitamin D Deficiency in Orthopedic Trauma Patients: A Cross-Sectional Survey From a Tertiary Care Trauma Center.

Background Vitamin D deficiency is prevalent globally, with potential consequences for bone health and trauma outcomes. This study aimed to assess the prevalence of vitamin D deficiency in orthopedic trauma patients and investigate its correlation with various demographic and injury-related factors. Methodology A cross-sectional investigation was undertaken at a tertiary care center. An evaluation of serum 25-hydroxyvitamin D3 levels was conducted on 124 individuals, aged 20 to 70 years, who were hospitalized with orthopedic injuries. Demographic information, the injury method, the bone involvement pattern, and socioeconomic status were documented. Statistical analysis was employed to evaluate the correlations between vitamin levels D and these variables. Results The overall prevalence of vitamin D deficiency was 54 (43.6%) cases, with nine (7.3%) cases exhibiting severe deficiency and 45 (36.3%) cases exhibiting moderate deficiency. Higher rates of deficiency were associated with lower socioeconomic status (p = 0.044) and low-velocity trauma (p = 0.037). No significant association was found with age, sex, or residence. Interestingly, patients with multiple fractures were more prone to deficiency compared to those with single fractures. Conclusions This survey revealed a significant vitamin D deficiency among orthopedic trauma patients. Factors such as socioeconomic status and the nature of the injury emerged as significant risk factors. While conducting routine vitamin D assessments might pose challenges in developing nations, consistent supplementation could prove advantageous in enhancing fracture healing and overall health outcomes among this demographic. There is a call for future research to delve deeper into the role of vitamin D in trauma management and refine supplementation strategies.

A single-surgeon experience with the internal joint stabilizer of the elbow across 56 cases

BackgroundRecurrent instability continues to plague outcomes of elbow trauma. Adjuvant stabilization - whether internal or external - is intended to acutely stabilize the elbow and off-load the repair construct(s) during early mobilization. Our objective was to report clinical outcomes for a single surgeon consecutive series using the internal joint stabilizer (IJS) of the elbow. Further, we intend to describe technical points that have been gleaned from the experience which may provide guidance. MethodsA retrospective follow-up was performed for cases of elbow instability treated with the IJS (Skeletal Dynamics, Miami, Florida, USA) from 2016-2023 with a minimum requirement of six months follow-up. Clinical outcomes and complications including recurrent instability were compiled. ResultsOf 87 potential cases, 56 met the inclusion criteria. Simple dislocations (30%) and terrible triad injury (21%) were the most common injury patterns. The mean MEPS was 81 and the mean DASH score was 22.5. Recurrent instability occurred in 5.3% of cases. The mean time to removal was 21.1 weeks. DiscussionOur utilization of the internal joint stabilizer of the elbow has evolved from simple dislocations to complex instability cases. Results demonstrated satisfactory clinical outcomes with low rates of recurrent instability and revision. The ability for early mobilization was a critical determinant for using an IJS in these cases. This advantage carried particular importance in cases that presented subacutely following an extended course of immobilization. Our protocol for removal timing is applied on a case-by-case basis and involves identification of sufficient rehabilitation and clinical stability.

Facilitating Greater Understanding of Trauma-Informed Care in Applied Behavior Analysis: An Introduction to the Special Issue.

Trauma-informed care (TIC) refers to the guiding principles that inform how organizations or individuals arrange services with respect to acknowledging both the prevalence and impact of trauma. Given the elevated risks of trauma in the populations with which many behavior analysts work, clarifying why, how, and if TIC should be incorporated into behavior analytic work seems prudent. Although the core commitments of TIC are inherently aligned with ethical and effective applied behavior analytic practice, there are few exemplars of how TIC can be intentionally incorporated into behavioral assessment and treatment. This special issue is intended to begin to fill that gap, as well as to promote further discussion of the benefits and limitations of TIC in ABA. In this introduction, we review both the prevalence and potential outcomes of trauma, as well as attempting to dispel misconceptions about TIC that appear common among the behavior analytic community. We highlight how the articles in the special issue are important in developing an evidence base for TIC in ABA, as well as suggesting areas for future research.

Early use of professional interpreters improves trauma outcomes: Results of a single-center retrospective study

Patients with limited English proficiency (LEP) experience reduced pain assessment and treatment, less comprehensive physical exams, and fewer explanations of the next steps in care. These disparities persist in hospitals with staffed professional interpreters, raising questions about interpreter access and the impact on outcomes. A retrospective review of 1133 trauma activations at a single center Level 1 Trauma Center in 2021–2022 was conducted. Demographic, injury, and outcome data were drawn from the institutional trauma registry, and patient-preferred language was pulled from EMR data. Early interpreter use was defined as documentation of professional interpreter use within 24 h of arrival. LOS and ICU LOS were compared between language groups using Cox regression, and mortality was compared using Fischer's exact test. 1114 patients had data available on initial injury severity and preferred language. Of the 70 LEP patients, 62 (88.6 %) required an interpreter, and 41 of those (66.1 %) had evidence of professional interpreter use within 24 h of arrival. LEP patients who lacked early interpreter use had longer hospital stays than both English proficient (EP) patients (HR 0.59, p < 0.05) and LEP patients with early interpreter use (HR 0.51, p < 0.05) when stratified by ISS and controlling for GCS and patient age. There is no difference in LOS between LEP trauma patients who used an interpreter and EP patients, suggesting that early use of an interpreter may improve the length of stay in LEP trauma patients.

Geriatric Trauma Outcome Score in predicting mortality of Korean older adult patients with trauma: Is applicable in all cases?

This study aimed to validate the Geriatric Trauma Outcome Score (GTOS) for predicting mortality associated with trauma in older Korean adults and compare the GTOS with the Trauma and Injury Severity Score (TRISS). This study included patients aged ≥65 years who visited the Chungbuk National University Hospital Regional Trauma Center between January 2016 and December 2022. We used receiver operating characteristic (ROC) curves and calibration plots to assess the discrimination and calibration of the scoring systems. Among 3053 patients, the median age was 77 years, and the mortality rate was 5.2%. The overall GTOS-predicted mortality and 1-TRISS were 5.4% (IQR [3.7-9.5]) and 4.7% (interquartile range [IQR] [4.7-4.7]), respectively. The areas under the curves (AUCs) of 1-TRISS and GTOS for the total population were 0.763 (95% confidence interval [CI], 0.719-0.806) and 0.794 (95%CI, 0.755-0.833), respectively. In the Glasgow Coma Scale (GCS) ≤12 group, the in-hospital mortality rate was 27.5% (79 deaths). The GTOS-predicted mortality and 1-TRISS in this group were 18.6% (IQR [7.5-34.7]) and 26.9% (IQR [11.9-73.1]), respectively. The AUCs of 1-TRISS and GTOS for the total population were 0.800 (95%CI, 0.776-0.854) and 0.744 (95%CI, 0.685-0.804), respectively. The GTOS and TRISS demonstrated comparable accuracy in predicting mortality, while the GTOS offered the advantage of simpler calculations. However, the GTOS tended to underestimate mortality in patients with GCS ≤12; thus, its application requires care in such cases.

The link Between traumatic experiences and health in late life: challenges and opportunities for US-based longitudinal aging cohorts.

Trauma, defined as exposure to actual or threatened death, serious injury or sexual violence, is a pervasive, major public health challenge that disproportionately burdens socially disadvantaged groups and has known consequences for health outcomes in early and midlife. Despite plausible mechanisms by which trauma may also be a critically important risk factor for health outcomes in late life, there is presently a lack of literature evaluating the consequences of trauma on aging related health outcomes and inequities, such as dementia. In this commentary, we (a) discuss drivers of the paucity of epidemiological evidence on trauma and health outcomes in late life, namely a lack of available data, supported by detailed review of trauma measures, including interpersonal violence-a particularly common form of trauma-in seven established longitudinal aging cohort studies in the United States (US); (b) address four common concerns about the inclusion of trauma measures in cohort studies; and (c) suggest ways forward, including specific assessment tools to measure interpersonal violence after a structured review of the PhenX Toolkit, to facilitate critical research to understand the impact of trauma on outcomes in late life.

Outcomes of head trauma in children admitted to a tertiary paediatric intensive care unit in South Wales

Objective This study aimed to evaluate the demographics and outcomes of major paediatric head trauma managed in our Paediatric Intensive Care Unit (PICU) in South Wales and comparison is made with the existing published literature. Design and setting A retrospective review of medical records and imaging of patients identified from the paediatric neurosurgical trauma database at University Hospital Wales (UHW) from March 2013 to July 2021. We assessed the GCS at admission, mechanism of injury, CT scan, type of surgery required and GOS after 12 months. Patients A total of 46 children (<16 years old) who were admitted to intensive care secondary to a traumatic brain injury were identified. Mean age was 7.6 years (range 0 days–15.7 years). Results Road traffic accidents (RTA) were the predominant mechanism of injury (56.5%), followed by falls (32.6%). Neurosurgical intervention, including stand-alone ICP monitoring was required in 69.6% of patients. Post discharge outcome was defined using the Glasgow Outcome Score (GOS), with a good functional outcome (GOS ≥4) accounting for 86.4% at 12 months follow-up. Survival rate was 93.4%. Conclusion Demographics in South Wales are similar to the published literature, except falls had a higher mortality than RTA in our cohort. Head injury mechanisms, surgical interventions and outcomes show variation between patients from the pre-covid and lockdown periods. Outcomes are good for surgically and conservatively treated patients and very comparable to the published literature.

Remote Monitoring, AI, Machine Learning and Mobile Ultrasound Integration upon 5G Internet in the Prehospital Care to Support the Golden Hour Principle and Optimize Outcomes in Severe Trauma and Emergency Surgery.

Feasibility and reliability evaluation of 5G internet networks (5G IN) upon Artificial Intelligence (AI)/Machine Learning (ML), of telemonitoring and mobile ultrasound (m u/s) in an ambulance car (AC)- integrated in the pre-hospital setting (PS)- to support the Golden Hour Principle (GHP) and optimize outcomes in severe trauma (TRS). (PS) organization and care upon (5G IN) high bandwidths (10 GB/s) mobile tele-communication (mTC) experimentation by using the experimental Cobot PROMETHEUS III, pn:100016 by simulation upon six severe trauma clinical cases by ten (N1=10) experts: Four professional rescuers (n1=4), three trauma surgeons (n2=3), a radiologist (n3=1) and two information technology specialists (n4=2) to evaluate feasibility, reliability and clinical usability for instant risk, prognosis and triage computation, decision support and treatment planning by (AI)/(ML) computations in (PS) of (TRS) as well as by performing (PS) (m u/s). A. Trauma severity scales instant computations by the Cobot PROMETHEUS III, pn 100016) ) based on AI and ML complex algorithms and Cloud Computing, telemonitoring and r showed very high feasibility and reliability upon (5GIN) under specific, technological, training and ergonomic prerequisites B. Measured be-directional (m u/s) images data sharing between (AC) and (ED/TC) showed very high feasibility and reliability upon (5G IN) under specific, technological and ergonomic conditions in (TRS). Integration of (PS) tele-monitoring with (AI)/(ML) and (PS) (m u/s) upon (5GIN) via the Cobot PROMETHEUS III, (pn 100016) in severe (TRS/ES), seems feasible and under specific prerequisites reliable to support the (GHP) and optimize outcomes in adult and pediatric (TRS/ES).