Trauma Patients Research Articles

The Role of Screening for Venous Thromboembolism in Pelvic Trauma Patients: A Single-Centre Retrospective Study.

Background: Venous thromboembolism (VTE) is a severe complication following pelvic trauma. Thromboprophylaxis has reduced the risk of VTE in the pelvic trauma population; nevertheless, the risk remains high. A substantial pulmonary embolism has emerged as the unexpected cause of death among patients presenting with 'minor pelvic fractures'. The purpose of this study was to analyse the single-centre experience with a surveillance protocol. We hypothesised that DVT surveillance with VUS and CTPA may reduce the perioperative mortality-morbidity rate in the subpopulation of patients with pelvic or acetabular fractures. Methods: This is a retrospective analysis of patients admitted with pelvic or acetabular fractures between January 2001 and December 2021. In April 2013, a screening protocol for VTE was introduced. This protocol included venous ultrasound and CTPA for patients with chest injuries. Patients from two groups-one screened for VTE and one without screening-were compared. Results: Of the 3186 patients with pelvic and/or acetabular fractures who were admitted, 1975 were not screened for VTE and 1211 underwent screening. There were more VTE cases in the screening group (5.62% vs. 0.86%, p < 0.001). Nine (0.46%) cases of sudden death occurred in the non-screening group, and all of them died with symptoms of acute PE. Since the screening was introduced, we have not encountered any deaths in the perioperative period (0.46 vs. 0, p = 0.02). Conclusions: The combined use of VUS and CTPA in chest-injured patients is a trustworthy means of screening for VTE, resulting in decreased mortality rates for those with pelvic and acetabular fractures by accurately diagnosing VTE during the perioperative phase.

Comparison of Emergency Department Disposition Times in Adult Level I and Level II Trauma Centers

Introduction: The efficient utilization of resources is a crucial aspect of healthcare, particularly in both Level I and Level II American College of Surgeons (ACS)-verified trauma centers. The effect of resource allocation on emergency department length of stay (ED-LOS) of trauma patients has remained under-investigated. As ED crowding has become more prevalent, especially at quaternary care centers, an evaluation of the potential disparities in ED-LOS between Level I and Level II trauma centers is warranted. We hypothesized a longer ED-LOS at Level I centers compared to Level II centers. Methods: We queried the 2017–2021 Trauma Quality Improvement Process (TQIP) database for trauma patients ≥18 years of age presenting to either a Level-I or -II center. The TQIP defines ED-LOS as the time from arrival until the time an ED disposition (admission or discharge) order is written. We excluded transferred patients and those with missing data regarding ACS trauma center verification level. We performed bivariate analyses, as well as subgroup analyses based on location of disposition. Results: Of 2,225,067 trauma patients, 59.3% (1,318,497) received treatment at Level I centers. No significant differences were found in Injury Severity Scores between patients admitted to the operating room or non-intensive care unit (ICU) locations, or discharged home from Level-I and -II centers (all P &amp;lt; 0.05). The ED-LOS for trauma patients was longer at Level-I centers for all patient categories: overall (198 vs 145 minutes [min], P &amp;lt; 0.001), discharged home (286 vs 160 min, P &amp;lt; 0.001), non-ICU admissions (234 vs 164 min, P &amp;lt; 0.001), and those requiring surgery (126 vs 101 min, P &amp;lt; 0.001). Conclusion: Even when treating patients with similar injury severity, trauma patients at Level I trauma centers had longer ED-LOS compared to Level II centers, irrespective of the patients’ final disposition (surgery, non-ICU admission, or discharge). To optimize resource utilization and alleviate ED saturation, further research must delve into the underlying causes of these discrepancies to identify best practices and solutions.

The impact of trauma relevant concentrations of prostaglandin E2 on the anti-microbial activity of the innate immune system.

The mechanisms underlying the state of systemic immune suppression that develops following major trauma are poorly understood. A post-injury increase in circulating levels of prostaglandin E2 (PGE2) has been proposed as a contributory factor, yet few studies have addressed how trauma influences PGE2 biology. Blood samples from 95 traumatically-injured patients (injury severity score ≥8) were collected across the pre-hospital (≤2 hours), acute (4-12 hours) and subacute (48-72 hours) post-injury settings. Alongside ex vivo assessments of lipopolysaccharide (LPS)-induced cytokine production by monocytes, neutrophil reactive oxygen species production and phagocytosis, serum concentrations of PGE2 and its scavenger albumin were measured, and the expression of enzymes and receptors involved in PGE2 synthesis and signalling analysed. Leukocytes from trauma patients were treated with cyclooxygenase (COX) inhibitors (indomethacin or NS-398), or the protein kinase A inhibitor H89, to determine whether injury-induced immune suppression could be reversed by targeting the PGE2 pathway. The effect that trauma relevant concentrations of PGE2 had on the anti-microbial functions of neutrophils, monocytes and monocyte-derived macrophages (MDMs) from healthy controls (HC) was examined, as was the effect of PGE2 on efferocytosis. To identify factors that may trigger PGE2 production post-trauma, leukocytes from HC were treated with mitochondrial-derived damage associated molecular patterns (mtDAMPs) and COX-2 expression and PGE2 generation measured. PGE2 concentrations peaked in blood samples acquired ≤2 hours post-injury and coincided with significantly reduced levels of albumin and impaired LPS-induced cytokine production by monocytes. Significantly higher COX-2 and phospholipase A2 expression was detected in neutrophils and/or peripheral blood mononuclear cells isolated from trauma patients. Treatment of patient leukocytes with indomethacin, NS-398 or H89 enhanced LPS-induced cytokine production and neutrophil extracellular trap generation. Exposure to physiological concentrations of PGE2 suppressed the anti-microbial activity of monocytes, neutrophils and MDMs of HC, but did not influence efferocytosis. In a formyl-peptide receptor-1 dependent manner, mtDAMP treatment significantly increased COX-2 protein expression in neutrophils and monocytes, which resulted in increased PGE2 production. Physiological concentrations of PGE2 suppress the anti-microbial activities of neutrophils, monocytes and MDMs. Targeting the PGE2 pathway could be a therapeutic approach by which to enhance innate immune function post-injury.

Pelvic Traumas and Hybrid Emergency Medicine System: Literature Review Based on Two Cases

Objective: Bleeding, the most common life-threatening complication of pelvic trauma occurs due to injuries of pelvic arterial and venous structures and bone fractures. The outcomes of patients can be improved by a timely performed angioembolisation (AE). Hybrid Emergency Service System (HERS) has been recently introduced a novel approach which provides trauma resuscitation room equipped with computerized tomography, fluoroscopy, and an operating room, thus effects the outcomes of trauma patients. Cases: We presented two pelvic traumas and in both cases with the most common life-threatening complication was bleeding. In both cases, whole-body computed tomography (WBCT), endovascular procedures (Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), transcatheter arterial embolization (TAE)), and injury control surgery can be simultaneously performed without the need to transport a patient to an operating room which is called HERS resuscitation. Both patients were discharged and remained free of any medical problem at long-term (12 months) follow-up. Conclusion: Considering the recently introduced HERS system in patient management and integrating it into emergency services will be extremely useful in the management of trauma and trauma-induced bleeding.

Evaluation of the Effects of Concomitant Alcohol Positivity on the Characteristics and Severity of Injury in Geriatric Trauma Patients in the Emergency Department

Evaluation of the Effects of Concomitant Alcohol Positivity on the Characteristics and Severity of Injury in Geriatric Trauma Patients in the Emergency Department

Improving communication during damage control surgery: a survey of adult major trauma centres in England.

Deficiencies in non-technical skills can severely impede the functioning of teams in high-intensity scenarios, such as in damage control surgery for the critically injured trauma patient. Truncated preoperative checklists, modified from the standard World Health Organization preoperative checklist, and situational reporting at intervals during surgery are long-established practices in the military, and are recommended in the National Health Service guidelines on major incidents. These tools allow the multiprofessional team to create a shared mental model of the anaesthetic and operative plan, thereby improving team efficiency. Our aim was to establish whether adult major trauma centres in England are using truncated preoperative checklists and situational reporting for damage control surgery. An online survey was devised and distributed via the national programme of care for trauma in November 2020. Responses were received from all 23 adult major trauma centres in England. Nine centres (39.1%) reported using a truncated preoperative checklist for damage control surgery albeit in a variety of formats. Common components were blood products received and/or available, presence of allergies, tranexamic acid and antibiotic administration, availability of viscoelastic tests, equipment required, availability of cell saver, role allocation and reference to other personnel needed, and discussion of the plan. Twelve centres (52.2%) have formal policies in place for situational reporting. Again, these were in multiple formats but all focused on patient physiology to direct surgical planning. We have identified key components to advanced communication aids for damage control surgery, providing a foundation on which other major trauma centres can build their own versions of these potentially lifesaving tools.

Review article: Electronic screening and brief intervention for alcohol-related trauma: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to evaluate the effectiveness of Electronic Screening and Brief Intervention (e-SBI) in changing or reducing alcohol consumption and/or related risk behaviours among trauma patients compared to standard of care. Following Cochrane Collaboration's guidelines and PRISMA recommendations, a search of electronic databases (MEDLINE via PubMed, CINAHL, Scopus and Web of Science) and grey literature (Google Scholar) was conducted. Randomised controlled trials (RCTs) from 1995 to 2023 were included, focusing on e-SBI for alcohol misuse in trauma patients. Quality assessment utilised the Cochrane risk of bias tool. Bayesian meta-analysis was employed for synthesising outcomes. Four RCTs, totalling 2641 participants, were included. While e-SBI demonstrated a significant reduction in problematic alcohol consumption up to 6 months post-implementation, uncertainties were noted in risk behaviours determined by: average alcohol consumption, binge drinking and alcohol-related consequences. Heterogeneity in measurements and population variations contributed to the nuanced findings. The review suggests that e-SBI may be effective in reducing problematic alcohol consumption in the short term among alcohol-related trauma patients. However, uncertainties and methodological variations highlight the need for standardised outcome measurements, consistent reporting and further exploration of e-SBI's long-term impact. Relevance to health promotion: Understanding the effectiveness of e-SBI in managing alcohol-related issues among trauma patients is crucial for health promotion. Despite uncertainties, the findings underscore the potential of e-SBI as a scalable and accessible intervention. e-SBI in the setting of the present study, emphasises the importance of tailored approaches in public health strategies.

Prognostic significance of inferior vena cava volume defined by initial polytrauma CT-imaging: single-center experience of a level-1 trauma center

BackgroundThe significance of computed tomography (CT)-based volume measurement of the inferior vena cava (IVC) in the treatment and prognosis of trauma patients is not yet fully understood. The conflicting results that have been reported may be attributable to differences in injury severity and the use of different measurement methods, including IVC index and volumetry. The purpose of this study was to determine the relationship between IVC volume and red blood cell (RBC) transfusion and mortality in intubated trauma patients who were stable enough for initial CT imaging.MethodsA retrospective analysis was conducted on all consecutive trauma patients who underwent emergency tracheal intubation and mechanical ventilation before initial whole-body CT imaging at a level-1 trauma center over a 12-year period (2008–2019). The IVC volume was determined on initial trauma CT and included in multivariable models with demographic and diagnostic data. Associations of overall RBC transfusion, massive transfusion, 24-h mortality, and 30-day mortality were assessed using logistic regression analyses and Cox proportional hazard models.ResultsA total of 438 patients (75.3% male) with a median age of 50 years, and a median injury severity score (ISS) of 26 points were included in the analysis. Most of the patients (97.5%) had suffered from blunt trauma mechanisms. Median IVC volume was 36.25 cm3, and RBC transfusion and massive transfusion were performed in 197 and 90 patients, respectively. The 24-h and 30-day mortality rates were 7.3% and 23.3%, respectively. VCI volume was found to be independently associated with the necessity of RBC transfusion and 24-h mortality (OR 0.98, 95% CI 0.96–0.99, p = 0.01 and HR 0.96, 95% CI 0.93–0.99, p = 0.025, respectively), while associations with massive transfusion and 30-day mortality were not statistically significant in multivariable analyses.ConclusionInitial IVC volume may serve as a predictor of patients at risk for overall RBC transfusion requirements and 24-h mortality, suggesting the possibility of its diagnostic efficacy in short-term outcomes. Further studies are needed to confirm these findings.

Is human albumin injection the best choice to treat hypoalbuminemia?

Currently, there is an irrational use of drugs in the treatment of hypoproteinemia. This study evaluates the value of 12 injections to provide a basis for drug selection for the treatment of hypoproteinemia. The content of the first restrictive amino acid, the comprehensive quality of the total essential amino acid, and the closeness to the whole egg protein or FAO/WHO model were evaluated to compare their value in the amino acid synthesis of human serum albumin. A comparison was made between the matching degree of HA and therapeutic amino acids with the human plasma amino acid profile. Furthermore, the value and safety of synthetic human serum albumin were compared. The lowest synthetic value of human serum albumin was 18AA-V, and the highest was 18AA-II. The CS values of HA, 18AA-V, 18AA-II, 18AA-Ip, 18AA-IIp, and 19AA-Ip were 0.18, 0.58, 0.78, 0.55, 0.54, and 0.59, respectively. The similarity to egg protein was 0.81, 0.92, 0.94, 1.00, 1.18, and 1.18, respectively. The proximity values to FAO/WHO standards were 0.81, 0.85, 0.90, 1.36, 1.54, and 1.54, respectively. The changes in 3AA and the amino acid profile were matched when liver function was abnormal. When the renal function was abnormal, 9AA was matched. During trauma, 18AA-VII was matched. The amino acid profile of HA did not correspond. Patients with normal liver and kidney function should choose compound balanced amino acid injection, while patients with abnormalities should choose 3AA. Patients with renal dysfunction should choose 9AA. Trauma patients should choose 18AA-VII.

Comparison of continuous vital signs data analysis versus venous lactate for the prediction of lifesaving interventions in patients with traumatic shock.

The prehospital environment is fraught with operational constraints, making it difficult to assess the need for resources such as lifesaving interventions (LSI) for adults with traumatic injuries. While invasive methods such as lactate have been found to be highly predictive for estimating injury severity and resource requirements, noninvasive methods, to include continuous vital signs (VS), have the potential to provide prognostic information that can be quickly acquired, interpreted, and incorporated into decision making. In this work, we hypothesized that an analysis of continuous VS would have predictive capacity comparable to lactate and other laboratory tests for the prediction of injury severity, need for LSIs and intensive care unit (ICU) admission. In this pre-planned secondary analysis of 300 prospectively enrolled patients, venous blood samples were collected in the prehospital environment aboard a helicopter and analyzed with a portable lab device. Patients were transported to the primary adult resource center for trauma in the state of Maryland. Continuous VS were simultaneously collected. Descriptive statistics were used to describe the cohort and predictive models were constructed using a regularized gradient boosting framework with 10-fold cross-validation with additional analyses using Shapley additive explanations (SHAP). Complete VS and laboratory data from 166 patients were available for analysis. The continuous VS models had better performance for prediction of receiving LSIs and ICU length of stay compared to single (initial) VS measurements. The continuous VS models had comparable performance to models using only laboratory tests in predicting discharge within 24 hours (continuous VS model: AUROC 0.71; 95% CI, 0.68-0.75 vs. lactate model: AUROC 0.65; 95% CI, 0.68; 95% CI, 0.66-0.71). The model using all laboratory data yielded the highest sensitivity and sensitivity (AUROC 0.77; 95% CI, 0.74-0.81). The results from this study suggest that continuous VS obtained from autonomous monitors in an aeromedical environment may be helpful for predicting LSIs and the critical care requirements for traumatically injured adults. The collection and use of noninvasively obtained physiological data during the early stages of prehospital care may be useful for in developing user-friendly early warning systems for identifying potentially unstable trauma patients.

Effects of Multimodal Analgesia Combined with Comfort Management on Pain and Stress Indexes in Patients with Orthopedic Trauma after Intervention: A Retrospective Study.

This study aims to assess the impact of combining multimodal analgesia with comfort care on pain levels, stress, negative emotions, and quality of life in individuals recovering from traumatic fractures. This retrospective study analyzed clinical data from traumatic fracture patients who underwent emergency operations at our hospital between June 2022 and February 2024. Patients were divided into two groups based on their postoperative pain management: the control group, which received standard measures, and the exposure group, which received a combination of multimodal analgesia and comfort-based care. We compared these groups for pain intensity (baseline and activity Visual Analog Scale (VAS) scores), serum stress biomarkers (norepinephrine, adrenaline, cortisol), emotional distress (self-rating depression scale (SDS), and the self-rating anxiety scale (SAS)), and overall quality of life (Comprehensive Quality of Life Assessment Questionnaire (GQOLI-74) score). Overall, this study evaluated differences in postoperative complications between the two pain management approaches. In this study, we included 101 participants, 41 in the exposed group and 60 in the control group. Before the intervention, baseline characteristics were similar between the two groups (p > 0.05). However, one week after the intervention, the resting and active VAS scores were significantly reduced in the exposed group than in the control group (p < 0.05). Furthermore, one week after the intervention, the exposed group had lower levels of serum sodium, epinephrine, cortisol, stress, and anxiety, as well as higher physical and mental health scores on the GQOLI-74 scale. During the intervention period, there was no significant difference in postoperative complications between the two groups (p > 0.05). Combining multi-mode analgesia with comfort management for patients with traumatic fractures significantly reduces postoperative pain and stress levels. Additionally, this approach can effectively enhance patients' negative emotions and improve their quality of life. This approach holds significant promise for practical use in clinical settings.

Predictors of Conservative Management Failure in Pediatric Renal Trauma: National Trauma Database Insights

Aim of the studyThis study aimed to evaluate contemporary management strategies of pediatric renal trauma, focusing on the failure of conservative management and identifying its predictors. MethodsThe National Trauma Database (2018–2021) was queried for pediatric patients (≤18 years) with renal injury, identified via AIS codes aligned with the AAST kidney injury grading system. Urological surgical procedures were identified via ICD-10 Procedure Codes. Patients were categorized into immediate surgical management (within 4 h), conservative management (no surgery), and failed conservative management (surgery after 4 h). Demographics, injury characteristics, and clinical data were analyzed using descriptive and univariate statistical analyses (Wilcoxon Rank Sum, Chi-square, Odds Ratios). ResultsOf 7266 pediatric renal trauma patients, most were white (63.4 %) males (69.1 %), aged 12–18 (76.6 %), suffering from unintentional blunt trauma (86.9 %). Most (n = 6610, 95 %) received conservative management; however, 4.5 % (n = 298) failed. Common surgical interventions included ureteral stent placement (n = 200, 59 %), renal IR procedures (n = 44, 13 %), and nephrectomy (n = 33, 9.7 %). Nephrectomy rates at low AAST kidney injury grades (I–II) were higher with upfront surgical management (n = 7, 3.5 %) than with failed conservative management (n = 0). Predictors of failed conservative management included higher Injury Severity Score (ISS) and higher AAST kidney injury grades (III–V) (p < 0.05). ConclusionConservative management failed in 4.5 % of paediatric renal trauma cases, associated with higher AAST kidney injury grade and ISS. Upfront surgical management correlated with a higher nephrectomy rate at lower injury grades compared to failed conservative management. Refinement of pediatric trauma protocols is needed for optimal care. Level of EvidenceIII.

Outcomes of Open Knee Joint Injuries in Trauma Patients at Tibebe-Ghion Specialized Hospital, Bahir-Dar, Ethiopia

Background: Open knee joint injury is a deep traumatic laceration violating the joint capsule. This study aimed to assess outcomes and associated factors of open knee joint injuries in trauma patients at Tibebe-Ghion Specialized Hospital, Bahirdar, Ethiopia, 2021. Methods: An institution-based retrospective cross-sectional study was conducted by reviewing the medical records of 43 patients treated for open knee joint injuries from January 2019 to July 2021, with an 86% response rate. Data were entered and exported using Epidata Manager Version 4.4 and analyzed using SPSS version 25. Results: Fourteen (32.5%) of the study subjects developed either infections or limping during follow-up due to open knee injuries, with the majority of injuries (58.1%) being caused by car accidents. The presence of associated injuries, wound size, time to wound closure, debridement as a management option, sex, and diagnostic methods showed a significant association with complication outcomes. Among the diagnosed infections, 90% were cases of septic arthritis. During the study period, eight patients (18.6%) developed limping during follow-up. The complication rate among open knee injury patients in the study area was significantly high, with one-third of patients experiencing complications. Targeted public awareness campaigns like car accidents should be conducted to educate the population about orthopedic emergencies and strategies to reduce complication risks, aiming for more favorable outcomes.

Predicting Unplanned Trauma ICU Admissions for Initial Nonoperative, Non-ICU Patients.

Unplanned intensive care unit (ICU) admissions are associated with increased morbidity and mortality. This study uses interpretable machine learning to predict unplanned ICU admissions for initial nonoperative trauma patients admitted to non-ICU locations. TQIP (2020-2021) was queried for initial nonoperative adult patients admitted to non-ICU locations. Univariable analysis compared patients who required an unplanned ICU admission to those who did not. Using variables that could be known at hospital admission, gradient boosting machines (CatBoost, LightGBM, XGBoost) were trained on 2021 data and tested on 2020 data. SHapley Additive exPlanations (SHAP) were used for interpretation. The cohort had 1,107,822 patients; 1.6% had an unplanned ICU admission. Unplanned ICU admissions were older (71 [58-80] vs. 61 [39-76] years, p < 0.01), had a higher Injury Severity Score (ISS) (9 [8-13] vs. 9 [4-10], p < 0.01), longer length of stay (11 [7-17] vs. 4 [3-6] days, p < 0.01), higher rates of all complications and most comorbidities and injuries (p < 0.05). All models had an AUC of 0.78 and an F1 score of 0.12, indicating poor performance in predicting the minority class. Mean absolute SHAP values revealed ISS (0.46), age (0.29), and absence of comorbidities (0.16) as most influential in predictions. Dependency plots showed greater SHAP values for greater ISS, age, and presence of comorbidities. Machine learning may outperform prior attempts at predicting the risk of unplanned ICU admissions in trauma patients while identifying unique predictors. Despite this progress, further research is needed to improve predictive performance by addressing class imbalance limitations.

Nutritional therapy in a severely injured multiple traumas patients with hypovolemic shock, acute kidney injury, and hypoalbuminemia

Nutritional therapy in a severely injured multiple traumas patients with hypovolemic shock, acute kidney injury, and hypoalbuminemia

Impact of Pre-Hospital Intravenous Infusion on Physiological Parameters in Severe Trauma Patients

Impact of Pre-Hospital Intravenous Infusion on Physiological Parameters in Severe Trauma Patients

Leukocytosis and thrombocytosis after splenectomy: expected finding, infection, or something else: a case report

BackgroundLeukocytosis and thrombocytosis often follow splenectomy in blunt trauma patients, complicating the postoperative identification of infection. While the platelet count to white blood cell ratio provides diagnostic assistance to discern between expected laboratory alterations and infection, diagnoses such as leukemia are often overlooked.Case presentationA 53-year-old Hispanic male presented with abdominal pain, nausea, tachycardia, and focal peritonitis 4 days after being assaulted and struck multiple times in the abdomen. Initial white blood cell count was 38.4 × 109/L, platelet count was 691 × 109/L, and lipase was 55 U/L. Computed tomography abdomen/pelvis demonstrated a hematoma encasing the distal pancreas and abutting the stomach and colon. Emergent laparotomy revealed a nearly transected pancreas and devascularized colon, necessitating a distal pancreatectomy, splenectomy, and colonic resection with primary anastomosis. Postoperatively, he had a persistently elevated leukocytosis, thrombocytosis, segmented neutrophils, eosinophilia, and basophilia (peak at 70, 2293, 64, 1.1, and 1.2 × 109/L, respectively). Despite sepsis workup, including repeat computed tomography, no source was identified. Hematology/oncology was consulted for concern for hematologic etiology, with genetic testing and bone marrow biopsy performed. The diagnosis of breakpoint cluster–Abelson gene-positive chronic myeloid leukemia was made based on genetic tests, including polymerase chain reaction and fluorescence in situ hybridization analysis, which confirmed the presence of the Philadelphia chromosome. Bone marrow biopsy suggested a chronic phase. The patient was treated with hydroxyurea and transitioned to imatinib.ConclusionsThrombocytosis following splenectomy is a common complication and a plate count to white blood cell count ratio < 20 indicates infectious etiology. A significantly elevated white blood cell count (> 50 × 109/L) and thrombocytosis (> 2000 × 109/L) may suggest something more ominous, including chronic myeloid leukemia , particularly when elevated granulocyte counts are present. Chronic myeloid leukemia workup includes peripheral smear, bone marrow aspiration, and determination of Philadelphia chromosome. Post-splenectomy vaccines are still indicated within 14 days; however, the timing of immunization with cancer treatment must be considered. Tyrosine kinase inhibitors are the first-line therapy and benefits of pretreatment with hydroxyurea for cytoreduction remain under investigation. Additionally, tyrosine kinase inhibitors have been associated with gastrointestinal perforation and impaired wound healing, necessitating heightened attention in patients with a new bowel anastomosis.

Evaluation of incidence and outcomes of compressive extradural haematoma-related infarcts in the paediatric population.

Traumatic extradural haematoma (EDH) is one of the neurosurgical emergencies in the paediatric population. One of the rare complications of extradural haematoma is adjacent parenchymal infarct from the compressive effect of haematoma leading to further morbidity. We aimed to evaluate the incidence and outcomes of this rare complication in paediatric trauma patients. We undertook a retrospective review of all operative extradural haematoma cases in single centre paediatric neurosurgical unit between the years 2008 and 2024. Cases with postoperative imaging were analysed for demographics, age, sex, dimensions of haematoma and underlying infarct, pre-operative GCS and pupillary abnormality and time interval from scan to surgery. Infarct was defined as well-defined parenchymal hypodensity corresponding to vascular territory and not attributable to contusions on postoperative CT head performed at 24-72 h. All patients suspected of stroke had further MRI brain for evaluation. Statistical analysis was then performed comparing groups with and without infarct. Overall, 115 cases of extradural haematoma were identified during the study period. Eighty cases had adequate postoperative imaging to allow assessment for infarcts; 7.5% demonstrated evidence of infarct underlying extradural haematoma. Mean age in the infarct group was 1.8 years (M:F ratio 2:1) with mean EDH dimensions of 77 mm × 31.4 mm × 79.7 mm). Mean age in the non-infarct group was 8.6 years (M:F ratio 2:1) with mean EDH dimensions of (57.5 mm × 19.6 mm × 62.6 mm). Children with infarcts were significantly younger with larger haematoma dimensions and hada higher proportion of pupillary abnormalities. There was no significant difference in pre-operative GCS and scan-to-surgery time-lapse between the groups with and without infarct. Compressive effect of EDH can lead to underlying parenchymal infarct. Children with extradural haematoma-related infarct were younger with larger haematoma size and a higher proportion of pupillary abnormalities.

Understanding and Assisting the Recovery of Non-English-Speaking Trauma Survivors: Assessment of the NESTS Pathway.

Spanish-speaking trauma and burn patients have unique needs in their post-discharge care navigation. The confluence of limited English proficiency, injury recovery, mental health, socioeconomic disadvantages, and acute stressors following hospital admission converge to enhance patients' vulnerability, but their specific needs and means of meeting these needs have not been well described. This prospective, cross-sectional survey study describes the results of a multi-institutional initiative devised to help Spanish-speaking trauma and burn patients in their care navigation after hospitalization. The pathway consisted of informational resources, intake and follow up surveys, and multiple points of contact with a community health worker who aids in accessing community resources and navigating the healthcare system. From January 2022-November 2023, there were 114 patients identified as eligible for the NESTS pathway. Of these, 80 (70.2%) were reachable and consented to participate, and 68 of these patients were approached in person during their initial hospitalization. After initial screening, 60 (75.0%) of the eligible patients had a mental health, social services, or other need identified via our survey instrument. During the initial consultation with the CHW, 48 of the 60 patients with any identified need were connected to a resource (80%). Food support was the most prevalent need (N=46, 57.5%). More patients were connected to mental health resources (N=16) than reported need in this domain (N=7). The NESTS pathway identified the specific needs of Spanish-speaking trauma and burn patients in their recovery, notably food, transportation, and utilities. The pathway also addressed disparities in post-discharge care by connecting patients with community resources, with particular improvement in access to mental healthcare.

Evaluating predictors of mortality in octogenarians undergoing urgent or emergent trauma laparotomy.

This study aimed to identify associated risk factors for mortality in octogenarian trauma patients undergoing urgent or emergent laparotomy (UEL). Trauma patients ages 80-89 years-old undergoing UEL within 6-hours of arrival were included. A multivariable logistic regression analysis was performed to determine associated risk of mortality. From 701 octogenarians undergoing UEL, 324 (46.2%) died. Compared to survivors, UEL octogenarians who died had higher rates of cirrhosis (3.5% vs. 1.1%, p = 0.028), injuries to the brain (17.3% vs. 5.6%, p < 0.001), heart (8.6% vs. 1.6%, p < 0.001), and lung (57.4% vs. 23.9%, p < 0.001) and lower rates of functional independence (6.4% vs. 12.6%, p = 0.007). The strongest independent associated patient-related risk factor for death was cirrhosis (OR 8.28, CI 2.25-30.46, p = 0.001). However, undergoing concurrent thoracotomy increased risk of death significantly (OR 16.59, CI 2.07-132.76, p = 0.008). Functional independence was not associated with mortality (p > 0.05). This national analysis emphasizes the need to identify and manage pre-existing conditions like cirrhosis and not determine futility based on pre-trauma functional status alone. Concurrent thoracotomy for hemorrhage control increases risk of death over 16-fold.