Pub Date : 2025-07-01DOI: 10.1016/j.cjtee.2024.04.007
Yan-Jun Wang , Zi-Hou Zhao , Shuai-Kun Lu , Guo-Liang Wang , Shan-Jin Ma , Lin-Hu Wang , Hao Gao , Jun Ren , Zhong-Wei An , Cong-Xiao Fu , Yong Zhang , Wen Luo , Yun-Fei Zhang
<div><h3>Purpose</h3><div>We carried out the study aiming to explore and analyze the risk factors, the distribution of pathogenic bacteria, and their antibiotic-resistance characteristics influencing the occurrence of surgical site infection (SSI), to provide valuable assistance for reducing the incidence of SSI after traumatic fracture surgery.</div></div><div><h3>Methods</h3><div>A retrospective case-control study enrolling 3978 participants from January 2015 to December 2019 receiving surgical treatment for traumatic fractures was conducted at Tangdu Hospital of Air Force Medical University. Baseline data, demographic characteristics, lifestyles, variables related to surgical treatment, and pathogen culture were harvested and analyzed. Univariate analyses and multivariate logistic regression analyses were used to reveal the independent risk factors of SSI. A bacterial distribution histogram and drug-sensitive heat map were drawn to describe the pathogenic characteristics.</div></div><div><h3>Results</h3><div>Included 3978 patients 138 of them developed SSI with an incidence rate of 3.47% postoperatively. By logistic regression analysis, we found that variables such as gender (males) (odds ratio (<em>OR</em>) = 2.012, 95% confidence interval (<em>CI</em><em>)</em>: 1.235 − 3.278, <em>p</em> = 0.005), diabetes mellitus (<em>OR</em> = 5.848, 95% <em>CI</em>: 3.513 − 9.736, <em>p</em> < 0.001), hypoproteinemia (<em>OR</em> = 3.400, 95% <em>CI</em>: 1.280 − 9.031, <em>p</em> = 0.014), underlying disease (<em>OR</em> = 5.398, 95% <em>CI</em>: 2.343 − 12.438, <em>p</em> < 0.001), hormonotherapy (<em>OR</em> = 11.718, 95% <em>CI</em>: 6.269 − 21.903, <em>p</em> < 0.001), open fracture (<em>OR</em> = 29.377, 95% <em>CI</em>: 9.944 − 86.784, <em>p</em> < 0.001), and intraoperative transfusion (<em>OR</em> = 2.664, 95% <em>CI</em>: 1.572 − 4.515, <em>p</em> < 0.001) were independent risk factors for SSI, while, aged over 59 years (<em>OR</em> = 0.132, 95% <em>CI</em>: 0.059 − 0.296, <em>p</em> < 0.001), prophylactic antibiotics use (<em>OR</em> = 0.082, 95% <em>CI</em>: 0.042 − 0.164, <em>p</em> < 0.001) and vacuum sealing drainage use (<em>OR</em> = 0.036, 95% <em>CI</em>: 0.010 − 0.129, <em>p</em> < 0.001) were protective factors. Pathogens results showed that 301 strains of 38 species of bacteria were harvested, among which 178 (59.1%) strains were Gram-positive bacteria, and 123 (40.9%) strains were Gram-negative bacteria. <em>Staphylococcus aureus</em> (108, 60.7%) and <em>Enterobacter cloacae</em> (38, 30.9%) accounted for the largest proportion. The susceptibility of Gram-positive bacteria to Vancomycin and Linezolid was almost 100%. The susceptibility of Gram-negative bacteria to Imipenem, Amikacin, and Meropenem exceeded 73%.</div></div><div><h3>Conclusion</h3><div>Orthopedic surgeons need to develop appropriate surgical plans based on the risk factors and protective factors associated with postoperative SSI to reduce its
{"title":"Analysis of risk factors, pathogenic bacteria characteristics, and drug resistance of postoperative surgical site infection in adults with limb fractures","authors":"Yan-Jun Wang , Zi-Hou Zhao , Shuai-Kun Lu , Guo-Liang Wang , Shan-Jin Ma , Lin-Hu Wang , Hao Gao , Jun Ren , Zhong-Wei An , Cong-Xiao Fu , Yong Zhang , Wen Luo , Yun-Fei Zhang","doi":"10.1016/j.cjtee.2024.04.007","DOIUrl":"10.1016/j.cjtee.2024.04.007","url":null,"abstract":"<div><h3>Purpose</h3><div>We carried out the study aiming to explore and analyze the risk factors, the distribution of pathogenic bacteria, and their antibiotic-resistance characteristics influencing the occurrence of surgical site infection (SSI), to provide valuable assistance for reducing the incidence of SSI after traumatic fracture surgery.</div></div><div><h3>Methods</h3><div>A retrospective case-control study enrolling 3978 participants from January 2015 to December 2019 receiving surgical treatment for traumatic fractures was conducted at Tangdu Hospital of Air Force Medical University. Baseline data, demographic characteristics, lifestyles, variables related to surgical treatment, and pathogen culture were harvested and analyzed. Univariate analyses and multivariate logistic regression analyses were used to reveal the independent risk factors of SSI. A bacterial distribution histogram and drug-sensitive heat map were drawn to describe the pathogenic characteristics.</div></div><div><h3>Results</h3><div>Included 3978 patients 138 of them developed SSI with an incidence rate of 3.47% postoperatively. By logistic regression analysis, we found that variables such as gender (males) (odds ratio (<em>OR</em>) = 2.012, 95% confidence interval (<em>CI</em><em>)</em>: 1.235 − 3.278, <em>p</em> = 0.005), diabetes mellitus (<em>OR</em> = 5.848, 95% <em>CI</em>: 3.513 − 9.736, <em>p</em> < 0.001), hypoproteinemia (<em>OR</em> = 3.400, 95% <em>CI</em>: 1.280 − 9.031, <em>p</em> = 0.014), underlying disease (<em>OR</em> = 5.398, 95% <em>CI</em>: 2.343 − 12.438, <em>p</em> < 0.001), hormonotherapy (<em>OR</em> = 11.718, 95% <em>CI</em>: 6.269 − 21.903, <em>p</em> < 0.001), open fracture (<em>OR</em> = 29.377, 95% <em>CI</em>: 9.944 − 86.784, <em>p</em> < 0.001), and intraoperative transfusion (<em>OR</em> = 2.664, 95% <em>CI</em>: 1.572 − 4.515, <em>p</em> < 0.001) were independent risk factors for SSI, while, aged over 59 years (<em>OR</em> = 0.132, 95% <em>CI</em>: 0.059 − 0.296, <em>p</em> < 0.001), prophylactic antibiotics use (<em>OR</em> = 0.082, 95% <em>CI</em>: 0.042 − 0.164, <em>p</em> < 0.001) and vacuum sealing drainage use (<em>OR</em> = 0.036, 95% <em>CI</em>: 0.010 − 0.129, <em>p</em> < 0.001) were protective factors. Pathogens results showed that 301 strains of 38 species of bacteria were harvested, among which 178 (59.1%) strains were Gram-positive bacteria, and 123 (40.9%) strains were Gram-negative bacteria. <em>Staphylococcus aureus</em> (108, 60.7%) and <em>Enterobacter cloacae</em> (38, 30.9%) accounted for the largest proportion. The susceptibility of Gram-positive bacteria to Vancomycin and Linezolid was almost 100%. The susceptibility of Gram-negative bacteria to Imipenem, Amikacin, and Meropenem exceeded 73%.</div></div><div><h3>Conclusion</h3><div>Orthopedic surgeons need to develop appropriate surgical plans based on the risk factors and protective factors associated with postoperative SSI to reduce its","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 4","pages":"Pages 241-251"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141138544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/S1008-1275(25)00072-0
{"title":"Guide for Author","authors":"","doi":"10.1016/S1008-1275(25)00072-0","DOIUrl":"10.1016/S1008-1275(25)00072-0","url":null,"abstract":"","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 4","pages":"Pages I-V"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144623449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.cjtee.2024.08.004
Meng Wang , Jian-Min Liu , Xing-Bo Dang , Long-Yang Ma , Gong-Liang Du , Wei Hu
Trauma is an important cause of death in young- and middle-aged people. Trauma is comprehensive and includes many surgical specialties, and the surgical techniques of these specialties have long been mature. To reduce the mortality and disability rate of trauma patients, it is necessary to improve trauma management. Trauma has attracted attention in China and trauma treatment and care developed rapidly in recent years. To decrease traumatic mortality and disability rates, our team is committed to building an efficient trauma system in Shaanxi province and has successfully developed a trauma limb salvage map to address the high rates of amputation and disability in patients with limb injuries. This article elaborates on the construction experience of a trauma limb salvage map and its application details in Shaanxi province of China.
{"title":"The construction and application of a trauma limb salvage map in Shaanxi province","authors":"Meng Wang , Jian-Min Liu , Xing-Bo Dang , Long-Yang Ma , Gong-Liang Du , Wei Hu","doi":"10.1016/j.cjtee.2024.08.004","DOIUrl":"10.1016/j.cjtee.2024.08.004","url":null,"abstract":"<div><div>Trauma is an important cause of death in young- and middle-aged people. Trauma is comprehensive and includes many surgical specialties, and the surgical techniques of these specialties have long been mature. To reduce the mortality and disability rate of trauma patients, it is necessary to improve trauma management. Trauma has attracted attention in China and trauma treatment and care developed rapidly in recent years. To decrease traumatic mortality and disability rates, our team is committed to building an efficient trauma system in Shaanxi province and has successfully developed a trauma limb salvage map to address the high rates of amputation and disability in patients with limb injuries. This article elaborates on the construction experience of a trauma limb salvage map and its application details in Shaanxi province of China.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 4","pages":"Pages 235-240"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.cjtee.2024.09.004
Nurşen Zeybek , Özcan Gayretli , Yüsra Nur Şanlıtürk , Ayşin Kale
Purpose
In surgical procedures commonly employed for the management of scaphoid and distal radial fractures, the incision and dissection of the pronator quadratus muscle play a pivotal role. Nevertheless, comprehensive investigations into the anatomical intricacies of the pronator quadratus muscle have been relatively scarce within the clinical community. In light of this, our study endeavors to make a substantive contribution to the medical literature by conducting a meticulous examination of the morphology and morphometry of this muscle.
Methods
This study is a cross-sectional observational study conducted on 22 cadaveric upper extremities (44 sides) preserved between January 2005 and December 2018 at Istanbul University. The study included specimens with intact dissection areas and no prior surgical intervention. Observations focused on the morphometry of the pronator quadratus muscle and related anatomical structures. Statistical analysis was performed using SPSS v23.0, employing Student's t-test and paired t-test, with significance set at p < 0.05.
Results
Significant differences were found in the morphometric measurements of the pronator quadratus muscle between the right and left upper extremities, particularly in the vertical distance between the proximal and distal attachment points of the pronator quadratus to the radius (p = 0.008). Additionally, significant differences were observed between male and female samples for radius length (p < 0.001), ulna length (p < 0.001), pronator quadratus width (p < 0.001), and the vertical distance between pronator quadratus attachment points on both the radius (p = 0.001) and ulna (p = 0.001). Furthermore, significant correlations were identified between radius length and parameters such as the vertical distance between pronator quadratus attachment points on both the radius (p = 0.002) and pronator quadratus width (p = 0.030), and between ulna length and parameters including the vertical distances on the radius (p = 0.001) and ulna (p = 0.024).
Conclusion
In light of our comprehensive analysis, which encompasses not only the anatomical features of the pronator quadratus muscle but also its vascular supply and the organization of its neurovascular structures, we posit that our study holds significant implications for the field of orthopedic surgery. We anticipate that this research will furnish valuable insights that can inform and enhance orthopedic procedures.
目的：在治疗肩胛骨和桡骨远端骨折的常用外科手术中，切开和剥离前庭大肌起着关键作用。然而，在临床上，对握前肌复杂解剖结构的全面研究相对较少。有鉴于此，我们的研究通过对这块肌肉的形态学和形态计量学进行细致研究，努力为医学文献做出实质性贡献：本研究是一项横断面观察性研究，对象是伊斯坦布尔大学 2005 年 1 月至 2018 年 12 月期间保存的 22 具尸体上肢（44 侧）。研究对象包括解剖区域完整且之前未进行过手术干预的标本。观察的重点是发音肌和相关解剖结构的形态测量。统计分析使用 SPSS v23.0，采用学生 t 检验和配对 t 检验，显著性以 p 为标准：左、右上肢之间的旋前肌形态测量结果存在显著差异，尤其是旋前肌与桡骨近端和远端附着点之间的垂直距离（p = 0.008）。此外，男性和女性样本在桡骨长度上也存在明显差异（p 结论：男性和女性样本在桡骨长度上存在明显差异：我们的综合分析不仅涵盖了旋前肌的解剖特征，还包括其血管供应及其神经血管结构的组织，因此我们认为我们的研究对矫形外科领域具有重要意义。我们预计，这项研究将为矫形外科手术提供有价值的见解。
{"title":"Morphometric and anatomic characteristics of pronator quadratus muscle","authors":"Nurşen Zeybek , Özcan Gayretli , Yüsra Nur Şanlıtürk , Ayşin Kale","doi":"10.1016/j.cjtee.2024.09.004","DOIUrl":"10.1016/j.cjtee.2024.09.004","url":null,"abstract":"<div><h3>Purpose</h3><div>In surgical procedures commonly employed for the management of scaphoid and distal radial fractures, the incision and dissection of the pronator quadratus muscle play a pivotal role. Nevertheless, comprehensive investigations into the anatomical intricacies of the pronator quadratus muscle have been relatively scarce within the clinical community. In light of this, our study endeavors to make a substantive contribution to the medical literature by conducting a meticulous examination of the morphology and morphometry of this muscle.</div></div><div><h3>Methods</h3><div>This study is a cross-sectional observational study conducted on 22 cadaveric upper extremities (44 sides) preserved between January 2005 and December 2018 at Istanbul University. The study included specimens with intact dissection areas and no prior surgical intervention. Observations focused on the morphometry of the pronator quadratus muscle and related anatomical structures. Statistical analysis was performed using SPSS v23.0, employing Student's <em>t</em>-test and paired <em>t</em>-test, with significance set at <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>Significant differences were found in the morphometric measurements of the pronator quadratus muscle between the right and left upper extremities, particularly in the vertical distance between the proximal and distal attachment points of the pronator quadratus to the radius (<em>p</em> = 0.008). Additionally, significant differences were observed between male and female samples for radius length (<em>p <</em> 0.001), ulna length (<em>p <</em> 0.001), pronator quadratus width (<em>p <</em> 0.001), and the vertical distance between pronator quadratus attachment points on both the radius (<em>p</em> = 0.001) and ulna (<em>p</em> = 0.001). Furthermore, significant correlations were identified between radius length and parameters such as the vertical distance between pronator quadratus attachment points on both the radius (<em>p</em> = 0.002) and pronator quadratus width (<em>p</em> = 0.030), and between ulna length and parameters including the vertical distances on the radius (<em>p</em> = 0.001) and ulna (<em>p</em> = 0.024).</div></div><div><h3>Conclusion</h3><div>In light of our comprehensive analysis, which encompasses not only the anatomical features of the pronator quadratus muscle but also its vascular supply and the organization of its neurovascular structures, we posit that our study holds significant implications for the field of orthopedic surgery. We anticipate that this research will furnish valuable insights that can inform and enhance orthopedic procedures.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 4","pages":"Pages 252-256"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.cjtee.2024.02.007
Yongli Wang , Bencai Du , Xueliang Han , Lianjun Qu
Propose
To investigate the molecular mechanisms underlying the protective effects of ischemic preconditioning (IPC) in patients undergoing total knee arthroplasty.
Methods
GSE21164 was extracted from an online database, followed by an investigation of differentially expressed genes (DEGs) between IPC treatment samples at 2 time points (T0T and T1T). Function and pathway enrichment analyses were performed on the DEGs. A protein-protein interaction network was constructed to identify hub genes according to 5 different algorithms, followed by enrichment analysis. In addition, long noncoding RNAs (lncRNAs) were identified between the T0T and T1T samples. Furthermore, a competing endogenous RNA network was predicted based on the identified lncRNA-messenger RNA (mRNA), lncRNA-microRNA (miRNA), and mRNA-miRNA relationships revealed in this study. Finally, a drug-gene network was investigated. Statistical analyses were performed using GraphPad Prism 8.0. Differences between groups were determined using an unpaired t-test. p < 0.05 was considered significant.
Results
A total of 343 DEGs at T0 and 10 DEGs at T1 were identified and compared with their respective control groups, followed by 100 DEGs between T0T and T1T. Based on these 100 DEGs, protein-protein interaction network analysis revealed 9 hub genes, mainly with mitochondria-related functions and the carbon metabolism pathway. Six differentially expressed lncRNAs were investigated between T0T and T1T. A competing endogenous RNA network was constructed using 259 lncRNA–miRNA–mRNA interactions, including alpha-2-macroglobulin antisense RNA 1-miR-7161-5p-iron-sulfur cluster scaffold. Finally, 13 chemical drugs associated with the hub genes were explored.
Conclusion
Iron-sulfur cluster scaffold may promote IPC-induced ischemic tolerance mediated by alpha-2-macroglobulin antisense RNA 1-miR-7161-5p axis. Moreover, IPC may induce a protective response after total knee arthroplasty via mitochondria-related functions and the carbon metabolism pathway, which should be further validated in the near future.
{"title":"Molecular mechanism underlying the protective effects of ischemic preconditioning in total knee arthroplasty","authors":"Yongli Wang , Bencai Du , Xueliang Han , Lianjun Qu","doi":"10.1016/j.cjtee.2024.02.007","DOIUrl":"10.1016/j.cjtee.2024.02.007","url":null,"abstract":"<div><h3>Propose</h3><div>To investigate the molecular mechanisms underlying the protective effects of ischemic preconditioning (IPC) in patients undergoing total knee arthroplasty.</div></div><div><h3>Methods</h3><div>GSE21164 was extracted from an online database, followed by an investigation of differentially expressed genes (DEGs) between IPC treatment samples at 2 time points (T0T and T1T). Function and pathway enrichment analyses were performed on the DEGs. A protein-protein interaction network was constructed to identify hub genes according to 5 different algorithms, followed by enrichment analysis. In addition, long noncoding RNAs (lncRNAs) were identified between the T0T and T1T samples. Furthermore, a competing endogenous RNA network was predicted based on the identified lncRNA-messenger RNA (mRNA), lncRNA-microRNA (miRNA), and mRNA-miRNA relationships revealed in this study. Finally, a drug-gene network was investigated. Statistical analyses were performed using GraphPad Prism 8.0. Differences between groups were determined using an unpaired <em>t</em>-test. <em>p</em> < 0.05 was considered significant.</div></div><div><h3>Results</h3><div>A total of 343 DEGs at T0 and 10 DEGs at T1 were identified and compared with their respective control groups, followed by 100 DEGs between T0T and T1T. Based on these 100 DEGs, protein-protein interaction network analysis revealed 9 hub genes, mainly with mitochondria-related functions and the carbon metabolism pathway. Six differentially expressed lncRNAs were investigated between T0T and T1T. A competing endogenous RNA network was constructed using 259 lncRNA–miRNA–mRNA interactions, including alpha-2-macroglobulin antisense RNA 1-miR-7161-5p-iron-sulfur cluster scaffold. Finally, 13 chemical drugs associated with the hub genes were explored.</div></div><div><h3>Conclusion</h3><div>Iron-sulfur cluster scaffold may promote IPC-induced ischemic tolerance mediated by alpha-2-macroglobulin antisense RNA 1-miR-7161-5p axis. Moreover, IPC may induce a protective response after total knee arthroplasty via mitochondria-related functions and the carbon metabolism pathway, which should be further validated in the near future.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 4","pages":"Pages 257-268"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.cjtee.2024.07.009
Shan Liu , Lin Ling , Yong Fu , Wen-Chao Zhang , Yong-Hu Zhang , Qing Li , Liang Zeng , Jun Hu , Yong Luo , Wen-Jie Liu
Purpose
Emergency resuscitative thoracotomy (ERT) is a final salvage procedure for critically injured trauma patients. Given its low success rate and ambiguous indications, its use in blunt trauma scenarios remains highly debated. Consequently, our study seeks to ascertain the overall survival rate of ERT in blunt trauma patients and determine which patients would benefit most from this procedure.
Methods
A retrospective case-control study was conducted for this research. Blunt trauma patients who underwent ERT between January 2020 and December 2023 in our trauma center were selected for analysis, with the endpoint outcome being in-hospital survival, divided into survival and non-survival groups. Inter-group comparisons were conducted using Chi-square and Fisher's exact tests, the Kruskal-Wallis test, Student's t-test, or the Mann-Whitney U test. Univariate and multivariate logistic regression analyses were conducted to assess potential predictors of survival. Then, the efficacy of the predictors was assessed through sensitivity and specificity analysis.
Results
A total of 33 patients were included in the study, with 4 survivors (12.12%). Multivariate logistic regression analysis indicated a significant association between cardiac tamponade and survival, with an adjusted odds ratio of 33.4 (95% CI: 1.31 – 850.00, p = 0.034). Additionally, an analysis of sensitivity and specificity, targeting cardiac tamponade as an indicator for survivor identification, showed a sensitivity rate of 75.0% and a specificity rate of 96.6%.
Conclusion
The survival rate among blunt trauma patients undergoing ERT exceeds traditional expectations, suggesting that select individuals with blunt trauma can significantly benefit from the procedure. Notably, those presenting with cardiac tamponade are identified as the subgroup most likely to derive substantial benefits from ERT.
目的急诊开胸复苏术是抢救重症外伤患者的最后手段。鉴于其低成功率和不明确的适应症，其在钝性创伤情景中的应用仍然存在高度争议。因此，我们的研究旨在确定钝性创伤患者ERT的总体生存率，并确定哪些患者将从该手术中获益最多。方法采用回顾性病例对照研究。选择2020年1月至2023年12月在我院创伤中心接受ERT治疗的钝性创伤患者进行分析，终点结果为住院生存率，分为生存组和非生存组。组间比较采用卡方检验和Fisher精确检验、Kruskal-Wallis检验、学生t检验或Mann-Whitney U检验。进行单因素和多因素logistic回归分析以评估潜在的生存预测因素。然后，通过敏感性和特异性分析评估预测因子的疗效。结果共纳入33例患者，存活4例（12.12%）。多因素logistic回归分析显示，心包填塞与生存率之间存在显著相关性，校正优势比为33.4 （95% CI: 1.31 ~ 850.00, p = 0.034）。此外，针对心脏填塞作为幸存者鉴定指标的敏感性和特异性分析显示，敏感性为75.0%，特异性为96.6%。结论钝性创伤患者接受ERT手术的生存率超过传统预期，表明选择性的钝性创伤患者可以从手术中显著获益。值得注意的是，那些表现为心脏填塞的患者被认为是最有可能从ERT中获得实质性益处的亚组。
{"title":"Survival predictor in emergency resuscitative thoracotomy for blunt trauma patients: Insights from a Chinese trauma center","authors":"Shan Liu , Lin Ling , Yong Fu , Wen-Chao Zhang , Yong-Hu Zhang , Qing Li , Liang Zeng , Jun Hu , Yong Luo , Wen-Jie Liu","doi":"10.1016/j.cjtee.2024.07.009","DOIUrl":"10.1016/j.cjtee.2024.07.009","url":null,"abstract":"<div><h3>Purpose</h3><div>Emergency resuscitative thoracotomy (ERT) is a final salvage procedure for critically injured trauma patients. Given its low success rate and ambiguous indications, its use in blunt trauma scenarios remains highly debated. Consequently, our study seeks to ascertain the overall survival rate of ERT in blunt trauma patients and determine which patients would benefit most from this procedure.</div></div><div><h3>Methods</h3><div>A retrospective case-control study was conducted for this research. Blunt trauma patients who underwent ERT between January 2020 and December 2023 in our trauma center were selected for analysis, with the endpoint outcome being in-hospital survival, divided into survival and non-survival groups. Inter-group comparisons were conducted using Chi-square and Fisher's exact tests, the Kruskal-Wallis test, Student's <em>t</em>-test, or the Mann-Whitney <em>U</em> test. Univariate and multivariate logistic regression analyses were conducted to assess potential predictors of survival. Then, the efficacy of the predictors was assessed through sensitivity and specificity analysis.</div></div><div><h3>Results</h3><div>A total of 33 patients were included in the study, with 4 survivors (12.12%). Multivariate logistic regression analysis indicated a significant association between cardiac tamponade and survival, with an adjusted odds ratio of 33.4 (95% <em>CI</em>: 1.31 – 850.00, <em>p</em> = 0.034). Additionally, an analysis of sensitivity and specificity, targeting cardiac tamponade as an indicator for survivor identification, showed a sensitivity rate of 75.0% and a specificity rate of 96.6%.</div></div><div><h3>Conclusion</h3><div>The survival rate among blunt trauma patients undergoing ERT exceeds traditional expectations, suggesting that select individuals with blunt trauma can significantly benefit from the procedure. Notably, those presenting with cardiac tamponade are identified as the subgroup most likely to derive substantial benefits from ERT.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 4","pages":"Pages 288-293"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Non-operative management (NOM) has been validated for blunt liver and splenic injuries. Literature on continuous intra-abdominal pressure (IAP) monitoring as a part of NOM remains to be equivocal. The study aimed to find any correlation between clinical parameters and IAP, and their effect on the NOM of patients with blunt liver and splenic injury.
Method
A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries. Hemodynamically unstable patients or those on ventilators were excluded, as well as patients who suffered significant head, spinal cord, and/or bladder injuries. The study predominantly included males (83.9%) with a mean age of 32.5 years. IAP was monitored continuously and the relation of IAP with various parameters, interventions, and outcomes were measured. Data were summarized as frequency (percentage) or mean ± SD or median (Q1, Q3) as indicated. χ2 or Fisher's exact test was used for categorical variables, while for continuous variables parametric (independent t-test) or nonparametric tests (Wilcoxon rank sum test) were used as appropriate. Clinical and laboratory correlates of IAP < 12 with p < 0.200 in the univariable logistic regression analysis were included in the multivariable analysis. A p < 0.05 was used to indicate statistical significance.
Results
Intra-abdominal hypertension (IAH) was seen in 19.0% of the study population. IAH was strongly associated with a high injury severity score (p < 0.001), and other physiological parameters like respiratory rate (p < 0.001), change in abdominal girth (AG) (p < 0.001), and serum creatinine (p < 0.001). IAH along with the number of solid organs involved, respiratory rate, change in AG, and serum creatinine was associated with the intervention, either operative or non-operative (p = 0.001, p = 0.002, p < 0.001, p < 0.001, p = 0.013, respectively). On multivariable analysis, IAP (p = 0.006) and the mean change of AG (p = 0.004) were significantly associated with the need for intervention.
Conclusion
As a part of NOM, IAP should be monitored as a continuous vital. However, the decision for any intervention, either operative or non-operative cannot be guided by IAP values alone.
目的：非手术治疗（NOM）已被证实适用于钝性肝脾损伤。有关作为非手术治疗一部分的连续腹腔内压力（IAP）监测的文献仍不明确。本研究旨在找出临床参数与 IAP 之间的相关性，以及它们对肝脾钝性损伤患者 NOM 的影响：2018年10月至2020年1月，在一家一级创伤中心进行了一项前瞻性横断面研究，包括174名因肝脾钝性损伤而接受NOM的患者。排除了血流动力学不稳定或使用呼吸机的患者，以及头部、脊髓和/或膀胱严重损伤的患者。研究对象主要为男性（83.9%），平均年龄为 32.5 岁。对 IAP 进行了连续监测，并测量了 IAP 与各种参数、干预措施和结果的关系。数据以频率（百分比）或平均值 ± SD 或中位数（Q1、Q3）表示。分类变量采用χ2检验或费雪精确检验，连续变量则酌情采用参数检验（独立t检验）或非参数检验（Wilcoxon秩和检验）。IAP < 12 与 p 结果的临床和实验室相关性：19.0%的研究对象患有腹腔内高血压（IAH）。腹内高压与损伤严重程度评分较高密切相关（p 结论：腹内高压与损伤严重程度评分较低密切相关：作为 NOM 的一部分，应持续监测 IAP。但是，不能仅根据 IAP 值来决定是否进行手术或非手术干预。
{"title":"Relevance of intra-abdominal pressure monitoring in non-operative management of patients with blunt liver and splenic injuries","authors":"Vivek Kumar , Ramesh Vaidyanathan , Dinesh Bagaria , Pratyusha Priyadarshini , Abhinav Kumar , Narendra Choudhary , Sushma Sagar , Amit Gupta , Biplab Mishra , Mohit Joshi , Kapil Dev Soni , Richa Aggarwal , Subodh Kumar","doi":"10.1016/j.cjtee.2024.02.006","DOIUrl":"10.1016/j.cjtee.2024.02.006","url":null,"abstract":"<div><h3>Purpose</h3><div>Non-operative management (NOM) has been validated for blunt liver and splenic injuries. Literature on continuous intra-abdominal pressure (IAP) monitoring as a part of NOM remains to be equivocal. The study aimed to find any correlation between clinical parameters and IAP, and their effect on the NOM of patients with blunt liver and splenic injury.</div></div><div><h3>Method</h3><div>A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries. Hemodynamically unstable patients or those on ventilators were excluded, as well as patients who suffered significant head, spinal cord, and/or bladder injuries. The study predominantly included males (83.9%) with a mean age of 32.5 years. IAP was monitored continuously and the relation of IAP with various parameters, interventions, and outcomes were measured. Data were summarized as frequency (percentage) or mean ± SD or median (Q<sub>1</sub>, Q<sub>3</sub>) as indicated. χ<sup>2</sup> or Fisher's exact test was used for categorical variables, while for continuous variables parametric (independent <em>t</em>-test) or nonparametric tests (Wilcoxon rank sum test) were used as appropriate. Clinical and laboratory correlates of IAP < 12 with <em>p</em> < 0.200 in the univariable logistic regression analysis were included in the multivariable analysis. A <em>p</em> < 0.05 was used to indicate statistical significance.</div></div><div><h3>Results</h3><div>Intra-abdominal hypertension (IAH) was seen in 19.0% of the study population. IAH was strongly associated with a high injury severity score (<em>p</em> < 0.001), and other physiological parameters like respiratory rate (<em>p</em> < 0.001), change in abdominal girth (AG) (<em>p</em> < 0.001), and serum creatinine (<em>p</em> < 0.001). IAH along with the number of solid organs involved, respiratory rate, change in AG, and serum creatinine was associated with the intervention, either operative or non-operative (<em>p</em> = 0.001, <em>p</em> = 0.002, <em>p</em> < 0.001, <em>p</em> < 0.001, <em>p</em> = 0.013, respectively). On multivariable analysis, IAP (<em>p</em> = 0.006) and the mean change of AG (<em>p</em> = 0.004) were significantly associated with the need for intervention.</div></div><div><h3>Conclusion</h3><div>As a part of NOM, IAP should be monitored as a continuous vital. However, the decision for any intervention, either operative or non-operative cannot be guided by IAP values alone.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 4","pages":"Pages 307-312"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.cjtee.2024.03.012
Ravi Patel , Muhammad Murtaza Khan , William Gibson , Robin Banerjee , Asif Pardiwala
<div><h3>Purpose</h3><div>Surgical management of the lateral end of clavicle fractures has been a challenge for orthopedic surgeons considering the high rate of non-union. There has been no right and wrong answer to these types of fractures and many methods discussed in the literature, but the 2 most used bony procedures are hook plate and locking plate with or without the use of supplementary soft tissue procedures. The available evidence, in this case, is scarce with questionable reliability. The idea of this systemic review is to promote evidence-based practice when choosing between the 2 implants for this fracture. This study aims to review the results by performing a systemic review of the literature comparing the results of locking plate <em>vs</em>. hook plate for the lateral end of clavicle fracture fixation with an emphasis on outcome and associated complications.</div></div><div><h3>Methods</h3><div>A search of the literature was made with the keyword “clavicle” in PubMed/Ovid Medline/Embase and University of Edinburgh online library “discover Ed”. A total of 4063 articles were identified including case series (with at least 3 cases) and review articles focusing on locking plate alone, comparisons of locking plate and hook plate, or hook plate alone. Articles were excluded if they were not published in English, focused on pediatric studies, or consisted only of book chapters. Studies examining tension band wiring, soft tissue procedures for fracture fixation, arthroscopic-assisted procedures, additional soft tissue procedures along with plate fixation, and fracture dislocation of the lateral end of the clavicle were also excluded. The search was then narrowed down to 21 articles after consideration of inclusion and exclusion criteria. A detailed review of the surgical methodology further excluded additional soft tissue procedures, resulting in a final selection of 15 studies. The quality of the studies was assessed using the Modified Coleman Score by the authors.</div></div><div><h3>Results</h3><div>A total of 15 studies related to Neer type II fracture met the inclusion criteria. However, 2 other studies also included type V fracture as well. The mean age of patients in these studies was 32 years. The mean follow-up period was 24.3 months (ranging from 6 to 65 months). The time of radiological union was documented from 2 to 4.5 months. Constant and disabilities of arm, shoulder, and hand scores were most used as the criteria for patient outcomes. The size of the lateral fragment that can accommodate/provide bicortical fracture was documented in only 3 studies. The mean incidence of removal of hook plate was 86.9%. In contrast, the mean incidence of removal of locking plate was 27.0%. Superficial wound infection was documented in 5 studies and deep wound infection was seen in 1 study. The mean union rate for hook plate was 97.0% compared to 100% for locking plate. Complications associated with hook plate have been documented in 11 studi
{"title":"Comparison of hook plates vs. locking plates for Neer type IIB fractures of lateral end clavicle: A systematic review","authors":"Ravi Patel , Muhammad Murtaza Khan , William Gibson , Robin Banerjee , Asif Pardiwala","doi":"10.1016/j.cjtee.2024.03.012","DOIUrl":"10.1016/j.cjtee.2024.03.012","url":null,"abstract":"<div><h3>Purpose</h3><div>Surgical management of the lateral end of clavicle fractures has been a challenge for orthopedic surgeons considering the high rate of non-union. There has been no right and wrong answer to these types of fractures and many methods discussed in the literature, but the 2 most used bony procedures are hook plate and locking plate with or without the use of supplementary soft tissue procedures. The available evidence, in this case, is scarce with questionable reliability. The idea of this systemic review is to promote evidence-based practice when choosing between the 2 implants for this fracture. This study aims to review the results by performing a systemic review of the literature comparing the results of locking plate <em>vs</em>. hook plate for the lateral end of clavicle fracture fixation with an emphasis on outcome and associated complications.</div></div><div><h3>Methods</h3><div>A search of the literature was made with the keyword “clavicle” in PubMed/Ovid Medline/Embase and University of Edinburgh online library “discover Ed”. A total of 4063 articles were identified including case series (with at least 3 cases) and review articles focusing on locking plate alone, comparisons of locking plate and hook plate, or hook plate alone. Articles were excluded if they were not published in English, focused on pediatric studies, or consisted only of book chapters. Studies examining tension band wiring, soft tissue procedures for fracture fixation, arthroscopic-assisted procedures, additional soft tissue procedures along with plate fixation, and fracture dislocation of the lateral end of the clavicle were also excluded. The search was then narrowed down to 21 articles after consideration of inclusion and exclusion criteria. A detailed review of the surgical methodology further excluded additional soft tissue procedures, resulting in a final selection of 15 studies. The quality of the studies was assessed using the Modified Coleman Score by the authors.</div></div><div><h3>Results</h3><div>A total of 15 studies related to Neer type II fracture met the inclusion criteria. However, 2 other studies also included type V fracture as well. The mean age of patients in these studies was 32 years. The mean follow-up period was 24.3 months (ranging from 6 to 65 months). The time of radiological union was documented from 2 to 4.5 months. Constant and disabilities of arm, shoulder, and hand scores were most used as the criteria for patient outcomes. The size of the lateral fragment that can accommodate/provide bicortical fracture was documented in only 3 studies. The mean incidence of removal of hook plate was 86.9%. In contrast, the mean incidence of removal of locking plate was 27.0%. Superficial wound infection was documented in 5 studies and deep wound infection was seen in 1 study. The mean union rate for hook plate was 97.0% compared to 100% for locking plate. Complications associated with hook plate have been documented in 11 studi","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 4","pages":"Pages 269-275"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.cjtee.2025.04.003
Wang Hu , Guomei Yang , Luoquan Ao , Peixin Shen , Mengwei Yao , Yuchuan Yuan , Jiaoyue Long , Zhan Li , Xiang Xu
Purpose
To investigate the regulatory role of nerve injury-induced protein 1 (NINJ1) in the anti-inflammatory function of human umbilical cord mesenchymal stem cells (hUC-MSCs) co-stimulated by interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α).
Methods
hUC-MSCs were expanded in vitro using standard protocols, with stem cell characteristics confirmed by flow cytometry and multilineage differentiation assays. The immunomodulatory properties and cellular activity of cytokine-co-pretreated hUC-MSCs were systematically evaluated via quantitative reverse transcription RT-qPCR, lymphocyte proliferation suppression assays, and Cell Counting Kit-8 viability tests. Transcriptome sequencing, Western blotting and small interfering RNA interference were integrated to analyze the regulatory mechanisms of NINJ1 expression. Functional roles of NINJ1 in pretreated hUC-MSCs were elucidated through gene silencing combined with lactate dehydrogenase release assays, Annexin V/Propidium Iodide apoptosis analysis, macrophage co-culture models, and cytokine Enzyme-Linked Immunosorbent Assay. Therapeutic efficacy was validated in a cecal ligation and puncture-induced septic mouse model: 80 mice were randomly allocated into 4 experimental groups (n=20/group): sham group (laparotomy without cecal ligation); phosphate-buffered saline-treated group (cecal ligation and puncture (CLP) + 0.1 mL phosphate-buffered saline); hUC-MSCs (small interfering RNA (siRNA)-interferon-gamma and tumor necrosis factor-alpha co-stimulation (IT))-treated group (CLP + hUC-MSCs transfected with scrambled siRNA); and hUC-MSCs (siNINJ1-IT)-treated group (CLP + hUC-MSCs with NINJ1-targeting siRNA).
Results
hUC-MSCs demonstrated compliance with International Society for Cellular Therapy criteria, confirming their stem cell identity. IFN-γ/TNF-α co-pretreatment enhanced the immunosuppressive capacity of hUC-MSCs, accompanied by the reduction of cellular viability, while concurrently upregulating pro-inflammatory cytokines such as interleukin-6 and interleukin-1β. This co-stimulation significantly elevated NINJ1 expression in hUC-MSCs, whereas genetic silencing of NINJ1 effectively suppressed pro-inflammatory cytokine production and attenuated damage-associated molecular patterns release through inhibition of programmed plasma membrane rupture. Furthermore, the NINJ1 interference potentiated the ability of cytokine-pretreated hUC-MSCs to suppress LPS-induced pro-inflammatory responses in RAW264.7 macrophages. In cecal ligation and puncture-induced sepsis model, NINJ1-silenced hUC-MSCs exhibited enhanced therapeutic efficacy, manifested by reduced systemic inflammation and multi-organ damage.
Conclusion
Our findings shed new light on the immunomodulatory functions of cytokine-primed MSCs, offering groundbreaking insights for developing MSC-based therapies against infl
{"title":"NINJ1 impairs the anti-inflammatory function of hUC-MSCs with synergistic IFN-γ and TNF-α stimulation","authors":"Wang Hu , Guomei Yang , Luoquan Ao , Peixin Shen , Mengwei Yao , Yuchuan Yuan , Jiaoyue Long , Zhan Li , Xiang Xu","doi":"10.1016/j.cjtee.2025.04.003","DOIUrl":"10.1016/j.cjtee.2025.04.003","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the regulatory role of nerve injury-induced protein 1 (NINJ1) in the anti-inflammatory function of human umbilical cord mesenchymal stem cells (hUC-MSCs) co-stimulated by interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α).</div></div><div><h3>Methods</h3><div>hUC-MSCs were expanded <em>in vitro</em> using standard protocols, with stem cell characteristics confirmed by flow cytometry and multilineage differentiation assays. The immunomodulatory properties and cellular activity of cytokine-co-pretreated hUC-MSCs were systematically evaluated via quantitative reverse transcription RT-qPCR, lymphocyte proliferation suppression assays, and Cell Counting Kit-8 viability tests. Transcriptome sequencing, Western blotting and small interfering RNA interference were integrated to analyze the regulatory mechanisms of NINJ1 expression. Functional roles of NINJ1 in pretreated hUC-MSCs were elucidated through gene silencing combined with lactate dehydrogenase release assays, Annexin V/Propidium Iodide apoptosis analysis, macrophage co-culture models, and cytokine Enzyme-Linked Immunosorbent Assay. Therapeutic efficacy was validated in a cecal ligation and puncture-induced septic mouse model: 80 mice were randomly allocated into 4 experimental groups (<em>n</em>=20/group): sham group (laparotomy without cecal ligation); phosphate-buffered saline-treated group (cecal ligation and puncture (CLP) + 0.1 mL phosphate-buffered saline); hUC-MSCs (small interfering RNA (siRNA)-interferon-gamma and tumor necrosis factor-alpha co-stimulation (IT))-treated group (CLP + hUC-MSCs transfected with scrambled siRNA); and hUC-MSCs (siNINJ1-IT)-treated group (CLP + hUC-MSCs with NINJ1-targeting siRNA).</div></div><div><h3>Results</h3><div>hUC-MSCs demonstrated compliance with International Society for Cellular Therapy criteria, confirming their stem cell identity. IFN-γ/TNF-α co-pretreatment enhanced the immunosuppressive capacity of hUC-MSCs, accompanied by the reduction of cellular viability, while concurrently upregulating pro-inflammatory cytokines such as interleukin-6 and interleukin-1β. This co-stimulation significantly elevated NINJ1 expression in hUC-MSCs, whereas genetic silencing of NINJ1 effectively suppressed pro-inflammatory cytokine production and attenuated damage-associated molecular patterns release through inhibition of programmed plasma membrane rupture. Furthermore, the NINJ1 interference potentiated the ability of cytokine-pretreated hUC-MSCs to suppress LPS-induced pro-inflammatory responses in RAW264.7 macrophages. In cecal ligation and puncture-induced sepsis model, NINJ1-silenced hUC-MSCs exhibited enhanced therapeutic efficacy, manifested by reduced systemic inflammation and multi-organ damage.</div></div><div><h3>Conclusion</h3><div>Our findings shed new light on the immunomodulatory functions of cytokine-primed MSCs, offering groundbreaking insights for developing MSC-based therapies against infl","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 4","pages":"Pages 276-287"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.cjtee.2024.08.008
Mor Rittblat , Nir Tsur , Adi Karas , Sami Gendler , Zivan Beer , Irina Radomislensky , Ofer Almog , Avishai M. Tsur , Guy Avital , Tomer Talmy
Purpose
Prompt vascular access is crucial for resuscitating bleeding trauma casualties in prehospital settings but achieving peripheral intravenous (PIV) access can be challenging during hemorrhagic shock due to peripheral vessel collapse. Early intraosseous (IO) device use is suggested as an alternative. This study examines injury characteristics and factors linked to IO access requirements.
Methods
A registry-based cohort study from the Israel Defense Forces Trauma Registry (2010 – 2023) included trauma casualties receiving PIV or IO access prehospital. Casualties who had at least one documented PIV or IO access attempt were included, while those without vascular access were excluded. Casualties requiring both PIV and IO were classified in the IO group. Univariable logistic regression assessed the factors associated with IO access. Results were reported as odds ratios (OR) with 95% confidence intervals (CI), and significant difference was set at p < 0.05.
Results
Of 3462 casualties (86.3% male, the median age: 22 years), 3287 (94.9%) received PIV access and 175 (5.1%) had IO access attempts. In the IO group, 30.3% received freeze-dried plasma and 23.4% received low titer group O whole blood, significantly higher than that in the PIV group. Prehospital mortality was 35.0% in the IO group. Univariable analysis showed significant associations with IO access for increased PIV attempts (OR = 1.69; 95% CI: 1.34 – 2.13) and signs of profound shock (OR = 11.0; 95% CI: 5.5 – 23.3).
Conclusion
Profound shock signs are strongly linked to the need for IO access in prehospital settings with each successive PIV attempt increasing the likelihood of requiring IO conversion. IO access often accompanies low titer group O whole blood or freeze-dried plasma administration and higher prehospital mortality, indicating its use in emergent resuscitation situations. Early IO consideration is advised for trauma casualties with profound shock.
{"title":"When to choose intraosseous access in prehospital trauma care: A registry-based study from the Israel Defense Forces","authors":"Mor Rittblat , Nir Tsur , Adi Karas , Sami Gendler , Zivan Beer , Irina Radomislensky , Ofer Almog , Avishai M. Tsur , Guy Avital , Tomer Talmy","doi":"10.1016/j.cjtee.2024.08.008","DOIUrl":"10.1016/j.cjtee.2024.08.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Prompt vascular access is crucial for resuscitating bleeding trauma casualties in prehospital settings but achieving peripheral intravenous (PIV) access can be challenging during hemorrhagic shock due to peripheral vessel collapse. Early intraosseous (IO) device use is suggested as an alternative. This study examines injury characteristics and factors linked to IO access requirements.</div></div><div><h3>Methods</h3><div>A registry-based cohort study from the Israel Defense Forces Trauma Registry (2010 – 2023) included trauma casualties receiving PIV or IO access prehospital. Casualties who had at least one documented PIV or IO access attempt were included, while those without vascular access were excluded. Casualties requiring both PIV and IO were classified in the IO group. Univariable logistic regression assessed the factors associated with IO access. Results were reported as odds ratios (<em>OR</em>) with 95% confidence intervals (<em>CI</em>), and significant difference was set at <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>Of 3462 casualties (86.3% male, the median age: 22 years), 3287 (94.9%) received PIV access and 175 (5.1%) had IO access attempts. In the IO group, 30.3% received freeze-dried plasma and 23.4% received low titer group O whole blood, significantly higher than that in the PIV group. Prehospital mortality was 35.0% in the IO group. Univariable analysis showed significant associations with IO access for increased PIV attempts (<em>OR</em> = 1.69; 95% <em>CI</em>: 1.34 – 2.13) and signs of profound shock (<em>OR</em> = 11.0; 95% <em>CI</em>: 5.5 – 23.3).</div></div><div><h3>Conclusion</h3><div>Profound shock signs are strongly linked to the need for IO access in prehospital settings with each successive PIV attempt increasing the likelihood of requiring IO conversion. IO access often accompanies low titer group O whole blood or freeze-dried plasma administration and higher prehospital mortality, indicating its use in emergent resuscitation situations. Early IO consideration is advised for trauma casualties with profound shock.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 4","pages":"Pages 294-300"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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