Trauma Surgery & Acute Care Open最新文献

Background: Benzodiazepine use among adults ≥50 years is increasing and frequently co-occurs with other substances, a pattern linked to trauma risk and greater hospital resource utilization. This study evaluated the impact of benzodiazepine-related polysubstance use on resource utilization in older trauma patients.

Methods: We conducted a retrospective cohort study of trauma patients aged ≥50 admitted to four US trauma centers (January 2016-July 2022). Patients were classified as positive for ≥2 substances including benzodiazepines (PSB+), positive for ≥2 substances excluding benzodiazepines (PSB-), or substance negative (SB-). Outcomes included urine drug screening (UDS) trends, benzodiazepine positivity, and the following hospital resource utilization outcomes: intensive care unit (ICU) admission, ventilation, transfusion, surgery, ICU length of stay (LOS) >4 days, hospital LOS >5 days, or in-hospital complications. Covariates were balanced using inverse probability weighting (IPW).

Results: Of 24 045 older patients, 13% (n=3008) underwent UDS; 38% were substance positive. The final cohort (n=2201) included 158 (7%) PSB+, 181 (8%) PSB-, and 1862 (85%) SB- patients. UDS rates declined over time (p<0.001), while PSB+ use slightly increased (p=0.02). Compared with PSB-, PSB+ patients were older (median 60 years vs. 56 years, p<0.001), more often female (37% vs. 23%, p=0.007), and more likely to have falls (47% vs. 32%, p=0.04), high alcohol levels (68% vs. 26%, p=0.001), Glasgow Coma Scale score ≤8 (25% vs. 8%, p<0.001), and Injury Severity Score ≥16 (31% vs. 19%, p=0.02). Unadjusted analyses showed higher ICU admissions, ventilation, transfusions, and complications in PSB+ patients. After IPW, PSB+ remained associated with higher odds of ICU admission (OR 1.84, 95% CI 1.18 to 2.85, p=0.007) and transfusion (OR 1.87, 95% CI 1.04 to 3.39, p=0.04). Among patients aged ≥65, PSB+ conferred more than threefold higher ICU admission odds (OR 3.35, 95% CI 1.32 to 8.51, p=0.01).

Conclusions: Benzodiazepine-positive polysubstance use in older trauma patients is independently associated with higher odds of ICU-level care and transfusion, supporting early identification of this high-risk population.

Level of evidence: Level IV, retrospective study.

Background: Timely initiation of venous thromboembolism prophylaxis (VTEp) has been known to decrease venous thromboembolism (VTE after trauma; however, early VTEp in patients undergoing neurosurgical interventions (NSIs) is controversial with conflicting reports in the literature from retrospective studies. We aimed to evaluate the safety and outcomes of early VTEp in this high-risk cohort.

Methods: The study was a secondary analysis from the prospective multicenter Consortium of Leaders in the Study of Traumatic Thromboembolism database. Traumatic brain injury (TBI) patients receiving NSI were included. Patients were divided into early (≤72 hours) and late (>72 hours) VTEp groups. Mortality, VTE, deep vein thrombosis (DVT), pulmonary embolism, and bleeding adverse events including progression of intracranial hemorrhage (pICH) were compared.

Results: Among the total 238 patients, 233 (97.9%) underwent craniotomy or craniectomy, and 140 (58.8%) received early VTEp. Patients with a head Abbreviated Injury Scale score of 5 and craniectomy were more likely to delay VTEp (>72 hours) (all p<0.05). Compared with late VTEp, early VTEp exhibited lower rates of VTE (10.7% vs 16.3%, p=0.28) and DVT (8.6% vs 15.3%, p=0.16), though without achieving statistical significance. Through generalized estimating equation and competing risk analysis, early VTEp did not demonstrate a significant decrease of VTE risk (OR) 0.74, 95% CI 0.33 to 1.67; HR 0.90, 95% CI 0.45 to 1.84), whereas the risk of adverse bleeding events (OR 0.79, 95% CI 0.24 to 2.57) or pICH (OR 1.10, 95% CI 0.30 to 4.03) did not increase with early VTEp either.

Conclusion: Early VTEp is not significantly associated with reduced rates of VTE or DVT in patients with severe TBI requiring emergent NSI, but it also does not increase the risk of adverse bleeding event or pICH.

Level of evidence: Level IV; therapeutic/care management.

Background: Retroperitoneal rectal injuries (RRIs) caused by combined military trauma represent a complex clinical challenge, especially in modern armed conflicts. Traditional management protocols have evolved significantly since World War II, emphasizing fecal diversion and presacral drainage. However, emerging evidence supports primary repair as a viable alternative for select cases. This study evaluates the efficacy of primary repair for RRIs among military trauma patients treated at a tertiary center.

Methods: A retrospective cohort study was conducted at the National Cancer Institute, Kyiv, Ukraine, from February 2022 to March 2024. Patients with RRIs due to combined military trauma were analyzed, excluding isolated or intraperitoneal rectal injuries. Surgical interventions included primary repair, loop sigmoidostomy, presacral drainage, and rectal washout. Postoperative outcomes were assessed, including complication rates, hospital length of stay (LOS), and mortality. Statistical analyses included χ2, Fisher's exact, t-tests, and logistic regression, with p<0.05 considered significant.

Results: Twelve patients met the inclusion criteria, with a median age of 33 years (IQR 27-40). Seven patients underwent primary repair, achieving an 85.7% success rate (χ2=10.89, p=0.001). Patients receiving primary repair experienced significantly shorter LOS (55 days, IQR 44-64 140 days, IQR 99-141, p=0.048) and lower complication rates (28.5% vs 80%, p=0.079). No mortality was reported. Loop sigmoidostomy showed a 66.6% success rate, while presacral drainage and rectal washout yielded limited efficacy, particularly in severe injuries.

Conclusion: Primary repair may represent a viable and promising option for managing RRIs in selected patients with combined military trauma, potentially reducing LOS and postoperative complications compared to more invasive approaches. Nevertheless, given the limited sample size (n=12), these findings should be regarded as exploratory, underscoring the need for larger, prospective studies to confirm their validity.

Level of evidence: III-2 A comparative study with concurrent controls.

Background: In pediatric patients presenting after blunt trauma, the incidence of clinically significant cervical spine injury (CSI) is approximately 1%. Although multidetector CT (MDCT) is widely accepted for cervical spine clearance in adults, its utility in children remains uncertain. The purpose of this study is to evaluate the sensitivity of MDCT in identifying clinically significant CSI in pediatric patients, stratified by age groups: adolescents (12 years to 17 years) and children (0 years to 11 years).

Methods: We designed a national, multicenter, prospective observational study to assess the diagnostic performance of MDCT in detecting clinically significant CSI in pediatric trauma patients. Data are being collected from participating centers on imaging findings, clinical outcomes, and the presence of confirmed CSIs after blunt trauma. The analysis plan includes stratification by age group and calculation of sensitivity, specificity, and predictive values of MDCT for CSI.

Results: This abstract outlines the background, methodology, and analytical framework of the study. Data collection and analysis are ongoing. This study represents the largest known cohort of pediatric patients undergoing cervical spine imaging after blunt trauma and is the first prospective study of its kind focused exclusively on this population.

Conclusions: This study will provide critical data to inform guidelines for pediatric cervical spine clearance after blunt trauma. By evaluating the sensitivity of MDCT in detecting clinically significant CSI, the findings aim to support evidence-based imaging strategies and improve the safety and efficiency of pediatric trauma care.