Pub Date : 2024-11-14DOI: 10.1016/j.injury.2024.112023
Xigong Zhang , Jie Tan , Nan Li , Barden Kelsang , Xiao Han , Renwei Cao , Yufu Zhang , Xieyuan Jiang
Background
Clavicle fractures represent approximately 2.6∼4 % of all fractures. The management of midshaft clavicle fractures is a topic of debate. The evaluation of clavicular shortening relies on the assumption of clavicular symmetry.
Objective
Our hypothesis posited that clavicles were not of identical length, challenging the assumption of clavicular symmetry.
Methods
This retrospective study was conducted at a level 1 hospital between February 1, 2022, and February 28, 2022, with a total of 200 consistent thoracic CT scans from patients with suspected pneumonia reviewed. Bilateral clavicle lengths were measured using thoracic CT plain scans. Intraclass correlation coefficients (ICC) were examined. Linear and logistic regression were performed.
Results
In a total number of 170 patients, the left clavicles were 1.96 mm longer than the right clavicles on average (95 % CI 1.25-2.68, p < 0.001). In 118 patients (69.4 %), the bilateral clavicle length difference was between 0-5 mm; In 45 patients (26.5 %), the difference was 5-10 mm, and in 7 patients (4.1 %), the difference was greater than 10 mm. Positive correlations were found between height (p = 0.002), male gender (p < 0.001), and the absolute difference, respectively.
Conclusion
Clavicle asymmetry is present with a positive correlation with male gender and height. Surgeons shall be aware of this asymmetry in managing midshaft clavicle fractures.
{"title":"Measurement of clavicular symmetry: A hint for midshaft clavicle fracture management","authors":"Xigong Zhang , Jie Tan , Nan Li , Barden Kelsang , Xiao Han , Renwei Cao , Yufu Zhang , Xieyuan Jiang","doi":"10.1016/j.injury.2024.112023","DOIUrl":"10.1016/j.injury.2024.112023","url":null,"abstract":"<div><h3>Background</h3><div>Clavicle fractures represent approximately 2.6∼4 % of all fractures. The management of midshaft clavicle fractures is a topic of debate. The evaluation of clavicular shortening relies on the assumption of clavicular symmetry.</div></div><div><h3>Objective</h3><div>Our hypothesis posited that clavicles were not of identical length, challenging the assumption of clavicular symmetry.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted at a level 1 hospital between February 1, 2022, and February 28, 2022, with a total of 200 consistent thoracic CT scans from patients with suspected pneumonia reviewed. Bilateral clavicle lengths were measured using thoracic CT plain scans. Intraclass correlation coefficients (ICC) were examined. Linear and logistic regression were performed.</div></div><div><h3>Results</h3><div>In a total number of 170 patients, the left clavicles were 1.96 mm longer than the right clavicles on average (95 % CI 1.25-2.68, <em>p</em> < 0.001). In 118 patients (69.4 %), the bilateral clavicle length difference was between 0-5 mm; In 45 patients (26.5 %), the difference was 5-10 mm, and in 7 patients (4.1 %), the difference was greater than 10 mm. Positive correlations were found between height (<em>p</em> = 0.002), male gender (<em>p</em> < 0.001), and the absolute difference, respectively.</div></div><div><h3>Conclusion</h3><div>Clavicle asymmetry is present with a positive correlation with male gender and height. Surgeons shall be aware of this asymmetry in managing midshaft clavicle fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112023"},"PeriodicalIF":2.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-13DOI: 10.1016/j.injury.2024.112022
Philip Verdonck , Matthew Peters , Tom Stroobants , Johan Gillebeert , Eva Janssens , Sebastian Schnaubelt , Suresh Krishan Yogeswaran , Sabine Lemoyne , Anouk Wittock , Lore Sypré , Dominique Robert , Philippe G Jorens , Dennis Brouwers , Stijn Slootmans , Koenraad Monsieurs
Introduction
The centralisation of care for trauma patients in trauma centres, alongside the creation of inclusive trauma networks, has proven to reduce mortality. In Europe, such structured trauma programs and trauma networks are in development.
Objective
To describe the aetiology and evolution of in-hospital mortality in a developing European level 1 trauma centre, to determine the early effect of trauma care reorganisation on mortality and to identify the areas for future investments in trauma care.
Materials and methods
This retrospective analysis included the calculation of the standardised mortality ratio (SMR), the time to in-hospital death and the cause of in-hospital death of all primary major trauma admissions to the Antwerp University Hospital from 2016 to 2023.
Results
A total of 1470 patients was included with a crude mortality of 16.4 %, a median Revised Injury Severity Classification II (RISC II) adjusted mortality of 1.47 %, and a SMR of 1.12. A limitation of care directive was registered for 18.1 % of the patients. The causes of in-hospital death were traumatic brain injury (TBI) in 60 %, haemorrhagic shock in 15 %, organ failure in 10 %, miscellaneous in 14 % and unknown in 1 %. Sixty percent died in the first 48 h of hospital admission (mainly due to TBI and haemorrhagic shock) and 27 % died after more than seven days (mainly due to organ failure and TBI). In 24 % of the deceased patients with severe TBI, a non-TBI related cause of death was found. Overall, the SMR showed a nonsignificant decreasing trend, with a significant decrease of the SMR in the highest risk group (RISCII > 75 %) and a nonsignificant increase in the lowest risk group (RISC II <15 %).
Conclusion
The standardised mortality ratio declined over a period of 8 years, even though the SMR increased nonsignificantly in the lowest risk-adjusted mortality group. Future analysis of this subgroup could clarify whether this trend is due to an increase of limitation of care directives and if these deaths could have been prevented with improved trauma care. There might be opportunities to increase the survival of patients with severe TBI who have a non-TBI cause of death.
{"title":"Effects of major trauma care organisation on mortality in a European level 1 trauma centre: A retrospective analysis of 2016-2023","authors":"Philip Verdonck , Matthew Peters , Tom Stroobants , Johan Gillebeert , Eva Janssens , Sebastian Schnaubelt , Suresh Krishan Yogeswaran , Sabine Lemoyne , Anouk Wittock , Lore Sypré , Dominique Robert , Philippe G Jorens , Dennis Brouwers , Stijn Slootmans , Koenraad Monsieurs","doi":"10.1016/j.injury.2024.112022","DOIUrl":"10.1016/j.injury.2024.112022","url":null,"abstract":"<div><h3>Introduction</h3><div>The centralisation of care for trauma patients in trauma centres, alongside the creation of inclusive trauma networks, has proven to reduce mortality. In Europe, such structured trauma programs and trauma networks are in development.</div></div><div><h3>Objective</h3><div>To describe the aetiology and evolution of in-hospital mortality in a developing European level 1 trauma centre, to determine the early effect of trauma care reorganisation on mortality and to identify the areas for future investments in trauma care.</div></div><div><h3>Materials and methods</h3><div>This retrospective analysis included the calculation of the standardised mortality ratio (SMR), the time to in-hospital death and the cause of in-hospital death of all primary major trauma admissions to the Antwerp University Hospital from 2016 to 2023.</div></div><div><h3>Results</h3><div>A total of 1470 patients was included with a crude mortality of 16.4 %, a median Revised Injury Severity Classification II (RISC II) adjusted mortality of 1.47 %, and a SMR of 1.12. A limitation of care directive was registered for 18.1 % of the patients. The causes of in-hospital death were traumatic brain injury (TBI) in 60 %, haemorrhagic shock in 15 %, organ failure in 10 %, miscellaneous in 14 % and unknown in 1 %. Sixty percent died in the first 48 h of hospital admission (mainly due to TBI and haemorrhagic shock) and 27 % died after more than seven days (mainly due to organ failure and TBI). In 24 % of the deceased patients with severe TBI, a non-TBI related cause of death was found. Overall, the SMR showed a nonsignificant decreasing trend, with a significant decrease of the SMR in the highest risk group (RISCII > 75 %) and a nonsignificant increase in the lowest risk group (RISC II <15 %).</div></div><div><h3>Conclusion</h3><div>The standardised mortality ratio declined over a period of 8 years, even though the SMR increased nonsignificantly in the lowest risk-adjusted mortality group. Future analysis of this subgroup could clarify whether this trend is due to an increase of limitation of care directives and if these deaths could have been prevented with improved trauma care. There might be opportunities to increase the survival of patients with severe TBI who have a non-TBI cause of death.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112022"},"PeriodicalIF":2.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-10DOI: 10.1016/j.injury.2024.111999
Graham Radcliffe , Jean-Baptiste Trouiller , Suzanne Battaglia , Ricardo Larrainzar-Garijo
Introduction
Hip fractures have a high patient burden and mortality rate, particularly following revision surgery. Cement augmentation of cephalomedullary nails has been shown to lower the risk of cut-out, aiming to reduce the need and expense of revision surgeries. The aim of this study was to assess the economic impact of cement augmentation for the fixation of trochanteric hip fractures in fragile, elderly patients, across a range of European countries (UK, Spain, Italy, Germany, and France), from both a provider (hospital) and a payer perspective.
Method
The budget impact (hospital perspective) and cost-effectiveness (payer perspective) analyses were informed by clinical outcomes from a meta-analysis published in 2021, additional published literature, registries, and clinical experts. Economic inputs included length of stay and operating time for the hospital perspective, revision surgery, outpatient, and rehabilitation days costs for the payer perspective. Outcomes included the breakeven cost below which using cement augmentation would begin to generate cost savings for the hospital, and potential cost savings for the payer with incremental costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were conducted to assess model uncertainty.
Results
From a hospital perspective, the breakeven cost below which the hospital would start saving money using cement augmentation was £491 (UK), €1490 (Spain), €1075 (Italy), €852 (Germany), and €834 (France) per patient, driven by reduced length of hospital stay. From a payer perspective, cost savings were £1675 (UK), €2202 (Spain), €993 (Italy), €944 (Germany), and €892 (France) per patient, mainly driven by fewer revision surgeries. Payer cost savings, coupled with incremental QALY gain of 0.004 across all regions, led to cement augmentation being the dominant strategy. These budget impact and cost-effectiveness results were rigorously tested in sensitivity analyses and were found to be robust.
Conclusion
These models support the wider adoption of cement augmentation to reduce the healthcare system costs associated with length of stay and revision surgery. These results provide useful information to providers, payers, and policymakers to ultimately influence choice surrounding the ‘gold-standard’ treatment of an unstable trochanteric fracture following low energy trauma.
{"title":"Cost-effectiveness and budget impact of cement augmentation for the fixation of unstable trochanteric fractures from a European perspective","authors":"Graham Radcliffe , Jean-Baptiste Trouiller , Suzanne Battaglia , Ricardo Larrainzar-Garijo","doi":"10.1016/j.injury.2024.111999","DOIUrl":"10.1016/j.injury.2024.111999","url":null,"abstract":"<div><h3>Introduction</h3><div>Hip fractures have a high patient burden and mortality rate, particularly following revision surgery. Cement augmentation of cephalomedullary nails has been shown to lower the risk of cut-out, aiming to reduce the need and expense of revision surgeries. The aim of this study was to assess the economic impact of cement augmentation for the fixation of trochanteric hip fractures in fragile, elderly patients, across a range of European countries (UK, Spain, Italy, Germany, and France), from both a provider (hospital) and a payer perspective.</div></div><div><h3>Method</h3><div>The budget impact (hospital perspective) and cost-effectiveness (payer perspective) analyses were informed by clinical outcomes from a meta-analysis published in 2021, additional published literature, registries, and clinical experts. Economic inputs included length of stay and operating time for the hospital perspective, revision surgery, outpatient, and rehabilitation days costs for the payer perspective. Outcomes included the breakeven cost below which using cement augmentation would begin to generate cost savings for the hospital, and potential cost savings for the payer with incremental costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were conducted to assess model uncertainty.</div></div><div><h3>Results</h3><div>From a hospital perspective, the breakeven cost below which the hospital would start saving money using cement augmentation was £491 (UK), €1490 (Spain), €1075 (Italy), €852 (Germany), and €834 (France) per patient, driven by reduced length of hospital stay. From a payer perspective, cost savings were £1675 (UK), €2202 (Spain), €993 (Italy), €944 (Germany), and €892 (France) per patient, mainly driven by fewer revision surgeries. Payer cost savings, coupled with incremental QALY gain of 0.004 across all regions, led to cement augmentation being the dominant strategy. These budget impact and cost-effectiveness results were rigorously tested in sensitivity analyses and were found to be robust.</div></div><div><h3>Conclusion</h3><div>These models support the wider adoption of cement augmentation to reduce the healthcare system costs associated with length of stay and revision surgery. These results provide useful information to providers, payers, and policymakers to ultimately influence choice surrounding the ‘gold-standard’ treatment of an unstable trochanteric fracture following low energy trauma.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111999"},"PeriodicalIF":2.2,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142650439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-09DOI: 10.1016/j.injury.2024.112020
Paris Liokatis , Georgios Tzortzinis , Carl Peter Cornelius , Yoana Malenova , Katharina Theresa Obermeier , Wenko Smolka
The fractures in the condylar area are a challenge for every surgeon, for the treatment of which trapezoidal condylar plate is used in most cases. However, it is not possible to position the plate in the ideal osteosynthesis lines according to Meyer et al. in every clinical situation. In many cases, the fracture line is also not in the centre of the trapezoidal plate. The aim of this study is to investigate the osteosynthesis rigidity and the effect of plate localisation relative to the fracture line.
In a simulation model in the first group the plate was positioned in the ideal position in the middle of the condylar base, in the second group the plate position was changed - the plate was shifted upwards until the fracture passed underneath the centre of the plate again and in the last group the plate was moved further down so that the fracture passes underneath the middle of the plate. Heterogeneity of the bone was simulated using different sets of biomechanical properties.
In the experiment, the joints were fully constrained and a force of 500 N was applied to the opposite side. An interaction between bone and plate was completely excluded and the stability of the plates as well as the mobility of the bone fragments was analysed.
The results have shown that an inferior position of the fracture line leads to greater mobility of the fragments if the position of the osteosynthesis material is the same. With a deep fracture line, a more cranial positioning of the plate leads to better stabilisation. This study needs to be experimentally validated.
{"title":"A finite element analysis of the trapezoidal plate. How to get a stable fixation at different fracture lines?","authors":"Paris Liokatis , Georgios Tzortzinis , Carl Peter Cornelius , Yoana Malenova , Katharina Theresa Obermeier , Wenko Smolka","doi":"10.1016/j.injury.2024.112020","DOIUrl":"10.1016/j.injury.2024.112020","url":null,"abstract":"<div><div>The fractures in the condylar area are a challenge for every surgeon, for the treatment of which trapezoidal condylar plate is used in most cases. However, it is not possible to position the plate in the ideal osteosynthesis lines according to Meyer et al. in every clinical situation. In many cases, the fracture line is also not in the centre of the trapezoidal plate. The aim of this study is to investigate the osteosynthesis rigidity and the effect of plate localisation relative to the fracture line.</div><div>In a simulation model in the first group the plate was positioned in the ideal position in the middle of the condylar base, in the second group the plate position was changed - the plate was shifted upwards until the fracture passed underneath the centre of the plate again and in the last group the plate was moved further down so that the fracture passes underneath the middle of the plate. Heterogeneity of the bone was simulated using different sets of biomechanical properties.</div><div>In the experiment, the joints were fully constrained and a force of 500 N was applied to the opposite side. An interaction between bone and plate was completely excluded and the stability of the plates as well as the mobility of the bone fragments was analysed.</div><div>The results have shown that an inferior position of the fracture line leads to greater mobility of the fragments if the position of the osteosynthesis material is the same. With a deep fracture line, a more cranial positioning of the plate leads to better stabilisation. This study needs to be experimentally validated.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112020"},"PeriodicalIF":2.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-09DOI: 10.1016/j.injury.2024.112018
Juan Enrique Berner , Adele Pope , David Winston Hamilton , Jagdeep Nanchahal , Abhilash Jain
Background
Ortho-plastic evidence-based clinical guidelines for open fractures have demonstrated to standardise care and improve outcomes for patients admitted following lower extremity trauma. Despite its benefits, very few countries have introduced such guidance. The aim of this study was to explore the attitudes, barriers and limitations to the development and implementation of guidelines for lower limb open fractures
Methods
Twelve renowned orthopaedic and plastic surgeons, based in countries with no guidelines at present, underwent semi-structured interviews. A qualitative appraisal was conducted using reflexive thematic analysis methodology. Systematic coding led to the development and refinement of themes to address the research question.
Results
Individualistic decision-making, reliance on multidisciplinary interpersonal relationships, and the presence of immobile determinants of open fracture care emerged as three themes that define how patients are currently managed in settings with no guidelines in place. Although guidelines can potentially improve care by presenting evidence-based recommendations, introducing audit practices, establishing pathways for multidisciplinary collaboration, and enhancing effective leadership; if barriers to the implementation are not considered, they may end up as a “piece of paper on the wall that everyone ignores”
Conclusions
This study is the first to explore the challenges of introducing ortho-plastic guidelines for open extremity trauma. The themes presented describe the status quo in settings with no such protocols in place, establishing the foundation for future initiatives aiming to provide a practical strategy to aid the development and introduction of clinical guidelines for open lower limb fractures.
{"title":"Avoiding “a piece of paper on the wall that everyone ignores”: A qualitative study on the barriers for implementing open fracture guidelines","authors":"Juan Enrique Berner , Adele Pope , David Winston Hamilton , Jagdeep Nanchahal , Abhilash Jain","doi":"10.1016/j.injury.2024.112018","DOIUrl":"10.1016/j.injury.2024.112018","url":null,"abstract":"<div><h3>Background</h3><div>Ortho-plastic evidence-based clinical guidelines for open fractures have demonstrated to standardise care and improve outcomes for patients admitted following lower extremity trauma. Despite its benefits, very few countries have introduced such guidance. The aim of this study was to explore the attitudes, barriers and limitations to the development and implementation of guidelines for lower limb open fractures</div></div><div><h3>Methods</h3><div>Twelve renowned orthopaedic and plastic surgeons, based in countries with no guidelines at present, underwent semi-structured interviews. A qualitative appraisal was conducted using reflexive thematic analysis methodology. Systematic coding led to the development and refinement of themes to address the research question.</div></div><div><h3>Results</h3><div>Individualistic decision-making, reliance on multidisciplinary interpersonal relationships, and the presence of immobile determinants of open fracture care emerged as three themes that define how patients are currently managed in settings with no guidelines in place. Although guidelines can potentially improve care by presenting evidence-based recommendations, introducing audit practices, establishing pathways for multidisciplinary collaboration, and enhancing effective leadership; if barriers to the implementation are not considered, they may end up as a “piece of paper on the wall that everyone ignores”</div></div><div><h3>Conclusions</h3><div>This study is the first to explore the challenges of introducing ortho-plastic guidelines for open extremity trauma. The themes presented describe the status quo in settings with no such protocols in place, establishing the foundation for future initiatives aiming to provide a practical strategy to aid the development and introduction of clinical guidelines for open lower limb fractures.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112018"},"PeriodicalIF":2.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-09DOI: 10.1016/j.injury.2024.112016
Anthony J. Duncan , Samuel J. Bloomsburg , Mentor Ahmeti
Introduction
Traumatic injuries remain a leading cause of mortality across age groups. Despite advancements in medical care, addressing the broader determinants of health is essential. Social determinants of health (SDOH), including socioeconomic factors, play a crucial role in patient outcomes. The Social Vulnerability Index (SVI), developed by the CDC, integrates various indicators, providing a comprehensive framework for assessing community vulnerability. The objective of this study is to evaluate the connection between SVI and trauma patient outcomes.
Methods
A systematic literature search was conducted using PubMed, EMBASE and Web of Science. Inclusion criteria consisted of studies that were peer reviewed, obtainable in English, used SVI as a measurement and involved blunt or penetrating trauma. Of the initial 623 papers 12 studies met inclusion criteria.
Results
In adult studies, high SVI correlated with increased trauma mortality, especially in specific domains like Household Composition and Disability. For gunshot injuries, residents of high SVI communities had a higher likelihood of recurrent injuries. Readmission rates showed mixed results, with potential associations in younger patients. Long-term outcomes, such as functional limitations and PTSD, were more prevalent in higher SVI quartiles. Pediatric studies indicated associations between SVI and outcomes like firearm injuries, intentional injuries, and rehabilitation admission rates.
Discussion
In summary, these studies collectively demonstrate that there is a predictive value that SVI carries as it relates to trauma outcomes, underscoring that targeted interventions and policies to address social vulnerabilities can be done using this index. Further research is imperative to delve into the intricate interactions between SVI and specific trauma outcomes, considering demographic variations and exploring the potential implications for public health interventions.
导言：外伤仍然是各年龄段人群死亡的主要原因。尽管医疗保健取得了进步，但解决更广泛的健康决定因素仍至关重要。健康的社会决定因素（SDOH），包括社会经济因素，对患者的治疗效果起着至关重要的作用。美国疾病预防控制中心开发的社会脆弱性指数（SVI）综合了各种指标，为评估社区脆弱性提供了一个全面的框架。本研究旨在评估 SVI 与创伤患者预后之间的联系：使用 PubMed、EMBASE 和 Web of Science 进行了系统的文献检索。纳入标准包括经同行评审、以英语撰写、使用 SVI 作为测量指标、涉及钝性或穿透性创伤的研究。在最初的 623 篇论文中，有 12 项研究符合纳入标准：在成人研究中，高 SVI 与创伤死亡率的增加有关，尤其是在家庭组成和残疾等特定领域。就枪伤而言，高 SVI 社区居民再次受伤的可能性更高。再入院率的结果不一，年轻患者可能与此有关联。在 SVI 四分位数较高的社区，功能受限和创伤后应激障碍等长期结果更为普遍。儿科研究表明，SVI 与火器伤害、故意伤害和康复入院率等结果之间存在关联：总之，这些研究共同表明，SVI 具有与创伤结果相关的预测价值，并强调可以利用该指数制定有针对性的干预措施和政策，以解决社会脆弱性问题。进一步的研究势在必行，以深入探讨 SVI 与特定创伤结果之间错综复杂的相互作用，考虑人口统计学差异，并探索对公共卫生干预措施的潜在影响。
{"title":"“Utility of social vulnerability index in trauma: A systematic review”","authors":"Anthony J. Duncan , Samuel J. Bloomsburg , Mentor Ahmeti","doi":"10.1016/j.injury.2024.112016","DOIUrl":"10.1016/j.injury.2024.112016","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic injuries remain a leading cause of mortality across age groups. Despite advancements in medical care, addressing the broader determinants of health is essential. Social determinants of health (SDOH), including socioeconomic factors, play a crucial role in patient outcomes. The Social Vulnerability Index (SVI), developed by the CDC, integrates various indicators, providing a comprehensive framework for assessing community vulnerability. The objective of this study is to evaluate the connection between SVI and trauma patient outcomes.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted using PubMed, EMBASE and Web of Science. Inclusion criteria consisted of studies that were peer reviewed, obtainable in English, used SVI as a measurement and involved blunt or penetrating trauma. Of the initial 623 papers 12 studies met inclusion criteria.</div></div><div><h3>Results</h3><div>In adult studies, high SVI correlated with increased trauma mortality, especially in specific domains like Household Composition and Disability. For gunshot injuries, residents of high SVI communities had a higher likelihood of recurrent injuries. Readmission rates showed mixed results, with potential associations in younger patients. Long-term outcomes, such as functional limitations and PTSD, were more prevalent in higher SVI quartiles. Pediatric studies indicated associations between SVI and outcomes like firearm injuries, intentional injuries, and rehabilitation admission rates.</div></div><div><h3>Discussion</h3><div>In summary, these studies collectively demonstrate that there is a predictive value that SVI carries as it relates to trauma outcomes, underscoring that targeted interventions and policies to address social vulnerabilities can be done using this index. Further research is imperative to delve into the intricate interactions between SVI and specific trauma outcomes, considering demographic variations and exploring the potential implications for public health interventions.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112016"},"PeriodicalIF":2.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142650438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-07DOI: 10.1016/j.injury.2024.111981
Christina Julia Lorenz , Claus-Christian Carbon , Rainer Meffert , Lars Eden
Background
The surgical treatment of radial head fractures like Mason type III comminuted radial head fractures is challenging and controversial. Whether to use open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA) as treatment methods is under constant debate.
Methods
We retrospectively analyzed clinical and radiographic mid- to long-term results of 42 patients with a mean follow-up time of 4.56 years (1.92–7.58 years). Patients were grouped according to fragment numbers and the type of intervention performed (3–4 fragments vs. 4+ fragments; ORIF vs. RHA). At the final follow-up, range of motion (ROM), functional rating scores and subjective pain and function levels were documented by a blinded outcome assessor.
Results
Although minor differences in the mean values were detected when comparing the results of the functional scores, ROM and subjective pain and function levels, only the movement in pronation and supination direction yielded statistically better results in the group of 4+-fragments for the RHA compared to ORIF. However, the 33 % rate of required implant removal amongst the ORIF group should be considered.
Conclusions
This study provides evidence that 3- and 4-part Mason type III fractures are prone to plate osteosynthesis. In contrast, greater than 4-part fractures can more reliably be treated by replacement. This leads to a proposed increase in fragment numbers to four, where ORIF most likely leads to good clinical results. However, in patients with 4+ fragment patterns, ORIF did not show statistically significantly worse results concerning the collected clinical values. This study supports the use of the ORIF approach to save the radial head.
{"title":"Plate or Arthroplasty for complex Mason Type-III Radial Head Fractures? Mid-to-long term results from a blinded outcome assessor study","authors":"Christina Julia Lorenz , Claus-Christian Carbon , Rainer Meffert , Lars Eden","doi":"10.1016/j.injury.2024.111981","DOIUrl":"10.1016/j.injury.2024.111981","url":null,"abstract":"<div><h3>Background</h3><div>The surgical treatment of radial head fractures like Mason type III comminuted radial head fractures is challenging and controversial. Whether to use open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA) as treatment methods is under constant debate.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed clinical and radiographic mid- to long-term results of 42 patients with a mean follow-up time of 4.56 years (1.92–7.58 years). Patients were grouped according to fragment numbers and the type of intervention performed (3–4 fragments vs. 4+ fragments; ORIF vs. RHA). At the final follow-up, range of motion (ROM), functional rating scores and subjective pain and function levels were documented by a blinded outcome assessor.</div></div><div><h3>Results</h3><div>Although minor differences in the mean values were detected when comparing the results of the functional scores, ROM and subjective pain and function levels, only the movement in pronation and supination direction yielded statistically better results in the group of 4+-fragments for the RHA compared to ORIF. However, the 33 % rate of required implant removal amongst the ORIF group should be considered.</div></div><div><h3>Conclusions</h3><div>This study provides evidence that 3- and 4-part Mason type III fractures are prone to plate osteosynthesis. In contrast, greater than 4-part fractures can more reliably be treated by replacement. This leads to a proposed increase in fragment numbers to four, where ORIF most likely leads to good clinical results. However, in patients with 4+ fragment patterns, ORIF did not show statistically significantly worse results concerning the collected clinical values. This study supports the use of the ORIF approach to save the radial head.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 111981"},"PeriodicalIF":2.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We aim to explore and target factors contributing to disparities in trauma-care outcomes between urban vs rural trauma centers including EMS protocols, trauma centers’ (TC) distribution, infrastructure, and hospital resources.
Methods
A comprehensive literature review was conducted from January 1988 through April 1st, 2024, using Google Scholar, Embase, Cochrane, ProQuest, and PubMed. Included studies evaluated prehospital and in-hospital factors impacting trauma outcomes in urban and rural care settings. Key outcomes of interest were EMS transport times, TC access, inter-hospital transfers, trauma system utilization, and workforce infrastructure.
Results
A review of 29 studies demonstrated prolonged EMS on-scene and transport times, higher undertriage rates, and lower geospatial access to TCs in rural compared to urban settings. Transferring from rural to urban TCs was associated with increased mortality and designating rural TCs as Level III TCs reduced mortality (32 % decrease, p < 0.0001). The unregulated expansion of TCs did not improve patient access or outcomes. Rural hospitals lacked specialized providers, had more hospitalizations (x̄ rural = 685.4 vs x̄ urban = 566.3; p = 0.005), ICU admissions (20.2% vs 11.6 %, p = 0.042), and ventilation requirements (37.8% vs 20.7 %, p = 0.001) among trauma patients.
Conclusions
Rural trauma patients often experience worse outcomes than their urban counterparts, possibly due to longer prehospital times, reduced TC access, and less specialized care. The designation of targeted Level III TCs in rural areas has been associated with improved outcomes. In contrast, unregulated TC expansion has not necessarily enhanced access or outcomes for rural patients.
背景：我们的目标是探索造成城市与农村创伤中心之间创伤护理结果差异的因素，包括急救服务协议、创伤中心（TC）分布、基础设施和医院资源：方法：使用 Google Scholar、Embase、Cochrane、ProQuest 和 PubMed 对 1988 年 1 月至 2024 年 4 月 1 日期间的文献进行了全面回顾。纳入的研究评估了影响城市和农村医疗环境中创伤结果的院前和院内因素。关注的主要结果包括急救服务转运时间、交通管制接入、医院间转运、创伤系统利用率以及劳动力基础设施：对29项研究的回顾表明，与城市相比，农村地区的急救服务现场和转运时间更长、漏诊率更高，而且在地理空间上更难到达创伤中心。从农村到城市的转运中心与死亡率上升有关，而将农村转运中心指定为三级转运中心可降低死亡率（降低 32%，p < 0.0001）。不受管制地扩大转诊中心并没有改善患者的就医条件或治疗效果。农村医院缺乏专业医疗人员，创伤患者的住院率（x̄农村=685.4 vs x̄城市=566.3；p = 0.005）、入住重症监护室率（20.2% vs 11.6%，p = 0.042）和通气需求（37.8% vs 20.7%，p = 0.001）均高于城市医院：结论：农村创伤患者的治疗效果往往不如城市患者，这可能是由于院前时间较长、交通管制中心使用率较低、专业护理较少等原因造成的。在农村地区指定有针对性的三级创伤中心与改善预后有关。与此相反，不规范的创伤治疗中心扩张并不一定能提高农村患者的就医机会或治疗效果。
{"title":"Factors contributing to disparities in trauma care between urban vs rural trauma centers: Towards improving trauma care access and quality of care delivery","authors":"Nickolas Hernandez , Ruth Zagales , Muhammad Usman Awan , Sarthak Kumar , Francis Cruz , Kelsey Evans , Kathleen Heller , Tracy Zito , Adel Elkbuli","doi":"10.1016/j.injury.2024.112017","DOIUrl":"10.1016/j.injury.2024.112017","url":null,"abstract":"<div><h3>Background</h3><div>We aim to explore and target factors contributing to disparities in trauma-care outcomes between urban vs rural trauma centers including EMS protocols, trauma centers’ (TC) distribution, infrastructure, and hospital resources.</div></div><div><h3>Methods</h3><div>A comprehensive literature review was conducted from January 1988 through April 1st, 2024, using Google Scholar, Embase, Cochrane, ProQuest, and PubMed. Included studies evaluated prehospital and in-hospital factors impacting trauma outcomes in urban and rural care settings. Key outcomes of interest were EMS transport times, TC access, inter-hospital transfers, trauma system utilization, and workforce infrastructure.</div></div><div><h3>Results</h3><div>A review of 29 studies demonstrated prolonged EMS on-scene and transport times, higher undertriage rates, and lower geospatial access to TCs in rural compared to urban settings. Transferring from rural to urban TCs was associated with increased mortality and designating rural TCs as Level III TCs reduced mortality (32 % decrease, <em>p</em> < 0.0001). The unregulated expansion of TCs did not improve patient access or outcomes. Rural hospitals lacked specialized providers, had more hospitalizations (x̄ rural = 685.4 vs x̄ urban = 566.3; <em>p</em> = 0.005), ICU admissions (20.2% vs 11.6 %, <em>p</em> = 0.042), and ventilation requirements (37.8% vs 20.7 %, <em>p</em> = 0.001) among trauma patients.</div></div><div><h3>Conclusions</h3><div>Rural trauma patients often experience worse outcomes than their urban counterparts, possibly due to longer prehospital times, reduced TC access, and less specialized care. The designation of targeted Level III TCs in rural areas has been associated with improved outcomes. In contrast, unregulated TC expansion has not necessarily enhanced access or outcomes for rural patients.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112017"},"PeriodicalIF":2.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-06DOI: 10.1016/j.injury.2024.112012
Kate Dale , Charlotte Winkleman , Ian Hughes , Katharine Heathcote , Elizabeth Wake
Introduction
The routine collection of long-term patient health outcomes after serious traumatic injury at the health service level is uncommon. In 2019, we implemented the longitudinal Trauma Service Follow Up (TSFU) program at a level I trauma centre. Delivered by the trauma service clinicians involved in inpatient care, it assesses quality of life and disability. This study reports the 6- and 12-month outcomes of the first two years of operation of the TSFU program.
Methods
This is a prospective cohort study of seriously injured adult trauma patients admitted to a level I trauma centre with 6- and 12-months post-discharge outcome assessments. Outcomes were quality of life and function/disability as measured using the EQ-5D-5L and WHODAS 2.0 validated instruments. Changes from 6 to 12 months were assessed using generalised estimating equations methods. Logistic regression models were used to identify factors associated with ongoing problems at each time point.
Results
Five-hundred and eight seriously injured patients were eligible for the TSFU program with follow-up rates over 80 % at both 6- and 12-month timepoints. At six months, ongoing problems with pain (69.9 %), anxiety and depression (49 %) and carrying out usual activities (57.5 %) were highly prevalent; at 12 months problems with pain (61.4 %) and anxiety and depression (43.8 %) persisted. Lower extremity and/or pelvic surgery was associated with ongoing pain, odds ratio (OR) = 3.77 (95 % CI 1.54–9.21, p=0.01), anxiety and depression (OR 1.95, 95 % CI 1.09–3.48, p=0.02) and problems carrying out their usual activities (OR 3.19, 95 % CI 0.75–13.5, p=0.11) at six months. These patterns mostly persisted at 12 months. Similar associations between surgical intervention and high levels of disability were evident at both time points.
Conclusion
Persistent impairments in physical and emotional health continues to affect many people following serious traumatic injury. The collection of longitudinal health outcomes by trauma clinicians enables identification of factors that contribute to disability and a reduction in quality of life. This in turn can drive quality improvement initiatives within the hospital trauma system. Longitudinal follow-up programs may provide a platform to provide ongoing specialist trauma-informed care after hospital discharge.
{"title":"Health related outcomes of patients with serious traumatic injury: Results of a longitudinal follow-up program delivered by trauma clinicians","authors":"Kate Dale , Charlotte Winkleman , Ian Hughes , Katharine Heathcote , Elizabeth Wake","doi":"10.1016/j.injury.2024.112012","DOIUrl":"10.1016/j.injury.2024.112012","url":null,"abstract":"<div><h3>Introduction</h3><div>The routine collection of long-term patient health outcomes after serious traumatic injury at the health service level is uncommon. In 2019, we implemented the longitudinal Trauma Service Follow Up (TSFU) program at a level I trauma centre. Delivered by the trauma service clinicians involved in inpatient care, it assesses quality of life and disability. This study reports the 6- and 12-month outcomes of the first two years of operation of the TSFU program.</div></div><div><h3>Methods</h3><div>This is a prospective cohort study of seriously injured adult trauma patients admitted to a level I trauma centre with 6- and 12-months post-discharge outcome assessments. Outcomes were quality of life and function/disability as measured using the EQ-5D-5L and WHODAS 2.0 validated instruments. Changes from 6 to 12 months were assessed using generalised estimating equations methods. Logistic regression models were used to identify factors associated with ongoing problems at each time point.</div></div><div><h3>Results</h3><div>Five-hundred and eight seriously injured patients were eligible for the TSFU program with follow-up rates over 80 % at both 6- and 12-month timepoints. At six months, ongoing problems with pain (69.9 %), anxiety and depression (49 %) and carrying out usual activities (57.5 %) were highly prevalent; at 12 months problems with pain (61.4 %) and anxiety and depression (43.8 %) persisted. Lower extremity and/or pelvic surgery was associated with ongoing pain, odds ratio (OR) = 3.77 (95 % CI 1.54–9.21, <em>p</em>=0.01), anxiety and depression (OR 1.95, 95 % CI 1.09–3.48, <em>p</em>=0.02) and problems carrying out their usual activities (OR 3.19, 95 % CI 0.75–13.5, <em>p</em>=0.11) at six months. These patterns mostly persisted at 12 months. Similar associations between surgical intervention and high levels of disability were evident at both time points.</div></div><div><h3>Conclusion</h3><div>Persistent impairments in physical and emotional health continues to affect many people following serious traumatic injury. The collection of longitudinal health outcomes by trauma clinicians enables identification of factors that contribute to disability and a reduction in quality of life. This in turn can drive quality improvement initiatives within the hospital trauma system. Longitudinal follow-up programs may provide a platform to provide ongoing specialist trauma-informed care after hospital discharge.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112012"},"PeriodicalIF":2.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-06DOI: 10.1016/j.injury.2024.112015
Kaja Matovinovic , Michael Leslie , Richard Buckley
{"title":"Do scoring scales work for determining salvage of extremities with severe trauma?","authors":"Kaja Matovinovic , Michael Leslie , Richard Buckley","doi":"10.1016/j.injury.2024.112015","DOIUrl":"10.1016/j.injury.2024.112015","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 112015"},"PeriodicalIF":2.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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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