Trauma-related Deaths Research Articles

Predicting the critical administration threshold in bleeding trauma patients.

Delays in promptly recognizing and appropriately managing hemorrhagic injuries contribute to preventable trauma related deaths nationwide. We sought to identify patient variables available at the time of emergency department arrival associated with meeting the critical administration threshold. We conducted a trauma registry review from September 2016 to March 2020 of trauma team activations at The Ottawa Hospital, a Level 1 Trauma Center. Our primary outcome was the frequency of meeting the critical administration threshold. Secondary outcomes included time to critical administration threshold, 24-h all-cause mortality, and 30-day all-cause mortality. Multivariate logistic regression identified factors independently associated with meeting the critical administration threshold. We assessed 762 patients, of which 78 (10.2%) met the critical administration threshold. The median time to critical administration threshold was 28.9min. Mortality at 24h occurred in 58 (7.6%) patients. Four variables available upon patient arrival predicted the critical administration threshold, including systolic blood pressure ≤ 90mmHg (OR 6.6; 95% CI 3.7-12.0), Glasgow Coma Scale ≤ 8 (OR 5.9; 95% CI 3.2-10.6), heart rate ≥ 100 beats/minute (OR 4.4; 95% CI 2.4-8.1), and respiratory rate ≥ 20 breaths/min (OR 2.2; 95% CI 1.2-4.0). We identified four clinical variables readily available to physicians upon patient arrival associated with meeting the critical administration threshold: systolic blood pressure ≤ 90mmHg, Glasgow Coma Scale ≤ 8, heart rate ≥ 100 beats/minute, and respiratory rate ≥ 20 breaths/min. Patients presenting with any of these clinical parameters should prompt physicians to consider ordering blood products immediately.

Analysis of the hemogram and biochemistry parameters of patients with trauma

Aims: Trauma-related deaths remain a significant public health concern, with organ complications in over 30% of multitrauma patients leading to high morbidity and mortality. This study aims to understand the changes and reliability of hemoglobin, hematocrit, AST, and ALT levels in trauma cases and their impact on treatment planning. Methods: A retrospective analysis was conducted on 259 multitrauma patients admitted to Ankara Atatürk Training and Research Hospital between July and December 2012. Data on demographic details, trauma types, laboratory parameters, physical and tomographic examinations, treatment modalities, and outcomes were analyzed using SPSS software. Results: The study group predominantly comprised males (74.9%) with a mean age of 42.15 years. Various trauma types were analyzed, including traffic accidents and falls. Significant fluctuations in hemoglobin and hematocrit levels were observed post-fluid resuscitation, regardless of bleeding status. Notably, AST and ALT levels were reliable indicators of hepatic injury. The study also highlighted the effects of fluid hydration volumes on hemoglobin and hematocrit levels. Conclusion: The findings challenge the conventional understanding that drops in hemoglobin and hematocrit levels primarily indicate bleeding in multitrauma patients. Instead, these changes might also result from fluid resuscitation. The study underscores the importance of considering both bleeding and resuscitation efforts when interpreting these laboratory parameters. This study provides new insights into the interpretation of hemoglobin, hematocrit, AST, and ALT levels in trauma patients. It suggests a more nuanced approach in treatment planning, considering the significant impact of fluid resuscitation on these parameters, alongside bleeding.

EP241 - Managing Cervical Spine fracture in a district general hospital

Abstract Introduction Cervical spinal injury affects 2–3% of trauma patients and accounts for 8.2% of all trauma-related deaths. Respiratory complications are cited as the primary cause of mortality with a 14 - >27 % rate in patients aged more than 65 years old. Aim Produce a clear set of guidelines in an aim to reduce mortality in patients > 65 years presenting with cervical spine fracture. Method Data was retrospectively collected for patients aged >65 between September 2021 and August 2022 in a district general hospital. Patients with confirmed cervical spine injury were included in the study. Data was collated and analysed using Excel. Results 36 patients presented to ED with acute cervical spine fracture. 22 (61%) were female and 14 (39%) male with an age range of 66-98 years old. 31 (84%) patients were discussed with a tertiary centre. Complications ranged from constipation, delirium, DVT/PE, chest infections (n=5, 36%) to spinal shock (n= 3, 27%). 11 (30.6%) patients presenting with a c-spine fracture died within 30 days of admission.9 (25%) patients had an outpatient appointment booked in a tertiary centre and 13 (36%) were seen locally in the fracture clinic. 14 (39%) patients did not have any follow ups planned. Conclusions To mitigate in-hospital complications and improve outcomes, shared care with orthopaedics, geriatrics, and physiotherapy is being proposed for this group of patients. It would be beneficial to compare the data from the local network and aim at publishing an up-to-date set of robust guidelines.

Application of extracorporeal membrane oxygenation combined with renal replacement therapy in the treatment of war traumatic sepsis

Sepsis is an important factor for trauma related death, especially the refractory septic shock, which has a mortality rate exceeding 50%. The treatment of sepsis is a medical problem that needs to be solved urgently. The role and status of extracorporeal membrane oxygenation (ECMO) in the treatment of cardiopulmonary failure has become more and more prominent, and its role in the treatment of sepsis in children and infants has gained remarkable achievements. However, its role in adult sepsis remains controversial, with current reports showing varied outcomes for ECMO in adult sepsis treatment. ECMO application can potentially cause renal impairment, and renal impairment can affect the outcomes of ECMO treatment in turn. Studies have shown that adjunctive renal replacement therapy during non-ECMO treatment of septic shock can improve the prognosis, and whether the combination with renal replacement therapy in the early stage of ECMO treatment can effectively improve the treatment outcome still needs to be confirmed by multicenter and prospective studies. Based on this, this article reviews the relevant research on the application of ECMO combined with renal replacement therapy in the treatment of sepsis after war trauma, aiming to provide clinical reference for the treatment of sepsis after war trauma.

Vanillic acid-based pro-coagulant hemostatic shape memory polymer foams with antimicrobial properties against drug-resistant bacteria

Uncontrolled bleeding is the primary cause of trauma-related death. For patients that are brought to the hospital in time to receive treatment, there is a great risk of contracting drug-resistant bacterial wound infections. Therefore, low-cost hemostatic agents with procoagulant and antibacterial properties are essential to reduce morbidity and mortality in patients with traumatic wounds. To that end, we introduced vanillic acid (VA) into shape memory polymer (SMP) foams through a dual incorporation mechanism to make dual vanillic acid (DVA) foams. The dual mechanism increases VA loading while allowing burst and sustained delivery of VA from foams. DVA foams exhibit antimicrobial and antibiofilm properties against native and drug-resistant Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis. Also, DVA foams inhibit the growth rate of both methicillin-sensitive and -resistant S. aureus colonies to limit their size and promote small colony variants. DVA SMP foams induced primary and secondary hemostasis in in vitro blood interaction studies. As a proof of concept, we demonstrated easy delivery and rapid clotting in a porcine liver injury model, indicating DVA foam feasibility for use as a hemostatic dressing. Thus, the inexpensive production of DVA SMP foams could enable a cost-effective procoagulant hemostatic dressing that is resistant to bacterial colonization to improve short- and long-term outcomes for hemorrhage control in traumatically injured patients. Statement of significanceUncontrolled bleeding is the primary cause of preventable death on the battlefield. Of patients that survive, ∼40 % develop polymicrobial infections within 5 days of injury. Drug-resistant infections are anticipated to cause more deaths than all cancers combined by 2050. Therefore, novel non-drug-based biomaterials strategies for infection control in wound care are increasingly important. To that end, we developed hemostatic polyurethane foams that include antimicrobial and pro-coagulant vanillic acid, a plant-based antimicrobial species. These foams provide excellent protection against native and drug-resistant bacteria and enhanced coagulation while remaining cytocompatible. In a pilot porcine liver injury model, vanillic acid-containing foams stabilized a bleed within <5 min. These biomaterials provide a promising solution for both hemorrhage and infection control in wound care.

Cardiac Evaluation of Children Presenting with Trauma

Background: Trauma is a critical public health issue, particularly impacting the young and caus-ing significant financial and moral losses. Approximately one-third of trauma-related hospitaliza-tions and 20-25% of trauma-related deaths are caused by serious chest injuries. We aimed to determine the prognostic value of changing pediatric global troponin levels in the emergency department after trauma. Materials and Methods: Patients who applied to the emergency department with complaints of trauma between January 1, 2015 and January 31, 2022 were evaluated. Records of pediatric patients between the ages of 0 and 18 were reviewed. The cause and severity of the trauma, electrocardiography and echocardiography results, and laboratory data (biochemical, hemogram, C-reactive protein, pro-BNP, CK-MB, troponin, etc.) of the patients were evaluated. This study is an observational and retrospective. Results: Falling from height was the most prevalent cause of injury, accounting for 43% of cases. Chest trauma was observed in 55 patients (56%). All patients with chest trauma exhibited ele-vated troponin levels. Troponin levels were found to be significantly higher in patients with chest trauma (p=0.011). Conclusions: Our findings highlighted the prognostic importance of cardiac troponins, especially in pediatric patients presenting with trauma.

Characteristics of Trauma Patients Who Died at UGM Academic Hospital (RSA UGM)

BACKGROUND : Trauma becomes the main health problem worldwide due to its high mortality rate. Traffic accidents are a trauma with a high incidence and death rate in Indonesia, specifically in Yogyakarta. Factors causing trauma-related death are the lack of hospital infrastructure, the lack of quality human resources, the lack of standardization of trauma management, and the limited number of hospitals providing comprehensive trauma services. This research aims to identify the characteristics of trauma patients who died while receiving medical treatment at UGM Academic Hospital and to analyze the mortality of patients according to the trimodal distribution to prepare this hospital to become a trauma center hospital.METHOD : This quantitative descriptive research used a cross-sectional method. Data were taken from medical records of patients admitted to the ER of UGM Academic Hospital in 2018-2023 based on predetermined inclusion and exclusion criteria. The research was conducted from March to November 2023.RESULT : This research involved 58 patients consisting of 42 (72.4%) male and 16 (27.6%) female patients. The most common cause of death was brain injury (63%), followed by spinal cord injury (13.7%), multi-organ failure and sepsis (8.6%), cardiac and respiratory arrest (6.8%), and comorbidities patients (6.8%).CONCLUSION : The majority of trauma patients who died at the UGM Academic Hospital are male and aged 60-80 years with the main cause of death of brain injury. The patient dies at the late death stage based on trimodal distribution of death time.

Preventability of injury-related morbidity & mortality at four hospitals in Cameroon: A systematic approach to trauma quality improvement.

Adverse events reviews are a fundamental component of trauma quality improvement (QI) that facilitate the correction of systemic issues in care. Although injury-related mortality in Cameroon is substantial, to our knowledge, opportunities for QI have not been formally assessed. Thus, a formal review of adverse events in Cameroonian trauma patients was implemented as a first step toward identifying targets for systems modification. A QI committee composed of multidisciplinary experts at four hospitals in Cameroon was formed to review adverse events including deaths among trauma patients from 2019 to 2021. Events were discussed at newly established morbidity and mortality conferences and committee meetings to identify contributing factors and overall preventability. During 50 meetings, 95 adverse events were reviewed, including 58 deaths (61%). Other adverse events were delays in diagnosis/treatment (22%) and surgical site infections (17%). Overall, 34 deaths (59%) were classified as preventable, 21% potentially preventable, and 21% not preventable. Over half (52%) of the 46 preventable or potentially preventable deaths occurred in the emergency department (ED); while brain injury (57%), respiratory failure (41%), and hemorrhage (39%) were the most frequent physiologic factors associated with mortality. Contributory factors identified include lack of a structured approach to patient management, absence of continuous training for personnel, and locally adapted protocols. Basic improvements in evaluation and management of life-threatening issues in the ED can significantly reduce the high rate of preventable trauma-related deaths across Cameroon. Formal trauma QI methods can be utilized in low-resource environments to determine mortality root causes and identify intervention targets.

Trauma-related preventable death; data analysis and panel review at a level 1 trauma centre in Amsterdam, the Netherlands.

Trauma-related death is used as a parameter to evaluate the quality of trauma care and identify cases in which mortality could have been prevented under optimal trauma care conditions. The aim of this study was to identify trauma-related preventable death (TRPD) within our institute by an external expert panel and to evaluate inter-panel reliability. Trauma-related deaths between the 1st of January 2020 and the 1st of February 2022 at the Amsterdam University Medical Centre were identified. The severely injured patients (injury severity score ≥ 16) were enrolled for preventability analysis by an external multidisciplinary panel, consisting of a trauma surgeon, anaesthesiologist, emergency physician, neurosurgeon, and forensic physician. Case descriptions were provided, and panellists were asked to classify deaths as non-preventable, potentially preventable, and preventable. Agreements between the five observers were assessed by Fleiss kappa statistics. In total 95 trauma-related deaths were identified. Of which 36 fatalities were included for analysis, the mean age was 55.3 years (± 24.5), 69.4% were male and 88.9% suffered blunt trauma. The mean injury severity score was 35.3 (± 15.3). Interobserver agreement within the external panel was moderate for survivability (Fleiss kappa 0.474) but low for categorical preventable death classification (Fleiss kappa 0.298). Most of the disagreements were between non-preventable or potentially preventable with care that could have been improved. Multidisciplinary panel review has a moderate inter-observer agreement regarding survivability and low agreement regarding categorical preventable death classification. A valid definition and classification of TRPD is required to improve inter-observer agreement and quality of trauma care.

Pattern and Outcome of Abdominal Injury Management in Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia

Background: Abdominal injury is one of the major causes of trauma admissions. Evidence based information about causes of trauma related deaths is relevant for health policy making about prevention and control. The aim of the study was to identify the mechanism of trauma, commonly injured organs, patterns and outcome of abdominal trauma in Yekatit 12 Hospital Medical College. Method: ALongitudinal study design was conducted from April 2022 to May 2023 G.C Results: During the study, 42 patients were observed, with males comprising 83.3%. Most patients fell within the 20-29 age groups. Penetrating trauma was the most common mechanism (54.8%), with stabs (38.1%), RTAs (31.0%), and gunshots (14.3%) leading the causes. Negative laparotomy rate was 4.8%. Laparotomy was performed in 88.1% of cases, with the small bowel (33.3%) being the most commonly injured organ. Postoperative complication rate was 21.6%, mainly surgical site infections (10.8%). Complication rate was higher in penetrating injuries (62.5%) compared to blunt trauma (37.5%). Mortality rate for abdominal injury was 4.78%. Conclusion: Abdominal trauma predominantly impacts younger males. Stab wounds and road traffic accidents (RTAs) are the primary causes, emphasizing the importance of public awareness for preventing RTAs and similar injuries.

Resuscitation following trauma & role of trauma training programmes in emergency settings: A literature review & survey.

Background & objectives Traumatic injuries, especially in low- and middle- income countries (LMICs), present significant challenges in patient resuscitation and healthcare delivery. This study explores the role of trauma training programmes in improving patient outcomes and reducing preventable trauma-related deaths. Methods A dual approach was adopted, first a literature review of trauma training in LMICs over the past decade, along with a situational assessment survey. For the review of literature, we searched the PubMed database to identify key challenges and innovative practices in trauma training programmes in LMIC's. The survey, conducted among healthcare professionals in various LMICs, collected direct insights into the challenges and the status of trauma training programmes in these countries. Results The literature review analysed 68 articles, with a significant focus on the African subcontinent (36 studies), underscoring the region's emphasis on research on trauma training programmes. These studies mainly targeted physicians, clinicians, postgraduate trainees in surgical or anaesthesia fields and medical students (86.8%), highlighting innovations like simulation-based training and the cascading training model. In our survey, we received 34 responses from healthcare professionals in India, Belarus, Azerbaijan, Nepal and Pakistan. Around 52.9 per cent reported the absence of established trauma training programmes in their settings. The majority of respondents advocated for hands-on, simulation-based training (94.1%) and emphasised the need for structured training programmes (85.3%), feedback sessions (70.6%) and updated protocols (61.8%). This combined data underlined the critical gaps and potential improvements in trauma training programmes and resuscitation practices in LMICs. Interpretation & conclusions Effective trauma care in LMICs requires the establishment of comprehensive, tailored training programmes. Key interventions should include subsidization of pre-existing trauma courses and the adoption of World Health Organization Guidelines for essential trauma care, implementation of trauma quality improvement and review processes and the incorporation of focused assessment with sonography in trauma (FAST) in emergency departments. These steps are crucial for equipping healthcare workers with vital skills and knowledge, fostering a culture of continuous learning and improvement in the realm of trauma care.

Demographic Profile, Clinical Features, Imaging, and Outcomes in Patients with Traumatic Brain Injury Presenting in Garhwal Himalayas in Tertiary Care Hospital

Abstract Introduction Traumatic brain injury (TBI) poses a significant global health challenge, accounting for over 50% of trauma-related deaths and emerging as a leading cause of mortality and disability. Objective This article studies the demographic characteristics, clinical features, imaging findings, and outcomes of TBI patients. Materials and Methods This was a retrospective observational study conducted on 490 patients with TBI. Data regarding age, gender, socioeconomic status, and residential location were extracted from medical records. Neuroimaging reports, including computed tomography (CT) scans results, were analyzed for structural and functional insights. Results The majority of TBI cases involved individuals aged 21 to 40, with a higher incidence in males. Road traffic accidents were identified as the most common mode of injury, followed by falls. Most of the patients had moderate Glasgow Coma Scale scores at admission. CT scans indicated skull fractures, cerebral edema, and subdural hematomas as common findings. Most patients did not require ventilator support, and the majority had a hospital stay of less than 10 days. At discharge, 89.8% exhibited favorable outcomes, while 4.3% experienced mortality during treatment. Follow-up data demonstrated an overall mortality rate of 8.8%, with 89.2% achieving complete recovery within a month. Conclusion The study underscores the importance of understanding the multifaceted aspects of TBI, emphasizing the need for integrated approaches in tertiary medical care to optimize patient outcomes and contribute to effective public health strategies.

COMBAT-C: COntrol of Major Bleeding by Application of Tourniquets over Clothing

IntroductionExternal bleeding is the leading cause of preventable trauma-related death. In certain circumstances, tourniquet application over clothing may be necessary. Therefore, the aim of this study was to assess the effectiveness of tourniquets over different clothing setups.MethodsThree windlass tourniquets (CAT, SAMXT, SOFTT-W) were applied over nine different clothing setups and without clothing on the Hapmed™ Tourniquet Trainer. We compared each tourniquet in each clothing setup to the tourniquet trainer that was not dressed, and we compared the three tourniquets within each clothing setup concerning blood loss, applied pressure and application time. Regression analysis of the effect of thickness, mean weight, mean deformation, application time, and applied pressure on blood loss was performed.ResultsAlthough blood loss was significantly greater in the CAT and SAMXT tourniquets when they were applied over leather motorcycle trousers, the overall findings showed that the clothing setups significantly reduced or did not affect blood loss. The mean blood loss was the lowest with CAT and the highest with SOFTT-W. The measured mean pressures were lower than 180 mmHg in four out of nine clothing setups with SOFTT-W, but CAT and SAMXT always exceeded this threshold. CAT had the fastest application time. Blood loss was significantly influenced by applied pressure and application time but was influenced to a far lesser degree by clothing parameters.ConclusionThe effects of the clothing setups were of little clinical relevance, except for leather motorcycle trousers. The effects of rugged protective equipment, e.g., hazard suits, are conceivable and need to be tested for specific garments with the tourniquet intended for use. No clothing parameter for predicting tourniquet effectiveness could be identified.

Deceased Donors With HIV in the Era of the HOPE Act: Referrals and Procurement.

The HIV Organ Policy Equity Act legalizes organ procurement from donors with HIV (HIV D+). A prior survey of Organ Procurement Organizations (OPOs) estimated >2000 HIV D+ referrals/year; however, only 30-35 HIV D+/year have had organs procured. Given this gap, we sought to understand HIV D+ referrals and procurements in practice. We prospectively collected data on all OPO-reported HIV D+ referrals, including reasons for nonprocurement. We evaluated trends and compared HIV D+ characteristics by procurement status using regression, chi-squared tests, and Wilcoxon rank-sum tests. From December 23, 2015 to May 31, 2021, there were 710 HIV D+ referrals from 49 OPOs, of which 171 (24%) had organs procured. HIV D+ referrals increased from 7 to 15 per month (P < 0.001), and the procurement rate increased from 10% to 39% (P < 0.001). Compared with HIV D+ without procurement, HIV D+ with procurement were younger (median age 36 versus 50 y), more commonly White (46% versus 36%), and more often had trauma-related deaths (29% versus 8%) (all P < 0.001). Nonprocurement was attributed to medical reasons in 63% of cases, of which 36% were AIDS-defining infections and 64% were HIV-unrelated, commonly due to organ failure (36%), high neurologic function (31%), and cancer (14%). Nonprocurement was attributed to nonmedical reasons in 26% of cases, commonly due to no authorization (42%), no waitlist candidates (21%), or no transplant center interest (20%). In the early years of the HIV Organ Policy Equity Act, actual HIV D+ referrals were much lower than prior estimates; however, the numbers and procurement rates increased over time. Nonprocurement was attributed to both medical and nonmedical issues, and addressing these issues could increase organ availability.

Extracellular vesicles in disorders of hemostasis following traumatic brain injury.

Traumatic brain injury (TBI) is a global health priority. In addition to being the leading cause of trauma related death, TBI can result in long-term disability and loss of health. Disorders of haemostasis are common despite the absence of some of the traditional risk factors for coagulopathy following trauma. Similar to trauma induced coagulopathy, this manifests with a biphasic response consisting of an early hypocoagulable phase and delayed hypercoagulable state. This coagulopathy is clinically significant and associated with increased rates of haemorrhagic expansion, disability and death. The pathophysiology of TBI-induced coagulopathy is complex but there is biologic plausibility and emerging evidence to suggest that extracellular vesicles (EVs) have a role to play. TBI and damage to the blood brain barrier result in release of brain-derived EVs that contain tissue factor and phosphatidylserine on their surface. This provides a platform on which coagulation can occur. Preclinical animal models have shown that an early rapid release of EVs results in overwhelming activation of coagulation resulting in a consumptive coagulopathy. This phenomenon can be attenuated with administration of substances to promote EV clearance and block their effects. Small clinical studies have demonstrated elevated levels of procoagulant EVs in patients with TBI correlating with clinical outcome. EVs represent a promising opportunity for use as minimally invasive biomarkers and potential therapeutic targets for TBI patients. However, additional research is necessary to bridge the gap between their potential and practical application in clinical settings.

Early GFAP and UCH-L1 point-of-care biomarker measurements for the prediction of traumatic brain injury and progression in patients with polytrauma and hemorrhagic shock.

Traumatic brain injury (TBI) and hemorrhage are responsible for the largest proportion of all trauma-related deaths. In polytrauma patients at risk of hemorrhage and TBI, the diagnosis, prognosis, and management of TBI remain poorly characterized. The authors sought to characterize the predictive capabilities of glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) measurements in patients with hemorrhagic shock with and without concomitant TBI. The authors performed a secondary analysis on serial blood samples derived from a prospective observational cohort study that focused on comparing early whole-blood and component resuscitation. A convenience sample of patients was used in which samples were collected at three time points and the presence of TBI or no TBI via CT imaging was documented. GFAP and UCH-L1 measurements were performed on plasma samples using the i-STAT Alinity point-of-care platform. Using classification tree recursive partitioning, the authors determined the measurement cut points for each biomarker to maximize the abilities for predicting the diagnosis of TBI, Rotterdam CT imaging scores, and 6-month Glasgow Outcome Scale-Extended (GOSE) scores. Biomarker comparisons demonstrated that GFAP and UCH-L1 measurements were associated with the presence of TBI at all time points. Classification tree analyses demonstrated that a GFAP level > 286 pg/ml for the sample taken upon the patient's arrival had an area under the receiver operating characteristic curve of 0.77 for predicting the presence of TBI. The classification tree results demonstrated that a cut point of 3094 pg/ml for the arrival GFAP measurement was the most predictive for an elevated Rotterdam score on the initial and second CT scans and for TBI progression between scans. No significant associations between any of the most predictive cut points for UCH-L1 and Rotterdam CT scores or TBI progression were found. The predictive capabilities of UCH-L1 were limited by the range allowed by the point-of-care platform. Arrival GFAP cut points remained strong independent predictors after controlling for all potential polytrauma confounders, including injury characteristics, shock severity, and resuscitation. Early measurements of GFAP and UCH-L1 on a point-of-care device are significantly associated with CT-diagnosed TBI in patients with polytrauma and shock. Early elevated GFAP measurements are associated with worse head CT scan Rotterdam scores, TBI progression, and worse GOSE scores, and these associations are independent of other injury attributes, shock severity, and early resuscitation characteristics.

Computed tomography benefits and cost in hemodynamically stable patients with blunt abdominal trauma at an Egyptian University Hospital

BackgroundTrauma is a significant cause of mortality, especially among individuals aged between 15 and 44 years, with a substantial burden falling on economically active populations. Low- and middle-income countries (LMICs) bear the burden of trauma-related deaths, accounting for over 90 % globally. In Egypt, trauma rates are increasing, primarily due to road traffic crashes (RTC), affecting males disproportionately. Blunt abdominal trauma, often caused by RTC, can lead to missed intra-abdominal injuries (IAIs) due to atypical symptoms. Computed Tomography (CT) offers high sensitivity and specificity in detecting IAIs, but concerns about cost and radiation exposure exist. MethodologyThis study investigates the roles of Focused Assessment with Sonography for Trauma (FAST) and CT in managing blunt abdominal trauma. A retrospective cohort study was conducted on hemodynamically stable patients. Data included patient demographics, trauma details, healthcare decisions, costs, and outcomes. ResultsComputed tomography significantly reduced unnecessary laparotomies (12.3% vs. 24.8 %, p = 0.001), shortened hospital stays (4.83±0.71 days vs. 6.15±1.28 days, p = 0.005), and reduced ICU admissions (8 vs. 32, p = 0.023) compared to FAST alone. Overall costs were lower in the CT & FAST Group ($2055.95 vs. $3488.7, p = 0.0001), with no significant difference in missed IAIs. ConclusionThis study highlights the limitations of relying solely on FAST for IAIs and underscores the value of CT in guiding healthcare decisions. Incorporating CT led to reduced negative laparotomies, shorter hospital stays, and fewer ICU admissions. While CT incurs initial costs, its long-term benefits outweigh expenditures, particularly in LMICs. This study provides insights into optimizing diagnostic approaches for blunt abdominal trauma in low-resource settings.

Trauma-Related Deaths in the Accident and Emergency Department of a Nigerian Teaching Hospital

Background: Trauma is a significant contributor to morbidity, disabilities, loss of man hours and mortality in both the developed and developing world with 90% of global trauma deaths occurring in low and middle income countries. The extent of motor vehicular use, degree of adherence to use of safety gadgets, strength of enforcement of industrial safety regulations, level of civil unrest as well as other socio-demographic indices predict the contribution of various etiologic factors. Deaths from the trauma may perhaps have far more psychologic and physical impact on families that from acute/chronic medical cases Method: A retrospective study of the admission records and in-patient records of all trauma related deaths in the accident and emergency unit of the University of Port Harcourt Teaching Hospital from 1st January 2018 to 31st December 2022 was done. Relevant information was extracted and analyzed. Data obtained was analyzed descriptively. Results were presented in tables and charts where necessary. Means and standard deviations were used to represent certain variables. Results: Total emergencies (medical and surgical) seen within the study period were 42,443, total injuries seen were 10,787 giving a crude injury prevalence rate of 25.4%. There were a total of 766 deaths among injured patients giving a crude mortality rate of 7.1%. Road traffic accidents (RTAs) (46.3%) and Firearm injuries (23.5%) were the most common injury mechanisms seen. Traumatic brain injuries are by far the leading cause of trauma-related deaths in the ER (82.5%) with most deaths (96.1%) occurring within the first 72hours of Admission. Conclusion: Trauma-related deaths occur in 7.1% of all injuries presenting at the study sight. The most common mechanism is RTA while the most affected victim is the young adult male. Traumatic brain injury accounts for more deaths than all others combined with most of the deaths occurring within the first 72hours of presentation. All efforts at reducing these injuries should be encouraged.

Plasma proteomics profile-based comparison of torso versus brain injury: A prospective cohort study.

Trauma-related deaths and posttraumatic sequelae are a global health concern, necessitating a deeper understanding of the pathophysiology to advance trauma therapy. Proteomics offers insights into identifying and analyzing plasma proteins associated with trauma and inflammatory conditions; however, current proteomic methods have limitations in accurately measuring low-abundance plasma proteins. This study compared plasma proteomics profiles of patients from different acute trauma subgroups to identify new therapeutic targets and devise better strategies for personalized medicine. This prospective observational single-center cohort study was conducted between August 2020 and September 2021 in the intensive care unit of Osaka University Hospital in Japan. Enrolling 59 consecutive patients with blunt trauma, we meticulously analyzed plasma proteomics profiles in participants with torso or head trauma, comparing them with those of controls (mild trauma). Using the Olink Explore 3072 instrument (Olink Proteomics AB, Uppsala, Sweden), we identified five endotypes (α-ε) via unsupervised hierarchical clustering. The median time from injury to blood collection was 47 minutes [interquartile range, 36-64 minutes]. The torso trauma subgroup exhibited 26 unique proteins with significantly altered expression, while the head trauma subgroup showed 68 unique proteins with no overlap between the two. The identified endotypes included α (torso trauma, n = 8), β (young patients with brain injury, n = 5), γ (severe brain injury postsurgery, n = 8), δ (torso or brain trauma with mild hyperfibrinolysis, n = 18), and ε (minor trauma, n = 20). Patients with torso trauma showed changes in blood pressure, smooth muscle adaptation, hypermetabolism, and hypoxemia. Patients with traumatic brain injury had dysregulated blood coagulation and altered nerves regeneration and differentiation. This study identified unique plasma protein expression patterns in patients with torso trauma and traumatic brain injury, helping categorize five distinct endotypes. Our findings may offer new insights for clinicians, highlighting potential strategies for personalized medicine and improved trauma-related care. Prognostic and Epidemiological; Level III.

Causes of Death in the Presence of Law Enforcement in Johnson County, Iowa, 2011-2020.

Objectives. To examine sudden and unexpected or trauma-related deaths that occurred in the presence of law enforcement in Johnson County, Iowa, between 2011 and 2020. Methods. We identified deaths in the presence of law enforcement using definitions from the National Association of Medical Examiners. We obtained data, including demographics, cause and manner of death, toxicology results, and circumstances and location of event leading to death, from comprehensive medical examiner investigative reports. Results. There were 165 deaths that occurred in the presence of law enforcement: 114 were from a known disease, and 51 were either trauma related or the sudden, unexpected initial presentation of a previously unrecognized disease. Three deaths occurred in the context of physical restraint by law enforcement. Suicide was the leading manner of death among trauma-related deaths; the means of suicide was predictable based on in-custody (hanging) or precustody (firearm) circumstances. Conclusions. Our findings highlight the potential role of medical examiners and coroners in improving completeness of data on reporting death in the presence of law enforcement to public health agencies. (Am J Public Health. 2024;114(6):642-650. https://doi.org/10.2105/AJPH.2024.307616).