Journal of Trauma Nursing最新文献

Background: The American College of Surgeons mandates eight trauma activation criteria for full trauma activations, yet many centers exceed this number to minimize undertriage. The association between trauma activation criteria and triage accuracy and resource use is poorly studied.

Objective: To assess the relationship between the number of criteria for full trauma activation and rates of activation, undertriage, overtriage, mortality, and hospital length of stay.

Methods: This multicenter retrospective cohort study analyzed survey and trauma registry data from 36 trauma centers across 16 U.S. states and the District of Columbia. Centers reported their activation criteria used for full trauma activation from 2017 to 2019, and outcomes were evaluated using multivariable negative binomial regression and weighted linear regression.

Results: Among 218,832 patients, the number of trauma activation criteria per center ranged from 8 to 28, with a mean of 16.75 and an SD of 4.47. The number of criteria was not significantly associated with the proportion of full trauma activation (adjusted incidence rate ratio [aIRR] = 1.02 [95% CI 0.996, 1.05], p = .097), undertriage (aIRR = 0.98 [95% CI 0.96, 1.003], p = .081), mortality (aIRR = 1.00 [95% CI 0.99, 1.01]; p = .952), or length of stay ( b = -0.001 [95% CI -0.059, 0.058], p = .985). However, more criteria were significantly associated with greater overtriage (aIRR = 1.02 [95% CI 1.003, 1.03], p = .010).

Conclusion: Increasing the number of trauma activation criteria was not linked to improved undertriage or clinical outcomes, but was associated with higher overtriage, suggesting a greater burden on trauma resources without clinical benefit.

Background: Unidentified patients pose challenges in emergency care due to missing clinical history and identification, impacting patient safety and decision-making. Despite known risks, little is understood about this group in middle-income countries.

Objective: To describe the epidemiological profile and the clinical, structural, and social challenges that influence the care of unidentified patients in a public teaching hospital.

Methods: This retrospective cohort study was conducted from January 2019 to December 2022 in the emergency department (ED) of a public teaching hospital in Belo Horizonte, Brazil. Data from unidentified patients were extracted from electronic medical records, including demographics, admission reasons, risk classification, clinical management, outcomes, and hospital length of stay. Multivariate logistic regression was used to identify factors associated with adverse outcomes, adjusting for clinical and sociodemographic variables.

Results: Among 2,425 unidentified ED admissions, 332 cases were sampled using a finite population correction formula. Of these, 81.6% were male; median age was 32 years (interquartile range 26-43). Main admission causes were physical assault (39.8%), falls (20.5%), and road traffic collisions (10.8%); 69.9% were triaged as very urgent. Only 29.2% were identified before discharge; time as unidentified ranged from 0 to 411 days (median 1 day). Remaining unidentified beyond one day was strongly associated with adverse outcomes (odds ratio 8.56; 95% confidence interval 5.0-14.6; p < .001).

Conclusion: Delayed identification was associated with adverse outcomes, but causality cannot be inferred. Early identification initiatives should be combined with broader strategies to address underlying risks and ensure continuity of care.

Background: In adult patients with head trauma, the location and characteristics of the visible head injury have been associated with adverse outcomes, such as traumatic intracranial hemorrhage and cervical spine injuries.

Objective: This study aimed to evaluate the reliability of head injury location and characteristics between Emergency Medical Dispatcher (EMD) and Emergency Department (ED) assessments in patients contacting an EMD for head injuries. A secondary objective was to assess how this reliability varied depending on the individual contacting the EMD.

Methods: This study was a planned sub-analysis of a multicenter, prospective, observational cohort study conducted over three 3 days in March 2023 in France (EPI-TC study). Main outcome was visible head injury location and characteristics. Standardized data collection occurred during the EMD call and upon ED admission. Interobserver reliability between EMD and ED assessments was measured using kappa coefficient.

Results: Overall, 241 patients from 20 participating EMD and 20 EDs were included in this sub-analysis and most of them (79.3%) were community-dwelling patients. The EMD was most frequently contacted by unrelated witnesses (27.8%). Head injury location and characteristic were reliable between EMD and ED, with kappa coefficients of 0.76 (95% CI 0.73-0.79) and 0.76 (95% CI 0.72-0.81), respectively. However, this reliability was low when EMD was called by the patient himself (kappa coefficient 0.59 (95% CI 0.50-0.69) and 0.52 (95% CI 0.38-0.66) respectively).

Conclusions: In cases of head injuries, phone-based assessments by EMD regarding head injury location and characteristics are reliable in adult patients when reported by a witness. However, caution is recommended if the patients call the EMD themselves. In these cases, alternative evaluation methods could be considered, such as onsite assessment by a health care professional or telemedicine-based photographic transmission.

Introduction: Patients with reduced mobility face elevated risks of complications, including pressure ulcers and functional decline. Automated beds and robotic mobility systems are emerging tools to support early mobilization and reduce caregiver burden, but their overall impact remains unclear.

Objective: To systematically review the evidence on the effectiveness of automated bed systems and robotic mobility technologies compared to conventional care in improving clinical and functional outcomes in immobile adult patients.

Methods: We searched PubMed, Scopus, Web of Science, CINAHL, and Google Scholar from inception to September 29, 2025. Eligible studies included adults (≥18 years) with neurological conditions or immobility receiving automated or robotic mobilization interventions compared with standard care. Outcomes of interest were motor function, quality of life, hemodynamic stability, caregiver workload, and cost-effectiveness. Two reviewers independently screened studies and extracted data. Risk of bias was assessed with validated tools. A narrative synthesis was performed due to heterogeneity in study design and outcomes.

Results: Nine studies involving 380 patients met the inclusion criteria. Robotic and automated systems were associated with improved functional outcomes, reduced incidence of pressure injuries, and enhanced caregiver efficiency. Heterogeneity in study design and intervention protocols precluded meta-analysis.

Conclusion: Automated and robotic mobility systems may support early mobilization and improve care outcomes in immobile patients. Further high-quality studies are needed to confirm their long-term clinical and economic benefits.

Background: Imaging interpretations for pediatric trauma patients transferred from general emergency departments to pediatric hospitals differ in up to 40% of cases, with more than half affecting patient care. Delays in radiology image interpretation lead to extended emergency department stays, unnecessary reimaging, and delayed injury recognition. Currently, no streamlined imaging protocol exists to ensure timely image interpretation for severely injured pediatric patients.

Objective: To assess improvements in timeliness and consistency of imaging interpretation before and after implementation of a streamlined protocol for severely injured pediatric trauma patients.

Methods: A quality improvement pre- and post-intervention study was conducted at Level I and Level II Pediatric Trauma Centers located in the western United States from April 2023 to December 2024. Pediatric patients aged 18 and younger who met the institutional trauma activation criteria and came from a referring facility with images were included in the study. Outcomes included image interpretation timeliness and consistency (measured by variability in interpretation times and sustained process change via statistical process control charts).

Results: There were 86 patients meeting criteria during the study. After implementation, the median time to image interpretation decreased from 145 to 51 min, and variability in interpretation times decreased (standard deviation decreased from 680 to 170 min). No missed injuries that changed patient care were observed before or after the intervention.

Conclusion: Implementation of a streamlined imaging protocol for pediatric trauma patients led to faster and more consistent image interpretation without compromising care quality.

Background: Acute agitation in the trauma population complicates emergency care. While droperidol effectively treats agitation in general emergency department populations, literature specific to trauma patients is limited.

Objective: This study aims to describe the safety outcomes and clinical success rates of droperidol for acute agitation in trauma patients.

Methods: This retrospective, observational cohort study at a Southeastern, U.S. Level I trauma center included adults who presented as a trauma activation and received droperidol in the emergency department between February 1, 2020 and August 31, 2024. Patients were excluded if the droperidol dose was <2.5 mg or received antiemetics or sedatives prior to droperidol. The primary outcome was the need for rescue sedation within 60 minutes of droperidol administration. Secondary outcomes included intubation, hypoxia, and hypotension.

Results: There were 66 patients included. Patients were primarily white males with a median age of 44 years. Majority of patients received droperidol 2.5 mg ( n = 48, 73%) intravenously ( n = 60, 91%). Twenty-six (39.4%) patients required rescue sedation within 60 minutes of droperidol administration, 16 of which required additional droperidol. These patients were younger and had a shorter time to initial droperidol administration. Fourteen (21%) patients had a new oxygen requirement, two of which were intubated. One patient experienced hypotension not attributed to hypovolemia.

Conclusion: This study provides descriptive data suggesting droperidol may be useful for agitation in trauma patients with few serious adverse events. However, prospective randomized controlled studies are required before routine use can be recommended over other agents.

Background/rationale: Deep vein thrombosis (DVT) is the second leading cause of morbidity among hospitalized pediatric patients. The current literature evaluates individual risk factors in isolation while failing to comprehensively evaluate other injuries and clinical characteristics.

Objectives: Our study aims to identify various demographic, injury, and clinical characteristics associated with DVT in pediatric polytrauma patients.

Methods: This retrospective cohort study utilized the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP-PUF) database 2017-2023 to evaluate DVT risk in pediatric patients (<18 years) with polytrauma injuries. Data were further stratified by demographic, injury, and clinical characteristics.

Results: A total of 620 pediatric polytrauma patients diagnosed with DVT were included. Risk factors associated with increased DVT incidence included age 15-17 (aOR: 3.03, p < .001), male sex (aOR: 1.40, p = .043), and obese patients (adjusted odds ratio [aOR: 1.48, p = .004]). Patients with penetrating injuries (aOR: 2.10, p < .001), Injury Severity Score >15 (aOR: 3.71, p < .001), severe abdominal trauma (aOR: 1.17, p = .049), undergoing craniotomy (aOR: 2.26, p = .044) or exploratory laparotomy (aOR: 3.17, p < .001), on mechanical ventilation > 72 hr (aOR: 6.53, p < .001), and receiving blood transfusions (aOR: 3.51, p < .001) also had an increased DVT risk.

Conclusion: Pediatric polytrauma patients aged 15-17, obese, with penetrating severe injuries, on mechanical ventilation >72 hr, undergoing craniotomy or exploratory laparotomy, and those receiving blood transfusions, especially transfusions within 4 hr and massive blood transfusions, are at increased risk of developing DVT.

Introduction/rationale: Traumatic brain injuries (TBIs) are a leading cause of death among adults, resulting in approximately 214,110 TBI-related hospitalizations and 69,473 TBI-related deaths in the United States. There remains some debate regarding the optimal timing of craniotomy particularly as it relates to the use of intracranial pressure (ICP) monitoring.

Objective: Our study aims to determine the association of time to craniotomy intervention (≤6 or >6 hr), ICP monitoring, and trauma center level on patient outcomes in blunt, severe, non-subarachnoid TBI with skull fracture.

Methods: This retrospective study utilized the American College of Surgeons-Trauma Quality Improvement Program (ACS-TQIP) database to examine adult trauma patients (age ≥18 years, Injury Severity Score ≥15) between 2017 and 2023. The study included patients with isolated, severe, blunt, non-subarachnoid hemorrhage TBIs (Glasgow Coma Scale ≤8, Abbreviated Injury Scale ≥2) measuring ≥8 mm. Outcomes of interest were stratified by trauma center level and whether they underwent ICP monitoring.

Results: A total of 3,265 adult patients with isolated, blunt, severe, non-subarachnoid TBIs were included in this analysis. Patients who had ICP monitoring and received craniotomy within 6 hr had no significant difference in odds of mortality (aOR: 0.662, 95% CI: 0.326-1.345, p = .254). Patients who received craniotomy beyond 6 hr were 2.5 times more likely to be associated with in-hospital mortality (aOR: 2.54, 95% CI: 1.19-5.39, p = .016). ICP monitoring correlated with a 1.4-day longer intensive care unit length of stay (β = 1.40, 95% CI: 0.56-2.25, p = .001) and 2.0 fewer ventilator-free days (β = -1.95, 95% CI: -3.16 to -0.74, p = .002). ICP-monitored patients had 50% lower odds of discharge to home (aOR: 0.50, 95% CI: 0.30-0.82, p = .006).

Conclusion: In patients with severe TBI, our findings indicate that late craniotomy had increased odds of in-hospital mortality, suggesting a benefit to craniotomy prior to 6 hr. ICP monitoring should be evaluated on a case-by-case basis in this patient population to ensure proper and effective use toward improving patient outcomes and overall prognosis.