Robotic surgery (RobSurg) usage has increased in multiple surgical fields. We aimed to review recent trends in RobSurg use in trauma surgery and hypothesized that its use is increasing and varies across hospital types. The 2017 to 2020 American College of Surgeons-TQIP database was used to identify all injured patients 18 years or older undergoing RobSurg, defined by robotic ICD-10 procedure codes. We examined the annual trends of RobSurg use. We then examined patient demographics, mechanisms of injury, time to surgery, procedures performed, hospital type, outcomes (eg mortality, postoperative complications), and conversion to open surgery. Of 4,005,762 trauma patients, 1,391,350 (34.7%) underwent surgical procedures, of which 210 (15 of 100,000) were robotic. The use of RobSurg has increased from 7.5 per 100,000 procedures in 2017 to 25.5 per 100,000 in 2020 (p < 0.001). The median age was 55 years, 88.6% had a blunt mechanism of injury, 6.7% had gunshot wounds, and 4.8% had stab wounds. RobSurg most commonly involved the lung (17.1%), spine (13.8%), and diaphragm (4.3%). Only 3 patients (1.4%) underwent a nonspecific robotic peritoneal exploration for trauma. The median time to surgery was 76 hours (interquartile range 30 to 170.2), the rate of conversion to open was 28%, and mortality was 3.3%. Nonteaching hospitals performed RobSurg more frequently than teaching hospitals (19.2 per 100,000 procedures in nonteaching vs 10.5 per 100,000 in teaching hospitals, p < 0.001). RobSurg was also more frequent in lower-level trauma centers (12.2 per 100,000 in level I, 17.6 per 100,000 in level II, and 22.6 per 100,000 in level III trauma centers, p = 0.04). RobSurg use in the trauma setting remains limited but perhaps increasing, especially in nonteaching and level II or III trauma centers, with its use largely restricted to subacute interventions. Further studies are needed to examine the effectiveness of RobSurg compared with open or laparoscopic surgery in injured patients.

Mild traumatic brain injuries, stable spine fractures, and low-grade blunt cerebrovascular injuries are frequent at level I trauma centers and often prompt neurosurgery consultation, regardless of clinical status. We evaluated the safety and utility of virtual consultations (teleconsultations [TECs]) in the management of these injuries. We performed a retrospective review of 260 patients admitted to a level I trauma center from 2020 to 2022. Groups were divided by consultation type, with 210 in-person consultations and 48 TECs. Propensity score matching, accounting for covariates, was performed to maintain unbiased comparability based on observed characteristics. With a 4:1 matching ratio, 165 in-person consultations were compared with 48 TECs. Outcome differences between groups were assessed by χ 2 test based on neurological and/or neurosurgical re-evaluation. Univariate and multivariate regression models were used to determine predictive value of patient characteristics and outcomes. Of the total matched 213 injuries, the average age was 55 years for the in-person cohort and 59 for the TECs ( P = .3). Gender distribution was similar in both groups. Rates of neurosurgical re-evaluation (18%) and neurological decline (3.29%) were similar, and no patients experienced permanent neurological injury or death. Higher Glasgow Coma scale scores were associated with decreased likelihood of re-evaluation ( P = .02) or neurological decline ( P < .001). No predictive factors were identified in the TEC group. Neurosurgical TEC may be effective in management and treatment of nonoperative mild traumatic brain injury and low-grade blunt cerebrovascular injuries. Future multicenter studies should evaluate TEC safety and generalizability across diverse clinical settings.

Shedding of the proteoglycan syndecan-1 (SDC-1) from the vascular endothelial surface into the circulation in severe trauma predicts mortality in trauma patients. However, the timing and duration of SDC-1 elevation in trauma patients have not been defined. The primary aim of this study was to describe the longitudinal pattern of SDC-1 elevation in trauma patients with either mechanical and/or burn injury during the first 120 hours of resuscitation and initial stabilization. Our secondary objective was to determine the association of endotheliopathy, as defined by elevated SDC-1 levels, with trauma-induced coagulopathy (international normalized ratio [INR] ≥ 1.4). This prospective observational study enrolled adults meeting trauma activation criteria at 1 of 3 trauma centers. The blood was collected at presentation in the emergency department (time 0) and again at 2, 4, 6, 12, 24, 72, 96, and 120 hours. SDC-1 was quantified by ELISA, and elevated levels were defined as ≥40 ng/mL. The primary outcome of coagulopathy was defined as a clinical laboratory report of INR ≥ 1.4 during this timeframe. We determined the association between elevated SDC-1 and coagulopathy using logistic regression and adjusted for age, sex, burn status, and injury severity. We studied 301 severely injured individuals, including those with mechanical and burn injuries. Among these individuals, 96 (31.9%) had coagulopathy, 122 (40.5%) required transfusions, and 42 (14%) died. SDC-1 plasma levels were significantly greater in subjects with coagulopathy relative to noncoagulopathic patients. Plasma levels of SDC-1 ≥ 40 ng/mL conferred significantly increased odds of presenting with INR ≥ 1.4, with an adjusted odds ratio of 17.88 (95% CI, 5.14-62.24), P < .05. High SDC-1 levels (≥40 ng/mL) were most often evident at the initial blood draw and tended to remain elevated. Plasma SDC-1 peaks early and remains elevated across time in most individuals with mechanical and/or burn injury. Individuals with elevated SDC-1 levels have an increased risk of coagulopathy independent of injury severity.

Fixation failure following femoral neck system fixation for intracapsular femoral neck fractures: Association with fracture orientation.

Pediatric trauma surgeons have been the vanguard of nonoperative management of blunt splenic injuries. However, there is no uniform consensus on the determination of failure of nonoperative management and variability exists in management strategies across institutions. We hypothesized that centers with pediatric surgical fellowships would be less likely to pursue surgical management of blunt splenic injuries than other trauma centers without fellowship programs. The Pediatric Health Information System was queried for all patients 15 years old or younger admitted with splenic injuries between 2016 and 2024. Penetrating injuries were excluded. ICD-10 diagnostic codes were used to estimate the Injury Severity Score. The primary outcome was splenic surgery or embolization, identified by ICD-10-Procedure Coding System code. There were 6,853 patients identified with blunt splenic injury, of whom 319 (4.7%) underwent either splenic surgical intervention or percutaneous endovascular embolization. There was significant variability in splenic intervention rates among institutions, with fellowshiptraining hospitals having significantly lower rates of intervention (4.2% vs 6.3%, p < 0.01). Multivariable logistic regression, controlling for patient demographics, injury severity, and hospital characteristics, demonstrated that patients with severe splenic injuries treated at hospitals with a fellowship were less likely to undergo splenectomy (odds ratio 0.37, 95% CI 0.20 to 0.66, p < 0.01) or endovascular intervention (odds ratio 0.45, 95% CI 0.22 to 0.91, p = 0.03). In the setting of significant interinstitutional variability in the management of pediatric blunt splenic injury, institutions with pediatric surgical fellowship training programs are more likely to successfully pursue nonoperative management, even after controlling for injury severity and patient demographics.

E-scooter related head trauma has emerged as a growing contributor to neurosurgical and critical care workload internationally, yet data describing injury patterns, resource utilisation and costs remain limited. This study characterises the epidemiology, clinical features and hospital costs of e-scooter related traumatic brain injury (TBI) within a state-wide Level 1 trauma centre. A retrospective study was conducted using the trauma registry of a state-wide Level 1 tertiary trauma centre in Western Australia, identifying e-scooter-related head injuries from 1 January 2019 to 30 June 2024. The registry captures the majority of moderate to severe TBI, although less severe injuries managed at other hospitals may be under-represented. Cases were stratified into a primary TBI cohort (ICD-10-AM S06) and a secondary cohort of isolated calvarial or skull base fractures (S02). Temporal trends were analysed using negative binomial regression. All clinical, neurosurgical, ICU and cost analyses were restricted to the TBI cohort to ensure internal validity. Multivariable logistic regression identified predictors of ICU admission. Hospital costing data were obtained from activity-based management systems. 93 e-scooter related head injury admissions were identified. TBI accounted for 82 cases (88.2%). There was a steep rise in annual incidence (IRR 1.98; 95% CI 1.58-2.48) over the study period. Most patients were male (81.7%) and intoxication due to alcohol or drugs was common (53.8%). Of the primary TBI cohort, calvarial or skull base fractures occurred in 42.7% of patients. Only 9.8% required neurosurgical intervention, yet 50.0% were admitted to the ICU. In univariate analysis, lower GCS (p=0.003) and concurrent skull fracture (p<0.001) were associated with ICU admission. In multivariable analysis, both GCS (OR 0.66 per point; 95% CI 0.44-0.87) and concurrent fracture (OR 7.47; 95% CI 2.47-25.85) remained independent predictors. Total hospital costs increased from $16,103.88 (AUD) in the 2019-2020 financial year to $1,842,153.68 in the 2023-2024 financial year with an annual percent change of 194% (95% CI 105-323). The median cost per TBI admission was $17,720.11 (IQR $9,155.99-$50,311.89). ICU admitted patients incurred significantly higher costs than non-ICU patients (median $30,767.26 vs. $12,906.19). Ward nursing was the largest cost driver. This study documents a growing neurosurgical and critical care challenge in Western Australia. Despite low operative rates, e-scooter related TBI is associated with substantial economic impact, exceeding that reported in other Australian trauma series. These findings highlight opportunities for targeted prevention and policy intervention, including helmet compliance, alcohol riding restrictions and ride-share safety governance.

Incidence and independent predictors of heterotopic ossification after posterior acetabular fixation without routine prophylaxis: A large cohort study.

Venous thromboembolism in pelvic ring and acetabular fractures - A prospective cohort study.

To compare implant failure rates, reoperations, and postoperative mobilization between lateral locked plate (LLP), retrograde intramedullary nail (rIMN), and nail-plate combination (NPC) constructs in treating distal femur fractures. Retrospective cohort study. Single level 1 trauma center. Adult patients treated operatively for distal femur fractures (OTA/AO 33A and 33C) from 2019 to 2024 were included. Patients were excluded if they sustained partial articular injuries, pathologic fractures, multifocal femoral injuries, or critical bone defects. Construct failure was the primary outcome, defined as displaced implant breakage, gross loss of fracture reduction, or any reoperation for nonunion. Secondary outcomes included all-cause reoperation, deep infection, death within 90 days, and mobilization status at the time of discharge. In total, 196 distal femur fractures in 188 patients were included. There were 83 fractures treated with NPC fixation (mean age 70 years, 24% men, BMI 31), 37 fractures treated with rIMN (mean age 55 years, 54% men, BMI 28), and 76 fractures treated with LLP (mean age 65 years, 29% men, BMI 32). Across the 3 treatment groups, patients with rIMN were younger ( P < 0.001) and had a higher proportion of men ( P = 0.004). Immediate weightbearing was allowed in 70% of NPC constructs, 32% of rIMN constructs, and 3% of LLP constructs, respectively ( P < 0.001). After controlling for age, BMI, and open fracture status, NPC was associated with a lower risk of construct failure, occurring in 1 of 83 (1.2%) cases, compared with LLP, which failed in 15 of 76 (19.7%) cases (hazard ratio 17.43 [95% confidence interval [CI], 2.23-136.10], P = 0.006). Although NPC had the lowest rate of failure among the 3 constructs, the difference between NPC and rIMN, which failed in 2 of 37 (5.4%) cases, was not statistically significant (hazard ratio 7.62 [95% CI, 0.66-88.24], P = 0.104). All-cause reoperation occurred in 7 (8.4%) patients in the NPC group, 4 (10.8%) patients in the rIMN group, and 18 (24.7%) patients in the LLP group. Deep infection occurred in 6 (7.2%) patients in the NPC group, 1 (2.7%) patient in the rIMN group, and 1 (1.3%) patient in the LLP group ( P = 0.085). There were no differences in estimated blood loss ( P = 0.137), or death ( P = 0.999) between groups. Geriatric patients (age ≥60 years) with NPC fixation were more likely to discharge within a higher mobilization strata relative to single implant constructs (OR 2.93, P = 0.049). NPC and rIMN demonstrated a lower hazard of construct failure and reoperation than LLP in the treatment of acute distal femur fractures. Although NPC had a higher number of deep infection cases, controlling for multiple comorbidities found no statistical difference in infection rates between NPC, LLP, and rIMN, but rather an increased risk of infection in smokers and patients with high BMI. NPC fixation was associated with improved postoperative mobilization in geriatric patients compared with single implant constructs. Therapeutic, Level III. See Instructions for Authors for a complete description of levels of evidence.

This study assessed the impact of implementing an admission discharge registered nurse (RN-AD) on five inpatient units at an acute care, 718-bed Magnet®-designated, academic, and Level I trauma center on throughput pressures, nurse staffing ratios, and increased workload. To assess the impact of implementing RN-ADs, the authors conducted a nonequivalent pre/post quasi-experimental study utilizing electronic health record data (discharge time, admission date, discharge date) and standardized patient experience survey scores. Predata were collected from August 2016 to July 2017, and postdata were collected from August 2017 to July 2018. Of the 19 114 patient encounters examined, length of stay decreased, discharge before noon increased, and patient experience scores increased; nurses also noted a positive impact on patient discharge. Implementation of an RN-AD role was associated with improvements in length of stay, earlier discharge timing, patient experience, and nurse satisfaction. These findings suggest that dedicated admission and discharge nurse support may be an effective workforce strategy to improve patient flow while reducing the operational burden on bedside nurses.

Patient and fracture characteristics associated with six-month patient-reported outcomes following acetabular fracture fixation.

To describe a novel percutaneous technique utilizing a curved intramedullary implant for fixation of complex anterior pelvic ring fractures and to report preliminary clinical outcomes from a retrospective case series. Retrospective case series. Single academic Level I trauma center. Nine female patients (mean age 74.8 years, range 53-89 years) with anterior pelvic ring injuries treated with percutaneous trans-symphyseal fixation using a curved intramedullary device between June 2023 and December 2024. All patients were treated by a single orthopaedic trauma surgeon and followed for a minimum of 6 months. Percutaneous intramedullary fixation of the superior pubic ramus crossing the pubic symphysis and terminating in the contralateral ramus using a novel flexible, curved implant. Operative time, estimated blood loss, implant complications, fracture union, and discharge disposition. The novel technique was successfully performed in all 9 patients. Average total surgical time was 106.3 minutes, with a mean of 54.8 minutes dedicated to the anterior fixation. Average estimated blood loss was 132.2 mL. All fractures progressed to union with no cases of implant failure or surgical site infection. Assistive measures were required in 3 of 9 cases. Discharge disposition was favorable, with 5 of 9 patients discharged to home or acute rehabilitation. No complications related to the anterior implant were noted. This retrospective review suggests that trans-symphyseal curved intramedullary fixation is a feasible and safe technique for managing anterior pelvic ring fractures, including fragility and high-energy patterns. The method provides stable fixation while minimizing operative time, blood loss, and surgical exposure. Further studies are warranted to compare this technique against established modalities in larger cohorts. Level IV-Therapeutic study.

Three-year outcomes following retained intramedullary nails (DAIR) in early fracture related infections: A prospective case series.

Post pelvic binder radiograph can identify bladder injury associated with pelvic trauma: A multi-centre observational study.

Simulation as a catalyst for surgical teamwork: Insights from a high-fidelity trauma training experience.

Association between prehospital time and injury severity in traffic crash patients.

Is imaging the spine enough? Characterizing outcomes in injured patients who underwent computed tomography (CT) of the thoracic or lumbar spine.

Glenoid fracture morphology predicts associated trauma and patient-reported outcome measures (PROMs); A multicenter evaluation.

Previous retrospective studies involving mixed intensive care unit (ICU) populations found antipsychotic continuation rates ranging from 21% to 61% at hospital discharge. Surgical ICU admission was cited as a risk factor for antipsychotic continuation, although data in the trauma population are limited. The purpose of this study was to evaluate the number of critically ill trauma patients with escalated psychotropic medications in the surgical ICU and the rate of continuation at ICU transfer and hospital discharge. This single-center, retrospective, Institutional Review Board (IRB)-approved study examined adult trauma patients admitted to the surgical ICU at an urban Level 1 Trauma and Academic Medical Center from December 1, 2021, to May 31, 2023. Patients were excluded if they had a history of select psychiatric disorders or were in the ICU for less than 48 hours. Prior psychotropic medication use was noted, and escalation was defined as a new or increased dose of psychotropic medication. The incidence of delirium and agitation was recorded to assess the indication for psychotropic medication escalation. The primary and secondary outcomes were the percentage of patients with escalated psychotropic medications in the ICU who were continued on therapy at the time of ICU transfer and hospital discharge, respectively. Four hundred and twenty-four patients admitted to the surgical ICU were included; 51.4% were escalated on a psychotropic medication while in the ICU. Nearly 35% and 31.8% of the overall population were continued on psychotropic medication at ICU and hospital discharge, respectively. Of patients on psychotropic medication at hospital discharge, 55.6% were discharged to acute rehabilitation, 28.9% to home, and 13.3% to long-term care. Escalation of psychotropic medications was common in trauma patients admitted to the surgical ICU. Further investigation into the appropriateness of psychotropic medication prescription during care transitions is needed.

Epidemiology, management, and outcomes of pediatric traumatic brain injury: a prospective study from a tertiary trauma centre in North India.