Penetrating Trauma Research Articles

Structural Racism, Residential Segregation, and Exposure to Trauma: The Persistent Impact of Redlining.

As part of New Deal era federal housing policy, the Home Owners Loan Corporation (HOLC) developed maps grading US neighborhoods by perceived financial security. Neighborhoods with high concentrations of racial and ethnic minorities were deemed financially unstable and denied federal investment, a practice colloquially known as redlining. The aim of this study was to assess the association of historical redlining within Austin, Texas to spatial patterns of penetrating traumatic injury. Retrospective cross sectional study utilizing data from violent penetrating trauma admissions between January 1, 2014 - December 31, 2021, at the single Level 1 trauma center in Austin, Texas. Using ArcGIS, addresses where the injury took place were geocoded and spatial joining was used to match them to their corresponding census tract, for which 1935 HOLC financial designations are classified as: "Hazardous", "Definitely Declining", "Still Desirable", "Best", or "Non HOLC Graded". Tracts with designations of "Hazardous" and "Definitely Declining" were categorized as Redlined. The adjusted incidence rate ratio comparing rates of penetrating trauma among historically Redlined vs. Not Redlined and Not Graded census tracts was calculated. 1,404 violent penetrating trauma admissions were identified for the study period, of which 920 occurred within the county of interest. Among these, 5% occurred in census tracts that were Not Redlined, 13% occurred in Redlined tracts, and 82% occurred in non HOLC graded tracts. When adjusting for differences in current census tract demographics and social vulnerability, historically Redlined areas experienced a higher rate of penetrating traumatic injury (Not Redlined IRR = 0.42, 95% CI 0.19-0.94, p = 0.03; Not Graded IRR = 0.15, 95% CI 0.07-0.29, p < 0.001). Neighborhoods unfavorably classified by HOLC in 1935 continue to experience a higher incidence rate of violent penetrating trauma today. These results underscore the persistent impacts of structural racism and of historical residential segregation policies on exposure to trauma. Level IV, Prognostic and Epidemiological.

Mechanism matters: Differential benefits of cold-stored whole blood for trauma resuscitation from a prospective multicenter study.

Resuscitation with cold-stored low-titre whole blood (LTOWB) has increased despite the paucity of robust civilian data. Most studies are in predominately blunt trauma and lack analysis of specific subgroups or mechanism of injury. We sought to compare outcomes between patients receiving LTOWB versus balanced component therapy (BCT) after blunt (BL) and penetrating (PN) trauma. Secondary analysis of a prospective multicenter study of patients receiving either LTWOB-containing or BCT resuscitation was performed. Patients were grouped by mechanism of injury (BL vs. PN). A generalized estimated equations model using inverse probability of treatment weighting was employed. Primary outcome was mortality and secondary outcomes were acute kidney injury, venous thromboembolism, pulmonary complications, and bleeding complications. Additional analyses were performed on no-traumatic brain injury (TBI), severe torso injury, and LTOWB-only resuscitation patients. There were 1,617 patients (BL 47% vs PN 54%) identified; 1,175 (73%) of which received LTOWB. PN trauma patients receiving LTOWB demonstrated improved survival compared to BCT (77% vs. 56%; p < 0.01). Interval survival was higher at 6 hours (95% vs. 88%), 12 hours (93% vs. 80%), and 24 hours (88% vs. 57%) (all p < 0.05). The survival benefit following LTOWB was also seen across PN non-TBI (83% vs. 52%), and severe torso injuries (75% vs. 43%) (all p < 0.05). After controlling for age, sex, injury severity, and trauma center, LTWOB was associated with decreased odds of death (odds ratio, 0.31, p < 0.05) in PN trauma. However, no difference in overall mortality was seen across the BL groups. Both PN and BL patients receiving LTOWB had more frequent acute kidney injury compared to BCT (19% vs. 7% and 12% vs 6%, respectively; p < 0.05). Low-titre whole blood resuscitation was independently associated with decreased mortality following PN trauma, but not BL trauma. Further analysis in BL trauma is required to identify subgroups that may demonstrate survival benefit. Therapeutic/Care Management; Level III.

Total patellectomy in a dog: Long term outcome

Patellectomy alters stifle biomechanics and has been demonstrated to result in degenerative joint lesions and to increase the force required for its extension. A 3-year-old male dog was admitted with right hindlimb lameness due to a penetrating wound in the stifle. After exploratory arthrotomy, diagnosis of straight patellar ligament avulsion and patellar fracture was established. In three months, the dog underwent three surgeries to repair the straight patellar ligament, drainage of the stifle, and total patellectomy. Antimicrobial and anti-inflammatory drugs were administered. Restriction of activity and physiotherapy were also advised. Patellectomy was performed because the patella was no longer adhered to its adjacent soft tissues and appeared to be necrotic. Follow-up information for seven years showed mild lameness in the affected limb and a body attempt to substitute the patella.

Acute Bacillus cereus endophthalmitis caused by ocular perforation injury and occult intravitreal cilium implantation: a case report.

Acute Bacillus cereus endophthalmitis caused by ocular perforation injury and occult intravitreal cilium implantation: a case report.

Coagulating blood into adhesive gel by hybrid powder based on oppositely charged polysaccharide/tannic acid-modified mesoporous bioactive glass

Hemostatic powder is widely utilized in emergency situations to control bleeding due to its ability to work well on wounds with irregular shapes, ease of application, and long-term stability. However, traditional powder often suffers from limited tissue adhesion and insufficient support for blood clot formation, leaving it susceptible to displacement by the flow of blood. This study introduces a hemostatic powder composed of tannic modified mesoporous bioactive glass (TMBG), cationic quaternized chitosan (QCS), and anionic hyaluronic acid modified with catechol group (HADA). The resulting TMBG/QCS/HADA based hemostatic powder (TMQH) rapidly absorbs plasma, concentrating blood coagulation factors. Simultaneously, the water-soluble QCS and HADA interact to form a 3D network structure, which can be strengthened by crosslinking with TMBG. This network effectively captures clustered blood coagulation factors, leading to a strong and adhesive thrombus that resists disruption from blood flow. TMQH exhibits superior efficacy in promoting hemostasis compared to Celox™ both in rat arterial injuries and non-compressible liver puncture wounds. TMQH demonstrates excellent antibacterial activity, cytocompatibility, and blood compatibility. These outstanding superiorities in blood clotting capability, wet tissue adhesion, antibacterial activity, safety for living organisms, ease of application, and long-term stability, make TMQH highly suitable for emergency hemostasis.

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

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

Visual Outcome following Blunt Ocular Trauma among Patients attended Tobruk Medical Center

Visual Outcome following Blunt Ocular Trauma among Patients attended Tobruk Medical Center

A National Analysis of Alcohol Withdrawal Syndrome in Patients with Operative Trauma

BackgroundAlcohol withdrawal syndrome (AWS) presents with a complex spectrum of clinical manifestations that complicate postoperative management. In trauma setting, subjective screening for AWS remains challenging due to the criticality of injury in these patients. We thus identified several patient characteristics and perioperative outcomes associated AWS development. MethodsThe 2016–2020 National Inpatient Sample was queried to identify all non-elective adult (≥18 years) hospitalizations for blunt or penetrating trauma undergoing operative management with a diagnosis of AWS. Patients with traumatic brain injury or with a hospital duration of stay <2 days were excluded. Outcomes of interest included in-hospital mortality, perioperative complications, hospitalization costs, length of stay (LOS) and non-home discharge. ResultsOf an estimated 2,965,079 operative trauma hospitalizations included for analysis, 36,415 (1.23 %) developed AWS following admission. The AWS cohort demonstrated increased odds of mortality (Adjusted Odds Ratio [AOR] 1.46, 95 % Confidence Interval [95 % CI] 1.23–1.73), along with infectious (AOR 1.73, 95 % CI 1.58–1.88), cardiac (AOR 1.24, 95 % CI 1.06–1.46), and respiratory (AOR 1.96, 95 % CI 1.81–2.11) complications. AWS was associated with prolonged LOS, (β: 3.3 days, 95 % CI: 3.0 to 3.5), greater cost (β: +$8900, 95 % CI $7900–9800) and incremental odds of nonhome discharge (AOR 1.43, 95 % CI 1.34–1.53). Furthermore, male sex, Medicaid insurance status, head injury and thoracic operation were linked with greater odds of development of AWS. ConclusionIn the present study, AWS development was associated with increased odds of in-hospital mortality, perioperative complications, and resource burden. The identification of patient and operative characteristics linked with AWS may improve screening protocols in trauma care.

Exception to the Puppe's rule reloaded and a warning in the interpretation of skull fractures: they run even through recent craniotomy burr holes.

A possible "exception" to Puppe's rule regarding the intersection of skull fractures has been previously addressed due to the observation that skull fractures can pass through old and remodeled craniotomies. In a further case presented herein, however, it was shown that cranial fractures are also able to pass through recent burr holes, a phenomenon never previously described. A 63-year-old man sustained a self-inflicted gunshot wound to the right temple region, with an exit wound in the left temporal region. Twenty-five days prior, the patient had undergone parietal craniotomy for the evacuation of a subdural hematoma secondary to glioblastoma. Among the fracture lines originating from the exit wound, one traversed the craniotomy hole, terminating approximately 1.4cm beyond its contralateral margin. This illustrates that cranial fractures possess the capability to cross "fresh" burr holes that have not undergone to bone remodeling. Consequently, the evaluation of Puppe's rule should be reconsidered, particularly in cases of gunshot injuries, wherein fractures pass through full-thickness circular lesions (such as entry and exit wounds). The varied scenarios underscore the potential for fractures to "pass through" these burr holes if they have not themselves generated fracture lines, as may be the case with entry holes with circular lesions without fractures.

Cost-effectiveness analysis of routine computed tomography angiography (CTA) for lower extremity penetrating trauma

BackgroundRoutine evaluation with CTA for patients with isolated lower extremity penetrating trauma and normal ankle-brachial-indices (ABI) remains controversial. While prior literature has found normal ABI's (≥0.9) and a normal clinical examination to be adequate for safe discharge, there remains concern for missed injuries which could lead to delayed surgical intervention and unnecessary morbidity. Our hypothesis was that routine CTA after isolated lower extremity penetrating trauma with normal ABIs and clinical examination is not cost-effective. MethodsWe performed a decision-analytic model to evaluate the cost-effectiveness of obtaining a CTA routinely compared to clinical observation and ABI evaluation in hemodynamically normal patients with isolated penetrating lower extremity trauma. Our base case was a patient that sustained penetrating lower extremity trauma with normal ABIs that received a CTA in the trauma bay. Costs, probability, and Quality-Adjusted Life Years (QALYs) were generated from published literature. ResultsClinical evaluation only (no CTA) was cost-effective with a cost of $2056.13 and 0.98 QALYs gained compared to routine CTA which had increased costs of $7449.91 and lower QALYs 0.92. Using one-way sensitivity analysis, routine CTA does not become the cost-effective strategy until the cost of a missed injury reaches $210,075.83. ConclusionsPatients with isolated, penetrating lower extremity trauma with normal ABIs and clinical examination do not warrant routine CTA as there is no benefit with increased costs.

First Report of Alternaria gossypina Causing Stem Base Rot on Passilora edulis in Guangxi, China.

Passion fruit (Passilora edulis), known as the "king of fruit juices", is popular in southern China (Yuan et al. 2019). Stem base rot is a devastating disease of passion fruit commonly caused by several Fusarium spp. (Zakaria, 2022). In July 2022, typical symptoms of stem base rot were observed in a poorly managed "Qinmi No. 9" Golden passion fruit orchard in Jingxi (23°13'10"N, 106°5'23"E). The disease incidence had reached 40% (n=200) in the survey. Symptoms included ulceration and mutilation at the stem base, making the plants prone to breakage when pulled, wilting and drooping leaves above ground, and severe cases leading to the entire plant withering and dying. Fourteen plants with obvious symptoms were collected. Thin sections of plant tissue were cut from junction of sickness and health of stem, sterilized with ethanol and sodium hypochlorite, and placed on PDA medium at 28°C. Sixty fungal strains were obtained, 90% of which was identified as Fusarium based on morphology. 80% of Fusarium were F. oxysporum species complex (FOSC), but pathogenicity experiment showed all FOSC were weakly pathogenic. However, two severely pathogenic fungi with similar morphology but distinct from Fusarium were identified from the same plant. The representative strain C11 was selected for further study. C11 demonstrated a rapid growth rate, reaching a 90 mm diameter colony on PDA cultured at 25°C for 7 days. The colony displaced a round, flat shape with an overall light brown front, and cottony gray or light brown mycelium, while the reverse side was dark brown. Conidia production was observed as typically occurred in multiple chains after 14 days culture on OA medium, with round, oval or straight rod-like brown conidia ranging in size from 5.74-23.42×14.67-67.22, featuring 1-8 transverse septa and 0-3 mediastinum (Figure S1). For molecular identification, the internal transcribed spacer (ITS, OR616614), translation elongation factor 1-alpha (TEF, OR633298), alternaria major allergen (Alt a1, OR633294) gene, glyceraldehyde 3-phosphate dehydrogenase (GAPDH, OR633295), RNA polymerase subunit II gene (RPB2, OR633297), 18S Small subunit rDNA (SSU, OR616608) , 28S Large Subunit rDNA (LSU, OR616615), the KOG1058 gene regions (OR633296) and an approximately segment of the anonymous noncoding region (OPA10-2, OR633299) were amplified from C11 (Liu et al. 1999, Li et al. 2023, Andrew et al. 2009), and deposited in GenBank with accession number shown in the brackets. Phylogenetic trees were constructed in MEGA11 after splicing by BioEdit (Figure S3). Combining morphology and molecular analyses, C11 was identified as Alternaria gossypina (Woudenberg et al. 2015). To test the pathogenicity, the base of the seedling stem (20cm in height) of 50 healthy "Tainong No. 1" variety of purple passion fruit, which was more susceptible to stem-base rot, was puncture wound with needles, inoculated with 6 mm diameter colonies of fungi, and then wrapped in wet cotton (Ángel et al. 2018). Ten healthy seedlings inoculated with PDA were used as controls. These plants were cultured in an artificial greenhouse at 30±5℃with 80±5% humidity. After 15 days, the plants inoculated with C11 exhibited symptoms similar to those in the field, whereas the controls remained healthy. A. gossypina was reisolated from the diseased plant stems, with the morphology and GAPDH sequence consistent with the inoculated (Figure S1, S2). This is the first report of passion fruit stem rot caused by A. gossypina. This finding will aid in the prevention and control of stem rot in passion fruit.

Captive Bolt Gun-Related Vascular Injury: A Single Center Experience.

This article investigates the clinical and radiological characteristics of captive bolt gun head injuries, a rare form of low-velocity penetrating brain injury. Eleven consecutive patients were included in the study. Vascular injuries and the rate of infection were systematically analyzed. Radiological findings reveal common bolt trajectories in the anterior cranial fossa, with identified risk factors for a poor outcome including trajectory crossing midline, hematocephalus, and paranasal sinus involvement. Only one patient had a good outcome. Despite meticulous microsurgical techniques, this study highlights often unfavorable clinical outcomes in captive bolt gun injuries, with vascular injury identified as a potential contributing risk factor for a poor outcome. Knowledge of variant vascular tree anatomy and corresponding vascular territory is important. To avoid potential vascular injuries, a complete removal of bone fragments was not always performed and it did not increase the rate of infection, challenging the conventional wisdom advocating for the complete removal of bone fragments. These findings contribute novel insights into captive bolt gun-related injuries, paving the way for further research.

Injuries in Fatalities of Dismounted Blast: Identification of Four Mechanisms of Head and Spine Injury.

Blast is the most common injury mechanism in conflicts of this century due to the widespread use of explosives, confirmed by recent conflicts such as in Ukraine. Data from conflicts in the last century such as Northern Ireland, the Falklands, and Vietnam up to the present day show that between 16% and 21% of personnel suffered a traumatic brain injury. Typical features of fatal brain injury to those outside of a vehicle (hereafter referred to as dismounted) due to blast include the presence of hemorrhagic brain injury alongside skull fractures rather than isolated penetrating injuries more typical of traditional ballistic head injuries. The heterogeneity of dismounted blast has meant that analysis from databases is limited and therefore a detailed look at the radiological aspects of injury is needed to understand the mechanism and pathology of dismounted blast brain injury. The aim of this study was to identify the head and spinal injuries in fatalities due to dismounted blast. All UK military fatalities from dismounted blast who suffered a head injury from 2007-2013 in the Iraq and Afghanistan conflicts were identified retrospectively. Postmortem computerized tomography images (CTPMs) were interrogated for injuries to the head, neck, and spine. All injuries were documented and classified using a radiology brain injury classification (BIC) tool. Chi-squared (χ2) and Fisher's exact tests were used to investigate correlations between injuries, along with odds ratios for determining the direction of correlation. The correlations were clustered. There were 71 fatalities from dismounted blast with an associated head injury with a CTPM or initial CT available for analysis. The results showed the heterogeneity of injury from dismounted blast but also some potential identifiable injury constellations. These were: intracranial haemorrhage, intracranial deep haemorrhage, spinal injury, and facial injury. These identified injury patterns can now be investigated to consider injury mechanisms and so develop mitigation strategies or clinical treatments. Level of Evidence: Observational. Study type: cohort observational.

Comparative imaging of septic navicular osteomyelitis caused by a solar penetration injury in a 15‐day‐old Shire foal

SummaryA 15‐day‐old female Shire foal presented for acute lameness after sustaining a solar penetration injury, due to a nail, to the right hind sole 4 days previously. The foal was moderately lame at walk; all vital parameters were within normal limits. Clinical examination of the foot found a 2 mm long slit‐like defect in the plantar third of the lateral body of the frog. Radiographs revealed an ill‐defined rounded radiolucency within the navicular spongiosa that was surrounded by a halo of increased radiopacity. Transcuneal ultrasound corroborated the findings and found the navicular bone lesion to be closely associated with a hypoechogenic region within the lateral lobe of the deep digital flexor tendon (DDFT) all of which was continuous with a hypoechogenic tract extending from the sole. Computed tomographic examination confirmed a tract extending from the solar surface into the lateral portion of the navicular bone and confirmed a suspected impacted bone fragment. A diagnosis of septic navicular osteomyelitis and bursitis was made. The tract, navicular bone and DDFT were surgically debrided and navicular bursa lavage performed. The foal initially recovered well but navicular bursal sepsis recurred 6 days post‐operatively and the foal was euthanised. This report provides comprehensive comparative imaging of septic navicular osteomyelitis and bursitis secondary to a solar penetration in a 15‐day‐old foal and highlights the importance of different imaging modalities in case assessment and management.

Ayurvedic Management of Traumatic tympanic membrane perforation

Traumatic tympanic membrane perforations are common in Otolaryngological practice. These perforations can be due to direct penetrating trauma, infections or due to eustachian tube disorders. These perforations can lead to reversible high frequency deafness, tinnitus and vertigo. Small perforations heal spontaneously within three months after the injury while large perforations are treated with myringoplasty. This is a case report of 35year old female patient who presented to Shalakya OPD with complaints of sudden onset of earache and reduced clarity of hearing in left ear, since 7 days. The tympanic membrane was ruptured. While compairing the size of perforation relative to circumference of the tympamic membrane, it was observed to be a large sized perforation affecting 50% of tympamic membrane. Large sized perforations are usually considered non healing as it exert influence on the malleus and umbo at tympanic membrane insertion and would interrupt the sound conducting mechanism. She was managed conservatively with Ayurveda treatment. Karnalepa applied over the pre auricular and mastoid region makes the healing fast and effective. Karnapichu, the modified form of karnapoorana provides a much larger skin contact time with controlled release of drugs.The case report shows the effect of local and systemic medication in the form of Murivenna karnapichu. The healing of tympanic membrane occurred within one month of follow up.

Suicide by Gunshot Wound to the Posterior Head and Neck: A Retrospective Case Series and Review of the Literature.

Suicide by firearm is a significant public health concern in specific regions of the world. Depending on firearm availability, any type of firearm may be used, including handguns, shotguns, and long rifles. Common entrance wound sites in suicidal gunshot wounds include the head, with classic gunshot wound locations including the temple, the forehead, the submental aspect of the chin, and inside the mouth. Occasionally, suicidal gunshot wounds occur in atypical body locations such as the back of the head and neck. Given their relative rarity, suicidal gunshot wounds in these regions may be mistaken for homicides. In this report, we present 5 cases of suicidal gunshot wounds to the back of the head and/or neck. In our series, we focus on differentiating each case from homicides involving gunshot wounds in similar areas of the head and neck.

PSIII-6 Tail damage caused by tail biting in growing-finishing pigs housed in two group sizes

Abstract Tail biting can compromise the welfare of pigs and cause economic losses for pork producers, but little is known about the development of tail biting and its resulting impact on pigs. In this study, we investigated victimization by tail biting and the resulting impacts on the welfare and performance of pigs housed in two group sizes. Pigs (n = 432, initial body weight = 22.0 ± 3.7 kg) with intact tails were housed in large (LG = 18 pigs/pen, 12 pens) or small groups (SG = 9 pigs/pen, 24 pens) in a barn with fully slatted floors for 14 wk until market weight (120.7 ± 11.8 kg). Floor space (0.76 m2/pig) and feeder space (4 feeder spaces/9 pigs) allowance were identical between group sizes, and pigs were stratified by initial body weight and sex across treatment pens. Growth performance, pig removal, and tail damage were monitored throughout the study. Tail damage was assessed for each pig weekly and during tail biting outbreaks, using a subjective scoring system (0 = no damage; 1 = healed lesions with small scabs; 2 = puncture wounds with visible blood; 3 = wounds with signs of infection; 4 = partial or total loss of the tail). The maximal tail score (MTS) each pig received every four weeks and over the entire 14 weeks was summarized. Pigs that received MTS of ≥ 2 were considered victimized by a tail biter. Data were analyzed using Glimmix procedure with logit function and FREQ procedure with chi-square and CMH test of SAS software. Compared with SG, LG had greater MTS during the initial 4 wk (1.1 vs. 0.8, chi-square = 17.9, df = 1; P &amp;lt; 0.001) and reduced MTS during the last 2 wk (0.7 vs. 0.9, chi-square = 4.8, df = 1; P = 0.03), suggesting that tail damage declined as pigs grew in LG, but not in SG. The number of pigs removed for tail biting tended to be less and those removed for death and sickness tended to be greater in LG than in SG (chi-square = 7.4; df = 3; P = 0.06). Across group sizes, 68% of the removed pigs (n = 28) were victimized by tail biters (MTS ≥ 2). Between group sizes, there was no difference in time to first victimization or how often individual pigs were victimized throughout the study. Across group sizes, 45% of pigs were never victimized, but 22%, 16%, and 9% were victimized 1, 2, and 3 times, respectively. Eight percent of pigs were victimized more than three times, including 6% with MTS of 3 or 4. Pigs with MTS of 4 over the entire study period were three times more likely (odds ratios between 3.18 and 3.70; all P ≤ 0.03; Table 1) to have market weight lower than the average compared with other pigs. Based on these results, we suggest that management strategies should prevent multiple victimizations or tail loss to maintain pig welfare and performance.

Every minute matters: Improving outcomes for penetrating trauma through prehospital advanced resuscitative care.

Prehospital resuscitation with blood products is gaining popularity for patients with traumatic hemorrhage. The MEDEVAC trial demonstrated a survival benefit exclusively among patients who received blood or plasma within 15 minutes of air medical evacuation. In fast-paced urban EMS systems with a high incidence of penetrating trauma, mortality data based on the timing to first blood administration is scarce. We hypothesize a survival benefit in patients with severe hemorrhage when blood is administered within the first 15 minutes of EMS patient contact. This was a retrospective analysis of a prospective database of prehospital blood (PHB) administration between 2021 and 2023 in an urban EMS system facing increasing rates of gun violence. PHB patients were compared to trauma registry controls from an era before prehospital blood utilization (2016-2019). Included were patients with penetrating injury and SBP ≤ 90 mmHg at initial EMS evaluation that received at least one unit of blood product after injury. Excluded were isolated head trauma or prehospital cardiac arrest. Time to initiation of blood administration before and after PHB implementation and in-hospital mortality were the primary variables of interest. A total of 143 patients (PHB = 61, controls = 82) were included for analysis. Median age was 34 years with no difference in demographics. Median scene and transport intervals were longer in the PHB cohort, with a 5-minute increase in total prehospital time. Time to administration of first unit of blood was significantly lower in the PHB vs. control group (8 min vs 27 min; p < 0.01). In-hospital mortality was lower in the PHB vs. control group (7% vs 29%; p < 0.01). When controlling for patient age, NISS, tachycardia on EMS evaluation, and total prehospital time interval, multivariate regression revealed an independent increase in mortality by 11% with each minute delay to blood administration following injury (OR 1.11, 95%CI 1.04-1.19). Compared to patients with penetrating trauma and hypotension who first received blood after hospital arrival, resuscitation with blood products was started 19 minutes earlier after initiation of a PHB program despite a 5-minute increase in prehospital time. A survival for early PHB use was demonstrated, with an 11% mortality increase for each minute delay to blood administration. Interventions such as PHB may improve patient outcomes by helping capture opportunities to improve trauma resuscitation closer to the point of injury. Prospective, Level IV.

Obesity and Penetrating Trauma: Outcomes from a Level 1 Trauma Center in New York City.

Obesity is associated with increased morbidity and mortality in trauma scenarios; however, there has been conflicting evidence on outcomes of obesity and penetrating injuries, specifically gunshot wounds and stab wounds. We hypothesized that obesity may be protective due to a "cushioning effect" attributed to increased adiposity. This was a retrospective cohort study of patients presenting to a Level 1 Trauma Center with a penetrating trauma (gunshot/stab) injury during 2008-2021. Patients with a BMI ≥ 30 were compared to those with a BMI < 30. The primary outcome was Injury Severity Score (ISS). Secondary outcomes included intensive care unit (ICU) length of stay, days on ventilation, length of hospital stay, service of admission (trauma surgery, general surgery, discharged home, general medical floor), the body region of injury(s), Abbreviated Injury Scale (AIS), OR requirement, type of surgery, and discharge status. Statistical analysis was performed using χ2-test or Fisher's exact tests for categorical data, and Student's t-test or Mann-Whitney U-test for continuous variables with p < 0.05 as statistically significant. Subgroup analysis was performed based on the mechanism of injury. There were 721 patients that met inclusion criteria, of which 540 were classified in the non-obese group and 181 (25.1%) in the obese group. The primary outcome, mean ISS score, in obese patients (9.0, SD = 13.0) and non-obese patients (9.4, SD = 13.8) was similar between groups respectively. Secondary outcomes, which included rates of severe abdominal injury (AIS ≥ 3), rates of intra-abdominal organ injury, and rates of gastro-intestinal resection, were also similar between non-obese and obese patients. This study did not demonstrate the existence of a "cushioning effect" in the setting of penetrating traumatic injury. Patients with increased BMI had similar a ISS score and patterns of injury as their non-obese counterparts.

Resuscitative Thoracotomy for Penetrating Trauma, a Valid Option in the Right Circumstances

Abstract The need to perform a clamshell thoracotomy in the emergency department for thoracic injuries is infrequent. The rates of survival after emergency thoracotomy are considerably low, with penetrating trauma cases exhibiting survival rates of 9% to 12%, and blunt trauma cases observing survival rates of 1% to 2%. We present an atypical instance of survival following resuscitative thoracotomy performed in the emergency department. The procedure was undertaken on a 30-year-old male victim of gunshot wounds to the chest and abdomen. On arrival to emergency department, the patient had a traumatic cardiac arrest. A resuscitative thoracotomy was carried out, restoring a spontaneous heart rhythm before transferring the patient to the operating room. A midline exploratory laparotomy was performed for abdominal injuries. Remarkably, the patient survived the procedure and fully recovered. This case serves as an illustration of how clamshell thoracotomy can be an effective resuscitative lifesaving intervention for penetrating thoracic trauma when accompanied by the appropriate setup.