Trauma Hospital Research Articles

Pulmonary and Physical Virtual Reality Exercises for Patients With Blunt Chest Trauma: Randomized Clinical Trial.

Adequate pain relief, early restoration of breathing, and rapid mobilization pose a clinical challenge in patients with blunt chest trauma. Virtual reality (VR) has the potential to achieve these 3 interrelated treatment objectives with enhanced self-efficacy and autonomy of patients and limited support by clinicians. This study aimed to assess the effectivity of breathing and physical exercises using VR on the pulmonary recovery of patients with blunt chest trauma at the ward. A pilot randomized controlled trial was performed. The control group received usual physiotherapy consisting of protocolized breathing exercises (8 times daily for 10 minutes) and physical exercises (2 times daily for 10 minutes). The VR group was instructed to perform these exercises using VR. The primary outcome was vital lung capacity at day 5 or earlier at discharge. Secondary outcomes were patient mobility (time standing, lying, and sitting), clinical outcomes (length of hospital stay, pulmonary complications, transfer to intensive care unit, and readmission within 30 days), pain, activities of daily living, patient-reported outcome measures (satisfaction and quality of recovery). Patient experiences and barriers and facilitators toward implementation were assessed through interviews. The study was prematurely ended due to enrollment failure combined with poor protocol adherence to exercises in both groups. A total of 27 patients were included, of which 19 patients completed 3 or more days. Vital lung capacity at 5 days (or last measurement) was equal between groups with 1830 (SD 591) mL and 1857 (SD 435) mL in the control and VR groups, respectively. No marked differences were observed in secondary outcomes. Patient interviews showed positive attitudes toward the use of VR, describing that visualization of the exercises helped patients to perform the exercises correctly and to continue the exercises for a longer duration. Also, patients experienced the immersiveness of VR as an analgesic. However, patients did not experience added value over usual care and reported that better integration in treatment and the hectic hospital environment could improve the use of the VR exercises. The suitability of patients to use virtual reality therapy (VRx) in a hospital (trauma) ward setting is lower than generally expected. Effective application of VRx requires professional guidance and needs thorough alignment with clinical practice. For future research, we recommend to chart adherence to study protocol before designing a VR clinical trial. Patient-reported experiences need to be prioritized in evaluating VR acceptance, usability, and effectiveness. In line, we recommend performing a systematic analysis (eg, using the technology acceptance model) on the acceptance before pilot or main effectiveness studies. Finally, the eligibility of patients and exclusion of patients due to the inability to use VRx should be routinely reported. ClinicalTrials.gov NCT05194176; https://tinyurl.com/2bzh4tzx.

Experience of total hip arthroplasty in a patient with post-traumatic aseptic necrosis of the femoral head

A hip fracture is a common injury in old age. It can be noted that the number of fractures is several times higher in women compared to men. Without surgical treatment, this pathology is highly likely to lead to complications and death of the patient within a year. High mortality rates in elderly people who have sustained a hip fracture can be attributed to various reasons. Due to prolonged forced bed rest in such patients, the risk of developing respiratory and cardiovascular complications, thrombosis, bleeding and infection significantly increases. In modern clinical practice, all fractures of the femoral neck are the reason for surgical intervention, according to vital indications. The only exception is the general severe condition of the patient in case of disruption of the normal functioning of the cardiovascular and respiratory systems, multiple organ failure and oncological diseases in the stage of decompensation.Purpose of a study: to demonstrate successful total arthroplasty of the left hip joint in elderly patient with posttraumatic avascular necrosis.Data from the medical documentation of the trauma hospital, data from instrumental research and the results of dynamic observation were used to write the article. The results were obtained using the equipment of the Center for Collective Use of Scientific Equipment of Tambov State University named after G.R. Derzhavin.As a result of total hip arthroplasty, the function of the patient's limb was restored.Conclusion. Total arthroplasty is an effective treatment method for patients with post-traumatic changes in the hip joint, allowing to restore the patient’s motor activity and prevent the development of hypostatic complications.

Peri-Operative Hypothermia in Trauma Patients: A Retrospective Cohort Analysis at a Busy District General Hospital Within the National Health Service (NHS).

Perioperative hypothermia is defined as a patient's core body temperature of less than 36°C, whichcan lead to several complications. Even mild hypothermia increases the incidence of post-operative wound infection, post-operative ischaemic cardiac eventsand intra-operative blood loss and prolongs post-operative recovery. It is, hence, essential to maintain and provide normothermia during the perioperative phases for optimal surgical results and patient satisfaction. One of the most significant contributing factors to intra-operative hypothermia is the induction of general anaesthesia, where a significant amount of heat is shifted from the core to the peripheral circulation with consequent loss to an often-cold environment. The difference between the patient's skin and ambient temperature during the interval from entering the operating room through anaesthesia induction until draping and active warming may be significant. This study aims to look at the incidence of perioperative hypothermia in trauma and orthopaedics patients who present to a busy district general hospital in the National Health Service (NHS) and correlate this with the ambient theatre temperature and phases of surgery to draw a statistical significance. This retrospective observational study conducted at the North Manchester General Hospital's trauma and orthopaedics department included 300 patients listed in the trauma surgery list from 1 July 2023 to 31 August 2023. Inclusion criteria were trauma patients aged 16-85 years. Elective orthopaedic and other surgical speciality patients were excluded. The perioperative temperature measurements were collected from the anaesthesia records. Statistical calculations were conducted using the StatsDirect software (StatsDirect Ltd, Wirral, UK) from Manchester University NHS Foundation Trust, Manchester. Among the 300 patients, the overall incidence of hypothermia was 3% pre-operative, 18% pre-induction, 21% intra-operative, 21% post-operative, 3% in recovery and 0% post-recovery. Intra-operative hypothermia incidence was significant, given that active warming was applied to patients with pre-operative hypothermia. Multivariate regression analysis showed that pre-induction temperature and theatre ambient temperature were statistically significant in predicting intra-operative hypothermia. This study highlights the need for active interventions to recognise and prevent perioperative hypothermia in trauma and orthopaedics patients. Active pre-warming of patients and the operating rooms, regardless of surgery type and duration, is feasible and potentially beneficial. Further studies should include a randomised controlled trial comparing active and passive warming strategies to evaluate their effectiveness in improving perioperative outcomes.

Structural Antibiotic-Coated Hindfoot Nail Preparation: A Technique Guide

The current guide describes a technique that has been in place at the University of Louisville for several years and has been utilized to create structural antibiotic hindfoot nails. This has the intention of creating a stable construct that can be utilized in the setting of previous osteomyelitis, or that is at high risk of developing infections in the postoperative state. This technique guide provides a reproducible way to apply an antibiotic delivery system to a tibiotalocalcaneal nail at the time of definitive surgical intervention. It described our method at rural state level one trauma hospital of utilizing antibiotic-impregnated polymethylmethacrylate around a nail for both antibiotic properties as well as structural properties. Antibiotic delivery systems are a well-researched surgical tool, combining this with a hindfoot nail offers definitive surgical management of otherwise complicated surgical cases. Although this technique has been in use at the University of Louisville for many years, additional research should be done to determine long-term outcomes. Level of Evidence: Diagnostic Level VII. See Instructions for Authors for a complete description of levels of evidence.

Impact of COVID-19 pandemic on traumatic brain injury emergency department visits, interfacility transfer and mortality in the United States, 2016–2020: a cross-sectional study

ObjectiveThe aim of this study was to determine how the COVID-19 pandemic affected patient demographics, injury mechanisms, interhospital transfers and mortality of patients with traumatic brain injuries (TBIs) treated in...

Does distance to hospital and interhospital transfer negatively impact time to definitive fixation and outcomes in patients with fractured neck of femur in a rural setting?

This study aims to investigate in patients over 65 with neck of femur (NOF) fractures in Rural Australia, does initial presentation to a peripheral hospital result in a delay to surgery? Retrospective cohort study. Dubba Base Hospital, Trauma Hospital Rural Australia(Modified Monash Model (MMM) 3) and catchment area (MMM 3-7), NSW, Australia. The study includes 350 patients over 65, presenting with closed, unilateral NOF fractures who underwent operative management at the operating centre, 203 from peripheral hospitals. Primary outcomes include time to surgery and adherence to recommended timeframes for NOF fixation. Secondary outcomes encompass complications, hospital length of stay and a subgroup analysis to identify causes of surgery delay. Patients transferred from peripheral hospitals experienced a statistically significant delay in time from presentation to surgery compared to those presenting directly to the operating centre (42 h vs. 24 h, p < 0.001) and were more likely to be outside of current guidelines for NOF fixation within 36 h of presentation (OR 5.1, p < 0.001). There were no differences in mortality at 1 year between the two groups (15% vs. 18%, p = 0.5). On subgroup analysis, distance from the operating centre, time to x-ray and after-hours presentation were associated with increased likelihood of surgery outside of 36 h in the peripheral hospital group. This study underscores an inequity in service delivery for rural patients with NOF fractures, particularly those requiring transfer. Pre-arrival delays necessitate targeted interventions to address diagnostic service delays, logistical challenges and transport issues in rural health care.

Twelve-year review of horse-related trauma registry presentations to a regional Australian Emergency Department.

The size, strength, and unpredictability of horses, makes any interaction a potential situation for minor to severe injury. Despite this, horses continue to be popular for work and recreational activities. There have been five recent Australian publications that have examined various aspects of horse-related trauma, but none have been conducted in regional New South Wales (NSW). This study aims to report on the pattern of horse-related trauma that met the Institute of Trauma Injury Management's (ITIM) Trauma Registry criteria for people who presented to the emergency department at a regional NSW hospital, Australia. An analysis of horse-related trauma extracted from the Wagga Wagga Base Hospital's Trauma Registry from 2012 to 2023 was undertaken. Demographic and clinical variables were reported on all people (n = 85) and statistically evaluated. The cohort median age was 46 years (range 2-78). Males represented 51.8%. Fall from mounted position was the most common mechanism of injury (84.7%) followed by kick while unmounted (11.7%). The head (45.9%) and chest (32.9%) were the most common regions of injury with head (45.9%) and fractures (44.7%) the most common types of injury. 11.8% of people required ICU admission. Horse-related trauma, whether a person is mounted or unmounted, causes mild to severe injuries and can require hospitalization. Horse-related trauma has the potential to significantly impact morbidity, result in death and must not be underestimated. Establishing a protocol for horse-related trauma presentations and increasing awareness of injury patterns sustained from this mechanism has the potential to improve diagnosis and reduce morbidity.

The Impact of Non-trauma Factors on Trauma Patient Mortality and Hospital Resource Utilization: Population-Based Retrospective Review.

The death of trauma patients with low injury severity scores (ISS) may not be fully explained by the severity of their injuries. Our objective was to evaluate preexisting conditions (PECs) that may contribute to the mortality rate of and hospital resources consumed by patients with low ISS. Trauma patients with ISS <9 were selected from the National Trauma Database Bank [NTDB] [2019-21]. Bivariate and multivariate analysis identified the risk factors associated with mortality, adjusting for secondary PECs, mechanism of injury, AIS body region, vital signs, and blood transfusion. A t test was used to compare PEC status with intensive care unit (ICU) and hospital length of stay (LOS) for significant differences (P < .05). 1,689,392 patients suffered mild injuries [59.1% male, mean age 45.2, 8579 expired (0.5%)]. Mortality was associated with the presence of several risk factors, especially advanced directive [OR = 9.13, P < .001], cirrhosis [OR = 8.55, P < .001], disseminated cancer [OR = 8.53, P < .001], congestive heart failure (CHF) [OR = 6.62, P < .001], chronic renal failure (CRF) [OR = 6.16, P < .001], chemotherapy for cancer [OR = 5.64, P < .001], peripheral arterial disease (PAD) [OR = 5.32, P < .001], myocardial infarction (MI) [OR = 4.96, P < .001], dementia [OR = 4.62, P < .001], and functionally dependent health [OR = 4.57, P < .001]. In addition, there was a relationship between the presence of several PECs and increased ICU and hospital LOS, especially cirrhosis, CRF, CHF, and PAD. Nontraumatic factors and preexisting conditions are associated with increased mortality and hospital resource consumption in trauma patients with a low ISS. They should be considered during clinical decision-making for these patients, who may otherwise masquerade as part of a low-risk population.

Injury epidemiology and emergency department length of stay in trauma hospital in Addis Ababa, Ethiopia.

Injuries are a major cause of health problems in low- and middle-income countries than in high-income nations. This study aimed to describe injuries and identify factors associated with the emergency department (ED) length of stay (LoS). This study was conducted at the Addis Ababa Burn, Emergency, and Trauma (AaBET) hospital in Addis Ababa, Ethiopia. All injured patients who visited the ED between April 1, 2021, and March 30, 2022, were included in the study. Data were collected through a retrospective medical record review. Descriptive statistics were used to present the data and a multivariable binary logistic regression model was used to assess factors associated with LoS in the ED. A total of 6991 (86.8%) injured patients were studied out of 8055 patients who visited the ED. The majority of the patients were male, 5184 (74.2%), and aged between 18-44 years, 4368 (62.4%). The most common mechanism of injury was road traffic accidents, 2693 (38.5%), followed by falls, 1523 (21.8%). The most commonly reported injured body parts were the head (2179, 31.2%). Of the total injured patients, 101 (1.8%) died. The LoS in the ED was greater than 24 hours for 24.4% (95% CI: 23.3-25.5) of the injured patients, with a mean duration of 2.51 (SD = 5.18) days. Factors significantly associated with a prolonged LoS (>24 hours) in the ED included being residing in outside Addis Ababa in Oromia [AOR: 1.61, 95% CI (1.38-1.88)], Amhara [AOR: 1.56, 95% CI (1.14-2.14)] and other [AOR: 3.93, 95% CI (2.73-5.64)], male [AOR: 1.30, 95% CI (1.09-1.54)], aged 60 years or older [AOR: 1.38, 95% CI (1.03-1.85)]; sustaining injuries from road traffic accident [AOR: 2.43, 95% CI (1.19-4.94)], being triaged to orange [AOR: 3.03, 95% CI (2.40-3.83)] and red zones [AOR:3.37, 95% CI (2.65-4.28)]; having fracture injuries [AOR: 1.95, (1.34-2.83)]; and experiencing contusions and crushing injuries [AOR: 2.63 (1.57-4.42)]. Injuries are the major share of cases among ED patients at AaBET hospital. Patients were staying in the ED for longer than the recommended 24 hours by the Ethiopian health system. Intervention measures focusing on injury prevention are necessary to reduce the patient burden on the hospital and strengthen the hospital's capacity to reduce prolonged LoS.

Effects of a Virtual Trauma Clinic on admissions and length of stay for minor to moderate trauma.

To investigate the feasibility of a Virtual Trauma Clinic (VTC) for patients with minor to moderate trauma, and evaluate patient satisfaction and outcomes. One hundred VTC patients were matched 1:1 with historical patients from the hospital trauma registry who received conventional care. Matching was based on age ± 5 years, sex, mechanism of injury, Injury Severity Score ± 2, trauma team activation and day of week of presentation. VTC patients were sent surveys on experience and outcome measures. VTC was associated with reduced average hospital length of stay for admitted patients by 1.81 days (95% CI = -2.82, -0.79; P = 0.001) and reduced hospital admissions (odds ratio 0.26; 95% CI = 0.14, 0.48; P < 0.001). There was an avoidance of 199 inpatient bed days in total, with no trauma-related readmissions within 30 days post-hospital discharge. 92% of respondents (n = 22) rated the care they received from VTC as excellent or good. Patient-reported outcome surveys showed overall improvement in functional domains but evidence of ongoing disability, with persistent issues of pain and psychological distress at 1 month post-injury. Patients with minor to moderate trauma have ongoing care needs with high rates of pain, psychological distress and disability remaining prevalent long after discharge. VTC provided an innovative strategy for hospital avoidance with high levels of patient satisfaction and no adverse effects on safety. The overall quality of care for these patients was enhanced through the provision of standardised, patient-centred and multidisciplinary follow-up.

Successful experience of hip arthroplasty with a unipolar endoprosthesis

Introduction. Fractures of the femoral neck occupy a significant place in traumatology and orthopedics and represent a serious pathological problem. Without surgical treatment, this pathology leads to complications and death of the patient within a year. Hip replacement is the choice of treatment method that allows the injured patient to be mobilized as early as possible. This promotes and has a positive effect on the timing and effectiveness of rehabilitation measures and minimizes the risk of developing possible complications. The purpose of this publication is to demonstrate the successful experience of treating a patient with a fracture of the right femoral neck with displacement of fragments using endoprosthetics. Materials and methods. To write the article, we used medical documentation data from a trauma hospital, the results of instrumental research and dynamic observation of the patient. A search was also carried out in the open electronic scientific databases PubMed of the US National Electronic Medical Library and the databases of the Russian scientific electronic library elibrary, using keywords and phrases: Results. Endoprosthesis replacement of the hip joint with a unipolar endoprosthesis was performed. On the sixth day after the surgical intervention, the patient was discharged in satisfactory condition for outpatient treatment by a traumatologist at his place of residence. The wound and sutures have no signs of inflammation, sensitivity and blood supply to the limb are preserved. The patient moves independently using a walker. Discussion. Analyzing the results of surgical treatment in the described clinical case, we can conclude that the method of hip replacement is highly effective in elderly people. Conclusion. Endoprosthesis replacement surgery is low-traumatic and allows the patient to be mobilized early. Our experience allows us to believe that treatment with endoprosthetics is effective for fractures of the femoral neck and allows us to achieve positive results in the early stages.

Health related outcomes of patients with serious traumatic injury: Results of a longitudinal follow-up program delivered by trauma clinicians

IntroductionThe routine collection of long-term patient health outcomes after serious traumatic injury at the health service level is uncommon. In 2019, we implemented the longitudinal Trauma Service Follow Up (TSFU) program at a level I trauma centre. Delivered by the trauma service clinicians involved in inpatient care, it assesses quality of life and disability. This study reports the 6- and 12-month outcomes of the first two years of operation of the TSFU program. MethodsThis is a prospective cohort study of seriously injured adult trauma patients admitted to a level I trauma centre with 6- and 12-months post-discharge outcome assessments. Outcomes were quality of life and function/disability as measured using the EQ-5D-5L and WHODAS 2.0 validated instruments. Changes from 6 to 12 months were assessed using generalised estimating equations methods. Logistic regression models were used to identify factors associated with ongoing problems at each time point. ResultsFive-hundred and eight seriously injured patients were eligible for the TSFU program with follow-up rates over 80 % at both 6- and 12-month timepoints. At six months, ongoing problems with pain (69.9 %), anxiety and depression (49 %) and carrying out usual activities (57.5 %) were highly prevalent; at 12 months problems with pain (61.4 %) and anxiety and depression (43.8 %) persisted. Lower extremity and/or pelvic surgery was associated with ongoing pain, odds ratio (OR) = 3.77 (95 % CI 1.54–9.21, p=0.01), anxiety and depression (OR 1.95, 95 % CI 1.09–3.48, p=0.02) and problems carrying out their usual activities (OR 3.19, 95 % CI 0.75–13.5, p=0.11) at six months. These patterns mostly persisted at 12 months. Similar associations between surgical intervention and high levels of disability were evident at both time points. ConclusionPersistent impairments in physical and emotional health continues to affect many people following serious traumatic injury. The collection of longitudinal health outcomes by trauma clinicians enables identification of factors that contribute to disability and a reduction in quality of life. This in turn can drive quality improvement initiatives within the hospital trauma system. Longitudinal follow-up programs may provide a platform to provide ongoing specialist trauma-informed care after hospital discharge.

Variations in Trauma Education Practices Across Emergency Medicine Residencies: Insights from a National Survey of Program Directors.

Care of the acutely injured trauma patient is integral to the practice of emergency medicine. It is currently unknown how most emergency medicine residencies structure their residents' trauma experience and little guidance for competency assessment is provided by the Residency Review Committee. Our study aimed to determine current emergency medicine residency practices in trauma resuscitation. We conducted a cross-sectional survey of members of the Council of Residency Directors in Emergency Medicine (CORD) listserv in April 2023. Frequency with percentage of item responses is reported and differences across trauma levels assessed via Fisher's exact test (α = 0.05). Fifty-seven program directors responded to the survey (21.9%), the majority of whom operate at Level I facilities. Significantly more Level II/ III centers send residents to other sites for trauma experience compared to Level I (p = 0.000). Residents participate in all key procedures (eg, airway management, central venous access) when managing traumas except thoracotomy where participation was notably lower and statistically different across levels (p = 0.000). Lastly, program directors were very confident their residents can lead traumas independently and few acknowledged citations for deficiency in trauma training. Trauma training and confirmation of competency is critical among EM residents who may serve as the sole lead in rural emergency departments. This study demonstrates that there is considerable variability in how residency programs structure trauma education, particularly with regards to the exposure to invasive procedures and the opportunity to lead trauma resuscitations. As the American Board of Emergency Medicine has introduced requirements for program directors to attest specifically to the competence of residents to lead trauma resuscitations, standardized and validated tools should be adopted to support this attestation and ensure competence regardless of the program hospital's trauma level.

Mortality association with extremity trauma and transferring patients for higher level of care.

Rising healthcare costs and reduced Medicaid reimbursements pose lasting challenges for trauma centers. Various studies have highlighted the adverse effect of these cost-related circumstances on trauma center survival and the need for local hospitals to transfer patients to tertiary and quaternary care centers. Our study seeks to assess the relationship between patient transfer status to a higher-level health center and its association with mortality. A total of 19417 patients were identified, of which 15317 patients presented directly to the higher level health center, and 3830 patients who transferred from 49 different outside hospitals within a 500-mile radius. Data collection was collected from the receiving higher level of care hospital trauma registry. IBM SPSS version 23 was used to analyze the data. A 1:1 propensity-matched analysis based on age, sex, and injury severity score yielded 3566 patients that presented directly to ARMC and 3566 patients who were transferred to ARMC for a higher level of care. Amongst various factors we considered mechanism of injury, response levels, arrival methods, and transfusion of blood products. The univariate analysis of the propensity-matched analysis demonstrated 88% blunt injury in the nontransferred group and 82% in the transferred group (P<0.001). Overall, hospital mortality was 3% in nontransferred patients versus 4% in the transferred group (P<0.001). A multivariate logistic regression demonstrated mortality is more likely in patients with higher injury severity scores [odd ratio (OD) 2.351 (1.029-1.082), P<0.001] and lack of packed red blood cell (pRBC) transfusions received within first 4h [OD 6.852 (3.525-13.318), P=0.001]. The transfer of trauma patients with extremity injuries to level 1 trauma centers has significant implications on patient outcomes. In our retrospective observational cohort study, the authors noted increased mortality among patients with higher injury severity scores, penetrating injuries, pRBC administration within the first 4h of hospitalization, and among patient transfers.

The Incidence and Severity of Pediatric Injuries Sustained by Electric Bikes and Powered Scooters: The Experience of an Urban, Tertiary Pediatric Emergency Department.

This study aimed to describe the incidence and severity of electrical bicycle (E-bike)- and power scooter (P-scooter)-related injuries and their secular trends among pediatric patients presenting to a pediatric emergency department (ED). This retrospective cohort study of patients aged <18 years who sustained E-bike and P-scooter injuries was performed between 2018 and 2023. We explored trends of severe trauma cases, ED visits, hospitalizations, and surgical interventions. Severity of trauma was rated by either an injury severity score (ISS) of >15 or the patient's need for acute care as defined by intensive care unit (ICU) admission, direct disposition to the operating room, acute interventions performed in the trauma room, and in-hospital death. Of the 1466 pediatric patients who presented to our pediatric ED following P-scooter and E-bike injuries, 216 (14.7%) were hospitalized, with a median age of 14.0 years (interquartile range, 10.5-16.0 years) and male predominance (69.0%). The number of ED visits increased 3.5-fold by study closure, with a parallel increase in hospitalizations, surgical interventions, and severe trauma cases. The relative percentages of severe trauma cases were not significantly different over time. Among hospitalized patients, 3 patients (1.4%) died and 9 (4.1%) required rehabilitation care. The incidence and severity of E-bike and P-scooter injuries and fatalities continue to increase within the pediatric population. Current personal and road safety regulations are providing inadequate in preventing these injuries, highlighting an urgent need for revision and stricter enforcement.

Clinical study of isthmic spondylolisthesis treated with Mis-TLIF assisted by preoperative posture reduction and intraoperative lifting reduction

To investigate the clinical effect of minimally invasive transforaminal lumbar interbody fusion(Mis-TLIF) technique combined with preoperative position reduction in the treatment of spondylolisthesis and summarize its advantages. Between July 2016 and July 2022, 60 patients with lumbar isthmic spondylolisthesis were retrospectively analyzed, including 26 males and 34 females, with an average age of (51.32±4.24) years old ranging from 35 to 72 years old. They were divided into observation group and control group according to the operation methods. There were 30 patients in the observation group, including 12 males and 18 females;the age ranged from 35 to 71 years old with an average of(51.80±6.38) years old, the course of disease ranged from 12 to 60 months with an average of (24.17±1.98) months;there were 18 cases of L4 spondylolisthesis and 12 cases of L5 spondylolisthesis;according to Meyerding classification, there were 20 cases of grade Ⅰ spondylolisthesis and 10 cases of gradeⅡ. The observation group was treated with preoperative postural reduction combined with intraoperative reduction assisted minimally invasive transforaminal lumbar fusion via Quadrant channel(Mis-TLIF). There were 30 patients in the control group, including 14 males and 16 females, with an average of (50.00±4.24) years old ranging from 36 to 72 years old;the course of disease ranged from 12 to 60 months with an average of (23.70±1.53) months;there were 16 cases of L4 spondylolisthesis and 14 cases of L5 spondylolisthesis;according to Meyerding classification, there were 19 cases of grade Ⅰ spondylolisthesis and 11 cases of grade Ⅱ. The control group was treated with open transforaminal lumbar interbody fusion(Open-TLIF). The differences of operation time, intraoperative and postoperative blood loss, hospital stay, radiation exposure time and complications between the two groups were analyzed. Visual analogue scale (VAS), Oswestry disability index (ODI) and Japanese Orthopaedic Association(JOA) score were used to evaluate the clinical effect. X-ray and CT were followed up to evaluate the interbody fusion. All patients were followed up for 12 months. There was no significant difference in operation time, VAS of low back pain, slip angle and slip rate between two groups (P>0.05). The intraoperative and postoperative blood loss in the observation group (165.50±15.56) ml and (59.17±10.59) ml were less than those in the control group (259.33±35.32) ml and (165.33 ±29.56) ml (P<0.05). The length of hospital stay in the observation group (3.53±0.68) days was less than that in the control group (5.20±0.41) days (P<0.05).The intervertebral space height, slip angle, slip rate, ODI, VAS and JOA scores were significantly improved in the two groups at the final follow-up (P<0.05). There were significant differences in ODI [(9.93±1.11)% vs (10.93±1.11)%] and JOA [ (26.07±1.01) points vs (25.43±1.25) points] between the observation group and the control group at the final follow-up (P<0.05). In the treatment of spondylolisthesis, preoperative position reduction combined with intraoperative reduction assisted Mis-Tlif technique has advantages of less trauma, less bleeding and shorter hospitalization period than traditional open surgery. It is a safe and effective technique.

Post-injury use of opioid analgesics in patients with traumatic injury: A registry-based study.

Opioid analgesics are commonly used to treat acute and chronic pain following traumatic injury. Psychiatric comorbidity has been reported to be associated with increased pain and persistent opioid use. Our aims were to determine the extent of post-injury opioid use and assess whether pre-injury antidepressant, benzodiazepine, and z-hypnotic drug use is associated with increased post-injury opioid use. Data on trauma patients aged 15 years and older included in the Oslo University Hospital Trauma Registry between 2005 and 2014 was linked to data from the Norwegian Prescription Database. We identified opioid dispensing within the first 90 and 365 days following trauma and determined subsequent persistent use. Multivariable logistic regression was applied to examine associations between pre- and post-injury drug use. 3912 of 11,057 patients (35.4%) had opioids dispensed within 90 days after trauma, and 4644 (42.0%) within 365 days. Among 9800 previously opioid-naïve, the proportions were 33.0% and 39.0%, respectively. One year after the first post-injury opioid dispensing, 9.6% of all opioid users and 4.5% of new users were defined as persistent users. Pre-injury benzodiazepine use and z-hypnotic use was associated with new persistent opioid use (adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.47-3.45, and aOR 2.04; 95% CI 1.33-3.13, respectively), whereas pre-injury antidepressant use was not (aOR 1.49; 95% CI 0.97-2.30). Opioid use after trauma is widespread. Development of persistent use is limited, particularly in previously opioid-naïve patients. Pre-injury benzodiazepine or z-hypnotic use seem to increase odds of new persistent use. This large registry-based study adds to the body of knowledge on opioid use beyond in-hospital care in patients having sustained traumatic injury, a field which is scarcely investigated and not yet fully understood. It suggests that both previous drug therapy and the nature of opioid treatment initiation may affect outcome. This will help guide clinicians in selecting the appropriate pain management in this patient group.

Streamlining management in thoracic trauma: radiomics- and AI-based assessment of patient risks.

In blunt chest trauma, patient management is challenging because clinical guidelines miss tools for risk assessment. No clinical scale reliably measures the severity of cases and the chance of complications. The objective of the study was to optimize the management of patients with blunt chest trauma by creating models prognosticating the transfer to the intensive care unit and in-hospital length of stay (LOS). The study cohort consisted of 212 cases. We retrieved information on the cases from the hospital's trauma registry. After segmenting the lungs with Lung CT Analyzer, we performed volumetric feature extraction with data-characterization algorithms in PyRadiomics. To predict whether the patient will require intensive care, we used the three groups of findings: ambulance, admission, and radiomics data. When trained on the ambulance data, the models exhibited a borderline performance. The metrics improved after we retrained the models on a combination of ambulance, laboratory, radiologic, and physical examination data (81.5% vs. 94.4% Sn). Radiomics data were the top-accurate predictors (96.3% Sn). Age, vital signs, anthropometrics, and first aid time were the best-performing features collected by the ambulance service. Laboratory findings, AIS scores for the lower extremity, abdomen, head, and thorax constituted the top-rank predictors received on admission to the hospital. The original first-order kurtosis had the highest predictive value among radiomics data. Top-informative radiomics features were derived from the right hemithorax because the right lung is larger. We constructed regression models that can adequately reflect the in-hospital LOS. When trained on different groups of data, the machine-learning regression models showed similar performance (MAE/ROV 8%). Anatomic scores for the body parts other than thorax and laboratory markers of hemorrhage had the highest predictive value. Hence, the number of injured body parts correlated with the case severity. The study findings can be used to optimize the management of patients with a chest blunt injury as a specific case of monotrauma. The models we built may help physicians to stratify patients by risk of worsening and overcome the limitations of existing tools for risk assessment. High-quality AI models trained on radiomics data demonstrate superior performance.

The Use of 3D Model Printing for Acute Planning in Oral and Maxillofacial Traumatology

Introduction Due to the complex anatomy of craniomaxillofacial structures, facial reconstruction following high-impact traumas is extremely challenging. Therefore, this study aimed to evaluate the use of biomodels in the surgical planning of complex fractures and the sequelae in the oromaxillofacial region. Materials and Methods This is a cross-sectional, exploratory, descriptive, and quantitative documentary study. It was conducted at the “Dom Luiz Gonzaga Fernandes” Emergency and Trauma Hospital, in the hinterland of the state of Paraíba, in Brazil, based on cases recorded between November 2021 and November 2022. The research instrument utilized was a self-developed questionnaire. Results No statistically significant correlation was observed between the biomodel acquisition time and the length of hospitalization, with a Spearman's correlation coefficient of r = -0.079. Although the need for adjustment of osteosynthesis material was 50% in cases where acrylonitrile butadiene styrene (ABS) models were used, with p (1) = 0.464, in order to be significantly more faithful, it would require a study with a higher sample size. The average length of surgery, in minutes, was 91.25 ± 28.00. The average cost of the materials used to manufacture the biomodels, in Brazilian reais (R$), was R$122.00 ± R$89.09. Conclusion The use of biomodels in the surgical planning of complex fractures and oromaxillofacial sequelae did not increase the length of hospitalization. The material used for the prototype manufacture suggests a potential influence on its faithfulness. The length of surgery was shorter in interventions that utilized biomodels in the planning phase. It was also noted that the average cost of manufacture varies according to the type of material chosen and the quantity required.

A 6-month Review of O pRBC Utilization in Non-O Blood Type Patients in a Level 1 Trauma Center

Abstract Introduction/Objective Using O pRBCs for non-O patients for acute events is not unusual in a level 1 trauma hospital. However, we occasionally utilize this blood type to meet the needs of our patients that are not acutely bleeding. In this study, we evaluated the utilization of O units in non-O patients to improve our transfusion practices. Methods/Case Report We reviewed the indications of the O pRBCs transfused to non-O patients from October 2023 to March 2024. We evaluated the number of units used in acute events such as massive transfusion protocol (MTP), acute blood loss, sickle cell disease (SCD) patients in crises, bleeding associated with surgery and in patients with symptomatic anemia. Results (if a Case Study enter NA) There were 258 O pRBCs transfused to non-O blood type from October 2023 to March 2024. 135(52%) of these units were used for bleeding patients, of which 91%(124/135) were used for acute events. Most of the units utilized for acute hemorrhage had activated MTP (92%, 89/124) due to trauma (88%, 78/89). Only 12%(31/258) were used by SCD patients, with a little over half of these units being used acutely and the rest used prophylactically. About 69% of the 16 units used in surgery were due to bleeding. Lastly, 76 units (29%) were used for symptomatic anemia patients with 45% of these units transfused for anemia of prematurity. Conclusion In a level 1 trauma hospital, advocating for conserving O units is crucial to ensure enough units are available for trauma. As anticipated, acute bleeding was found to be the leading cause for patients with non-O blood types to receive O pRBCs. Notably, the prevalence of using O units for acute and prophylactic transfusion is relatively the same for SCD patients and phenotypically matching the Rh and Kell systems likely plays a role.